Community acupuncture and the political nature of Professional Boundaries

Last month I went to Vikki Reynolds’
home office and sat in a supportive circle with a small group of
service providers in east Van. These are people who work within a
social justice framework and are dead serious about keeping their
hearts open, about keeping hope and spirit alive in the face of grief
and suffering. I was the only acupuncturist there, but my experience
was rich with shared understandings around accessibility (not
just about stairs and doorways and fees, although those things are
important) harm reduction, care for oneself, and the political nature
of Professional Distance.

Ever since the inception of a regulatory body for acupuncture and Chinese Medicine in British
Columbia we’ve received friendly-but-stern reminders about
Professional Boundaries, about what kinds of interactions are
Appropriate and Safe and which are not. Sometimes they mail out
booklets with stories containing teachable moments, printed on glossy
paper. None of them have ever seemed very relevant to my life or my
practice.

I had a hell of a time learning boundaries in school. I didn’t have the energetic boundaries to
protect myself from taking on my patients’ headaches, gut problems,
physical pains – I got quite physically ill. I also found myself
treating about a dozen members of the local queer community for
mental health issues, and due to a homophobic culture at school, and
my own inability to articulate a request for help, (clinical
supervision would’ve been nice!) I was woefully unsupported.

I notice a fascinating blend of boundaries in the community acupuncture setting. It does involve a
specific client-practitioner relationship, with clearly-defined
roles, and we state and restate boundaries with clients as necessary.
But we practitioners also access the same service – all three
‘punks at Poke snore, bliss out, and bawl as necessary in the
recliners, alongside our patients. This is trust-building, community
building, and no, I don’t think it blurs any boundaries. Boundaries
exist to protect and strengthen relationships. And relationships are
complex, it’s the nature of the beast. It does get pretty interesting
– especially as someone belonging to several small &
overlapping communities, say, an anarcha-queer community
acupuncturist involved in the cocounseling community with a
regularly-indulged performance poetry habit.

Yep, one of my acupuncture clients is dating someone I do peer counseling with. Everytime I go to a demo in Vancouver I see someone I treated for PTSD and/or injuries after
police brutality at the g20 protests in Toronto. One of my
acupuncture clients was in the audience at the poetry slam one night
I did a heavy poem about sexual assault. And I treat a lot of queers
I see in social spaces.

But when I’ve got support around me, when I have uncensored debriefing space to unburden, I don’t have a problem with engaging with these complexities. For me, the word
“community” in “community acupuncture” does not just refer to
treating 6 patients an hour in the same room.

I navigate that cocounseling relationship by not talking about my acupuncture clients. That night
at the slam, my acupuncture client paid me a grave compliment on my
poem and showed up for his treatment the following week without
further comment. My involvement in street-level activism, makes me a
more trustworthy practitioner for folks traumatized by state
violence. My queerness make me a more trustworthy practitioner for
other queers. This isn’t messiness, this is solidarity. This is about
doing our work within the communities we live in. This is healing.

Vikki commented “The distance between the professional and the client is not a measure of professionalism. It’s a measure of privilege.” One of the ways class functions has
to do with privacy. Folks living in poverty have their privacy
violated by the state on a constant basis. Those providing services
to poor people have much more control over how they are seen. Service
providers have the opportunity to create distance through the
presentation of objectivity.

I think that one of the wounds we carry as middle-class people is around being fearful to be fully seen, to be fully known. We must keep it buttoned-down, keep it “together”,
keep up with the Joneses. I hold a deep knowing of what this feels like.

But you know what? My middle-class programming, my fear-of-falling, my wanting-desperately-to-look-like-I’ve-got-it-all-sorted-out, those clamouring voices, they get quieter and quieter, the more I do this work.

I imagine that British Columbia’s acupuncture regulatory bodies would have sharp critiques of the
varied relationships winding through and around Poke Community
Acupuncture, of our Lax Professional Boundaries. I say, Let ’em.
They’re probably subsidizing their one-person-an-hour practices with
bureaucratic work anyways; they need something to do, right? 😉

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

Responses

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  1. Amen!

    Thank you for this post. This is something that I’ve been feeling at the periphery for some time now, but haven’t been able to articulate. I’ve found myself withdrawing from my community at times for fear of invading my patients’ privacy when I see them out and about. Dumb, I know. But not something I was doing consciously. More and more though, as my patient base grows and I feel like I’ve treated half the town at least once (though that’s far from the truth) people remind me that they don’t want or need me to pretend I don’t know them when we’re at the Farmer’s market together the way some did when I was in private practice.

    It’s a nice feeling to embrace this part of “community” in community acupuncture.

    🙂

  2. Thank you, Lisa

    for articulating some things I have felt or known but didn’t quite have words for.  Lots to think about here – lately I’ve been thinking a lot about the difference between messiness and solidarity in particular.  I also really appreciate the explicit reminder about how privacy can be a function of privilege.  My programming is also wearing away with this work, and it’s a relief. 

     

  3. thank you

     for this post and comments. It is so helpful to me. I love what you’ve said about trust and privilege.

    We are treating a number of victims of trauma and violence lately, as well as a lot of grief. All of these experiences can be so uncertain and isolating. I don’t know for sure, but I think being able to really connect with an open heart (fuck professional distance) is a big part of why some of these patients are able to keep coming for care–care that they really need right now! I think it also shows our willingness to actually witness suffering, without using the professional boundary line as a priveleged act of turning away from the pain and injustice.

    Thanks for all the work in your communities and for writing, Lisa. I always learn a lot from your posts 😉

     

     

     

    Melissa

    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  4. lovely

    echoing all the above, thank you for writing this.   “The distance between the professional and the client is
    not a measure of professionalism. It’s a measure of privilege.”
    It’s so helpful to see it expressed that way. I know that the intention behind professional boundaries is about protecting the client, and sometimes that works, but sometimes it feels like it’s all about maintaining a position of power. I have always failed at pulling off the buttoned-down, keep it together professional facade, and I know that part of that has to do with class. But I haven’t run across such an articulate explanation of how it has to do with class before. Thank you very much.

  5. POCA Fest?

    Lisa, promise us that you will be able to attend the Spring POCAFest in the Bay Area!  You have so much wisdom and heart to share.  I can’t wait to meet you in person.

    Thank you for your post.  I am always trying to navigate that privacy space when I see our peeps out in the world. I am a caretaker by nature but know that when they aren’t at the clinic, they aren’t asking to be cared for by me in the same way. When they show up at the ciinic, they learn that it’s a safe place to be vulnerable.  When they are out in the world, many of them have to put up a protective shield just to make it through the day, especially if they have been victims of assault.  Sometimes when they see me, I worry that they will have to navigate that intersection of wanting to be vulnerable (bc I remind them of the healing they do when at the clinic) and how where they are when they see me isn’t a safe place to even address those feelings.  I am learning to let go of being responsible for taking care of everybody all the time.  Having our clinic has helped me with that so much.

    I, too, “took home” my patients’ complaints for years.  It was funny when it was only flatulance or mild shoulder pain, but then I started seeing people for more serious things and I knew I had to find another way to hold their pain.

    I think that since it’s absolutley true that I cannot function well in my life unless I get acupuncture at least once a week, and I’m the first person to admit that to new patients who come in for anxiety or stress, I continue to be humbled by the reality that we are all in this together. And, as your comrade Vikki reminds me, that I am privileged to be able to even comtemplate all of this.

    Thank you again, Lisa, for this. 

    Julia in Berkeley

  6. Totally agree with your

    Totally agree with your assessment of why your patients are emotionally safe with you, thanks for your comment.

  7. I think that’s so cool that

    I think that’s so cool that folks remind you that the boundaries don’t need to be the same with private practice as with community acupuncture. (I like picturing those conversations happening over festival squash at the market, too.)

  8. There’s something elegant about sharing space….

    .. and i’m so grateful to be living in the community where i work, because normal-ass people tend to blend  those boundaries themselves, especially before they come in for treatment… thanks for your thoughts, as always, and definately keep them coming, because i know it’s probably more complicated to navigate as a punk than as reception staff…

  9. to clarify

    when I said things like “we” and our” in terms of what we do, I refer not to myself but to ALL of us punks working in this way, in these clinics.

    I think this gets at what’s really going on when non-CA acupuncturists try to characterize us as a bunch of angry crazies. (and why I always wonder why they aren’t a little more angry)

    I think the ability of CA to create this kind of open container bring us into countless real relationships inside our clinics with people living very challenging lives in our current world. It’s different than compartmentalizing it somehow or just being activist in our personal lives. It may happen suddenly, seamlessly from our outside lives, it may be a shocking awareness, it may be the slow grinding, but it does break our hearts open, we become absolutely empowered by it on behalf of our patients, and become unwilling to ever look away again.

     

    Melissa

    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.