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Boundaries: set limits, give space

All healthy relationships require limits and clear boundaries but for people experiencing psychosis or other disturbed states, clear limits are especially important. It is often difficult for them to distinguish reality from non-reality and to know where the boundaries of one’s self or others are, so it is crucial that family members know how to set limits clearly and firmly for the protection and well-being of everyone in the family. Limits can be internalized, but must first be external. They are containers of excitement by saying “this is how far you can go”. They give structure, rules, a sense of order and predictability. As acceptance and respect prepare the ground for recovery, clear limits stabilize the ground and help make the client’s situation reliable and trustworthy.

Limit setting skills have to do with respecting both our own autonomy and the autonomy of the client. They have to do with accepting and respecting our own feelings, and with taking our own personal needs as seriously as those of the client. They have to do with asserting our right to be comfortable in our own homes. They have to do with making clear “I statements” about what we need, want or expect, rather than blaming and judging statements (which usually start with “you”). Limit setting skills include being prepared to take action to enforce limits if necessary. These are not easy skills to acquire, so we must work on identifying where limits need to be set and on how to set them.

Setting limits also involves setting limits on oneself. For example, it is very common that siblings and spouses feel neglected and unheard because so much attention and intense concern are inevitably drawn to the family member who is disturbed. It is important therefore that parents set limits on themselves by not obsessing too much about one member of the family and by not allowing their lives to be dominated by crises or grief.