Welcome to Ask for Coaching! We are so glad you're here. Here is a guide to use this function on our website.
1) Label your question with a memorable title. You can tag it with the date or a symbol unique to you if you'd like such as @3@.
2) Think of a topic you would like brief coaching on and do a thought download on it here in this space.
3) Try to pull out a thought and run it through a model right below your download. It doesn't have to be perfect, just give it your best shot.
4) Hit "submit" at the bottom and one of your coaches will reply within ~ 1-3 days.
5) Come back here and search for your post (try to remember the title and scroll down until you find it), and you will see our answer in the text below your question.
6) Read the questions and coaching your colleagues receive - chances are they are running into similar issues as you!
7) Use this as much as you like, 24/7, for coaching on ANY topic. There's no wrong way to do this. There are no gold stars or failures here. The more you ask for coaching, the more you will learn, grow and benefit from this course. Try to remember that we will keep our answers fairly succinct - if you find yourself needing clarification, feel free to respond back in a new post (there's no way to respond in a "thread"), or consider bringing it to one of the live zoom coaching sessions that week.
8) Remember that this space is completely anonymous and of course confidential to our group. Totally fine (and welcome!) to share successes, give support, shout-outs or love to your colleagues here too, doesn't always have to be a place for problems.

I feel accomplished and free in my professional life; within my bubble, I also feel this way in my personal life. I've been in a relationship for 3 years and it's going well! My immediate family (parents and brother) know about my relationship but I have not been courageous enough to tell my extended family. They are very traditional and I worry will judge my inter-racial relationship. It feels stifling not to share my joy with them. How do I process this?

ANSWER: Thanks so much for bringing this here. Before we figure out how to talk to them, let's start by getting clean on why you are feeling stuck. I'm going to start a model for you.

Circumstance- You have extended family (this is a neutral fact)
Thought- "They will judge my inter-racial relationship"
Feeling- Judged? Stifled? (what does it feel like when you think that thought?)
Action- What do you do when you feel Judged? - avoid conversations - don't share your joy - hide parts of your true life and self - what else do you do? What do you NOT do?
Result- Is you judge them and yourself

So in the model above we see that it's not your family themselves that make you feel judged, it is your thought about what they think of you.

I am asking this out of love: Why does it mean about you if they approve of your relationship? What does it mean about you if they don't?
Much love, sister!

When is anger good, and when is it bad? The current political situation makes me so mad, but I don't think I want to be not mad about it. I know that continuously checking the news and stewing in anger isn't serving me, but how do I change it while leaving core beliefs that I want intact?
C: Politics
T: This is fucked up and wrong
F: Angry
A: look at news, social media, vent, be mad
R: I'm mad? And nothing changes?

ANSWER
Thanks for bringing this here, and great job filling out your model!
You ask the question "When is anger good and when is it bad?" What do you think? Can you think of examples of how anger is productive for you?

You listed above the actions you take from anger- doom scroll the news, vent, etc, and the result is that you stay angry.

Your anger isn't good or bad. It is a signal. You have identified that something going on in the world is in conflict with your values. Often times anger is what we feel when we don't want to or don't know how to feel other uncomfortable emotions. What other feelings are under the umbrella of your anger? fear? sadness? grief? rage?

Keep digging here, friend. This is important work!

TD: Will pink OR shoes cause people to view me differently at work? I really wanted to buy these bright neon pink OR shoes, and I know it sounds silly but I ended up stressing out about what pink OR shoes would entail at work. I loved the pink ones, but I thought maybe they will be too bright, maybe they will draw too much attention, maybe they will make me look unprofessional. Will these shoes make me look too young, too inexperienced, or even immature? Will patients and/or attendings not take me seriously if I buy these? Then I thought maybe I should just buy the black ones instead. They will match more, they are more conservative, they won't make me stand out for undesirable reasons.

C: Different color OR shoes exist.
T: Pink OR shoes will make me look unprofessional, young, and inexperienced and subsequently patients and attendings won't take me seriously.
F: I feel anxious and indecisive about buying new OR shoes. I feel inadequate and worry that pink shoes will make my job harder than it already is as a young, female physician. Maybe I even worry that my shoes will "give me away."
A: I looked at the same two pairs of shoes (black and pink) over and over again for hours. I procrastinated buying them. I asked multiple friends for advice. I overthought and overcontemplated for an entire day. Even considered not even needing them. Then I bought the pink shoes and regretted it for the entire next day and wished I had bought the black ones.
R: I stressed so much about other people's thoughts on my shoes and wasted a lot of time and mental energy instead of just buying the shoes I wanted.

ANSWER:
This is a beautiful thought download, thank you for sharing it! Worrying about appearance and professionalism is so common to women physicians - it's one of the things that we ask for coaching on most frequently.
First - some model tips: You want keep the F line to just one feeling - usually the most dominant one. Then the A line is where you want to get really bulky - what are alllllll of the things your T and F drive you to do (and not do)? Be careful to "stay in one model" (I bet your A of buying the shoes came from a different T... see below).

C: Pink OR shoes on sale
T: Pink OR shoes will make me look unprofessional, young, and inexperienced and subsequently patients and attendings won't take me seriously.
F: Anxious
A: Worry, spin in indecisive thoughts, look at shoe options for hours, poll friends for advice, over-contemplate, question your need for them, and ultimately judge yourself for any shoe-related thoughts.
R: You don't take your own self (and your wants) seriously.

Now you get to decide if that is a thought you want to keep or not! Looks like you had another T running simultaneously that led to this model:
C: Pink OR shoes
T: I want them! (anything else here?)
F: ??? (desire?)
A: buy the shoes
R: What did you let yourself experience in the moment that you bought them? Right *before* the regret set in? Was there satisfaction?

Now that you bought the shoes (your new C!) - how to you want to think, feel and act? One tip to keep in mind when choosing a new thought is that you can NOT ever control what other people think about you. It may feel as if you can - but remember that they are in their own models with their unpredictable brains. The more we can let go of the false belief that we can micromanage other people's feelings about us, the bigger and better our own world gets. Remember you get to create YOUR result now that you can see what your thoughts are up to.... keep us updated!

I received some negative feedback on a rotation I was on over a year ago (!) that I felt was totally untrue. The evaluator said I was "below expectations" in three areas. My evaluator did not have the courage to tell me this feedback in person; in fact, I left our in-person feedback session feeling that I was doing a good job. I read this on a written evaluation and was completely blindsided. This is one of several instances where I felt my feedback was myopic, incomplete, upsetting, or all three. I'm not sure how much stock I should place in these evaluations. I tend to forget or downplay the positive feedback I receive and perseverate on the negative feedback. I have learned to let go of some feedback, but it still hurts because I feel that the 10 things I do right go unnoticed to the 1 thing I do wrong (for example, I got negative feedback that I forgot about pseudohyponatremia, when my responsibilities as a senior reached far beyond this and I felt I was doing a good job). This leads me to reject feedback that I don't agree with.

ANSWER:
Oooo - thanks for opening pandora's box of feedback. This is a super important topic and I'm sure relevant to all of us. Let me start by admitting that there are a few pieces of feedback from training that I still coach myself on- over a *decade* later!! First, let's try to plug one of these thoughts into a model.

C: Evaluator marked "below expectations" in 3 areas on a written form about me.
T: This negative feedback is totally untrue. It's myopic, incomplete, and upsetting.
F: Blindsided
A: Question the validity, ultimately reject the feedback, focus on the negative parts over the positive, relive the moment over and over, fume, hang on to this for over a year (!).
R: You upset yourself. And (this is said with love) - you are myopic in how you think about this feedback.

Here's the secret - the words that are said to us are always neutral. Yes! Even if the words themselves are "positive" or "negative"... we get to decide what we make them mean. When something comes out of left field, remember that the attending has their own (sometimes crazy) model going on that causes actions that may or may not serve them. Here's the thing - when we get defensive, it's usually a sign of our brains fearing that the feedback might be true (and then immediately slamming the door on those unpleasant feelings). If you truly didn't believe the feedback, like say the attending said "this resident used too many swear words in her presentations" (and you for sure did not do this) you wouldn't be so defensive. You might be... amused? Worried about your attending's mental status? But you wouldn't internalize it or use it against yourself. You might take action to correct it, but not with any harmful defense or real anger.

Can you allow yourself to receive negative feedback and not make it mean anything about you? What if the only person’s opinion of you that matters is yours? What would be different if you gently gave your attending their model back (i.e recognize that this attending's thoughts create their feelings and actions) and kept the focus on your model where you have all the control?

Try to fill out this intentional model:
C: feedback
T: what do you want to think here?
F: how do you want to feel about this feedback?
A: listen to feedback from others objectively then decide if I agree, be honest about what I want to do or not do, have my own back, not judge myself, love myself for who I am, find the ways I am amazing no matter what, practice seeing my identity as separate from my work
R: create space to show up as authentic self

Stay tuned! This is hard, and we are doing an entire month on feedback in the future! Sending love to you in this journey!

Ok, this is super silly, but it's something I've held onto since high school, so I feel the need to coach it out.

Circumstance: I was intentionally not invited to go on my senior year spring break with my group of friends because I didn't drink alcohol at the time and they "didn't want to be judged." My best friend was invited to go on the trip and I wasn't. She went without me.
Thought: I'm not cool; no one likes me; I can't believe she would go without me
Feeling: I felt unimportant, betrayed, left out, nerdy, and super hurt; ultimate FOMO!
Action: Feel sad, feel the need to prove that I'm successful to these high school b*tches, try to impress others in general, get offended when I'm not invited to things
Result: This put a huge damper on my relationship with my best friend. We didn't talk for a while. We have since repaired our relationship, and I am not in contact with anyone else from that group (who imo are terrible people). I still think about this >10 years later (yikes!) when I'm sure no one else does.

ANSWER:
Great, let's dig in! It's not silly at all!
Nice job putting everything into the various lines in the model. I'm going to help clean it up a little bit. You have several models going on (which is normal!) but it's helpful to look at each one separately. We always want to have only one sentence on the T line, and one feeling on the F line. The A line can be super juicy- just like you did. And the result is always for YOU (the result is never for anything outside of you or your experience).

C- Spring Break Trip
T- I'm not cool
F- unimportant
A- create distance in your friendship with your best friend. rehearse this painful narrative time after time.
What else do you do or not do?
R- You reinforce your painful belief that they rejected you and thereby you reject yourself

C- Spring Break Trip
T- No one likes me
F- left out (?)
A- disconnect/create distance with your friend, look for all the other evidence from other times they (or others) leave you out, pity yourself, overcompensate by trying to prove your success or impress people.
R- You hunt for approval of others and don't give approval to yourself.

I know this story feels so real and even feels still raw. In this version of the story, they are the villains and have all the power to make you feel betrayed/rejected/unimportant etc. As the victim of the story you are powerless and completely at the effect of them. It was painful because you gave them all the power over how you felt. It remains painful because now you have internalized that narrative and your brain seeks to show you all the ways that could happen again (do they like me? am I cool?).

I have really good news for you. That version of the story is totally optional to believe. As you point out, you are fairly certain that none of them think about this anymore, so we know that would be possible for you too.

What way could you tell this story in a way that serves you better? How could you tell the story where instead of mean girls and a "nerd", it's just human beings navigating high school? What would it take to let it go now?

Much love, sister! Digging through the stories we tell ourselves is SO MUCH of the work we will do together. Keep it up!

I need to finish a spreadsheet for one of my research projects that involves chart review in cprs and putting data into an excel spreadsheet. it's not that hard, doesn't actually take that long. but i found myself logging in to the VA this afternoon and actually thinking "maybe i'll have cprs alerts to do instead!" WTF? since when did I hope for cprs alerts OVER doing research? i've procrastinated this for weeks and justified it saying to myself that this doesn't really matter, I did a different related spreadsheet already and that has all the data I need. but for completeness I do really need this spreadsheet, and as i mentioned, it's not that hard. doesn't take that long. my mentor did point out to me last week that every time I bring up the problems I'm having with this particular study, I make it sound like a failure. I told him that's because I think it's a failure. I wrote a grant, I naiively thought we would quickly, easily execute the grant, data pulled and analyzed no problem, paper written, i might struggle to publish but i'm used to that... overall easy peasy. welp, that has not been the case because the data are not what i thought they were and i have not figured out the solution yet. In talking through the possible solutions with him, I concluded that the best one is to just figure out how to identify many of the patients I cannot currently identify. and doing this spreadsheet is part of that. Oh yes, and this intense spreadsheet work gives me the WORST eye strain so I also don't want to do it b/c it hurts after a while. sigh. C - spreadsheet T - this project is a failure so I am a failure F - shame A - avoid, mope, don't work on other research projects either R - no progress made on research projects, creating suffering for myself (or as Kara Loewenthiel puts it... stressing myself out)

ANSWER: Good awareness here. So you start by asking yourself why you are avoiding this project, and you see that the project is painful because you have a thought that it is already a failure and that means something about you (that you too, are a failure).

I have great news for you. Neither of those things have to be true. Some questions to ask yourself:

How do you define "failure" in terms of your study?
If your results are not what you expected is that a failure? Is it possible to "succeed" with a negative study?
How would a negative study help you refine your next hypothesis?
Why are you linking the success of the study to your worth as a researcher?
Do successful researchers sometimes have negative studies?
Do successful researchers sometimes not complete projects?
What does it mean about them?

Much love, sister!

I'm lost on this one. My mom (my thoughts about my mom) is a mess. She has diagnosed but untreated mental illness which causes her to act in a way that is hard to be around. She is unable to manage her basic life needs but instead of intuiting that it's because of her illness, she blames the people around her (mostly me) for doing various things that make her life impossible if we try to help her. As her daughter I have all kinds of thoughts about how she should be different and how sad I am to have "lost" the mom I grew up with, how unfair it is, etc. But what I struggle most with on a daily basis is that I feel guilty for the boundaries I've drawn now, (to protect my own mental health, and let's be honest, to not have to listen to her bullshit every day). I like my reasons for my boundaries now, but also still feel guilt that my lack of presence in her life is making it easy for her to have thoughts that cause her to feel very, very sad. I also fear that if and when she dies, I will have massive regret that maybe I could prevent by managing myself better now.

ANSWER
Hey There,
Thanks for bringing this here. I can tell these feelings are very raw for you. I want to help you start to tease apart the circumstances from the thoughts in your story about your mom. I'll help you get started

CIRCUMSTANCES
- You have a mom
- She has a Dx and is not currently treated.
- She will eventually die.

Everything else in your narrative above is the story you tell yourself about your mom and yourself
- she is hard to be around
- she is unable to manage her basic life needs (you would need to be more specific here to make it a C. EX- house is in foreclosure? or phone bill sent to collections? what do you mean that she is unable to meet her basic needs?)
- she should be different
- I have lost the mom I grew up with
- my lack of presence in her life makes it easy for her to have thoughts that make her feel very sad

These sentences you tell about your relationship are so painful for you. Let's start by taking one and starting a model.

C- Mom
T- "My lack of presence in her life makes it easy for her to have thoughts that make her feel very sad"
F- Guilty
A- (When you feel guilty, what do you do? What do you not do?)
R- (can you come up with what the result is for you?)

This is hard work. Keep going, friend.

I've noticed that I HATE letting people down. Like, If there is something I told someone I would do (project, plan a zoom happy hour with friends, literally anything) I will prioritize that over something I KNOW I need to do for myself. Sometimes I'll get caught up on the phone with a friend of a friend answering stupid medical questions they should ask their own doctor and I will waste the precious time I have for dinner with my husband. He feels annoyed. I feel obligated and frustrated, and in the end, I end up wasting my own time. Ugh!

All of this to say that I am coming here to commit to spending 5 minutes a day to doing a thought download for the next week. Maybe I'll try longer, but I just want to start with 1 week where I give myself 5 minutes to myself and my thoughts. I'm writing it here so it's a real commitment.

ANSWER:
First of all, great commitment, friend! It's smart- specific, measurable, action-oriented, realistic, and time-bound, and will undoubtedly give you more insight into what comes up for you around this issue as you go through the week!
Let's see what your example looks like in a model:
C: Friend of friend asks a medical question
T: what's the thought here? (maybe "I don't want to let her down?")
F: obligated
A: spend time on the phone with the friend, don't spend time with family at dinner, don't spend time on yourself.
R: you let yourself down.

This result here may seem trivial (what's one more missed dinner?) but you said this pattern, so what you are creating in actuality is a shattered relationship with yourself, the MOST important person in your life. This is a big deal! Also - I wonder how you showed up to both the person on the phone (knowing that your husband is waiting) and then to your husband afterwards (having just let your brain be distracted with yet another thing)? Was it your best self?

You have insight into the change you'd like to make just by bringing this here and making your commitment. The next step is to come up with a thought to help you in the moment (because there will be many) when someone asks for an unplanned piece of your time. Let's try a result model:

R: You honor your pre-set priorities and time and have dinner with your family
A: (maybe schedule the non-negotiables first in your calendar like family dinner, sleep... what else? - then say no to anything that comes up in the moment that doesn't fit this). You may also need to practice the language that feels good to you around saying no. It probably won't come naturally, so might need to plan on some self coaching around the thoughts and emotions around this action for you)
F: what do you need to feel to do these things?
T: what do you need to think?
C: friend of a friend calls at dinner time

The work here far extends from managing your to-do or prioritization list- doing this will help you become an accountable friend to yourself. Only then can you even begin to show up in the way that you want to the people around you! Can't wait to hear how this goes <3

I have 3 close friends from high school (non-doctors). We are in constant text communication all day, but I text maybe once for every 100 texts from them, mostly because I look at my phone less. They also talk to each other on the phone a lot, and I rarely do. I am getting a sneaking suspicion that they kind of feel like I'm not putting in time or effort that is required for this friendship and worry that eventually I'll be nudged-out of the group, which would be really painful for me. I love these girls, but find myself dreading texting or having to say sorry one more time for missing something or not calling in forever. I really just constantly feel like I'm not doing my job as a friend to them.
C: 3 best friends
T: I'm not doing a good job being a friend to them.
F: Inadequate, guilty
A: further avoid calling them, apologize a lot, talk about how busy I am so they know it's not them, it's my job
R: Don't show up as my real self to them?

ANSWER:
Hi There. Good awareness here.

You have a thought "I'm not doing a good job being a friend to them" and that's a painful thought for you. That's totally OK.
Let's look at your beliefs about what it means to be a good friend.

What does being a good friend mean to you?
How do you qualify or quantify good friendship? If you had to describe what friendship was to an alien, what would you tell them was required between people for them to be "friends"? Would you describe friendship as static or changing over time? what are all the different ways friendship can manifest and change?

There are no wrong answers. Just dump your brain out about the rules of friendship and bring that definition back here.

Much love, friend.

I am really struggling with jealousy of a friend at work. We are in residency together, and I think I'm doing a pretty great job, but it always feels like she is doing BETTER. I know that it isn't a competition, but I am having a lot of really negative feelings about it. Most of the time it comes down to the fact that I feel like I am just as good as she is, so why don't the faculty or our chiefs recognize that????!!! Luckily it hasn't impacted how I feel about my friend (who is great! And really supportive! And a wonderful friend and doctor!), but I am worried it might.
C- I am the same quality of resident as my friend but don't get the same credit, which is not fair.
T- This is unfair. I deserve the same recognition.
F- Anger at my chiefs/faculty that it isn't fair. Guilt and shame that I'm angry about my friend's (deserved) success. Spiral about being a bad friend and apparently a bad doctor.
A- being short with my parents, who are my support system. Passive aggressive in minor ways. Vent to non medical friends.
R- I don't actually think about how I can be a better doctor on my own, I don't study more, I don't have productive introspection, I try to keep complaining out of work, but probably impacts my work performance, which proves that I don't deserve the credit I think I do and leads to further shame spiraling.

Hi There,
Thank you for bringing this here and for getting this into a model. Let's start with cleaning up your model. Your C is not neutral. I know this because I don't think everyone would understand the criteria for or necessarily agree that "you are the same quality resident and don't get the same credit and it's not fair". I do think everyone would agree that you are both residents, so let's put that in the C line. This is important because when we get really neutral on the C line, we can see your thoughts more clearly.

C- You and your friend are residents.
T- I am the same quality resident and don't get the same credit.
F- (What is the emotion/feeling you feel when you think this T- choose ONE)
A- (What actions do you take or not take from that emotion- Make this JUICY)
R- Nice job on your Rs above. The R is always FOR YOU. You continue to compare/despair and you don't aren't fair to yourself.

A few other questions for you to chew on: What would "Fair" look like here?
Why should things be fair?

Bring your next model back here!
Much love, sister.

I have been feeling unappreciated and undervalued lately. Trying my hardest to make my patients and their families feel safe and supported no longer seems enough to sustain my drive to work. Attempting to constantly stay positive and looking towards the future is demoralizing. I have not felt inspired by the work that I do, and I decided to speak up because I have realized that I am not the only person in my program who feels this way.

Recently, I’ve been thinking that I’m just a pawn in a huge system that fails to acknowledge us as individuals and support our growth as physicians. The focus is on patient turnover and appropriate documentation. The majority of my time is spent performing busy work at the expense of my own learning, health, and sanity. With our increased workloads, previous morning didactic sessions or teaching during rounds have gone by the wayside. I spend all day documenting, fielding calls from the lab, nursing, and pharmacy, and acting as a mediator for consultants that will not talk to each other. I act as a therapist for the patients’ family members and spend hours on the phone talking to them or being the target of their displaced anger. Documentation is causing me to burn out. My team has to write three long, detailed notes just to discharge a patient to another facility in addition to clicking a thousand buttons to officially get them discharged. No matter how early I try to complete the paperwork or how prepared I try to be to make everyone aware of the plan, it is never a simple process. Unfailingly, my team and I will receive a barrage of phone calls disrupting our ability to complete other daily tasks in a timely manner. I have never been able to make it to our noon conferences because of either the workload, or the constant interruptions. I rarely have a moment to myself to try to learn about a topic on my own.

I’ve become a fantastic secretary, I know all the back channels to get someone a follow up appointment with a specialist or who to call to make sure their outdated contact information is changed, but my medical knowledge has taken a huge hit. Today, I stayed late yet again to admit someone at the very end of the day for hypertension. Not hypertensive emergency, just hypertension. All because the ED had already put in admission orders and assigned the patient a bed. I feel as though my specialty is a dumping ground for everything no one else wants to deal with whether it is appropriate or not, and we are just expected to accept that reality. We take orders from a consulting team that is, in actuality, the true primary team, or spend hours writing H&Ps only to spend hours writing discharge summaries when the patients leave the next day.

I don’t believe I am developing as a person or as a physician in this environment because I have so little time to devote to myself or my team members during or after the work day. I also feel guilty that I cannot give my med students or intern the attention I feel that they deserve because of the demands on all of our time. I am a little ashamed of being so vocal about how I feel. I do not believe that venting is the purpose of this program. I do not know if what I am describing is something I can be “coached out of” and I’m not sure if it would be healthy to try to perceive this reality in a better light.

I wish I could find something that would inspire me to envision a pro that outweighs all the cons. It seems naïve to think that simply getting to the next level, or getting through residency is an answer to this problem.

ANSWER:
Thanks so much for bringing this to Better Together. This is absolutely the purpose (maybe even the core purpose) of the program. and this is exactly what we want to be helping you through - as coaches that have literally BEEN THERE, SISTER. There is a lot to unpack in this, and I can't get to everything here, so I really encourage you to bring this to a zoom session (like the one today at 2:30!) for some live coaching.

Our work as coaches is to sit with you and help you take a look at your thoughts, so that's what I will do here. The goal is NOT forced positivity or to convince you believe that something you think is bad is actually good. The goal is for you to have tools to look at this story, practice awareness of your thinking and understand how it impacts your experience. The MODEL is a tool (like a SOAP note) that helps sort out the objective from the subjective.

You've written a perfect Thought Download. The next step in processing all of this is to separate out the circumstances (objective) from the meaning/narrative your brain creates about them (subjective). "Circumstances" are neutral facts, like the temperature outside, your PGY year, what program you are in, etc. Let's list all the things in the story that EVERYONE would agree on:

CIRCUMSTANCES-
- You are a resident
- Documentation is part of doctoring
- ER can admit people
- Consultants give recommendations
- You work x hours per day
- you spend y hours per day in direct patient care, and z hours per day in indirect patient care (multidisciplinary communication, documentation, calling families...)
- Noon conference exists and you haven't been able to go

Everything else in your TD is the story your brain is telling about those circumstances. I know they really feel like Cs, but we know that they are Ts because different people may have different thoughts.

- THOUGHTS- (SUBJECTIVE)
I'm just a pawn.....
Teaching on rounds has gone by the wayside
I act as a therapist for patients families and a target for their displaced anger
I am not developing as a person or physician
What are the other Ts?

- FEELINGS- (generated by Ts)
Undervalued
Unappreciated
Demoralized
Guilty
Ashamed

OK- Sister. Go back through this and choose ONE C and ONE T to put into the model. How do you feel when you think that T? What actions do you take or not take? Bring the model back here. We will chip away at this block together.

For EVERYONE:
1) The purpose isn't always to change your thoughts, it's to be aware of them and learn to choose them. Sometimes you WANT to think and feel negatively about a situation. The human experience is 50/50 comfortable and uncomfortable feelings. THIS IS NORMAL.
2)The goal is to understand that our thoughts (not our circumstances themselves) cause our feelings.
3) There are many things in life that you choose to feel bad/sad/anger/rage/violated about (a loved one dying, an unjust political system, starving children, and residency programs that don't value trainee growth and wellness, to name a few). In those cases, you can feel the feeling all the way through for as long as it takes. But, you might want to choose a different thought and emotion to ACT from. You have a choice when you find something in this world is "wrong": you can let it be wrong and move on, you can let it be wrong and dwell on how bad you feel, or you can act to change it. None of these are bad or good or right or wrong. You get to decide which option will serve you best in the long run, sometimes it will be one thing, and other times it'll be another.
4) Suffering comes not from the painful feelings themselves, but our belief that we shouldn't have the pain in the first place. Frustration, guilt, shame, those feelings are part of being human. The suffering happens when we think we shouldn't feel them. THIS is the part we can change.

What parts of being a doctor in the past or your visualization of yourself in the future give you inspiration? Why did you choose this? Do you remember?

Is there any aspect of your current life where those reasons show up?

Can you think of a reason why being a "therapist for a patient's family" might serve you and them?

Are there any ways that your program does care about your growth and learning?

Did you or could you affect positive change (even in one tiny way) for the patient with HTN?

Returning to your "greater why" is so important when you are feeling burnout, and so is reminding yourself that burnout is an emotion that won't last forever. But we are here to help you in these dark times - please keep coming back with questions. Sending constant love and care to you <3

Hi Team!

Thanks for a great call today! To learn more about comparative suffering and why it never works, check out Brene Brown's

https://brenebrown.com/podcast/brene-on-comparative-suffering-the-50-50-myth-and-settling-the-ball/

( I can't figure out how to make the link clickable but you should be able to copy and paste into your browser- sorry!)

Have a great weekend, friends.
Adrienne

I'm approaching the end of residency and feeling a tremendous amount of pressure to move back home, and guilt that I might not want to. I'm actually not sure if I want to go back or not, which is confusing. I lived in one state for my entire life until residency, and then moved to Colorado for residency. As soon as I matched here, my mom was happy for me but asked when I was coming back. This is because SHE moved away when she was young for 7 years, only to move back to our home state to be closer to HER mom, and she always reminds me that she wishes she had stayed so she could spend more time with her mom who died of pancreatic cancer in her 60s. For deeper context, my mom has mild MS so I fear that she may be right. She sends me job opportunities in my home state that aren't at all what I'm looking for (she is not in medicine) and talks about how she can't wait for me to come back so she can have a grand-dog (not to mention grandchildren). I know she desperately wants to live near me, and she's essentially given up on my sister who moved to a different part of the country. She knows just what to say to make me feel terrible. As I am actively in the job search, I really don't want to limit myself geographically and I feel bad that I am looking elsewhere because based on my career goals there really aren't great opportunities in my home state aside from the single large academic center there that I've already interviewed at. I feel like I either need to move home to be near family and sacrifice my career or sacrifice my family connection. It is important to me to be near family eventually... but I don't know if that's what I truly believe or if it's what she wants me to do.

C: I am searching for jobs. My mom sends me articles about jobs I don't want in my home state. My mom has multiple sclerosis and won't live forever. Her mom died young. My sister lives out of state.
T: I should just go home
F: Guilt
A: Worry, resent my mom, catastrophize
R: ?? feel like I have to choose between my career and being near my family
----
Instead, would like to feel validated in my choices and live/work wherever is best for me.

ANSWER:
Ooof - mom models often bring up deep, core issues; this is very important work! Nice job on your model - remember to keep the C perfectly factual, no adjectives or qualifiers. Also, best to keep it simple since there are different thoughts and feelings for each thing in there (different T about "her mom died at age X" than for "I am searching for jobs").
C: My mom has MS and said she wants me to move home
T: I should just go home
F: Guilt (is the guilt actually from the corollary "I should go home.... but I don't want to"? "I should go home" might drive an F of defeated or resentful? Guilt typically comes from feeling like you are in the wrong)
A: Worry, catastrophize, engage in all or nothing thinking, ongoing confusion with no actual decision, look elsewhere for jobs but beat myself up for it, not get clear on what I want.
R: Turn mom's words into an unsolvable problem.

Notice first how much power you give your mom for your emotions. Your mom basically has complete control over your feelings which is a lose-lose situation, because she is not going to change in the way you want so that you can feel better. That's ok - she doesn't have to change at all for you to feel better - YOU can. It's not a problem that your mom wants you to move home, the real problem is that you haven't really considered what you really want. Pretend that your mom will be 100% happy no matter what you do (let this be true for 15 mins), then write what you want for this phase based on your desires and goals. This is good info - doesn't mean you need to act on it, but it's important to know what your heart wants without your model on your mom getting in the way. Now - come back to reality and let your mom be exactly how she is - and clean up your thoughts about how this should play out from a place of emotional adulthood (each adult controlling their own Fs and no one else's):

-Do you believe your mom shouldn't have unpleasant emotions? Why?

-Do you believe it's your job to make your mom happy?

-What do you think your mom's model might look like (what thoughts is her brain giving that drive her emotions)?

-What if there is not one perfect solution to this, how could you feel happy no matter where you work/live?

-How could you live separately from your mom and NOT sacrifice the connection?

Write back here with some answers and we can help you continue to work through this - mom-models are almost never a "one and done" type of thing <3

I don't have a close group of girlfriends and I feel like this is a missing piece in my life. I have separate individual friendships, but I see others in close-knit groups and I feel like I'm missing my tribe. I pride myself on being a loyal friend and I've been telling myself this narrative that when I get to the next phase in life (college, med school, residency) I will magically find my group, but this has never lasted long. I had a solid group of girlfriends in medical school but these were mostly situational friendships, and despite my best efforts we haven't stayed as close as I'd like. I also tell myself that the people in high school, college, and med school weren't so great anyway, and I want to surround myself with supportive people that make me a better person, and I just haven't found such a group yet. I feel isolated because I have a few individual girlfriends but not a group, whereas my husband has a solid group of guys. We have a great relationship but some things just need a same-sex perspective for validation, which I know he derives from his guy friends.

C: I have friends who aren't friends with each other
T: I don't belong anywhere
F: Isolated, fear of missing out
A: Feel bad about myself, replay the narrative that I don't have a group, compare to others who do have a group
R: Continue living without a circle of friends?

---
I would like to change to this model
T: "I will find/have found my people"
F: Belonging
A: maintain relationships with a group of people I love and respect
R: continue to grow as a person due to amazing friendships

Thanks for your help!

ANSWER:
Thanks for bringing this here! Great job putting this into your models. Let's take a look at your first model and clean it up a little bit.

C: I have friends who aren't friends with each other
T: I don't belong anywhere
F: Isolated (Stick to one)
A: Feel bad about myself, replay the narrative that I don't have a group, compare to others who do have a group.
(What else? When you feel isolated, do you withdraw from the friendships you have?)
R: Continue living without a circle of friends?- I think the result here is that you abandon/isolate yourself.

I like your new model, but I get the sense that your new T "I have found my people" is not believable to you yet. It's not believable because you think that it's not enough to have individual friends, that they should be a group of friends. It is totally fine to continue to think this, but right now that thought is painful and isolating for you. Let's make sure first that it's one you want to keep.

I'm going to pose a few questions to you here. Choose a few to copy and paste them to a new post and we will keep digging together

Write down your beliefs about friends. Pretend you are describing the rules of friendship to an alien. I'll get you started:
- My friends should be friends with each other (why/why not?)
- It's not sufficient to have a few close friends (Why/why not?)
- "I am a loyal friend" I love this and am sure you are! What does it mean to be a loyal friend? What actions do you take in your friendships that come from loyalty? Get really granular here. How does that loyalty make it easy to have a few closer friends and harder to have more friends who are more superficial?
- friend groups should magically appear or "just happen". Is that how it works? Do you think groups of friends maintain themselves passively or is there action required among the members? What might those actions be?
- Friend groups should be static (why/why not?)
- What other beliefs do you have about friendships?

OK sister. I see you and am here for you with this.
I promise you that the feeling of belonging that you long for comes from your THOUGHTS about your friends. Not the friends themselves. I know this because some people have a large group of friends (or a million instagram followers) and still feel isolated, and some people experience belonging with 1-2 close friends. It's OK to decide you want a group of friends, let's just make sure you like your reasons. From there we can work on your new model. OK?

Come back with what comes up for you. 🙂

I'm struggling with how to deal with a perceived sense of rejection. I am finding that this comes up a lot for me. The last time I felt it was this week. I was hosting a zoom happy hour for some friends from college. 10 people RSVPd but only 3 showed up. These are all people I know and have some relationship with. Some friends texted and said they were so sorry to miss but others just didn't show and have not contacted me. I really do understand how hard it is. Everyone has a full life and on a cognitive level I can tell myself that it has nothing to do with me but I still feel hurt when it happens. I don't want to think this way anymore or more importantly feel this way anymore.

C: Some friends didn't show up to my zoom event
T: They don't care enough about me to show up. If I was really important to them, they would have made it a priority to be there or at least they would have cared enough to reach out and text me a message about why they couldn't make it. I am in some way not lovable enough, not worthy enough
F: Shitty. Sad. Rejected.
A: I go into a mind funnel of negative thoughts that usually ends in some version of I don't want to be friends with them anymore and I'm never going to invite them to anything, which is followed by shame and guilt that I am being so juvenile.
R: I feel terrible and I don't act like the friend or person I want to be

C: Some friends didn't show up
T: It has nothing to do with how they feel about me but rather how busy they are with life.
F: Less sad, more calm, some acceptance
A: I do not ruminate on other negative thoughts
R: I decide not to cut them out of my life 😉

I can write the reframe but it still doesn't feel completely settled. I feel like I harbor some resentment and I don't want to feel that way. I think of myself as this generally caring, forgiving, kind, and generous person and the way I am thinking/feeling is not any of these.

ANSWER- Congratulations! You have a normal human brain that makes you feel rejection sometimes.

Quick feedback on your models: You want to only have one T and one F per model. So first model would be:
C- zoom event
T- If I were important to them, they would have [made an effort to show up]
F- Rejection
A- allow your brain to spiral un-controlled, look for all the evidence that proves that they don't like you, think about ways to reject them, throw a tantrum
R- You double down on the experience of rejection

OK my big question for you is this.

Why is it a problem to feel rejection sometimes?
Sometimes you feel happy, sometimes you feel grief, sometimes you feel anticipation, sometimes you feel excitement. All of these feelings including rejection are part of the human experience.

What is it that is problematic about the feeling of rejection? What is so awful about it?
Can you describe in your body what it feels like to experience rejection? (Where in your body is it, does it have a shape, a color, does it move)?

Is it possible to know that you can feel rejection sometimes and allow that to be OK?

I always have big plans for self improvement. After a few days, I forget, lose interest or give up. I'm so tired of this cycle - which I watch play out in relationships, self care and work. Any suggestions on how to stick to my guns are welcome.

ANSWER:
Hi Friend. Thanks for bringing this here. I know you are asking for the answer. We will get to it together.

What do you make this cycle mean about you?

Take the answer to that question and put it on the T line of this model. Can you fill out the rest?

C- plans
T- ______________
F- ______________
A-_don't create structure/mechanism to succeed, give up, (what else?)
_______________
R- _______________

Other things to consider: Are the goals you set for yourself reasonable or possible given the other pressures on you right now? If not, can you adjust so they are reasonable/possible? Are you setting these goals out of obligation ("I should..." ) or out of honor to yourself ( "I'd love to see myself...")Do those different reasons to set goals feel different to you? How? Why?

So much love, sister. The first step in showing up for yourself is showing up HERE. Keep it up!

I just had a breakthrough listening to Helen.
What if I am just trying to avoid letting people down who I think want me to stay in academics? Or maybe that I just need to be ready to grieve the road not taken but I've been avoiding that?

I need to do a TD on this but just wanted to say that Helen helped me. Wahoo!

ANSWER:

Yes to this! Come back and tell us what happens when you answer those questions!

My husband is jealous over something ridiculous. He started turning things into a story that was completely different than the reality of the situation. I’m trying very hard to stay in the facts, but also to be caring and compassionate for him.
How do you apologize to someone when you know their thoughts are causing their feelings? How do you give love in this situation? How do you move forward?

ANSWER:
OK. Let's look at this.

C- your husband said words...
T- He is jealous over something ridiculous
F-?
A- judge him, blame him, what else?
R- you are acting just as ridiculous ( Ouch, I know!!!)

So if you want to be in a new model you have to first see it's your thought in the model above that is making you feel whatever you are feeling. He doesn't know about the model yet. The way you show him the model is by living it yourself. That means taking responsibility for yourself first.

What would need to happen for you to get to this model?

R- Accept him and his opinion w love and compassion
A- ??
F- ??
T- ??
C- Husband says words.

Do you want to apologize? Why or Why not?

Much love, sister!

I am really struggling with thinking about how my priorities have shifted since becoming a mom during residency. Before having kids, I was on the "med school train" and was thinking about fellowships, academic positions, etc. Now, with one child during residency and another before I finish residency, I find myself just wanting a job that allows me to spend time with my kids and be around when they are young and yet I have not let go of wanting to compete for fellowships or chief positions. This has been hard to navigate. Help!

ANSWER:
Notice how much you are judging your desires. What do you think about your new desire for a job that allows you to spend a lot of time with your kids? Why do you use the qualifier "just" here? Is it because there's some thought that this is "less than" a fellowship/chief year? Are you making this mean anything about yourself (for instance that you don't "care" as much about achievement/producing/patient care or anything else)? How is this true and not true?

Why do you want to compete for fellowship/chief positions? Is it for the position itself or is it what you are making the position mean about you? What are the pros and cons of continuing to believe these things about yourself in a "competitive position"? Does it serve you?

Your unintentional model:
C: many different future jobs exist
T: My priorities shifted, now I want time with my kids (what else here... "and I shouldn't?" "and that means ______ about me as a doctor?"
F: what's the feeling? ("confused" "torn" "ambivalent?")
A: Engage in black and white thinking ("I can either get a competitive position or I can spend time with my kids"), not pay attention to what I really want, worry about making the wrong decision (what else here? What do you not do?)
R: You are judgemental and and don't hold space for your authentic self.

How can you love your authentic self (whether that is a fellowship/chief year, not doing this, or some combination/compromise between the two???)?

Bring some of your answers back here, friend! <3

I got married 5 months ago and still can't decide if I should change my last name to my husband's name. So far I haven't since I've been finding excuses [how will they know its me for perhaps the most important election of our lives/what if my ballot gets rejected? how will I register for boards if I change my name now?]. I can tell my husband wants me to because he wants us to be 'one family.' He also thinks this is the best time to do so at a transition point in my career. I've asked him if he would consider changing his name and he said he definitely would not since he always imagined his wife taking his name. I also brought up whose name our (future) kids would have and he is adamant that they would take his name. What does this say about me? I know that changing my name to his would make him very happy, and that changing my name is just exchanging one man's name for another, so what's the difference?

C: I got married in September and haven't changed my last name
T: should I change it?
F: indecision, remorse about losing my identity, injustice that he doesn't have to think about this
A: delay the name-changing process, question my motivations, wonder if I should just change it already, resent him
R: maintain the status quo [aka keep my name]

ANSWER:
Hi There,
I am so glad you are bringing this here. One of the things I like to do is to pretend I'm explaining something to an alien. I can just imagine us trying to explain the rules and traditions about surnames to an alien and they would be like...."whaaaaa? Why so many names? Why are so many feelings involved? " It just always makes me chuckle and helps me get a little perspective on teasing apart Cs and Ts when I bring an alien into the conversation.

OK- I'm going to start some feedback on your model.
- Nice job working to make your C neutral. While we would agree that you got married in September and haven't formally changed your name yet, I suspect that even that circumstance is not neutral to you. Try putting "Surname" or "Last name" in the C line. This will create some space for you to see your thoughts.
- T line should always be a statement not a question. When your initial T is a question, answer it, and put that in your T line. In this case it might be "I don't know if I should change my name or not".
- In your F line, list only ONE emotion or feeling. You can write 10 models with 10 different thoughts and 10 different feelings -all are going on simultaneously in your head in real life, but for our purposes here, we want to look at one at a time.

So after a little cleaning up, your model might look like this
C- Surname
T- I don't know if I should change my name or not
F- Indecision
A- make excuses, delay, spin in indecision/confusion, resent him,
R- you don't make a decision.

This model shows that it's not the name itself or your husbands thoughts about last names that is keeping you stuck, it is your thoughts about it. This is great news, because you are in charge of your thoughts (you aren't in charge of his).

Alright friend. The answer of what to do only exists within you. It is hidden and tangled in your thoughts. I'd like you to go back through your TD up there and write an answer to each of the questions you posed- the logistical ones, the future focused ones, all of them. This will help you exit confusion/indecision and get to the meat of the problem. The most important question you asked is "what does this say about me"?

What do you think it says about you if you do adopt his surname?
What do you think it says about you if you don't?

Dump it all out of your brain and bring it back here. You will receive no judgement from us here. We've got you.

Hi Friends!
I found coaching after I'd had my 2nd daughter and I no longer recognized my body (or my brain for that matter). Every day I am continuing to do the work on accepting, respecting, and loving my physical body. This has not and may never come naturally to me, and that's OK. I'm going to keep working on it. One of the books on my nightstand right now is is "The Body Is Not An Apology" by Sonya Renee Taylor. It is beautiful, and mind-blowing. You can listen to the author as a guest on Brene Brown's podcast here: https://open.spotify.com/episode/6K5ytRMH1tMPldejD5TbKK

I have 6 extra copies of this book and would love to share them with you. Just shoot an email to Btphysiciancoaching@gmail.com and I'll drop it in the mail to the first 6 people who reach out.

XO
- Adrienne

I'm a graduating third year resident. I got a job offer at the place I want (verbal and via email, with documentation in the email that they would send me a formal offer letter in 1-2 weeks). After about day 3 I got super nervous that it hadn't arrived and worried that they were never going to send me paperwork bc they found out something terrible about me or changed their minds or would send me a radically different offer and that I was going to have to start job searching all over again etc etc. (There was no rational reason to think this. It wasn't debilitating worry, just in-the-background worry.) The formal paperwork arrived today (day 10). It is exactly the offer that I had discussed on the phone and via email, with no surprises, and is a great offer. Now I feel like a moron for worrying instead of celebrating.

My model for this incident is:
C: I'm a competent applicant waiting for formal paperwork for a job where the department chair already offered me a job verbally and via email, in the time frame I was supposed to get it.
T: OMG THEY ARE NEVER SENDING ME THIS PAPERWORK AAAAHHHH
F: anxiety.
A: I am walking around being irritable at a time when I HAVE IT MADE.
R: I worry instead of enjoying the good times when I have a job offer at the place I wanted! And then feel like a moron when things turn out OK.

I'm not really asking for advice on this specific scenario because it's over. But Ive been like this my whole adult life. For example, when I met my now-husband he seemed way too good to be true and I spent the first several months trying to figure out if he had a secret wife or was an axe murderer or (insert crazy thing), and then expecting that he was going to get tired of me and dump me, because men like that don't just happen. I found nothing (and we are happily married now) but I still remember the exhausting anxiety of just expecting that SOMETHING TERRIBLE had to be coming. This plays out on smaller scales not infrequently for me (like with this job thing).

I didn't used to be like this. I think I have learned to expect the worst as a defense mechanism due to significant life challenges in my adulthood. I suspect that during residency this has been compounded by learning and cementing the medical thought process of "ok whats the WORST THING that could happen to this pt and did I account for it in my differential and plan". Now I feel like I'm stuck always looking for and expecting the worst no matter what and I don't know how to break out of this thought process loop. (or how to separate the medical search-for-the-never-miss-catastrophe thought process from my regular life thought processes.)

I want my model to look like this:
C: good thing happens
T: I am happy and grateful and excited that this good thing happened
F: happy!
A: presumably I'm less anxious and irritable, and more able to fully experience the good things in life.
R: I carry less background stress and burdens (but hopefully am prepared when bad stuff actually happens.) I am more able to celebrate wins and enjoy the good times, without letting them be marred by the thought that maybe the bad times will come.

How do I get there? Thanks!

ANSWER:
Great job bringing this here, my friend. This is THE WORK.

CONGRATULATIONS! You have a human brain. Your human brain is working really really hard to try and protect you. The part of your brain that is overactive here is what I consider the "primitive" brain. I think of it like a toddler. It is really excitable, distractible, unrestrained, volatile, and scared. Your prefrontal cortex is the part of your brain that is in charge of listening to that toddler, and responding like an adult. Sometimes that means acting on the toddler's demands, and sometimes it means saying "thanks for the suggestion that we have ice cream for dinner, we aren't going to do that tonight". Your toddler brain is totally hypertrophied and wants to tell you everything is going to fall apart and that the other shoe is bound to drop any minute. Your adult brain can say "maybe it will, maybe it won't. that's not going to stop me from doing what I want to do". Your adult brain/frontal cortex is not exercised in talking to your primitive brain like this. It needs to practice. This is no problem. You can practice this now that you know how.

You want to get into your final model so you can feel better. You want to change your thoughts immediately so you can stop feeling anxious. I get it. Before we can do this, you need to drop your resistance to the fact that this is happening in the first place.

Can you answer these questions?
What if your very normal human brain ALWAYS wants to show you the worst case scenario? So What?
What if that didn't mean you had to become anxious or frantic or overwhelmed? What other options are there?
What would it be like to allow your primitive brain to throw it's tantrum and just notice it instead of judging yourself for it?

It might look something like this
C- thing happens
T-Ah! I notice I'm feeling anxious about this, and that's OK.
F- Acceptance? Curiosity?
A- listen to your toddler brain. thank it for it's concerns. hold space for yourself to feel anxiety, fear, or whatever comes up. Do a TD. What else?
R- you begin to show yourself that your frontal cortex can take the reigns in time like this.

what's coming up for you?

Q: What do you think it says about you if you do adopt his surname?
A: I am the last person with my last name in my family because my older sister already changed her name, I have no other siblings, and I know my kids won't have my last name. So if I change to his last name, I feel like I'm erasing my family's legacy because my last name is unusual and there aren't many of us on earth. Then again, if my kids won't have my name anyway, then my name ends with me regardless of whether I change it to his or not. I care about retaining my own identity and I feel that adopting his surname perpetuates patriarchal norms that I'd like to resist. Another part of me wants to adopt his name because I like it and because I want to be seen as a united family.

Q: What do you think it says about you if you don't?
A: If I don't, I am keeping my own identity by rejecting societal rules that say that a woman is her husband's property and therefore she must give up her (dad's) name upon marriage. The other part of me thinks I am somehow rejecting our marriage or I'm not 100% invested if I don't take his name [but I am!].

ANSWER:
Very nice job doing the work here! The good news is that you can paint the story of your last name however you want. You need to ask yourself two things about each argument:
-1)Are these thoughts true?
-2)Do you LIKE your reasons? (i.e. do you want to keep these thoughts?) - run each through a model. What's your result? Does it serve you? BRING IT BACK FOR A PART 3!!

So... if you CHANGE your last name to his: Is it true that you will be "erasing your family's legacy?" Is it true that you'll "be seen as a more united family"? Is it true that you "risk losing part of your identity"?
Do you like any of these thoughts?

If you instead KEEP your last name: is it true that you'll be "rejecting a societal rule of the patriarchy"?
Is it true that you'd be "rejecting your marriage"? Or that you would "not be as invested"? How is that not true? How could the opposite be true?
Do you like these reasons?

What are ALLLL of the other actions to maintain some core values you mentioned like: investment and acceptance of your marriage, counteracting the patriarchy, maintaining your identity (realizing that you decide how to think about identity, that lives in the T line), and be seen as a united family?

Hi! Wanted to submit this here because I am on nights and might not be able to make coaching.
I have been feeling really badly about my weight/body these days. I have gained probably 15-20 lbs since mid-medical school. I feel like I eat healthy but still feel like my weight has been hard to get under control. I try to give myself a break about it because residency is so hard and I'm sure my sleep schedule and limited time to be able to exercise really contributes but is also valid. Hoping to hear about some helpful ways to manage this. I've thought about whether this is something for other people versus myself and I feel like it's really for myself. I don't feel comfortable in my body right now, I feel like I'm in such bad shape. Thanks!I

realized I should send my thought download:
C: I have gained 15-20 lbs since mid-medical school and have not been successful at maintaining weight
T: I don't feel comfortable in my body, I feel unhappy in my body, I keep trying and nothing seems to help
F: self consciousness, disappointment, discouragement
A: don't try to workout because I don't have time and it doesn't seem to help, indulge in that treat to make me feel better, continue gaining weight
R: continued cycle of feeling bad about myself!

ANSWER:
Hello, friend. I am so glad you brought this here. I want you to know that I have felt this same way and have done (and continue to do) this same work. Asking for coaching is the first step towards breaking the cycle you are in. I'm so proud of you for bringing these thoughts into the light. Know that everything I will say comes from love and 100% compassion for you.

OK, to start, I'd like to give you some feedback on your model.
C- We always want this to be as neutral and factual as possible. In the case of bodyweight, I encourage you to just put the number on this line. Consider this, if you took a 150lb human body and a scale to the moon, the scale would say 25lbs. Same body, different weight. one way I accidentally proved this to myself was by switching the units on my scale to Kg instead of lbs. I had no idea what to think when it said "eleventy Kg" or whatever, and couldn't even form a thought about it until I converted it to lbs.
T- Keep it to only one sentence per model (you have many models running at the same time, but this helps keep things clean.
F- Only one emotion per model.
A- This part should have MANY verbs. As many actions or inactions as you can list from that feeling go here.
R- always for you and always proof of your original thought

So your model looks like this:
C- current weight in lbs or "weight up 15lbs since x date"
T- "I keep trying and nothing seems to help"
F- Discouraged
A- skip workouts, eat "treats", Justify skipping workouts and eating treats, cycle with self-talk and chatter about giving yourself a "pass" and then also beat yourself up. What else do you do or not do when you feel discouraged? Buffer or neutralize emotions with other habits? Netflix? Zone out on social Media? Snap at loved ones? Plan for an extra restrictive diet or double the workout tomorrow that you know you won't stick to?
R- you give up on yourself

Here is what I know: It is possible to accept and even love your body EXACTLY as you are today. Those feelings are available to you now (I know you don't believe me yet, and that's OK). It is also possible to accept and love yourself as you are AND decide that you'd like to change the number on the scale. The process of changing the number on the scale feels 100% better when it comes from a place of self-acceptance and love than it does when it comes from self-consciousness, discouragement, disappointment, or worse- self rejection or loathing.

The first step is to bring awareness to your thoughts.

I'm working on a body image Bonus Module for you all, but here is a sneak peak. This one is called the "Scale Worksheet". What comes up for you when you go through these questions?

1. Before you step on the scale, write down how you are feeling (an emotion, 1 word)
2. Number on the scale today_________
3. How do you feel about this number?
4. What do you believe this number means?
5. Are these thoughts true?
6. Can you see it is not the number causing your feeling but the thoughts about it?
7. Describe what it feels like to be in a body that weighs that number?
8. What can you do right now to choose acceptance or joy regardless of the number?
9. Here's what I'm going to believe when I step on the scale tomorrow:"________"

If you want to keep doing this work, we can do some coaching on what you eat and how you move your body, and what changes you might want to make out of love and respect for yourself. I'm here for you, sister!

XO