Book Rounds: Boundaries


Book Rounds, Clinical Practice, Mindset, Personal Growth, Professional Health, Professional Skills Development, Well-being / Monday, January 4th, 2021

Boundaries

Dr. Henry Cloud & Dr. John Townsend

https://www.goodreads.com/book/show/944267.Boundaries?from_search=true&from_srp=true&qid=GW5XPG8IHT&rank=1

Who should read: All humans. Seriously. 

Favorite quotes: 

“He doesn’t have a problem. You do… He doesn’t have a problem because you’ve taken it from him.”

“We are responsible to others and for ourselves.”

Why I feel it is important to veterinary medicine: We are conditioned and pre-selected as a profession to have poor professional and personal boundaries.

You suck at boundaries. That’s not a criticism. It’s an observation.

You’re probably thinking: “You don’t know me!!!” You’re right. I don’t. But I know this profession, and my observation is that it has selected you based on your boundary setting skills. Or, more importantly, the lack thereof. And after choosing someone who has dubious boundary setting skills, it conditioned you to degrade them even worse! I’m mad about it. You should be too. But, neither of us should give up hope. Just like learning to walk, you can learn to set boundaries. It has been one of the most powerful skillsets I’ve learned that applies across all aspects of my life. Buckle up for Boundary Setting 101. Stay tuned later this month for a view of where I think we struggle the most in this profession when learning boundary setting.

What are these boundaries everyone is yammering about and why should I care? 

“Boundaries define us.” How is that for a definition? Yeah, I wasn’t satisfied either! My favorite definition of personal boundaries is: the physical, emotional, mental and spiritual limits we establish to protect ourselves and distinguish us from other people, creatures and things. This gives “boundaries define us” a little more context for me. What I’d like to highlight is that it is a very intentional action on our part. Boundaries may just passively happen. But the implication there is that we are allowing others to define us. To be our best, healthy self, we need to take some ownership and define our boundaries. If you feel like an aspect of your life is out of control, it probably is, and it’s probably due to misplaced or absent boundaries. If someone else’s chaos is steam-rolling your life, you each have some boundary work to do. They have the responsibility to place boundaries to manage the chaos, and you have the responsibility to place boundaries around how much you let it impact your life. 

Boundaries exist within time, emotion, physical objects and contact, relationships, communication, thoughts, actions, finances, choices, and anything we can and should take responsibility for. As painful as it can be to learn strong boundary skills, it is also the most powerful strategy for a sense of personal freedom and empowerment. 

A common early misunderstanding about boundaries to be aware of: boundaries are definitions, not fortresses. The common analogy is that they are a fence, with a gate, not a wall without a door. You have the ability and responsibility to decide who you allow to cross over your boundary, and who doesn’t. When to allow them to cross, and when not to. You are the gatekeeper to your own life. You may choose to allow your child to disrupt your sleep schedule, but not your work. You may choose to lend freely to your sister who just lost her job, but not to the childhood friend that has never paid you back. 

What are some common boundary dysfunctions? 

Sue feels taken advantage of, as she once again agrees to cover for a coworker on her only Saturday off a month. If she doesn’t, the rest of the coworkers end up working extra hard. She mutters to herself as she feeds the litter of kittens she agreed to foster, because they were dumped on the clinic steps. She hasn’t slept through a night in a week and a half. “This is only temporary, she tells herself, as her six foster failure dogs and cats roll their eyes collectively. All of them with expensive diseases she spends a student loan repayment amount on to keep them healthy each month. It had made Jeff mad. He said he left because he couldn’t deal with the constant fur and piles of vomit, and the kittens were the last straw, but every month they have the same argument about how much the pet medical bills cost. It was definitely the money, too, but her coworkers all reminded her how selfish and sociopathic he must be if he couldn’t be around her pets. 

Sue is a compliant boundary setter. Compliants are pretty sure the word “no” is the worst, most offensive word in any language. Common etiologies in our field that create compliant boundary setters are fear of hurting someone’s feelings, fear of being shamed, fear of being seen as selfish, or fear of your own self-criticism and conscious (guilt). Compliants are primed for abusive relationships. Whether that is romantic, client relationships or toxic work environments. They do not protect themselves, and often don’t recognize the bad for what it is. 

Troy is a veterinary assistant. He started pre-vet school, but stopped just before applying to vet school. He knows more than half the technician staff, who are all a decade or more younger than him, and have a fraction of his work experience. He is the guy that catches mistakes before they happened. Even some of the doctor’s drug calculations. But he has more excuses for not going to vet school than a cat has lives. He also has excuses for why his girlfriend of 10 years stopped coming to work parties. But no one knows she told him she wasn’t waiting another 10 years for a proposal. He walks out of the hospital manager’s office, narrowly avoiding a promotion to vet assistant manager, with a work project of developing a recruitment, training and mentoring program for  veterinary assistants, with a goal of encouraging them into and through vet tech school. He wasn’t against the program. He was assured by management he was the perfect fit. But he begged off the responsibilities because he was considering applying to vet school. He wasn’t. But it got him safely out of commitment.

Troy is an avoidant boundary setter. As much as compliants struggle to say no and protect themselves, avoidants struggle to say yes to things that can be good. Troy doesn’t have boundaries. He has walls. He spends so much time protecting his fears of failure that he misses out on growth opportunities. 

Joy is anything but. Dr. Jones, to you, that is. Dr. Joy Jones signed on to a clinic that pays her salary based on her production. It is the busiest practice in the state. But that’s still too much chance. She poaches the cases that look like money makers, and dumps the time suckers on her department coworkers, or other departments. If you haven’t worked with her, she seems nice enough. Friendly to your face, she manipulates behind the scenes, knowing who to chat up to advance her goals, and who isn’t going to say no. Her team is tense. Not because they are bad people, but because she is hypercritical. There is only one Pandora station allowed around her. There is only one computer she works at. There is only one way to do everything, and that is her way.

Joy is a controller. She has no problem setting boundaries. She has problems respecting other’s boundaries. She cannot stand to hear no. And she has set herself up quite nicely to be surrounded by an overabundance of compliant boundary setters, and knows to suck up to those that have strong boundary setting skills. She is a manipulative controller with some people, and an aggressive controller with others. Regardless, joy is pretty sparse around Joy. 

Emily sits across from the hospital owner. Again. To discuss a client complaint. Again. And, oh, by the way, the technicians have also raised some concerns. She disagrees with both sets of complaints. She provided three options to the client for their pet. She spent the twenty minutes of appointment time with the owner, described each thoroughly with pros and cons, and when the client clearly was not going to make up her mind anytime soon, told her to let a technician know when she had decided. Her next client had already been waiting five minutes. She didn’t feel she was being rude. She was being efficient. She hadn’t neglected any options, she hadn’t implied judgement for any of them, and she hadn’t wasted the client’s time. The technicians were apparently upset because when they approached her another thirty minutes after the client’s appointment time, stating that the client was still asking questions, Emily had reviewed the questions and informed the techs that she had already covered the answers and the owner was just stalling. When one tech told her the owner needed some reassurance, and she was pretty sure the owner was in the early stages of dementia, Emily told her that her job wasn’t to manage dementia. The client could come back with another family member another time to help with decision making, or could wait to receive the written record detailing their discussion within the next 24 hours.

Emily is a nonresponsive boundary setter. She is fully capable of setting her own boundaries, and she expects others to as well. She doesn’t recognize the needs of others in the midst of her boundaries. Her techs need her support, but she doesn’t hear that. The client needs reassurance, but she can’t make that fit with her boundaries. They tend to either be overly critical of other’s issues, or can’t see beyond themselves to connect with others over their issues. They are not responsible for other people’s issues, but often wrongly fail to be responsible to other people when they are navigating their issues. 

Unless you’ve done some very intentional work, you likely have a common point of struggle with boundaries in one of these capacities. Many people struggle with more than one, depending on the context. 

How do I learn to improve my boundary setting skills? 

Be kind and gentle with yourself!!! This is a tough journey!!! Self-compassion is a key component of the learning process. Most of us have issues setting boundaries because of a lifelong pattern of behavior and observation of those around us. There are a few, graceful, healthy, and mature boundary setters are out there, but if you are struggling with setting your own boundaries, chances are you didn’t have anyone in your close circles with a strong skillset. 

Be on the look-out for people you feel have good skills in this area. Stalk them (in a curious, observational, totally benign way) to learn their ways! 

It is never, ever, ever wrong to seek guidance or coaching in this area. A therapist, counselor or coach can be invaluable here. You can learn it on your own, but expect the journey to be longer and more challenging. You are trying to invent your own wheel by going it on your own! If you suffer boundary issues due to trauma or abuse, please, please, please, work with a therapist. You deserve a kind, compassionate advocate to help you navigate your healing. If you have very specific areas of boundary placing outside of an abusive situation, a coach can be an extremely valuable advocate, witness, curiosity guru and accountability source! If these are not options for you, a full read of the book is a great place to start!

Remind yourself on the daily that this is a journey, and as with any skill, you learn as you go. There will be times it feels like it backfires, or people may not respond well to your boundaries. Learn from these times, rather than giving up or being self-critical. It’s OK to start small (“Sorry, I’m saving this chair!” equals no, and exercises your no muscle!) as you work towards bigger goals, unless you are at a breaking point that only boundaries will fix. I’ll say it again- if you are at a crisis situation with boundaries, please seek professional help! 

Practical Implementation Exercises: 

1. Do you recognize your behaviors in any of the dysfunctional boundary behaviors above?

2. Is there are area of your life where you feel resentment popping up frequently? Resentment is a sign that boundaries are being violated.

3. Many people feel selfish setting boundaries (not accurate at all!). What are the benefits that others will gain by you setting this boundary? 

4. How will you communicate your adjustments to your boundaries? What needs to be communicated to avoid misunderstandings or minimize unexpected impacts on other people? 

Additional resources:

Articles by Dr. Cloud on a wide range of boundary topics

Boundaries Blueprint for Veterinary Professionals

Boundaries as self-care     

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