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CAREER GOALS VS PERSONAL/FAMILY GOALS >>2

Hello!

Thank you so much for answering so fast! I think this is so true, I have been told in the past that I am always trying to make others happy and I tend to leave me and what I want at the end...

This answer actually really made me reflect on what it is that I want, I feel like maybe I was confused thinking that what I want is making the people I love happy and in my mind, making them happy would automatically make me happy as well.

Now, about the questions...

Do you WANT to be with my ex- boyfriend? Yes
Why or why not? Because I do love him and even though we disagree on certain things about the future, I feel like him going to therapy is making him aware of what things matter to me and he seems more open to adapt and work together for something.

Do you WANT to do fellowship at a certain institution? I am not sure :/
Why or why not? Sometimes I feel like getting into a top place would be nice for learning about all those complex cases that you probably don't get/treat at other hospitals (example, we send some labs from my own institution sometimes to Mayo because they are the ones who can do them), I feel like it would be a challenge to be there as it would motivate me to study even harder and do my best to learn as much as possible. Now, is it worth it? I don't know. I sometimes just want to settle in here so I can have a family in the next couple of years and spend time with them (I feel like I have spent so much time in medicine that I haven't really gotten much time to enjoy my family/friends in the last 10+ years).

I just get scared that whatever I decide to go with option A I would always wonder if I should've done option B and vice versa.

ANSWER:
So interesting to live in this place: "what I want is making the people I love happy [...] because making them happy would automatically make me happy as well."
First: I want to highlight this for ALL the readers out there. This is a core belief that leads to people pleasing. It also illuminates the reason we do anything and everything - is because how we THINK it will make us FEEL.
But. There are two problems with this belief:
1) We can't make other people happy. This is a doozy to understand, but, ultimately, we can not. The only thing that makes other people happy is their thoughts. Yes - it's true that we can show up in a way that makes it easier or harder for people to have "nice" thoughts about us - but trying to play that game is tricky and full of landmines since everyone's brains are so unique, and so fraught with idiosyncratic tendencies and past experiences that if we run around trying to win that game, we ultimately fail anyway and lose ourselves in the process.
2) Other people's reactions won't make us happy. Another doozy, especially for us physicians who have been trying to hustle for worthiness for a long time. But again, it's not other people that create feelings for us, it's our own thoughts about it all. Which we can choose and practice in any scenario.

Second: your thoughts and feelings about your ex are so good to know! I want to give you permission to think and feel them fully RIGHT NOW, just because it is true in this moment for you. You are allowed to stay present and not slip into the future if you want. You are allowed to make the wrong decision and have your own back about it later! You are allowed to fall in love with a flawed person who may or may not behave in the way you'd choose later.... that is totally ok and part of being human. Guess what? You are also allowed to act in ways that YOU yourself regret or wish were different later. The minute you fully accept this, will make accepting others for who they are (flaws and all) come naturally.

Third: Your thoughts about fellowship- it's also ok that you don't know what you want right now! It's even ok if you don't know what you want for sure when you are making your rank list. Really, truly, it is. Right now, here is your model:
C: Fellowship
T: whatever I decide to go with, I'll always wonder if I should've done the other option, and vice versa.
F: scared
A: vacillate, second guess yourself, try to make other people happy (which seems familiar at least)
R: Experience regret ahead of time.

This is a super common model for all of us which is why I want to pull it out here - so many people are AFRAID to feel future regret, which keeps them stuck in nowhere land. Not labeling or even truly knowing what they really want out of fear that if you say it and go for it you may not get it, or perhaps worse, you do get it and then are unhappy with that "wrong" choice to begin with... sound familiar?

Questions:
-What is so wrong with regret? Can you recall something you regret now and process that feeling? Where is it in your body? What's it like? Why are you trying so hard to avoid it?

-Imagine you make the "wrong" decision (with your ex, or fellowship or anything else). SO WHAT? What are you making that mean? What is the worst thing that could happen?

Get it down and out of your head and let's work through it. <3

Career goals vs Personal/Family Goals

Hello! I wanted to bring this up as I really feel I need some help with this. I broke up with my boyfriend a couple of months ago. We had different points of view about future plans and couldn't really make a plan that worked for us. I have been missing him a lot and he started going to therapy afterwards. I think it has helped him a lot as he now understands several of the things I was expecting from him in the past.

He came to visit a couple of days ago and decided to talk and we both are considering trying again. The only thing is that he wants me to commit to certain things and I am not sure if I am willing to compromise on all of them. One is that basically, he wants me to apply for fellowship in the same state we currently are so he can keep his job, I have always dreamed of applying for the big name hospitals due to personal reasons (mainly, my family consists of my mom and I as she became a widow closely after I turned 1, she has been my biggest supporter and no one really ever helped her much, so I promised myself I would do my best to "get to the top of a mountain" I created -in this case, a prestigious hospital- to kind of show all those people who were mean with my mom the good job she did with me. My ex-boyfriend doesn't really know the reason why I aim for such "high-stakes" as he says, and feels I am being selfish as when we used to talked about getting married I was not prioritizing establishing here and having. a family together. in the state, he was born. Of note, I am not from the US so I have no family/ties to any state. I kind of mentioned this to him and asked him if he was open for me to leave to another state just for 1 year (duration of fellowship) and then I am willing to come back and establish myself here in this state. What concerns me is that on one side I feel like I am successful enough for having made it to a residency outside of my home country and maybe getting to a prestigious program wouldn't be as fulfilling as I think, but on the other hand, I am worried I may resent my boyfriend for not even trying to accomplish this goal (which I very well may not even match into these competitive programs and I have mentioned that too).

C- Want to do a fellowship in a prestigious program to prove wrong all the people who gave their back to my mom in the moments she needed the most, the man I wanted to marry doesn't want me to do this and thinks I am selfish
F- Confused, scared, uncertain about what decision to take, overwhelmed as I want to be with him but upset that he can't understand my reasons
T- I need to prove my mom did a good job. // I want to get married and be close to my husband's family, but also accomplish my academic goals, // I am so selfish, maybe I should listen to him and just stay, it may very well be more fulfilling than getting to a prestigious hospital. // I am scared, what if I regret not even trying?
A- Ended up breaking up with him because we wouldn't agree on this.
R- After seeing ex-boyfriend made a huge improvement after therapy, I now want to do the same and be more open about what we both need.

ANSWER:
Hi, friend - thank you for this authenticity and vulnerability. This is hard work and you are brave to dive in.

You gave a BIG story here, which is so helpful to see. To start doing this work, we can get at your thoughts from any angle. We could unpack your thoughts about your ex-boyfriend, your thoughts about your career or your thoughts about your mom. I encourage you to do them all - separately. I know they are tangled together right now, but untangling them will help and clarify.

Right now, what I see is a strong theme of you believing that your actions can control feelings or results for other people. This comes up for you several times in your thought download and I imagine it's an MO that you've been running on for a while. Many of us do. Here is where I see it:
-You believe that you can control how your mom feels by having a certain outcome in your career
-You believe you can control what your mom's friends (ex-friends) think by achieving a certain career
-You believe you can control your boyfriends emotions by making a certain choice

But - the truth is that you can not. You only have an illusion of control. These people are all living in their own models that rely on their thoughts, which you don't even always have access to not to mention power over.

The ONLY person you can actually control is...... wait for it ..... YOU <3.

But I don't see any idea in this thought download of what YOU really want. What do you desire if all of the other players are not in your control?
Do you know what you want, just for yourself?

Let yourself believe for a moment that the other people are all already taken care of, and think and feel the things about you and your situation that you want them to. Just pretend- your goals for how other people think feel and behave are already achieved and don't depend on you AT ALL.

NOW - from that place....

Do you WANT to be with your ex- boyfriend?
Why or why not?

Do you WANT to do fellowship at a certain institution?
Why or why not?

Listen, I'm not suggesting that you make final decisions from this place. We are always allowed to make choices based on whatever or whoever we want, I only offer that you factor yourself into the equation- and that starts with knowing what you really want.

Bring the work back! <3

dating in mid-30s - the struggle is real 🙁

This feels like a frankly embarassing thing to ask coaching for, but here goes: I feel like dating in my mid-30s as a trainee is a huge and triggering struggle. Career wise, I actually do feel ok: I'm currently in in my research time in fellowship (I finished residency) in a very wonderful program with incrediblely supportive leadership and lovely attendings, co-fellows, and other co-workers -- a FAR cry from my experience in residency, which many times felt like high school 2.0 (catty chiefs and co-residents, aloof attendings) but with sleep deprivation and patient lives at stake. My time in residency was by far the worst years of my life; though I am very grateful for my training and feel like a stronger physician, the opportunity cost was not having a life, going through a bad breakup just before starting residency, not being able to date successfully while in residency, and losing my sense of personhood and struggling with depression by the end. The years since then have allowed me to gain back much of my former sense of self, even during my clinical year of fellowship. Going through this coaching program (and seeking therapy though GME) has also been very helpful. Nonetheless, when it comes to dating, it feels very difficult for me not to feel down or get lost in an unproductive thought spiral.

C - Dating in one's mid-30s is difficult. It feels especially difficult as a female physician. Pickings feel very slim on the apps, but most of my friends are settled down / married / with kids and don't know of anyone they could set me up with. It's hard to commit to extracurricular activities and other "social" activities due to the nature of my job / fellowship, though I am trying. Also, my biological clock is ticking, but also.... I do feel like a fulfilled life (as per my values, independent of what anyone else tells me, and yes, I have done the soul searching for this) includes long-term partnership and hopefully children.
T - I'm never going to find my "person" -- i'm going to be alone forever. I'm going to miss out on a major joy in life but also not be able to fulfill my own personal values and potential
F - sadness, fear, lonliness. And.... I hate admitting this, but sometimes anger and resentment over this potential sacrifice (like, I love my job as a physcian, I'm so glad I went into medicine. And I know that my work has done so much "good" by way of patient care and impact.... but what about me? Does I not matter?). Also, irritation at friends who are well-meaning but give the usual "at least you aren't settling," or "the right one will come along" or "you just have to keep trying" or "you're so awesome, don't let this get to you" -- it's well meaning but doesnt' really help?
A -- feeling down / hopeless, which makes me feel less motivated to keep dating even though being off the apps hasn't brought success either. also feeling like I lost my "window" when I was earlier and now it's too late / im too old
R - thought spiral of hopelessness - pause dating to focus on other things (a busy clinical rotation, a research project, an upcoming vacation, etc). Also triggering of my prior feelings of worthlessness during residency (which also was in a very toxic environment - chiefs gossiping about residents and playing favorites, attendings not supporting trainees, residents gossiping about each other, huge pressure to be or appear perfect)

it feels very weird to admit this, since I have dated before, though clearly not successfully. I have good friends, a supportive family, and I'm in a field of medicine that's fast paced and requires a LOT of courage and confidence in the moment, so it feels frankly embarassing to feel like I'm struggling in dating (specifically: attracting guys who I'm attracted to / have things in common / can hold a decent conversation during a date, not feeling like my profile is scaring would-be suitors away), like shouldn't I be good at this? It's a really shitty feeling, struggling with dating - it also feels especially jarring after returing to this after a busy time at work where I feel valued. I would LOVE some coaching on how to deal with this thought spiral, since I know it's not productive. Thank you!

Answer:
Hello there. I'm so glad you brought this for coaching.

You know we aren't in the business of gaslighting or toxic positivity here, so I'm not going to try and get you to believe that dating is easy (or fun, or exciting, or... or..... or.... ) if that's not what you want to believe. I do want to show you how believing that dating is HARD, that you haven't been successful, that you aren't good at it is actually adding pain to the process.

Here are some facts I picked out of your download above- there are several!
- You are 3X years old.
- you are in fellowship, on research time
- you have friends who are married.
- You had a relationship before residency that ended
- You had depression at the end of residency
- You have worked with a therapist and with this coaching program
- you have a human brain
- you are experiencing emotions that are part of the human experience
- You desire a long-term partnership and children (Goals can go on the C line)

Here are some sentences that your brain is offering you to make sense of those facts (circumstances)
"Dating in one's mid-30s is difficult/triggering/a struggle as a female physician"
"Pickings are slim"
"It's hard to commit to social things"
"My clock is ticking"
"I'm going to be alone forever"
"It's too late"
"I'm too old"

I know these really feel like FACTS. But I promise you, that they are sentences in your brain. Because it's possible that other people might think different things about those same circumstances.

When doing your model, I want you to pick ONE Thought and ONE feeling and let's investigate the results for you. Remember, you are in many models at the same time (some comfortable, some uncomfortable, some "positive" some "negative", some helpful, some unhelpful), but for the sake of our investigation we want to look at just one at a time.

C- (as above)
T- "Dating in one's mid-30s is difficult/triggering/a struggle as a female physician"
F- My guess is DEFEATED (check in with yourself, does that feel right?)
A- Look for all of the proof that dating is hard. Make excuses for why you're too busy/too tired etc. Launch into this spiral, prove to yourself that it is true, be mad at the world, be mad at yourself. Blame residency, blame the stupid apps, commit to hating the process.
R- The result here for you is that you are undermining, betraying, and giving up on your relationship with YOURSELF.

Your inner critic is offering you all of those thoughts "It's too late, you're too old, It's never going to happen, you've missed your chance". Those are things she wants to convince you of so you don't have to experience the pain of something else (rejection, heartbreak, expectations not being met), but really she is CREATING rejection, heartbreak, and unmet expectations in advance.

Some questions for you to consider and bring back for more coaching.
1. You said you desire a long-term relationship and the possibility of a family. What things do you have to be willing to do in order to create that relationship with another person?
2. What feelings would you need to be willing to allow and process (over and over again) if needed on the path to creating that relationship?
3. Do you believe this is possible for you, why or why not?

Bring it on back here, sister. <3

#MARRIAGE CONT

Thank you for this answer. I think that for a very long time I have been running off the following models:

C: My husband lives his life/functions in emotional childhood
T: He's doing the best he can with what he knows
F: Alone, downtrodden, stable (in contrast to his emotional instability)
A: Listen to his tirade, know that he is out of whack, stay quiet, keep on keeping on, don't mention that his worldview is entirely f*ed up
R: Continue to get blamed for most of his negative emotions

or

C: My husband directly blames me or criticizes me for something that makes no sense
T: WTF he is crazy, why can't he see how his thoughts about this situation are the biggest problem?!?
F: Annoyed, misunderstood, alone, desperate
A: Keep on keeping on, continue to carry the burden of emotional responsibility
R: Continue to get blamed for most of his negative emotions

These are similar models with some slight differences so I wrote them both out. The previous model was something that I tried (a different action to get a different result). You suggest that emotional childhood might not be hard to deal with. I feel like I've tried this approach and the result is still the same, that I get blamed for most of his negative emotions.

You asked: What reaction would you LIKE to have to your husband's emotions?-- I guess here the trouble is that I'm not seeing his emotions, I'm just seeing that he is blaming me for them. If I step back and see that he is feeling angry or frustrated or mad or overwhelmed or tired or helpless or lonely I guess I would like my reaction to be supportive and comforting, but it's so so hard when I am immediately blamed in some way or another. ... Let's try a model:

C: Husband is making illogical statements that are pushing my buttons but I can see that he is feeling angry or frustrated or mad or overwhelmed or tired or helpless or lonely
T: Ahh.. he must be feeling helpless and doesn't know what to do except to blame others....
F: Warm, motivated to move in, offer my presence and active listening (in a less defensive way that I normally would)
A: Be less visibly angry (I'm horrible at hiding how I feel, even if I don't say anything)
R: The situation wouldn't escalate/I wouldn't feel so annoyed? (Often he feels better after "releasing" these emotions on me and I stay unhappy)

I am going to keep bringing this one back a few more times haha. Thanks for all your input/coaching I really appreciate it.

ANSWER:
Ok - great insight on your first two models. Isn't it interesting that the thought "He's doing the best he can with what he knows" doesn't actually work for you? It kind of seems like it would - it's one of those sneaky thoughts that is masquerading around pretending to be "nice" but in reality that thought creates feelings of isolation inside you (yes, you note some stability compared to other thoughts, but for the most part, this thought is creating negative feelings). Good to know - now you can recognize when your brain tries to go there and gently remind yourself that this is not actually helpful.

Your second model is perfectly unintentional and not serving you at all. Can you see how you slip into emotional childhood, here? You think you are "carrying the burden of emotional responsibility" but is this true? Or are actually stuck thinking that your husbands actions are making you angry here (emotional childhood)? Your result in this one is off- results are always FOR YOU, not ever something someone else is "doing" to you. Here, let's clean it up (and your C):
C: Husband blames or criticizes me for something.
T: WTF he is crazy, why can't he see how his thoughts about this situation are the biggest problem?!?
F: Annoyed, misunderstood, alone, desperate
A: Create an imaginary "burden" to carry, feel responsible for the situation, simmer in anger and isolation. Blame and criticize your husband in your mind, disconnect, bottle emotions so they are "less visible" with willpower, and ultimately continue to see husband as the problem.
R: You live in emotional childhood

Ok- deep breath. Before you move on, I want you to sit with this for a WHILE.
If you try an intentional model before you really see that it's your own brain creating your suffering (rather than your husband).... it won't work.

It's sometimes really tempting to see a model like this one in our brains and want to get out of it really fast... want to just swap for a new thought, but when you do that, your brain rebels a bit and pulls you hard back to the first one.

I want to challenge you to stay here, exploring the various ways that your OWN brain is keeping you in emotional childhood, and why it might be doing that. Try to be gentle, and remember that it is very human to blame others for how we feel. This is the way most of the world functions, so there is nothing bad or wrong about you that you are also slipping into it.... but now you have this little secret antidote to it (thought work). So let's see if it might ease some of your self-created pain, right?

For the next few days, I want you to notice when you start to go into anger, annoyance, resentment, or irritation. Often these "fiery" emotions feel a bit better than the "sad" ones (isolated, alone, misunderstood, downtrodden), and our brains knee-jerk to them to keep us from the sadness. But what if you allowed yourself to stay in sadness for a little longer?

What is really so wrong with feeling the sad lonely feelings? Try to process a few this week: write down what they feel like in your body, where they show up, how long they last, etc. Here, you will try to show your brain that there's nothing too scary about being with these feelings, no "need" to knee-jerk out of them.

Next step is to question a few of the thoughts that create them:

For instance:
-How are you NOT alone in this challenge with your husband? (in fact, how are you and your husband both feeling the same things? Can you find connection there.... even and especially if he can't?)
-Is it true that you are also doing the best you can with what YOU know? Can you find compassion for yourself here? What might you tell a younger version of yourself who was in struggle with something that she couldn't figure out?
-Is it true that sometimes you can't see that your own thoughts about the situation are the biggest problem?
-Are you also feeling helpless and knee-jerking into blaming others?

What comes up for you in answering these questions?

#MARRIAGE

My husband holds a significant amount of resentment towards me for various things (not being fun enough, having a less flexible life because of my job, feeling like I "pushed" him to have kids too early (since I told him it would likely take months to get pregnant and instead we got pregnant quickly), that some of my relationships with immediate family are complicated, that he didn't have fun at our wedding, that we have different opinions on things (i.e. furniture), that my career has impacted his career , and that in his opinion I am more thoughtful towards people out of home than I am to him. Also, despite being a responsible and often helpful partner and father he lives in emotional childhood and when he feels nearly any negative emotion it's almost always someone else's fault (mine, his parents, my brother, the kids, etc). So here's my model...

C: My husband lives his life/functions in emotional childhood
T: This is so hard to deal with
F: Alone, heavy/sad, exhausted
A: ?? (... I actually tried to explain that his thoughts and emotions are up to him and no the direct result of others actions/thoughts/words/opinions and he staunchly refused to acknowledge that this could even be close to the truth, telling me THAT"S WHAT BEING A HUMAN IS- YOU GET AFFECTED BY ANOTHER PERSON!- then criticizing me for not recognizing/acknowledging how my behavior/opinion/etc affects others)
R: ?? (this instance clearly went nowhere...)

What action should I be taking here, or perhaps you have a suggestion on other thoughts and feelings to consider? Thanks so much. PS. I love love love the concept of emotional childhood because it encompasses a large part of the difficulty I have in this realm.

ANSWER
OoooF. Thank you for sharing this deeply relatable marital challenge that you are in right now~ as we so often point out here, YOU ARE NOT ALONE. This stage of learning how our brains work is very reproducible and can be painful if we don't look at our own thoughts here.

Listen - of course you are right in that your husbands emotions are caused by one and only thing, his thoughts. All of our emotions are caused by thoughts. And yes, there are circumstances that make it EASIER or HARDER to think thoughts on purpose sometimes. So - perhaps he is also right as well, no? Our thoughts often come up subconsciously, (i.e. not by our own volition) at first.

Ok, Let's look at YOUR brain for the time being. I am even going to give you your "C" here for the purpose of this work - (thought of course that is debatable 🙂 ).
C: My husband lives his life/functions in emotional childhood
T: This is so hard to deal with
F: Alone, heavy/sad, exhausted
A: Try to explain that he is WRONG. Get mad/indignant/resentful at his reaction to being called wrong. Focus even harder on his negatives. Direct anger at him, double down on your narrative that he is wrong and you are right.
R: You make it harder to deal with

First question: What if it's not hard to deal with?

No, I'm serious. What if your husband being in emotional childhood is actually easy to deal with. In fact, MOST humans live in emotional childhood. We can't control that, even though we may do our best teaching, explaining, and even trying to coach them- if they aren't ready to see it - we can not control that.

And.

What if that's not hard? Is it hard when children are in emotional childhood? Patients? TV characters?

If it's true that the ONLY thing you can control is your own reaction - (and, I promise, it is) - then stay there.

What reaction would you LIKE to have to your husband's emotions?

Start anywhere on your current model here and bring it back with a T, F, A, or R that you would like, and see if you can fill in the rest. Bring it back here and we can help - I promise this is beneficial for ALLLLL of us who interact with other humans..... ever. <3

re: LATE

Irrational optimist with an inner toddler who is used to getting her way, here. Coming back (BELATEDLY! very on brand!) to try to complete this model. I also REALLY recognize myself in the concept of the perfectionist fantasy that someone talked about recently - I can make a beautiful plan for the morning but shred it in minutes and prove to myself that I am as worthless as I suspected.

Here's another try at the: "I'm late in the morning" model:
1, C- It's 5:30 AM. If I don't get out of bed in the next 5 minutes, I won't be able to shower, get dressed, make coffee, and commute to work in time for sign out at 6:30,
2. T- it's cold outside the covers and it's comfortable here in my bed, I will just stay for a little longer.
3. F- cozy, warm, restful, [+ enjoying the dopamine hits from looking at social media]
4. A-spend 20-30 more minutes in bed
5. R- late to work

You said "I hate the way being late makes me feel". what is the feeling you have when you walk into work late?:
I'm anxious, stressed, embarrassed, angry with myself, already a little defensive, etc. But if I had to summarize it into one word, the feeling would be SHAME.

ANSWER:
Hi Friend! So glad you brought this back for more coaching. I totally LOL'd at "irrational optimist with an inner toddler", cuz SAME.

Listen, there is no moral superiority of people who get out of bed when their alarm first goes off. There is no moral superiority to people who are never late to work. None of your actual worth as a physician, as a woman, as a human being on this earth actually depends on what time you get out of bed, how long it takes to get out the door, or what time you walk into your clinic. You are good inside and worthy simply because you exist. This is a fact. 😉

Also, "late" is a construct of the patriarchy and capitalism probably, so if you want to get mad at someone other than yourself for once, let's ask the question of who benefits from you being ashamed of yourself? (Cuz it ain't you).

OK I'm off my soapbox and here's some coaching:

The problem here is how you treat yourself when you are in shame. Usually when we are in shame, we are defensive, we hide, we justify, we sometimes lie (to ourselves or to others), we blame, we talk shit to ourselves, we then become super accommodating of our inner toddler under the guise of "self care", we do all of the things to avoid the bad feeling.

The result of that, though, is that you sell yourself short! You sell yourself short of experiencing your fullest potential, and you sell yourself short of experiencing any POSITIVE (but still maybe uncomfortable) emotions that come with blowing yourself away with your own awesomeness every day!

Your inner toddler is used to rebelling and then is used to you giving in. This is a very ingrained pattern for you. That's fine. Now you know about it. You get to decide how you want to engage with your inner toddler.

Some questions for you:
What is the sentence in your head that makes you feel ashamed when you show up for work after the time you intended?
When you are in shame, what do you see yourself doing or not doing?
What are you holding yourself back from when you are in shame?
What is the upside for you of being late to work sometimes (there has to be one since sometimes you choose this result)?

Bring it on back sister.

<3

Unhelpful thoughts

I have been thinking about the call last night, thoughts that don't serve me. The one that keeps popping into my head is that "what I think doesn't matter". Especially in the context of fellowship and my previous struggles. I have this scenario (that may or may not be true) that because of my previous struggles in fellowship the entire program views me a certain way and because of that my opinions don't matter, whether its patient management, fellowship improvement or personal things. I often catch myself thinking oh that would me an interesting meeting to go to but what's the point, no one cares what I have to say. Or I actually say it out loud to some of my co-fellows. I know this isn't serving me but I can't let it go. I think its partially due to me trying to protect myself by keeping everyone at arms length but on the other hand I am not growing. I'm not even sure how to model this. Trying to add "but I should try anyway/what if they did listen/my voice does matter" just doesn't feel realistic.

ANSWER:
Nice job questioning your auto-brain. Let's see what this looks like in a model:
C: Fellowship history
T: "the entire program views me a certain way, so my opinions don't matter, and no one cares what I have to say."
F: ?? (what's your F here? resentment? insecure? disconnected? ______?)
A: PROTECT mode. They don't want me, Fine. I don't want them: distance yourself, keep people at arms length, complain to co-fellows.
R: You view the entire program in a "certain way" and it doesn't serve you.

Ok - so you are clear that this isn't working for you, but you are stuck in the T, yes?
First of all.... of COURSE shoulding yourself doesn't work. In fact, how do you feel when you add "no one cares what I have to say, but I should try anyway"? I'm guessing it's not a super motivating feeling.
And when you think "my voice does matter" what do you feel? If it's not working for you, my guess is that you don't believe it.... yet. Which is totally fine, but important to know since this thought isn't going to work for you if you don't believe it.

Let's play with a few other thoughts - let me know if any of these land:

-"No one cares what I have to say, but I'm going to say it even knowing that they don't, just for practice"
-"Most people don't care what I have to say, but there is one person that does: ____. So I can practice being my authentic self with that person."
-"Oh- I'm noticing my brain thinking that no one cares what I have to say again. Huh, interesting."

Finally - how do you know what you think does matter? Your opener to this thought download was literally "What I think doesn't matter" but then you went on to show how you are creating your entire reality with what you think! What if what you think..... is the ONLY thing that matters???

Fell off the BT Wagon

I got busy for the last couple of months (work, studying for boards, applying for jobs, etc etc) and stopped engaging in Better Together.

C: haven’t watched videos on the website or been on coaching calls
T: I’m so behind, I can’t just restart, I need to go back and look at everything from the beginning, ugh that sounds like a lot,
F: ignore/avoid/feel bad
A: disengage more
R: not getting the benefit of BT!

Help me jump back in?

PS- is there any way to automatically sync the coaching calls to my personal calendar?

ANSWER:
You know how I know that your thought "I fell off the BT wagon" isn't true?

BECAUSE HERE YOU ARE! Showing up for yourself, asking for coaching, doing a model!

What if there is no problem here?
What if you can get something out of BT even if you take a break in the middle?
What if you can get good things out of BT BECAUSE you take a break in the middle?

how might all of these things be true?

So much love, sister! We love to have you back <3

PS- you should be able to add the calendar with this link:

https://calendar.google.com/calendar/u/0?cid=ZGtzbzNobWRlZzJ0OW9taDI3YTRobmhyOG9AZ3JvdXAuY2FsZW5kYXIuZ29vZ2xlLmNvbQ

Clinic stress

Hello! I have made the shift from internal medicine residency, with minimal clinic experience, to a mainly outpatient based specialty. Residency clinic used to stress me out a lot, and it was mostly centered around timing, running late, not wanting to miss anything, and having complex patients. I think I had a lot of negative loops in my head tied to clinic coming into fellowship and not surprisingly, now that I do more clinic those didnt magically disappear. Now it is mostly centered around lateness. Ie my patient showing up late and throwing off my whole schedule. Me running late and making a bad impression on my patients, throwing off their schedule. My attendings not being immediately available to staff and throwing off my schedule. I have to actively try to calm myself down to not spiral about it in clinic, and I often have a physical feeling of stress/anxiety. I find myself comparing to my other fellows and how late or not-late they are running, and use that to feel better or worse about myself. I worry that the medical assistants secretly hate me because I'm the late one (I realize this is likely not true). All of those thoughts take up a lot of energy and take away from my patient in front of me. On really bad days, it makes me think I'm not cut out for clinic, and feel unsure of how I will do this my whole life.

for a model
C: Patient is late/ I am late
T: UGH. I can't believe they didn't show up on time/I can't believe I am taking this long with this patient. Everyone is annoyed that I'm running behind
F: anxious, rushed, judged, annoyed. frazzled
A: Fight urge to rush the next visit, Skip over things I would like to talk about. Apologize. Speed walk.
R: Every action is shaded by worrying about the time it will take. Perseverate on how late I am. Not be fully present with patient. Feel bad about myself.
Like I said, I've been trying to work on staying calm in clinic, but its mainly by brute force deep breathing, and reminding myself that sometimes people are late and thats ok. I would love to have a better way to work through this and set myself up for more positive feelings about a lifetime of clinic.

Thanks! <3

ANSWER:
Hi friend 🙂 First of all- serious congratulations on your insight and ongoing work. I'm going to add to your A line just so it's even more clear that this thought is getting in your way (and I'm going to pick just one thought for the model for now):
C: Patient is late
T: UGH. I can't believe they didn't show up on time
F: anxious
A: Fight urge to rush the next visit, skip over things I would like to talk about. Apologize. Use brute force to return to my breath. Speed walk. Compare myself to my other fellows and how late or not-late they are running, (and use that to feel better or worse about myself). Worry that MAs secretly hate me. Every action is shaded by worrying about the time it will take. Perseverate on how late I am. Not be fully present with patient. Feel bad about myself. Question how I will do this my whole life.
R: You don't show up at all for YOURSELF. (All of those thoughts take up a lot of energy and sometimes create the narrative that you're not "cut out" for clinic)

Whew. Ok - the fortunate thing here is that you already see that it's your thoughts causing this, and not your circumstance (at least in retrospect when you write about it - it may be a different story in the moment). The next step to get out of your thought loop that is not serving you is to get curious about your so-called "throwing off my schedule" situations.

Your cue to do this work is probably going to be when you notice your anxiety and feel some urge (or "should yourself") to fix it using forceful deep breaths. I want you to STOP trying to fix it. No more brute forced breaths for now, ok?

Instead, I want you to just simply notice the anxiety and actually let it exist for you. Watch yourself move through the day WITH the anxiety instead of despite it and resisting it. Write down what it feels like in your body. Notice how you are still taking care of patients, listening to their stories, staffing and doing the work of being a doctor - even though you have the anxiety. Ultimately, (I know this sounds nuts, but humor me) - I want you to INVITE THE ANXIETY TO STAY. Yes. Stay. For now.

Here's the thing about feelings that are resisted.... they end up snowballing and ironically getting bigger.

So the work in the moment is to notice and not resist the anxiety - in fact, it may be perfectly fine for anxiety to just be present with you (it is for me on the reg in clinic - and I have learned that it's actually not even that uncomfortable in my body if I just allow it to be there!).

Once you reach a point where you aren't automatically resisting your anxiety, you can begin to play with your thoughts. Notice each thought (the ones about attendings being slow, patient's being late, you running behind) and for each one ask yourself "so what"? Not nonchalantly or judgmentally, but just with curiosity. Maybe even do a model for each one.

Do you have a core belief that you and others should not be late? What happens if you let go of this belief (and even play with the opposite being true: "human beings often run late, and that's part of life/clinic.") and plan on lateness being part of your experience?

Definitely bring this for live coaching- clinic lateness is my fav topics to unpack. <3

Procrastination revisited... again

This really hit home for me, the double edge of deserving vs undeserving. Tbh when you first labeled it as entitled, and suggested I separate it, my mind entered defensiveness, i think because this is how I. cope/ignore/push down my inner critic, by avoiding it and convincing myself i am worthy when deep down i still don't believe it and those to dos and the feelings of unworthiness are right at the corners of my mind unless i focus entirely on something else (buffering with TV).

Not needing to earn rest is hard to imagine. why is it so hard?
Seems to me like it is a basic human need that people need to rest.
Maybe i get to rest no matter what, a bit every day, as an act of self love, to care for myself.
or maybe rest is just rest..
I think i am trying to make it mean something still (as a way to earn it indirectly). It is not something i have to set rules around or earn or be deserving of. It just is. This would mean really learning to listen to my body and resting when i NEED it.

WOW.

Now i just need to learn to listen to my body. (As a side note, the comment about ignoring bodily functions like when i need to pee - i notice myself doing it alllllll the time) - this is a big area of work for me. But, I do feel lighter letting go of earning rest and relaxation.

I think when I go to sit down i need a moment of reflection - what is my motivation? Is there something I am avoiding right now? Is this what my body needs in this moment?

I am trying to fit this back into an intentional model,, here goes..

R: less numbing and movement away from earning worthiness.
A: rest when my body needs rest, identify when i am procrastinating
F: Curious
T: What truly needs to be done? Am i still within my working hours? Is my body telling my i need something? (snacks, a break, rest?)
C: There are things to do

This was actually quite hard to tease out. i think the real task is being curious in my T to prevent the self loathing, am i worthy cycle.

(Old model:
C: There. are many things to do
T: ?? I actually am having a hard time identifying my thougths on this because it feels like a jumble of different ones... You need to work all evening to get this done, i am tired, maybe I can relax. for just a bit (4 hours later it is time for bed..)
F:overwhelm, lack of motivation
A: binge TV and feel guilty, try and multitask to make myself feel better but then i am inefficient AND not really relaxing..
R: my to-do list gets larger and more overwhelming, Hello positive feedback loop!)

This certainly feels better!

ANSWER:
Hi Friend! I LOVE the work you are doing here. This is IT. I love to see you asking yourself hard questions and then answering them curiously and lovingly.

You are totally right. The act of rest itself does not have any moral value until we apply it with the sentences we run in our brain. Just think about early hominids and how they didn't work in busy offices or have an EMR inbox to clear every day. Their literal survival depended on listening to their bodies, eating when they needed to/could, and resting when they needed to/could. I choose to think they weren't thinking "I"ve gotta sweep this cave before I deserve to rest before my 10 mile hunt for food tomorrow". I mean it's a grossly over-simplified example, right, but there's something there worth investigating.

What would happen if we untethered or worth from our productivity?

Why does this feel scary?

I love your intentional model, but I'm going to make some changes
R- You develop a practice of honoring yourself in mind and body
A- notice signals from your body, notice judgements you have about those signals, dialogue with yourself around those judgements from a place of curiosity, compassion, and LOVE (!?!), Rest when you need it, eat food that nourishes you, allow yourself to enjoy entertainment and fun without guilt, allow your feelings.... what else?
F- curious
T- (Try this one on for size) "I'm learning to listen to and honor my body and mind"
C- You are a human being on planet earth.

OK what comes up for you with that model?

XOXO

Followup from Dr. Wrights Call #2

-Is taking time for sensual (or bodily, physical, felt, etc) pleasure important to you?- My immediate answer to this is no, though I did briefly try to “work on this” for a few months before having kids but I wasn’t that consistent or “successful.” I’ve spent most of my life finding the most satisfaction from my body by pushing it to its limits- running and contact-sports. For many years the only way/time I felt safe in my body was when I was completely and utterly exhausted; the less I had eaten and the more I had exercised the more drained and 'safe' I felt (this was also called an eating disorder, which, thankfully after many years has resolved). I have certainly made progress from these days/years and no longer require absurd/unhealthy amounts of exercise to tolerate myself, but- is taking time for sensual pleasure important to me?, In my day to day life the answer is no, I don't think that it is; taking time for sensual pleasure actually seems self-indulgent and is hard for me to think much about. But should it be important to me?

-What "counts" as sensual pleasure for you?- Hmm. Sexual intimacy that is focused on me, massage, getting my nails done (as in a luxury/extravagance that is enjoyable and sensory), ....honestly the actually most enjoyable thing would be a pleasant care-free walk along the harbor with the sun on my face and a light breeze. And here, to be even more honest, I don't really enjoy and always decline sexual intimacy that is focused on me as I actually find it more anxiety-inducing than pleasurable (mostly).

-Are there other things in life that you consider "important" but may NOT prioritize if you got a sudden day or weekend off?- Hmm. I’m not sure on this one. You are right to suggest/consider that I would fill this time with things that I actually don’t place too much importance on; I would be more likely to catch up on “things that need to get done.”

-What are the downsides/costs of prioritizing bodily pleasure (or making it a habit)?- Wasted time that should certainly be spent doing something more productive.

-What are the upsides/pros of prioritizing pleasure?- It seems like it’s probably a good thing to do?

Thanks for walking me through this I'm clearly feeling mixed up about it all haha.

ANSWER:
Girl - this is the WORK!! I see a lot of self discoveries in your words, and I know it may not feel like forward momentum, but I promise it is. Yes - there are thoughts to untangle there about what qualifies as self-indulgence and why that is a "bad" or even "unproductive" thing. I think you know this work exists. But before you even go there.....

I want you to go through the next week and notice ALL of the things that feel pleasurable on your body when they happen. Definitely go take a harbor walk and feel the sun on your face, but start noticing what else feels pleasurable. Clothing material, scents, visual beauty in the world, a hug, or perhaps it's something you wouldn't be able to predict. See if you can find pleasure in things that don't get labeled as self-indulgent by your brain and lean into them.

What if sexual intimacy is not where you find sensory pleasure (for now, or maybe ever)? What comes up for you if you let that be true for a minute? For the time being, release yourself and your thoughts about sensory pleasure from sexual intimacy. I want you go let go of "I should enjoy sexual intimacy". When you should yourself - it feels like "working on this" to get it to be true, which is not productive and actually kind of ironic when it comes to sensual pleasure (which often comes through ease and.... well... not working, but rather letting). See if you can "let" or "find yourself" having pleasure in other ways and NOTICE IT.

Lastly - I want more from you on that last question (what are the upsides to prioritizing pleasure). Your thought "It seems like it’s probably a good thing to do" likely doesn't create a feeling that opens you to curiosity, but rather closes you down. Get into a creative space and brainstorm what could be a benefit for you and your life if you prioritize pleasure more than you do now.

Procrastination revisited..

OK sister. I'm SO GLAD you brought this here. "But I don't wanna" (resistance)--> "I deserve to rest" (entitled)--> Watch netflix, zone out, --> "Ugh, why did I do that! I should have gotten that stuff done (guilt)--> "What is the matter with me?" (Shame)--> BEAT YOURSELF UP, punish yourself by adding MORE to tomorrow's to-do list, give yourself unrealistic timelines, etc., then repeat the cycle and prove to yourself that you are failing.

Does that resonate with you?
This feels exactly like what happens. The question about what does it mean to relax is actually very hard to answer.. I think rest is supposed to be something restorative, something that fills my cup and provides resilience. Sometimes that is relaxing on the couch with a good show or movie and snuggling with my dogs, usually more when i am feeling extra stressed or exhausted. I think for the longest time I did not have any energy to do anything else. It is hard to recognize the difference between wanting to just truly relax vs wanting to numb and avoid.

Because I have just defaulted to tv for so long, I feel like I don't have many other activities i do to relax. I used to occasionally paint with watercolor, or do other crafts. Sometimes time with friends is relaxing when i am in the mood to be around other humans. Going to dinner or drinks with my partner. Being outside when the weather is nice. But so often when i think of doing things i just feel tired and want to just do nothing, i.e. netflix numbing.

In an ideal world, i would like to only work from like 8-6 maximum and would like 1-2 hours to devote to life maintenance (bills, wedding planning, chores, etc) and then 1-2 hours a night of rest/relaxation/restoration.

I feel reluctant to separate the idea of "deserving" from the action of "resting".. but i do not really know why. Maybe because it is a coping mechanism for stress?I feel like i have worked hard for so long and i just want to be able to do what i want when i want though i know that is not realistic...

I think the planning of time to relax may be helpful in separating deserve from resting.

ANSWER:
I'm so glad you brought this back.

I think this is SO important and you're really onto something here.

Here is the trouble with attaching "Deserving" with the idea of rest.
When we approach it as "I deserve it!"---> entitled (because I work hard, because I've done so much, because of whatever VERY REASONABLE SOUNDING REASON), there is a flip side.

The flip-side of deciding that sometimes you are DESERVING of rest, is an unseen condition that sometimes you are UNDESERVING of rest (because you haven't gotten all your stuff done, because you think you were "too lazy" yesterday, or whatever reason your inner critic offers that you might NOT be deserving today).

So my guess it that you are rebelling/numbing when you are in conflict within yourself about thinking you deserve rest because you work hard, but you also DON'T deserve rest because you haven't worked hard enough.

A few things to tease apart:
1. what would it look like if rest weren't earned by good behavior or whatever accomplishments you had accumulated that day/week/month? What would you have permission to do if you didn't need to earn rest?

1. Watching TV in and of itself is not positive or negative until you have thoughts about it. Right now you have thoughts that it's "numbing" ( which you are labeling as a bad reason) and also that it can be "relaxing" (which is a good reason).
How can you learn to tell whether you are watching TV as an act of rest/restoration or from a place of wanting to numb/buffer against something?

Bring it on back, sister!

Procrastination

I am in fellowship and a masters program. I am hitting a really busy point where i have a mix of assignments for school and a long list of To-Dos for fellowship research and patient care. Instead of sitting down and just getting shit done, I spend so much time procrastinating and negotiating with myself that i deserve the rest and just end up zoning out to netflix instead of getting anything done. Over the last few weeks I have spent all my time (evenings, some weekends) working despite telling myself that I am going to establish work life boundaries this year and work only 8-6 (or something like that). However, I cannot physically get everything done in that time frame so I feel likeI am failing on 2 fronts - failing to maintain work life boundaries and failing to actually get work done. I can feel myself starting to burnout again which leads me to avoid work and numb with endless hours of netflix which just lead me to feel more guilty.

I feel like if i could jus work efficiently during work hours maybe I would have less to do in the evening and could really relax... I also then skip yoga and other "cup filling" activities because i feel like i do not have the time or energy..

C: There. are many things to do
T: ?? I actually am having a hard time identifying my thougths on this because it feels like a jumble of different ones... You need to work all evening to get this done, i am tired, maybe I can relax. for just a bit (4 hours later it is time for bed..)
F:overwhelm, lack of motivation
A: binge TV and feel guilty, try and multitask to make myself feel better but then i am inefficient AND not really relaxing..
R: my to-do list gets larger and more overwhelming, Hello positive feedback loop!

I am working really hard to not beat myself to a pulp over this which is progress. I have removed the I am bad/failure etc talk which is HUGE! But i also just want to work when i need to work and relax when. I can relax.

Thank you so much as always!

ANSWER:
OK sister. I'm SO GLAD you brought this here. "But I don't wanna" (resistance)--> "I deserve to rest" (entitled)--> Watch netflix, zone out, --> "Ugh, why did I do that! I should have gotten that stuff done (guilt)--> "What is the matter with me?" (Shame)--> BEAT YOURSELF UP, punish yourself by adding MORE to tomorrow's to-do list, give yourself unrealistic timelines, etc., then repeat the cycle and prove to yourself that you are failing.

Does that resonate with you?

A few questions to consider:
What does it mean to you to "relax"?
Why is it worth it to spend time relaxing?
Get super granular here. What activities are relaxing or restorative to you? How much time would you like to dedicate to rest and restoration of your mind and body?

How might it be helpful to separate the idea of "deserving" from the action of "resting"?

Bring it on back here, friend.
XOXO

Followup from Dr. Wright's call

I listened to the special coaching call with Dr. Sonia Wright a little over ten days ago. It prompted some good thinking but then I got busy. I can't remember everything that was discussed in the call now that it has been some number of days, but I found myself thinking about it yesterday again. The part that I don't remember, or perhaps wasn't discussed, is -why is taking time for sensual pleasure important? If I was given 12 or 25 or 96hrs free with absolutely no responsibilities I would spend none of that time pursuing sensual pleasure. I remember Dr. Wright discussed barriers- time constraints etc.. but I can't quite remember the answer to why this is something that I should make time for. I will also try to listen to the call again. Thank you!

ANSWER:
I want you to look inside rather than outside for the answer here. I specifically don't want to lead you in any direction here: you may find out that sensual pleasure is not important to you, and then great! There's your answer. I just want to be sure you like your reasons.... and perhaps more importantly are aware/conscious of them either way. So, answer these here (don't go listen to Sonia's call for answers- tell me from your own inner wisdom!!), and bring them back to ask for coaching!

-Is taking time for sensual (or bodily, physical, felt, etc) pleasure important to you?

-What "counts" as sensual pleasure for you?

-Are there other things in life that you consider "important" but may NOT prioritize if you got a sudden day or weekend off? (i.e. is this a good test of importance, or are there things that may be important that don't fall in the category of the first thing you'd do with some surprise free time)

-What are the downsides/costs of prioritizing bodily pleasure (or making it a habit)?

-What are the upsides/pros of prioritizing pleasure?

Surgery

C: The attending took over a surgery because I was slow (although I'm trying to make that sound objective, it feels...not)
T: I'm never going to get better at surgery
F: Inadequate, embarrassed, frustrated
A: ...not sure
R: I never get better at surgery

Tyra! I feel like my model relates to your central line story in one of the BT lessons. I'm trying to take all that y'all have taught me, particularly the growth mindset, but I feel stuck. I'm not mad at myself for being slow because I know that I just need more experience... I feel like the main way to get better is through repetitive experiences, but what do you do if your attendings take those experiences away from you because you're not where they want you to be technically? It feels like a lose lose - I'm slow at surgery because I'm inexperienced, but I can't seem to get more experiences because I'm slow. How can I reframe this so I can perhaps feel less stuck?

ANSWER:
Hi friend! There is such good news here - which is your amazing level of insight (much higher than mine during my central line dark days). I would start by getting clarity on your C line in this case. You think that it is a fact that you are slow. But this is actually a thought. Do you have evidence that the attending took over because you were slow? What specifically did the attending say to you? This is important so that you can get an idea of your attending's expectations for your speed (perhaps this attending takes over every resident after 30 minutes or something, and expects to do that and you are right on track... or perhaps the attending would tell you that you are the slowest one that she's ever worked with and offer advice on how/where to speed up.) My guess is that it's somewhere in-between.

But let's pretend, just for the sake of this coaching argument that your attending does say to you: "yes, you are the slowest resident I've ever worked with and I had to take over because your hands were moving at sloth speed." Now, what you think of that is totally up to you. You have already proved that your current/automatic thought "I'm never going to get better" is not helpful to you, and is not making you better. My guess is that the actions it prompt are mostly... inaction, yes?

So, let's see if there is a different thought that at least feels as true to you. Have you ever gotten better at something you were really not good at before (medical or non-medical)? Write about that time. If you can't come up with anything, then let's say this will be the first time you can practice and then prove that you can go from being task-incompetent to being task-competent. Start by filling out this result model and bring it back here so we can help coach you into a believable thought to practice:

R: Get better at this surgery
A: What actions would someone in a growth mindset??
F: What feeling would fuel these actions?
T: **** (the key of it all) - can you think of a thought you believe now that creates this feeling, in this scenario? If not, let us help!
C: Attending takes over surgery and tells you it is because you are moving too slow

Grand rounds regrets

C: I was asked to do a grand rounds presentation and am now regretting saying yes.
T: I am not well-equipped for this nor am I an expert in this subject area. I don't have career aspirations in academia (honestly just trying to survive residency at this point) and I don't see how this will help me in the long run. Working on this presentation has also cut into my vacation time which has been much needed in the middle of a very stressful and taxing few months. There are so many others are more deserving, intelligent, and would have been more appreciative of this opportunity than I am.
F: Regret, anxiety, stress, (and honestly) guilty for taking away someone else's opportunity
A: Procrastinating tasks resulting in further shame. Putting stress onto family members.
R: Further regret, anxiety, and stress. Inability to enjoy moments when I'm not working on this presentation.

ANSWER:
Love this very VERY relatable model. I'm going to push you to pick just one thought to work through so that it becomes crystal clear if it's serving you or not. Each thought leads to a different feeling and slightly different actions/result. Let's pick this one:
C: I was asked to do a grand rounds presentation
T: I am not well-equipped for this nor am I an expert in this subject area.
F: Anxiety
A: Procrastinate tasks and then shame yourself for it. Take out stress on family members. Regret the decision and question if I should have said yes. Work on presentation during vacation instead of relax. Make up a story about you you took away someone else's chance (as if you had that power).
R: You unequip yourself to present or enjoy the prep.

Ok- good to know that telling yourself how you aren't enough only results in procrastination, shame, and regret (instead of getting what you need or thinking about what the audience needs from the presentation).
Do you think that everyone that's given a good GR has been an expert? We can probably agree that every single person who has given GR talks has had a first one at some point..... and that at that one they were unexperienced, or to use your words.... not well-equipped, yet.

Let's start by making this presentation more about the audience and the content than about you.
Do you believe that you have to be an expert to give a grand rounds talk that helps people? What do you have to do to deliver information that is useful to people?
From this space, see if you can fill in a result model:

R: you do your best to equip yourself and find enjoyment in the prep
A: what would this look like? List everything you need to do or not do
F: what feeling would fuel these actions?
T: what thought gets you to this feeling?
C: I was asked to do a grand rounds presentation

Thoughts to try if you are stuck:
"I may not know that this is fun for me!"
"I have gone from unequipped to equipped before in my life, I can do that"
"Sometimes, the audience needs a non-expert to present to them"
"I wonder in what ways this could be fun"
"I wonder how this can serve me even though I don't think I want to stay in academia.... what might this experience teach me"

Assessment Bias

If feedback is mostly subjective and mostly dependent on the rater, how do we know which feedback items to take to heart vs. discard? (ie, how do we avoid just rejecting all constructive pieces of feedback and only holding onto positive pieces of feedback...along those same lines, what if there is a true issue with my performance that I should probably address but I just discarded those pieces of feedback because I didn't value it/want to take it to heart?)

ANSWER:
Yes! Feedback is mostly subjective and dependent on the ratOR much more than the ratEE. Yikes.
The answer to your question is: You get to decide which feedback items SERVE YOU and which ones don't. The caveat is that the feedback that serves you will not always be the feedback that feels good or easy. So the work here lies in that caveat, and we highly recommend you start by shifting yourself into a growth mindset (See the worksheets for weeks 1 and 2 of this month!) - where you are: 1) not linking your assessment to your worth and therefore 2) open and curious about constructive feedback rather than defensive.

The way to see if this feedback serves you or not, is to bring awareness to what thoughts, feelings, actions and results the CIRCUMSTANCE of feedback is giving you in this moment. Then, you get to decide if you want to keep thinking that way about it, or if you'd like to change it in some way (and reach out here for help!! That's what we are here for!).

So, yes, feedback is mostly subjective and rator dependent, BUT - you get to decide how you think and feel about this rator's opinion, what you want to make it mean, and how much weight you put on it.

Next step - bring a model back here with a feedback situation you have going on and let's get to work!

Difficult mentoring situation

I am a second year fellow (3 year fellowship) entering into research years. Our program requires application to a research grant our first year but there are only 2 attendings qualified to mentor on that grant (one is mentoring allll the other fellows and the other is my mentor). I was kind of left without a choice but to pursue this person as a mentor and it’s not going well for a few reasons. First, I don’t think this person intended on mentoring fellows. They are new to the institution in the last 1-2 years and they are our new division chief. However, this person is head of a research database and I have an interest in informatics and so getting “in” on this could be really great for my career and align with my long term goals. Lastly I want to stay here after fellowship so this allows me a unique, valuable position here.

However, every step of the way I have needed to find my own way through things. My mentor is very busy and often doesn’t answer my emails or questions. I have a standing meeting with her monthly but it’s not enough to keep me moving forward. One of our meetings she started with, “so have you done anything yet?” I was devastated. I want to impress her since I want to stay but I also feel like I am getting no guidance at all and I have never done my own research before. I have started reaching out to other people for guidance which is helpful but this person is still supposed to be the guiding force for my project and I leave meetings with her more confused than when I go in. Am I just expecting too much hand holding.? Should I be able to just figure this out? I want to let go of what she thinks but she will ultimately decide if I can stay so that feels hard.

C: I have a research project and a mentor
T: my mentor is not guiding me, I am frustrated yet feel like it’s my fault and I just need to do better. I am stressed about not progressing in my research project and feeling like this is influencing my future career options.
F stressed, anxious, feeling like a failure. Stuck
A: spending lots of time trying to figure it out and still being lost. Not making progress. Seeking out other opinions but those people aren’t in the know about the project, so I spend time reexplaining in attempt to get guidance.
R: I’m 4 months in with little to no progress on a project.

ABSWER:
Hello Friend,
First off, I just want to compliment you and the recent posters who are doing a REALLY nice job in your models.

Wooof! OK sister. You are not alone in this. It is SO HARD to feel like you aren't getting the support you need when you are doing something new. I could totally jump into the pool and splash around with you and agree that she isn't being a good mentor, but that wouldn't help you, so I'm gonna get out of the pool and toss you a life jacket, OK?

In your model, It's important to choose just one sentence on your T line. You have several Ts in there and a couple Fs too. From there, choose the ONE feeling that T generates in your body.
- My mentor is not guiding me. -->?
- It's my fault---?
- I just need to do better---> FRUSTRATED
- I'm not progressing--> STRESSED
- This is influencing future career options--->?

Here's my guess at a refined version of that model
C- You have a research project and Mentor
T- I'm not progressing
F- STRESSED
A- look for evidence that she's not helping you, chase your tail trying to figure it out, seek guidance for others, (what else do you do when you are stressed? what do you not do?)
R- You are where you are now in the project

A few things I'd love for you to think/write on and come back here for more coaching...

- How is it NOT true that you have "made no progress"on this project. Make a list of the things you have done so far and all the things you have learned by figuring it out yourself. what was the model that lead to those results?

- Hypothetical situation: Let's just say we all (even the mentor) agree that she is not guiding you- she's got you on the back burner and is open about it. Let's put that on the C line. What are all the different thoughts you could have about that? Range them from catastrophic to success even despite the mentor. Which of those are believable? Why?
Ex:
C- Mentor is not going to guide you.
T1- if this fails I won't get a job here and that will suck because____
T2-
T3-
..........
T10- All of the results of this project will be because of me and the work I put in.

Ok my friend. I'd love to know what comes up for you here. Please bring it back for more coaching or to a call!

<3

More time with less product, now on the job trail

I am a fellow that chose (actually convinced their fellowship program) to do extra training (2 clinical years+2 research vs the normal 3 years total) to be able to do cross institution work (between adults and kids). I am now part way through the second year of my research training and in the process of getting a job. My research time has been close to a complete failure. My mentor and project ended up not being bad fits and I ended up having to do double work (what she wanted and anything else I could find so I could have an end product) while dealing with someone who is vindictive when crossed. Additionally, because i have x2 the clinical commitments, I have been stretched very thin. Now after 1.5 years of research, I have little product. I am now trying to get a job and need to do a "job talk" on what I have accomplished and what I can bring the institutions I am applying. I feel like my main accomplishment is just surviving, but that doesn't work to get a job in academia. I would like to have some protected time to utilize my double training by doing a cross over clinic/program, but I have no history of program building or successfully executing clinic research. I am panicking that I should just walk away from academia since I haven't been successful thus far. I feel overall like a failure and a fraud who bit off more than they can chew and is now dealing with the repercussions.

C: Chose to double train, spent extra time doing it, has no product to show for it and now has a more complicated job hunting process
T: i screwed up everything. I will continue to screw everything up.
F: Despair
A: Panic. Grasp at new projects to hopefully succeed at anything to be able to show that I can do things.
R: Become more thinly stretched.

ANSWER:
Great thought download and model. The only thing to change is the C line, since right now it's full of Ts. I also want to bulk up your A line as much as possible so your result becomes really clear:

C: I am a fellow that chose 2 clinical years+2 research. I am now part way through the second year of my research training and in the process of getting a job.
T: I screwed up everything. I will continue to screw everything up.
F: Despair
A: Panic. Consider leaving academia. Grasp for new projects thinking that they will make you feel better (to hopefully succeed!) and have a new R. Blame others (the mentor), blame yourself (a lot). Downplay all accomplishments ("just surviving").
R: Become more thinly stretched..... and turn away from your goals, achievements and vision.

Ok. This is where you are right now. What I know, as a coach, is that actually nothing has gone wrong. What I know also as a medical educator, an academic doctor, and a leader - is that a LOT of things have gone right. The work here is for YOU to find that and show it to yourself.

I want you to start by rewriting the lie you have told yourself that you "haven't accomplished anything except surviving." Write a list of the things you have accomplished in fellowship. The first list should include ALL the things. Patients you've cared for, learners you've taught, anything you wrote, read, learned yourself, and also relationships you've cultivated, haircuts, showers, dinners you've cooked, hell - hours you've slept. All the things. It feels silly, but humor me and do it anyway.

Then write a list of the things you have accomplished in this research endeavor. Your brain doesn't want to (it wants to continue to spiral in the above thought download, but we aren't going to let it for this moment). Write about the things you have learned about yourself. The things you have learned about difficult relationships. About good and bad mentorship. Write about any mentorship (formal and informal) relationships you've had. Write about what you DID do in your program. Did you do an IRB? Visualize a study design? How many emails have you written? What kind of research of the literature have you done? Get detailed. This is important.

Finally - consider where you are going with these skills, lessons and mistakes you've made? How will each one help you? Can you be glad for "biting off more that you could chew"?

I challenge you to bring a thought download back here about why this is *for* you rather than against you. I know it feels wrong and hard, but this is THE WORK. That narrative will move you forward, I promise.

MXE DECISION 2

C: "I divorced from x"
The divorce was definitely my choice and it happened as close as possible to what I wanted it to be. The most hurtful decision of my life was choosing x! I had a lot of resistance to accepting that it was a wrong decision and I spent 6 years of my life and a lot more of my psyche to fix it but it didn't work! I am glad that at the end I was able to accept my mistake and as you said show up for myself and leave...
T: I made some mistake in decision making on some important junctions in my life
F: regret? (sometimes, I listen to guilt and regret are my twin great brothers!; it's a song) It feels like a tension behind my neck and maybe under my chin. like feeling after. hanging yourself! I can only imagine how that might feel but it feels very close to regret. I am not sure if what I feel is regret. I think about regret a lot but don't feel it as much.
I feel more disappointed. disappointed feels like eyes filled with tears in a room full of strangers when you don't like to cry. It feels heavy in my airway and burning in my eyes. It is dark blue with red lines, like a heavy velvet curtain moving with the wind.
I feel lonely; feels small, painful (headache or stomach ache), I
A: makes me sleepy and weak. I read poetry and cry. I listen to myself and console myself (I am my own mother, daughter, sister, friend and partner sometimes: It felt so close to my heart when I read Samuel Becket wrote something like that about himself!), I help myself feel as good as possible, whenever possible
R: I continue to make important decisions for myself with a little dread of the mistakes and disappointments that might happen in the future.

ANSWER,
Hello there, I'm so glad you brought this back for more coaching. I'm really proud of you for putting this in a model and for feeling those feelings that came up.

Here's a secret: No one gets to tell you how to tell the history of your marriage or your divorce. You get to remember it however you want to, and you get to share the story when and how you want to. No one gets to do this for you.

Here's what I see:
When you think "I made some mistakes in some important junctions in my life"
F: regret
A- you speak to yourself condescendingly, you beat yourself up, you shame yourself for the decision you made, you dread future decisions and anticipate the ways you're going to make another mistake,.
R- You undermine your relationship with yourself

You also have a different model, that I think many of the actions you listed are coming from:
C- Your divorce
T- "I am my own mother, daughter, sister, friend and partner"
F- (how do you feel here?)
A- you read poetry and let the tears come, you listen to yourself, console yourself, you allow yourself to feel as good as possible whenever possible.
R- You support yourself and have your own back, showing yourself how to love by loving yourself first.

Right now, the way you are presenting the story to yourself is that you made a "mistake" or a wrong decision to marry X and that it's taken 6 years of your life. It is totally OK if you want to hold this version of the story. It's OK if knowing what you know now, you wouldn't make that decision again. But look at what happens when you speak to yourself this way: you cut yourself down. Then, look at what happens when you speak to yourself as your own mother, daughter sister, and friend: you show yourself love.

Regret, guilt, disappointment, loneliness, heartbreak, those emotions are all part of the human experience, and they aren't always the result of us doing something wrong or making a bad decision. They are sometimes the price we pay for experiencing connection, joy, fulfillment, and love. You can feel regret and guilt and disappointment, but you're also allowed to feel grief that it wasn't what you planned, sadness that it happened the way it did, or relief that it is now in the past.

If you could tell the tale of this relationship in a way that fully honored yourself at every step, how would it go? Sometimes, it helps to write it down as a letter to your past self...

"Dear _____,
I 'm writing to you from after the fact. The marriage wasn't what you expected......
I know that you_____________
I'm proud of you for____________
I'm sorry that _____________

What else would you say to yourself?

So much love, sister <3

feeling broken/defective

I have a long term partner who I've been with since medical school. They're great and I'm really glad they're in my life, but part of me worries that I don't love my partner or feel passionate about our relationship the way I "should" - the way that my friends and peers seem to feel about their partners. A large portion of what I imagine people feel about their partners comes from social media, books, movies etc which I know is 100% viewing through rose-colored glasses. Still, I think that my experience in my relationship feels different than what I hear from my very close friends and how I see them interact with their partners (again, not completely unfiltered but more real).

I've always called myself independent, an introvert. I love my friends and my family and my partner but at the end of the day I feel most relaxed when I'm on my own and my time isn't accountable to anyone else. I feel guilty that I don't want to spend 100% of my little free time with my partner. I feel like I should. I feel like I should be more excited to see them or to plan activities together, when really I just feel excited to take a breath and do nothing. They'll tell me they're so excited to do X thing together and I feel kind of neutral about it. I want to feel more excited, but I just don't. I feel like I've been holding back on moving forward with our relationship (ie the big marriage question) because worry I don't love them enough (even telling them "I love you" feels awkward and unnatural many years in). Yet at the same time, it's hard to imagine myself feeling "more" for anyone else (am I capable of feeling more strongly about someone? I tell myself it's just that I'm not keen to be dependent/reliant on another person). On paper my partner is everything I could ever ask for in a long-term partner (smart! funny! curious! caring!). I trust them unwaveringly. I don't want to break up but because of my "indecision" about moving forward I do think about it on occasion. Then again I've dedicated so much time to this relationship and can't imagine "finding anyone better" "at this age" (and again, maybe this is just how I as a person would function in any relationship). I guess on the whole I feel broken.

Even in other aspects of my life I've always felt indecisive, had difficulty committing, wondering if I'm making the decision that will lead to the maximal amount of happiness. I know this isn't a helpful way of thinking. I just can't stop myself! Even if/when I acknowledge it it just feels like I'm "ignoring" rather than "re-orienting." I tell myself I have good insight into my thoughts/feelings, but I'm bad at converting that into healthier thinking patterns.

C: My partner wants to get married.
T: Shouldn't I feel sure about this decision? Is this what love is supposed to feel like? Am I incapable of love? Should I just be alone?
F: Hollow, inadequate
A: Laugh off the question. Put off serious conversations. Make excuses to talk later. Fill my time with mindless television. Avoid rom coms because even though I know they're not real they minimize what I have. Worry about moving my life forward by delaying this decision (I want kids and all of my friends are starting to have kids).
R: Create distance in my relationship, which is part of what I worry about to begin with. A self perpetuating process!

ANSWER:
Hi Friend, I'm so glad you brought this here.

Something funny happened and it initially posted without my response, so I'm correcting that now. So sorry!

Alright my friend.
I want to offer you that here in this space you get to explore what YOU want. there is no right/wrong or good/bad way to imagine your relationship, no one's opinion matters here except yours. I'm going to ask you a few questions and I invite you to reflect on them for a few minutes and bring what comes up back here or to a live call.

1. If you got to decide what an ideal relationship was for YOU, what would it be like? Resist the urge to compare to your friends, to TV, to social media etc- what would YOU want if you could define it for yourself?

2. What does passion mean to you? Where do you experience passion in your life now? Would you like more? Why or why not?

3. You said you feel guilty because you don't want to spend 100% of your time with your partner. Why should you feel guilty about this? In what ways are you a BETTER partner to them because you aren't with them 100% of the time?

Ok friend. I invite you to come back here and we can keep exploring this. <3

indecision about life after residency

Thinking about what I will do after residency is extremely stressful. I feel a lot of pressure to be done and have a “real job” with a better income and more control over my schedule. My partner has supported me and our kids financially while I’ve gone through MD/PhD training and currently slogging through residency. My residency salary doesn’t even cover what we pay for daycare each year. It seems that one of the only long-term career options, without doing fellowship, is primary care. I don’t think I want to do primary care because it seems extremely stressful to be able to cover everything in short appointment times, feel responsible for not missing anything that requires specialty evaluation, have sufficient follow-up with patients when there is no time set aside for doing that properly, all over the background of the significant documentation burden. Fellowship would allow me to follow my research interests, build long-term relationships with patients, have a mix of inpatient and outpatient medicine, become an expert in a narrower field. Completing a fellowship would also provide me with more flexibility – stay in academia doing research, go into industry, go into private practice. I struggle with my reasons for wanting to do the fellowship. Is it on some level because I don’t want to feel like I have wasted time on an MD/PhD, don’t want to disappoint mentors or is it because my partner doesn’t want me to do fellowship, which makes me want it even more?

I feel like there is at least two different things that I am struggling with:

C: I am a resident who is making decisions about post-residency plans
T: I can’t make a decision that will make me and my partner happy
F: fear of partner’s resentment
A: avoiding talking with my partner about it (the few times we have tried to talk about it, the discussion gets heated and we switch subjects), reaching out to mentors and making plans for applying and not telling my partner about it
R: not moving forward with decision

C: I am a resident who is making decisions about post-residency plans
T: I am not sure if I want to do fellowship because it aligns best with my goals or because it is what is expected
F: Conflicted
A: Spending a lot of time ruminating on decision
R: not moving forward with decision

ANSWER: Great insight! The theme is that both of these thoughts are not getting you closer to a decision. A sub-theme is that you believe there is a "right" decision, yes? It sounds like you believe that the "right" decision is one in which everyone is happy, aligns perfectly with your well-defined goals, and will make you a bunch of money with ultimate flexibility. And here you are, sadly without a crystal ball, so you have created an impossible puzzle, sister. A final theme that I see is some black and white thinking. You make several assumptions here that may not be true:
-You can't follow research interests and have a thriving scientific career if you choose primary care.
-Your mentors will be disappointed based on your choice (or that you even have the power to cause disappointment in your mentors).
-Primary care is stressful
-Primary care doctors need to not miss anything
-There is not enough time set aside to follow up with patients as a primary care doctor
-Fellowship = more flexibility
-Not doing a fellowship means your MD/PhD is "wasted time"

You have laid out a beautiful argument of thoughts pointing you in the direction of fellowship (hooray, sounds like an easy decision!) and yet, here you are, feeling torn. Why? You say you "struggle with your reasons" about wanting to do fellowship, but why? Why are you judging your reasons? They seem perfectly fine to me if you give yourself permission to like them. Digging into why you aren't may be productive (feel free to bring that though download back here!).

Finally, I want to remind you that your career choice does NOT create happiness for you, or for your partner. Your career choice goes in the C line for both of you. And "happy" goes in the F line. This is great news since you can choose a thought that creates happiness no matter WHAT decision you make (which is why many people are happy with specialty or primary care and others loathe it, despite the C's being the same).

Let's play with your imagination here. Let's pretend for a moment that you will achieve the ultimate happiness no matter what you decide. That's in the bag. Let's also pretend that you have ZERO control over anyone else's feelings (including your partner, kids and mentors). Get into a place where you are not trying to figure out future happiness for yourself (pretend you will have this no matter what). Along with this, let's pretend that your worth and achievement is also in the bag with either decision. Give yourself permission for just this fantasy to believe that those things are taken care of. You get the Nobel prize as either a PCP or a specialist, or however you need to frame it for this pretend game.

NOW from here, what do you want to do? Purely for the experience of it? For the fun of it? For the process? What seems the most interesting to you? What seems like it will challenge you in ways you want to be challenged? Fulfill you in ways you want to be fulfilled? Where is the meaning?

hating chores

Thought download
I recently read an article about the impact of unpaid labor (e.g. housework, childcare) on mental health and how it disproportionately affects women. The article resonated with me because I find myself constantly dreading/resenting doing what feels like the majority of the daily household chores. My husband has always been messy. It is something that I was well aware of before we got married and I am not under the assumption that I can change his ways. We also have two little kids who by nature are mess-generating machines. I would not classify myself as a neat freak, but I do feel calmer when the house is clean and I can see the floors and I’m not cursing (under my breath, of course) stepping on Legos. When I get home from a 12 hour shift (that inevitably is actually 13-14 hours), it is incredibly difficult to find the energy to clean up after dinner, wash lunchboxes, get the kids ready for bed, etc, etc. I also feel guilty since because of my inflexible work schedule my husband is the one who is almost always doing the drop off and pick ups from daycare and entertaining them before I get home, which can be emotionally draining especially after a long work day. Then I feel the need to overcompensate by doing all of the things to make it easier for him.

C: household chores
T: why do I always have to do everything even when I am exhausted
F: resentment
A: do the chores, prioritize cleaning rather than spending quality time with my kids before they are in bed, snap at my kids when they are doing normal toddler/preschooler things by dragging out cleanup because they get distracted, don’t verbalize appreciation of the things my husband does since I feel like I do a lot and do not feel appreciated
R: create emotional distance between me and my husband, miss out on precious quality time

Please help me reframe the way I approach thinking about chores and the various thoughts and feelings it brings up. I have played with the idea of trying to think of it more as a gift to myself and my family, but would really appreciate any additional insight. Thank you!

ANSWER:
Hello! I wonder if, by any chance, you stole this thought download directly from my brain? You are not alone in this experience, sister.

I want to draw attention to something brilliant that you've done in this thought download and your very insightful model. You have shown that 2 things can be true at the same time:

1. There is a very real impact of unpaid labor that disproportionately affects women.

AND

2. When we think "Why do I always have to do everything around here" we create even more disconnection in our relationships and waste the time we DO have which makes that load even heavier.

right?

I'm curious about what happens (honestly) when you try and reframe it as "a gift to you and your family"

C- household chores
T- "Me doing them is a gift to me and my family"
F? (what comes up when you think that thought? If it's not believable to you right now, why? put that answer on the T line of a different model)
A?
R?

Why do you think that this reframe isn't working?

This is so important and I invite you to bring this next model back here for more coaching. This is IMPORTANT work, friend.

Anxious on Call

Hello!

I am a PGY2 in Pediatrics, and am currently on a rotation where for the first time I am taking home call. I'm also on a community rotation with both hospital and clinic responsibilities, so on my call nights I am covering community calls (essentially parents needing advice), the newborn nursery, ED consults, admissions, and nursing questions/concerns for kids admitted to the Pediatrics unit (so lots of different things!). I've found that on these call nights, even though I'm at home I have a really hard time relaxing or focusing on absolutely anything other the anticipation of my phone ringing. I think it's mostly the idea that I could be called about essentially anything at any time, and that a single phone call might change the course of my entire night or that it might be something that I don't feel prepared to handle. I was wondering if you have any advice of how I might be able to reframe my mindset so that I can still find a chance to rest or relax on the evenings that I'm on call? Thank you so much!

ANSWER:
Girl, you are speaking my (lower-brain) language. Let's see if we can put one of these thoughts into a model:
C: PGY2 pediatric residency with home call
T: A single call might change the course of my entire night and be something I don't feel prepared to handle.
F: ??? (fear? Unprepared? Anticipatory? ---> pick one)
A: Only focus on future moments that *might* happen. Disregard the many moments of rest and no phone ringing that you do have. Don't rest or relax, sit tensely. Wait for phone to ring.
R: YOU are changing the course of an otherwise pleasant night

Something that I find helpful in these situations is to play out the worst case scenario. What if you DO happen to get a call that you "don't feel prepared to handle?

No really though - answer that. What then? List the very specific actions (list all of them) that you can take to figure out or delegate what to do in the situation where you feel underprepared.

Digging a bit deeper here - I am wondering why you would resist the situation where you don't feel prepared. Do you have a belief that you SHOULD feel prepared to handle all of the calls that come your way?

If so: why? (thought download alllll the reasons).

If not: You might start playing with a "reframe" - try playing with a "Reverse Model" where you work your way up from an R that you pick:

R: You accept your night (and yourself!) as it is

A: ??? (what would this look like?)

F: ??? (how would you have to feel to fuel these actions?)

T: ???? (what thought do you believe now that cultivates this feeling?)

C: PGY2 pediatric residency with home call

Problem with the word "should"

I am trying to be ok with being human. And it’s hard, ha! I have such ideals of how/who I “should” be that it’s a struggle to be ok with believing that I am already enough.

Thought download: I have a dear friend, J, whom I’ve been friends with for 20 years. Our friendship started as roommates in college and then our paths have crisscrossed until about 6 years ago when we again lived in the same town. We are very similar but also very different. She has impossibly high standards for everything and seemingly everyone and at times is quite particular and critical, traits she is verbally owns. She’s married and has kids and I’m single with a dog-child, so I’ve bent and molded our relationship to fit around her. AND she has a much stronger personality than I do, so it always seems easier if things go her way. So many times, I have disagreed with things but I never felt comfortable sharing those thoughts. And part of that’s on me (I’m working on it!) but part of it is that I haven’t felt “safe” enough to disagree. I have since moved to a new city and over the past year there have become topics that I decided I cannot talk to her about, my dating life and covid, because at the end of a conversation I feel belittled. And ultimately poorly about myself and my feelings. I feel misunderstood by her. And part of it is I know 100% she is multitasking like a pro during our conversations which makes me feel more disconnected. Then this summer her family had a vacation planned, got covid, and went anyways. I was upset by her actions and she became defensive and said “I shouldn’t have told you we tested positive because I know you’re sensitive about it.” Enter the INFJ Door Slam. That text conversation about covid was the last straw. I have felt I just need time and space. She called me out about that too, but I wasn’t in the headspace to be honest. I feel once the floodgate opens, I will regret what I say. But my brain keeps ruminating over it all. She had major surgery a few weeks ago, I sent a card but am feeling very guilty that I cannot show up for her in the way I think I “should”

There are quite a few models in there that I can tease out.
C: J and I have been friends for 20 years. We had a disagreement where she called me “sensitive”
T: Gosh why can’t I be strong and stand up for myself
F: belittled
A: Ruminate over all the times we disagreed in the past and I never said anything, bring up/relive past events and emotions over and over again, wonder what’s wrong with me: why I am so sensitive, limit my connection with her, don’t offer myself patience/grace
R: me feeling worse about myself, taking precious brain energy away from the task of being a resident

C: My friend has complicated family dynamics and on top of that had major surgery
T: I know I “should” be there for my friend during her difficult time, but I don’t want to
F: guilt
A: beat myself up about not being the supportive caring person I have always prided myself for being, binge eat trying to eat away the feelings, tell myself that if I was a better person, I would forget and forgive, worry about what she thinks about me
R: same as above: me feeling worse about myself, taking precious brain energy away from the task of being a resident

C: I have a human brain
T: It’s so humbling to try to ‘believe” that I am enough right now
F: exhaustion
A: put more pressure on myself to accept myself
R: more exhaustion…

Gosh, I think the hardest thing is my brain is always thinking, so many thoughts, so many feeling. I’m trying hard to remind myself that I am ONLY responsible for MY happiness and not that of others

ANSWER:
Hello Friend. I'm so glad you've brought this here.

I totally get it! It's hard to suddenly ask yourself to believe you are "enough" when for 20+ years, you have probably believed some version of the opposite of that thought which got you really, really far (or maybe you got really far in spite of it, we don't know....).

Now you're rumbling with it because a part of you is outgrowing it and a different part of you wants to hold on to it. The part that wants to hold on to it isn't sure what is on the other side if you decide to believe you are "enough". What will happen? Will you suddenly give in to sloth and never get off the couch again? Will you stop calling all the people you love? What's scary about deciding you're enough?

The situation with your friend is presenting itself as a way for you to explore and define FOR YOURSELF what it means to be a "good enough" friend. Let's explore that a little bit.

Let's pretend we are visited by aliens who know nothing about human society. It's your job to tell the alien what it means when two human beings are "friends". What would you tell that alien are the rules of "friendship" and how we know if we are doing friendship right. Make this list as long and specific as you can

A good friend always:
-
-
-

A good friend never
-
-
-

A friend sometimes
-
-
-

Once you're looking at this list, I want you to take a look at it from a perspective outside of yourself.
Are those rules achievable?
Are those rules that most people would agree with about friendship?
If not, which ones do you need to change or get rid of?

What is left on that list when you're done? Bring it on back here for more coaching, friend <3