Hello, thank you so much for the prompt response. I took the break as advised and will have a talk with my boyfriend in the next few days. I talked to him and I told him I didn't feel as appreciated as I would like and that maybe we are just not good for each other at the moment and is nobody's fault. Perhaps we are just not compatible. Knowing this hurts me because I love him but I also feel like it's the best decision for us. However, after every hard conversation, we have he tends to be all nice again and that makes me question if I am doing the right thing or not.

C- I had a 2-week break from my relationship and talked to my boyfriend about us not being what the other needs and that we probably need to break up.
T- Is this a good decision? What if I regret breaking up with him? Maybe he could change and be how I would like him to be (but then again he hasn't been that person in. a year).
F- Scared, confused, sad, uncertain.
A- Have a conversation with him in the next few days.
R- We either break up or we don't.

I mentioned previously that I feel guilty if I decide to break up as he supported me throughout my residency application process, helped me move to this new city, and did other things. I would appreciate some guidance on why is it that I was sure about this but then when he tries a little bit I feel like I don't have the courage to end the relationship anymore. Thank you, coaches!

ANSWER:
Wow, wonderful job my friend! Way to let yourself have the break and feel all the feelings. It sounds like this was a really informative place for you and to reflect back what you wrote, you came to a clear (albeit painful) conclusion at the end. Now that you made a decision, your brain is doing what it does best and is trying to PROTECT YOU from more pain. That's its job. The problem is that the protective measures are inadvertently causing you even more pain. I'm going to clean up your model a bit to see this in action:
C- 2-week break resulted in a decision to breakup that I felt good about. Boyfriend now saying words that I wanted to hear previously.
T- Oh no, I made the wrong decision and might experience regret.
F- Scared
A- Tell yourself that maybe this time he will change (against the odds of data you have previously), spend time in rumination second guessing yourself, doubt your decision
R- You backtrack and no longer make any decision at all, prolonging and amplifying your pain either way.

Can you see your brain desperately trying to protect you here? But the result leads to LESS trust and overall more pain. You asked why it is that when he says words you previously wanted to hear, you lose your courage to stick with the original decision. You actually already answered this question in your prompt: you are AFRAID OF REGRET. That's all. All humans are, and here your brain is really trying to protect you from this specifically. I could try to tell you here to "just trust yourself!" "you won't regret this"! Right? But I won't because we both know that you can't control the future, and there is no "right" decision for any of us here. Instead, what if you trust yourself to do your best with the information you have and then to have your own back no matter what in the future:

Some places to practice getting comfortable and trusting yourself again:
-Why is it bad to experience regret?
-Is there anything positive that could come out of experiencing regret?
-Are you sure that regret is worse than the fear you feel now (what if the fear is actually worse? Would you be willing to let it go as an experiment?).

Please bring your emotions back here - or even better to a live call. There are so many eye opening and soul-building places to go from this beautiful opportunity you are in. I know it's scary and painful, but I also know you can totally handle those emotions. <3

I'm a second year resident now with more responsibility and this perceived expectation of being able to make clinical decisions independently. 

I feel like I lack confidence regarding being able to make decisions on my own and always feel this need to run things past someone else like an upper level or my attending to make sure that I'm doing the right thing. It's hard though when I'm on nights because I don't want to (seemingly) unnecessarily wake up an upper level or attending in the middle of the night with a decision I "should have" been able to make on my own. I'm worried that I have this dependence/reliance on being told what to do instead of knowing how to make my own decisions.

C: faced with the need to make a decision
T: "I can't do this, I don't think I know what to do... how do I know I'm making the right decision? Will I do the right thing?"
F: insecure, not confident, anxious
A: ask someone else what I should do
R: did not make decision independently

Help 🙂

ANSWER:
Hello There!

So glad you brought this here, friend. I love this concept, because it's the illustration of how we often think of things binary instead of on a scale.

What I mean is, we think that on July 1st when we come to work as an R2, we are supposed to magically know how to do things that we didn't know how to do on 6/30 as an R1. As a surprise to no one, unless we question this rule, we apply it to ourselves when we go from resident--> attending too. We think that we are expected to know things or be a totally different person on the day we start as an attending, that we didn't know on our last day as a resident. Wild right? Logically, we know that our ability to practice with increasing independence doesn't happen in ONE BIG STEP between 6/30 and 7/1, but in tiny incremental steps forever and ever, right?

Quick feedback on your model: Always stick to ONE sentence (thought) and ONE emotion/feeling. If your T is a question, answer it, and put the answer in the T line. Make the A line as juicy as you can Here's what I'm seeing for your model:

C- You are an R2, it is September. Clinical decisions need to be made
T- I might do the wrong thing
F- Insecure
A- second guess yourself, ask other people to tell you what to do/outsource the decision, look for approval externally, create impossibly high expectations for yourself, look for how you aren't meeting them, make the call to your upper level/attending, and then beat yourself up for calling them
R- You don't build trust in yourself to show yourself (or others) what you DO know

A few questions for you to consider:

Can you think of 5 examples of how you are managing things more independently now than you were in September of your intern year? Get super juicy here. give 5 examples of things that you could handle on your own, no sweat.

How did you learn how to trust yourself in doing those things?

Imagine now that you are an attending in your clinical practice, and working with an R2, what expectations would you want to have of them as far as managing things independently and calling you sometimes, even at night?

Bring it back here, sister 🙂

C-just completed one of my most brutal overnights in the NICU in which we had multiple very sick patients and multiple admissions overnight. I felt overwhelmed and had trouble trying to figure out where to spend my time. I didn’t have time to organize myself properly before sign out and realized while signing out that I didn’t have all the information for the day team to be able to do their tasks properly.
F- guilty, embarrassed, resigned, frustrated, depleted
T-would it have been possible to complete everything required of me in the time given? Why am I not as efficient and organized as other residents? How can I get to a point where I’m not signing out these huge tasks to the oncoming team?
A- this is where I need help from a coach. Typically I will wallow in self pity and just try to get through the rotation. But I honestly want to be better and do better but I’m struggling to be efficient with the time I have, despite asking others for their techniques and trying to be focused.

ANSWER:

Hi Friend,
Wow, it sounds to me like you did what was needed to take care of some really sick babies last night and babies made it through the night because of you. As a mom of a prior NICU baby, I know that you being there last night mattered, whether you signed tasks out to the day team or not.

OK I'm going to hop "out of the pool" now so I can help you look at your brain.

First, I want to say that when we are physically exhausted/sleep deprived, etc, it is really tempting to use the model against ourselves and say "Why am I like this!!!" and beat ourselves up. I want you to set this temptation aside.

I invite you to get some rest and then come back to this to look at it with fresh eyes.

When you are ready, a few things to ask yourself from a place of openness and curiosity:

What went right about last night?
how might it be the RIGHT thing to do to hand off tasks to the day team?
in what ways would "being more efficient" NOT be the right goal?

I'd love to continue coaching you on this, friend. Bring it on back.

I'm a pulm crit fellow, goals of care/end of life/palliative discussions are part of day to day and I generally don't mind them. There is a particular patient that makes me spiral in negativity and I feel horrible. I think there's a bit of moral injury

C: chronically vented patient with severe cerebral palsy, bedbound doesn't interact/speak. lives in a facility, frequent readmissions and complications from decades of chronic conditions. family is often not reachable when we need to consent for things/update, and pretty much never visits. we haven't made any headway in goals of care, it's always treating the next thing that pops up
T: initial thoughts - his body is literally decaying with his complications and he has no quality of life, he can't interact or contribute to society, and he has MDR everything, he is slowly dying and he would be horrible to code. follow up thought is wow i'm a horrible person, who am i to judge who lives, this is what his family wants and maybe this is part of their culture/religion/family values etc and within what they think is acceptable quality for him. then I spiral into thinking about other patients i've cared for before we (including attendings) thought they were definitely not going to make it out of the ICU or hospital alive etc but family said they were 'fighters' and insisted on continuing care and they did make it (obviously a very different scenario), and then I worry if I will end up pushing my preferences inappropriately, even though that's not how the family meetings are supposed to go or do go. Also then spirals and I question my choice of specialty - we've become very good at keeping people 'alive' but at what cost?
F: terrible, guilty, shame, sad
A: cry depending on how far I spiral. get a little stressed when I see the pt (or any of those chronic vent pts) is back in the hospital, think back to everyone else on the team who have shared similar thoughts/sentiments while caring for this / similar patients, and normalizing it
R: not sure - unnecessary burnout? more negativity at work in general just makes it a worse time. I don't think it's specifically changed my approach to meetings which has developed w a lot of different patients and families.

ANSWER:
Thank you for sharing this - so incredibly relevant. What I hope the model offers you is simply the revelation that it's not this patient that makes you spiral in negativity and feel horrible, it's your thoughts (surprise!). Here's a simplified version of your model (always helpful to distill as much as possible for clarity sake):

C: chronically vented pt with severe CP, bedbound, doesn't interact/speak who is frequently readmitted w/ complications from chronic conditions.
T: His body is literally decaying with complications, he has no quality of life, and we haven't made any headway in the goals of care that I think we should set.
F: Terrible (can you get more granular here? What is your initial/knee-jerk reaction to this thought? Is it frustration? Anger? Try NOT to judge yourself here, it's only your brain being a brain :)).
A: judge yourself harshly, call yourself a terrible person, spiral in guilt and shame, cry, stress out before you see the pt, and also other chronic vented pts, attempt to make yourself feel better by looking for others who feel the same angry things about these pts, feel worse instead, question choice of specialty.
R: You create unnecessary extra burden in your brain around chronically vented pts.

You mention moral injury here - and I think this is a great example to talk about this phenomenon. I won't argue with our country's approach to care in general. Hearing some of your thoughts, it sounds like you have a real VALUE of giving patients quality of life in their toughest phases.

Often the feeling of anger/frustration is great DATA that points us to thoughts that create conflict with an important value. I do NOT recommend questioning your value here, since I it's a beautiful and important one. Instead, I wonder if you can direct your brain better so that you are both enjoying your experience as much as you'd like to, and also moving your education and care in the direction of your value.

Unpacking your value seems to point to an additional thought you have that patients shouldn't suffer ever unnecessarily (as defined by you). This really seems like a virtuous and healthy value, but I wonder if it's realistic, since here you are with some heavy moral injury. Could it be true that even unnecessary suffering can also exist with our journey to creating the best quality of life for pts and families possible?

Some (re)direction prompts for your brain:
-In what (small) ways are/can YOU personally improve the QoL for these patients and their families in this circumstance?
-If anger/frustration isn't working to change the family, your rotation, or the system at large, can you experiment with a different thought to see what happens?
-Do you have an expectation that no patients should ever 'decay of complications' from their chronic diseases? (i.e. do you expect that we and families time palliative care at the right time for all the patients?).

How long will we have access to the website? #life has happened and I am on a very busy service, hoping to catch up with modules and listening to more of the podcast next week. Will we have access to the website/recordings/modules past the duration of the course, or do we lose access once the course is completed? Thx and thanks for all the work you all have been putting in!

ANSWER:
Hi! I'm so glad you asked this!

We know how busy you all are and know that you will come and go as your schedules vary. We built all of this so you can access what you need when you can and when you need it <3

You have life-long access to all of the monthly modules and the private podcast (call recordings)!
The only thing you lose access to after the program ends is the Ask-For-Coaching and live coaching calls.

XOXO

I am having a lot of difficulty with procrastinating tasks - all kinds of tasks. I am a fellow transitioning into research years and i feel like a fish out. of water. After years. of busy clinical loads. where there was hardly enough time to eat, I am now working from home and it is difficult. I went from having every minute filled with urgent to-dos to having the entire day to get "research" done without any real deadlines or current urgency. I now only have one half day a week of clinic and the rest of my time is my own - initially sounded like a dream but now I am struggling. The anxiety and guilt over NOT accomplishing tasks is worse than ever. I think my procrastination is multifactorial - first, i am not interested in research and my project is just "meh". Second, I am having trouble getting good guidance from my mentor on next steps and how to really move forward (and there really isn't another mentor option) . Third I have never done this before and do not know what I am doing which triggers anxiety and negative self talk about how I am a failure. My. mentor is also the division chief and as someone who wants to stay here after fellowship (i think) i feel like she is becoming increasingly disappointed by my performance and so I spiral into - she is never going to want me to stay, my career options are limited.

C - Now working from home
T - I don't know how to do this research project and I am afraid i am already failing, I am exhausted, Ill just do something else.
F - ?? Anxious? Incompetent? Lost?
Lost feels the most right. then that leads to the other feelings
A - no actions - instead clean the house, check email, look at phone, anything to avoid actually making progress
R - i end the day feeling terrible like I have gotten nothing done, feel like a failure. stress into the evening about how much i. need to do tomorrow. Do nothing tomorrow and build more and more stress.

ANSWER:
Fabulous insight, sister! What a beautiful example of how telling yourself "I don't know how to do this" leads to a result of..... drumroll... not doing it.

This is also a wonderful illustration of a common problem for physicians - because we are very used to being given the steps to accomplishment (even if they are very hard, sometimes disputable, etc), we are comfortable with having a plan laid out for us. So when we decide to tackle a goal withOUT a clear plan, our brains freak a little bit. This is normal, and your reaction is experienced by most physicians at some point in our careers (if we decide to set a goal outside of the clear track, that is). So.... welcome! You're doing it perfectly.

The way forward is to notice that your thought is creating your feeling, actions and result - NOT the research year. Where I want you to start is to watch your reaction to being a "fish out of water". Right now, your brain thinks this is terrible. The worst, and it is desperately seeking some water in things like housework, email, worry, and even beating yourself up a bit, right? Can't blame it.

But.

What if being a fish out of water, isn't so bad? What if it's this exact discomfort that you need to grow into the next version of yourself - one that isn't scared of uncertainty, but one that uses it to CREATE a future that you choose?

What if instead of seeking water (familiarity) - you instead should be seeking something different. Something you haven't defined yet. You say you aren't that motivated by your research project, why is that? Is there anything about it that you value? If not, can you change/modify it?

Give yourself 1 WEEK to linger in the exact place of being a fish out of water which, if you are unafraid of imperfection here, might be fertile ground to get after an even bigger goal you didn't know you had. During this week, create a list of everything you you think you *could* benefit from in this research time (don't limit yourself to classic research-y answers, let your mind run free!) and see where the passion lies for you. If you are having trouble, bring your list back here with your thoughts about it.

If you find a passion, but no motivation (or you are stuck in confusion)- bring those thoughts back here too.

We've got you.

Hi! I was on a vacation when this course started so I am just getting in to the materials. I have been having a lot of anxiety around a career question and was hoping to get some advice.

I am a child neurology resident in my last year and then next year I am doing an epilepsy fellowship. I hope to stay on as an attending after completing my epilepsy fellowship doing a combination of epilepsy and neurogenetics (both of which I've expressed interest in). They are interviewing an epilepsy candidate and a neurogenetics candidate now for jobs. Unfortunately, I am about 22 months away from being completely finished and it is too early for me to apply.. My husband is an optometrist at the University eye center at Anschutz and loves his job, so I feel a ton of pressure to get a job here and enable us to stay as a family (also have a 2 year old)

I realize I am too far our to apply for a job but I have begun to have a lot of anxiety around this and begin to go into a thought spiral of I am never going to get a job here and will be letting down my family etc etc

C: cant apply for job till next summer, neurogenetics and epilepsy providers are applying now, don't know if there will be a job in a year when I will be applying
T: Im never going to get the job, There won't be any space left for me. They didn't want me anyways. (I realize this last thought is irrational, but I can begin to spiral and wanted to give an example)
F: anxiety, fear,
A: Obsessing over something I can't do anything about, stress out to my husband who ensures me it will be fine (he is trying to be supportive, but then I just feel more pressure to keep us here)
R: worrying over something that cant be changed right now

I guess I wonder should I reach out to someone about a job even though it is crazy early? Will that look like I am anxious and desperate? Chill out and try to forget about jobs for a bit (I am trying to do this)

Thanks!

ANSWER:
Hi there! I hope you had a lovely vacation, and we are so glad you are here <3

First, some feedback on your model.
I wonder what is the sentence in your brain that is happening here at the highest volume? Is it "I'm never going to get the job?" is it the question "Will I look anxious and desperate"?

Choose ONE T and one F and put them into your model. Then get REALLY juicy on your A line.

You have great insight on your R line. You are creating worry NOW before you even know that there is something to worry about.

Your brain is doing what it has been trained for MANY YEARS of medical training to do: To imagine the worst case scenario, and then try and try and try and problem-solve your way to something better than that. This is literally how we train our brains to develop a differential diagnosis, and how to do the "If/then" part of sign-out by making plans A, B, C, D and E, and trying to control as many variables as you can

But unsupervised, it is using this skill against you and has you stuck in the spin cycle of worry here about something you rightly pointed out, you don't have any control over right now. Nothing has gone wrong, it's just doing its' job. But now you are onto it, so let's try and engage with it from a place of curiosity, OK?

As your coach, It's not my job to know what you should do or advise you on next steps, but sit with you as you explore and learn to trust yourself in sorting it out for yourself. I have some questions here, and I invite you to write for a few minutes about each of them. If there is one that resonates with you, I'd love for you to bring it back here for more coaching.

1. What emotion do you think the spin cycle of worry/anxiety is trying to protect or shield you from? In other words, if the worst thing you could imagine happened (no job available next year, have to move your family away from your husband's job he loves, etc...), what are you afraid you would feel? Why would you feel that way?

2. In what ways is the pressure you feel to get the job at your institution helpful? In what ways is it unhelpful?

3. Why does it feel hard to " chill out and forget about jobs for a bit" right now? Is there a way you can honor that reason instead of trying to push it away?

Bring it on back here sister, this is one we may need to look at from a few angles 😉

I'd like to preface by saying that I am an "extroverted introvert". Once I know people well, I let loose, I'm very outgoing, and I'm very comfortable in my own skin. I had a core group of about 15 friends in med school that I was very close with. We regularly spent time together doing activities with, such as going for drinks, listening to live music, festivals, etc. I had become comfortable enough with them to feel comfortable talking about my emotions and things that were going on with me personally, or with my family. I also had my smaller core group of 5 friends who are basically like family and who I know I could talk to about anything. However, I'm struggling to find time, energy, and confidence to build that network at my new program. On my one day off per week, I want to spend time with my partner, but it's also hard to find the energy to put myself out there in terms of meeting new people.

Circumstance: I see other interns and I am afraid to talk to them, or invite them to do something outside work
Thought: They probably won't like me. I'd rather have them think Im aloof than think I'm weird, or think I'm not good/smart enough to be in the program. I don't feel comfortable opening up to them at this point. Not reaching out to the interns I have kind of clicked with because I feel like I've already "missed the boat" on making friends since we're a few months into intern year. I don't want to be too forward in asking people to hang out. I feel like I have to be so perfect and professional at work now and I don't know how to merge that intensity with wanting to be relaxed and to be able to open up about things in my personal life outside of work.
Feeling: Loneliness, desire for friendship, vulnerable, feeling not good enough
Actions: continue not talking to other interns or residents other than the ones I have explicitly worked with; not texting the interns who I do know to make plans outside of work; sometimes
Result: continue feeling like I want to have more friends and more connections, but not doing much to change it
Thanks for reading my novel lol 😉 and I appreciate your insight in advance!

ANSWER:
Great question to bring here! Let's try to work with one thought at a time per model - since each thought creates a different feeling. I'm going to pull out a thought of yours that seems to come from a place of wanting to protect you from getting hurt, but instead adds to the struggle:
C: Intern year, I meet and work with other co-interns
T: They probably won't like me
F: Vulnerable
A: ARMOR UP: make yourself come off as aloof, continue not talking to colleagues (unless you explicitly worked with them), make up some story to justify this about an imaginary friendship boat that you've missed, not texting, not make plans outside of work.
R: Prevent them from even seeing you (i.e. prevent real connection)

I'm going to push back on your initial paragraph where you say that you are struggling to find time, energy, and confidence to build a network. It sounds to me like the time, energy and struggle come in this illusion you have that you are two selves, and you are trying to craft a perfect "friend" version to be and also a perfect "professional doctor" to be at work.

You identified perfectionism behind creating connection, which seems like it will protect you, right? Your brain thinks coming off as "aloof" is better than "weird" or, worse.... "not good enough". But in reality that aloof armor has prevented you from being YOU, from showing your colleagues your authentic self. Could it be possible that EVERYONE is also afraid of being "not good enough"? (read through old posts here or listen to call replays to answer this question, my friend!). This game of putting on your armor every day is an exhausting time suck. What if you drop it?

Listen, letting people see you is scary. It takes a lot of courage, and a lot of willingness to see yourself too. But most people walk through life with all of their armor on and end up with deep wounds from it. What if your people are out there, looking for you - will you let them see you?

I apologize, as this is a request for advice that is really more in the format of a thought dump, vs the CTFAR model. But I've been dating my current partner for about 3 years now. I'm now 29, but when I was 22, I dated a man for a year who was 35 that was emotionally manipulative and ended up cheating on me with multiple other women while I was a full-time caregiver for mom while she was dying from lung cancer. I broke up with him immediately, as soon as I found out he was cheating, and then only dated very casually for about 3 years, until I met my current partner after my first year of med school. My partner was extremely supportive in helping me work through some of that trauma and getting to a place where I felt I could trust him and felt loved and respected. However, in addition to my own experience with my previous partner, my parents had a very unhappy marriage that ended in divorce when I was in high school, and so I feel as if I don't fully believe in successful long-term relationships and marriages. I do can see them working for other people, but I'm not sure I believe deep down they will work for me. That fear is getting in the way me being able to move forward with my partner, who made the leap of moving with me to a new city for my residency and quitting a graduate program for me (graduated early) . In some ways, I feel like I'm always looking for reasons to get out of the relationship, not because it's bad right now (it's actually good) but because it might become bad later. My partner drinks more than he should and although I continue to try to be supportive and encouraging, in the back of my mind, I keep wondering if this is a red flag that I should be running away from--because of the *future* possibility he might become a true alcoholic and I might become unhappy. As a healthcare provider, it's somewhat natural for me to worry about him becoming dependent on alcohol, but I think there's more to it than that. I think about marrying him and my anxious brain freaks out about the possibility we *might* be unhappy later even though we are happy now. Any advice on how to stop thinking in this melodramatic that is so fearful of future negative possibilities that aren't currently present.
Thank you in advance!

ANSWER:
I'm so glad you brought this here. That is a perfect thought download! Let's pull ONE of those thoughts out and see what the result is for you.

Cs (objective facts)- You are 29 and have been dating current partner 3 years. You were dating a person before and he was sleeping with other people while you were together and your mom was dying. You ended that relationship. Your parents divorced while you were in high school. Your current partner moved here with you.

T (just ONE)- We *might* be unhappy later even though we are happy now

F- (what emotion comes over you while you think that thought?)

As- From that emotion, what do you see yourself doing or not doing? I see:
- look for "red flags", judge his drinking, justify your judgement of his drinking, judge yourself (call yourself melodramatic)

R- you said it right, you create unhappiness now. You hold yourself back from the full experience of your relationship- rejecting both yourself and your partner as you are now.

OK so I suspect this model isn't shocking to you, you said as much in your thought download. Please resist the urge to use this model against yourself, and let's just notice how that thought "We *might* be unhappy later", creates unhappiness now. That thought seems innocuous enough... it's true after all, you *might* be unhappy later, but the result is happening now.

I have a few questions I invite you to consider and bring back here for more coaching if they resonate with you:

1. What is YOUR definition of a "successful long-term relationship"? I invite you to answer this for YOU- not what you think you should say based on your socialization in your community, family, culture, etc.. but YOUR definition if you could create it for yourself.

2. Should we experience "unhappiness" in our relationships sometiemes? Why or why not?

3. In that definition of you created above, what criteria would have to be met for you to be "happy" enough? make as long a list as you can.

Bring it on back, friend.

C: I've gained more weight that I feel comfortable with since having two children. I am overweight.
T: I will never look how I did before children. I will never feel confident. I am unhealthy by being overweight. On the other hand, if I feel this bad about myself, I will set a bad example for my kids. If I have another baby (currently early pregnant), I will gain even more weight and will not be able to lose the weight from this pregnancy. My mother is obsessed with dieting and weight loss and a talks about it constantly. I don't want to be that way for my kids. I feel out of place in my own body. I don't like having my picture taken.
F: Shame, sadness, obsession, fear
A: I self-sabotage and eat from stress. If I weigh myself I am cranky and feel bad about myself all day, even when I'm trying to enjoy time at home or focus on work.
R: I stress --> eat --> feel shame --> feel gross --> gain weight --> feel worse. and on and on.
ANSWER:
Fantastic model! I urge you to get SUPER factual with your C line though (I promise it will help in mind management, and I also want you to pick one thought to work with per model:

C: I've gained ____ lbs in ____ years, and had 2 children in this time.
T: I will never look how I did before children.
F: ??? (sad?)
A: I self-sabotage and eat from stress. If I weigh myself I am cranky and feel bad about myself all day, even when I'm trying to enjoy time at home or focus on work. I stress --> eat --> feel shame --> feel gross --> eat more--> gain weight --> feel worse.
R: You don't look how you did before children, and make this unacceptable.

Ok, my friend. Here is the work. In this situation, you are believing that you are sad because of the weight you gained, right? But, you are actually sad because of the thoughts you are having and what you are making the weight mean. I promise, the pounds are simple, factual, NEUTRAL numbers that you can make mean whatever serves you the most. And in this model, your thought (which is catastrophizing, futuring, and optional) is not helping you.

Your brain thinks this thought is helping, right? It thinks if you continue to beat yourself up, to show yourself how unacceptable this cycle is that one day you will lose the weight, but I want you to simply see that this method is not working. In fact, this method is counterproductive - it is creating more stress eating. So - are you willing to try another method? It's scary to let go of a method that you believe will work, I know. So if you aren't ready to give up these thoughts, then I invite you to simply continue to witness them. I want you to write down a model for all of the other thoughts you gave me and ask yourself if any of them are working for you or not.

Can you bring back models for these thoughts and we can decide if you want to keep any of them?

T: I will never feel confident.

T: I am unhealthy by being overweight.

T: If I feel this bad about myself, I will set a bad example for my kids.

T: If I have another baby, I will gain even more weight and will not be able to lose the weight from this pregnancy.

T: I feel out of place in my own body.

C: I had to divorce
T: every decision I make, I regret afterwards
There's so many other other examples of decisions that I made with full autonomy that I regretted afterwards!!!! This the most hurtful. That's why I chose it.
F: sad, scared, disappointed
A: procrastination, I will do anything to leave the most important decisions for the last min. I tell myself over and over that I don't have anyone to support me (I don't belong to anyone!)
R: feeling dread and sadness again! A loop of sad thoughts and sad feelings

ANSWER:
Hello friend, I'm so glad you're here.
Thanks for bringing this model for coaching. I want to point out to you that even though you feel like you are in this endless loop of sad thoughts and feelings, here you are:
- thinking about your thinking
- asking for coaching
- showing up for yourself
- supporting yourself
- giving yourself an opportunity to belong, and be seen.
- looking for the crack where the light can start to shine through.

That takes tremendous courage. That takes commitment to yourself. That takes belief and HOPE, that even if it's tiny or fleeting, that feeling better is possible, and that its' worth working for.

Even when it feels dark and lonely and sad, you are here for yourself. That is incredible, and we honor that.

I can see and understand how painful this model is for you. We will be here to help you work through it.

I am going to ask you a few things from a place of genuine love and curiosity, friend. I invite you to think and reflect on them and come back for more coaching if there is anything that resonates with you here.

- I notice in your C line you said "I had to divorce", which shows me that on some level you didn't feel you had a choice. Then in your T line, you say "every decision I make, I regret", which implies that you made the wrong choice. It's no wonder this feels bad. You are beating yourself up for making a choice you didn't feel was a choice at all. I'll offer that a more neutral statement for your C line might be "I divorced from "x"". Does that change in phrasing change anything about how you think or feel? if so, how and why?

- Write for a few minutes about the feeling of regret. Where is it in your body? does it have a color? a shape? How do you know it's regret and not another feeling? really get explicit in your description. Once you KNOW that feeling, in what ways might the emotion of regret serve you and your growth now, and in what ways is it keeping you stuck? There is no right answer here, I'm just curious if there is more weight on one side or the other, and if so, how do you know?

Please bring this back here (or to a call) for more coaching, friend. We will absolutely walk alongside you as you make some more space for the light to shine through. <3

Hi! I'm a senior medicine resident and have had a hard time recently in my continuity clinic because I keep getting paired with an attending who I hate working with, over and over again. This person is detail-oriented to an extreme, and the expectations set for what I need to accomplish with each patient are unreasonable (e.g. a patient with a different PCP comes to see me for chief complaint of shoulder pain, and the expectation is for me to review all their prior outside lab work, their exhaustive list of medical problems, and make sure they are up-to-date on all their lab work and screening colonoscopy, mammogram, etc). It's just not achievable in the limited time allotted per patient; as a result, I am consistently spending my entire morning and lunch hour just catching up and I have maybe 5 minutes to myself to eat. Moreover, I think this person and I do not get along personality-wise (e.g. they sometimes make off-color or crass comments and I feel the need to laugh it off and move on with my day). It feels like I've been paired with this person a disproportionate number of times and there's nothing to say that it won't keep happening going forward. I get angry seeing other residents enjoy their lunch meal while I'm still seeing my last morning patient at 12:30pm - it feels unfair to be in this situation especially as I'm approaching the end of residency. I'm considering talking in private with one of the clinic directors about this, but in the meantime, I find myself absolutely dreading going to clinic and I think I'm just adding unnecessary stress onto myself because of it. I worry that if I can't change the schedule to work less with this person, that I'll be miserable the rest of the year.

C - I see that I'm paired with a particular attending I don't like for the next several clinic sessions
T - Clinic is going to suck, I will be so behind and won't get to eat lunch because I'll be catching up on seeing all my patients
F - I feel dread when I think about working with this person. I also feel inadequate and stupid after a day working with them because I inevitably miss something or other that they catch and point out
A - I talk with my peers/my family about how much I hate clinic and hate working with this person. I spend a ridiculous amount of extra time prepping notes before clinic to try to make sure I know all about the patient and to make things as efficient as possible.
R - My experience in clinic sucks, and despite how much time I spend prepping notes, I still somehow fall way behind and spend my lunch break/evening trying to catch up

I've been lurking in the shadows until now - listening in on the podcast weekly and gaining valuable insight from others' experiences. Just wanted to thank you all for doing this and for the other participants for being vulnerable so that others may also benefit and grow!

ANSWER:
Oooooo - I am JUST. SO. GLAD. you posted this here - this is such a common experience shared by all trainees, and one that doesn't go away when you graduate (I am currently sitting in here thinking of ALLLLL the past and current colleagues and supervisors in my life that I have the exact same narrative for). I'm going to tighten up your model, and for our purposes, let's call this person "Attending X"

C - See that I'm paired with Attending X for the next several clinic sessions
T - I don't like Attending X so clinic is going to suck, I will be so behind and won't get to eat lunch because I'll be catching up on seeing all my patients
F - DREAD
A - talk with peers/my family about how much I hate clinic and hate working with this person. Spend extra time prepping notes before clinic to try to make sure I know all about the patient and to make things as efficient as possible. Spend time in clinic trying to please Attending X and ultimately fall behind. Beat myself up if attending has critical feedback.
R - My experience in clinic sucks even more

I am not even going to try to convince you to like Attending X - it sounds like you have values and reasons for not liking them that you hold dearly. BUT - I do want to try to convince you that just because you don't like Attending X does not NECESSITATE clinic sucking. Truly.

I could summarize your model by saying that you have a belief that you need to like (or even just not hate) your attendings in order to enjoy clinic. But this is the overall thought error. First of all - as you know, you can not change your attending's behavior. And it sounds like you can't change your schedule to avoid them, so you are in a perfect place to practice changing your thoughts so that this is less painful for you. It's tempting here to feel justified in having the thoughts that are angry towards this person since "they deserve it", right? But in reality, your thoughts are only bringing YOU down, not Attending X.

So, instead of resisting the reality of Attending X, you can instead use them as a teacher in dropping thoughts that aren't serving you. In fact, what if Attending X is actually in your life on purpose to bring up all of these issues you have (I sensed some people pleasing, overwhelm, and self-judgment coming up in this narrative alone) that you could explore so that your future life is less painful?

A few questions to get you started:
-Why do you feel like you must please Attending X?
-Do you believe Attending X knows the objective truth of your doctoring skills?
-If not, can you practice letting Attending X be disappointed in you while you still believe you are a great doctor?

I invite you to come back with this topic you briefly touched on (but is a totally different model):
C: Worked with Attending X
T: I inevitably miss something or other that they catch and point out
F: Inadequate
A: ????
R: ??? (you miss yourself being awesome?)

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

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

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

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

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

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

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

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

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

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

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

A good friend always:
-
-
-

A good friend never
-
-
-

A friend sometimes
-
-
-

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

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

Hello!

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

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

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

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

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

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

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

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

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

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

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

C: PGY2 pediatric residency with home call

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

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

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

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

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

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

AND

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

right?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What else would you say to yourself?

So much love, sister <3

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

<3

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!

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"

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

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?

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