The Loneliness of Ethical Boundaries in a Dysfunctional System

There’s a particular kind of silence that follows an ethical decision. Not the kind born of indecision or doubt, but the silence that settles after the choice is made—after the contract is declined, after the underpaying panel is exited, after the long overdue rate increase is issued. It is not a triumphant quiet. It is not relief. It is something heavier: the strange, aching stillness of doing the right thing alone.

Most psychologists do not speak of this silence. It doesn’t fit into peer consultation or ethics trainings or practice management seminars. Yet it exists—and for many clinicians, it is one of the most disorienting parts of private practice. Because while ethics are taught as a shield, they often function as a wedge: separating you from the flow of what others seem willing to tolerate. And the moment you draw a line, even privately, you become aware of how few others are standing on that side with you.

Not because they don’t care.

Because the system makes it so hard to.

The Illusion of Ethical Consensus

In graduate training, ethics are often presented as a kind of professional glue. We are taught that the APA Code of Ethics, state laws, and best practices will guide us—and, by implication, unify us. The idea is that ethics are shared: that we will more or less agree on what they require, and that they will be easy to uphold when they matter most.

But in practice, ethical clarity rarely produces communal support. When a psychologist refuses to participate in a plan that underpays them, or decides not to provide a service outside of scope, or chooses to leave a job that violates their values, they do not receive applause. They do not receive solidarity. More often, they receive silence—or worse, subtle pressure to compromise. They are reminded, often gently, of how much the clients need them. How difficult the system is. How no one else seems to mind.

The message is clear: Don’t make things harder than they already are.

But ethics are, by nature, hard.

If they weren’t, they wouldn’t require codes or courage.

When Boundaries Look Like Betrayal

The ethical boundaries that most commonly trigger professional isolation are not about client care. They are about economics. Systems. Contracts. Money. The most painful boundary decisions are the ones that look, from the outside, like self-interest.

When a psychologist drops a contract because the rate no longer covers overhead, the backlash is often unspoken but real: You’re abandoning access. You’re choosing income over equity. You’re giving up.

When a therapist declines to take on another client in crisis because they are already over-capacity, they risk appearing cold or unavailable.

When a practice chooses not to enroll with Medicaid, or raises fees, or limits sliding scale to a small number of slots, the ethical calculus becomes suspect in the eyes of others—no matter how principled, thoughtful, or necessary those choices were.

There is a kind of loneliness that comes not from doing harm, but from refusing to be harmed further.

And that loneliness is rarely named.

The Internal Cost of Holding the Line

Most psychologists do not lack ethical insight. They lack ethical stamina.

It is exhausting to hold a boundary no one else seems to recognize. To keep refusing what everyone else has normalized. To repeatedly explain why something isn’t sustainable—and to watch others nod sympathetically while continuing to do it.

Over time, this dissonance wears on you. It becomes harder to trust your reasoning. Harder to maintain the conviction that you’re not just being rigid, difficult, or precious.

It doesn’t help that ethical strength is often mistaken for inflexibility. Or that principled dissent can be interpreted as moral posturing. Or that, in the era of burnout, saying “no” is often seen as a luxury rather than a necessity.

You begin to question whether it’s worth it.

You begin to wonder if it’s your standards—or your isolation—that’s the problem.

The Ethical Boundary as a Mirror

One of the hidden functions of ethical boundaries is that they show you who you are when no one is watching. They reveal what you’re willing to endure, what you refuse to normalize, what you believe care should cost—not just financially, but emotionally.

They are not declarations. They are mirrors.

And what makes them so destabilizing in a dysfunctional system is that they rarely reflect anything back. You hold the line. The system doesn’t change. The gap remains. You stand at the edge of what you can tolerate—and discover that almost no one will meet you there.

That’s when you must choose.

Not whether the boundary was right.

But whether you can keep holding it without company.

Reframing the Pain

The pain of ethical boundaries is not a sign you’re wrong. It’s a sign you’re intact.

Discomfort is not always a signal to revisit your choice. Sometimes it’s just the echo of having made one in a field that doesn’t reward it.

Staying on the panel would have been easier. Accepting the rate would have created less friction. Saying yes would have allowed you to feel momentarily useful, seen, good.

But none of those feelings would have lasted. And none of them would have spared you the deeper cost of betraying your own limit.

Pain is not always evidence of error.

Sometimes it’s evidence of integrity.

You Are Not the Only One

If it feels like you are the only one saying no, the only one renegotiating, the only one asking to be paid fairly, you are not.

There are others—quietly making similar decisions, quietly grappling with the same fatigue. They may not be loud. They may not be in your circle. But they exist.

And as more psychologists speak up, connect, and name these patterns publicly, the weight begins to redistribute. The story begins to change. The silence becomes less oppressive.

But even if no one else stands with you—right now, in this moment—you are not wrong to stand where you do.

Your boundary is not a rupture in the system.

It is a repair attempt.

Why It Still Matters

You do not have to hold every line. You do not have to be heroic. But you do have to be honest—with yourself, with your needs, with your limits.

Because every time you compromise a principle to avoid discomfort, the cost is cumulative.

And every time you hold the line, even quietly, you send a message: that the work has value, that the provider has value, that the system—however flawed—must not be allowed to erase either one.

It is lonely. But it is also leadership.

And it is how change, however slow, begins.

About the Editor
Cody Thomas Rounds is a Clinical Psychologist-Master based in Burlington, Vermont, specializing in psychological assessment and collaborative care. He serves as Editor-in-Chief of PsycheAtWork Magazine, founder of the Learn.Do.Grow educational platform and the PsycheAtWork YouTube channel. In addition to publishing, he offers consultation and supervision for psychologists and creates practical therapist resources designed to support ethical, sustainable practice.