How to Stand Up for Yourself

In February 2023, Cally Caillouet went to the emergency room with the worst headache of her life. The doctor gave her migraine medication and sent her home. “It was completely written off as a migraine, even though I hadn’t had a migraine in years,” Caillouet says. Days later, in indescribable pain and struggling to see, she returned to the ER. The doctor insisted she was having a migraine. “I felt this sense of impending doom. I thought, I’m not going to die just because a doctor doesn’t want to go the extra mile,” Caillouet says.

So she pushed back and fought for a CT scan. The scan showed a blemish, and a subsequent MRI revealed a massive blood clot. If she’d waited a day or two later to get treatment, she likely would have had a stroke or died. “I advocated for myself, and it genuinely saved my life,” Caillouet says. “That experience has made me much more assertive in my own care.”

Work

A Recipe for Assertive Behavior

How to find “the Goldilocks zone”—not too passive, not too aggressive.

By Jeremy Shapiro, Ph.D.

Assertiveness is a vital social skill and core component of emotional intelligence. When two people’s needs are in conflict, no solution can be adequate unless both sets of needs are addressed—at least to some extent—and that’s what assertiveness is all about. It doesn’t mean both people get what they want, but there is an attempt to acknowledge, respect, and try to meet both people’s needs while taking care not to make things worse.

Possible responses to conflict exist on a spectrum. At one extreme, there is aggressive behavior, in which the person behaves as if only her feelings and goals are important, and the other person’s needs don’t count.

At the opposite extreme, there is submissive or passive behavior, in which the individual behaves as if only the other person’s feelings and goals are important, and his own needs don’t count. The submissive person might not believe this, but he behaves as if he does by not doing anything to advance his agenda. Submissive behavior can be the result of intimidation and fear, but often the threat of harm lies less in external reality than in the person’s mind.

The middle of the spectrum—the Goldilocks zone—consists of assertive behavior. The person behaves as if both her own and the other person’s needs are valid and important, so there should be an effort to work things out. This quality of even-handedness means the word fair is practically a synonym for assertiveness, because this type of behavior is fair to both others and to the self. The solution to the problem of aggression is the same as the solution to the problem of passivity: assertive behavior.

As a therapist, I have seen that clients on both ends of this spectrum are afraid of the opposite side. People who have problems with aggression usually fear being perceived as weak, which they believe will result in being walked all over. People who have problems with passivity are usually afraid of being perceived as pushy, selfish, and rude, which they believe will make other people mad at them. There is some validity to both fears. But fortunately, once we move past black-and-white thinking, there are options involving balanced blends of different components. In the realm of conflict-related behavior, gray means assertive.

The two-sided nature of fairness means that definitions of assertiveness should combine respect for self and respect for others. Two good definitions: “standing up for yourself without pushing the other person around” and “saying what you’ve got to say without threatening or insulting the other person.”

Assertiveness at Work

Our jobs often confront us with challenges that need to be managed with assertive behavior. There are two main categories: problems with co-workers and problems with bosses. Co-workers present a simpler situation because we are operating from similar positions of power.

One form of conflict with co-workers concerns division of labor. Who is going to do this task? You think she should do it, and she thinks you should do it. To be fair, you should start by considering the possibility that it might be appropriate for you to do the task, and you should hear your colleague’s reasoning. Usually there are two main issues: Who already has more work and whose domain best fits the new task. For example: “I know you’re really busy, but I am overwhelmed right now. I worked late several times last week, and I’m still behind on a big project. I honestly don’t see how I can take this on.” Or, “I see how this is different from your usual responsibilities, but to me it looks related, while it doesn’t seem to fit into my job description.”

Asserting ourselves with our boss might be more difficult because of the power differential. The two-part trick here is to get our points across without seeming to question the boss’s authority. For instance: “Obviously this is your call, but I’d like to give you some information you might not be aware of before you plan how our team is going to tackle this project. Want to hear it?” Or, “Talking about raises is awkward—maybe for you, too—but there are a couple of points that seem important to consider, and I want you to be aware of them while you’re making your decision.”

Using Assertive Language

Assertive speech gives the other person information about your experience of the conflict. This information is of four main types: cognition (your view of the situation), emotion (how you feel about the situation), motivation (what you want to achieve from the outcome), and a proposed plan (ideas for resolving the conflict). Conveying these four elements as well as possible can show the other person where you’re coming from and establish a strong solution.

In conflict situations, “I” statements generally work better than “you” statements. “I” statements tell the other person where you’re coming from, which is important information for them to have. “You” statements make some claim, usually negative, about the other person in the conflict. These likely make the other person angrier and the situation worse. “I” statements are also generally more accurate than “you” statements.

We do not need to be concrete and rigid about this distinction: The word I is not literally required—“It upsets me when______” is an “I” statement—and the word you is not forbidden, as long as it refers to a specific action of the other person, not what they “always” or “never” do. Assertive communication means verbalizing our point of view rather than making judgmental statements about the other person in the conflict.

It might be difficult to articulate this point of view in the midst of a complicated, emotional situation. Here’s a helpful hint: We don’t need to figure everything out, we can just take things one step at a time by making “I” statements about what we know. For example:

• “I have no idea what led up to that scene, but I’m really upset about what happened.”
• “Maybe I’m missing something, but here’s how the situation looks to me.”
• “You might be right about ________, but I need a way to have input into the plans for this event.”

A passive communication style doesn’t work because it doesn’t get our message across. An aggressive style doesn’t work because it causes fear and anger, which interfere with problem-solving. Interpersonal conflicts can be difficult, but assertive communication has the best chance of making things better.

Jeremy Shapiro, Ph.D., is a clinical psychologist and adjunct faculty member at Case Western Reserve University.

Brandon Bendes is no stranger to self-advocacy: He’s a serial entrepreneur. But it was partly his former work as a hockey referee that helped hone his assertiveness. “When you’re put under a microscope and have to draw a line, one of the hardest places to do it, in my opinion, is on the ice,” Bendes says. “You have to do it in an emotionally charged environment, and you have five seconds to make your point, draw the line, and move on.”

The key to boundaried decision-making—and preventing 12 hulking hockey players from turning on you—is setting expectations collaboratively. As a referee, Bendes met the players ahead of time to align expectations about how the game would be called. He showed respect and listened to their concerns. Then he enforced the expectations they’d set together.

Health

Breaking Down Barriers in Healthcare

Move from despair to strength as you push for change.

By Susan Krauss Whitbourne, Ph.D.

When was the last time you found yourself running into a brick wall when you asked someone to help you with a problem? Did you back down immediately or figure out a way to approach the situation from a different angle? It’s hard for some people to keep pushing when it seems that the other person won’t give way—especially when that person is a medical professional. People have become increasingly vocal about experiences of not being believed or understood by their doctors—clearly health, particularly women’s, can suffer as a result.

A recent study published in the International Journal of Qualitative Studies on Health and Well-being, led by Jane Hutchens at the University of Technology Sydney, explored barriers women face with their healthcare providers. In setting the stage for the study, the authors defined advocacy in a healthcare context as referring both to people’s ability to gain knowledge and use that knowledge to “assertively communicate and make decisions” as well as the “ability to get their needs met in the face of a challenge.” The 24 women in the study had all experienced cardiac problems while pregnant or in their first year after giving birth.

Cardiac problems can lead women to lose trust in a healthcare system that doesn’t give the condition enough attention. Imagine what it’s like to be extremely ill and hospitalized as a parent of a newborn child and now imagine that, even worse, your medical team seems insensitive to your struggles. This is more than a circumscribed problem, though. As the researchers point out, the “complex management” of the illness over their lifetimes “places significant demands” on these women.

The researchers sought to sift through the women’s experiences to identify any patterns. Through in-depth interviews, four central themes emerged:

1. Silent screams. Feeling silenced, the women felt a combination of shock, fear, and confusion, feelings that led them to feel their needs were “lost in a vacuum of impotence.”
2. Easier said than done. This theme pertains to the lack of coordinated response the women felt they were getting from their providers. They came up with ideas only to be met with resistance, leading them to feel that they were getting nowhere.
3. Crazy-making. When women felt their “lived experiences were denied, it had a pernicious effect,” and things only went downhill. Indeed, one participant stated that “they were telling me that I was going crazy.”
4. Concentric circles of advocacy. Finally, the last theme speaks to the resilience of the women in this sample. In time, they learned to take the steps necessary to build strategies, in a circular fashion, to get what they needed. These strategies included their taking logs of their vital health indicators and the emergence of symptoms. They also did their own research on their condition, using that information in a proactive manner.

The final piece of the puzzle became community advocacy. Some organized social media groups or took on a range of projects to raise awareness or provide peer support to other women.

The researchers noted that getting what you want can be a function of personality. Not only do you have to be somewhat assertive (which may not come easily), but you also need to possess knowledge, the ability to communicate, and connections to the resources you’re seeking, like the time and ability to do your own online digging. A dose of self-compassion is also required to achieve your desired objective. By forgiving yourself for feelings of anger, rage, or being made to feel “crazy,” you can avoid the trap of self-blame.

Standing up for your rights is an important attribute when it comes to your health or the health of your loved ones. Knowing the various stages, from frustration to success, and some strategies to deploy can help make sure your voice is heard.

Susan Krauss Whitbourne, Ph.D., is a professor emerita at the University of Massachusetts Amherst.

Heather Kiernan grew up in Missouri in a strictly religious family. Her desire to leave began early—at just 12 years old. Her escape plan started with researching how to get into college. She enrolled in a university, relocated to Memphis, and eventually moved in with her boyfriend, knowing this would be unacceptable to her family. They cut her off.

“I lost everything. That’s when the silence settled in,” Kiernan says. But standing up for herself and drawing this boundary—living outside of the family’s religion—was necessary. She made friends, established a rewarding career in counseling, and met her husband. The couple now live in Florida with three dogs, two cows, and a cat her husband found roaming the Taco Bell parking lot. “It’s important to take a step back and evaluate the situation yourself. Make sure you’re not being dictated to. Know what you want to stand up for.”

Relationships

How to Defend Your Boundaries

Clear boundaries and assertive behavior are a powerful combination.

By Moshe Ratson, MBA, LMFT

A boundary is anything that marks a limit. In relationships, boundaries define where you end and another individual begins, how each of you relates to the other, and how you are connected—independence, dependence, or interdependence. Setting clear personal boundaries is key to achieving well-being and self-confidence. Boundaries set the standards for acceptable behavior from those around you, defining when they’ve crossed a line, put you down, disrespected you, or taken advantage of you. When your boundaries are unclear or misplaced, you may let in all sorts of unwanted stuff. Boundary violations include things like betraying trust and confidentiality, using another’s property without permission, making demands rather than requests, treating others in a patronizing or condescending manner, and manipulating others for personal gain.

Boundaries serve as your first line of self-defense. When you allow others to violate your boundaries, you give away your personal power, and this can drain you mentally, physically, and emotionally.
You may be suffering from problematic boundaries if you feel as if you’re walking on eggshells; you tend to do things you don’t want to do; you often feel disrespected; you find it challenging to express your feelings, thoughts, and needs; you feel obligated to take care of others at the expense of taking care of yourself; or you detach yourself from others because you are afraid of being judged.

Uncomfortable emotions can help you understand where your boundaries are and when they have been violated. Uncomfortable feelings present you with these questions: What is going wrong? What must be protected? What must be restored?

The answers to these questions give you an immediate and honorable way to work with your feelings. They point toward actions that will help reset your
boundaries and restore your sense of self.

Practice Assertiveness

Practicing assertiveness is an important element of boundary setting. Assertiveness is the ability to express feelings and thoughts openly and defend your rights directly while respecting the rights of others. It is about taking care of your own needs and wants while considering the needs and wants of others. It is the ability to take responsibility without being controlling. Assertiveness is the balanced space between surrender and aggressiveness.

Assertiveness is empowering. It manifests itself in healthy communication and behavior. It aligns your position with the person you aspire to be. Assertiveness skills are especially effective during angry situations and times of conflict. When you employ assertiveness elegantly, you give power not only to yourself but also to the people you interact with, and this promotes a win-win environment. You can dramatically enhance your well-being, increase your value, and influence others to gain positive results.

Being assertive about what you want affirms your right to want what you want—even if there’s little chance of getting it. When you understand your right to be who you are and ask for what you need, and at the same time you are flexible in your expectations about what you will actually get, you are able to be real and authentic and less attached to the outcome. Assertiveness builds and maintains resiliency and confidence.

Tips for becoming assertive include:

• Aim for open, direct, and honest communication.
• Listen to understand other people’s perspectives.
• Value yourself and your rights as well as others’ rights.
• Accept that you can’t control other people.
• Know and protect your boundaries and other people’s boundaries.
• Express your feelings and needs respectfully.
• Communicate calmly and pay attention to your body language.

When we allow ourselves to feel and process our emotions, understand our needs, and express them assertively, we establish healthy boundaries. We protect ourselves while approaching others with respect and compassion. Establishing healthy boundaries ensures that our relationships are mutually trusting, supportive, and caring—even when we are confronted by challenges.

Moshe Ratson, MBA, LMFT, is a psychotherapist and executive coach in New York City.

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