Redefining Boundaries

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Recently, I have found myself considering my personal and professional boundaries more and considering how I may or may not redefine them. In previous posts, I’ve shared my personal diagnosis of type 1 diabetes (T1D). I was not diagnosed with T1D until I was an adult and a practicing music therapist. I had historically been a healthy person throughout my life, so acquiring a chronic illness came as quite a shock. As I began to learn about this disease and my management of it, I chose to keep this information to myself for quite some time. Over the years, I’ve learned to become more open about it, especially with my co-workers, and particularly those who share close quarters with me.

One of the areas though where I’ve continued to keep this information to myself has been in my therapeutic relationships. I’ve written about this previously, especially in relation to determining how you balance being a healthcare professional while also dealing with your own health shortcomings. I’ve learned to figure out how to balance taking care of myself in ways that set myself up for success throughout my work day, despite often having incidences arise that you cannot prepare for (e.g. low blood sugar). While I feel I have fairly successfully found the right balance of my professional life and my physical health, recent patient situations have brought to light the imbalance of my professional life and my emotional awareness and self-reflection regarding T1D.

As my professional life has transitioned from adult mental health to full-time medical pediatrics, I’ve continued to come across more and more patients who closely align with myself when it comes to health. When I worked in mental health, patients who had T1D were not there because of their diabetes and it was easier to separate myself into a professional role without dealing with counter-transference. Now, however, working in pediatrics has revealed patients who are newly diagnosed with T1D, readmitted for diabetic ketoacidosis (DKA), or struggling with their own diabetes management. This has revealed a greater challenge in separating my professional self from my personal understandings and struggles with the disease.

I continued to wrestle with the ethics around personal and professional boundaries on my own for some time until an opportunity to receive clinical supervision from my co-workers opened up. During this time, I was able to share my challenges to my team, which gave us the opportunity to view this debate from a variety of perspectives. What I found to be the most helpful from this supervision was that the team agreed that my openness about my struggle with counter-transference and boundaries meant that I was ensuring the most ethical route moving forward.

While this was helpful, I continued to feel a little unsettled until I dialogued with my husband. This conversation was important to me because although he does not have T1D, he’s the person in my life who understands the disease almost to the level of someone who does. What our conversation revealed is the importance in determining my own emotional safety. As I toyed with the idea of opening myself up a bit to my patients in simply sharing that I also have the same disease they have, he reminded me that I have to ensure that I am protecting my own emotional safety and receiving the support that I need. In ensuring that I am emotionally supported outside of my work, my ability to rationally and therapeutically have difficult conversations with patients would remain stable.

As I considered these additional perspectives, I sought final guidance from my music therapy colleague. While I had received many suggestions and considerations, I wanted some closure to this internal debate and knew that only another music therapist could help me find that closure. What our conversation revealed to me is that our personal and professional lines are not set in stone, but can be fluid as we continue to grow, develop, and redefine how we connect with and serve our patients. She challenged my old, definitive line in the sand that said I needed to keep all of my personal details to myself in order to be an effective therapist. She instead made me consider the potential for rapport and therapeutic strength if I simply move my line a millimeter to have a patient simply know that they are not alone.

Through these many conversations, I have found myself redefining my boundary lines. While I have continued to choose to keep my diagnosis to myself in most instances,  I have found myself re-examining this decision in certain situations. While I ethically understand that sharing information with my patients about myself is typically not in the best interests of the patient, isn’t it also my duty to build rapport with patients and have them feel validated, heard, and supported?

I will likely continue to redefine my boundaries as I grow as a music therapist, experience more life situations, and encounter even more ethical challenges. But as it stands now, I will continue to reflect on my openness with my ethical wrestling, receive supervision, and dialogue with mentors. Only in remaining open to your own self-reflection can we ensure we are best meeting the needs of our patients. Hopefully, as I navigate these new boundary lines, I can help a patient feel less alone and more supported in a way that others may not able to offer. In this, I can accept the uniqueness of my situation and embrace its potential for serving my patients even greater than before.

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