I’m a late person, I always have been. I know that my thought patterns contribute and I need help working through them.

I hate the way being late makes me feel and how it makes me look to other people (rude, irresponsible, untrustworthy).

I notice that I can put together a full plan on how to get to work on time, including a timed checklist of tasks, but when it comes time to execute, I talk myself out of it.

Here’s what my model looks like:
C- it’s time to get in the shower so I can be on time for work, according to my post-it
T- I don’t want to. Getting ready is boring. [Depending on the circumstance, I’ll think:]
1- Let me spend a little more time on my phone zoning out on Instagram or playing a game. I hardly ever get time for myself anyway. I’ll just get ready really fast, it’ll be fine!
2- I JUST got started on this [research task, reading/laundry/other chore], I’m in the zone and I should really keep going. I’ll just get ready really fast, it’ll be fine!
3- [Lose track of time completely, realize with a jolt it’s time to leave, still spend the same amount of time getting ready because:] “I’ll just get ready really fast, it’ll be fine!”
F- swing between irrational optimism, anxiety, and despair
A- leave for work late, arrive very obviously late or at best only right on time or one minute late but stressed and sweaty.
R- continue to feel disappointed in myself, presume others hate me.

Help- how do I break the cycle?

ANSWER:
Hello friend!
I'm so glad you brought this here. If I had a dollar for every time I justified my procrastination through "irrational optimism" and "It'll be fine!" thinking, I'd have about a billion dollars right now. You are not alone! My brain likes to offer me the thought that I should only get out of bed when the minutes are in a multiple of 5, and it's VERY CONVINCING that this is a totally fine reason to stay in bed (and subsequently be late for work). Our brains are so tricky! 😉

So here is what is happening- you have a toddler living inside of your head and she just doesn't. wanna. do. it. You and your rational adult brain are pleading to her like "Pleaaaaase, please, it's important to me that we get to work on time" and the toddler is like "Nope, I have all the reasons not to get ready right now, and I'm in charge here!" Then, you engage in a tug-of-war with her, and surprise! no one wins! (if you've ever argued with a toddler, you know this is true, no one wins)

OK- Nothing has gone wrong here, your inner toddler is used to getting her way, and now you're trying to change the rules on her and she is going to throw a fit. That's fine, we will figure it out together.

First I want to offer some feedback on this model so we can look at one thought at a time. So a few pointers:
1. the C line needs to be very objective and factual
Ex: It is ___am, signout/1st patient is at ____am. I have not showered yet.
2. for your T line choose ONE thought.
3. on your F line, choose the main emotion that thought creates for you.

I invite you to explore one of these prompts and bring it back here for more coaching:

1. You said "I hate the way being late makes me feel". what is the feeling you have when you walk into work late?

2. What is the main justification that your inner toddler uses to convince you not to hop in the shower at the time you said you would? Why does she think that's a good reason?

Bring it on back here, friend. This is worth your time <3

C- Someone mentions something in a clinical context that I don’t fully understand/ know enough about
T- Omg I have no clue what we are talking about / I don’t know what this piece of information means/implies, and I should definitely already know this since I’m the fellow
F- Overwhelming anxiety/ feelings of being flustered/ wishes that I could disappear into the wall even though this is a Zoom call and no one yet knows/ has figured out that I’m an idiot/ I have no clue what we are talking about
A- Tell myself that I have to read more/know everything (all while knowing that’s not possible) and not doing anything to actually make progress on learning things (because who has time for that when on my best days I’m rushing home to hopefully have a chance to see my kids
R- Nothing really changes; I continue to grow in my clinical knowledge on the “moving sidewalk of medical training” but there are still so so so so so so so many things I have to learn/know more about and I remain nearly terrified of becoming an attending soon; am frequently terrified knowing that I will soon/ultimately be found-out to be a fraud.

ANSWER:
Hello Friend,

Alright, great work bringing your model! Before we dig in I want to give you a few notes. We always want to look at just ONE thought at a time. Of course we are thinking hundreds of thoughts all the time, but for the sake of this meta-cognitive practice, in each Model, I want you to pull ONE thought and ONE feeling that the thought evokes. The other important thing that we want to do is make sure the C line is objective. Your C line presumes that it's possible to "fully understand" and "know enough". These terms are very subjective, I know that because a) as human beings it's impossible for us to "fully understand" or EVER "know enough" right? We will always, always, always be exploring and learning,

So... Let's look at it a little more granularly

C- You are a fellow on a clinical service having conversations about medical concepts (I think everyone would agree that these are facts, right?)
T-I have no clue what I'm talking about
F- Flustered (how does this feel in your body? can you describe it?)
A- hide/withdraw, berate yourself, set unrealistic/impossible expectations for yourself,
(what else do you do from a place of "fluster"? What do you NOT do?)
R- You don't create a safe space for yourself to learn and grow

Now, we NEVER want to use the model as a tool to beat ourselves up further, OK? It's just to show you your thinking.

Here's what I want to offer you:

Just because you have this pattern of thinking does NOT mean something is wrong with you, and does not mean you are doing it wrong. In fact, it comes from a value of deep CARE about learning, growing, and developing your skills so you can best serve your patients, Your brain is just going about it in a not-so-helpful way.

Your brain is doing EXACTLY what it has been conditioned to do by your socialization and experiences. It is going overboard trying to protect you from exposure, rejection, embarassment, and all of those uncomfortable things. It's really trying to help.

But now, you're onto it, and you see that even if this way of thinking was helpful in the past, now it's not only unhelpful, but potentially keeping you from fulfillment at work and at home. Good to know.

The first step is to just notice that this thought pattern is there and to step into a "watcher" space, being curious and nonjudgemental.

Here are a few things to chew on and bring back for more coaching:
1. I invite you to look for the upside to the voice in your head- are there pieces of what she is telling you that might be helpful. If so, what/why?

2. what would it take for you to believe that you "Knew enough"?

<3 Bring it on back here, sister.

I am stuck. After so many years of hearing "it gets better after ___" i am tired of waiting for it to get better. I finally finished my first year of fellowship and I am heading into the research years but now I just have so much time where I just wonder if what I am doing is right for me and so I procrastinate doing anything at all, then feel guilty for underperforming/not meeting expectations, etc. I feel so burnt out but the thoughts around leaving or changing what I am doing challenge everything have worked towards since high school. When I decided to go into medicine I already knew i wanted this particular specialty, so I have had a singular goal for 15 years and now I am realizing that it may. not be what I want.

Cue the existential crisis.

I think I love the medicine aspect of my specialty, interesting patients, i connect with them which I love. And my division is overall wonderful. However, I don't feel like many of them are thriving and work life balance is few and far between. I WANT A LIFE! one that exists outside work and is robust and full of things that give me an identity again! I worry i cant have that if I stay here or even in this specialty. (For context - it is a small pediatric subspecialty and leaving my current institution despite loving the city and wanting to stay, would mean moving multiple states away. In addition, most if not all positions are in academia and i just do NOT want to do research but the full time clinical load at my current location seems unbearable. Also, if i leave for a smaller location it means more call (Big division = 8-10 providers, small =1-3). I feel trapped but I enjoy the medicine and the patients so I do not quite want to leave. How do I craft a life that fits me? Especially when i still operate on a mindset where asking for or making time for what I want/need is so difficult and if i do muster up the courage to ask for it I feel selfish.

Taking a stab at the CTFAR --
C - small specialty with limited job flexibility
T - I will never have the life I want
F - hopeless
A - spiraling constantly - should I leave my specialty? medicine? should i stick it out for 2 years then decide?
R - Unhappy, dreading work, grumpy

================================
ANSWER
Hello soul sister! Your brain is trapping itself, just like all of ours does. You believe you are trapped between two impossible choices, but what I want to show you is that it's just your black-and-white thinking that is trapping you. Here are a few examples of where you've given zero wiggle room:
-I love the specialty, patients and division, BUT I can't have a life outside of work if I stay here.
-I don't want to do research or full time clinical work, but I have to pick one of those.
-If I switch to a smaller program, life will get worse with more call

BUT there is brilliance in your post. You wrote: "How do I craft a life that fits me? Especially when i still operate on a mindset where asking for or making time for what I want/need is so difficult and I feel selfish doing it." That's just it, my friend! Dig in here. Answer that question and pretend there are no limits: how DO you craft a life that fits you? First step is to write out exactly what that looks like. All the parts.

Then the second part is working through your unnecessary mindst that it's 1) difficult and 2) selfish. Neither of these are a Circumstance, which is great news.
Let's pretend for the next week (or month?) that is IS possible to stay in your specialty, your location or wherever you choose and craft the life you want. Even if you don't have any examples of people that have done it before you - can you start exploring what it would take? Who might you go to for help? Who would you want to connect with (hint: maybe you don't know them yet). By focusing on this empowering question, you will put your brain to work figuring out how it CAN happen, rather than it's default which it telling you all the ways that it CAN'T. This exercise will be important to practice no matter what you decide, a strong black/white negativity bias towards our future is rarely helpful. Getting out of the victim/disempowered space, you are teaching your brain to take control of your life in the way that it wants.

C - my specialty
T - I wonder what it would look like to have exactly the life I want
F - ????
A - ???
R - Start creating that life now

C- Your inner critic says "you're going to do something dumb"
T1- "STFU"
F1- ?(how do you feel when you tell her that?- ONE emotion): it feels kind of ... powerful? (I can't tell if this is the 'wrong' answer or if you're trying to guide me towards something different). Like I can just say, hey, knock it off Inner Critic Self, you should know better than this.
A- what actions do you take from that F? Can sort of reorient myself to a more normal way of thinking about clinical work. Knowing that no one enters a training program knowing everything, because why else would they be there. Working on being inquisitive and curious rather than stiffly trying to save face all the time. Knowing that even if I make a mistake it's more about how I work through it than about whether I made it in the first place. And knowing that I've been working in this field for long enough to know how to do all of that.

T2- "It won't be that bad if I apply and I don't get hired"
F2? Is lying a feeling? Or at least insincerity? Maybe the feeling is 'incredulous' because it strains credulity to think that this wouldn't be painful.
A2s? Still having the bad feelings and then being annoyed at myself that I can't overcome them just by lying to myself.

T3- "It might hurt a lot, but this hurts too"
F3? This thought makes me feel somewhat serene. Almost zen-like. Like if I were the kind of person who could make this their primary thought, I could then imagine I'm the kind of person who could experience rejection and let the feelings wash over me, experience them, and then move on with some sort of acceptance or peace.
A3s? seems like this could help me neutralize the feelings of inadequacy, shame, avoidance, dread, etc etc that my Inner Critic is imposing on me. If I can have some confidence that even if the worst outcome comes to pass I will survive it, maybe my I.C. wouldn't have to fight me so hard right now.

Answer:
Well done! Our questions are always meant to help you explore your thinking so you can choose the thinking habit that serves you best. I promise I am not trying to lead you anywhere, and there is no "right" or "wrong" answer. 🙂

It looks like each of these paths takes you down a slightly different road. Here is what I see as the Rs

Model1
T1- "hey knock it off, IC!"
F1- Powerful
A1- (as you listed)
R1- You engage in a gentle but critical dialogue with your inner critic (ha!) and you have your own back.

Model2- this one does not take you where you want to go...
T2- "This won't be that bad"
F2- Incredulous
A2- (as you listed)
R2- You kind of gaslight yourself and then use it as a reason to be annoyed and beat yourself up further.

Good to know!

Model 3
T3- "It might hurt a lot, but this hurts too"
F3- serene
As- experience feeling like rejection without fear or resistance,
move forward with acceptance or peace
build confidence in your ability to handle these emotions while having your own back
you demote the inner critic to a less prominent position at the table in your head.
R- You accept the human experience as one that has pain but also all of the other things you want in life too, supporting yourself as you move through it with less resistance.

All of these models (and many more more) are available to you. I can tell that model 1 may be available to you right now, and model 3 feels like a stretch.

What comes up for you as you look at these result lines?

<3

So often I find myself just feeling stressed and anxious and not being able to pinpoint what it is that's bothering me. I find myself snapping at my husband, avoiding doing work, and just having a general feeling of not having anything left to give to the people around me. When I try to work through the CTFAR model, I often can't think of what the circumstance is.

C - ?
T - "I feel stressed."
F - tremulous, nervous, tightness in chest,
A - going to sleep early to avoid talking, snapping at my husband, watching TV instead of being productive so I can just zone out
R - I end up not getting done any of the work I need to get done and act grouchy towards my husband leaving me feeling even more guilty and stressed the next day.

But I have trouble pinpointing what exactly the circumstance is that's making me stressed and figuring out what I can do to change it.

ANSWER:
Great awareness here. It can take a bit of practice to tease things out. If it feels like a challenge, that's OK and it doesn't mean you're doing it wrong.

I picked out a few Cs that I think we'd all agree on, and I want you to move "Stressed" to the F line.

C-you are a human, in residency or fellowship training, have a husband.
T- ?
F- Stressed (feels like tremulous, nervous, tightness in chest)
As- avoid talking, go to sleep early, snap at husband, "zone out" on TV

It's not the Cs that are making you feel stressed, it's the way your brain is making meaning out of those Cs and narrating it to you.

I bet there are 10+ reasons you could feel stressed right now in your life. What might they be? I invite you to list as many as you can. Be as petty and mean and whiny as you want. We have no judgement here. Let it all out, sister <3

Response to the coaching from my first post, struggling to go on. (Thank you for answering!)

"I want you to look closer at this T. Why do you feel incredibly guilty for wanting to quit? Get really clear on this question first, what are the thoughts behind the guilt?"
I feel guilty that my family and partner sacrificed a lot to get me to where I am now, and I'm not happy with my job.
I think that quitting would make me a habitual "quitter" and that people would see me as lazy, unwilling to do hard things, quit when it gets tough.
But then I feel even more guilty that my partner and family has to put up with me STAYING in residency if I stay. I am miserable, I cry all the time, I never have time for them, I sleep a lot, etc.
I've had to make a lot of personal changes to stay in this job. I'm now on antidepressants. I worked through the embarrassment I felt of needing those a long time ago. But it has since caused me to gain a lot of weight and now I feel guilty I'm not as attractive as a partner as I used to be because I do not feel attractive or pretty. I feel like I'm letting myself go. (Will make a separate post likely on trying to lose weight/taking care of myself)

This is probably way too much to bring here, but that's my deep dive / thought download on the question.

ANSWER:
Thank you for the authenticity here! This is deep work worth doing, and I promise you are not the only one wrestling with this. Let's look at one of these thoughts in a model:
C: Decision to stay or go about medical training
T: I'm no happy with the job, but quitting would make me a habitual "quitter" and people would see me as lazy, unwilling to do hard things, quit when it gets tough.
F: Guilty
A: View both decisions through a strong negativity lens (focus on how residency pulls you away from people, "makes" you miserable, blame it for your C of depression and weight gain, and beat yourself up by saying you have let yourself go) and (spin a story of how if you quit you would quit other things, beat yourself up for being lazy, make yourself a villain for controlling where your family is and what they do, and catastrophize about what you think others will think of you if you quit).
R: You create a lose-lose situation.

Ok. Your brain is really trying to protect you here - it's playing out all of the worst case scenarios because it thinks by doing so it can prevent them from happening. But actually, you can not ever control other people, or the future - so not only can you not prevent things, but you are living both worst case scenarios for yourself NOW.
You are spending a lot of time worrying about what other people are thinking and feeling of and because of you - but in actuality, not only can you never create thoughts and feelings in other people, but you never even get to know what they really think.

Let's instead focus just on YOU. Let's start to unpack some of your core beliefs here:

Are you sure quitting once makes you a quitter forever? Have you ever stooped doing something before?

So what if you are unwilling to do hard things? Why do you think you must do hard things? What are your thoughts about people who decide to not do a hard thing? Could you be wrong?

I invite you to bring this to live coaching - (in multiple stages of your work!)- it's the best way I've moved the needle when I've found myself stuck, and you would be also benefitting so many of your peers.
If it doesn't feel right, keep coming back here! Sending so much love to you in this journey.

Thank you for the fast reply!

1. What do you think your Inner Critic wants? What is she trying to protect you from?
-exactly as you said - she's trying to protect me from all the things you mentioned - applying for the job and not getting it exposes me to SHAME, embarrassment, disappointment, letting down my family and having to move AGAIN, proof that everything I feared about myself is true

2. What would you like to say to her?
-my first inclination is to tell her to STFU
-but I think you're going to tell me to approach her with love and compassion
-maybe I could tell her that maybe it won't be that bad if I do apply and don't get hired and try to convince her
-or maybe I could tell her maybe it will be bad - it will hurt a lot - but if I'm already feeling all those bad feelings [dread/shame related to avoidance] she's inducing in me - then what is she really protecting me from?

what do you think?

ANSWER!
Yay! Thanks for bringing this back!

I'm curious... let's see what happens when we put a few options into a few models...

C- Your inner critic says "you're going to do something dumb"
T1- "STFU"
F1- ?(how do you feel when you tell her that?- ONE emotion)
A- what actions do you take from that F?

T2- "It won't be that bad if I apply and I don't get hired"
F2?
A2s?

T3- "It might hurt a lot, but this hurts too"
F3?
A3s?

What happens when you look at these separately?

I matched for a one year fellowship following multiple years of training at a different institution. My fellowship program indicated they would likely be hiring for more faculty positions in the coming years. They have a track record of hiring former fellows and it would be a dream come true to work here long term. I am starting fellowship next week and just found out they posted an ad recruiting for new faculty. Now that it's *actually true* that they are hiring, all of a sudden all of my imposter syndrome feelings are coming up. To add to that, I had to start late because of parental leave at my prior program so I haven't even started working yet and somehow I'm supposed to apply for a job there?!
If I had to put it in the model:
C- [new program] is recruiting for attending positions this year
T- there's no way I'm qualified for this, I haven't achieved enough yet to be an attending, they probably are already annoyed I had to start late, I'm going to do something dumb clinically when I start at this completely new institution and they'll think I'm an idiot
F-inadequacy, fear, avoidance
A-avoid working on an application, act anxiously/awkwardly at work instead of confidently
R-apply late, not even apply, not get the job, reinforce all of my inadequacies

How do I convince myself that the thoughts I'm thinking are invalid or at the very least unhelpful? Is there a way to 'fill myself up' with different thoughts to drive different feelings and actions?

ANSWER:
Hello! What a PERFECT thing to bring here.
I want you to pretend you and I are sitting on the couch and we are watching this like it is a movie:

It's the last big scene.... our heroine has made it THIS FAR! She is ALMOST THERE and there is nothing between herself and the thing she's been dreaming of forever except this sneaky little voice (we will call it the "Inner Critic") inside her head that says "You're not qualified for this, all of that work you've done over the past 10 years is not enough, you're going to mess it up, they'll think you're an idiot".

If we are the audience and we are watching this movie, it's not a surprise to us that this is the moment when our character's inner critic gets LOUD, right? It's been in the background waiting it's turn and now it's coming in hot. the Inner Critic says, "It's my time to shine! let me tell you ALLLLLLL the ways you can't do it, despite literally YEARS of evidence to the contrary, take a seat".

Right?

Here's the thing:
What if the Inner Critic is just trying to protect you. What if she, albeit misguidedly and loudly, wants to do everything she can so you don't have to feel exposed, vulnerable, disappointed, rejected, embarrassed, or ashamed. She thinks she's helping you by making sure you feel inadequate now so you don't have to feel disappointed (or worse) later. This is her MO.

The first step, after becoming aware that your Inner Critic exists and before you can convince her that her thoughts aren't helpful is to enter into a dialogue with her with much interest and curiosity as you can.

Ideas for you to consider and bring back for more coaching:
1. What do you think your Inner Critic wants? What is she trying to protect you from?

2. What would you like to say to her?

I'd love to continue coaching on this friend, and I invite you to bring back whatever comes up for you here.

<3

I was recently diagnosed with a rotator cuff injury and am supposed to start PT. I went to my first appointment, but most of it is about doing the work at home. I struggle with trying to create new healthy habits, and integrating PT exercises into my day seems like just another task that I don't have time for. And one that I see myself committing to, but not being able to achieve in the end (like exercising, this stretching program I wanted to do, meditation, etc. etc.). Here goes my model:

C - I have a rotator cuff injury and was assigned PT
T - I don't have time to do PT
F - Overwhelmed, stressed, fear of failure
A - Make more lists/schedules, try to prioritize things, set unrealistic goals, beat myself up for not being able to make a simple change, resent my career choice for giving me chronic stress injuries and not enough time to manage them
R - I become less motivated, continue to have daily shoulder pain

My mind knows that in the end it will be better for me to be in less pain, but it's hard to find the motivation and I have so many other competing priorities. Thanks for the thoughts!

ANSWER
Fantastic model, friend! Love that juicy A-line, which clearly summarizes your result.
Here you are holding two models: the one you wrote, and also this one:

C - I have a rotator cuff injury and was assigned PT
T - in the end it will be better for me to be in less pain
F: ???
A: ??
R: ??

Can you fill in the rest? What feeling does thinking about caring for yourself create?

This is normal for habit change - the cognitive dissonance between wanting to do something and also NOT wanting to do it in the moment is what behavior change is all about, and why most people end up feeling even more guilty without any actual change. A good

The trick is to not battle the first model, but to simply allow it to be there, and decide ahead of time what your "winning" thought will be. If you decide (ahead of time) what you would like to do and commit to doing it no matter what, then your work is to simply allow the overwhelm and fear to be there without listening to it. All of your thoughts are simply data, not directives. The first model is trying to keep you safe in some way (see if you can understand what staying there is doing for you, even if misguided), so we can let it float by without being mad, but also without listening to it.

The first question to gaining some perspective around this first model is:
-How is it (also) true that you definitely have time to do your PT exercises? List all the ways, even if you don't like some of them. Get creative here.

I have a lot of residency experiences that are kind of just sitting a box that I don't know what to do with. I had my intern year of residency in the pre-COVID setting but everything after that was in the COVID times, which gave me some really heavy experiences. I think everything in the box is all wrapped up, with sadness, grief, anger towards residency admin, feeling like no one knows what happened, feeling justified in my feelings, and feeling like I didn't have it that bad and shouldn't feel that way. I also know that all those experiences changed me and how I look at the world, how I care for and protect myself, and how I engage with work/patients. Its not something I'm dwelling on each day, but keeping with the box analogy, its in the corner, I look in it every now and then and still don't really know how to put it away or organize it, so I just leave it in the box. I just started fellowship and have a much different work/life balance, so I don't feel like I will have more situations like I did in residency. I could just tell myself that all of the bad experiences made me stronger and feel grateful for them, but then I feel like its me accepting how unsupportive our leadership was at times, how they didnt protect us,, and also accepting that so many of my patients who died from COVID "made me stronger", which feels disrespectful to them.

I can try to boil it down into a CTFAR as best as I can, even though I know there's a lot of different things wrapped up in each other.
C- Residency experiences were intense and heavy, more so because COVID
T -I feel like the experience weighs on me, and I don't know where to go with that. I feel like I need to do something with it but cant.
F- sadness, anger, injured
A - thought loops about past experiences, anger towards residency admin, thinking about patients I've had. wishing I didn't have to go through all of that. Commiserating with co-residents about the past.
R - perpetuating cycle of the same negative thoughts, distracts me from the present, makes me feel down momentarily. feel like I'm stuck in the same loop so I don't try to process it and just leave it as it is.

What is a good first step forward?
Thank you

ANSWER:

Hi Friend,
Thank you for bringing this here. This is so important.

I think everyone would agree that the pandemic brought innumerable reasons for us to experience grief, sadness, anger, fear in ways we wouldn't have if COVID never happened. It brought reasons for connection, service, compassion, and love too. Each of us may have felt those things for different reasons- all of which are valid, and we sometimes hold conflicting feelings at the same time (sadness and gratitude, or grief and love, for example).

You will experience anger, grief, sadness (and many other uncomfortable or "negative" feelings) because they are required in the human experience. None of us make it out without feeling them. We call these emotions "clean pain".

RESISTANCE (to what did/didn't happen, what admin did/didn't do, what you do/don't feel) is what is causing pain for you now. We call that "dirty pain", because we add it ourselves by wishing or believing it could or should be different than it is.

I have a few ideas for you to explore and bring back for more coaching if they resonate with you:

1. We usually think that ACCEPTANCE of what and how things happen requires our APPROVAL that they happened that way (or at all).
I'll offer that you do not have to approve of something to accept that it is.
Can you think of examples of how this true?

2. I can tell that you have some resistance to feeling sadness/grief/anger because you said "I didn't have it that bad and I shouldn't feel that way"
How might it be true that you SHOULD feel those things?

We will be here as you unpack that box, friend. <3

I was supposed to be out of town for this long weekend but had to cancel plans because my dog was sick (she’s fine now). I was on inpatient last month, so I was excited to get out of town and be in a different place. I was expecting to relax, eat out, just hang out… and maybe fit in a few work/side project things in my free/down time. Now that I am in town for the weekend I feel like I have just been wallowing every day. Its sort of a yo yo between feeling like I’m doing nothing or have nothing to do (and I guess innately feeling like that is a bad thing), and also feeling like I should take this time to tackle more of my to do list (work and not work) than I would have if I had not been in town. I don’t feel like I’ve really enjoyed my down time, but I also don’t feel like I’ve been very successful at making the most of my time. I think if I had been excited to leave town to also help me get into the relaxation head space. Ever since med school I’ve felt this pressure to “make the most of my time.” I remember trying to make a single day off the most jam packed agenda plus fitting in studying. But as residency has gone on I am more inclined to do less on my days off, but I still judge myself for that sometimes. It’s like staying in town and not having a ton of plans is a waste of my time. I think I would like to be grateful to have a weekend off (regardless of what I do), but I am not sure what thoughts would be best to get there and feel authentic

C: it’s the weekend
T: “I must maximize my time!”
F: disappointed
A: lots or pressure, hard to achieve what I want, wallow
R: don’t appreciate my weekend

C: its the weekend
T:
F: grateful
A:
R: appreciate having the weekend, return to work feeling rested and content

ANSWER:
Hi There! This is such a great thing to bring for coaching, friend. Great job on your awareness of your models. I'm noticing you want to move from your first model (which feels bad), to a new model (that feels good). This is totally normal... OF COURSE once you are aware of how one way of thinking is not having a good result for you, you want to get right out of it and feel better. But as you've noticed, your brain isn't moving as fast as you want it to and before you can work on changing your thoughts we want to take a closer look at some things.

You have some rules about what is or is not a good use of your time, and what it means to be productive.

I'm curious about 2 things, I invite you to chose one and bring it back here for more coaching.
- How do you know what's a waste of your time, and what's a good use of your time? Make a list of things that are NOT a waste of time and why, and things that ARE a waste of time and why. make it as juicy as you can 😉

- What would you be allowed to feel if you utilized all of your time with maximal efficiency? Why?

<3

C: We are struggling with male-factor infertility and just underwent a stimulation and egg retrieval which was c/b me being quite sick with OHSS requiring multiple surgeries (culdocentesis, 1.5 L fluid removed) and an ER visit for stitches after passing out. We had 7 embryos but just found out that only one of them is genetically normal and they now want us to go through another cycle of stimulation and egg retrieval
T: It is a sign that I shouldn't be a mom; I can't go through another cycle with residency. \
F: Trapped
A: Wanting to give up on both having a family and residency,
R: ??? I don't know, I just feel completely frozen and heartbroken. And judging myself for all the feelings and the ways it could be worse.

For context: My husband and I have been struggling with infertility for >2.5 years. We initially thought it was because of my past medical history (eating disorder, PTSD) c/b rough residency schedule. We ended up finding out that it was d/t male factor infertility. I am in a combination program so there is very limited elective time and it feels hard to schedule a pregnancy around required rotations and licensing exams. Let alone 1-2 months to be so sick if I get OHSS again. I already had so many thoughts about not being worthy of being mother because of my own pmh and fears about going through a pregnancy. I don't know if this is related to residency enough to be included here but I feel like being a doctor is just making it all more impossible.

ANSWER
First- just sending you love and care through this. I hope you feel our collective love to you (I'm sure so many women reading this are sending it your way).
Second, great job with the model! I'm going to distill your C a little and bulk up your A line to highlight how you are creating (one of) your result (s):
C: Partner has male-factor infertility and you have been advised to undergo a second stim/egg retrieval cycle after yielding one viable embryo w/ the first.
T: It's a sign that I shouldn't be a mom; I can't go through another cycle with residency.
F: Trapped
A: Consider giving up on both having a family and residency, judge yourself for having feelings that you think could be worse. Guilt trip yourself about your past and look at your prior self in a negative lens. Make your diagnosis mean you shouldn't be a mom (instead of confirming your own strength and making it mean that you of all people should), catastrophize about the future pregnancy and symptoms, lock yourself into only one view of how residency should look that doesn't include navigating health issues or parenthood.
R: You trap yourself by making the decision feel impossible and break your own heart

Here - your thought is creating a result for you. Can you see that?
I want to stay here with this thought and find out how true it feels for you. I also want to see if you are able to "play" with this thought in a way that feels less heavy to you. I wonder - can you write a paragraph about how the opposite is true? Try this: How is your current situation and your past proof that you SHOULD be a mom? List every way you can think of. Write out how your past experiences have equipped you to deal with what might be in the pipeline for you as a mom and doctor.

If you are up for it, you can play with the second part of the thought as well in the same way (what are some ways that you could go through another round in residency? Even if you do need to take time off - have you ever heard of other doctors needing to take time during residency? How might this look for you?).

This challenge is NOT to tug you to change your mind. It may be right for you to decide not to do another cycle right now, or it may be right to decide to. I don't know the right answer for you, but I do know that your current thought is narrowing your options unnecessarily, so all this challenge does is create some extra space and breathing room in your mind so that you can look at all angles. Bring whatever comes up back here!

C: I constantly see horrible diagnoses
T: One of these awful diseases is going to happen to ME too
F: Fear (of death, severe disease)
A: I avoid activities and spend a huge proportion of time thinking about my own death or the death of friends and family members
R: I don't enjoy life freely anymore even when I feel okay

More context: I am a neurology resident and was found to have a cerebral aneurysm a couple days ago. It feels like all my illness anxiety (that has been going on long before I had a real scary diagnosis) has been confirmed. Every time I see a patient with a disease that just strikes them out of the blue I can't help but feel like it could kill me or someone I love just the same. While this makes me more empathetic to my patients, it is making it impossible to live a normal life. Sometimes I wish I could go back to how my life was before I knew about medicine in this way that has filled me with constant fear. Sometimes I think I am not strong enough or tough enough to work in medicine; everything is too personal, too relatable, too scary for me.

ANSWER:
Thank you for bringing this here- I am certain that this core fear is shared by every single one of us since fear of death is part of what makes us HUMAN. Our brains are literally programmed to imagine the causes of death for us since this was an adaptive behavior thousands of years ago. Now.... not so much.
I'm going to bring your (excellent!) model into your more specific example since you gave a recent C that is touching you:
C: Found out I have a cerebral aneurysm
T: I could die from this
F: Fear
A: Illness anxiety is fueled: Think of it constantly, imagine yourself or a loved one getting all of the diseases your patients get, avoid activities, spend a huge proportion of time thinking about death as a scary outcome
R: Don't enjoy life even when you feel physically fine

Ok. Deep breath. Here is the truth: your thought is true. About ANY C. We could all die at basically any moment. There is no certainty at all, ever in life. Take another deep breath. This is the reality that we are always living in - it's what connects every person. I want to pose to you that this truth, ANY your thinking about it may not actually be a problem for you. In fact, there are many mindfulness based techniques that call our own or loved ones deaths to the forefront to remind us of life's preciousness. Being uber-aware of death may not have to be your achilles heel, my friend, it could be your superpower. The difference is if it's fueled by fear (which creates the problem) or by acceptance, love, or gratitude. Same thought, different flavor.

Now - it's a leap to go from "I could die at any moment and I'm terrified by this" to "I could die at any moment which makes me so grateful for this experience" right? This may be a lifetime's work. But we can take a baby step right now.
Today - let's just start with NOTICING.
Can you notice when your brain goes to your own mortality and create one moment of space around it before your lower-brain autopilots to fear?

C: you remember your aneurysm and consider your own death
T: "Oh! There my brain goes again, thinking about death. I am noticing this."
F: ??
A: ?? Is there any difference, even a small one, between your actions here and the ones above?
R: ???

I know your brain will still go to fear immediately after this. That's ok. That's what it's practiced at, it's familiar. We are just gently nudging it to create even one moment of non-judgemental observation just before or after this moment. Can you try this for a week and let us know how it goes? From one fellow anxious doctor to another - sending love <3.

C: Just moved to a new city for fellowship coming from a community hospital residency to a HUGE academic institution. I'm currently on the consult service.

T: They're going to find out I'm not worthy and I have no clue what I'm doing. They're going to think I'm an idiot

F: Inadequate, dread, shame, doubt, unworthy, guilty because this is what I've wanted for so long

A: Avoid situations, not asking questions that I should be asking

R: Fellowship won't be as fun as I wanted and I'll be hoping the next step after is better.

For context: I just fast tracked from residency into a fellowship where we work with children and adolescents mostly. It's so ironic because I work in a field where we help people with their own thoughts, emotions, and working through their own cognitive distortions, however I still find myself thinking negatively first and foremost about myself, my worth, and my abilities to do things well. I've wanted this position for so long, and am finally able to live with my fiance in the same city. However, the adjustment has been extremely hard for me being away from what I know. New EMR system, brand new hospital, all new people, and knowing absolutely no one. I feel like I have to please people in order to be liked and to succeed. I feel like sometimes I can't be myself or be stern for fear that people will not like me. I feel self conscious for how I write notes, how I collaborate with others, and how I come off. I feel like people are judging me because I'm an IMG and not as "smart" as them because I didn't go to an American med school. I definitely feel imposter syndrome and a heavy weight on my chest because I feel like they really will find me out to be less than what I portrayed in my interviews as if it's a facade.

My previous program director was an absolute prick and really made me think I was inadequate, Narcissistic and machismo, he enjoyed a sense of control and intimidation, but also kept me going with validation that I was doing well with patients. He would mention how I seem very anxious and that made me feel even more self conscious. I do feel a sense of inadequacy. Circumstances surrounding that include that /I come from a small community residency and now am at a big institution with people who look way more official, come from more prestigious backgrounds, and I feel lost. I don't know anyone's names well, I feel like I dread when there's a new consult because I'm not going to know anything, how to deal. The attending also makes me feel intimidated because he comes from a prestigious background and I feel like an idiot when presenting to him because sometimes I get things wrong. There was an incident where he wanted ammonia levels and I saw it but didn't really act upon it- not really sure why. He then mentioned it to me, I felt like an idiot, apologized and he said "well this is why you're here to learn. From a learning aspect ..this is something good to know about encephalopathy."

I dread criticism because I try my best to be a perfectionist although it has its pros and cons. I feel like I've come really far in life, but still have this automatic thought that I'm not good enough or less than.

ANSWER:
Hello friend, and WELCOME!
Thank you so much for your post- I know many people here have experienced similar things to you are describing.

First of all, CONGRATULATIONS! You are doing it! You are living in the same city as your partner and doing the job you've been dreaming of for many years. You are helping children and adolescents learn how to interact with their thoughts and feelings. you are doing what you are meant to do! That's incredible! I want you to linger here in this paragraph for as long as you can. How many seconds can you let this feeling wash over you? hold on to it for one....more....second.

Notice how quickly your brain wants to point out that despite literally accomplishing a dream of yours, you aren't doing it right and people are going to find out. I was just watching a clip of Dr. Brene Brown and Oprah asked her something about what is the most challenging emotion for human beings. Brene said "JOY" and described that for most people, joy immediately becomes forboding and we immediately go to fear of losing everything (or being found out). She offers that the key to softening into joy is willingness to be vulnerable.

Posting this here is vulnerable, and I honor this step you've made <3 Your brain is doing a normal human thing by offering you some thoughts that we can pick through together.

In your model above, I'd like us to get a little more specific- we do this by choosing just ONE thought at a time. (of course we always have more than 1 model running in our heads at a time, but for the sake of this work, we will look at one at a time).

C- Fellowship in new city, on consult service.
T- They're going to think I'm an idiot
F- (what ONE primary emotion do you feel when that sentence runs through your mind)?
A- (Get as specific as you can here, can you list 5 or more things you DO or DON'T do when you feel that F)

R- You don't show yourself or them your best.

In invite you to fill out the F and the A line on that model and bring it back here. What comes up for you as you do that?

I do this thing where I try to control the future to make it less painful. For example, I look at the ER tracking board and predict which patients will come to me. Sometimes (often, actually), I'm right, and I can prepare and look things up and all that. But obviously, often I am wrong and the downside is spending a lot of the night in dread of what might happen. I'm afraid of giving up this habit (or even stopping as a trial for a night) since being unprepared feels worse than the current dread situation, but I wonder if there's something better out there than these two options.....
Other places I find myself doing it are - preparing for clinic way in advance, packing for trips really far ahead of time, being overly scared about getting sick so trying to stock up on all the things, and generally thinking of ways things could go bad and then try to prevent them from going bad. I think I may be good at preventing badness though, so is it worth it?

ANSWER:
Thanks for bringing this here. I have a few questions for you, and I invite you to choose one and bring it back here for more coaching.

1. Let's get specific about your example of preparing for clinic. Why is it a problem for you to prepare for clinic way in advance"?

2. You said "being underprepared feels worse than the current dread situation". What is it that is causing you to feel dread? Can you sum it up in one sentence?

I'll be here when you're ready.

C-i received feedback that "people would like me more if i came to more social events after work"
T-i don't want to give these people ANY MORE OF MY TIME, >80 hours a week is enough!
F-pissed off
A-still skip events. worry about how other people feel about me skipping events.
R-treated like an outsider at work

For context, I am in a surgical residency that does 36 hour shifts once a week and works from Friday at 6 am nonstop until Monday at 5 pm once a month. I have struggled with this and have expressed this to my program. I asked for a leave of absence last year because I was depressed, suicidal, and needed time off to rethink my choice of being a surgical resident. It resulted in a huge blow up in my program, a change in the call schedule, and everyone hating me. They have told me I don't work hard enough, that they wish I would just quit, that I should feel grateful for the opportunity to take care of people, that I signed up for this, and that my priorities are wrong.

Ever since, I have no friends in residency. I am treated differently. They then tell me I need to come to social events. This has resulted in my peers telling me that if I make a mistake with patient care, it is attributed to me being lazy and not willing to wake up to come in to the hospital and see a patient. When my peers make mistakes, they get told things like "it's ok i bet you are tired since you have kids" or "he normally does a good job, this is an exception."

I feel resentful that they want MORE OF MY TIME when I have already expressed to them that I am struggling with exhaustion. This exhaustion has ruined my relationships, my health, my life. They don't deserve more of my free time. Why would I put in time with people who have already told me openly they don't respect my boundaries and disagree with my values? Why does the fact that I won't go out drinking with people make me a worse resident? How do I survive a malignant program?

ANSWER:
Hello! I'm so glad you brought this here, friend.

I can tell how painful this is for you. I'm not going to try and take you from feeling bad about this to feeling good about this- that's not how this works. What I want to do is ask some questions so you can find where your power is in this scenario. OK?

I want to start with the model you submitted and offer a few suggestions. You did a great job identifying a neutral circumstance on the C- line, and identifying your thought, and the one feeling that thought creates. I want you to get REALLY juicy on your A line. This should be as much as you can think of. What else do you see yourself doing or not doing when you are pissed off? Lastly, the result is always FOR YOU (not for anyone else. Their results go in THEIR R line of their model).

C-i received feedback that "people would like me more if i came to more social events after work"
T-i don't want to give these people ANY MORE OF MY TIME, >80 hours a week is enough!
F-pissed off
A-still skip events. worry about how other people feel about me skipping events.
- you look for confirmation and proof that folks are mad at you
- you imagine terrible things people might be thinking or feeling about you
- you engage in arguments in your head to defend yourself from those things you imagine they are thinking
- you keep your guard up
- you probably don't look for proof that people are on your side (maybe they aren't but if they were do you think you would see it?)
- you spend your beautiful and sacred time away from the hospital being mad about what happens in the hospital
R-You give away EVEN MORE of your time

I want to explore a few things. I invite you to choose ONE of these to chew on and bring it back here for more coaching.
1. You said your feeling was "pissed off"- often anger is a surrogate for another emotion that is harder to name or feel. If you had to guess, what do you think is one layer below "Pissed off" (often for me its rejection, embarrassment, shame, exposure, fear)?

2. The emotion of "pissed off" in and of itself is not a problem unless the result FOR YOU is not one you want. Sometimes, being pissed off helps us defend ourselves, advocate for ourselves/others, and resist the status quo to make positive change. In this case, the result is that you spending even more of your time on this program being angry about it. It is totally fine to stay pissed off if you want. I'm curious, what is an up-side of being "pissed off" in this scenario?

Let's keep chipping away at this. <3

C-i take home call
t-i can't do this anymore
f-resentful, depressed, exhausted, underappreciated
a-cry a lot, complain about home call
r-completely ostracized at work, make more mistakes at work, lose sleep and time trying to give myself the confidence to quit

it's more complicated than this, because i wan't to quit but i feel incredibly guilty. i have been told "it gets better as an attending" but all of my attendings are miserable. its affecting my relationship. its ruined my mental and physical health. i just don't know how much longer i should do this to myself before i try to exit residency.

ANSWER:
Wow, great job on your model! A few notes - in general it's helpful to pick ONE emotion that this thought brings up for you. Try to see what is the predominant emotion. Usually, when you have lots of feelings coming up, it means there are lots of nuanced thoughts in there (for instance, I bet "resentful" is coming from the spin, "I shouldn't have to do this anymore" or "this is too much, they shouldn't ask people to do this" or something, yes?). I'm actually going to take your second layer that you gave us and put that into a model to see if we can create any space there for you while you are making this decision.

C: training includes home call
T: I want to quit, but (???)
F: guilty
A: look with a negative view at your attending's career to confirm your T, close yourself off at work ("ostracize"), vent, complain about the call (I'm guessing to your partner? and others) in a way that affects your relationships in and out of work, lose sleep over rumination about whether to quit or stay, turn the issue over and over in your mind without actually moving forward either way.
R: You create extra misery for yourself and don't change your circumstance

I want you to look closer at this T. Why do you feel incredibly guilty for wanting to quit? Get really clear on this question first, what are the thoughts behind the guilt?
Do you think you shouldn't want to quit?
Do you think wanting to quit means something about you as a person? As a doctor? What?

Bring your answers back here, sister and we will help you work through this deeper level- you are definitely NOT the only one feeling this way!

Hello. I just had a hard day with a child who is whining (1.5 yo) and wants to be held all the time. Naturally, I want to be able to get some things done but it’s hard with a child on your hip at all times! So I put him down, and he whines. The sound of him whining brings up such anxiety/bad mom feelings it’s so so hard to deal with. What I end up doing is trying to finish what I started (ie get myself glad of water without holding him) and he whines. In the middle of my task I try to explain what I’m doing (which of course is wasted effort- he can’t comprehend waiting another 2 min! He’s 1,5!!! What am I doing?!?!)

C: child wants to be held, whines when put down
T: please make that noise stop so I can finish (whatever 1-2 minute task is easier with both arms)
F: anxiety
A: I explain to my 1.5 year old what I’m doing; naturally it doesn’t work and the whining and anxiety continued
R: I just get more and more flustered and frustrated and by the end of the day I’m exhausted and I say things in an annoyed tone to a child who just has separation anxiety, a normal developmental phase.

How can I do this better? Just accept there will be no 2 handed tasks done for a few months?

ANSWER:
Ohhhh- I love this one. I have been YOU. The issue here is not that you have a whining toddler. The issue is the thought: "the sound of him whining brings up such anxiety/bad mom feelings it’s so so hard to deal with" that you believe is a fact. This is not a fact, it is a thought. I will say, as a mother, that the sound of a child crying absolutely triggers an automatic cascade of neurotransmitters and hormones in us that are out of our control and create an instinctual urge to act to quiet them, (this is a fact), but this cascade of events does not necessitate you calling yourself a bad mom. That, my friend is hard to deal with.

What if you could choose how to respond to that hormone release from the crying a different way? How could that actually mean that you are a perfectly normal (even amazing?) mom? If that is a reach, can you at least get to a place of neutrality about this C?

What about this:
C: my kid cries and my body releases hormones creating an urge to help
T: ??
F: ??
A: ??
R: I show up as the mom and self that I want to be

So I'm still pretty new/unfamiliar with the CTFAR model. So I'm going to start with a thought download, and give it a stab. I have had a number of life circumstances occur this year, including a big move, transition from mostly clinical to now entirely research, had my first child, and am essentially a single parent due to my husband's unforgiving job requirements. Prior to this year, I achieved a lot of clinical, academic and leadership success, and I was really on track to continue that success in this research portion of my training. I am not used to falling behind the expectations of myself or others. But the life changes of this past year have been like a tornado through my life, and I haven't recovered. I can't quite explain it, and I actually think there is a significant element of mental health which has contributed (post-pandemic burnout/post-partum anxiety and depression) for which I am seeing a therapist. But the ways in which it has impacted my work has been devastating. My "work ethic" when it comes to work is not the same as it used to be, yet I'm always busy. The flexibility that research allows means that the rest of my life (my daughter, daycare drop off, doctor's appointments, meal planning, food shopping, homeowner headaches, etc) fills the time and my research essentially occurs when/if I get to it. It has now been a full year of "research" for me and I have presented one abstract at one conference. At my stage in training, after a year of research, I am far behind where I should be, and far behind where my mentors expect me to be. This has gently been communicated to me, but I feel it like a ton of bricks because I know what I am capable of, and cannot reconcile this with my complete lack of productivity this year.
This came to a head recently, as I am required to fill out a self-assessment for my training program. When given the choice of "Strong", "Acceptable" or "Needs Improvement", I cannot identify a single area in which I can honestly indicate strength, given that I have not achieved the skills/attributes of the self-assessment this past year. I struggle even to find the areas in which I can write "acceptable". This self-assessment will be discussed amongst our training leadership as well as our mentors, and I am utterly embarrassed by my own self-assessment, but moreso by what it is demonstrating: that I am behind, that I know I am behind, and that my usual confidence is shattered.

C: I am filling out a self-assessment for my training program
T: I think I "need improvement" in almost every asset on the self-assessment
F: guilt, shame, embarrassment, disappointment (both in that I am not meeting expectations and that I will need to submit such a pathetic self-assessment)
A: beat myself up for my lack of productivity, making my confidence suffer to an even greater extent
R: lack of confidence and embarrassment about perceived lack of productivity reduces my work ethic even more, creating self-defeating cycle

ANSWER
First of all- way to go with the model! This is exactly how it feels to learn a new thing (clunky, awkward and new) and you ROCKED it.
Second, thank you so much for sharing this- it surely will resonate with the rest of your colleagues here. I'm just going to use this succinct model for our sake:
C: I filled out self-assessment for my training program
T: I think I "need improvement" in almost every asset, I am behind
F: shame (let's look at this one first)
A: beat myself up for my lack of productivity (call it "complete lack"), making my confidence suffer to an even greater extent, struggle to see areas where I am acceptable or strong, feel gentle communication as a ton of bricks instead of soft words, come up with some vague metric about where I should be right now that doesn't match where I am
R: Reduce my work ethic even more, creating self-defeating cycle

Ok friend, this is a perfect example of your inner critic on overdrive. A few questions to consider:

-Given your stage of LIFE (not just training), where "should" you be right now?

-Looking at your total LIFE (not just training), where are you strong? List all the ways.

-Do you think that successful doctors ever have rough patches? Are they allowed to hit stages where they are less productive? How do you imagine they navigate through these?

-If a friend shared that she was going through some mental health struggles (like post-partum anxiety/depression, burnout), what would you tell her about setting expectations for her research year?

-If you looked at your whole LIFE this year (including you as a mom, wife, friend, doctor and HUMAN ) what is one expectation of success that you can choose from a place of self love? How will you know you have succeeded?

hello
This happens a lot but including one example below
C: husband asked "where is the bread"
T: i've already told you that this morning
F: irritated
A: my responses thereafter reflect the irritation, sometimes I answer in sass, sometimes I'm silent, other times I verbally highlight how this is something we talked about already earlier
R: he expresses that I am not being understanding, that I'm quick to point out when he forgets things and in turn become more irritated and recycle the above ----> tension and disconnection in relationship
I wish I could catch myself before expressing annoyance with someone forgetting such a trivial thing
ANSWER
Hi there!
Thank you for sharing this incredibly relatable model!
One small but important note: your result is *never* about someone else's actions. Your result is only for you. Your husband said words about your not being understanding because of HIS thought and feelings, not because of anything you did or didn't do. Your ultimate result of tension/disconnection is spot on though, mainly because you are busy in your head proving he is wrong and shouldn't be rather than just being in the actual relationship
C: husband asked "where is the bread"
T: i've already told you that this morning
F: irritated
A: Sometimes answer in sass, sometimes I'm silent, other times I verbally highlight how this is something we talked about already earlier. I'm quick to point out when he forgets things and in turn become more irritated and recycle the above.
R: Tension and disconnection in relationship
Your actions in this model are all coming from REACTING to the feeling. Remember back in month two when we learned that there are four options for us with any given feeling? React, Resist, Avoid or Allow. The piece of golden insight that you brought is that you "wish you could catch yourself before you act" - which is the perfect place to start. In order to do this, you need to notice the feeling without reacting to it. The tricky part is to also not avoid (with distractions) or resist (with willpower) the emotion, but rather allow it. This means feel it with acceptance.
What if it's completely normal to feel irritated in any given relationship a lot of the time?
What if irritation wasn't a problem?
What if irritation itself was actually a portal to presence in any moment? How can this be true for you?
Can you "play" with irritation?
Can you not wish it away, but instead use it to get to know yourself better?

Going through our week on feedback has made me realize I’ve been holding on to pieces of good feedback I got from residency to tell me I’m worthy. I think I’ve also been holding onto the fact that I wasn’t picked as a chief resident. It still haunts me. This was four years ago. I don’t think about it that much anymore, but when I do it still hurts.
C: not picked for chief
T: wait what? I didn’t get picked as chief ? You must be kidding. Ok, so there’s something wrong with me.
F: inadequate
A: dwelling on old missed opportunity to learn to be a better teacher, better leader.
R: wasting time thinking about how I should’ve been a chief, and what this means about me as a person.

ANSWER:
Great C to bring here - very relatable. My husband had pretty much that exact same model ten years ago and now swears that that C was one of the situations that made him grow the most in his life. Let's see if mind management could get to that place sooner than decade of time and experience can....

If it's possible that you get to determine your worthiness in any way that serves you - then let's play with that a little?

How is it (also) true that you SHOULDN'T have been a chief? What would have been much worse? How could it be absolutely perfect to go through that disappointment? How could that story be re-written in a way that serves you?

Can you fill in the blanks here?

C: not picked as chief
T:
F: worthy
A:
R: Your story doesn't hurt you (and in fact serves you moving forward)

Here's an example to get you started, but it's important that you come up with a story that fits your brain:
C: not picked as chief
T: Wow- that hurts, but I'm so glad that I get to experience XXXX, even the pain will certainly help me in future situations because XXXX. (How cool that I can choose this way to think about it!)
F: worthy
A: focus on how this serves you, see the open doors here (instead of the closed ones), start asking yourself how you will better grow as a leader and teacher because of this disappointment.
R: Your story doesn't hurt you (and in fact serves you moving forward)

C: i'm in training and am working 12 days in a row while doing home call and getting woken up a lot at night and working with a specific attending.
T: i'm tired and have just enough energy to get through my crazy inpatient day with very emotionally draining patients/families. this is what i signed up for and i actually do love my job - i feel wanted/needed at work and connect with my patients/families which saves me from burnout. but i don't have any energy left over. the specific attending i'm working with isn't (1) being helpful OR (2) teaching me something OR (3) letting me get my work done (i.e. i am doing all of the work). they are making more work for me that is unnecessary and getting in the way of how i do things efficiently (i.e. not letting me log into the WOW so that I can respond to epic chats and put in orders/check labs in between patients on rounds instead of having all my chats build up over 2 hours - instead the attending tells me she wants to be logged into the WOW so she can read notes from the day before and doesn't help me put in orders, etc.. i typically put my notes on the WOW which i bring into the room but she leaves the WOW outside the room and then gets mad that i left my notes, even though they were turned over, on the WOW. lots of these little things build up).
F: tired. frustrated. annoyed. under-appreciated. feeling like my life would be easier if i could just do my job without this person (because it's not my job that's the problem, its the person).
A: try to put my head down and get my work done and take good care of my patients and focus on them and their families. when the attending attempts to chat with me, i'm very short/passive with them (trying to get work done so I can go home and sleep and reset for the next day). i'm not friendly, which makes me feel like i'm not myself, which doesn't make me feel good.
R: i survive training for 3 more months? feel mad at myself because i wish i could use the skills i've learned in better together to not do this pattern anymore.

ANSWER:
Hi Friend. Thank you for bringing this here. I know, you're IN IT right now.

Look, you ARE using these skills! Here you are tonight with awareness of all of this, AND you've brought it here for coaching. You're doing it. This is the first step. Then, it's one foot after the other. We are right here with you <3

In your thought download up there, I see someone who values connection with her patients, efficiency and efficacy in her work, and desires the opportunity to demonstrate autonomy and independence (to others and probably also to herself) in these last 3 months of training. And you're experiencing conflict between your values and what you are experiencing day to day on this service. Add to that a 12 day stretch, and home call, and OF COURSE you are tired, OF COURSE you are feeling frustrated/annoyed/and under appreciated.

Breathe it in, and breathe it out. Again.

It is not my job as your coach to convince you to change your mind about how you feel right now. In fact, you may WANT to be feeling frustrated/annoyed and under appreciated. Perhaps that is actually helping you envision yourself entering your next role by showing you that you are ready to move on.

To get really clean on your models, I'm going to help you tease a few of them apart here. Remember, only ONE T and only ONE F per "model", and we can have several going on simultaneously. At least one of those models had the action of you coming for coaching here tonight. Let's take a look and see which ones are serving you:

C- Work
T- "they are making more work for me that is unnecessary and getting in the way of how i do things efficiently"
F- Annoyed?
A- push it all down. Act short/ passively with the attending, not as friendly as you would like to be, then you beat yourself up.
R- You double down on the annoyance first with the experience if the day, then adding shame on and beating yourself up for how you showed up.

Ouch!
Let's look at this one...

C- Work
T- I actually love my job, but my life would be easier if I could do it without this person
F- Frustrated?
A- think about all the ways you would do it differently/more efficiently/more effectively if you were on your own. Put your head down and do the work, take good care of your patients, no matter what. Do a thought download, ask for coaching about this. what else?
R- You are actually ONE DAY CLOSER to doing your job without an attending AND you have practiced the skill of self-coaching, applying what you are learning in BT to deliberate practice and self-improvement.

Do you remember the last few months of high school? Were you annoyed by your parents/adults no matter what they did or said, especially when they were micromanaging you? Were you frustrated with rules that existed seemingly just to get in your way? How did that actually help you launch?

What if nothing has gone wrong here?

What if, even if your attending is "not teaching you anything" clinically, she is actually teaching you something more important? Get curious. What could it be?

Could this be "senioritis" of medical training? What if this is a developmentally appropriate stage to help you prepare for your next launch?

ABSOLUTELY you will make it through the next 3 months, and just like the first three months of internship, there is a steep learning curve here too. What do you want the result to be?

Please come back for more on this, sister. This is the important work!

XO

C: humans exist
T: I think I’m better than most or want to believe that. Don’t know why? Maybe makes me feel better
F: superiority
A: end up behaving in way that I regret later, being curt, interrupting, judging
R: i’m not being the patient, kind, understanding person (in the right situation) that I would like to be

ANSWER:
Nice model! This is great insight, my friend, so happy you are doing the work.

Interesting that you think this thought will make you feel better, but then your result is that you aren't showing up the way you want to and I'm guessing you feel worse, yes?
Tell me more about why you believe this thought: Is it a practiced one that stems from a long time ago? Is it one that you put work into creating so that you might show up with confidence? Maybe you have never noticed it before now, or have tried hard to think it on purpose? In what ways do you think you are better (work? sports? health? morally? all skills? being a friend or partner? looks? achievements?)- or is it all the ways?

I want to also show you that this entire model only holds up if you believe that humans are ranked/graded on a system, right? You have a thought that "Some are better than others, and there is a way to determine this" - but what if this is the actual thought error? What if you are wrong about this?

Some places to start questioning:
-Is it possible to rank people as a whole?
-Can you ever know someone enough to judge their "goodness" as a human? Can anyone?
-What would be left in your mind if you dropped the ranking system? How would/could you think of people then?

Write back what comes up for you here. I want to commend you on your honesty, and tell you that I have coached MANY many women of all levels on this exact thought, it is one that is shared by a lot of people.

C: time exists
T: I’m always wasting time
F: guilt (did something bad by wasting time)
A: keep checking my phone or watch for the time, find myself then going on apps, checking notifications….which wastes more time. Think more about how much time I’m wasting and continue to waste more time
R: lots of time “wasted”

What’s wasting time? Anything that’s not work related which is ridiculous I know!

Any approach to to this appreciated!

ANSWER:
Ok friend, I'm going to hold myself back from getting existential on you here and questioning your C (but does time really exist??? Or did humans just make it up and put it on an arbitrary calendar to fit their needs based on our circadian rhythms? lol, apparently not holding back that much).

For the sake of this argument, I'll give you that time exists. I'm going to put in your thought that anything non-work related is a waste of time:

C: time exists
T: Anything non-work related is a waste of time, and I’m always wasting time
F: guilt
A: constantly check phone or watch for the time, buffer with apps, checking notifications, perseverate on "wasted time"
R: Waste even more time, by your definition

First of all- there is an easy thought error here: are you ALWAYS wasting time? Really? You never go to work? I doubt this. But if that's the story you are telling yourself then clearer why you fall into guilt so easily.

Secondly - by your last line, it seems like you don't fully believe your thought that non-work activities are a waste of time, and you may even see that it's not serving you to continue to think this.

Dig in here.
What, precisely, do you WANT to believe is a waste of time? What do you want to believe is a good use of time? Get specific. Context matters. Consider the following:
-Active work
-Rest
-Reading for work
-Reading for fun/pleasure
-Spending time with friends, family, partner, strangers, colleagues, etc
-Social media
-Meals (prep and eating)
-TV
-Shopping
-Emails (work and non-work)
-Health related activities (exercise, hygiene, meditation, self-coaching, sleeping)
-----WHAT ELSE DO YOU DO IN A DAY?
Is there anything you want to continue to believe is a waste of time? Is there anything you want to change your opinion of? Bring it back here and we'll help you change your thoughts, if that's what you would like.

C: someone says they "expect something of me"
T: omg, I have to do it/fulfill it/meet it/don't disappoint
F: obligation, pressure
A: Even if i don't want to do something, even if it's not a requirement, even if it causes some self-detriment, I DO IT
R: bitter about doing something to meet someone else's expectations, but what about my own?

Expectation is the root of all disappointment is something I read once. Maybe I should drop expectations altogether? Quite the jump here I guess, one step at a time.

ANSWER:
In what cases are expectations helpful?

What are some examples of things you do that you don't want to do but you do them anyway?

When does it make sense to do something you don't want to do? List some examples.

What would happen if someone says they expect something of you and you say "No, that won't work for me."

Keep going here, friend.