Session Summary
Session Host: Michele Hannay
Session Objectives:
At the end of this webinar, you will be able to:
- Explain the neurobiological responses that make setting boundaries and saying no difficult.
- Describe practical strategies for successfully setting and maintaining boundaries in a busy clinical practice – and beyond.
Recommended Resources:
- Session Recording
- Brene Brown, Braving the Wildness: The Quest for True Belonging and the Courage to Stand Alone
- Jillian Horton, M.D., We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing
Session Highlights & Themes:
- When we feel threatened, our bodies respond just like they did when we frequently encountered wild animals as primitive humans - we go into survival mode.
- This can be fight, flight, freeze - or fawn (do and say anything to de-escalate the threat)
- Saying no and setting boundaries creates the risk that we will be unliked or shunned.
- This triggers 2 of the 5 primordial fears – fear of separation and fear of ego death
Tips to manage people pleasing:
- It’s an automatic response, but when you’re aware of it, you have a choice!
- Sometimes ‘no’ is a full sentence - avoid a list of excuses and keep it brief.
- Start small with someone ‘safe’.
Tips for managing shame:
- Shame cannot exist in the light – talk about it.
- Consider using a mantra that you can say to yourself if saying no is hard for you.
- Examples:
- I’m the guardian of my time and energy
- I’m allowed to say no
- I’m enough just as I am
Tips for setting boundaries:
- Think about what really matters to you – what are your priorities?
- What specific boundaries would help you achieve those priorities?
- Work on one at a time.
- Remember that you can only control your own actions and responses.
- You can’t control how another person responds.
- Beware of leaky boundaries – some people will push to see if you will give in.
- Manage expectations – for example, patient often don’t realize that a standard appointment is 10-15 minutes.
- Give cues like, “In our 10 minutes today, what’s most important for you?”
Tips for saying no to patients:
- Get to the underlying issue – the patient may be asking for antibiotics, but what they really want is relief from symptoms.
- Mirror to develop understanding – connect with the patient by mirroring their language.
- Reframe the solution – instead of saying no to their ask, you’re saying yes to their underlying issue (e.g., Rx for anti-inflammatory, not antibiotics).