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San Diego Mayor Starting Rehab; Accusers Count Now At 10
August 5, 2013 1:14 p.m.
Elizabeth Becker, LCSW, Inner Solutions for Success, created first Professional Boundaries program.
Related Story: San Diego Mayor Starting Rehab; Accusers Count Now At 10
CAVANAUGH:. Our top story on KPBS, after three weeks of relentless headlines, allegations and late night comedy skits, San Diego's mayor is slated to begin therapy today. Mayor Bob Filner has admitted he's failed to respect women and engaged in intimidating conduct but he's not admitted to acts of sexual harassment or misconduct. Filner is not the first professional in San Diego who's had to deal with a behavioral problem in the workplace. In fact, there are special programs in place to try to re-educate people who've been accused of instances of harassment and so-called boundary crossings. I'd like to welcome my guest, Elizabeth Becker, a licensed clinical social worker. She created the Professional Boundaries program. It is set up for professionals who've done inappropriate things in the workplace including sexual harassment. Elizabeth, welcome to the program.
BECKER: Thank you, Maureen.
CAVANAUGH: Now, how are doctors and other professionals referred to the program? What kind of behavior have they engaged in?
BECKER: Usually we get our referrals from a variety of sources. They tend to come from organizations either where human resources or the attorneys have complaints against them for some sort of unprofessional conduct. And it can range from disruptive behavior to boundary crossing like sexual harassment.
CAVANAUGH: Is this program exclusively for people in professional careers like doctors and executives and lawyers?
BECKER: Yes, the majority of people that we work with are healthcare providers. But if anybody is in a role of public trust such as Bob Filner, they would be appropriate for this kind of program.
CAVANAUGH: I'm wondering, are there women as well as men referred to the training?
BECKER: There are, although the vast majority of them tend to be men that we see.
CAVANAUGH: Now, Professional Boundaries is a remediation program, not therapy. What is the difference?
BECKER: Remediation involves education and training. Therapy makes the assumption that there is some sort of psychiatric component that is driving the behavior. Usually the best form of response to allegations of sexual harassment is a combination of both remediation and training and cognitive behavioral therapy. So, putting those components together is the best way to deal with someone who has a chronic long-term history of engaging in this kind of unprofessional conduct.
CAVANAUGH: If indeed it is not a problem that needs therapy, how can remediation or behavioral therapy of some kind address the problem?
BECKER: Well, the first thing that would need to happen is that a professional, anybody including somebody like Bob Filner, the first thing that would happen is they would engage them in a thorough, full evaluation. That includes a full physical. So, what they are looking for is they are looking for any physiological changes that would impact conduct and behavior, or their thought process as well.
So in somebody like an older professional they're going to look to see had there been any physiological changes, have they had a small event or something like a stroke that would affect their ability to engage in executive functioning, decision-making, judgment, impulse control. Those are all concerns that they would have to find out whether or not there's any physiological cause. They would do at first a really thorough physical exam and they might include a neuropsych evaluation as well. So, once they've done that and kind of try to rule out any other causes that they would start to look at cognitive behavioral ways of contributing to this problem.
CAVANAUGH: And that would be trying to change somebody's behavior, right?
BECKER: Right, so what they would look at is, they would look at a person's values and beliefs and their experiences, the accumulation of their life experiences and how they made sense out of those experiences and then they would begin to say, they would be looking for psychiatric components, too. Does this person have a history or symptoms of depression? Has there been an acute event in their life that would contribute to them being emotionally unstable? So there are lots of things that contribute to a person's conduct. But they look, let me do a thorough evaluation a look at all those things.
CAVANAUGH: Now there's a terminology that crops up in your program. It's called boundary crossings. Probably has a larger life in your world as well. What is an example of a boundary crossing when it comes to how people deal with each other in the workplace?
BECKER: Well, think of boundaries as existing on a continuum. So there are, there is one in which is a minimal boundary crossing to the extreme, which would be something that when someone has been accused of engaging in physical contact, so hitting somebody or slapping somebody on their rear end, or forcibly kissing them, that most of the other end of the spectrum so boundary crossings can be anything from off-color jokes that somebody might find offensive, to sexual banter to physical touch. So, and then there's more subtle types of boundary crossings as well. Could be developing a dual relationship with somebody. For example, if I'm your boss or someone is your boss and they are also hiring you to mow their lawn were firing their child or to another type of job what happens is it begins to create a dual relationship which could down the road create confusion for a person about what the core nature of their relationship is.
CAVANAUGH: Now doctors and other professionals who take this program, the Professional Boundaries program, they enter the program willingly?
BECKER: Most of the time they do not. Most people especially if there's been a long history of tolerance where they have not been held accountable for their behavior, they do not enter willfully. They are usually referred, or when it comes to the attention of somebody else. Our experience is that it's usually an attorney, HR department, risk management department, medical executive committee or in some cases even the state licensing board so if that person holds a state license, they can lose that license as a result of boundary violation.
CAVANAUGH: I'm wondering if someone comes to your program sort of unwillingly, they are pressured to go, what do you do to overcome that? Because we've been hearing from other professionals that motivation to change is one of the biggest indicators as to whether or not a program is going to work.
BECKER: Right. I think it depends on their distress level. My guess is that most people go and copy treatment or some sort of evaluation process they are in a high level of distress so there's been a lot of complaints there's been a lot of problems identified usually by the time they get to a program they are a bit of a train wreck which means that lots of areas of their life are not working. And it becomes harder and harder for them to deny, especially when their career and their profession is at stake. So especially for men, I think men, both men and women but more so I think with men their identity is very much wrapped up into what they do and to feel a sense of failure, especially if they, you know someone like Filner or someone like a physician who has dedicated their life and is very passionate about the work that they do to have that level of failure especially toward the end of their career when they feel like they have a lot at stake and a lot at risk, they oftentimes do not want to end their career this way so they are pretty motivated by the time they get to us even if they are still minimizing the behavior. So I think that that is part of what will happen. You know, when Mr. Filner gets into treatment, they will evaluate them thoroughly from head to toe but they also assesses readiness and motivation for change.
CAVANAUGH: You say the professionals you deal with there is this problem of minimizing behavior. Are some of the people in this program shocked to realize what they are doing is a problem for others?
BECKER: Yes. There's oftentimes a lack of empathy and the shock comes from the perception of others. So that there is a huge mismatch between how others perceive them and how they perceive themselves. So often they are very, especially physicians because physicians often times enter the profession very much being selfless, being there because they see themselves as healers and so this kind of accusation that is harmful to a patient is often times very shocking for them and I think when the shock wears off a great deal of shame and embarrassment sets in, so you know, but it's usually it comes in stages, so denial is usually the first, or they minimize it, or they try to explain it away you know, and justify their behavior but I think that's part of the remediation process is to kind of walk them through those various stages so that hopefully by the end of the treatment ordered by the end of the remediation they have a great deal more empathy for how others might be experiencing them and there's less of a mismatch between their perception of themselves and how others are experiencing them and that is the goal is to really integrate that better.
CAVANAUGH: How do you go about teaching somebody to have that kind of empathy?
BECKER: Well it is a process and it often times takes a while. I think the way we do it in our program is we find a way to help them identify with what is meaningful for them so most of the people who come through the program have lives, and they have girlfriends or they have children especially if they have female children, one of the best ways to get them to identify and have empathy is to have them think about if these things happen to their wives or their sisters or their daughters. And that usually is hardly see the biggest shift in people. Because then it becomes more real for them to have their loved one have to endure some of this conduct of others. Makes it very difficult for them to minimize it or dismiss it.
CAVANAUGH: And as you are doing your evaluation of a professional this program and you try to find out if there is a kind of stressor there triggers this behavior?
BECKER: We look at stressors in general because sometimes we find there are find that there are circumstances a series of circumstances of their life a series of stressors with the onset of the behavior was really, really parallel process to other events going on in their life. For example, we've had people who are literally going through a divorce and at the same time they were experiencing the loss of a loved one. We had one physician whose wife and child had been in a terrible automobile accident during the separation in which one of the children was killed. And so, this does not excuse their unprofessional conduct, but it helps us understand that it occurred within the context of a series of events. I don't know that that is particularly true for Mr. Filner or you know, Anthony Wiener, or anybody else who engages in this kind of behavior but it is important to know that when they enter a remediation or treatment program all of those things are taken into consideration and looked at.
CAVANAUGH: I must tell people that your Professional Boundaries program is short; it is a three-day program, as I understand it. On the third day you have people participating make a behavioral contract. What is that?
BECKER: Yes, the program is only three days. But I will say again, it is remediation, and what we recommend is that at the end of that time we make recommendations so as a part of our brief evaluation, we don't do the kind of assessment by the way, we do not do the kind of assessment that Bob Filner is going to get. Bob Filner is going to get a much more thorough assessment than we do. When we evaluate we are looking as to whether or not there is anything else significantly going on in the person's life that would prevent them from being able to successfully participate in remediation so it is not treatment or rehab. But if we discover that they are having some other issues, like there are marital problems or marital issues we will make recommendations. If we discover that the person does have some acute episode that is a stress-related episode that they get the help that they need. We look at substance abuse to see if that's a factor that's contributing to unprofessional conduct. So we make all those recommendations and referrals.
But to go back to your question about the contract, what we do is we help them to synthesize the things that they've learned about themselves and about where appropriate professional behavior in the workplace and we help them synthesize that information into a behavioral contract and it is behavioral but it's also cognitive so we help them understand that the way that they think about things of the past was probably not serving them very well and then we have them right a summary of their new ways of thinking about it and then we have them put into place steps, behavioral steps and things they're going to do. So what they used to do is not an option anymore. Instead they're going to do these three or four other behaviors that they agree upon. And for everybody it’s a little different. It looks a little different. It's not illegal, binding contract but what it is a working plan so that when they leave at the end of three days they have a plan, an action plan. And then what we do as part of the action plan we say who's going to hold you accountable to this plan so that they have resources and these people are supposed to list three people that are resources for them who are supportive, not punitive. So, it could be a wife, it could be one of us, through the program. It could be a therapist –
CAVANAUGH: It could be a city.
BECKER: It could be a city, the city is a good idea, yeah it takes a village, right?
CAVANAUGH: Let me ask you, this has to be my last question for you, Elizabeth, if someone has engaged in harassing or inappropriate behavior for years, how likely do you believe that it would be that a brief program such as yours or two weeks in therapy how likely do you think that would be in changing that behavior?
BECKER: Not likely. It is important to understand that it takes us a long time to develop our behaviors and our behaviors are driven by the way we understand the world to work and the way we, our beliefs and values that lots of things go into driving our behavior so he may learn, not he, Bob Filner, or any professional can learn certain types of behavior but those behaviors will be sustainable unless there is a system in accountability, unless there's ongoing therapy in place to help support that. So the other thing I want to say is that one component the other component that could be extremely helpful is coaching and coaching is a little different than therapy in the sense that it's not been driven by psychopathology. It's really being driven more by success in the workplace.
CAVANAUGH: Okay maybe we can get into that in a later program. I've been speaking with Elizabeth Becker of Inner Solutions for Success and thank you so much.
BECKER: Thank you, Maureen.