Fenced Out
Boundaries are key to any relationship
By Dr. Justin Altschuler
July 2026
When we talk about “setting boundaries” with someone, it almost never means things are going well.
We usually think about boundaries in the context of a social norm or expectation being violated. Boundaries are typically a response to behavior we find inappropriate.
But boundaries exist in every meaningful relationship. If a friend inserts herself into our life too much, we might talk about setting a boundary about when we want to interact. Because of this, our conception of boundaries is often synonymous with moving away from someone.
But boundaries are what let relationships stay stable enough to exist.
Imagine a marriage without boundaries. No boundaries about fidelity, no expectation that our partner prioritizes the relationship, no understanding that despite the fact this relationship is important to us, we still have separate jobs.
In this scenario, it’s hard to imagine a stable relationship lasting very long. Boundaries allow the relationship to function, not to create impediments. Mature relationships are defined by clarity with boundaries.
I sometimes discuss with patients that I care about them and am invested in their wellbeing, while acknowledging constraints on the relationship because I am their doctor. This doesn’t reduce connection. It simply reflects that the relationship has a defined structure.
The expectation of boundaries allows someone to feel safe or comfortable confiding, being honest or sharing vulnerability. In medicine, 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.
There’s a broader cultural tension here. We often romanticize relationships that appear to thrive without boundaries, 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. In this confusion, boundaries begin to erode.
Part of maturity is learning to tolerate the fact that different relationships serve different roles. No single relationship is meant to hold everything.
As a doctor, I can be incredibly supportive and helpful, sometimes more so than family. But that doesn’t mean I supplant the family.
A friend doesn’t become a therapist, even if they are an excellent listener and trusted confidant. A partner doesn’t become every form of support simultaneously, even in loving relationships.
It’s unfair and unhelpful to ask one person to be everything, even when that person is committed and loving.
Boundaries can feel disappointing because they force us to acknowledge limits in what any one person can provide. But that disappointment doesn’t mean something is missing. It may simply mean the relationship is being accurately defined.
In medicine, this matters in a concentrated way. Patients are often vulnerable in ways that create strong relational pulls. Fear, isolation, shame, uncertainty or dependence can intensify the desire for closeness without limits.
Yet the work of care depends on structure. The caring is real enough that it requires containment.
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.
Dr. Justin Altschuler, a physician certified in family practice and addiction at Sequoia MD, can be reached at (916) 668-7164. Follow us on Facebook, X and Instagram: @insidesacramento.
