Your Obstacles Are Stopping You From Setting Boundaries

When you are in the business of caring for others' welfare, you are an expert at stopping yourself from prioritizing yourself. But plenty of others are there to stop you from it, too.

There is a moment when it clicks: you need boundaries. You want boundaries. You are ready, today, right now, to put up that wall and you are prepared like an army for the retaliation! This is what we call “the best circumstance” because the desire and motivation to hold your ground are both present. It is going to be hard and you are okay with that.

It should be expected that barriers are going to come up in your way and how you are prepared for them can mean the difference between failure and success.

But as a caregiver who may not want to place limits, boundaries can be especially difficult. Sometimes you may even be called selfish or a bad provider for establishing limits. It may be the patients, other caregivers or your own guilty conscious that fights you. It should be expected that barriers are going to come up in your way and how you are prepared for them can mean the difference between failure and success.

Consider the basic expectations around someone in career service to others:

· You have to see fifteen people a day, five days a week. You must also provide exceptional care to each, you must remember their details (with an occasional reference to your amazing notes), you must keep up with your billing codes. You must also be available after hours when you patient has an emergency, whatever that emergency may look like.

· You feel guilty if you turn down a potential patient. They are in need. Other providers are full, so if you do not accept them, then who will… you don’t really work well with eating disorders, but that isn’t the point. A person needs a provider. They’re asking You.

· Your patient trusts you – that’s great! But they trust only you. You must be at their beckon call. They will call, text and email throughout your weekend and you will be expected to respond. Your patient, your coworkers, your management and other may complain against you otherwise.

These expectations are, in many ways, unreasonable, but they will not be presented as such. So consider this, too:

· It is not enough to help people if there is no Quality to the help being provided.

· “But we’re in a mental health crisis!” I know. Believe me, I have been on the side trying to find a provider for a patient, I have been the family member trying to find a provider for a loved one, I have been the person who could not cope anymore myself. I get it. But if new providers are only coming in as fast we burning out the seasoned ones, then we are perpetuating that crisis. Moreover, we are not even helping the people we do reach, we are just treading water with them. This is a band aide at best and the crisis remains.

· Exhausted minds make mistakes. Mistakes can have rippling effects on coworkers, on patients and on the community. You are an asset to the community, not a means to an end.

So let’s review some of the difficult questions we need to ask ourselves. These are questions we need to answer honestly and seriously – questions that stop many service workers from stepping back and taking care of themselves. First, (stop and really consider the answer), is this:

How do you, as a provider, cope with how important you are to others?

This is the first thing to consider because this answer will inform every step forward. If your answer is that you accept every patient who walks in the door, that your mistakes are insignificant or the fault of others; if you answer that you don’t need boundaries or if your attempt to establish limits folds with any kind of pushback – then the answer to this question may be… you are not, in fact, coping with your significance.

The reality is that you are ever so important to a lot of people. They care about you, they trust you, and in some cases they may still be learning how to make decisions in life without you. This is okay! In fact, many patients are reaching out because they need you, and you both know it. If you are building a professional relationship based off trust and care, then it’s great to be so important to others. To a point.

The key here is “professional”. Relationships with patients must be professional, because you are providing a professional service to a vulnerable person and you are doing it from a position of power and trust. This must be clear. This is made clear with limits, boundaries and understanding. Yes, even with compassion.

So when it comes to coping with your place in someone else’s world, start here:

When someone is in need, how often is that need real? What systems are in place to take on some of that weight?

Now however it sounds, this is not a sarcastic question, nor is it a trick question – crisis looks different to every person, so crisis to one could be “I am ready to kill myself and have a plan”, or it could be “I was written up at work and I can’t deal with it”. For those dedicated to helping, stepping back or saying no can be an impossible scenario to consider in either of these situations. Yet it must be considered.

If you are not in your office, or you are not next to your phone, does Person A know where to go, or who to call? Are they already safe in an ER?

Does Person B have enough anxiety medication to calm down and reach out tomorrow for an appointment? Has Person B been working on coping skills which they need to now put into practice?

Can I set Boundaries and still be a loving person?

Yes, and some might argue that having boundaries is the most loving thing you can do. By setting boundaries and protecting your own well-being, you are in turn safeguarding your patients. They are getting the most rested, healthy, sharp and engaged provider they can, and this is what they need!

How do I know my boundaries are not arbitrary?

Generally, I tell providers that whatever boundaries they feel they need in order to protect themselves as a highly in demand asset, they are right. Arbitrary boundaries more than likely come from a place of stress and burnout. Make sure that what you are establishing is even handed (pick your boundaries from a time and place where you feel at peace), make sure that they are consistent and if you do not feel good about something, then talk it out with a fellow provider, coworker or friend. Chances are the worry you have about a boundary being arbitrary is Guilt, so is that guilt being imposed on you, or is it because something you did really was questionable? Take your time answering.

What if my boundaries make me feel guilty?

It is a certainty that at some time and on some level, boundaries will make you feel guilty. Why? Because you, as a caregiver of any kind, are not supposed to be allowed to say No, or ask for space, or need a break. Look into Human Giver Syndrome – it is a feminist philosophy, but it absolutely applies to caregivers, too, and it’s a powerful way to consider the world around you.

Patients may try to make you feel guilty to manipulate you, or because they are afraid of change, or because limited access to you is unnerving. Fellow caregivers may make you feel guilty because they feel in judgement of you, or nervous about what it means for them. Guilt may also come from your own inner voice, put there by many years of being told you were not allowed to say no.

Guilt is powerful. Take your time to sit with it. Talk to someone you trust about it, maybe someone who is not involved in your work – outside perspectives can be great clarity. Then, be compassionate to the source of the guilt, but hold your ground.

Am I selfish for wanting or need boundaries?

You are not selfish! You are being told you are selfish by people who are made uncomfortable by your boundaries.

On the other hand, maybe you are selfish, and what’s wrong with that? People need to be selfish sometimes.

What do I do if my boundaries upset someone?

… and they will upset someone. Again, boundaries are scary – they mean Change. Change is frightening.

Most times, with patients, if you talk to them and walk them through the changes, express compassion to their unease, and help them understand the impact on them, then they relax and agree. If your boundaries upset coworkers or fellow caregivers, first take time to consider where that resistance is coming from. Are they in a place where they feel they cannot set boundaries? Are they feeling helpless about their own situation, or jealous of yours? Have compassion.

Are they managers who see nothing but the lost dollars? Look, these guys have a business to run and businesses need revenue; your paycheck needs revenue. Do not deny that you have bills to pay, money matters. So have some compassion for their position, but also point out that reputation means revenue, and burned-out workers make for bad reputations. (Now, I know I am being optimistic here, some management sees patients as a conveyer belt of

Good or Bad Insurance, high and low earners, and providers are a means to an end – if that is where you find yourself, then Think Bigger.)

How do you treat yourself when you are tired? Overwhelmed? In over your head? Uncomfortable?

When you are up to your eyeballs in paperwork, stressed from a day with three crisis patients, four devastating stories of survival, billing codes to sort out and it’s seven o’clock at night – what do you do?

If your answer is not, Go Home and Get Sleep, then you are not treating yourself right.