65 | Boundaries with high needs clients

Leah: Hey there Annie.

Annie: Hey there, Leah, how are you today?

Leah: I'm doing really well. How about you?

Annie: I'm doing great, working as always trying to plan whatever's coming next, which feels like it's a lot this spring. But I'm excited about all of it. We're coming off of that amazing USLCA workshop we did in February and planning for our next one in June because it was so much fun. It's great. I love this stage of things where it's just about dreaming about everything that could be possible and like making it all happen and coming up with a plan. That's my Colby Quickstart, I guess.

Leah: It's so cool. I love that conference, the USLCA conference, was just like something I'd never experienced before. You and I concocted it up in our brains and it was so unique. Then being able to make it happen and see how well received our idea was just so cool. Cannot wait to do it again and bring even more to the table on another round. It's gonna be super exciting. That's in June so you all stay tuned.

Annie: That's in June, but we have other stuff coming up. We have at the end of the month a deeper dive into insurance. We're bringing Rebecca Castello, if any of you came to the IBCLC day, which was I scheduled it for the wrong day because apparently, I don't know when IBCLC day is and then I was like I kind of don't care. I like Thursdays, works for me. But if you came to our intro to insurance webinar with Rebecca Castello, then you know how great she is talking about insurance. This one, we really do need it to be a deeper dive and we don't mean a deeper dive into like, okay, like, what does that code meet again? Yeah, we're gonna talk about some of that but we're also going to be talking about, I don't know, maybe Leah can explain it better than me kind of like the emotional side of taking insurance.

Leah: Definitely and just like the extra self-care, I think we all need around that. When we're being an insurance provider in such an uncertain time. It's just, you really, really need some extra attention to caring for yourself as a business owner on so many different levels, not just emotionally but just from being a smart business owner and making sure that you're taking care of yourself, both business and emotionally. Insurance, I don't think they think in any emotional terms whatsoever, the insurance companies.

Annie: They don't.

Leah: We have to. We have to take care of ourselves for sure.

Annie: We're gonna drop the link to register to that in the show notes and it's also on our website if you go to lactationbusinesscoaching.com. It'll bring you to the page and that'll have registration information there, too. So today's topic is boundaries with high-needs clients. Uh-huh. Something that is ever evolving for me.

Leah: Oh, yeah. Oh, yeah. It's super tough. I have had my fair share just recently, and it's interesting how much I've evolved from when I was just a fresh new IBCLC to now how I've managed that. What's your experience? Have you changed over time or do you feel like you've handled these situations kind of the same the whole time?

Annie: I have definitely changed over time, because I really didn't have any boundaries when I first started because I just want to help you, and like, I want to answer all your questions, I want to make sure I get back to you right away. Part of it was like having little kids and spending a lot of time just sitting at the playground while they were playing and having all this kind of time. In retrospect, I look back I'm like I could have been reading a book instead of texting with clients. So it was a combination of having this time that I felt was not assigned to my family and then wanting to pour it into my work, wanting to really use it as marketing my practice and also growing my skills. For me, I felt like I learned through doing a lot of times and that was how I was sharpening my skills. It was how I was delivering the value to my clients so that I would get those word-of-mouth referrals. It all kind of felt like I would lump it in with continuing education and marketing. But really what it was was me panicking and freaking out that I was like, but we have to fix this right away because you're really upset about it and if we don't fix it, you're gonna hate me. There was a lot of fear underneath that. What about you Leah?

Leah: I had very very similar experience. I was also had just like, just my heartfelt so big like I could hold so much for people at that time. Even though I had a young family, the excitement and knowledge that I had in my head, I felt very expansive. It didn't feel like coming from a place of contraction and like, this is hard to answer all these questions. I was like, shoot me with more questions, I got them all. I got space to give you all the answers. Similar to you. I mean, I was sitting in car lines, I was hanging out playing Hot Wheels with my son while we were answering a couple of questions here and there. It just felt so helpful too, like you said, getting that consistent feedback. Okay, I'm telling the client to try this and then they come back within an hour and say, that's working. Then I'm like, okay, note in my head, that works and then like, no, that didn't work. That was such valuable lessons learned that I really, really can see the value in sometimes not having as tight of boundaries. As the practice grew, and you have more and more clients, that expansive heart and mind that I felt like I had started to feel like it was shrinking because you're also taking all this emotional stuff on with it. When things weren't working out, and how devastating that was to me and how, like you said, like, I gotta hurry up and fix this, and it's not getting fixed. It also felt devastating. That emotional toll, what I found over time, was really contributing to just an overall sense of drain, and eventually, you can get to burn out, just feeling so kind of heavy. That beautiful, kind of expansive feeling, I felt, maybe year one, two, and three started to feel like a weight and heavy. That's when I started to realize, and maybe it took a few more years of sitting in heavy, I started to realize, like, hey, maybe I could think about some of this in different ways, and maybe set up some kind of protective measures for myself. It's almost like having some armor around you so you can carry that heavy stuff a little bit more easier, you know, carry a wheelbarrow with you. I don't know.

Annie: If you think about it, maybe not armor because we're not trying to keep them out. I think about it like a soft structured baby carrier. It's got the belts around your waist so the weight of your baby is being supported by the strength of your hips. You've got straps and you get them tight just so and the little chest belt. When you have it all set up correctly, and you put your baby in there, it doesn't feel like you're carrying much of anything at all.

Leah: Yeah, I love that analogy and it totally resonates with me, because that was the carrier of choice that I had. That's exactly that kind of like balance and needing to kind of tweak and tweak until you're like, ooh, okay, my body feels really good in this. I think I'm just now getting to like, I got the perfect fit for this soft carrier. I love that analogy. That's so perfect.

Annie: What kind of boundaries have you set up? Because I feel like that's the first step in really managing these high needs clients is coming up with those boundaries. So what are some of the things that you've put into place that are giving you and your client the support that you both need?

Leah: Exactly. So one of the things I do is I try to set expectations with the client. I let them know sometime during the visit, I'll mention like, hey, you can message me on Spruce. I try to respond within 24 hours. So they know there's not going to be a 12pm or excuse me 12am response or if you message me at six, I might not answer until all the way to the next day at six. The expectation is not like this is a place to get instant. Now sometimes they actually do get that because I happen to have the time to look and do it but try to set that expectation. Also, expectations around follow-up. So that's helped me a lot. In the visit I'll talk about like this case is pretty complex. We're not going to solve all the problems today. We need to take this step-by-step approach. I schedule so many more follow-ups like so, so many more follow-ups than I ever did in the beginning. I tried to solve all their problems in one shot in the beginning I was like I will stay here for four hours and solve every problem you ever had and we will make sure until you wean you know everything. For many reasons, that doesn't work well. But it also helped me, again, set up the expectation from the client that like, we're going to have another touchpoint. So there's no need to ask all these questions, we're going to have another chance to talk again. Then I do really try to limit how much I even look at anything in the evenings. Now, there are those special cases where I've got a really kind of dicey situation where I am checking in a little bit more, and I am checking my phone because I'm like, okay, they were supposed to let me know how this or that went. I just had this happen over the last week so it's really fresh on my mind. It was a place where I knew I needed to make an exception, just given the circumstances of it. Then on the weekend too, I really, really tried to put my phone away. Our voicemail says, we'll respond to you at our best, but we aren't in the office over the weekend. If they're calling over the weekend like they already know the expectation is we're probably not going to be answering. Again, if I have a client that kind of watching out for them, I might peek a few times. That's been super helpful because I do feel the weekends are so much more restorative because I can kind of push all my work stuff out of my brain. I do really try to hold that as a sacred space to be with my family and really do things that fuel me in other ways than just the wonderful fuel I get from the work that I do, which is very energizing to me. But I know that I can't just be solely dependent on that because there is also like this balance of like, it energizes me, but it also is really heavy sometimes. So those are some things that I've tried to work on. I mean, I'm certainly not perfect with it. There are moments where I find myself slipping. I feel like, Annie, you're stronger on boundaries than me. I probably have not like the most boundary person but tell me about what you figured out because I know you've kind of had this same journey of learning over time. What's settling for you now?

Annie: I do all the same things that you do. A lot of it is like starting with having a boundary with myself is that I have to tell myself, you're not going to do this. I think a big thing that has really helped, there's two like kind of tech things that have helped me and one is moving everything to Spruce. I have a lot of things on my desktop computer that ping, my texts for my kids, like I have that. But Spruce, if I'm on my computer, and I don't have my phone anywhere near me, I don't see that somebody is messaging me through spurts. So on the weekends, I would love to say I'm living this blissful work free life, I'm not. I often have a lot of time to myself on the weekends and that's when I work on updating my website or planning out educational content, and all the cert stuff that has to happen for the conferences. When I'm in that mode, I really want to stay in that mode. So I don't have anything notifying me on my desktop that a client's reaching me. I do get them on my phone. I had to really trained myself to leave them when I'm not available to answer them. I can also see is that a client, is it urgent, is it not urgent, and then I can like leave it unread. I've gotten really good at ignoring that little red. I mean, I'm such like an inbox zero person but when it's on Spruce, I'm like it's okay, I can swipe it on a different screen on my phone, and I don't see it. The other thing that has really helped me is really getting the clients using the secure messaging in Intake Queue. I do not get email alerts if a client sends me a secure message. I have deliberately disabled those. So when I'm like, okay, I'm logging into Intake Queue because I've got to review charts, I've got to write a care plan. I've got to check out did they submit their forms, and then I'll see if there's a message from a client. I don't get notified for those because I know I'm going to be inside Intake Queue enough that I'll see them. I'll see them when I see them. Those are two tech things I've done. Then the kind of business thing I've done, which is I learned this from Rachel O'Brien is I charge for email support. So if you want to have email support after the two weeks that's included for self pay, or between visits if your insurance, I don't give my insurance clients included email support, because they have the ability to schedule a follow-up. If they want to email with me between visits, I charged them. It's $25 for a week. The best thing about this and I haven't had a lot of people take me up on it which is totally fine. However, I'm then able to have my interns and the new IBCLC that I just hired, be the one to respond to those. So they can actually be training, practicing scenarios, working with clients, it's been a real win on that front. It's more work that they can do in their training. The clients are getting what they want. They're getting the support they need, but it's not necessarily me that has to deliver it. Then I'm also modeling those boundaries for my new independent contractor and the interns that I'm working with.

Leah: I think one of the points that you made that I also have found to be super helpful is the language that you use, like in what's included in your visit. So making sure like, many, many, many times your clients are seeing like this is what's included. Are you going to include messaging and email support or not, and for how long? I'll have a lot of clients that come back and say, I know I'm outside my two-week window, I'm happy to pay for a phone call or another visit. But I had this question, which was like a really nice, like way more easy to manage door to open, like the doors open, now I can say you know what actually, like that is kind of complicated would be best if we did that in person, let's schedule something. It's so much easier because they know the expectation. But one thing I know for sure about tired postpartum parents, they have to see that on multiple places. So when you do your intake process, you're making sure they acknowledge that they know that's what the visit comes with whether it's gonna be your insurance clients or not. I think that's so helpful because it shows that you are taking care of yourself. I feel like my clients respond so much better when I say, I'll even say like, I want you guys to reach back out to me, but I won't be available to answer that on this day. But I will be looking, and we'll answer it as soon as I can. I'll say stuff like that and I feel like they really get it. Also, I feel like there's so much more respectful when I'm verbally saying it versus when I'm like, why do they think I can talk to them all hours of the night? Why is this the expectation, you know what I mean? It's like trying to be more like making sure they understand. People were super receptive to that like they get it, we have families, and we have other responsibilities. We also have other clients. So I do think that's one of the best things I've ever learned. It sounds like you're learning too is just being really communicative about your boundaries. It also helps us hold our own boundaries because I love it when a client comes back and says, oh, I know this outside my two weeks. I'm like, thank you so much for holding this boundary. Because if they hadn't said that I might have just answered the question. So in telling them, they're also helping me hold my own boundary too which I'm like learning to hold better boundaries. It's great when your clients can actually help you.

Annie: It's such a process and having it be a conversation because there are going to be times where you're gonna make exceptions. Like a common exception that I will make is that if you're an insurance client, and I've seen you four times, and we're still working on something, we're going to be messaging. At some point, I'm not going to let you go and let you flail, especially if things are really intense and it took a while to figure out what was going on. There are times where I'm allowing myself to break those boundaries. The worst one that I break that I really need to stop breaking, is I will totally text with clients at night time, because of scheduling. If I'm available or if my independent contractors available, and I'm trying to get the booking, I'm so bad about that. Then I'm like, well now they know like I'm awake at this time, but actually like I'm really not. I really fall asleep so early. But that's one place where I really need to be better about that. I do have an admin that helps and the independent contractors, we're all supposed to be kind of pitching in and doing it together so that nobody has to be on call, but I'm a bit of a, I don't know let's not use the word control freak about scheduling. I just wanted to be done. I don't want to leave anybody hanging if I'm available or I don't want to leave them hanging if I'm not available. It's like a whole thing.

Leah: You don't want to leave them without some support when they could be finding someone else and lining something up and then if we're delaying them that doesn't feel good either. I totally get that have, definitely made that same exception. My other exception seems to come, I see a lot of babies, this is a very hard timeline on day three or four, when milk is like just coming in. They're at the lowest weight they're going to be and then you're holding your breath, like, is this gonna turn the corners? It's gonna turn the corner, like, is everything gonna be okay or not? You're like going back and forth. Those clients tend to be the ones that keep me up at night a little bit more, because I'm like, okay, I'm gonna check-in and see how the last couple of feedings went. That timeline is the hardest. I love to see people after day five because it's gonna go that fork in the road, like, it's gonna go one way or the other. It feels like that timeline seems to be really hard. But when I see them, then I do feel like a lot of times I need to check in because they might not have their pediatrician appointment scheduled for a couple of days. So I feel like well, I'm the person kind of helping them work through this and so that's a hard timeline I tend to make probably my most exceptions are there from all of them. It's such a hard time for the families to they're just on edge too like, is it gonna work out? Those babies that are just teetering right on the edge, and you're like, this could all be fine by tomorrow, or could all be falling apart? I don't know which one it's gonna be. So yeah, that's when I make exceptions. And I don't beat myself up for that, either because I think some of our suffering comes from how hard we are on ourselves about like, oh, I should have held a boundary. I should have been better. Blah, blah, blah. It's like, can we just be like, hey you made that choice, and yeah, it made you maybe take a step away from family dinner to answer a question or something. Just be gentle with yourself because sometimes that's just how life is and it's okay.

Annie: Definitely, I mean, I have the same pull that you do, if I've done a prenatal with somebody, and then they just had their baby and they just need that hand-holding. That is the time in your life where you need some hand-holding, and to be able to be that person for somebody else. It's not going to be every single client that needs that but I know that when they do, it is impactful. You do have a chance to really influence how the rest of your clinical relationship is going to go by getting ahead of some of the things that might derail breastfeeding, and then require cleanup later. So in some ways, by breaking that boundary, making that exception in those first three days, first five days, you actually are probably making things easier for both of you.

Leah: 100%, and just helping that client see that there could be a light at the end of the tunnel, like keep holding that hand until they make it there. I feel like I've been helped so much by, we've had Brandie on a couple times, on podcasts, and deeper dives with us, and she's helped me be so much more aware of boundaries and how influential they are on our overall well being. Sometimes, for me as an extrovert, I can get real caught up into like, I actually really enjoy giving and talking to people and interacting, interacting, interacting, that I tend to like then crash and burn. It's like, some of the stuff that she shared on our podcasts and our deeper dives we've done with her has been so eye-opening to me and like, oh, I really like you said I almost have to parent myself into like, you're gonna have to slow down. You're gonna have to take a break, take some rest. Focus on how you're feeling right now. It's really crazy how you can get so swept up in, like my swept up is like, I can help so I should help everyone because I can. That's kinda like my mentality sometimes. It's like, if I can, I should do it for every person that I can come in contact with. Brandie has helped me see so much of the other side of that is like, then I can show up even better for the people I can help if I take care of myself, and I really focus on having some of those boundaries. Have you found any trainings? I know, of course, you've also mentioned how helpful Brandie is but I know there's some other trainings that you found really helpful in this world of boundary figuring out.

Annie: Yeah, definitely. I mean, I think the one that has been most impactful for me is Mental Health First Aid that Kristin Cavuto teaches, and being able to recognize that so much of that feeling that I get when there's a client who is is really high needs and I'm worried for them is that there's something in me recognizing that there's something not right about what's happening here. So having the training to be able to assess for Perinatal Mood Disorders at certain points assessed for maybe other kinds, she doesn't just talk about Perinatal Mood Disorders. She has a whole session on suicidality. She has one on eating disorders, one on one intimate partner violence, and that not having been afraid of like, okay, this could be it. So knowing how to handle myself, when I'm out of my depth with the kind of help that I can provide and recognizing when this is actually not a breastfeeding problem, this is something bigger. Then having the confidence to refer people out for the help that they need, has really helped. I had one client that really just always stays in my heart. We had some in person sessions, and we're working on things and the messages that she was sending me were like, she got in that loop, where she just kept saying the same thing over and over again. Because of that training that I'd had with Kristin, I was able to say, I'm concerned for your mental health and please, I've given you some names. Then in that case, I even called the pediatrician, I said I need you to help me because she needs help. And she did, she actually really, really needed help beyond what she was going to get without somebody recognizing it. Before that training, I might have just kind of stayed like I just got to stick with this until she gets it until she understands what I'm trying to teach her about breastfeeding. But that training, the Mental Health First Aid was really instrumental in me saying sometimes you need to change the direction of the train completely.

Leah: Hmm. Yeah, yeah, that's so important to understand. We're speaking today about high needs clients and oftentimes mental health can put a strain on dealing with breastfeeding issues. If you have additional mental health issues on top of that. It can look like just a breastfeeding problem but it's like, if you have that clarity of mind, you can recognize like, oh, wait a second, this is definitely more than just a high needs clients kind of wanting to get as many resources as possible for their breastfeeding issue. It's like, oh, wait a second, this is more than that. I think we just do such an immense service by having that awareness. It cannot be overstated how impactful and powerful that is, and how many times I wish that I could see it, like, oh my gosh, I wish so many other providers had recognized this ahead of me or something like that. It's hard because this is such an emotional time. I think we might identify really closely to the struggle that our client might be going through, which then kind of pulls our heartstrings so hard. I mean the times that I have literally cried about a client, like I'm just like my heart's breaking for the experience that they're having. Just you got to guard your heart, but you also can't be heartless in it either. There's a real balance in that, and I find that a real struggle. I kind of have like a easy way that I deal with it, some might feel like it's cheesy, but I'm very, like, doing something feels good to me. So I actually created this little, just like cardboard box that I made. I like wrote on the inside of it all the things I want to say to someone who was really struggling like you can do this, you're stronger than you think you are, love is helping you through this, like all the things that you would just like want to pour into somebody. I put that all on the inside of the box. Then I literally will put the person's initials in the box and close the box. I just feel like okay, I'm surrounding them with all this warm energy and love. Sometimes that really helps my brain kind of let go a little bit and say like, okay, I am giving them all my knowledge, but I'm also like putting them in a place of like, I care for you and I hope that all as well with you. That seems to help my little brain kind of process when I have like those really, really hard cases because, gosh, they can weigh on you and wake you up in the middle of the night and it's so challenging. Are there any strategies that you've found, tricks that you found over the years that feel good to you?

Annie: I mean, I love that with the box and I may need to make a box, a physical box. I've done that mentally where you build a box to put some specific problem in. But I love the idea that it's like a real box and that you've made it nice for them. You're putting them in a safe place. For me, the thing that I'm currently working on understanding and doing is this concept of completing the stress cycle, which I read about in Burnout by the Nagoski sisters. That book that recently came out. I think they're sisters

Leah: Twin sisters actually.

Annie: They're twins? Oh, goodness, talk about needing boundaries. So they talk about that you have a stress cycle and that there's certain things that will help your body physically complete that stress cycle. What I've learned about that, I was like there are two things that your body wants to do to complete a stress cycle that I actively try to avoid doing. One is taking naps. I'm always like, I hate naps, I'd rather read a book. But then learning like sometimes you need to just shut down to complete the stress cycle and not just like, one to one with a client like, okay, that client was really hard, I should take a nap. But just kind of the cumulative stress of dealing with all of our clients. I'm not really at a place yet where I'm going to say and now I'm taking naps, however, could take it under consideration, but the second one is crying. I am not a crier by nature. It's similar to naps. It's a little bit like I don't have time to just sit and cry about something. There is a real strong resistance to the energy it takes to face the depth of pain that comes up when you are having a good cry. I have struggled to even think of like a good cry but I know that's a thing so that's something I'm working on is not being scared to just cry and let it all out.

Leah: I love that so much. It's letting your body goes through the process of processing the emotions, I think is like, oh my God, is so valuable. We don't think about that. We're like, no, I just got to push on to the next day or I'll just wake up and do it again tomorrow, it'll be fine. The other one I really like about that because it really resonated with me that book, thinking about some animal that's been chased or whatever, and they finally get away from the predator and they'll still shake. They will shake for a little bit to release all that adrenaline energy that's already racing through their veins. We don't necessarily do that because we're not necessarily being chased by a lion, but our brain doesn't know that. But we don't physically allow our bodies to shake and release. So one thing I really like to do and I do this if I'm super anxious or if I'm just super stressed is I will like, shake it off. Sounds so, Taylor Swift. But literally, stand up and just shake my hands and try to get my whole body gyrating like not in a dance but like literally in shaking. It is so weird how relaxed that ends up making you feel. It is like freakishly, it works. It really, really works. So you can do that even in the car. I mean, just like shaking your hands if you're just really took a lot of something on during a console or something like, get it out of your body with that physical and it does help close that stress cycle. The book is so good.

Annie: It is good. I should probably proactively do some stress shaking because I think that's why I'm in my car driving around looking for traffic and pounding the steering wheel and screaming things at the top of my lungs. Things that are not said on this podcast. It does release it and then I'm like, oh, but now my voice is worse because I just like scream that at the top of my lungs.

Leah: Oh my gosh, I have been in a car with you so I know.

Annie: You know, I think you've actually seen me do that. You're a witness. My kids are used to it at this point. I will say that like shouting obscenities in the privacy of your own car is a great stress reliever. Sometimes that's what's required. It feels really good.

Leah: Yeah, for sure. It's all about that release. So I hope that all of you will find some ways to release the stress that comes up when we are trying to set boundaries with high needs clients and hopefully some of our experiences and things that we've learned over the years. So if you're a newbie out there, like know that we were right there with you and not wanting to put one boundary up at all but you'll learn as we did over time. Hopefully some of these tips and tricks and ideas and shaking will help you really process because we need you to keep doing the amazing work that you're doing. If we don't stop and place these boundaries and learn how to release the stress, then we get burned out and we don't do our great work anymore. So you guys keep taking care of yourselves and keep placing those boundaries and finding where you need that extra help.

Annie: We hope that we'll see you at our, where we can release all of our stress about insurance, at the end of the month that our deeper dive. So check the link in the show notes to sign up for that. We'll have a link for Kristin's Mental Health First Aid course and we'll have a link to more information about Brandie and our podcast episode and deeper dives with her. We will see you soon. Bye Leah.

Leah: Bye Annie.