Crazy Susie, boundaries, respect, and love
Last Spring, I met a woman at a social function whose personal presentation and style struck me as quite off-kilter. My friend and I started to refer to her as “Crazy Susie.” I know, I know, I’m a jerk, so feel free to make a point of that in the comments. Shortly afterward, Susie showed up in my clinic, and I dropped the nickname. Of course, that was a pretty basic, minimally respectful thing to do. That was the first – but not the last – thing Susie had to teach me about respect.
Susie visited the clinic every so often for help with a number of acute and chronic health issues. Then, several months ago, Susie came in and settled into a chair during a busy shift. When I arrived chair-side with my standard “What can I do for you today?” she looked around at the other patients, all sleeping, and said “My voice is kind of loud…” and indicated that she wanted to talk in the intake room, which is a separate space. I said “Sure,” and followed her in. As soon as the door closed behind us, she began to cry and express her distress in a number of disjointed sentences, mentioning a few psychological diagnoses, indicating a few family members she was having trouble with, and expressing deep frustration with what she saw as her own inability to be a better person. I listened, I held eye contact when she offered it, and then after 4, maybe 5 minutes, I patted her on the knee and said, “Let’s get some needles in; let’s trust the medicine to do its job.” She readily agreed, and we returned to the treatment room.
Subjective: Patient feels “psych term #1” and “psych term #2”. Reports difficulty with family. Feels “out of control of her emotions” and “frustrated”
Objective: Patient was sweating and crying. Red face. Smelled hot.
Assessment/Plan: Disordered qi/shen; heat. Descend qi, calm shen, clear heat. Kid-1, PC-8, yintang
I noticed her breathing become more regular and her shoulders drop as I placed the needles. After her treatment, her color was closer to normal, her eye contact was sustained, and her skin was dry. She smiled at me as she left.
That interaction seems important to me. For me, it forms a little tableau of the relationship between boundaries and respect. Most simply, I’m seeing that honoring boundaries is an act of respect, and respect in turn is an expression of a kind of love. I have a short story to tell that I think will be helpful:
Most of my friends are do-gooders of some sort. One evening I was talking to a social-worker friend of mine, and asking her what, really, the job is about. I was so impressed with her succinct response: “My job is to connect people with resources.” Nice. But, then I wasn’t really sure what resources she meant, so she gave a few examples – places where people who are having various difficulties can get services they need – government programs, non-profits, support groups, etc. I thought I got it. But then, I really got it the next day when she sent me a link to a local government program that helps new businesses think through questions like when to hire the first employee, a question of mine which we had also discussed at dinner. She clearly couldn’t help herself. She connected me to a helpful resource she knew about. It’s what she does.
So, social workers connect people with resources. Psychotherapists help people develop insights or skills or tools for evolving their thoughts, feelings, or behaviors. Psychologists can prescribe drugs to help balance brain chemistry so people can deal with their lives more easily. Friends listen and provide empathy, or distraction, or perspective.
There were times in school when it sure sounded like we, as acupuncturists, were going to be doing some or all of those things with our patients. We took a class called “Clinical Counseling” that particularly blurred the line about what we might be trained or qualified to do.
One of the best things about the CA ethic is the clarity that we are not here to offer any of those things to our patients. I call it the CA ethic– not the CA business model – in this context quite deliberately. It is not that the short intake aspect of the business model does not allow us to provide counseling to our patients, it is that the CA ethic of respect does not allow it.
What did our clinic have to offer Susie? A few thoughtfully-placed needles, a nice soft chair, a blanket, quiet music, a room full of sleeping people who also decided to take care of themselves that day, and time. All the time she cared to sit in that environment. That’s all we had. And in 4 or 5 minutes, I had all the information I needed to help arrange those elements in the most helpful way possible.
To listen any longer, to encourage more disclosure by asking questions, to offer advice or counsel or resources I didn’t have, would have been disrespectful. Stopping her story and disclosures as soon as I was sure how I could help was respecting a boundary that exists. Sometimes in these forums we talk as though boundaries are there to protect us from patients who “want or need too much”. We talk as though boundaries are there to help us, the practitioners. I have come to believe that honoring boundaries is an expression of deep respect for our patients.
When a patient decides to access one of our clinics as a resource, the CA ethic takes into account what is appropriate. The word appropriate has the root “prop”, which is also in “property.” It’s about who owns what. And when we respect a boundary, we acknowledge the fact that the patient owns their pain and owns their healing process. In fact, the only resources any of us will be able to use effectively and sustainably are the ones we can “make our own”/“appropriate”. Susie cannot sustainably appropriate my empathy, my open ear, or any of the perspective or support I would give a friend. As far as the things Social Workers, Psychotherapists, and Psychologists can offer, I just don’t have them, and neither does the clinic. What Susie does have at her full disposal, though, are the chairs, the blankets, the music, the community, the time, and the absolute best of my needling skills. And the most deeply respectful and loving thing I can do is to behave in a way that makes that really, really clear.
Ooh, ooh, got it, printing it, hanging it up in my staff-only area for general perusal! Thanks, Michelle!
At some point, if I’ve crossed the boundary and gotten into what is essentially advice-giving, many patients drift away. There’s just all these issues with advice-giving and advice-receiving that get in the way of our relationship, just as they do with any relationship. I had to be aggressively retrained by Andy at MAS from the typical “you pay me for my opinion” punk to “okay…got it…ready for needles?” punk.
I think I am going to start calling what I do the CA ethic instead of the CA business model. In fact, given the constant bickering around here about whether we are a business model or not, I’m going to start that transition right away. Because yes, I structure my business differently from a BA practice. But that is only the tip of the iceberg.
An entire ethics course
in a few paragraphs. This is one for the best of…book. Thanks Michelle.
Beautiful Michelle. And so
Beautiful Michelle. And so right. We provide SPACE. And respect.
Thank you for sharing the lesson! I had not quite realized that I held that belief about boundaries being for my benefit, but it is TRUE (and yet obviously false :)). Thanks for that shift.
Dana @ SCA
Susie and Sally
It may be useful to contrast this blog with this (terrible, horrible, no good, very bad) AT article and consider the differences in regards to ethics, respect, power, boundaries and our approach to people that seek help.
“I listened, I held eye
“I listened, I held eye contact when she offered it, and then after 4, maybe 5 minutes, I patted her on the knee and said, “Let’s get some needles in; let’s trust the medicine to do its job.”
This is the best part. This is one of the biggest lessons that I have struggled with in CA. I thought my patients were coming to me for answers and all I had were needles. Just being present, letting someone be heard. I can’t read accounts like this one often enough. Good work!
Eliz @ MAS
“honoring boundaries is an
“honoring boundaries is an expression of deep respect for our patients”…yes! You have said it how I’ve been trying to define it for years. Thank you 😉 what a wonderful story and great example of modeling boundaries and using an economy of words for compassion.
very, very well said and done. thanks for posting this, Michelle!
Good health is not a measure of adapting to a sick society.
When the power of love outshines the love of power, the world will know peace.
A great reminder
that there is a time a place for everything, especially humour. I love having a laugh and I tend to only be with people who have that in them as well.
But there comes a time when we come face to face with our liberties and ultimate responsibility for our words & deeds. Everyone loves the punchline, but we never see what happens when things hurt, until they do.
So no, I don’t think that you’re a jerk at all Michelle, you made a mistake and even one that didn’t hurt as much as some. You, the person, saw something odd & had a chuckle, then you, the acupuncturist, had to take on a different role for you patient. There was a bit of a conflict in how they dealt with the same person, but I hope you feel little regret or shame. Like you put it, our job isn’t to be so sensitive to everything for everyone, but rather to be safe for them to be with us.
Very, very nicely put,
Very, very nicely put, Michelle. Thank you!