In my practice as a doctor and stress counselor, I often work with people with psychosomatic complaints such as headache, migraine, eczema, irritable bowel syndrome, back aches, or even epilepsy. While doing so, an interesting phenomenon caught my eye. After the patient had taken a large step into the right direction, I would almost always hear the following during our next meeting, and then often in the last minute of the conversation: 'Doctor, there was something which I wanted to tell you.' 'Yes?', I then ask with a smile on my face, because I already know what they are going to say. 'Something has changed in my life.' 'Yes, what?' 'My relationships have changed.', the answer then most often is. 'In what sense?', I then ask. 'I set more limits.' 'Towards whom?' 'Towards everyone ... um, maybe especially towards my partner.' People who spontaneously heal from a psychosomatic complaint often seem to set clearer boundaries and stand up for themselves in the moment of the improvement.

Why does good assertiveness reduce stress?

Most psychosomatic complaints and psychological illnesses such as depression, burnout, anxiety disorders, and in indirect ways even brain issues, are caused or at least triggered by a chronic overdose of the stress hormone cortisol. Every time someone does not in a healthy, constructive way stand up or the way in which they want to live, it creates discrepancy between how you experience your life and how you wish to live. This is perceived as an (existential) threat, causing stress.

Assertive boundary setting as to who you want to become

Lower species of animals are only stressed when a life threatening situation requires that they fight or flee in order to survive. From research done by Robert Sapolsky from Stanford University it has become clear that primates (including people, that is) can experience stress caused by psychological situations. As a result therefore, more triggers can cause stress than they can in lower animal species. However, this does mean that primates have more opportunities to pick which situations they accept the stress in and which they do not. I theory, a large amount of extra stress is therefore avoidable, except for when one does not set any boundaries. Sapolsky believes that the ability to regulate psychological stress in a better way has not had the time to fully develop yet in the evolutionary history of primates. This observation led to the development of types of training in assertion, in which people learn better communication skills in order to be able to set such boundaries respectfully, in order to ensure that their friend, colleague, or partner does not feel rejected personally. These techniques are definitely a good thing, but they are not enough because setting boundaries in itself does not reduce stress. The stress is reduced because, after setting healthy boundaries, you start to live in a way in which you want to live. Because of this, the feeling that we are in danger of missing out on our own lives disappears. Traditional courses generally skip the most difficult step, namely training the participant to learn which boundaries they want to set, and with what goal. That is why this article provides a practical step-by-step plan in order to become more assertive in a way which helps the cortisol levels of the blood lower, and with that the results of negative stress. The goal is learning to think and act in a more peaceful, balanced, and assertive way, so that our own brain and that of our conversational partner has the opportunity to relax, meaning we can do more of that which we really want to do.

What is lacking in traditional assertiveness courses?

Reducing the stress in your partner The second mistake is that they sometimes do not help the cortisol levels in the blood of your conversational partner lower as much as they should, meaning the intended effect does not occur. When the conversational partner is stressed, chances are small that you can get something out of them. That is why we will look at how to reduce the stress levels of both parties involved, while setting boundaries. To help the conversational partner accept a boundary, you must know which positive intention this person had in order to realize their existential values - for example to be a good employee or a good life partner. If you can communicate your message in such a way that it helps your conversational partner see that what they do is valuable, you will increase their level of self-worth and self-control. This results in their stress lowering, making them feel more comfortable with accepting the new boundary, and even with supporting rather than ending up in a 'fight or flight' stress response. People are namely willing to do things for people who acknowledge their good intentions. And to be 'seen' and 'acknowledged' by these rare individuals, there is a lot we are willing to do. A good approach therefore not only makes it easier to set a boundary, but also offers the opportunity to build a better, durable relationship with the conversational partner.

The stress reducing assertive boundary-setting technique

We already stated that our goal has two parts to it: on the one hand it is to set boundaries which contribute to your concrete goal and mission in life, and on the other hand to reduce stress and resistance in yourself and your conversational partner. For this, two phases are needed: a preparative, mental phase, followed by a conversational technique with 5 concrete steps.

The mental preparation

In a previous article we already stated that stress occurs when people get the feeling that they cannot (any longer) realize their deeper existential values. The main question therefore becomes: Who do I want to be? Who does my conversational partner want to be or to become? In figure 1 we summarize the questions for each conversational partner which should be answered during this mental preparation. Then, the question needs to be asked which positive goal both conversational partners concretely strive for in order to move into the direction of their deeper existential life mission. This positive goal-setting often explains both the positive behavior which you want to reach as well as the unwanted behavior which you want to stop or limit in the other person. The third important question them effectively becomes which specific desired behavior one wants to ask the other person for, in that situation or context, in order to add to this positive goal and to build up or maintain a durable relationship (professional or private). When it comes to the other person, they can then clearly define which specific behavior is disturbing. The fourth question, which we will mainly need to later on be understanding, empathetic, and thereby stress-reducing in communication, is which positive intention is hidden behind the undesirable behavior of the other person. This will most often be a positive intention coming from their goal in life, and sometimes also from a positive intention toward the relationship. Chances are, however, that this last intention is lacking in both parties due to stress, frustration, or having felt rejected in the past. But it is this positive intention, to build up a positive private or work relationship, which is necessary to get out of the vicious cycle. That is why it is important to ask yourself the question which positive intention the desired behavior should support, both toward the relationship as well as toward the personal life goal. In case the desired behavior which you want to request does not add to a positive intention toward the relationship, it might be so that you should re-think the desired behavior, and possibly alter this. The fifth step is to take a piece of paper and to write down how you can formulate understanding toward the positive intention of the other person and at the other hand how to concretely formulate and motivate the boundary or the desired behavior. Formulating the desired behavior is best started by: 'I expect from you that you ... in situation ... because I care about ... and our good relationship.' One clearly states what it is that one 'expects', and uses a powerful word such as 'expecting' because the importance of the question is otherwise not adequately underlined, which would lead to increased chances of the other person not taking you seriously. One thus expects a desired behavior in a concrete situation or context. This sentence will form the building block for the third step in the communication technique which we describe further on. The famous psychologist and persuasion expert Robert Cialdini recommends to use the word 'because' in order to motivate which value or goal ou want to support with the message. His research has shown that this word increases the persuasive power of a message tremendously. People are apparently more likely to follow someone who uses the word 'because' when explaining why they believe something to be important. With the sentence above, one is already ready to set one's own boundaries, and these will - like we have seen before - reduce the personal stress experienced. Now, we should consider how one can reduce the stress experienced by the other person. The key is to let the other person feel that one understands him, as well as to make the positive intention of the other person become explicit.

The conversational technique

The previous paragraph described the mental preparation for the coming conversation. The answers to the questions of the preparation will become the ingredients for te conversational techniques with five steps. We recommend to plan in the preparation several days before the actual conversation, so that the different points of view can sink in for a while. The technique improves stress reduction for the other person and is ended with a request of a promise or engagement, preferably followed by a follow-up moment in the future in order to evaluate the results from the conversation, and to eventually alter these in some way. Between two positive moments there is a turning point and the real boundary with the desired behavior, as can be seen in figure 2. You may copy the sentence examples from this schedule and alter them.

Assertive limiting in 5 steps

Step 1

The triple compliment You open the conversation with a triple compliment, as prepared in the previous phase. This is preferably done in several full sentences and with a strong voice, saying something along the lines of: ‘I have noticed that you have done ... in situation ... . In situation ... I noticed that you did ... and in situation ... I observed that you did ... in order to realize your desire for ... . I find it great of you that you put so much effort into it, with such dedication.' It is important that your voice remains strong until the end, and does not go down as if one were to move toward the rejecting 'but'. The voice intonation should make this sentence solid and affirming. As described above, this opening is used on the one hand to strengthen the relationship, but even more to give the other an honest, authentic feeling of self-worth. Thanks to the preparation you help the other person to discover an aspect of themselves which they hardly knew about. Te three concrete behavioral observations help them to see themselves in a positive light. We therefore are not looking for meaningless compliments here.

Step 2

The transition After this positive piece, you need to have a transitional sentence which is respectful and non-threatening in order to communicate the new expectation for the future, especially the desired behavior which guards the boundary which you find to be important. The transition never starts with the rejecting word 'but'. One starts the sentence with another word, such as 'on the other hand' or 'however'. This way we avoid, at a subconscious level, that our body language undermines our powerful message. You now shortly describe the disturbing behavior and the undesired effect (or feeling) which is causes: ‘On the other hand I do want to say that behavior ... in situation ... has ... as a consequence.' This negative transitional sentence is formulated clearly but as shortly as possible. It is useless to think about that which is negative for too long of a time - on the contrary, actually.

Step 3

Setting your boundaries The boundary must be clear, powerful, and shortly formulated. Not using too many words. Just concretely describing the desired behavior and use the word 'because' in order to explain the link to the positive goal. That is why it is best to start with a clear statement, such as 'I expect from you ...' and 'I expect you to ... in situation ..., because I find it important that ...' Do note that, like in the traditional assertiveness techniques, the main messages here still are the 'I-messages', and not the 'you-messages', which can easily be perceived as judging or guilt-instilling. Nothing is wrong with the other person. The other is not rejected and should not change, either. I am the one asking something concrete from another person: a new desired behavior, eventually to replace an old undesired behavior which should be stopped, formulated in a way which makes it clear which desired behavior one would see appear in its place. This way, one avoids the risk that the other person feels rejected or leaves the conversation with the vaguely uncertain feeling that they do know what they are doing wrong, but not what is expected from them.

Step 4

Repeating your compliment & appreciation. After setting the clear boundary with a definite desired behavior, you should once again repeat your appreciation, mentioned in the first step. This can be done by once again focusing on one positive behavior and the positive intention of the person: ‘I have often noticed that you do ... because you are someone who is dedicated to ... and I want to once again let you know how much I appreciate your input.' Keep this short in order to ensure that it does not come across as too sweet.

Step 5

Requesting the promise It is very important to end by asking (and eventually pushing) for a promise. You do not leave the room before you have gotten the engagement of the other person regarding the situation that you have mentioned! ‘I understand that this is not easy for you. Can I count on your engagement?' If the answer is yes, you can plan a meeting together to check if the engagement has been followed through. It is important to follow up and alter whatever is necessary until the desired behavior has been automated. With any answer other than 'yes', you return to step 3 and start again until the answer is 'yes'.


We described here the theoretical 15 Minutes 4 Me model which helps the participants to develop deeper and more positively work and private relationships by setting clear boundaries. It is crucial to formulate these positively as desired behavior needed to reach a positive goal which is in accordance with who you want to be and become. Only when you manage to communicate in such a way that both parties feel respected and supported, a constructive and durable cooperation will develop. For an illustration of both the verbal language and the voice intonation and body language, you can surf to the video found on (Dutch). This schedule is practised daily, step by step. You can definitely take fifteen minutes per day for this. This way it will slowly but surely become a natural habit.

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Paul Koeck, MD