By Dr. East Phillips, DAOM, LAc
According to one of my favorite thought leaders, Brené Brown, people with strong boundaries are the most compassionate[1]. What do you think of that statement? Does it seem counterintuitive to you?
It often seems to me as though many of us lack solid boundaries because we don’t want to disappoint our patients or hurt their feelings.
However, aren’t we actually hurting our patients, and ourselves, by not having solid and clear boundaries? I’d like to begin by sharing something that came to my mind as I contemplated the question:
How important are boundaries in private practice?
My neighbor grows plumerias in his yard. He literally has over 300 plumeria plants, each one carefully planted within its own large pot. Many of his prized plumerias are rare and exotic with values over $1,000 each. He keeps telling me he is going to give me a clipping from one of the plumerias. I’m eagerly waiting… but that’s not the part about boundaries. This is:
Let’s say he gives me a clipping from one of the prized plumerias and I place the clipping on my driveway with some dirt around the exposed roots. How well do you think that little plant will do? Not very well, I can tell you that. Wind, rain, and the elements will damage this little plant and most likely send it down the street in the gutter with the other leaves and landscaping discharge. This little clipping needs a container within which to grow and thrive. A thick plastic or ceramic pot filled with good soil would give it a much better chance.
Isn’t that the same for our patients? They need a container in which to grow, heal, and ultimately thrive. Having boundaries with our patients is just like having a solid container or planter for growing a plant. If we use a weak container, water, soil and nutrients can leak out.
We can also look at how important boundaries are in raising children. Solid boundaries give children a sense of safety and security. Can’t we say the same for our patients? Giving them clear boundaries within our practice will give them a sense of safety and security. Furthermore, could we also say that having solid boundaries in our practice, and holding to those boundaries will also give us a sense of safety and security as well?
Boundaries are essential to a successful practice and enjoyable career
Let’s face it. People-pleasing (in other words not holding up your boundaries) isn’t sustainable. Sooner or later a people-pleaser will find themselves feeling taken advantage of, burned out, resentful and angry! Sound familiar? How about any of these common scenarios:
- You don’t like working on weekends or evenings, but you keep saying yes to that one patient because you feel bad for them.
- You don’t want to raise your prices because you feel bad for your patients, but you feel resentful because you can’t afford something you really want and now you are thinking to yourself “maybe I chose the wrong profession”.
- Your patient cancels last minute again, and you are so frustrated because you turned away other patients for that appointment slot and now, because you don’t have a cancellation policy, you are not going to receive anticipated income.
- Your coworker left the room a mess again and now you are hustling to clean it up before your first patient arrives. The stress and resentment this causes you leaves you flustered during the session with your patient rather than grounded and present.
- Your patient shows up 20 minutes late, which will now push out all your appointments for the day and ruin your whole workflow.
Let’s move on to the many benefits of having strong boundaries. After that, I’d like to offer strategies on setting some boundaries in your practice so that you can increase your level of compassion and feelings of inner peace and joy.
Benefits to having strong boundaries:
- You won’t feel taken advantage of
- Eliminate burnout
- Feelings of safety and security for you and your patients
- Equal exchange of energies
- Feeling respected
- Your needs are met
- Greater sense of joy since you are saying “no” to things that deplete your energy
- Less conflict
- Eliminate stress and/or anxiety
If you think a career in holistic medicine is something you would like to pursue, contact us and speak to an admissions representative to get started on your new journey!
Six Strategies for Creating & Maintaining Solid Boundaries
1. Communicate your boundaries. Don’t keep your boundaries in your head where they can’t serve you. You’ve got to communicate them to your patients and any prospective patients.
Clearly state your practice policies on your:
- Website
- New patient paperwork
- Intake forms
- Signs in your waiting room
- Newsletters to patients
- Welcome emails and appointment confirmation emails
- Social media posts
- Promotional materials like postcards and brochures
The practice policies that you want to make sure you clearly state include:
- Hours of operation
- Your service offerings
- Prices for your services
- Cancellation policies and fees associated
- Package cancellation policies and fees
If you once offered massage but hate doing massage, stop offering it and take it off your services page. No exceptions. Otherwise, you will find yourself doing massage again!
On my intake/new patient form I clearly state prices for my services and that if for any reason they cancel their appointment with less than 24 hours’ notice, their credit card will be charged the full amount for the service for which they booked.
In addition, for facial rejuvenation package patients I clearly state that if they decide to cancel the program/package at any time, they will be reimbursed according to my single-session price and not by pro-rating how many sessions they have used out of their package.
2. Stay true to yourself. If you don’t like to work weekends–don’t. If you don’t like working late at night–don’t. If you like having your dog at the office instead at home, bring your dog. When you start making exceptions for certain people you start to weaken your boundaries. Over time you will become resentful. In addition, you will not be fully present during your treatment sessions because all you will be thinking about is either “I hate working on weekends”, “I hate working late at night” or “my poor dog is sitting at home all by herself”.
3. Be consistent. This one is tough, I’ll admit, but it’s so important. Think of raising children. Consistency with boundaries is key. Children rely on boundaries for a sense of safety and security. Aren’t our patients the same way? If we aren’t consistent, they will be confused and unsure. Sometimes we say yes to seeing them on the weekends and sometimes we say no. Sometimes we give them lower prices, sometimes we charge them full price. Yikes! Before we know it, they go somewhere else because they just don’t know what to expect from us and they’d rather go to another practitioner that is consistent and reliable.
4. Stop explaining yourself. I read something recently that fits within the context of this article: “no is a complete sentence.” How often do we find ourselves explaining our why’s to our patients? Why we don’t work weekends. Why we don’t work late at night. Why we no longer offer massage. Why we raised our prices. Why we don’t extend their treatment time if they are late. The real question is why are we explaining ourselves and our boundaries to people?
It seems to me that when we start to explain our why’s, we weaken our boundaries and give our patients an opportunity to give us opposing reasons. Next thing you know we are feeling bad for them and saying “yes” to something we really want to say “no” to.
How often do you find yourself justifying the price of your services to patients? Don’t do it. Your services are valuable. State them clearly on your website and hold to them. One of the biggest sources of feeling resentful and dissatisfied in practice is allowing patients to pay you too little for all the value and hard work you provide. I can’t tell you how many people want to give up their practice because they are angry that they don’t make enough money. Please don’t give up your practice or leave this profession. Charge appropriately for the value of what you are offering.
Remember, no is a complete sentence. If you need more help in this regard, I love the advice given by two experts in setting strong boundaries: Cheryl Richardson in her book The Art of Extreme Self-Care: Transform Your Life One Month at a Time and Derek Silver’s where he says “if it’s not a hell yes, it’s a no.[2]”
5. Stop saying you’re sorry. This took me a while to finally get but once I did it feels so great. Instead of saying things like “I’m sorry, I don’t work weekends.” Or “I’m sorry, but I have to charge you a cancellation fee because I had someone else that wanted your spot, and you didn’t show up.” There is no need to say sorry for holding up your boundaries.
Here’s an idea: use “thank you” instead.
- “Thank you for understanding/honoring my cancellation policy.”
- “Thank you for understanding/honoring that I don’t work weekends.”
- “Thank you for understanding/honoring that I don’t discount my prices.”
6. Assess and Re-Assess How You Feel. If you are feeling frustrated with your practice, burned out, resentful, unfulfilled, or angry, chances are you have allowed someone or something to cross a boundary of yours. Only you know what you truly desire, so ask yourself where you are not completely satisfied, then make a commitment to getting yourself there. If you slipped and said “yes” when you wanted to say “no”, just stop doing that and be consistent from here on out. Use the words “thank you” in the situation. “Thank you for understanding that I made an exception when I treated you on that day/time or gave you that discount but from here on out I will not be doing that.”
Upholding our boundaries is a work in process and we will mess up. Our feelings towards our practice and patients act as our guides to let us know when there are holes in our containers. Listen to them and fortify as necessary.
Are these “how-to’s” easy? Not always. I must admit that while writing this article I recognize that while I’ve come a long way regarding boundaries, I still have work to do. I meet with a mastermind group of like-minded colleagues every two weeks, and we bounce ideas off each other. I often ask them boundary-type questions and they act as mirrors reflecting to me my true desires and remind me to stay true to myself and uphold my boundaries. Perhaps this is one more strategy for you?
In the end, I sincerely want us all to become and enjoy being the best versions of ourselves. I want us all to be the most compassionate people we can be for our patients. After researching and writing this article, it is even more apparent to me that solid boundaries are a crucial element to accomplishing this. I hope this discussion has been helpful for you and will lead you to becoming the best version of yourself where you feel an immense sense of joy, passion, and fulfillment in your chosen profession.
[1] www.theworkofthepeople.com/boundaries
[2] https://lifehacker.com/if-its-not-a-hell-yes-its-a-no-1723393142
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