Wednesday, February 29, 2012


About 25% of people under age 50 have tatoos, and that number goes up when you look at younger segments of the population. It seems like it's almost a rite of passage these days to get "ink." While I don't actually have one, many of my friends and colleagues do. More conservative folks may get tattoos in areas they keep covered, but it's becoming more and more mainstream to have tattoos on places much harder to hide - hands, forearms, neck, ankles, feet (yes, I know feet can be hidden - but I wouldn't want to wear socks all summer!).

However, for better or worse, the corporate world - including healthcare - has not caught up with the times. Every company I've worked for has a policy barring visible tattoos. While enforcement of that policy seems to vary widely based on the agency and position, I can see how many clinicians in my age group might face tattoo-related difficulties at work.

When such difficulties arise, it may be tempting to abandon agency life for the freedom of private practice. However, regardless of the setting, it's important to consider the possible impact of tattoos on the treatment process.

The senior managers who establish tattoo policies are probably doing so based on their ideas about "professionalism" - along with other decisions about dress code, and the like. While a professional presentation is certainly important for therapists, I also think it's possible to appear professional with visible tattoos (if they are tasteful and unobtrusive). The bigger concern for me is how clients will interpret the tattoo.

Tattoos are a mode of expression, so we have to assume they will express something to clients - but much of their own individuality shapes their interpretation of the tattoo's "message." It would be a mistake to make assumptions about what that interpretation might be. When in doubt, and it seems that a visible tattoo is drawing a client's attention, I would say the best bet is to make it a manifest, rather than latent, part of the conversation - it's all grist for the mill, after all.

The tattoo may also shape the client's transference to the therapist. After all, a tattoo, as a form of self-expression, is the opposite of the "blank screen. It may influence what other relationships get layered over the therapeutic relationship, what associations are called up, and therefore significantly shape the content and context of therapy.

Whether or not transference becomes a factor, tattoos are inevitably a form of self-disclosure, and should be considered with the same care as other forms of self-disclosure. Will it help, hinder, or be neutral to the therapy? What would it be like for you to have the client interpret (and possibly misinterpret) it? What might it say about who you are, and how might that influence the client?

In all of these considerations, the population matters quite a lot. With some populations, a tattoo may make the therapist feel more accessible, and be a way of joining with clients. In other populations, it might lead to negative judgments of the therapist, or (with kids, for example) be seen as advocating a lifestyle key stakeholders (parents, funding sources, the board) don't support.

The bottom line is that, while you might not even think about your tattoo that often, if it's visible, you need to think about how that might impact your clinical work. If you're thinking about getting a tattoo, you might want to consider one you have the option of hiding if necessary (rather than wearing a band-aid all the time, as one of my colleagues had to do). If you're bent on a spot that you can't hide easily, consider the tattoo and it's message carefully - it will become part of your presentation as a professional!

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