What we’ve said about Boundaries

“boundaries exist as a way to provide protection from anxiety for the patient and the clinician. And it provides patients with predictable parameters by which to interact with the clinician”

“a crossing is anything that risks harm to the treatment process for the patient or you, and a violation is something that definitively harms the treatment process, the patient or you”

“There are some boundaries that are absolutely essential to every practitioner. Things like protecting confidentiality, things like, you know, listening and doing like, yeah, there are things that absolutely cannot be changed”

“all the feelings and thoughts that people may be having these issues are unfortunately core par for the course for any long-term treatment and in particular any long-term psychiatric treatment”

“The less you have hard and fast rules about boundaries and frame, the more dangerous things are. Even if nothing bad ever happens, all you're doing is that you're making it harder on yourself”

“rules are important because there is actually a freedom to operating within a system of rules. And it's actually anxiety provoking to be operating within a system that doesn't have rules”

“the courts and society love to hold clinicians accountable OK, even for things that are outside their control. So because of that, my recommendation, my personal recommendation is that you follow some pretty strict rules and boundaries”

“especially when you're starting out and you don't have a ton of experience, it's best to just follow the rules relatively strictly. And I think something like a hug is something that should only be done or violated once you have a lot of experience”

“it matters a little bit less whether or not you correspond to my style. What matters is that your Boundaries and frame match all the patients that you're seeing in that setting. That's way more important”

“you shouldn't violate a principle rule or standard of practice because you think it's for the greater good. You know, read your state board medical boards, disciplinary hearings or outcomes, and you're going to find so many situations where someone lost a license”

“The basic gist is, is this person relatively healthy in their personality functioning or unhealthy in their personality functioning? And with patients who are unhealthy, you really need to tighten and have your boundaries be very, very strict”

“for patients that are really pushing boundaries, the boundaries aren't nuisances that get in the way. They are the treatment. So when I'm too flexible on boundaries, when I'm too forgiving, when I'm too like I don't acknowledge my own boundaries, I don't acknowledge my own resentment towards patients”

“My goal is to balance them feeling warmth towards me, but also understanding that this is a professional relationship”

“My advice to the interns is stick with doctor. It's not about your ego. It's not about anything like that. It's to erect a role where it's that i'm in charge of your treatment and i'm here for your good”

“I do think that escalating or allowing more and more physical contact is just, you know, uh road to hell paved with good intentions in many cases maybe you're fine with it maybe you can get away with it i think it just depends”

“I don't just go like, oh, no worries. You're 10 minutes late. We still have 10 minutes. Let's get this done. We focus on it and we talk about it”

“A clinic is not an emergency room. A clinic is not urgent care. A clinic is a place where you have to and you get to learn to wait and to sit with yourself”

“you gotta get comfortable with being socially unusual as a mental health clinician, the whole, endeavor is socially unusual we have to understand that you know while we try to replicate certain early experiences for treatment purposes or at least echo them”

“just as I have to respect their boundaries, I have to respect mine. And there may be times and maybe this is also like, you know, it's it's it's communion and agency and the therapist has both, too”

“I'll have to insist this is still a medical relationship. The reason why we're meeting is for your good. I'm not just here to be friends. I'm your doctor too”

“I'm not feeling those feelings. And what I feel is care for your well-being as a patient. That's my job here. And that's always going to be my job as long as we're working together”

“it's actually very common to develop feelings that might not make sense about your treatment provider, including myself, doesn't mean that it's real. And certainly it would interfere with your treatment if we take it as anything other than a sign of your underlying thoughts and feelings”

“in any situation like this in the doorknob common you're going to be thrown off kilter as a clinician So you better try your best. You're going to fail sometimes to keep your composure and try to keep it warm, interested, and connected to the next session”

“the temperament of a therapist typically is open, accepting, non-confrontational. And if you don't have this good conceptualization of the importance of setting boundaries, I see early therapists and psychiatrists really struggle with setting boundaries”

“a lot of patients act out their conflicts and truly because they're on. It's weird because they're unable to think about them because it's so overwhelming. They act them out”

“The only thing I can take issue about is maybe discussion of your own professional work and achievements when it's not necessarily pertinent to the treatment process”

“malpractice insurance might specifically exclude coverage for mishandling the transference which actually is a uh disguised way of saying having sex with your patients”