Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And in this episode, we are continuing our discussion of Codependence in Medicine and talking about one of the core healing practices in recovering from codependence, which is boundaries and not just any boundaries.
Boundaries that are clear, kind, and consistent. This is good, I think, for everybody on the planet in general, not just codependent. I think boundaries are the key to a great life. Mm-hmm. If you're a physician who's ever found yourself saying yes, when you really meant to say no, covering a shift when seething inside or feeling responsible for keeping everyone else happy, this episode is for you.
Yeah, this is a great little series that we're doing. I can only speak from a recent experience spending the entire weekend with my whole family, extended family, and I would say 90% of the drama is either lack of effective, clear communication, or lack of boundaries. Mm-hmm. I mean, I just sat and observed my family in a different way this weekend.
I love them all dearly. They all contribute to my life, but I was like, wow, that could have been avoided by just clear communication and oh wow, that person probably wouldn't have been resentful if they just would've set a clear boundary. So this is great for all things, and we talked about this before, but these episodes are based on the work of Pia Melody.
And we give homage to her 'cause she recently passed. But she really is the pioneering expert on codependence. She did a lot on relational trauma and boundaries. And all of these are pretty interconnected. She's a trained nurse and addiction counselor. She developed her foundational theories while working at The Meadows, which is a treatment center in Arizona.
She continues to influence their programs today. She leaves quite the legacy. She's authored several books once called Facing Codependence. Another one's called Facing Love Addiction, and then the Intimacy Factor. That's probably the one I'm most familiar with. Her work focuses on healing five core symptoms of codependence.
Number one is difficulty with self-esteem. Number two, difficulty setting functional boundaries. Number three, difficulty owning one's own reality. Number four, difficulty acknowledging and meeting one's own needs and wants. And number five, difficulty expressing one's reality moderately and staying calm, basically.
Melody's approach blends clear boundaries, trauma informed insight, and inner child healing to help individuals move from reactivity and people pleasing to emotional maturity and healthy self connection. Codependence as defined by Pia Melody is a condition rooted in our childhood relational trauma.
This leads to challenges not only in self-esteem, but boundaries, owning our reality, meeting our needs, and expressing our truth. And one of the most defining traits of a codependent doctor is this. We override our own limits to meet the needs of others, and then we resent them for it. Let me just say that one more time.
We override our own limits to meet the needs of others. And then we turn around and resent them for it. So today we'll explore why boundaries are hard for us, how codependence blurs them and why they're essential for sustainable, connected, and ethical practice. Okay, so let's talk a little bit about what boundaries actually are.
And I feel like we've had several podcasts on this and we reference it all the time. Boundaries are not something that doctors are in general well acquainted with. I referenced my new favorite meme, which was how did you wind up in medicine? Well, I was good at school and bad at boundaries, and that that is true for so many of us.
So boundaries, especially through the lens of codependence and all these codependence episodes are my brainchild because as I've been clear about, I grew up in a home with a significant substance use disorder. And so I have related with the term codependence throughout my life.
What has come to my attention recently is that actually a lot of the behavior that we see in doctors experiencing burnout is codependent in nature, and while there may or may not be substance use involved in the family of origin or family, even generations back, the hospital systems or the healthcare system now oftentimes acts like that substance abuser in the way that it treats its employees.
And it's not true for every hospital system or every healthcare system. It is pretty common and the way it expects us to participate in its ecosystem without having any boundaries ourselves is what I'm talking about here. So a boundary is the line between where I end and you begin. It's how I protect my time, energy, body, thoughts and emotions.
Pia Melody describes three types of boundaries, either physical boundaries, which include personal space, touch, access to your body or your time. Second is emotional boundaries, your feelings, values, or identity. And the third is internal boundaries. The ability to regulate your own behavior and to not take responsibility for what isn't yours.
And I like the idea of three sets of boundaries in additional training that I've done. I've heard it termed external boundaries, internal boundaries, and then intrinsic boundaries. Where we can manage our own behavior those are those intrinsic boundaries. So in a codependent dynamic, these lines get blurred.
We'll often take responsibility for how other people feel. I mean, case in point, we're actually expected to do this via our Press Ganey scores. We are somehow responsible for how other people feel, even though their feelings about their healthcare encounter may have nothing to do with us, may have a small amount to do with us and a large amount to do with the fact that they couldn't find a parking spot or that they got a parking ticket when they went out to their car, or that their bill was higher than they thought.
But yet we are expected to be responsible for that. We might feel guilty for saying no, or we might tolerate treatment that violates our values because we don't wanna upset anyone. Codependent doctors, and again, this doesn't mean that you are in a relationship with someone who is substance abusing at this time.
It means that we have some behaviors that align with codependence, so we often obligate without boundaries because we think our value lies in being endlessly available or that somehow that's expected of us because we quote, signed up for this. How many times have we heard that you signed up for this?
No, actually no. No, no. I didn't. How many of us knew what was going to happen to us in training? I certainly didn't. Yeah, and I often wanna point to the fine print of the disclosure statement that I signed saying that I agree to all the liabilities faced during training. No, I never got that.
Yeah, no. Yeah, so we did not know. We confused being helpful with being self-sacrificing. And sometimes we don't even know what our limits are because we've never been allowed to have any. And this happens a lot of times, especially in doctors experiencing burnout. They don't even realize it for years until they hit a wall and you just can't move anymore.
Literally can't move. So it's important for us to figure out what a reasonable limit might be and enforce that for ourselves. So instead of saying, you know, when we get asked to be on the 10th committee or teach a class for free, or who knows what else we're being asked to do, instead of saying that I'm not available for that, or I just can't, we say yes and then we do instead of holding a limit.
We overexplain, we over function and overextend. We trade self-respect for approval, and often we don't notice it until we're deep in resentment or burnout. And so resentment is a key indicator that we have either not established or not held a boundary that needed to be held. And so that's information for us.
That's just something to look at, to say, okay, well what is that boundary that's not being established or held? So why do doctors have leaky boundaries? Why does this happen? In medicine specifically, it's codependence isn't just an individual issue, it's reinforced by culture. And in medical training we're taught that self-sacrifice is noble.
We're praised for staying late, skipping meals, holding it all together. Our worth gets tangled up and being the one who always comes through, being the one who keeps it all together, shows no signs of weakness. So this is the perfect storm. We feel responsible for everyone, our patients, our colleagues, our partners, and yet deeply, deeply uncomfortable tending to ourselves. And if someone had told me this 10 years ago, I would've said, yeah, well, that's who I am. That's who I want to be. Until you realize how resentful you can become and realize resentfulness is not who I want to be. So yeah, there's part of your brain that can keep doing, keep doing, keep doing, keep doing.
There is another part of our brain that actually is concerned with us staying alive and being happy and thriving. And that part is the part that's generating resentment, saying like, Hey dude, let's pay attention to what's going on here we are on an unsustainable path. So this is how you get doctors who are burned out, bitter and exhausted, but still signing up to chair the next committee is this culture of, you know, suck it up.
I mean, I remember very distinctly coming into residency and being told nobody here cares how smart you are. They care how hard you work and how nice you are to be around. And that's really true. There's something to be said about working hard and being nice to be around and being a good team player, but there is a toxic, dark side to that too.
And that is when you are not having a relationship with yourself, not taking care of yourself at all. That it becomes toxic. It's how you get people who are silently screaming for rest, but say, of course, to picking up extra work for a system that either didn't staff itself appropriately or for other reasons that might or might not be as important as getting a little more rest for ourselves.
Because what we've internalized is if I don't show for everyone, I'm bad. If I protect my time, I'm selfish. If I set a boundary, people will be disappointed and I can't tolerate that. And what I would like to offer is that you can be more kind, more of who you really want to be, the more boundaried you are.
Brene Brown says this over and over again. She did studies on compassion and the people who were the most compassionate were the most boundaried. So holding boundaries doesn't mean that we're dismissing the needs of other people. It is attending to our own needs so that we can then in turn, do whatever it is we wish with our energy, and if we wish to attend to the needs of other people.
So be it, but doing so at the expense of our own selves is just bad for everyone. And classic codependence boundary work isn't just about self-care. We're not talking like you just are blowing all your colleagues off to go get, you know, a mani every day and leaving them with a bunch of extra work.
It's about figuring out what it is that you really need and giving that to yourself and healing.
Love that. This is such a good episode. And I'm introspecting a little bit because I don't consider myself codependent, like I don't have a lot of concern about disappointing other people, and yet I still had a lot of this behavior from an internalized story that I had, like the most toxic story that I had, which sounds like the most lovely thought of all time, but for me was poison was to whom much is given, much is expected.
Well, I could always do more, always. I could always do more. And then if I didn't, was I just asking for bad karma or like maybe it was codependence with the idea of my own integrity or even like a version of God that isn't necessarily what I now understand, but like one that would be exacting if I didn't fulfill my potential, you know?
I don't know. I actually don't know. That's probably something I need to go to therapy over, so anyway, long story short, let's talk about healing. And that is going to require, we've hinted at this earlier, boundaries, so let's talk about what healthy boundary setting looks like, especially for those of us recovering from codependent or codependent like habits.
First of all, and this is so fascinating, it starts with the body. Whenever you feel that tightness, that knot in your shoulder, your stomach turning that dread or irritation, that is your nervous system telling you that a line is being crossed. The discomfort isn't the problem. It's just a signal.
It's just a message from your body. Second remember this truth, that clear is kind. You don't need to justify or overexplain. In fact, that gets you into some trouble. I would suggest, I'm not available for that is enough. So is I need to think about it and get back with you. Or I need to check my bandwidth.
So here's a few scripts. You're gonna need to have practiced some of these things because in the moment, or at least I do, I freeze and then opt for my default, which is not a good strategy if you're trying to change your behavior. A good strategy if you're trying to change your behavior is to intentionally think about it and intentionally predict something that somebody might ask you and have a script ready.
So something like, I'm at capacity and I can't take anything else extra on right now, or, I need to leave this meeting on time to protect the rest of my day. Like, can you imagine like the previous version of me was like, what? Oh my gosh. But that's perfectly reasonable. Another script you might have at the ready would be I need a break before we revisit this conversation, or I need time to think about this before we revisit this conversation.
Something like that. Those are all perfectly reasonable asks as a human being. Also stop needing to fill the silence. Stop being so uncomfortable with it that you just say yes to get it over with. Boundaries are uncomfortable, not because they're wrong, but because a lot of us haven't ever been allowed to have them as kids.
Codependent systems train us to prioritize everyone else's needs and call that love. That is a painful statement, but that is real. I'm gonna read it again. Codependent systems train us to prioritize everyone else's needs and call that love. But love without boundaries is not sustainable. So as Pia Melody says, you are not responsible for others.
You're responsible to them. You're responsible to them with honesty and respect. That's beautiful. So let's talk about boundaries as a form of leadership, because here is the problem with medical culture I think, is that we don't have a lot of good examples for boundaries. It is something that nobody has modeled for us.
So let's get this straight. Boundaries don't damage relationships. They actually protect them. They're how we stay honest, grounded, non-resentful, and present. So when a doctor sets a boundary, it sends a signal that I too am human. I too respect my limits, and I trust that you can handle yours also.
Which is a form of respect for them. Like I trust that you are adult enough and capable enough to handle your own emotions and reactions. Also, that's not abandonment, that is modeling integrity. When you are clear on what you're available for, people will push back. They will push back because they have been benefiting from your lack of boundaries up until now.
And that is okay. We've taught them to do that. We've taught them that we're completely available to have zero boundaries and be available at all times for whatever. That's okay. They're just doing what we've taught them and so now we're gonna teach them something else.
The goal isn't to avoid discomfort. It is to stay truly aligned with yourself, even if it ruffles a few feathers at first. I do think that once you start practicing this, it becomes the expectation, and then there's not a lot of feathers that need to be ruffled anymore. So here's a reframe that helps. My boundary is not a rejection of you.
It's a commitment to me. Here's the problem is that I wish that you could teach your children by what you tell them to do, but my experience at least has been that they are much more aware of what you do than what you say. And so we can't expect our kids, our trainees or our peers to set boundaries if we don't model it for them first.
And when we set them, we are not withdrawing love, we're reinforcing trust. We are becoming our most authentic self. We're saying, I will show up for you with a full tank, or I won't show up at all. And honestly, what would you rather. Truly. Do you want somebody to show up resentful? I don't.
I would much prefer they say no another time and show up with a full tank. That would be so much more efficient and useful in my opinion. You're not responsible for others. You are responsible to them with respect and honesty. I would like to add to that when we take on things that we don't have the bandwidth for or we take on other people's emotions and try to become responsible for them, that's actually not being honest.
It helps us get out of discomfort for the moment because it feels uncomfortable sometimes to say, I'm sorry, I can't do that because we're afraid of the reaction of whoever's asking us for something, but it's not being honest when we know, especially if you know immediately when you say yes to that fifth PTA committee, or that fourth hospital committee you've just agreed to that we're gonna immediately resent it.
It's not being honest. It's not being kind to say that we'll do it. If we're saying we're gonna do something, it's saying that we'll do it and we'll be glad to do it. Like really glad to do it. Not just, oh, yes, I'm happy to do that, but I'll hate you behind your back. That's not healthy for us or for them.
I think this makes a lot of sense when we're talking about time and having the bandwidth and the energy, but I also think it makes sense because we constantly are talking about living in alignment with our values and our why, and what really happens behind the scenes or maybe subconsciously, is that we say yes to all these things that are not in alignment with why we show up to work every day and inadvertently we start resenting the thing that we actually love to do. And I really had to make that connection because as you guys know Laura and I took some time completely away from medicine, but I struggled with it because one of the things in my mind I couldn't be clear about was, I love medicine.
Like, I love this. Like, I did put all this time and effort and energy into this because I do love this. What exactly am I walking away from? Like, I could not put those two together. And it was the same way in my relationships with some of my family members. I love them. They are beautiful people. What is happening that I want distance between us? Why am I pulling back?
And it was, I was unboundaried with them or in that relationship and I love the person, but my resentment and my discomfort with how this was going was the thing that I was left with. And I also think the third aspect is this performance based worth.
I think that's another hurdle that we have to get over with setting boundaries is if I'm not performing, if I'm not doing everything that I can, just like you alluded to I've been given much, I'm smart, I have talents, I'm a good doctor. I think if I'm not doing much, then what happens with that?
Right. Well, yes and no. I think we do already know, we gotta trust that we are being good stewards with the talents and the treasures and the time that we're given in as much as one of the ways that you continue to pour out and serve and everything is if you are being that good steward of the amount of energy, time, talent and resources.
And I think we gotta trust that. I think we gotta know that we were made to do this and we've gotta trust that we know best of how to manage the assignment we were given. You know, like I see those memes all the time, like they understood the assignment, right? I think we gotta trust more that we understand the assignment.
So if this resonates with you, here's what I want you to know. You are allowed to have needs. We're human. Everyone is allowed, you are allowed to have limits. Once again, it's the end of your humanity that helps dictate where your limits are, and you don't have to prove your worth by disappearing into other people's expectations.
So recovering from codependence means learning how to stay connected without abandoning yourself, and that starts with boundaries. So your homework this week, try something new. How about saying no kindly? And if no doesn't resonate as a full sentence, then I love you and no. Or thank you for thinking of me, but no.
Right. And then pause. How about try pausing before you commit? If something comes across your plate that doesn't feel like you have the bandwidth for or doesn't align with your values, how about you pause and really listen to that and take heed to that and really listen to what that's saying before you commit.
And then let discomfort be your guide, not your enemy. Don't shy away from that nervous system going, mayday, mayday. So let that be your guide, not your enemy. And as Pia Melody once said, you are not responsible for others. You are responsible to them with respect and honesty. So in our next episode, we'll continue this talk about codependence.
We'll explore how to reclaim your identity beyond your role as the fixer. We'll talk about what it means to move from martyr to healer and how to rebuild your sense of self as something more than a constantly available helper. So as always, leave us a review. We'd love to get that five stars
and if you've had any experience with this or if you're struggling with anything and wanna bounce a few questions off of us, email [email protected]. We're always posting amazing stuff. So follow us on the socials and until next time, you are whole. You are a gift to medicine and the work you do matters.
