I’ve been asked this question multiple times now. How do I handle working with people in hospice? How do I not get sad when they die? How do I not get emotionally drained from this work? The answer is simply boundaries. When I was training under Dr Phuntsog Wangmo at the Shang Shung Institute of Tibetan Medicine she taught me that one of the most important qualities of a sMenpa (Tibetan doctor) is detached compassion. What is that? Simply put the state of detached compassion allows for one to show up with compassion for another while not getting attached to what they are experiencing. Can I explain this in terms of technique? I’ll try, but really it’s more of a state of being than anything else. Before I work with a hospice client I go over their briefing. I read my notes so that I know what I’m walking into when I start working with them. I use something called “choosing.”
Choosing is when you get 100% real with yourself about something instead of denying it. It is radical acceptance of something that you can not change. When I start a new journey with a hospice client I know what I can do for that client and what I can not do for that client. Nothing that I do for them will change their diagnosis. Nothing that I do for them will extend their life. Nothing. I am completely clear about what my role is in their life in that present moment. In that present moment I am a massage therapist who shows up with love, therapeutic touch, and a compassionate presence. That’s it.
This clarity is what creates my boundaries. This knowing of my role is what supports me in this work. Knowing my place and my purpose, and never deviating from that path.
What is a boundary? Defined by Merriam-Webster a boundary is, “something that indicates or fixes a limit or extent.” What stands out to me most here is limit. A boundary line on the edge of a property or a line on a map identifying a country. A protective circle of salt. The words “no” and “stop.” These are what come to my mind when I think of different types of boundaries.
Brene Brown talks about boundaries a couple of different ways. Simply put she says it’s defining for yourself what’s ok and what’s not ok. In an article for Oprah she says, “daring to set boundaries is about having the courage to love ourselves, even when we risk disappointing others.” In an interview she gives on boundaries she explains that compassion is not genuine without boundaries. That empathy without boundaries isn’t possible. This all makes so much sense to me. If I’m going to work with someone who experienced trauma in their life at some point I have to be able to sit with them while they tell me what happened and (this part is essential) not take their stuff home with me at the end of the day. In this way I have to be boundaried around how I offer myself to that person. Otherwise I will carry their pain. Something that I can not allow.
An observation I’ve made about us as a society is that we are crap about setting boundaries. When in reality a boundary often isn’t about anyone else but ourselves. We’ve become so paranoid about upsetting other people that we are willing to suffer resentment instead of discomfort in communicating those boundaries. If you think about it, what does a boundary do? It defines. As Brene says “what’s ok and what’s not ok.”
I recently came face to face with this in communicating a boundary to someone who was not hearing me. In retrospect I let the conversation continue for too long. What I gained from this exchange is that in connection with boundaries offering support to someone isn’t about what you want for them. I’m going to repeat this. Support is NOT about what YOU want for THEM. Support is about really listening to what that person is sharing in regard to what they truly need. In some cases that is also about what they don’t need or don’t want. The exception of course is if they are a threat to themselves or others. In essence in our support of others requires boundaries if it strives to be genuine.
We’re on the verge of buying a house so you can imagine the sea of boxes my life has become in the past few weeks. My sister offered to come down for the day to help me pack. OMG yes was my response. Ok great, she replied, I can be there from about 11 to 2 and then I’ll need to head home so I can finish my homework. What did she do in that scenario? She explained to me the extent to which she can offer support while communicating her limits around that support. I guarantee you she didn’t think twice if I’d be disappointed by the fact that that she could only stay for 3 hours. Cool, any amount of time you have would be great, was my response. In that short amount of time we got a lot done and we were able to spend some time together. Was I upset that she only had a limited amount of time to help me? Nope.
Like most people my relationship with boundaries has been wishy washy most of my life. That changed once I became a mother. About six or seven weeks after I had my daughter I was talking to my dad about coming down for a visit with my new baby so that he could meet her. My sister would come too so that we could share the driving and to be an overall support person. I had mixed feelings about the trip. Mostly I felt a sense of obligation around going. Since I was a child my narcissistic bi-polar father had parentified me. I had always been the adult in that dynamic. The child from whom he had always sought external validation. His favorite. The one who spoke up the least and would let him ramble on and on about subjects that I had zero interest in and quite frankly felt uneasy in listening to. When he would visit or if I would visit him I would emotionally shut down in order to survive his narcissistic behaviors. He’s also delusional. Has zero sense of culpability. My whole life he has prioritized his own needs above his children’s. He really is a textbook narcissist. So when he suggested that on my visit we get a babysitter to watch my newborn daughter so that he could take my sister and I out to a show I decided that I had had enough. He believed wholeheartedly that he could impose his own agenda onto me and my child. No. We are done here. I have not spoken to him since.
What most people perceive when someone communicates a boundary is that the boundary setter is being mean, or uncaring, or unkind. Generally people are so confronted by clear and direct communication that they perceive it as aggressive. When confronted by someone’s boundaries they think it is a reflection on them. It is in fact the opposite. A boundary is self care. A boundary is self love. A boundary is self validation. Self validation is the single most important skill in emotional resilience. For healing practitioners this is essential.