The Meadows Blog

Life seems to offer plenty of opportunities to practice boundaries! Whether it is in our relationships with family and friends or at the grocery store check-out line, we have many chances to decide if, when and in what ways information and people can be part of our lives. Maintaining healthy boundaries is widely considered a fundamental aspect of the recovery process and an important practice for general well-being. However, without a measure of thoughtful awareness, boundaries can inadvertently create walls around our heart, keeping us from connecting wholeheartedly with ourselves and others.

At The Meadows we often talk about two kinds of personal boundaries: external and internal. An external boundary has to do with monitoring and regulating the quantity and quality of other people's interactions with us. An external boundary is sometimes considered a physical boundary because it deals with how much closeness we allow between ourselves and others. This degree of space between us and others can be related to actual physical proximity and contact or it can be related to emotional closeness and intimacy.

An example of an external boundary might be that an individual decides to engage in a face-to-face visit with his or her family once a month and will otherwise make contact by phone. Depending on the situation, this individual may or may not choose to share the boundary and/or the reason for the boundary with his or her family. Another example of an external boundary might be that an individual sets limits with his or her new dating partner regarding physical contact and intimacy. Discussing this sort of boundary openly with a dating partner can help establish healthy interpersonal patterns early in the relationship. External boundaries like these lay the foundation for other types of personal and interpersonal boundaries.

The other type of personal boundary involves learning to establish an internal boundary that can act as a filter for incoming information. Practicing an internal boundary helps us to recognize that incoming information is not necessarily truth with a capitol "T" but is the subjective perspective of another person or group of people (i.e., religious group, political party, society, culture, etc.). Establishing an internal boundary, while also regulating our own reactivity, allows us to respond more wisely by checking the incoming information against what we know about our own truth. If the incoming information has merit, we can choose to let some or all of it in, otherwise we can exercise an internal boundary and let it slip off our backs. (Easier said than done, right?)

An example of an internal boundary might involve a situation where an individual is being blamed for a poor work outcome by a colleague. (The individual may first choose to exercise an external boundary by deciding whether or not to stay and hear what the colleague has to say.)  If the individual decides to listen, then he or she can exercise an internal boundary by choosing to see the incoming data as the colleague's subjective opinion and can then decide what to do with the presented information. After a personal reality-check, the individual may be able to see how well the colleague's point of view fits with his or her own personal truth. Alternatively, the individual may find it useful to acknowledge that the colleague's information was heard, but that more time will be needed to process what it means for him or her. (Again, easier said than done.)

You may notice that I have repeatedly used the words "practice" and "exercise" when referring to boundaries. This is not easy work and it doesn't always come naturally! This may be especially true for people who grew up in family systems where boundaries were unhealthy or non-existent. (Anyone who was exposed to a family environment containing elements of addiction or maltreatment probably experienced serious boundary violations.) However, there is hope! Over the years, I have worked with many people with very challenging backgrounds who have learned how to incorporate healthy boundaries in their everyday lives. Like training our bodies to perform a new physical skill, boundaries are strengthened by regular practice and exercise.

Once we learn about boundaries and recognize their utility in our lives, what keeps us from practicing them more consistently? There are probably many reasons, but I will mention two: 1) fear of disconnection from others and 2) disconnection from our true self.

First, I think we fear that setting external boundaries will lead to disconnection from other people. For example, we might be afraid that our efforts to explicitly identify the quantity and quality of contact we desire to have with other people will result in hurt feelings and emotional distance. We may worry that by exercising boundaries and making our needs known to others we will be seen as demanding, selfish, unreasonable and difficult. At a deeper level, we might be afraid to clearly make our needs known because the pain will be that much greater if the other person then chooses to disregard them. That is, to have our innermost wishes fall on deaf ears may be an especially undesirable outcome.

It is certainly true that practicing boundaries does involve some risk. But it is important to recognize that without clear external boundaries we can miss out on critical opportunities to let other people know what is important to us and how we want to be treated. People in our lives who are dominated by fear and are prone to using control or aggression in relationships may not appreciate our efforts to practice boundaries, at least initially. The relationship may even get worse before it gets better... if it does get better. However, by courageously implementing external boundaries, we honor our fundamental human right to be treated with respect and we have a greater chance of cultivating loving relationships.

The second reason why a regular practice of boundaries, in this case internal boundaries, can be challenging has to do with our tendency to experience disconnection from our true self. Establishing an internal boundary in the face of incoming information, some of which can be extremely uncomfortable, requires that we have some sense of ourselves as a unique person with inherent worth. If our sense of self is mostly derived from external sources, like what other people think of us, then we might find it very difficult to exercise an internal boundary. If our sense of worth is primarily dependent on whether or not we are pleasing to other people (codependence), then any semblance of an internal boundary will easily be whipped about like a flag in the wind. In order to filter incoming data according to how well it resonates with a deeper sense of ourselves, we must first have some notion of our deeper self - we must have an inkling of our own truth!

Paradoxically, exercising boundaries helps us to better understand the nature of our true self - we become more intimate with ourselves through the self-loving act of setting boundaries. So, it's a catch-22, isn't it? Finding our center allows us to establish healthy boundaries and by exercising healthy boundaries we cultivate greater awareness and acceptance of our true self. What are we to do with this chicken-or-the-egg paradox? Well, we can start where we are at...with the awareness of true self that we do have. Right now, in this moment, we can begin to truly care for ourselves by letting go of any information that is incongruent with what we know of our inherent value and worth. Gradually, we can develop a regular practice of internal boundary work by meeting incoming information with greater awareness of, and care for, our maturing true self.

As our practice of healthy boundaries continues to develop and grow, it is very useful to pay attention to our tendency to inadvertently make boundaries into walls. For example, we can easily trick ourselves into thinking that an external boundary is necessary with a particular person, in order to feel safe and secure. However, when we get real honest with ourselves, we might find that our external boundary was more about a subconscious wish to avoid an undesirable aspect of ourselves that comes up with this particular person. In this scenario, the external boundary isn't necessarily based on an intention to honor our fundamental human right to respect and security, but is actually driven by a fear of facing our vulnerabilities.

Another example of replacing boundaries with walls is when we react to incoming information by putting walls up between us and the person offering the information. For example, when outside information is offered, instead of saying to ourselves, "How well does this incoming information match or enhance what I know of my true self?" we can find ourselves in a state of reactivity saying something like, "I could care less what you say, I don't need you in my life anyway!" In this case, the boundary turns into a wall when we outright discard the information and the person or people offering the information. In other words, we sometimes close our hearts and minds to others in the name of creating an internal boundary. The driving motivation behind creating a wall of this kind isn't necessarily rooted in a desire to honor our inner truth, but may actually be another form of avoiding uncomfortable bits of truth about ourselves by vilifying and shutting out other people and outside information.

You might be thinking, "Wall versus boundary, what's the big difference...if I need to protect myself from unhealthy information and people, either one will do the job, right?" While it is true that both a wall and a boundary can establish a safe distance from others and temporarily protect us from potentially harmful information, the wall does so at considerable cost to ourselves. Walls are forged in the fire of reactivity and are tempered under a dangerous duality of mind that argues, "It's me against you; I'm right and you're wrong." In this sort of battle for safe ground, walls can be fashioned into a formidable fortress that restricts other people's access to vulnerable areas of the self. These fortress walls may keep stuff out, but they also keep parts of us walled in; we can end up feeling cut off from ourselves and others.

So, how do we practice boundaries without armoring our hearts?

Listed below are several suggestions on how to exercise external and internal boundaries with an open mind and heart.

1)Pay attention to our intention: Our efforts will be greatly enhanced if we can identify and repeatedly revisit our deepest intentions underlying our commitment to practice boundaries.  Again, boundary work is tough and others may not always appreciate our efforts to speak and live our truth. Reminding ourselves of our innermost intentions will cut through the confusion and help sustain us during difficult times.

2)Boundaries are a form of self-care: It is tempting to make our boundary work about other people (e.g., "I must practice boundaries to keep others from hurting me"). Yet, at its core, boundary work is about self-care. Plain and simple. Practicing boundaries is a powerful way to cultivate self-compassion. When we keep the focus of our boundary work on self-care, we are less likely to armor our hearts; and that means we get the opportunity to live more wholeheartedly.

3)Watch for judgment and blame: In boundary work, judgment and blame are telltale signs that boundaries are about to become walls. Judgment and blame indicate that our focus has shifted from self-care to a duality of mind that, if left unchecked, will result in separation by making us right and others wrong. Bring the focus back to our deepest intentions and let judgment and blame fall away as we offer gentle loving-kindness to ourselves by making and keeping boundaries.

4)Boundaries show compassion to others: As mentioned above, we often fear that practicing boundaries will disconnect us from others. Yet, in healthy and loving relationships, boundaries are a compassionate means of clearly identifying our needs so that others have the opportunity to meet those needs, if they so choose. Boundaries show compassion to others by offering clear guidelines on how we want to be treated.

5)Let go of the outcome: Practicing external and internal boundaries doesn't guarantee any particular response or behavior from other people. We might exercise boundaries with a subconscious hope that people will recognize our worth and offer greater respect. This would be a nice outcome, but it isn't the reason for our practice of boundaries. Boundaries are a way for us to recognize our own worth and to show ourselves greater respect and compassion. When we do that; others will naturally follow our lead.

It is our inalienable right and our responsibility to practice healthy boundaries. No one else can do it for us; not because other people don't care enough about us, but because we must care enough about ourselves for boundaries to have any meaning. When boundaries are used to avoid and protect against vulnerability and intimacy, they become walls. These walls may provide temporary protection from fear, pain and shame, but they can also become a fortress around our hearts - creating separation within us and between us and others.  On the other hand, the practice of exercising external and internal boundaries is a profound act of self-care and compassion; compassion for ourselves and for others.

Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. Dr. Caldwell currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg, Arizona. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. Dr. Caldwell's clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation.

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The Meadows' Senior Fellow, Alexandra Katehakis, MFT, CSAT-S, CST-S, along with Dr. Sonnee Weedn and Jill Vermiere, are the recipients of the 2013 Clark Vincent Award from the California Association of Marriage and Family Therapists (CAMFT) for their role in writing sections of the textbook, Making Advances: A Comprehensive Guide for Treating Female Sex and Love Addicts. The award was presented at CAMFT's 49th Annual Meeting in Sacramento, Calif. on May 16-19, 2013.

Katehakis is the Founder and Clinical Director of the Center for Healthy Sex in Los Angeles, Calif. She is an expert in the treatment of sexual addiction and other sexual disorders and has incorporated interpersonal neurobiology into her Psychobiological Approach to Sex Addiction Treatment (PASAT). Katehakis was the 2012 recipient of the Carnes Award, a distinguished acknowledgment for her significant contributions to the field of sex addiction. She is author of "Erotic Intelligence: Igniting Hot Healthy Sex after Recovery from Sex Addiction" and is currently writing a book for the W.W. Norton Interpersonal Neurobiology Series edited by Allan Schore and Daniel Siegel titled, Sex Addiction as Affect Dysregulation: A Holistic Healing Model (2014).

"The Meadows is thrilled that Alexandra Katehakis was presented with the prestigious Clark Vincent Award honoring a literary or research contribution to the profession of marriage and the family," said Jim Dredge, CEO for The Meadows. "We also applaud and congratulate Dr. Sonnee Weedn and Jill Vermiere."

The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 Sub-Acute Agency that is accredited by the Joint Commission.

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The Meadows' Senior Fellow, Dr. Shelley Uram, and Meadows' Psychiatrist, Dr. Jon Caldwell's presentation at the International Trauma Conference on Friday, May 31 can be accessed live via a webinar. For more information visit (outside link is no longer active) .

Dr. Uram and Dr. Caldwell's workshop "A Neurobiological Perspective on Trauma and Attachment and the Role of Mindfulness in the Healing Process," will be presented on Friday afternoon, May 31. In a manner that is easy to understand, they will identify ways that psychological trauma affects brain development and attachment relationships across the lifespan. Additionally, a mindfulness-based approach will be introduced for promoting attachment security in individuals with a history of trauma.

Dr. Uram, a Harvard trained, triple board-certified psychiatrist, is a Distinguished Fellow of the American Child and Adolescent Psychiatry. She speaks nationally and internationally and is best known for transforming the complexity of the brain and traumatology into interesting and easily understandable explanations. Dr. Caldwell is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. In November 2012, Dr. Caldwell was the recipient of a research grant from the International Society for Traumatic Stress Studies (ISTSS) for his research proposal entitled "A Wait-List Controlled Study of a Mindfulness-Based Workshop for Promoting Attachment Security."

The focus of this year's conference is "Psychological Trauma: Neuroscience, Attachment, and Therapeutic Interventions." The conference goal is to present current research findings on how people's brains, minds, and bodies respond to traumatic experiences; how they regulate emotional and behavioral responses; and the role of relationships in protecting and restoring safety and regulation.

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Tuesday, 21 May 2013 20:00

Not This Time

By: Kevin Becker, Psy.D.

As a psychologist who has worked solely in the field of trauma for 24 years I am accustomed to getting phone calls and emails about tragedies that are happening somewhere in the world. But not this time. This time was different. I've lived in Boston since college and I've been all over the world to help people prepare for and respond to the awful things that happen in an unpredictable world. Those who know me and the type of work I do, will often ask me "so are you going to (fill in the blank)?" when they hear news reports of a particularly horrid disaster or violent incident. Usually of course I'm not going, there are just too many to respond to. But this time it was my town and I didn't have to go far to make use of my training

Within six hours of the bombing I had a first request for help from an agency who knew me from a previous tragedy they had suffered. In those first few hours we in Boston weren't really sure just how bad it was going to be. But it quickly became apparent that there were going to be many victims who had been deeply affected on many different levels. There would be no delay in the need for ongoing response and services that are still unfolding over a month later. I've been to disasters that have so devastated areas that it would be decades until they completely recover. That is not what I expect here but the true ripple effect of these tragic bombings is still unknown, as it continues to ripple.

The most unusual aspect of this crime, for me as a trauma professional, has been the unexpected twists that come with having it happen in my town. Usually when I spend day after day after day focused on a single tragic event, I am in someone else's town. But not this time. This time I would hear story after story of fear, life threat, anger and the like and then instead of retreating to a hotel room or debriefing with a team of others who were also away from home, I had to come home, to my house and my neighborhood. I had to be dad and husband and neighbor. Usually I'm afforded at least the length of a plane ride to make that transition. But not this time. Every day for two weeks I listened to stories and provided the education and support that we know helps the healing proceed. And at the end of the day I came home, turned it off and prepared for the next day. Of course after all these years my family recognizes the weight of the work I do. And thankfully they are caring, understanding, and terrifically therapeutic.

Ironically, one of my primary stress management tools is running. I've run the Boston Marathon twice and I have a wide circle of friends and running buddies who took part in this year's race. My extended family hosts a huge marathon party every year. My brother has made it a priority to only buy homes that are located on the marathon route because the race and race day are so special to us. So as often as I've seen someone else's special place or special event tragically altered by some form of violence or disaster, unfortunately for me and many others that's not how it went...not this time.

Kevin Becker, Psy.D. is former Director of The Trauma Center in Boston. He will moderate a panel of providers who were engaged in supporting marathon bombing victims at this year's 24th Annual International Trauma Conference. The conference, co-sponsored by The Meadows trauma and addiction treatment center and the Trauma Center at Justice Resource Institute, is adding a new workshop to its roster entitled "Marathon Bombing: Supporting Victims Across Systems." The conference is being held May 29, through June 1, 2013, in Boston at the Seaport World Trade Center. For more information visit http://www.themeadows.com/events/detail/international-trauma-conference.

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By: Nancy Bailey, PhD, Clinical Director at The Meadows

As we enter into the beautiful desert summer - I was reflecting on my professional journey with The Meadows. When I was hired at The Meadows in 2008 as a Workshop Facilitator, I knew that I was entering into a program of excellence and world recognition. After being in the field of mental health and addiction treatment for almost 20 years, when I stepped foot on the serene surroundings of the campus, I knew I was going to be part of something special.

The significance of the deep work offered to the patients at The Meadows is profound. During those first few years here, I was astounded week after week to see miracles occur and inner shifts transform peoples’ lives. I had been part of providing education and treatment for several years prior and spent many of those years focusing on treating complex women's issues. This work was deeper.

Transitioning from Workshop Facilitator to Intake Interventionist was the next step for me at The Meadows. This position offered me additional experience and multi-faceted perspectives in working with the referral resources, families, and patients at onset of their journey to find healing. This journey had many paths; often hearing and working through challenges of anticipatory anxiety, denial, minimization, extreme pain, and sadness; hoping that the loved one would take that huge step toward healing. Working side by side with the Intake Coordinators provided me with a newfound respect for the skill set needed to be relational from a distance while still engaging with therapeutic alliance and boundaries. Once again, The Model proved to be a hands-on and ongoing tapestry of daily living skills.

As The Meadows leadership continued to recognize the need for excellence, not only in patient care, but also in customer service - my position morphed into a clinically based business development role of Senior Clinical Liaison. Providing the bridge between business development, referral resource, interventionist, and clinical department again offered opportunities for personal and professional growth. Once again, Pia's Model provided a foundation for communication and boundary skills.

After a brief sabbatical to complete my PhD, I was honored to return to The Meadows in my current role of Clinical Director. Since taking the position as Clinical Director in September, many program enhancements have occurred and I continue to work with our Program Development team to assess and integrate better programming. I have the opportunity to work directly with some of the best thought leaders in the world in the areas of clinical excellence and research, as well as the pioneers who blazed the trails for family, codependency, and trauma treatment.  I also have the support of a forward thinking and extremely accessible administrative leadership team and board of directors to help me to integrate new treatment modalities and program enhancements to the already world renowned program The Meadows has been for over 35 years. Pia Mellody's Model still lays the foundation of The Meadows treatment. Cutting edge research and Senior Fellow advisors help me to develop and enhance our program to even higher levels of excellence. I am so excited to be a part of such a system of healing!

Professional journey imitates recovery journey - Life journey imitates recovery journey. As we remain engaged in a program of recovery, one day at a time, we will realize life "beyond our wildest dreams." Please stay tuned to our website and blog for ongoing events, announcements, and educational outreaches. Thank you to our Alumni and business professionals who continue to put your trust in The Meadows for excellence in patient care.

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