I'm halfway through a 3 year fellowship in a pediatric subspecialty and I'm finding myself overwhelmed by feelings of panic around finding a job after graduation and it's impacting my ability to enjoy my work (and often my personal life too) and to get the most out of my training. While the job market for my field is actually pretty good nationwide, there's really only 2 possible employers in the city we currently live in so the pool of potential jobs is small since I strongly value not moving for reasons I like (1. my husband has been highly successful in his career and just recently landed his dream job here 2. we're hoping to start a family soon and both sets of our parents are nearby 3. we generally just love the city/state we live in, own a house here and want to continue the life we've built). I've done well in my fellowship program so far and I've gotten positive feedback from my program director, attendings I work with clinically and the scholarly oversight committee for my research. In fact, several have commented that they would like to see me stay on as faculty

Despite that, I find myself perseverating on the possibility of not having a job when I finish because it's a small field, several of my co-fellows are hoping to be hired as well (and they are quite awesome) and there's no guarantee that there will be even one position at our institution when we finish let alone multiple since the department doesn't need to hire every year. I worry that if I'm honest about not being willing to leave this city for. a job that people will look down on me as not caring enough about my career and it may hurt my chances of a job here because it may look like I only want to stay for personal reasons, but simultaneously know that at some point I have to tell my chair and program director this because I'm not going to apply for jobs I wouldn't accept.

This worry is impacting my work in tangible ways and is also impacting my mental health and putting stress on my marriage. It's exacerbating my perfectionist tendencies and feelings of imposter syndrome. Two recent examples:
C: At the department holiday party last week one of the attendings commented "X (department chair) is making business plans for next year - I'm not sure she knows you want to stay. I let her know, but you should set up a meeting with her soon."
T: Our chair doesn't know I want a job here, it's already too late. She's planning to hire my co-fellow and there's no way to hire us both
F: Panic - tightness in chest, warmth in cheeks
A: Withdraw into myself, unable to continue engaging in conversation with the attending or others at the party who are interested in seeing me succeed and helping my career. Being distant with my husband both at the party and over the next few days
R: Not advocating for myself to get a position at my training institution as well as I could and husband brings up that he is frustrated with how I'm acting around him

C: I had to present my research progress to my scholarly oversight committee (SOC)
T: They are all experts in this field and are going to discover I know nothing about what I'm researching and it's going to negatively impact my ability to get a job
F: Worry
A: Spend weeks putting together slides at the expense of other work that needs to be done. Trying to read everything on the topic and memorize findings from prior studies that are only tangentially related to my work in case I get asked a question I don't know the answer to.
R: Presentation goes well, but I'm unable to spend time on my clinical work or set up mentoring meetings that I've been intending to or to actually make progress on my research since all I'm working on is a single 1 hour talk.

For context, the typical time period for the job search is late summer/fall of 3rd year (in roughly 6 months). I've thought about what it would actually look like if there was no job for me and I can list out answers that are suboptimal, but would be ok (another fellowship, a research year, not practicing in my specialty) and we thankfully are in a good place financially so that is not an added stressor.

Through this program, I've been working hard at emotional adulthood, but have a lot of trouble applying it here. I'm convinced that it's the circumstance of not knowing whether I'll have a job or not that is making me unhappy and not my thoughts about it (which is of course not true). I need some help with a thought ladder or other ways to rework my unhelpful thoughts in this area.

Thanks for all you do! Loving the coaching calls.

ANSWER:
Hi there! Great insight to the fact that you are still living in emotional childhood here. I also want to point out a thought error: you believe it's possible to actually know what you will be doing in 2 years. Actually, you *never* really know what the future holds. Never. Our thinking brains like to convince us that they have a plan to rely on, but there are endless possibilities that can throw that off (death, disease, natural disasters, winning the lottery, an ah-ha moment you couldn't even predict, etc).

Yes, you can still make plans, and a good portion of them will happen, but the way to calm down this overwhelm you are in is to remind yourself of what kind of person you are when plans *don't* pan out. I wonder if you have been in that situation before? Can you think of a time when you thought you were going to do something and something else completely different happened? Go there for a minute. Write about it. What did you do for yourself? Are you happy things turned out the way they did? Are you sad? Are you... ok in the end?

Zooming in on one of your examples:
C: Someone told you your chair doesn't know you want to stay
T: It's already too late. She'll hire my co-fellow and there's no way to hire us both
F: Panic
A: Withdraw into myself, unable to continue engaging in conversation with the attending or others at the party who are interested in seeing me succeed and helping my career. Being distant with my husband both at the party and over the next few days. Halt efforts to advocate for yourself and your dream.
R: You make it "too late" with an imaginary timeline

Your awesome insight shows exactly how this thought (offered by the skewed reality of your inner critic) is not helpful at all. So let's see if we can ditch it:
(Optional questions here:
-Could it actually be "too early" to start advocating for a job? Could it be "just right on time"? What are the downsides to believing this?
-What do you want to feel when you learn that your chair doesn't know you want to stay? (pretend you could pick from any emotion, including "excited" , "curious" , "rage" , "grateful" , "sad" ---> notice which Ts create each of these emotions. Really play with it. See how many believable Ts there are for just this one C).
-What do you want to do when you learn of this C? Write all of the actions you wish you'd do. Then see which of the Fs above create them.

The other example:

C: Presenting research to the SOC
T: They are all experts in this field and are going to discover I know nothing about what I'm researching and it's going to negatively impact my ability to get a job
F: Worry
A: Spend weeks putting together slides at the expense of other work that needs to be done. Trying to read everything on the topic and memorize findings from prior studies that are only tangentially related to my work in case I get asked a question I don't know the answer to.
R: You people please your way in to a great 1 hour talk at the expense of bigger goals

Again, let's question (gently) your T here:

-What do you think the "experts" believe you should be research-wise compared to them?
-Could it be normal to not know that much about scholarship at your stage in your career? What would be the benefits of showing this?
-Do you think there are other things that they are looking for in a colleague besides how well she presents research? What could they be?
-What are you looking for in your future colleagues?
-Who do you want to be in your career? What feelings do you want to show up in? How do you want to dress? Act? Converse with people? Where/How can you practice being that person now?

I was working an ED shift recently when a favorite and much beloved patient of mine came in in cardiac arrest and unexpectedly died. I had known her for over a year and a half and taken care of her on many occasions in different settings in residency. I took a few minutes after it happened to have a breakdown in the bathroom, but pulled it together and finished my shift. This is not the first time I have lost a patient, but I had a different relationship with her because I had become friends with her family and taken care of her so many times - to the point where her picture is up on my fridge to remind me every morning why I do my job. Since this happened, I have found myself unable to stop thinking about it. I keep going over it in my head and feel distracted at work. I feel on the verge of tears all the time. I am trying to pull it together and be ok, but it just seems very overwhelming at the moment.

I realize that part of this reaction is just the normal grief process, and that it will get better in time as I process through it. However, specifically the work-related part of it is making things difficult. I feel angry and frustrated that when these things happen we as trainees and doctors are expected to just continue to work as though nothing happened, and I feel dehumanized that I *can* continue to work as though nothing happened. I feel frustrated that even with all the care and support and technology we have, we could not do anything more for her. I have found it difficult to go back to work for each shift, as I can't stop thinking about it.

So, I suppose my model is (work in progress, I think some of the categories are mixed up):

C- A beloved patient and friend passed unexpectedly
T - Sadness, grief, frustration and anger with the medical profession for not allowing for human emotions after things like this happen
F - Aversion to going back to work, lack of focus, not feeling like there is anyone in my life who I can talk to (I have plenty of supportive people in my life, but this is a unique situation that I feel most people cannot relate to very well), feeling in a "fog"
A - Still going to work but feeling unmotivated, keeping things to myself
R - A cycle where I don't want to face going to work, feel unmotivated and looking for ways to get away from people, even though I love my job

ANSWER:
Oh dear friend, I am so sorry this happened.

Someone you cared deeply about died in front of you. This was a traumatic event, and you are having a human response to that trauma.

What you are experiencing is real. Asking/expecting yourself (or us asking or expecting each other) to bounce back on the spot, or bottle up your response to that trauma deepens the wound of moral injury.

The persistent or intrusive thoughts, desire to avoid the place where it happened, and increased psychophysiological reactivity (increased vigilance, sleep trouble, and trouble focusing) can be symptoms of post traumatic stress. As you point out, some parts of that response might be normal or even adaptive as you process this trauma, and other parts may not be.

First, I want you to know that it's OK to get professional help with this and I encourage you to access the mental health resources in your program that are in place to support you for things exactly like this. I know you think that you are "expected to work as though nothing happened", and perhaps you have internalized that expectation of yourself. Is it possible that that's not what is expected of you from your peers? your program? From medicine? What if by allowing our human emotions, we have even more capacity as carers and clinicians?

When you are ready, I invite you to allow the pain you are feeling to be there with you without trying to make sense of it or fix it.

It can be helpful to repeat the sentence "I am processing the pain" over and over again.

Watch where the pain is for you and notice how it feels.

Notice when you have a desire to resist, react to, or avoid the pain. Acknowledge it by writing it down or noting it in your brain. For example if you notice yourself having a short fuse, getting angry, or snapping at someone (or yourself), gently remind yourself that that won't help.

Process the pain.

Say, "this pain is part of my journey. I can honor my patient by processing the pain of her passing".

Notice the heaviness, the ability it has to rob you of breath.

Notice.

Let it be there as long as it needs to be there- don't try to force it,

When you are ready, do a thought download and see what comes up. Look at your thoughts with curiosity instead of judgement. Avoid the urge to "fix" any emotions that come up, just keep processing the pain.

As much as possible, keep staying aware through this.

Come back here for as much help as you need.

<3

I'm working on an intentional model for an Impossible Goal and just want to run it by you. I filled in the C, A, and R first and then added in the T and the F and I'm seeing how the T really does drive the whole model. I know that I have more questions about setting this impossible goal, but I can't figure out what they really are. What pitfalls can I anticipate as I embark on this impossible goal over the next three months? Any other advice, or thoughts for my T line that you might be able to suggest? Here's my intentional model...

C- I took written boards, now I need to take the oral boards
T- I can do this
F- Empowered
A- Study and purposeful practice--> confidently and knowledgably answer the examiners questions
R- Pass oral boards!

If it helps, here is the unintentional model I'm battling-

C- I took written boards, now I need to take the oral boards
T- Oh god, there is an impossible amount of material, I'm horrible at remembering things, how am I going to do this, I don't want to do this, just thinking about this is so overwhelming
F- Small
A- I've set a timeline to start at Jan 1st to minimize the # of wks of pain (so I haven't started actually studying yet); spending valuable energy in anticipatory worry; trying to spend the weeks before Jan 1st to mentally prepare for success, including making this model.
R- I made the intentional thought model above, labeled my goal as Impossible because it feels that way, and am proud/excited now to work towards an impossible goal(?)

ANSWER:
Ok - first I want to ask you, is "passing your oral boards" actually an Impossible Goal (something you believe is impossible for you), or is it just a regular goal? The purpose of setting an Impossible Goal is that you PLAN to fail a lot on your way to achieving it, and you practice having your own back about it. So it should be something that you will definitely fail at many times - not something you are likely to succeed at on trial one. Is this true for your oral boards? If not- let's take it into just a "normal goal" realm and look at your UM:

C- Goal = pass my oral boards
T- Oh god, there is an impossible amount of material, I'm horrible at remembering things, how am I going to do this, I don't want to do this, just thinking about this is so overwhelming
F- Small
A- set a timeline but haven't started actually studying yet; spending valuable energy in anticipatory worry.
R- You don't start the process or look forward to it

In this UM, I cut out things that belong in a different model - I doubt you created an IM from a feeling of "small" - that was probably created from a different model, yes?

You also are trying on this IM:
C- Goal = pass my oral boards
T- I can do this
F- Empowered
A- try to mentally prepare for success by creating an IM, Study and purposeful practice--> confidently and knowledgeable answer the examiners questions,
R: Create pride and work towards your goal

So you are in the beautiful land of straddling two models. My questions for you here:
-Do you truly believe the T in your IM? I'm sensing you may need a bridge thought. What can you truly believe in this moment? Is it true that you have conquered other things in your life that you initially felt overwhelm towards?

Potential Ts to try on:
"I wonder how I can make studying fun...."
"I'm curious how I could show up if I believed in myself from the start of this process...."
"I know I am a person that has done hard things well in the past"
"I totally know how to prepare for this, and am committed to it even though I don't want to"

Another hack is to try a result model (fill in these blanks):

R: Prepare for your oral boards and enjoy the process!

A: (what are all the things a person who gets this result would do? What do you imagine they would NOT do? Get really detailed here - even if you can't imagine yourself doing them yet).

F: (what feeling would you need to create to do these actions?)

T: (what thought can you believe today that cultivates this feeling towards your oral boards? AVOID TOXIC POSITIVITY - the biggest pitfall 😉 )

C: Goal = pass oral boards

Hello again! Thank you so much for getting back to me so quickly.

First, off, yes, "defeated" is probably the feeling that springs to mind the most. And yes, feeling defeated and like dating is a struggle is very much adding pain and making the process feel even more tedious and difficult.

Re: the questions:

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?
So much -- being willing to be vulnerable, put myself out there in order to meet said person, create and maintain a healthy relationship and partnership, feel ok with myself, be emotionally available for this other person, etc. etc. What i worry is: do I have the capability for that? Previously (by the end of residency), i felt so burnt out I knew that I wasn't emotionally ready to enter a new relationship or even have the bravery to put myself out there. Now, my worry is more existential: 1. what if my "best" isn't good enough, either to find a partner or, after finding said partner, in creating a healthy and supportive partnership? and 2. it feels like in order to "do well" in medicine (or at least, academic medicine) one has to be willing and able to put in the super super long hours, take on the additonal tasks and positions, do the junior attending hussle --- but that takes away from time outside the hospital, time that's also needed for fostering relationships and also protecting one's own sense of self -- how does one balance that?

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?
Hah! So many feelings -- self-compassion, grace, confidence, patience, feeling comfortable with vulnerability and possible rejction/pain, intermittent periods of feeling defeated / frustrated / scared / lonely, courage to feel all the feelings and not feel "weak" -- interestingly, many similar feelings that come up within medical training and practice

3. Do you believe this is possible for you, why or why not?
interestingly, when I was in my "dark space" during residency, I didn't believe it was possible for me to find love again, mainly because I already felt so down but also guilty that I "allowed" myself to be treated terribly in resdiency, sink into depression ... to the point that I felt too afraid to be vulnerable even to myself, let alone others -- very self-defeating in retrospect, yikes! Having climbed out of that hole, I then felt like "ok, if I can do that, I guess other things are possible." That was about a year ago, as I was starting fellowship. Doing therapy + better together has slowly helped me change some of my thought processes so that I do have more self-compassion overall, enough to feel that finding love / partnership as a female physiian in my 30s is possible for me.... but it does feel like an active effort, not letting my inner critic take the wheel, particularly when guys ghost or don't communicate well, even as I'm trying and putting myself out there. Does it ever get easier, shutting out one's inner critic?

ANSWER:
Wow! Great reflections here, friend.

I see a lot of perfectionism and black and white thinking showing up in your answer to question number 1. There are some assumptions in there that I want to point out to you:

1. that it's possible that anyone's best could be not enough. Do you think that about other people, that "their best isn't good enough"? Is it helpful to believe that? if so, how? If not, why think that about yourself?

2. That time at work "takes away" from time at home. I know we only have 24h in the day and that some of those hours are spent at work and those feel out of your control especially in training. AND, notice that when you have work time and home time pitted against each other that it's easy to think that one has to lose to honor the other. How could that not be true?

I think you are spot on about all the emotions that will come up for you to process! This is the price we pay for being human and seeking connection with other people. <3

Let's talk about self compassion now.
What does Self-Compassion mean to you?
What kind of things would someone who had compassion for you say to you if you were in struggle? Write as many as you can.

What would a conversation between your inner-critic and your inner-self-compassion-fairy-godmother (for lack of a better word) be like?

Could you write it out as dialogue?

IC: What if your best isn't good enough?
ISCFG:

IC: Yeah but......
ICSFG:

Bring it on back, friend
<3

I'm doing a one year fellowship at a program where I am also trying to get a job. It's been a disappointment because I haven't liked the unit or the people as much as I was hoping to and I have felt much more scrutinized and judged than embraced and invested in, but my family is well settled here and really wants to stay so I'm feeling a lot of pressure.

I've had an especially tough week. I did a practice 'job talk' to some of the attendings for an upcoming interview at another institution and got some 'be more confident' feedback (my least favorite kind, I've actually been very confident in my training prior to this but I feel that I've lost my confidence entirely since coming here.

And then I got some 'helpful advice' from another attending while on call a day later that 'some people' might interpret the way I was asking about patient management as 'questioning their decisions.' She also helpfully noted that this year is a 'year-long job interview' not just for this program but for anywhere I'd like to get a job. She also noted that I started this fellowship late (which was for baby reasons) but the rest of the attendings probably don't remember that so think I am halfway through the year and should be performing as such.

I feel so down and dejected now and like I've lost whatever I initially liked about this field. I have to keep my chin up and keep applying for jobs and talking myself up while believing I'm worthless, and also showing up to work with a (fake) smile on my face when all I want to do is crawl in a hole. And during this last year as a trainee when I should be soaking up knowledge, I now have to stay on my toes because 'some people' might interpret questions as a personal attack.

Here's a crack at a thought model:

C: some attendings said words to me last week
T: I was right to not feel welcome here, people don't like me, I'm in an impossible situation where people are judging my knowledge base and confidence, but also judging me for trying to learn
F: depressed, confused, disappointed
A: not show up as my best self to work, appear standoffish/uninterested/lazy
R: not get what I need out of this year - both educationally and professionally

I clearly see how my thoughts are leading me to a bad outcome here, but I just don't know how to convince my brain that my circumstances don't mean what I think they mean.

ANSWER:
Wow - this is such a wonderful example of finding your unintentional model and doing you work to own it! You have stepped into the uncomfortable (but empowering) space of emotional adulthood by realizing that your thoughts here are what are creating your result.

And... your brain is not ready to believe any alternative thoughts yet, it seems, which is totally fine and normal. One nice place to start here is to simply notice and accept this current model, just as it is. One trick to doing this is to add on a "I'm noticing that I'm thinking......." to the beginning of your thought. Or to add on a "...., and that's ok right now." To the end of it.

So you might say to yourself: "Oh, I am noticing that my brain is offering me the thought that people don't like me and I'm in an impossible situation." Huh, I wonder why it is clinging so tightly to this thought?

Is there anything good about this thought? What is your brain's motive here in continuing to think it? What does it think are the risks of believing a different thought?

EVENTUALLY - you will want to see if you can create any space or wiggle room in these beliefs.
You might start with just noticing that while your brain says this situation is "impossible" - in fact it's totally possible (evidence is that you are already navigating it, therefore proving your brain wrong).
Then you may challenge yourself by asking if it's possible that your unintentional or "automatic" thinking brain may have misjudged them? If it seems to still think that it is 100% right (welcome to my own automatic brain!) then you might even try to play with it instead of force a new thought. Can you play "pretend" just for a day that the attendings don't dislike you at all? Can you pretend that they are on your side? Just for the sake of giving yourself that gift for one day, to see what might happen if you choose to live in that space?

I wonder....

(also - bring this for live coaching this week! Only a few sessions left my friends!!) <3

I moved to the U.S. from another country for residency, and I couples matched with my husband. We worked on this goal for years, and were excited to match in the same city, but a few months into residency my husband became increasingly frustrated and sad with his program, the specialty he had chosen and our life here. For me the first year was also hard, especially the long hours and being away from family, but I still see the advantages of training where we are and I can definitely still see myself living here for at least the next few years (at least finishing residency and fellowship). But it's been so hard seeing my partner so sad, burnt out and demotivated, and sometimes I feel like I'm keeping him prisoner here for me. I try to be there for him and create happy moments for us, maybe even overcompensating trying to be extremely positive and cheerful all the time, which leads to lots of pressure and frustration when none of my efforts seem to make him feel better about living here, especially on the days where I'm also tired or sad (almost feels like I don't have the right to feel these things since I have it so much better than him here). Other times I resent this situation, thinking it's not fair to me since this was our plan all along, and that I shouldn't feel bad for building a career I like and being excited about residency. But then I feel very guilty about my resentment, because it's not his fault he's miserable here and we're a team who should put each other first. But then I think that so many women compromise on their careers for their husbands and I become so defensive. And then the guilt comes back. It's a terrible cycle. Sometimes I feel like walking on eggshells when we talk about residency, or when I want to share something good that happened to me at work because I fear this might make him sad - he tells me he feels so bad for preventing me to live the life I might want, and that just kills me. I'm just so disappointed with the way our lives turned out after we apparently "got everything we wanted", going through a very hard couples match process as IMGs and matching in our top choices. I also miss being on the same page with him, we've always made a wonderful team and now we constantly find ourselves in opposite sides, him pointing out how great it was back home and me trying to point out all the great things about our current lives, which is exhausting sometimes.

It's hard for me to even think about the future, as we clearly have no idea what our next move should be, and everything feels like one of us would be sacrificing something for the other. I'm super excited about going into fellowship and he's been very supportive, although this would sign him up for at least 3 extra years here. I'm still undecided about my long term goals, at this point I might want to stay and build a life in the U.S. or maybe come back to our home country to be closer to family after completing training, as both have big advantages for me, but now I feel like I'll never know if I did this for me or for my husband and I'm afraid I might end up resenting the decision if we do go back.

I definitely need help figuring all this out and breaking the tension I've built around it so I can make the best decisions for my professional and personal life. I appreciate any insight! Thank you!

ANSWER:
Well hello! So glad you brought this here.

First of all, I want to honor and acknowledge all the work you both have done and all of the challenges I suspect you both have had to face to pursue this dream. This sounds really tough.

You are both grieving the loss of the life you thought you would have here, and that grief looks different for each of you.

Here is the error in your thinking:
You think you are responsible for making him happy and you think he is responsible for you not feeling guilty. This keeps you caught in a tango of guilt and resentment, as you point out in your thought download.

This is what we call "emotional childhood", where we put the responsibility for our Feelings--Actions--Results on someone else, or where we take responsibility for the Feelings--Actions--Results of other people

Look, OF COURSE you want him to be happy. You care about him, and you love him! But you also want him to be happy because then you think you can stop feeling guilty. And if you can stop feeling guilty, then you can be allowed to be happy pursuing more training here.

If you have been practicing the Model with us, you have learned that it's YOUR thoughts that create YOUR feelings. By extension, it's HIS thoughts that are creating HIS feelings. You, where you live, what jobs you have or don't have, all of those things go on his C line, and he has thoughts about those things that are DIFFERENT than yours and that generate his Feelings-->Actions-->Results.

Ownership of our own model is "emotional adulthood".

Now, that doesn't mean that we just walk around making decision only for ourselves. We can care very much about how we show up on other people's C lines. We are responsible for that. But we aren't responsible for what they think or how they feel if we have showed up in the relationship in integrity with ourselves and love for them.

I have a few things for you to think about and bring back here:
1. How might it look if you allowed yourself to grieve the loss of the life you thought you were have here? Can you allow yourself to hold both disappointment and also hope and optimism and excitement for the future at the same time? How?

2. If you allowed your husband to feel the grief of the loss of the life he thought he would have here without wanting him to cheer up or be happier, what would that be like? Can you allow him to hold disappointment, homesickness and also love and support for you at the same time time? How?

3. The tension you feel is that you have created an artificial binary: Either you're happy or he is happy. In what ways is that binary not true?

XOXO. We will be here when you are ready to pick through this before.

Thank you so so much for this answer! I just copied and pasted all so I can have it on hand because I feel like you just asked me a question that blew my mind: "what is so wrong with regret?" The answer? I don't know! But it actually makes total sense, from what I have been learning with this coaching program (which I haven't been able to attend most of the calls unfortunately) our thoughts about something being bad is what really makes it bad. The only reason we don't like regret and because we have been conditioned to THINK that it is a bad thing to experience. Maybe if I change the way I think about, say, thinking that whatever I do, if I ever regret it, I can take it as an opportunity for making a change or doing something about it and not necessarily a bad thing per se.

I feel like things can really work with my boyfriend, we just need to seat down and talk about this again, hopefully with all this information I've gotten from here and him getting his therapist's advice we could come up with an idea that works for us. I hope so at least, and if not, I guess I'll just need to be positive about it.

Regarding the people pleasing, I totally get it. That is something I have done it my whole life and I am aware of, I just don't know how to balance it out, any advice? I tend to do things to make people happy or to avoid saying know even though it could not make me happy in the end (eg, say I should be able to leave the hospital at 5 pm, but if someone asks me to do something and I know I would end up leaving at 6 pm, I still do it so I don't say no to it...)

Thanks again for all the help, it really means a lot to me!!!

ANSWER:
Yes, my friend, this is IT!! You are exactly right that it's just our thoughts about regret that make it negative. The actual emotion, withOUT the thoughts, usually isn't so bad. While not physically *comfortable* to feel regret, the physical sensations of it usually not painful or long-lasting. So what if you just allowed that to be a possibility of an outcome for yourself? Regret has a lot of benefits overall (check out Dan Pink's latest book on the topic) - and if you were willing to feel it you may actually find that your life overall improves.

Re: People pleasing.... The way out is actually to stop lying. People pleasing is simply doing something you don't really want to do in order to try to control another person's feelings. So the antidote is to choose to do things from a place of emotional adulthood (realization that the only person's feelings you control is YOURS) and choose to control those instead.

Here's your current model:
C: Other people exist:
T: Trying to please them is something I have done it my whole life and I am aware of, I just don't know how to balance it out
F: (how does this feel?? "Stuck"? "Anxious"? , "intimidated"?)
A: Do things to make people happy, avoid saying no, disregard your own feelings, self-sacrifice (eg, say I should be able to leave the hospital at 5 pm, but if someone asks me to do something and I know I would end up leaving at 6 pm, I still do it so I don't say no to it...)
R: You don't figure out what YOU really want, or how to live authentically

First step is to notice it - like you are doing. Second step is to understand what people pleasing is getting you right now. What are the benefits? There always are some (likely some form of ego-protection), and it's important to be honest about them. Then start asking yourself what it would look like to NOT people please in a given situation - what would showing up truthfully about what you want to do from a place of owning your own feelings and letting others own theirs look like.

So - in the case where you wanted to leave work at 5pm and someone asked you to do a task, what would it look like to act from a place of NOT people pleasing?
(*hint - it won't always be that you say no. You are allowed to do a task that you don't want to do for reasons that you value and align with! So in this case, you might still stay, but the thought would be very different than "I don't want to disappoint them" or "I want to look good" or "I can't say no because I'm ...." or whatever it currently is).

Bring back the next unintentional people pleasing model that happens to you, and then see if you can map out an INTENTIONAL model to try out.

I was on the excellent call with Dr. Shah last night and I got to ask this question via the chat while she was coaching another BT colleague, but the question that I asked was along the lines of...

When we reveal vulnerabilities, i.e. that we don't know something, or have a question that we feel brave enough to ask (even though we *should* already know the answer), it seems like there always might be real downsides/consequences to "letting this incompetence out." By this I'm mostly worried about my own reputation, which, in medical training actually matters quite a bit because once you get labeled as the incompetent resident/fellow that certainly has downstream impacts. The answer that Dr. Shah gave was good, though I do want to re-listen to the call. What do you think of this?

I can change my thoughts/feelings and decide that risking my vulnerability is in the best interest of becoming the doctor I want to become... but what if that shoots me in the foot?

ANSWER:
Hello Friend!
This is so good to think about.

One thing I want to be really clear about is that a psychologically safe learning environment is required for any party (learners or teachers) to reveal the limits of their knowledge and skills. This means you can do so without fear of harassment, belittling, punishment, exclusion etc. If you are in an environment where you are actively punished for being "wrong", then it makes sense why it feels VERY SCARY to reveal your limits or be vulnerable.

We can all imagine (if we haven't experienced) the downside of that kind of culture and how that contributes to problems down the line. Not only for us but for our patients too! I WANT a colleague who knows how to acknowledge the limits of their knowledge, I WANT a leader who knows how to ask for help when they need it and who models vulnerability and humility in leadership, I WANT my loved one's doctor to trust themselves to know what they can and can't do and not proceed with something they "should" know, but aren't really sure about. Right?

Listen, I will NEVER try to convince you that your learning environment is psychologically safe if you don't believe it is. I will never ask you to reveal the limits of your knowledge to someone you don't trust to receive and honor your vulnerability. Only you can know who among your teachers this feels right to practice this with. This should be someone who you respect, who you believe has your growth and best interests at heart.

Between us right here, what we CAN explore and craft is the psychological safety of the learning environment that exists within your own brain.

1. How do you treat yourself when you are "wrong"? Is it safe in your own head to acknowledge (without fear of punishment, or harassment) the limits of your knowledge or skills? Why or why not?

2. Are you vulnerable with yourself? What would this mean to you?

3. You seem to equate revealing or exploring the limits of your knowledge or skills as the same thing as "letting the incompetence out". In what ways could that NOT be true? Can you think of any examples?

In BT we literally DREAM about changing the culture in medical training so that we all can exist in an environment where it is safe to learn, and grow, and flourish. All of you are seeds of this dream. You have the power to create something in your micro-culture- with how you treat yourselves and each other, and take this with you in your practice. You are an example of what is possible. What do you want that example to be?

SO MUCH LOVE, FRIEND
<3

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

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

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

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?

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

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

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???

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

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

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

-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.

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!

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

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?

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

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"

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!