Learning to set and maintain healthy boundaries is a beautiful practice that allows me to offer the most love and care outwards possible. In both personal and professional spheres, we can find ways to continue onwards without feeling overwhelmed by what’s needed. I aspire to love and to allow myself to be loved. By setting these boundaries, I allow space for myself to just be. This in turn supports me, as much as possible, to live and act in accordance with my deepest values. I don’t think I had labelled this effort with the word “boundary” until I heard a recent talk from Anh (a.k.a. Nho) Tran, who has a beautiful way of describing mindful boundaries in the context of deep listening and loving speech.
Nho’s legal name is Anh Tran, but she goes by Nho, which is a name given to her by her teacher, Thich Nhat Hanh. She is currently a Ph.D. candidate at Harvard University’s Graduate School of Arts and Sciences, and was previously a Plum Village nun for 15 years. When she was 13 years old, she left Southern California to travel to Plum Village where she eventually ordained as a monastic, along with a few other teens near her age. One of those teens was Brother Phap Huu, who I’ve referenced quite a bit via his podcast. She lived as a nun for 15 years, and is now living as a lay person – as she puts it:“I am fully outside, living in the world, seeing what I can see, but with my nun heart.”
Nho’s Ph.D. research is focused on power, ethics, and statecraft with a focus on Buddhist communities in French-colonial Southeast Asia. In addition to this area of research, she is deeply committed to her mindfulness practice as it intersects with practices in communication, negotiation, and conflict resolution. She teaches negotiation and conflict resolution at Harvard Law School, Harvard Graduate School of Education, Harvard Divinity School, and Harvard College. Nho has a joint degree in Cognitive Neuroscience and Religion from the University of Southern California, and an M.Div. from Harvard Divinity School. Outside of research and work, she is a martial arts enthusiast, snack connoisseur, and all around wonderful person to spend time with.
The talk that I reference below is a guest lecture that Nho delivered on Feb 1, 2023 to Elli Weisbaum’s class at the University of Toronto in the Buddhism, Psychology and Mental Health program, BPM381 – Buddhist Perspectives on Current Social Issues (2023 Winter). The talk is titled by Nho, “Loving Speech and Deep Listening When All You Want To Do is Rage.” Unfortunately, the talk in full is not available publicly. Keep an eye on the BPM YouTube Channel, in case any clips get posted.
Coincidentally, the most recent episode of the podcast The Way Out Is In, just released two days ago, is on Healthy Boundaries. As I was in the midst of drafting this post, my friend Thien Kim told me about it. I’ve listened to the first bit of it (it’s brilliant) and so I’ve incorporated some ideas from that episode at the end of this post.
This post is split into two major sections. In the first, I share a story from Nho and use it as a jumping off point to discuss several concepts that are useful to keep in mind for setting mindful boundaries. In the second, I share a few stories from healthcare and then transition to some concrete practices we can start using right away. Sprinkled throughout is wisdom from Nho, Br. Phap Huu, and a few other teachers that crept their way into my consciousness as I wrote this.
I’m excited to dig into this one – please come along with me, dear reader, on this journey of exploring communication with ourselves and others.
Discovering boundaries: Nho
Early on in Nho’s talk, she told a story of an interaction she had when she was a Buddhist Chaplain in a hospital in Boston, Massachusetts.
One of Nho’s responsibilities as a Buddhist Chaplain was to be present for those that don’t have loved ones there. She often offered herself as a source of comfort, communication, friendship, and companionship. She offered deep listening.
Nho told the story of encountered a young woman (28 years old, who I’ll call “Rachel”) in the hospital awaiting heart surgery. The doctors and nurses had communicated to Nho that Rachel was an “unruly, non-cooperative patient with lots of anger.” The healthcare team asked for Nho’s support in calming the situation down. When Nho first entered Rachel’s room, Rachel “went off on her.” Rachel attacked Nho’s race, she was angry with the hospital institution, she was yelling at Nho, “go to hell, get out of my room.” Nho responded, with as much grace as she could, “It sounds like this is not a good time, I’ll come back.”
Over the course of 6 or 7 interactions, much of this dynamic repeated itself. Nho had to really check in with herself. What first came up for her was an instinct to respond to Rachel with equal and opposite “rage” (to use Nho’s language). Instead, Nho paused each time, took some space, and then came back to Rachel’s room later. Over and over, Nho tried to offer space for listening, until finally something clicked, and Rachel started to open up and share about her experiences.
Nho describes boundaries as,
”The space that allows you to love yourself and the other person.”
I can only imagine how difficult it would be to set the intention of love with someone that is attacking my identity in the way that Rachel did with Nho.
Nho stuck to her guns and trusted that the practice of deep listening and allowing space for Rachel to speak would open something up. Nho also took the space that she needed to be able to offer this – she skillfully walked away from the conversation numerous times, recognizing that it wasn’t a good time (for either of them).
Eventually, as Rachel began to share and open up, Nho realized how much her assumptions, of who Rachel was, had impeded some of their early interactions.
I think there are countless lessons here.
I think that there are all kinds of situations where we, as healthcare providers, as friends, as partners, or as colleagues, need to consider what boundaries we are setting. Sometimes these boundaries are between me and another person or situation. Sometimes I need to recognize a healthy boundary to set within myself.
Nho was able to bring mindfulness awareness to what was happening inside of and around her so that she could respond skillfully to the person in front of her, while at the same time caring for herself as much as possible.
She worked to make space that allowed here to care for herself and the other person.
Rachel’s anger is a manifestation of conditions
One of the things that Nho discusses in the talk is how many conditions had come together to manifest the Rachel that she met on that day.
“Conditions” and “manifest” are two specific words that Nho uses. My understanding of them is from Thich Nhat Hanh. Basically, things manifest due to conditions that come together to make that thing possible. Take, for example, the sound of a symphony, all the sounds of different instruments come together to make one rich and complex sound. The sound would be different without any one of the conditions (e.g. Instruments).
The example Thich Nhat Hanh often uses is that of a flame. If we have a match and a match box sitting next to each other, we can recognize these two things as “conditions” that make fire possible. However, we do not yet have enough conditions for fire to “manifest.” We have to strike the match on the box, providing the final necessary condition, and only then the flame will manifest. When there is no longer enough match stick left, the flame no longer has sufficient conditions to manifest.
Thay frequently uses this analogy when discussing birth and death, but that’s a conversation for another time. Let’s get back to Rachel.
Responding with curiosity to see the conditions
In speaking to Rachel, and taking the time to listen to her, Nho was able to learn about her life. Nho responded to Rachel’s anger with curiosity, and that curiosity opened up new possibilities for understanding.
Nho could see that Rachel’s anger was like the flame. There were many conditions that allowed it to manifest in that way at that time. The same could be said for Nho’s initial instinct for raging in response to Rachel’s attacks – Nho explains that this was in part conditioned in her by her upbringing in Los Angeles. It is also true that many conditions in Nho’s life came together to allow her to listen deeply with patience and curiosity, including her deep training as a Plum Village nun.
Both anger and patience are like a flame, many conditions come together to allow them to manifest.
Some conditions around Rachel had produced some really difficult circumstances. Rachel had gone through a difficult postpartum depression and was unable to find help in the American healthcare system. She turned to drugs at that time, and was now in need of heart surgery. Nho saw that Rachel had felt less than human in the way she had been treated after giving birth, and in the way she was being treated now by others in the hospital. Rachel was treated and labelled as an “unruly addict.”
Consuming our assumptions
Nho shared skillfully, during her lecture, that in their early interactions, she was
“consuming my own assumptions about who ‘Rachel’ was as a person”
Nho had walked into the room with assumptions, and those assumptions had changed her way of being with Rachel. She didn’t go into too much detail in the lecture, but I’m guessing that slowly some of those softened by the 6th or 7th interaction when Rachel finally started to open up.
Rachel had likely also made many assumptions about Nho, she was after all another person who was part of the healthcare system that she felt so wronged by. Rachel had gone into fight and defend mode. Nho reflects,
“There was not space for her to just be.”
Pausing in a moment of rage
The pauses that Nho took in between encounters with Rachel are a direct expression of Applied Mindfulness. Nho says that this pause creates possibility, and it allows for space. With that space,
”We are no longer victims of reactions, we are agents of response.”
Nho was attacked, in every possible way, in those first few encounters. Nho’s initial, and very human, response was to fight back, to “rage.” By pausing, she was able to (re)set the intention of seeing the human in front of her. Nho knew that with the practice of developing understanding, of this human, that compassion would arise.
Hearing about Nho’s story of setting boundaries, I am inspired to share two more stories about boundaries that feel relevant to me as a healthcare worker.
Discovering boundaries: part two
The first story I want to share is one that was told to me by a physiotherapist while I was an intern at a Toronto rehab hospital.
When I was a student, we were often encouraged to give some kind of presentation while on student placements (internships where we learned in the clinical setting to be a physiotherapist under the supervision of other physiotherapists). Other students in my class mostly did research on a condition and presented that. At the rehab hospital I was at, I chose instead to offer an introduction to mindfulness within the context of healthcare worker burnout.
I shared the statistics of burnout and recognized that, simply based on the numbers, it was possible some of our colleagues sitting in the room could be experiencing burn-out, and we might not know it. I relayed how mindfulness can help us to be aware of how we are feeling, and with that, we can then decide to care for ourselves as needed. Mindful awareness opens up the possibility for a response to ourselves so that we can continue to offer care within the system.
René’s experience with stroke patients
After the presentation, I was approached by a physiotherapist, let’s call her René, in the hallway afterwards. René said to me that she wished she had “some of this” earlier in her career.
She specializes in rehab for folks after they’ve had a stroke, and when she was earlier in her career, she had taken a pause to care for her mother post-stroke. After René’s mother passed away, she came back to the hospital and continued her work. In those early months after coming back to work, René’s patients consistently reminded her of her mother, but she didn’t realize it. It was subconscious and it was really painful. It took her a long time to recognize how affected she was, and therefore it took her a long time to see that she needed to care for herself. She was delighted that this conversation, about self-care and the emotional impacts of working as a clinician, was happening.
This short conversation, about 5 years ago now, with René has stuck with me. By not being able to see how much her patients were triggering some of her grief about her mother, she was unable to set the boundaries that she needed. I wonder what taking a little more time away from work might have offered her. I also wonder if it would have been possible to ask for a reduced case-load to allow for more space between patients. Instead, she continued to offer so much outwards in caring for her patients. I got the feeling from her that that had a significant impact on her.
She taught me an important lesson at that moment that is resurfacing for me now. It was healing for René to be able to have that conversation with me, and in this present moment, I see that her sharing has helped me to illuminate some of my own challenges as a healthcare provider.
This is the beauty of having a really honest conversation with our colleagues. You never know what impacts it will have now or in the future. It’s remarkable how a moment of that physiotherapist feeling seen and validated has now reverberated in my own life.
My work as a physiotherapist with chronic pain patients
My first job after graduating was working in a publicly funded chronic pain clinic in downtown Toronto. All in all, I trained and worked there for roughly two years – part of that as a student in my final internship, and then afterwards with a few short-term temporary contracts (primarily related to helping with covid-related redeployments). My last contract ended in Fall of 2022.
In looking back on this time, I recognize that I hadn’t set the boundaries that I needed to care for myself, and I’m feeling the impacts of that now. I had some beautiful colleagues at the hospital that helped me start to see this, but it really was hard for me to see what boundaries were needed at the moment.
Folks that experience chronic pain often have some strong emotional and/or traumatic experiences in their history. As a physiotherapist, I regularly ask the person about how and when their pain started. In acute pain, the answer can be quite simple - maybe someone sprains their ankle or breaks a bone. In the case of chronic pain, the answer is usually more complex – perhaps the person has sprained their ankle, and they’ve often also gone through something like cancer, surgery, a motor vehicle accident, or some kind of trauma (with a big T).
I feel that if I can understand how a person relates to their body, it changes the way that I instruct them in physical movement. Understanding a bit of their history changes how we, as a team (the client and physiotherapist), relate to their physical body in physical therapy, and this sometimes can help someone shift their relationship with their body. If I only see that person as a physical body, I miss so much of the picture.
However, in my endeavour to understand my patients, I got myself into hot water frequently. I heard many stories in more detail than was necessary as a physiotherapist. Maybe I was the first healthcare provider really listening to the patient in a long time. I heard this feedback more than once. Patients told me personal stories about chronic illness, mental health challenges, trauma, self-harm, and of instincts to harm others. It was a lot.
In the moment of hearing someone’s story, the healthy boundary is really hard to see, especially when the healthy boundary might be pausing a person who is vulnerably sharing.
I felt a deep desire to recognize patients as human, and at the same time, I didn’t have the capacity to manage my own relationship with the stories in my head afterwards. The stories built up in me over time. Impacts of this seeped into my life outside the hospital.
I didn’t make the space to offer love to myself, and yet, I continued to offer so much space for my patients. Sometimes I wonder how effective I was as a clinician as I became more and more emotionally exhausted.
I’m currently taking a bit of a break from clinical work, and this is helping me to see more clearly how impacted I was. I didn’t understand it at the time.
I think there were many conditions that came together for my emotional exhaustion to manifest. Conditions both outside of myself and within. Our health care system has its challenges – for me, a major one was the quantity of patients, combined with the intensity of their problems, that I saw during that time.
Care is easier to offer when there is space around it.
There are also many conditions within me that led to me to offer more than I was capable of. I can look to my upbringing, my social/cultural context, and my own history of chronic pain. There is too much to unpack here for this post, but I imagine that more will come out as I continue to write going forwards.
Concrete practices for setting boundaries
Below are some concrete practices that are an amalgamation of some of what Nho said in her lecture and a number of other mindfulness teachers I have come into contact with recently.
(re)Defining your purpose
Nho says that often when entering a conversation, we might not have a purpose. We can get pulled away by our emotions if we do not have a purpose. She encourages us to define our purpose, which will give us autonomy. It helps us guide our responses to a situation.
You will see if your original purpose continues to be helpful during a conversation.
We need to keep our purpose in conversations flexible.
The way to do this is through mindfulness. We maintain our awareness and understanding of ourselves and the other person, and adjust accordingly.
Aware of what I “consume”
When I think about what boundaries I need to set, I think about the Buddhist concept of The 4 Nutriments. Basically, the teaching says that we “consume” more than just edible food, and what we consume can be healthy or unhealthy.
We also consume our senses, our volition, and consciousness (both ours and the collective).
An example of consumption that can be healthy or unhealthy is reading the news or taking in social media. These are things we consume through our eyes and consciousness.
Our volition, which is what we care about, can also be healthy or unhealthy to consume within ourselves. For example, I might look at how I consume my intention to care for others as a healthcare provider. My intention to care for others can provide great purpose in my life and the fuel to continue. If, however, I grasp on to that too tightly, it can become unhealthy to “consume” that within my own mind. If I hold on too tight to the need to fix / cure / heal, I can slip into a reality where my happiness is dependent on someone else’s healing journey. What if there are conditions that prevent healing in them that are beyond my control?
If you want to read more about The 4 Nutriments, see pages 25-27 in Silence: The power of quiet in a world full of noise by Thich Nhat Hanh (2015).
Sometimes I need to protect myself
Sometimes, as we become aware of what we are consuming in a conversation and how it is impacting us, we may see that we need to stop a conversation or step away from a situation. We may not have the capacity to continue and have to protect ourselves.
Brother Phap Huu, in his most recent episode of The Way Out Is In, talks beautifully about capacity. He says that,
I practice to recognize what capacity I have right now and “what capacity do I not have yet?”
“Yet” is the keyword here. We recognize what we can and cannot do in this present moment. We may need to draw a line and protect ourselves in a certain way. Maybe this means stopping mid-conversation.
When we recognize our limited capacity, this is not to fall into despair. This recognition becomes the fuel for our practice.
Our limited capacity becomes our motivation to build capacity for the future.
Is self-care selfish? —> Broadening the scope of my love
One might ask, is caring for my self selfish? If I need to step away from a conversation or even from a person or situation, am I doing harm? In my mindfulness practice, I often feel conflict between offering kindness and compassion to others and the need to care for myself. I can be quite hard on my own limited capacity, and this can lead to self-sacrifice. I offer more than I actually have capacity for.
What if, instead of focusing on the question of selfishness, I consider the scope of what I include in my love and care?
What if I broaden my scope of who and what I intend to be kind, compassionate, and loving towards?
How does including myself, my friends, my family, my colleagues, and all the relationships I have in my community change what I offer to one individual? Can I include all the other patients that I might interact with on a weekly, monthly, or even a yearly basis in my awareness as I set a boundary with one specific patient?
If I stop a conversation with one person to protect myself, that also protects my relationships with all of these other people. It protects my ability to continue to offer care with everyone else in both my personal and professional spheres.
Maintaining boundaries is about loving everyone as much as possible, including myself.
Aligning intention with impact
In defining our purpose in conversation and considering how we can protect ourselves, I also need to be aware of the impact I am having on the other person. Nho quotes the following statement from one of her supervisors at Harvard,
“Good intentions pave the way to hell.”
Intentions are not enough. Commit to learning more.
We need to have understanding of the other person as well as ourselves. Invite in some curiosity. Nho encourages us to ask the person what impact our communication is having during the conversation.
This is mindfulness practice. I practice becoming aware of what is happening inside and around me in the present moment. Put that awareness into action. Communicate with yourself and the other person/situation from this place of understanding and love.
Love is badass
I love this quote from Nho:
Love “sounds soft, and it is soft, but it’s also hard”
I think she uses the word “hard” to communicate both that it can be difficult to express love and that it’s a bit badass.
When she was as a chaplain, she often sat with people during their last days alive. She would ask them what they wanted her to carry forwards on their behalf. She asked, “What is your legacy?”
99% of the time, the answer was, “I wish I had loved more and that I had allowed myself to be loved more.”
Returning to Nho’s definition of boundaries, ”The space that allows you to love yourself and the other person,” I think she uses the word love very specifically. In response to one of the students questions about self-love during her lecture, she says that,
We can “be the source of” our own love.
It might be easier sometimes to offer love and care outwards, but by coming home to ourselves, we make even more space to offer care outwards.
Loving ourselves, as Nho says, is “a practice of honesty, truth, grace, forgiveness, kindness, and gentleness.”
If we can take moments of pause in our life, maybe we can see what is needed more clearly. This isn't to imply that we solely focus inwards. There is a balance and a middle way to be found. Sometimes offering outwards helps us to see what is needed inwards. Nho also encourages us to not get caught in feeling that we need to completely love all parts of ourselves before being able to offer love outwards. She says,
Do not “demand perfection before exercising love in the world.”
It’s not about being perfect
In the stories I told above, Nho began to recognize what was needed on the same day of her challenging conversation, whereas it has taken me quite some time to recognize what I consumed and how that impacted me. I think it’s important that, at whatever time-point in the process we have a lightbulb go off and our awareness of ourselves increases, we try not to be hard on ourselves for not noticing sooner.
Practicing mindfulness is not about practicing perfectly as soon as we have an intellectual understanding of a concept. It’s not about preventing an emotional impact or reaction in ourselves, it’s about embracing them when they do happen. I practice having more and more awareness in the present moment, and I’m in a constant process of learning to understand myself better (to use some language from Sr. Chan Duc).
When I (re)discover myself, I see more clearly the boundaries to set now and in the future.
Please, dear reader, take some time to reflect on your life. Are there some interactions with yourself or with someone/something outside yourself that might be having a bigger impact on you than you realize? Can you afford a moment to pause?
What space might be possible to allow you to love yourself and the other person/situation going forwards?
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