When we talk about “setting boundaries” with someone, it is almost never a sign that things are going well. Setting a boundary might be discussed in the context of my boss is calling me all night or my mother-in-law shows up at my house unannounced and lets herself in. We usually think about boundaries in the context of some social norm or expectation being violated, and we think about setting them in the context of behavior that is inappropriate.
In this context, boundaries often have a sharpness and a rigidity about them. Because we often think about drawing boundaries in the context of being hurt, we are often setting them from a place of reactivity; at minimum, they come about in response to behavior we find inappropriate. But boundaries are present in every meaningful relationship we have. There are expectations, roles, and limits that define what is acceptable within that relationship, and what is not. Our relationship with our partner is different from our relationship with our parents. Our relationship with our children is different from our relationship with friends. The relationship we have with a coworker is different from the relationship we have with a therapist, a teacher, or a doctor.
We often think about boundaries in the context of creating separation within a relationship. For example, if a friend is inserting herself into our life too much, we might talk about setting a boundary about when we want to interact, or what we find acceptable. Because of this, our conception of boundaries is often synonymous with moving away from someone. However, boundaries are a key component of close relationships, and having them does not make a relationship less meaningful or significant. In many cases, they are what allow the relationship to remain stable enough to exist at all, or what allow the formation of particularly close relationships.
It is easy to assume that intimacy and caring require fewer limits. That if a relationship is important enough, the structure should dissolve into something more open-ended and fluid. Imagine for a moment a marriage without boundaries. No boundaries about fidelity, no expectation that our partner prioritizes the relationship, no understanding that despite the fact that this relationship is important to us, we still have separate jobs. In this scenario, it is hard to imagine a stable relationship that persists for long. Boundaries on the relationship are what allow the relationship to function, not impediments to it. Mature relationships are defined by clarity about boundaries.
I sometimes discuss with patients that I care deeply about them and am genuinely invested in their wellbeing, while also acknowledging that there are constraints on the relationship because I am their doctor. This does not reduce connection or emotional presence. It simply reflects that the relationship has a defined structure. Again, it is the very nature of that structure that enables the connection. The expectation of boundaries on the relationship is what allows someone to feel safe or comfortable confiding, being honest, or sharing vulnerability. In medicine especially, the absence of clarity creates predictable problems. A therapist cannot become a friend in the ordinary sense. A parent cannot rely on a child for emotional grounding. A boss cannot become a peer without consequence. These are not arbitrary restrictions on authenticity; they are structures that protect the integrity of the relationship itself.
There is also a broader cultural tension here. We often romanticize relationships that appear boundaryless, as if total emotional access or complete lack of inhibition is the highest form of authenticity. In that framing, any limitation can be interpreted as distance or lack of genuine care. It is in this confusion that boundaries begin to erode. What feels like closeness becomes a reason to loosen structure, rather than recognize its importance. Without structure, the very intensity that feels meaningful becomes harder to sustain in a way that is safe, predictable, or fair to both people.
Part of maturity is learning to tolerate the fact that different relationships serve different roles, and no single relationship is meant to hold everything. As a doctor, I can be incredibly supportive and helpful– more so than family sometimes– but that does not mean I supplant the role of family. A friend does not become a therapist, even if they are an excellent listener and a trusted confidant. A partner does not become every form of support simultaneously– even in deeply loving relationships. It is unfair and unhelpful to ask one person to be everything, even when that person is deeply committed and loving.
Erosion of those edges may not be evidence of greater intimacy, but of discomfort with differentiation itself. Boundaries can feel disappointing because they force us to acknowledge limits in what any one person can provide. But that disappointment does not mean something is missing. It may simply mean the relationship is being accurately defined. There’s a further irony here, in that well-defined relationships often have the possibility of being more helpful, more meaningful, and more connected precisely because of the clarity around them.
In medicine, this matters in a particularly concentrated way. Patients are often vulnerable in ways that create strong relational pull—fear, isolation, shame, uncertainty, or dependence can all intensify the desire for closeness without limits. And yet the work of care depends on structure. The caring is real enough that it requires containment. Clarity around boundaries is what allows for vulnerability that would be too risky in another context.
This idea extends far beyond medicine. In many areas of life, we lose sight of the fact that relationships can be both deeply meaningful and clearly bounded. We sometimes assume that if boundaries exist, something essential is being withheld. Or conversely, that if a relationship is real, it should not require boundaries at all.
Part of what allows intimacy to deepen is the sense that a relationship is stable and understandable. We know where we stand with the other person. We know what role they occupy in our life, and what we can expect from them over time. Boundaries help create that stability. They protect relationships from becoming emotionally chaotic or unpredictable in moments of stress or need. There is something profoundly calming about relationships with clear shape—not because they are distant, but because they are steady enough to hold closeness without confusion.
Love,
Doc
Forwarded this email? Sign-up here
See past posts here.