The Problem with Boundaries

Rachel Morris: This is a You Are Not A Frog Quick Dip, a tiny taster of the kinds of things we talk about on our full podcast episodes. I’ve chosen today’s topic to give you a helpful boost in the time it takes to have a cup of tea so you can return to whatever else you’re up to. Feeling energised and inspired for more tools, tips, and insights to help you thrive at work. Don’t forget to subscribe to You Are Not A Frog wherever you get your podcasts.

I’d like to talk to you about the problem with boundaries because I hear a lot of people saying that doctors, other healthcare professionals and other people who work in high stress, high stakes industries have a real problem with boundaries. That they are unable to set boundaries, and I don’t think that this is actually the problem. If you ask any doctor what their boundaries should be, they know.

They know what their professional boundaries should be. We’ve all learned so much about well-being that we know we’re better if we have a lunch break, if we don’t work longer than 10 hours, for example. We know that we need to have holidays. We need rest periods, we need time off. We know that we need to be able to say no to people. We certainly know that other people should respect our physical boundaries, and I’m sure that many of you listening to the podcast will have set some boundaries.

Now, I was listening to a podcast recently with the author Glennon Doyle called, We Can Do Hard Things, and she was saying that because she’s quite famous and she’s quite an introvert when she goes to school to collect her children on the occasions that she can make it, she wants to fully focus on her kids and she tries not to talk to the other parents. That is a boundary she’s put up that she wants to be able to give all her time and attention to her own children.

She was saying that one day she got an email from one of the other children in her son’s class, and there was some sort of problem going on with the kids, and she emailed back saying, ‘I’m so sorry. I didn’t know anything about this’. The mother said, well, ‘It’s been going on for quite a while’. At which point Glennon Doyle said, ‘How come you didn’t tell me about this earlier?’ The mother just wrote back and said, ‘Well, to be honest, we find you unapproachable.’ She was really shocked and upset. She didn’t want to be seen as unapproachable. She phoned one of her friends and said, the other mothers at school find me unapproachable.’ Her friend just said, ‘Well, do you want to be approached?’ She said, ‘No.’ Her friend just said to her, ‘Well, congratulations, honey. It’s working. It’s working.’

You see, our problem is not that we don’t know what boundaries we want to set. Our problem is when we set them and the boundaries have consequences, we do not like the consequences of our boundaries. Now, what are these consequences? Well, things like people being disgruntled, people being upset with you, maybe causing somebody some inconvenience, maybe somebody not thinking very highly of you, and this is where the rubber hits the road.

Because whenever I do training with doctors, we always get the pushback, ‘Well, I cannot leave the surgery on time because what if there is an urgent test result that needs doing or there’s an urgent visit? I do not want to cause patient harm through the consequences of my actions.’ And of course, we don’t want to cause patient harm.

But my question is, when we set boundaries and they crumble, is it because we know it’s gonna cause significant patient harm or is it for another reason? I actually did a poll in a recent webinar about why our boundaries crumble, and only 3% of people said it was because of patient harm. The vast majority of the people said, well, it’s because I feel guilty, or it’s going to inconvenience somebody else, or I don’t want people to feel bad about me.

The real issue with boundaries is the consequences of setting those boundaries, and it leaves us with the illusion that we are no longer in control. Because people say to me, I have no choice about when to leave work. I cannot leave work if I have to do that urgent result, or if I have to do this other thing.

The reality is that you are totally in control of it, but you are choosing to stay because you are choosing not to have adverse consequences for the patients, but so often we are also choosing to stay because we don’t want adverse consequences for ourselves. Now, this thing about boundaries is so important because as you will have known from the previous podcast episodes that I’ve done, we can’t work that much harder right now.

There is no time to spare, so we’re gonna have to start saying no, we’re gonna have to start setting priorities and boundaries. We need our boundaries, don’t we? We need our boundaries to be able to keep ourselves well for well being. We need our boundaries to keep ourselves productive because unless we stop ourselves working 24 hours a day, we will just burn out and we are seeing loads and loads of our colleagues burning out, becoming ill, and leaving the profession altogether.

The other good reason for setting boundaries is it lets us get our lives back. It means that we will be free to do those things that make life worth living. If you’re setting a boundary about having a coffee break, then you will get to connect with fellow human beings. If you’re setting a boundary about family time, the time that you are not gonna be working, you will develop much better, closer, more loving relationships with your family rather than just being glued to your emails the whole time. We know what our boundaries should be, but we have problems with the consequences of the boundaries, which we set. This is where it becomes really difficult because this is where our amygdala gets involved.

Now I’ve talked about the amygdala a lot. Quick recap, that’s your threat detection bit of your brain. It’s the bit that’s trying to keep you safe. doesn’t necessarily keep you happy. Your amygdala will detect a physical threat, a hierarchical threat or a group threat. When we were living in caves, if we were not liked by the group, if they chucked us out, then we would die of exposure, or be eaten by a lion or both. This worry about people not liking us, about upsetting people we experience as an existential threat. No wonder we don’t like it when we put a boundary up and it upsets somebody. We experience that as an existential threat. When you set a boundary, and somebody doesn’t like it. Every bit of your being will be crying out to do something different, to try and do something to make them happy, to make sure that they’re not upset.

Let’s face it, nobody likes to hear a no. I don’t like to hear a no. If someone says no to me, I will probably feel a little bit disgruntled, initially, and then I’ll go away and I’ll think about it and I’ll then realise that actually that was totally fine for them to say no. I was just being a bit of a spoiled brat really by reacting to it. The other day, I had a lot of work planned. I was delivering quite a few sessions. I was chock a block and one of my children asked for a lift into town because it was pouring down with rain and they normally cycle in to get to school.

I initially said, ‘I’m sorry darling, I can’t do that.’ I set a boundary and I said no. This particular child at this particular time got in a bit of a strop, ‘What sort of mother are you? That’s not fair. Everybody else’s mothers drive them to school all the time.’ What happened to me will, my amygdala flared up and said, you are not a nice mother, you are upsetting this child. They won’t like you, they’ll end up in therapy for the rest of their lives because you are not taking them into school. I buckled and I said, ‘Okay darling, let’s just jump into the car.’ We raced off into the centre of Cambridge, which in the morning takes about 40 minutes at least, to get in and back again.

I was back just in time for the rest of the day, but I was just behind on everything that I had to do. When I got to the evening, I was prepping for a webinar I was doing and I got another phone call from the child who said, ‘Right, mum, you need to come and pick me up again because I’m in town. I don’t have a bike, et cetera, et cetera.’ Oh, crumbs, I hadn’t figured that one in. I went outside into the drive, jumped into my car, and reversed straight into my neighbour’s car. Ended up causing 750 quids worth of damage. How frustrating. In order to avoid that short-term pain of saying no, I said yes, my boundary crumbled, and then long-term I was in problems.

We can see the problems that crumbling boundaries cause can’t we, for example, in a practice, if you have agreed as a bunch of doctors that you are not gonna be prescribing a certain thing because it’s not the right thing to do, and one of the doctors crumbles for a particularly tricky patient, it undermines everybody else. Often we undermine ourselves by just letting our boundaries crumble, the minute it gets a little bit uncomfortable just like I did, so short-term gain for long-term pain.

So firstly, recognise that it is normal to find setting boundaries uncomfortable, and just because somebody else is upset or you’re feeling a bit guilty, or there are slightly inconvenient consequences for somebody. It doesn’t mean that setting the boundary was wrong. Think about why are you doing it. What is the long-term gain here? Because mostly we set boundaries for good reasons, not just because we are incredibly selfish.

By the way, setting boundaries for self-care and for looking after yourself is not selfish. It is part of being a good doctor, a good nurse, a good professional. You have to do that. You have to put yourself first and make sure you have enough energy. You have enough internal resources to be able to help other people and to be able to do your job.

Now, there’s something about consequences here as well. Because the consequence for my child would’ve been getting a little bit wet on the way to school and probably being a little bit late and probably having their form tutor have a go at them. Okay not severely dire consequences. The consequences of setting a boundary and saying, I am leaving at this time and I’m not gonna deal with that urgent test result, might mean that there is significant harm to the patient. In that case, you would choose to break that boundary. It’s okay for your boundaries to crumble occasionally, if you’ve worked out that the consequences are something that you will not tolerate. That might be something, as we said, like patient harm. It might be because you won’t tolerate doing something that is lacking in integrity or honesty or will lose you, your job, et cetera, et cetera.

You can choose what boundaries you’re gonna enforce and what you’re not gonna enforce based on how significant and severe the consequences are gonna be. But so often we don’t look at the consequences. We just look at how it’s feeling in the moment. The next thing that will help you set boundaries is know exactly what you’re gonna say yes to so that you know what you’re going to say no to. For example, if I had a workshop starting at the time that my child asked me if I lift into town, I would’ve said no because my priority at that point was to do that particular thing.

At work, many of us do not know what our true priorities are. Side note, if you are running a department, running a practice, and you’ve got all these conflicting priorities, then you might want to just think about what your one overarching priority is right now. It may be something like keeping this department sustainable and making sure that everybody who works here is okay, and that might trump some of the other things.

Know what you’re gonna say yes to so that you know what you’re gonna say no to. If you know why you’re setting the boundary, it will be really helpful. Last year, I signed up to a load of group tennis lessons and they started at 6:30 on a particular day. Now I knew I was always gonna be finishing work by quarter past six so I could get to my tennis lesson.

I had a reason to put the boundary up and to stop. I had a why. Keeping your why at the front of your mind means that you can start to use power, language and power language is so important when it comes to boundaries. Rather than saying, I can’t do this or I have to do this, you start to say, I am choosing to do this so that. I’m choosing to have a lunch break so that I am fresh and able to see my patients well this afternoon. I’m choosing to say, no, I can’t do that extra shift, so that I am able to work the rest of the week. I’m choosing to say no to that particular role because I know I need to finish my masters and that is going to take a significant amount of time.

At the moment, I am choosing not to travel in a couple of months of this year because my children have GCSEs and A levels and I am choosing to be around for them. When someone says to me, can you come away for a weekend or can you fly here or there, I will choose to say, no. I won’t be doing that because I am choosing to stay at home, to be here for my children.

Rather than saying ‘I can’t go away for a weekend’, I’ll be saying, ‘I won’t be going away for a weekend.’ That subtle difference between can’t and won’t will make all the difference. If you say, ‘I can’t do something,’ it’s very powerless. We know that one of the basic human needs is autonomy. If you say, ‘I can’t do that,’ it immediately makes you think, ‘Well, I’m losing my autonomy. That’s not fair.’ If you say, ‘I won’t do that, I will not do that,’ you are much more in your power. You are choosing not to do that, and that helps you keep your boundaries.

Back to my various children and their travel arrangements in the morning, a couple of weeks after I’d crashed into my neighbour’s car, the same child asked me for a lift into town far too late for me to do it. This time, because I knew what had happened last time, I said, ‘Darling, I’m really sorry. I can’t do it. You’re gonna have to cycle, try putting on some waterproof trousers.’ Did that child say to me, ‘Oh, mom, you are right. No worries at all. That’s fine. I’ll jump on my bike.’ Of course they didn’t, I got exactly the same reaction. ‘That’s so unfair. You never take me anywhere.’ All that sort of thing. And off they left in a big huff, slamming quite a few doors as they went along, at which point I just had to grit my teeth and say to myself, it’s working.

I’ve put in some boundaries which have had consequences. The consequences show me that my boundaries are working right, and it was really uncomfortable and I felt bad. But I knew why I had said no at that point. I did not have time to do it that day, and it would’ve made me very late for the thing I had committed to do. I was choosing to say no. You know what? 10 minutes later, the child actually texted me and said, ‘Oh mama, I’m sorry for being grumpy and all was well.’

Now, when you set boundaries, when you say no, you won’t always have a gracious response. After you’ve done it, people won’t always go away and think, oh, you know what? I’ve thought about it and it’s fair enough. You may have some back biting, you may have some bitching. You may have people misunderstanding you. You may have complaints, and this is hard stuff. It’s not easy, but it does not mean that you are wrong in setting the boundary in the first place. But if you can start to predict some of the consequences that might happen, start to prepare yourself and start to think to yourself, actually am I prepared to accept these consequences or am I not?

Then you will have a firmer foundation from which to set these boundaries. One thing that I have noticed through talking to lots of people about how to say no, prioritise, set boundaries and deal with pushback, is that the major reason we fail to set boundaries is not necessarily because of people-pleasing, because of other people’s reaction. It’s due to our own internal stories that we tell ourselves in our heads when we say no. I’m gonna cover how to deal with pushback and how to deal with ourselves and the stories that we are telling ourselves in our own heads in the next Quick Dip episode.

If you are interested in this whole area of saying no, then we have a special toolkit for you to download. Just click on the link in the show notes. There’s lots of advice there, a short video as well as some other podcasts that will help you. Go well, know that you are saying no and setting boundaries for a reason. Not because you are a lazy, bad, and selfish person. It is only by saying no and setting boundaries that you are gonna be in it for the long haul.