What are the Forces Behind Boundary Violations?

What are the Forces Behind Boundary Violations?

January 2016

A round table discussion with Stephen Schenthal, Jennifer Schneider and Gary Schoener

What makes people who presumably know better commit boundary violations?

Gary: When someone has crossed or violated a boundary, it’s almost never an isolated instance. Almost always, they are in the grip of forces they can’t control—and aren’t willing or able to face up to.

How do you avoid facing up to a direct accusation?

Gary: They might admit to a single mistake, but they’ll say, “It was just a screw up. It won’t happen again.” They might even admit that some slight readjustment is necessary, but not that they have some kind of personal vulnerability. Since they don’t perceive themselves as having anything really wrong with themselves, they don’t accept that they have to change something major, that they can’t just keep going this way. In so many cases it’s not a total failure to see the problem, but greatly understating it, underestimating it.

What does “facing up to it” mean here? Why is it so hard?

Gary: It’s not enough to simply accept the idea that you made a mistake, or even that you have a failing. Just having some insight doesn’t make your failings magically disappear. You have to recognize that you have some real vulnerabilities that aren’t going to go away, and make some serious, often profound changes in your life.

Jennifer: If you understand that you have to change, it means you have to look inside yourself and really understand what led you to do these things, your vulnerabilities, and it’s very uncomfortable, which is why people chose addiction as one avenue of escape. It’s simply too painful for them to face up to their problems and have to deal with them, so they find other ways of coping. Whether it’s addiction to a drug or to sex or to gambling, their compulsive behavior is their way of coping.

three doctors seen talking

Steve: The work itself can also become an addiction. People will bury themselves in the work rather than deal with marital or family problems, for instance.

Jennifer: That’s why we often ask doctors how many patients they’re seeing each day or how many hours they’re working; if they are taking any time for their family or themselves. Many are escaping problems through work, which can be very rewarding, because they’re getting all this positive feedback from patients they’re helping. And that in itself can interfere with their willingness to face problems, because they want to have that positive feedback and they don’t want to risk losing it by making any changes.

Is that particularly true for doctors or is that a pretty common escape mechanism?

Jennifer: I think if you put yourself in a profession where you get a lot of respect and even adulation, like the clergy or medicine, you’re going to be more resistant to admitting you’re a flawed person, to taking responsibility for some of these bad things. In many cases, people who crave adulation have the feeling inside that they’re not really a worthwhile person, for whatever reason, and they are very fearful of losing the cloak of respect that protects them from that hollow feeling. If they admit that they are responsible for these behaviors, beyond just a momentary lapse, then they feel at risk of being exposed as worthless.

Gary: Top performers are another at-risk group. They can get into trouble because they believe their own advertising. I’ve known people who early in their career are not at all what they turn out to be later, because suddenly they start believing in this unrealistic image of themselves, they become hooked on the adulation. These are people who earlier in their career could look at their faults, but later in their careers they’re unable to face their limitations. One politician I know identified the moment he started to go off the rails as this one time when he ran a red light by accident. He had a moment of guilt, he remembers, but then he said to himself, “I’m on the people’s business.” Looking back now he recognizes that when he was younger he never would have said that, felt that way. But he didn’t see it at the time.

Steve: One of the most common ways people resist facing up to such moments at the time is by seeing themselves as victims. They generally blame the board for over reacting. “I have no idea why I’m here. Everybody does it, they just decided to pick on me.” That kind of thing. It’s a way of shifting the blame, the accountability, to someone else.

Jennifer: I had a person in a class recently just like that—very entitled, chip on his shoulder, doesn’t think he should be here, very much in denial. And he had been very minimally disciplined; he really got off easy. But then we went around the room and people talked about what happened to them. This guy was near the end, and when he started complaining about what a raw deal he’d gotten, several people jumped in right then and said, “Are you kidding? You have no idea how you just escaped a bullet. You have no idea what they could have done to you… what would happen if you ever did this again!”

And it woke him up. Being in that room with a lot people, people he respected, his peers, some of whom had received very severe punishments, really changed things for him, because he had not experienced that pain. The pain is what gets your attention, gets you to recognize that you need to change. It’s what happens when people bottom out in addiction.

Steve: Pain is not just a great motivator; I think it’s often an essential motivator.

People who have been dragged through the mud often come back renewed. The people I tend to worry about are the people who get a light hit. One doctor I know had his license revoked but was given probation. And he really was not feeling the impact. In fact, he mentioned in passing that he had just written a prescription for a friend outside of the office. And when I told him that he had just violated his parole and could lose his license for that one stupid act, he just shrugged and said he hadn’t realized that and wouldn’t do it again.

He didn’t feel the real pain that someone experiences when they lose their license or they’re suspended. Those people feel that their whole identity is shattered. This guy, three or four months later tells me he’s going to dinner with a patient. I mean, how much do you have to lose before you understand?

I guess the pain has to be so severe that it forces you to face the pain you’re running away from.

Steve: And it takes time for the pain to really sink in. I think there’s a time exposure gradient. It’s interesting: we were wondering if we could shorten a three-day course to two days, and we polled a lot of graduates and everyone of them said to not shorten it, that the third day had been transformative. There’s a kind of saturation process through the weekend that eventually penetrates the various kinds of resistance people protect themselves with.

Group of professional trying to get a handle on a violation

Gary: In a recent class, there were people that I would not have bet on. Even at the two-day mark I wasn’t too optimistic. But in the end they turned things around. And it’s not what happened on the third day, it’s that the whole process didn’t end quickly. You can fake your way through a day; two days is harder but you can do it. But three days—you can only play act so long, you can only ignore your fellow group members so long, you can only look in the mirror so long without noticing the problem.

Steve: That’s why we feel so strongly in our linear approach to education and rehabilitation: multiple days and follow-up, rather than single-point, one-day classes. Often when someone is first confronted with an issue, their first reaction is to double down on their resistance—we call it “Double-R.” It takes time for them to unclench, to let go of that coping mechanism.

Gary: It’s not easy, especially when it involves people’s sense of who they are. They believe that because they’re basically good people and not evilly motivated, that whatever they did isn’t as bad, that it’s not a real problem. I get that a lot, in a whole range of situations. People will say, “Yeah, I know that wasn’t a good thing to do, but I certainly didn’t mean to do any harm.” People have a really hard time seeing that we don’t split so neatly into good and bad.

And sometimes those around them—not in class, but back in the office or in the hospital—fail to help them by confronting them, simply because they don’t want to rattle someone who’s bringing in the big bucks—one of those top performers I was talking about. A couple of hospitals have been in touch with me about surgeons who are sexually harassing other staff or patients. The hospitals know they have to get the guy to stop the harassing, but they say, “We can’t afford to be without this person, this person brings in most of our business.

We don’t want him to feel threatened.” It’s very short-term thinking but not uncommon.

Steve: It’s what I call organizational resistance. The hospitals or medical practices don’t want to think about it, confront something painful, any more than the individual does, until it’s right on top of them.

Dr. Stephen Schenthal is the founder and CEO of Professional Boundaries, Inc. He is trained as a Board Certified Psychiatrist and Board Certified Diplomate in Clinical Social Work.

Dr. Jennifer Schneider is the author of numerous papers on addiction and pain management as well as 8 books. She is certified by the American Board of Internal Medicine and the American Society of Addiction Medicine.

In addition to his 37 years as Executive Director of the internationally recognized Walk-In Counseling Center (WICC) in Minneapolis, Dr. Gary Schoener is a sought-after speaker on professional sexual misconduct.