C: moving back to home state this summer
T: my family is going to want me with them 24/7 but I have my own home there and I am married and my husband does not want us with my family every week. I don't want that either actually, family stressed me out (lots of thoughts but related in my head)
F: anxious, conflicted
A: I get frustrated trying to think of ideas on how to maintain my married life with less tension caused by family but still have family know that I care about them. Similarly I want to reduce the stress I let my family cause me by trying to shoulder all their burdens and demands, financial issues, interpersonal issues. Not sure how much time is "enough time" to satisfy family. Not sure I'll ever know. So this is basically a bunch of inaction I guess
R: same spot as how I started

ANSWER:
Nice model. Remember to try and keep one sentence on the T line and one feeling on the F line.

OK You feel anxious and conflicted about moving home.

What are you making it mean that you are frustrated?

What is actually causing the tension?

So you don't want to see them every week. Why is that a problem?

How much time is "enough time" to satisfy YOU?

Bring it back here, sister!

Hello hello! I have a few things I've been working on this week and would like to share for input. I will submit them separately to help make it digestible.

C: Feedback "You speak in a negative tone"
T: First "no I don't" then right after " I think I do".... I do see the defensive/shame cycle here. I took time to notice it when it happened this time.
F: shame as above but also hurt (not liking when some "flaw" is pointed out in me BUT ALSO that I don't intend on being that way, have been working on it, and feels like a uphill struggle when still pointed out)
A: First cried. Then wrote about it to figure out what happened here. Decided to see how this could help me grow. I would like to speak in a more neutral way, without assumptive or bold statements. Decided to try and ask questions to loop the other person in instead of saying things as frank statements that can be seen as negative. I know I can't control how someone else feels but in this case I do think my statements could be more considerate of other people. AND HOPEFULLY this could somehow convey that I do not think of the other person as less than me or that what they're saying as unimportant
R: Don't know yet, because this is a hybrid model but this is also how the event occurred and my thoughts in the short span thereafter

Still in the result part, I do overall felt better about having a plan and hope to try it soon. Requires a short pause in my thoughts and speech I think.

ANSWER:
Hi! So glad you brought this here.
Yes, your models are mixed up here, but that's OK. I'll help you tease the apart. The different thoughts/feelings lead to different results. Both are going on at the same time in your brain because we are beautiful complex creatures 😉

C- "you speak in a negative tone"
T-No I don't
F- Defensive
A- Armor up, (cross arms, roll eyes? those are my moves) reject feedback
R- stay the victim, don't grow.

C- " You speak in a negative tone"
T- I think i do!
F- Shame
A- beat yourself up (look for your "flaws", wish you were different, etc )
R- basically you hide and are not kind to yourself

C- "You speak in a negative tone"
T- I don't intend to be that way
F- ?? Guilt maybe??
A- cry a bit, reflect on it with this TD, look for the truth in a way intended to help yourself grow, think about what you would like to do instead, think about asking questions, be curious, acknowledge that you are not responsible for their T/F lines, but do try to be responsible for how you show up on their C lines.
R- You work on communicating with intention and grow towards who you want to be.

OK! Great awareness here.

Looking at these models, what's coming up for you now?

All of these models are normal and they will will happen in your brain when you get feedback like this- the path is well worn. However, once you notice them, you can choose which one gets the most air time.

XO

What are you making this story mean about him?

-he's irresponsible, mean, insecure, resentful, ungrateful (not nice thoughts)
-he's ruining relationships, turning away his support system
-also that he's alone, stuck in an undesirable situation, treated unfairly, not appreciated enough

What are you making it mean about you?
-I'm a bad sister, maybe I should / should have done more to force some interaction with him (he is very quiet and usually gives answers of a few words so conversations don't go for long but I could have tried harder)
-other siblings don't think I am a bad sister so maybe I am not?
-maybe I should not have given so much time to school/studies and created memories with him. am I someone who gave too much priority to things outside of family?
-spend a lot of time thinking how I can "fix this"......keep trying to contact him but he's not responding. If i listen to his request to be "left alone" I feel this would validate his feelings that he doesn't matter to anyone

What would be different if things were different?
-This is all my opinion but maybe had he felt more loved (not sure how that could have happened exactly because of course none of thought we were doing something "wrong"), he wouldn't feel so alone or insecure (maybe I'm making assumptions here)
-had he had a better relationship with our mom, maybe he wouldn't be so angry all the time (also projecting emotions on him here but I see a lot of anger in his behavior)
-If I lived nearby, I could actively visit and spend more in-person time with him and try to have him see I care
-When I move back, which I will, I can plan to be more present

a lot of maybes here.....

Not sure I am addressing the questions as expected, but that's my stream of thoughts!

ANSWER:
Hi there. Great job on this reflection, and thanks for bringing it back here. Stream of consciousness is EXACTLY what we are looking for.

Now let's take ONE of those thoughts and plug it into a model.

C: Brother
T: I'm a bad sister, I should have done more
F: (regret? guilt? sadness? what is the feeling here?)
A: judge him
Judge yourself
judge your mom
project your values on him
second guess yourself and your love for him
Wish things were different
Imagine all the ways things could have been different in the past or could be in the future
R- You make this relationship harder on yourself

Of COURSE it's easier to be angry with him than it is to peel back another layer and see that underneath that anger is some judgement you have of yourself (bad sister, didn't do enough, should do more to "fix" him etc--> guilt/shame/regret/worry/fear). Of COURSE You want him to feel better, because then you can think thoughts about him that make YOU feel better. That's OK. It's human! All of this struggle for you is driven by values of love and care and desire for connection with him- all beautiful (and sometimes painful) human experiences.

Here's the thing. Just like your brother is on the C line of your model, you are on the C line of your brother's model. He gets to have a million thoughts about you, your siblings, your parents, everything. Right ones, wrong ones, painful ones, loving ones. His thoughts create HIS feelings, which drive HIS actions (isolating, blaming, disconnecting etc), and create HIS results.

You are NEVER responsible for his R line. You are only ever responsible for your R line.

Recognizing that your brother is responsible for his own emotional experience, how do YOU want to show up in your relationship? Let's run a model backwards.

R: I show up in this relationship with _________________
A: ???
F: ???
T: ???
C: Brother.

I"m not looking for "toxic positivity" here. This is not going to look like going from your current thoughts to "Everything is perfect and I love him exactly as he is and everything is shiny and new".

What would it look like to allow things to just BE. Exactly as they are without trying to change or fix them? What if you dropped the resistance?

What's coming up for you now?

Sending so much love, sister.

C: brother said "I don't have the patience to hear from people who are not present in my life"
t: i had no idea he felt this way or at least this strongly
f: hurt , guilty
a: first i paused, didn't answer the message, shared with others close to me including other siblings, then answered message after thinking through it all and saying "i didn't know he felt that way and if there is any way i could help him (besides going away) to let me know"
r: i didn't ignore the situation, tried to address it, but i also have not stopped thinking about it

some context is that this brother is one of 5 kids, the rest of us are at least 9 years older. most of us are in different states and he is with parents and one brother. he is helping with parent's business and feels pressure and has expressed being trapped in the situation. I know he's grown up different from us because there's a large age gap and didn't always have siblings around to play, fight, grow with. financial situation of parents was different when we were growing up vs him growing up (better when we were growing up).....but we have noticed for years this brother seems sensitive, gets upset more easily and can "snap" over things that seem a bit of an overreaction the rest of us. we usually walk on egg shells around him knowing his threshold for being hurt/upset is much lower than us and don't directly antagonize him but parents do

i have some judgmental thoughts about this: he had the chance for a regular job after college and didn't pursue it. he chose to work with parents, he needs to have some accountability, not everything is someone else's fault. he wasn't forced to be in this job but now is in a situation where he is being relied upon by parents. the rest of siblings all have different career tracks and moved out of home when he was young, he likely has felt lonely and ignored for a while. Perhaps we could do a better job in showing him appreciation but unsure how because every time i reach out it is an answer with a few wors, he doesn't answer calls, during in person visits he stays in his room, prefers to keep to himself

Not sure if this is the best "asking for coaching" topic but something that has been taking over my mental space so decided to share - thank you for hearing me out!

ANSWER:
Hi Friend, Glad you brought this here

Look at the great awareness you have about your thoughts about him. You see how you are being critical and judgmental, and you see that you are spending a lot of energy thinking about all of this and you are noticing it's too expensive a use of your time and brain waves. You're half way there!

Great job putting what your brother said in quotes on the C line. What are the other C's in your story?

Cs
- you have a brother
- he is X years younger than you
- he lives in the same state as his parents and one brother
- he works at parents' business, the other siblings don't
- he said "I don't have the patience to hear from people who are not present in my life"

You have many thoughts about him:
"I didn't know he felt that way"
"he feels pressure and feels trapped"
"He is sensitive and "snaps" over things" (I know this feels like a C to you, but not everyone would agree on what that means, including him)
"He had a chance at a regular job..."
"He needs to have some accountability"
"We could do a better job

Let's look at the model you gave- I've tidied it up a bit.
C- Brother said words
T- I didn't know he felt this way or at least not that strongly
F- Guilty (choose one)
A- justify your actions and your siblings' actions, look for reasons he brought this on himself, walk on eggshells, avoid conflict, stew on this, you judge him, and then judge yourself.

what else do you see yourself doing or not doing from a feeling of guilt?

R- You stay in this spin cycle.

Ok, so all of this is happening. Your brother, the work he does or doesn't do, the childhoods you had or didn't have.

What are you making this story mean about him?

What are you making it mean about you?

What would be different if things were different?

we can tease through this together. Bring it back here, Sister.

I was initially indecisive in my career decision and with that and the ranking system I ended up in a specialty that I did not think I would end up in. I cannot imagine moving my family again for residency so did not reapply in the match this year, leaving me feeling stuck and a little hopeless. I am normally a motivated, enthusiastic, and engaged person but feel as though I've lost a lot of that due to my current situation. I then am more mad at myself for not making a change early in the year. I no longer feel worthy or a desirable candidate. I would like to be in a specialty/position that lies with my values, goals, and dreams. But with this initial feeling of extreme failure, I've lost sight of most of what my goals and dreams truly are. I feel as though I'm fishing for answers in a big sea and coming up empty handed.

I tried here but I do not think encompasses the results I really want.

C - not in the residency specialty that I initially decided on.
T - The specialty I ended up in does not align with my passions, values, interests
F - I am a failure, I am not worthy because I went against my values and no one will want me in another residency program because I was initially indecisive. can't imagine moving my family again. feel hopeless, frustrated, stuck
A - avoidance, resentment, loss of motivation (very anti-normal self)
R -

ANSWER:
Beautiful insight on your model! Let's clean it up a bit to get clear on the feeling that your thought creates. A feeling is just one word- one single emotion that comes from the thought when you think it. You have MANY thoughts in this narrative, but let's look at just this one:
C - Your current residency specialty
T - This doesn't align with my passions, values, or interests, so I am a failure.
F - What's the one feeling that you feel predominantly here? (unworthy? hopeless? stuck?)
A - avoid, resent your choice, indulge in a negativity bias, get mad at yourself, stay stuck in black and white thinking, fish externally for answers instead of looking inward
R - Come up empty handed

Some questions to consider:
-Are there any ways that your specialty could align with your passions, values, interests or goals?
-Do you find anything (even something small) interesting about your work?
-Can you imagine a creative way to fulfill your goal in your current specialty?
-What if you challenge yourself to look for one way in which you act in line with your values and passion at work each day? Are you willing to open up to this possibility?

C: Current Specialty
T: I cannot imagine moving my family again, so I'm stuck with this
F: hopeless
A: Label yourself as an undesirable, unworthy candidate. Not imagine (or act) to consider reapplying. Create a narrative where you've lost yourself, and then prove it right.
R: You are, indeed stuck in this narrative

Good news! It's just a narrative your brain created. It's not reality.
Is it true that you cannot imagine moving your family again? Try it now. Close your eyes, and just *imagine* it. You don't have to plan it, just see if you can imagine it for one minute. What comes up? Are you sure it's true? Could the opposite be true?

Can you imagine how you are perfectly desirable not in spite of, but BECAUSE of your experience this year? What have you learned about yourself? How do those lessons mature you in a way that serves you? How could this all be for you?

I saw the example below which was helpful but I’d like to share one of my conflicts:

Family and connection

Vs

Growth and success (related to career)

I know they don’t need to oppose each other but right now, they do for me

These values are very important to me and the ones I’ve associated with career often overshadow the family and connection

I think that’s because my family is understanding and patient and as awful as it is, this kind of lenience has me focusing / stressing / perseverating about work, career growth, and eventually career success. Over taking out time for family, doing activities, creating memories, having kids, etc

I want to add that success and wealth are some of my values because I want a good quality of life for my family so in my head these are related yet conflicting

!!!!

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

Ok- let's put this in a model

C- life
T- Purusuing growth and success in my career takes me away from connection and family
F- what is the emotion you feel when you think this?
A- from that emotion, what actions do you see yourself taking?
R- the result for you is you disconnect from your family AND you don't make as much progress in your work because you are disctracting yourself with these rules of how they can't coexist.

Good to know!

OK so now what? Let's look at this with curiosity. In what ways does professional and career success allow you MORE connection and meaning with your family? In what ways do your thoughts about your family help you in the way you show up in your work?

Where is the overlap in the venn diagram of these values? Can you draw it out and see what comes up?

Bring it back here!

Hi friends!
Thanks for showing up for coaching tonight. What a great call.

I wanted to share this link Brene Brown's podcast where she talks about comparative suffering. She hits on it mostly at the end of the episode, but the whole things gold.

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

My take away is that when we compare and rank suffering (or anything else really), all it does is diminish the amount of empathy and connection we get to experience in the world.

how does comparison come up for you? In what ways does it move you forward? In what ways does it hold you back?

Bring it here for coaching!

I'm reflecting on today's session and realizing that scenarios that conflict with my values are ones that are charged with strong-negative emotions. Can you help me work these out?

C - I haven't had a day off/really had time to mentally "check-out" since July (Lots more background why here, but I think this is a good summary.)
T - It's not fair that others in my program/department have
F - Resentment, burn-out, frustration, anger
A - Perseverate on the feelings
R - Feel worse/more exhausted/more negative energy

Same F, A, T - different C & T
C - To date, I have struggled to say "no" to anything patient-related. I've put patient care above all else. I feel that taking short-cuts/assigning my work to others goes against my values.
T - It's not right that others around me don't share these values. (Part of me knows that's crazy though...that they are just better at setting boundaries/creating a balance...something that I need to work on.)
F - Resentment, burn-out, frustration, anger
A - Perseverate on the feelings
R - Feel worse/more exhausted/more negative energy

I feel like I'm on the right track in re-framing scenario 2. But not sure where to go from here.
Thanks for your help!

ANSWER:
Great insight! Yes - strong negatively-charged emotions are often an indicator light for a conflict in values, and a handy thing to consider! Just remember that emotions are DATA not DIRECTIVES here, you want to be sure to use your prefrontal cortex to look at your thoughts and make sure you are in control rather than your amygdala 🙂 I'm going to re-state your model to keep the C totally factual. I hear you on the background, but I bet most of that goes in the T line, we always want to keep the C totally objective.
C - I haven't had a day off since *** (when was your last day off? what story are you telling about how you couldn't check out here?)
T - It's not fair that others in my program/department have more days off
F - Resentment
A - Perseverate on the feelings (what else do you do? Complain/vent? continue to focus on how your situation is unfair? Not see any positive moments in your days off?)
R - Hand the power over to others for how you feel.

In this model, you need to have more days off to check out. Also, your program (or others) are in control of what you believe is a "day off" or how you think you can "check out."
But what if you got to take the power back and decide that you were going to check out no matter what on your next day off?
What if taking your power back means realizing that you CHOOSE how to prioritize your days off - and that you are doing the best you can given the information you have?

Notes on your second model: You put a lot of actions in your C line. I wonder what the actual C is here, and what T/Fs are driving you to prioritize others?
C - My life
T: ?? (I have to X/Y/Z? This person needs me? I am responsible for?)
F: ??
A: Struggle to say "no" to anything patient-related. I've put patient care above all else. I label short-cuts/delegation as something that is against my values.
R: You prioritize others over yourself

Fill in the rest and bring it back sister!

Finally your last model:
C: My values
T - It's not right that others around me don't share these values.
F - Resentment
A - Perseverate on the feelings
R - Feel worse/more exhausted/more negative energy

Can you see a theme here? Whenever you think "it's not right" or "it's not fair" it leads to resentment. Which leads to more pain and perseveration for YOU, not for the "others". Shoot!

Why do things need to be fair for you?
Can you think of ways that your life is unfair in the positive side for you? Are you the beneficiary of any luck or privilege that is also unfair and could balance out the bad luck you are perceiving?
Do you think that things should be fair for you to be happy?
Why?

Hello friends!

I hope you were able to join Dr. Arnold's BONUS call on Sunday Feb 6th. It was incredible. If you haven't yet, please check the recorded calls (in the Coaching Calendar tab).

Dr Arnold shared her "O Rules" for processing feelings about difficult people. Here's what I took away

--- Dr. Arnold's O Rules-----
1. Of Course!- Of course you are feeling that way. This is a permission slip to allow yourself to feel the way you are feeling.

2. Observe- Can you observe that feeling in your body? do an H&P on that emotion. Can you get to know it a little better?

3. maybe OR maybe not- maybe it is the way you think, maybe it isn't.

4. Options- What else is possible here?

5. Own it- you can choose to feel however you want. The final step is to own that emotion for yourself.

Thanks, Christina, for this amazing tool!

• Circumstance: I will be graduating from my peds fellowship in June (yay!) and now I am trying to figure out what to do with my life. I have a virtual interview with UW/SCH on Monday and earlier today I convinced them to let me come out there in person next Friday 🙂. I have gotten offers from the other places where I have applied (DC, CHOP, UCSF) and now Seattle is the last one I have before decision-making crunch time (UCSF said I need to give them an answer by 2/11 and I need to get back to DC and CHOP pretty soon too)! My current chair (who used to be the chair in Seattle) said she would be surprised if they didn't offer me a position so when writing this I am working under that assumption so I can give myself more time to sit with these options to make a decision. Unfortunately, the few pieces of information I don't have that I need to make this decision are more information about the DC position (the call schedule is ridiculous and I set a firm boundary on that and am waiting to hear what they say...they mentioned in my interview that they may actually be changing the call system...) and I also need more information about the Seattle position (it may be the best job for what I want and for my career and my current chair loved the people she worked with when she was there and speaks very highly of it, and the call isn't as crazy as DC). Other factors that come into play are that I lived in DC for 10 years and have a ton of friends there (I basically said the job in DC would have to suck for me to not take it...which does if I have to be on call >1/3 of my life...) and my half sister and her family lives in Seattle (although our relationship is a little complicated so I'm trying to not let that weigh too heavily on my decision). My fiance is moving with me and has been so incredibly supportive and says he is down to move anywhere (where did I find this guy??).

• Thought (some feelings mixed in): I need a job. Every option has pros and cons that are all so different from each other and I can't figure out how heavily to weigh each pro and con to make this decision. Luckily, I feel confident that I would have a great mentor in my boss at each place (truly mean that). Current thought is that Seattle and CHOP are probably the best jobs (in terms of what I want in a job, career advancement, not dying from call, etc) but I love DC and have lots of friends there and I thought I was gonna move there. I am pretty much eliminating UCSF. I thought I was going to eliminate CHOP because I literally don't know a single person in Philly (and i am not super excited about the city) but it's a great job and the chair convinced me that it's only 1.5 hours from DC on the train. So it seems like it is coming down to DC vs. Seattle vs. CHOP (if Seattle is great and gives me an offer then CHOP gets eliminated). I'm worried about the job in DC (it would be a good job with a great boss but I do have some concerns, not only because of the call) but I'm worried about living in Seattle (with the rain/darkness - i love the sun/warmth, 'seattle freeze', not actually getting along with my sister, and not really knowing anyone, although I do love nature/hiking and Seattle looks beautiful when it's not cloudy and my fiance is excited because he's Canadian and its closer). The pro/con list for Seattle/DC is very different (but also similar) in a way that makes this decision difficult and it's so hard to know what is actually going to matter in the end in terms of my happiness.

• Feeling: grateful that I have so many great options. Scared I will make the wrong decision (although I know there is no 'wrong' decision although a few months ago I had a meltdown that I would drag me, my fiance, and our dog somewhere that we will both be miserable and regret my decision and wish I could go back in time). Excited to be an attending. also some imposter syndrome. Seattle feels more unknown (which is a little scary and a little exciting) and DC feels like more of a known quantity (but knowing myself and that the job in DC isn't perfect, I may always be asking myself...what if I went to Seattle?).

• Action: me asking for coaching, gathering as much information as possible to make this decision! I've also spent a TON of time looking at apartments/houses in both cities...and googling places to go salsa dancing/hiking in seattle (my passions)...and how to survive the darkness...and lots of other questions that someone who has actually lived/worked there could probably answer much better 🙂

ANSWER:
Such great insight packed in there - thank you for sharing it! There are a lot of thoughts (and F/A/Rs) happening here. So great to get them down, but for coaching purposes, it’s easiest and clearest if you can pick one thought to focus on:
C: You have a choice of UW, CHOP and DC for fellowship
T: I can't figure out how heavily to weigh each pro/con to make this decision, so I could make the wrong one.
F: Scared
A: Continue to gather data that isn’t helping you. Poll outside sources. Search externally for some “right” answer. Worry about a future scenario that hasn’t happened. Pre-experience the regret that you are afraid of
R: You don’t make any decision. You don’t actually figure out what’s important.

Can you see here that the thought “I can’t figure out….” Is not getting you any closer to figuring it out?
What if you believed that you could absolutely figure this out?
What if you have everything you need right now to make a decision and have your own back about it?
What if these external factors (job logistics, family drama, weather) were not “weighable” and you trying to make them fit into an equation is actually setting you back?
What is your deep intuition telling you? What does your gut say? Is it helpful? Do you know? What are you afraid of? If you are afraid of a future feeling (regret, stress, overwhelm, loneliness) – can you trust yourself to handle it in the future? Why are you afraid of normal human emotions?

Let’s zoom in and look at this more focused model:
C: UW vs. DC:
T: The pro/con list for Seattle/DC is very different (but also similar) in a way that makes this decision difficult and it's so hard to know what is actually going to matter in the end in terms of my happiness.
F: ?? torn?
A: same as above. Lots of perseveration, vacillating, trying to weigh and value intangible things. Believing there is a “right” answer out there that you need to figure out.
R: You make it hard to know what matters. You block your inner knowing.

I’m going to tell you a secret. The only thing that will create your experience in your job is…. (drumroll) your THOUGHTS about it. Seriously. Not the call schedule, not the weather, not how your husband feels. I know this seems impossible right now, but it is really true.
That is not to say that positive thoughts are harder to come by in certain circumstances… absolutely we can choose a C that sets us up for success. To a point though. Right now, you are in “try to control everything in the future” mode, and you are feeling torn/stuck/scared because THAT IS IMPOSSIBLE.

The real secret to making a decision is that you have to: Just. Make It. You already know intellectually that there is no right or wrong answer, you can be happy (or miserable) in either place. If you are willing to feel any emotion (including misery) and trust that you’ll have your own back (if it’s absolutely awful in DC then you’ll support yourself in getting out right? If you are exhausted in the call structure then you can absolutely change or advocate for change. If Seattle clouds get you down then you can be sure to get yourself out of there too), but you can’t predict what you may need until you get there. What if the call schedule is nbd? What if you actually love the misty fog? What if your PNW family is a huge diamond in the rough situation? You lose nothing by choosing to believe that ahead of time.
You lose a lot by trying to prepare for the worst. Trust yourself to handle the worst in the moment if you find yourself there, but enjoy the anticipation of an amazing job opportunity in the meantime!

I'm an intern currently halfway through 2 months of ED shifts (I want to do primary care eventually so this is not my forte) and am struggling with feeling invisible. I'm an off-service resident for both months, so I constantly don't feel like I belong and don't know what I'm doing. The erratic ED shift schedule also means that I rarely work with the same people, so I haven't been able to build relationships with other residents, attendings, or nurses. My role is always as an "extra" resident, so I'm not a critical part of the care team. All of this to say that I often feel that one would notice if I didn't show up to my shifts, and nothing I'm doing at work is important. I've tried switching my mentality to remind myself that it's an opportunity for me to take my time and learn, but I just get frustrated that I don't feel like I'm learning much and my seniors and attendings are too busy to teach me anyway. I'm constantly fighting the feeling that I'm wasting my time and getting mad at myself for it at the same time.

On top of this, I haven't been able to see any of my friends or co-interns in ages because my schedule is weird + Omicron fears, and I live alone, so there's a big sense of invisibility in my personal life as well.

C: Halfway through 2 months of ED rotations
T: I'm not learning anything, I hate the ED
F: lonely, unimportant, invisible, frustrated, expendable
A: feeling resentful during my shifts, dreading going to work, rushing through patient visits, complaining
R: Not learning as much as I could during these months, not taking advantage of my time off between shifts to do things I enjoy

ANSWER:
Hello, friend. Great awareness here!

Just a few points of feedback on your model- You actually have several models running simultaneously, one for each of the feelings you have (lonely, unimportant, invisible, frustrated, expendable), each of those has a different thought in the T line (even if only slightly). Just to keep things clean, try to keep each model to ONE thought and ONE feeling.
The rest of your model, though, is spot on.

Your brain is working REALLY HARD to show you all the reasons to be hate this rotation.. It's really trying to convince you you are wasting your time, and in turn, you waste your time. Good to know.

You are absolutely right on your R line. The result for you is that you waste your own time by not getting the most out of the clinical experience OR your time off.

The reason you're having a hard time moving out of this model is because you're resisting those emotions and thinking you shouldn't be feeling them. Those feelings are there for a reason. They reflect values that you have in your work. Perhaps the underlying values are:
- respect for one's time and contributions
- inclusion of folks who are "outsiders" to a group-
- responsibility for learners' education-
- connection with friends-
- stability of time/schedule-

All feelings are welcome here. It's OK to feel ALL of those feelings. It's important to feel frustrated sometimes! Frustration helps us solve problems. It's OK to feel unimportant sometimes. Feeling unimportant helps us remember our purpose and step back into it. All of these feelings are signals to help you regain the meaning in your work.

The trouble you've identified is when those feelings keep you stuck and hold you back from living into your values, as you very adeptly noted in your R- line.

A few questions for you:
- what other values do you have in your life aside from those I pulled out above?

- In what ways are you living into your values now? Ask your brain to show you proof of this too. In other words, in what ways are you treating others with respect? In what ways are you inclusive of others? in what ways do you create connection with people you care about? In what ways are you honoring the parts of your schedule that you do control?

- What would it look like to live into those values even further on this rotation?

- What's coming up for you now?

You don't have to convince yourself to not be frustrated.

You don't have to convince yourself not to feel invisible.

Just by writing in for coaching here tonight, you are bringing yourself into greater focus.

Come on back for more coaching on this, friend.

<3

One of the main reasons I joined BT was to work on developing calm confidence. The goal is to be like a duck - cool and calm on the surface, while allowing flutters beneath the surface.

I am in my chief year of a surgical specialty and will be going off to fellowship next year, so I want to work on this calm confidence both in and out of the OR. I am normally a completely open book, I tell people what I'm thinking and I am comfortable being vulnerable with my emotions (crying when a patient dies or verbalizing my uneasiness about a situation), which is not necessarily the norm in surgery. I've been told time and time again by attendings to just "fake it til you make it" and to not say these things.

So, working backwards through the CTFAR...

R - Embody calm confidence.
A - When feelings of worry about a patient or surgical approach arise, do not verbalize it as direct brain to word vomit and instead restructure this as more objective facts. Instead of saying "I'm afraid we are going to injure the IVC, I'm worried the tumor is encasing it. Should we maybe get blood ready?" it would be more effective to restructure and say "The tumor is encasing the IVC. Let's get some blood in the room." Slowing down thoughts and translating before speaking. I can still feel the feelings & have my thoughts and do my due diligence, but I do not need to let the world experience these emotions with me.
F - Feelings of worry about all possible outcomes about a patient. Conflicted about whether I am voicing my concerns enough to ensure all sides of patient care are being looked at. Feeling like I need to advocate for the patient. Feeling judged for showing any emotion or being vulnerable. I am confident in my surgical ability and my knowledge base. Feeling inferior when demonstrating any doubt or hesitancy.
T - It is still a man's world. I need to work twice as hard and be twice as good. Any inkling of self doubt or worry is seen by all members of the team and in the OR and can directly undermine my own actions. Women whom I admire & who gain respect demonstrate calm confidence.
C - Female in a surgical field.

I'd love some feedback of the structure/content of my CTFAR but I'd also like to know how the heck I can transition to slowing down my thinking before word vomiting it all out. I think I generally know what I need to do, but with how quick it happens I'd love ways to slow it all down in my mind or remind myself to do so in the moment. This is not to say I will never be vulnerable, because I believe there certainly still is room for that, but I'd like to pull back in certain circumstances.

Thank you for your time!
ANSWER:
Ok - there is a lot going on here, which is perfect. I am going to start by helping you with model organization. The model you gave us is a mix of unintentional and intentional, and it's easy to get confused. Also, it's important to clean up your model by just using one thought and one feeling per model. The first step after a thought download is to write out your UNINTENTIONAL (or automatic) model. This is the one that represents your current state. You want to be careful here to check that the thought creates the feeling and the actions are fueled by *this* feeling. So for your UM:
C: Female in surgical field - and you often experience doubt (let's try putting this in the C line since it's true for you and it's what most of your thoughts are around).
T: Any inkling of self doubt or worry is seen by everyone and can directly undermine my own actions.
F: What's the strongest feeling from *this* thought? Is it judged? Inadequate?
A: Worry, constantly question whether you voice concerns, hesitate, what else here (specifically from feeling inadequate/judged?)
R: you undermine your OWN actions.

Can you see how your own thought that others will judge you is causing you to judge yourself? Causing you to do the undermining in your own head?

Now - before you try to move into a result model, I want you to stay here and question the thought until you see all of its angles and counter arguments. When you still believe that OTHERS hold the power of your career, you are not ready to change your thoughts.
-Why do you think you know what everyone thinks of you? Could you be wrong?
-Is it true that your self-doubt is seen by "everyone" in the OR?
-Is it possible that your colleagues also feel self-doubt much of the time? Do you have examples of this?
-Can you imagine the women you admire having felt self-doubt at some point and using it to help them grow? How might that look?

Ok -for "model cleanliness" sake, I'm going to show you an example of how to step into an INTENTIONAL model (IM) which you started to do with your reverse model above.

R: Embody calm confidence

(what does this look like? What would you need to do and not do?)

A: When feelings of worry about a patient or surgical approach arise, do not verbalize it as direct brain to word vomit and instead restructure this as more objective facts. Ex: "The tumor is encasing the IVC. Let's get some blood in the room." Slowing down thoughts and translating before speaking. Process feelings, but do not react to them. ​Be like a duck - cool and calm on the surface, while allowing flutters beneath the surface.

(what feeling would you need to feel to do these actions?)

F: (is it Calm? Confident? Self-compassion? Something else?)

(what thought cultivates this feeling - that you believe today?)

T: ??

C: Female in surgical field - and you often experience doubt

Fill in the blanks and bring it back here! <3

I’m wedding planning on top of fellowship and it’s been crazy rough. My parents and my fiancés parents are incredibly involved and everyone has a lot of very strong opionions. There’s a lot of pressure on the wedding because it’s the first on both sides of the family. On top of all of this, the wedding is in San Diego and I’m not local. It’s been rough to say the least.

ANSWER:
OK, sister let's dig into this.

What are the circumstances?
- you are in fellowship
- you are getting married on (date)
- you and your fiancee both have parents
- human beings have opinions on things.
- wedding in SD and you don't live in SD

What are the thoughts?
- there's a lot of pressure on the wedding because it's the first on both sides
- it's been rough (not sure this is something everyone would agree on, no matter how true it is for you, OK)

So, let's put this in a model:

C- wedding
T- There's a lot of pressure on the wedding because it's the first on both sides
F- ?? (when you run that sentence through your head, what emotion do you have?
A- ?? What actions do you take (blame parents/inlaws for interfering? avoid planning? focus on some things more than other things? snap at people? What do you do? what do you not do?)
R- You double down on the pressure and keep yourself stuck

Step one in processing all of this is just looking at your thoughts without judgement. Can you fill out the rest of the model and bring it back here?

We've got you!

I timed myself for two minutes so that the list didn’t go on forever! this is a summary:

-want to cook more/be a better cook. Help partner with this
-do more activities where we can continue to learn about each other. plan things together. build memories
-communicate more openly
-welcome vulnerability, practice apology when I realize I may have done something hurtful rather than denying it
-be less consumed with work at home and letting work trickle into the weekends
-Show more empathy. Ex. partner is not in medicine, if ever brings up medical issue that doesn’t seem serious to me, I tend to be frank and not give it too much attention. Although for someone not a medicine it might be a big deal. I give my patients more time and attention , why can’t I do that at home.
-support healthy eating (he does, I don’t). Bringing junk food in the house doesn’t help the cause
-Join him for exercise, might be a way to do an activity together
-Listen more actively, not passively
-Address issues as they come, rather than holding onto them and letting them get stronger

Maybe these are perfect human fantasies rather than perfect wife fantasies but I really do associate each one of these things with my personal relationship with my partner specifically

I’ve started writing models for these things as they come up but that’s the list!

ANSWER:
Hi! Great work here. Look at all you came up with in just 2 minutes!

Ok, what do you think looking at this list?
looking at these things, do you see that most of them are not objective? how would you know if you were successful in one/any of these?

In other words, what would it have to look like for you to give yourself credit for doing this?

"Be a better cook"- what does that mean? how will you know when you are doing this right? do you need to cook every meal? do you just need to try to cook once a month? do you need to take a class?

"Communicate more openly"- what does that mean? what does "open communication" mean to you? Is that a reasonable thing to expect all of the time? in what ways are you already communicating well and openly? how could you translate that into other areas?

It seems like there are some values you have in your relationship that you'd like to honor. What are they?
I hear themes of
- communication
- accountability
- partnership
- health
- connection

what other things do you value in your relationship?

what are some ways you ARE honoring your values in your relationship?

Bring it back here, sister!

I quickly identified "burn-out" as a strong feeling during tonight's session. It felt like too heavy of an emotion to put into the Q&A. I certainly do a lot of buffering to try to avoid acknowledging the "burn-out" though I feel like recently I have been accepting that it is present and that it is impacting me. I guess this is processing? Or at least a start? I'm looking for advice on how to continue with this process. Where do I take the feeling next? What can I do about it?

ANSWER:
Thanks for bringing your burnout to us. No such thing as too heavy of an emotion anywhere in this program, I promise.
The place to start is with a thought download around the things that you think are bringing up burnout for you. Let your mind go wild, don't judge yourself, and just put a pen to the paper. Then - pull out the C's - all of the facts (careful here, easy to think your Ts are Cs :)). Then pick just one thought that creates that feeling of burnout for you (like - "I don't want to do this anymore" or... "I don't like this part" or "This is terrible"... whatever the thought is) and plug it into a model. See what comes up and bring it back here!

Then - to answer your question - it's normal to want to get out of the feeling of burnout. It's really uncomfortable, and not pleasant. It's natural to reach for a buffering activity to avoid it. But - as you are probably seeing, the burnout comes back, and then is sometimes layered with other "buffering-badness".

So - the next time you notice the feeling, see if you can sit with it. Don't judge it, don't even think about it except with curiosity and wonder. What does it feel like? Where is it in your body? You have a thought that it is impacting you - but try to stay out of this story when you are simply describing the emotion.
Notice what happens after you process the emotion all the way through - how to you feel then?

Bring back your models here and let's work through it together <3

This prompt couldn't have come at a better time... I sometimes forget how easy it is for our brains to project work experiences into our home lives...

C: 3 year old daughter has a 103 degree fever
T: What if she dies? (Seems like a jump...but) We recently went over a case of a 3 year old who collapsed and died from viral myocarditis following a simple viral illness! What if that happened to her?
F: Dread/Fear
A: Text my husband every hour for updates, play through the worst case scenarios in my head over and over..., focus on getting home rather than focusing on work
R: Distracted from my work duties/not giving my best to patient care, made my husband more anxious than necessary

From the outside, I see that these are extremist thoughts and feelings. I tried to allow the feeling and let it pass... it sort of worked but I still reacted (cried for a minute).

Proposed new model that I tried to work through:
C: 3 year old daughter has a 103 degree fever
T: Her body is doing exactly what it needs to in order to fight off her illness. Her dad is with her and doing everything he can for her.
F: Relief
A: Answer my husbands questions about medicine calmly, encourage him in his ability to care for her. Focus on the task at hand
R: Gave my husband the tools he needed to feel confident in caring for our daughter, was able to stay focused at work and give the appropriate attention to my clinical duties.

In reality, I swapped back and forth between these models throughout the day... is that normal? It felt normal.

ANSWER:

Hello, Friend. I'm so glad you brought his here. Look at all that awareness you have about this!

YES, it is totally normal for your brain to be batting these different models around in your head all day. Thats what we do best.

OK, let's not judge you or your brain for your first model. It is your brains literal JOB to keep you and your family (and your patients) safe by identifying all of the dangers. This is part of your "inner critic" and it exists for a reason. It's part of what keeps you alert and attentive to things that could harm you/yours. The trouble is when we let that voice run the show all the time, the result is exactly what you see in your first model- you linger in dread/worry/fear and the result doesn't make anything safer for anyone, just more miserable for you!

Great job on your 2nd model too. Did it feel believable when you were using that thought in real life?

So look, your brain might always reflex to that first thought ("OMG what if....."). What you want to build is awareness about if and how long it will serve you to stay in that first model, and practice gently transitioning yourself into another that serves you in a way that is more helpful or productive for you.

That can start with a little empathy and compassion for yourself
"of course, I"m worried! I'm still processing that really devastating case"
"I notice I"m feeling dread and fear right now, that's OK"
"Oh! There's my brain offering me the worst case scenario. noted ;)!"

Keep up this good work, friend!

Just wanted to share that my work in the workbook today was very eye opening to me.

C: I have a highly demanding job and often take on other tasks outside of work for others.
T: No one will like me and I am not good enough if I don't do it all, all of the time.
F: Pressure: to perform, solve problems, give to others.... Chaos: feeling pulled in many different directions and not at peace with things,... guilt: if I take a step away or rest
A: Putting aside things for myself or doing things I enjoy to meet the above expectations (that I've created for myself)
R: Feeling overly stressed, exhausted and depressed and not happy with my life choices. Finding it difficult to enjoy my work.

But! If I change my thoughts about my work to create the feelings I wish for (love, motivation, peace), I can still achieve the same result but just be happier while doing it. Still working on changing those thoughts though, and would love feedback.

Thanks!

ANSWER:
Amazing, thanks for sharing your ah ha moment with us! Your insight is RIGHT ON. It all begins with the thoughts. You mentioned three distinct feelings here, which means that you actually have three thoughts going on about this circumstance. Let's pull them all out to look at them and get some clarity (spoiler - you probably have LOTS more thoughts and feelings in addition, good to know when you are trying to choose a new one that you believe!).

Model 1:
C: your job + other tasks exist outside of work (note: "highly demanding" is a thought!)
T: No one will like me and I am not good enough if I don't do it all, all of the time.
F: Pressure
A: Perform, solve problems, give to others, put aside things for myself or doing things I enjoy to meet the above expectations (that I've created for myself)
R: You create a false game where you can control if people like you or not (impossible!) and thus never reach your "good enough" place that you are chasing.

Model 2:
C: your job + other tasks exist outside of work
T: I'm pulled in many different directions
F: Chaos
A: Try to do all the various things for all the people. What else do you do (and not do) when you are feeling chaotic? Do you multitask? Procrastinate? Worry?
R: Don't focus on what you enjoy, and end up not enjoying any of it

Model 3:
C: your job + other tasks exist outside of work
T: If I step away or rest... (what here? I'm no good? People will suffer? Finish this thought.)
F: Guilt
A: Don't step away or rest. Don't do things I enjoy to meet the above expectations (that I've created for myself).
R: You pretend that you are responsible for other's feelings, and in doing so, you deplete yourself.

Ok friend, you already have the insight here. You realize that it's your THOUGHTS that are controlling your feelings and result. If that's the case, let's start at the F line (you gave three feelings that you are hoping to cultivate) and work our way through your intentional models. I'll give you some example thoughts, but I encourage you to fill them in with thoughts that you believe in today and get back to us here!

C: your job + other tasks exist outside of work
T: ("I chose this job and these tasks because ____"?)
F: Love
A:
R:

C: your job + other tasks exist outside of work
T: ("I have chosen this life and I can create what I want"? "I am excited about my goal of ___"?)
F: Motivation
A:
R:

C: your job + other tasks exist outside of work
T: ("I'm not in charge of how other people feel" ? or "Taking care of myself first may create even better results") - what works here??
F: Peace
A:
R:

Trick is finding thoughts you BELIEVE in about your current circumstance that make you feel your intentional feeling. Can't wait to hear back!

C-Argument / Disagreement
T- I am always right 100% of the time
F- Defensive
A-Use silent treatment
R-disconnected from partner, don't actually reach root of problem. cycle repeats itself

I want to be able to break this kind of pattern of behavior. Be able to put ego to the side because I know I'm not "right" all the time but it's easy to finds flaws and blame the other person. It's easy to admit to myself that I may be wrong but saying it out loud might be the end of the world? Help please!

ANSWER:
Yaaasss - friend, this is really THE WORK!! Thanks for writing in here. First, I applaud you on your model! It's right on, friend - you are insightful in seeing that this thought really isn't serving you. The blame game never does. I love this very general model you've given us - it's widely applicable. What's really useful in the moment, though, is getting super specific with a circumstance. Truthfully, we can't put "argument" in the C line, since people define arguing in different ways. It's more revealing if you can put the actual words that the other person said, verbatim, in the C line and see what you think about those words, exactly.

You wrote that you can see intellectually that you are not right 100% of the time, yes? But in the moment, it can be really hard to switch from "I know I am right about this" to "I might be wrong, and the other person could be right here". So, instead, what if we just let your lizard brain/ego have this one.... let's say you ARE right? Now what?

Let's try this trick of letting your ego have this one by putting it right in the C:

C: Partner says words. I am thinking they are wrong and I am right.
T: I'm practicing letting them think whatever they like, and I'll think what I like.
F: how does this feel?
A: what might you do or not do from this feeling
R: what is YOUR result?

Another option if this feels like a stretch is simply to drop into a watcher state with this all. Notice how much you are "shoulding" yourself into "breaking" this behavior... what if it's no problem that you think you are right? What if your brain is programmed that way, and you can see it, hear it, and choose not to react to it?

C: Partner says words.
T: I'm noticing that I am thinking I'm right and they are wrong.
F: how does this feel?
A: what might you do or not do from this feeling? Do you notice anything else from the watcher space? Are you able to watch the feeling as well? Notice your breath? Notice the urge to do something? Or the resistance at the thought of doing another thing?
R: what is YOUR result here?

Some final thoughts to consider:

-What's the problem with your partner being wrong?
-Why not try letting them be wrong?
-Do you only want to be with your partner if they are also "right"? Or can you want to be with them also believe that they are wrong?
-What's great about them thinking differently from you sometimes?
-Is there anything in their "wrongness" to appreciate? To love, even?
-Do you think you behave in the right way when you believe that you are right in an argument? Is the silent treatment "right"?

Just wanted to share my workbook entries this week. No exact question here!

1. What motivated you to join: Conflict over career direction and ability to keep up. Ever since early success at age 23 and maybe before that, I have envisioned myself as a leader, an expert and in charge (a boss!). But since kids, my kids are priority #1 and I am willing to sacrifice work for them. The fact is that one of my kids has a unique form of autism and needs a ton of support- about 5x more than the average kid and daily tasks can be soul crushingly difficult.

2. what uncomfortable things could come out of this: Maybe I always wanted to be a part time house wife? Maybe my perfectionism about a clean and beautiful home is undercutting by work and family?

3. Three reasons I'm committed to myself: 1, I want to be true to myself (in order to be a happy mom) 2. I want to be productive, reliable and respected. I want to live up to my potential. I hate it when I'm surrounded by people who are not intellectual or curious or deep thinkers. 3. I want my life to be manageable. I don't want to have so much stress that I can only focusing on getting through the day (i.e not more than 50 hours or maybe even 40 hours of work a week in the long run?)

4. Obstacles: a) time limited by inpatient service b) loss of productivity due to sleep deprivation from my son's freak outs in the middle of every. single. night. c) my husband not doing his own work to keep himself improving in these circumstances of a child with autism and his own dysfunctional family that leads him to cycle through exhaustion/despair/irritability/perseverating on the worst possible outcomes

ANSWER:
I love that you brought this here! Thank you!

If you're ready to take the next step, I'd like you to take ONE of the thoughts that came up for you and put it into a model. Here are some ideas

C- Life
T- I might want to be a part time housewife
F-?
A-?
R-?

C- Life
T- I want to live up to my potential
F- ?
A- ?
R- ?

C- LIfe
T- My husband doesn't do his own work
F-?
A-?
R (remember this result is FOR YOU, not for him)

Ok, sister. Start with any of those. Let's see where these thoughts lead. Which ones help? Which ones are holding you back?

We are right there with you.

Just finished watching the call from Thursday and it was mentioned that we should all really try to self praise. I was wondering if you could share tips on how to do this?

Write some self compliments daily for example?

Just curious to see how you would suggest starting this thing that I'm sure many of us aren't too familiar with (!)

Thank you!

ANSWER:
Yes- there is so much data behind self-appreciation leading to positive things (goal accomplishment, expertise, productivity, and generally feeling better in life). The trick here is to try to catch your inner critic before she runs the show.

One easy place to start is by writing down THREE GOOD THINGS that happened each day, and then tag on an attribution with what strength you used to make them happen, or to enjoy them.
For example:
- I got out of clinic on time (attribution: I used a new efficiency technique in agenda setting and it paid off!)
- Beautiful sunset tonight (attribution: I am someone that appreciates natural beauty and was able to slow down enough to notice it!)
- Had a lovely family dinner (I have made it a goal to sit down for the last 4 years with my kids, and it's been up and down, but I am starting to see the pay off, go me!)

The three good things alone work like a gratitude journal. The attribution is a self-praise process that helps you start a habit of noticing how much you rock.

Once you start paying attention to the areas you rock, you can stay in them longer!

To take this to the next level, you might try taking one of these "good things" and plugging it into the RESULT line of the model, then work backwards to see what thought created that result for you. Then you can practice thinking this thought on purpose to keep getting that awesome result.

Ex:
Result: Had a lovely family dinner
Actions: Prioritize sitting down together routinely, relax enough to accept the chaos, appreciate my kid's cuteness, connect with my partner, sing our family song, laugh
Feeling: Connected, present
Thought: I am so happy to have this dinner with my family, I love that I created this.
Circumstance: Dinner time.

Now - tomorrow, I can intentionally think this thought and create the same result - no matter what happens.

C- started SSRI for anxiety/depression but this has lead to decreased libido
T-"i want to do what i can to improve my mental health so this side effect is okay for now"
F- guilt because my husband has previously mentioned that sexual intimacy is a large part of a relationship for him, I remember him saying it's "50%" of a relationship based on a therapy question we answered together earlier this year (for me it was 10% - he is aware). Now probably less than 1% ...although I know not all intimacy is not only sexual of course
A - I don't even try if not in the mood which hasn't been for a while
R- we haven't been intimate in this way for over 2 months

My husband hasn't said anything. I haven't said anything about the side effect of the SSRI which has decreased my already baseline low interest further. but I feel guilt about it. Will talk to my prescriber as well but I am looking on advice for how to have this conversation with my husband or should I continue to leave it unaddressed (?)

ANSWER:
Great work here. Let's dig in.

C- on SSRI, Libido lower than you'd like. (I don't think this is purely OBJECTIVE, but I'll allow it because we want to not debate whether or not your libido is low, but to look at your thoughts about your libido, OK?)

T- you wrote "I want to do what I can to improve my mental health, so this side effect is OK for now". I think that's what you WANT to think, but you're not really there yet.
The T in this model is "Sexual intimacy is important to him and ___________(I'm not doing enough? I'm not holding up my end?)_________. What is the thought there?

F- Guilt.
(Read that T line again. Is it guilt? Is it shame? is it obligation?)

A- Avoid
- you don't share with him that you are having a hard time with this side effect.
What else do you do? What do you not do?

R- You prove to yourself that your libido is not enough.

OK, my friend. You are not alone here.

Our Queen, Brene Brown, says guilt is the thought "I DID something bad/wrong", and shame is "I AM bad/wrong". Which do you think you are feeling in this case?

You think that you should be doing more to have physical intimacy with your spouse and you're judging yourself for it. Maybe you feel shame. Maybe you feel guilt. That judgement is making it hard for you to open yourself or your relationship to honest conversation about needs, wants, desires. And that's OK! It's hard!

Let's start by just getting curious about YOUR needs/wants/desires.

I wonder:
- what feels right for you right now when you think about intimacy and libido?
- are there types of physical intimacy that you are more or less interested in right now?
- in what ways can you imagine intimacy with your partner that is not physical?

You asked for advice for how to have this conversation, or even if you should.

What do you think?

Also, This is a PERFECT thing to bring to our BONUS call with Dr. Sonia Wright on 1/24 at 6pm. Her specialty is in coaching on sex and intimacy, and I can promise you she will blow your mind.

So much love, friend.

I just have one example below of trying to practice the model but my overall issue is a recurring one:

It is being irritated, annoyed, dismissive to my partner if I have a long day at work, or a tough day (due to patient complexity or note load for example), or haven't eaten like I describe below (which wasn't even his fault!)

C-I did not eat and was picked up by partner 2 hours late from clinic
T- "I wish I had brought food with me so I could finish work while waiting" "What the heck is he doing that he hasn't answered for over an hour"
F-annoyed, frustrated, hungry (FYI I get very grumpy if I don't eat but I am also a picky eater, don't prepare lunches even if I had planned to so leave myself at the mercy of the limited cafeteria)
A-when I was picked up, I was irritable and snappy. So was he...as he rushed to come and had a few issues along the way
R-we both had heightened emotions, led to an argument eventually on that car ride (on a different topic, even though not directly related to being picked up late/not eating, those seemed to have set the tone for a problem)

Argument led to silent treatment. My ego usually gets in the way of apologizing and I also spend all this time thinking of how the other person went wrong and I'm the one who deserves an apology,

I do try to write out thoughts when these arguments happen, I try to pick up if any patterns exist. The theme usually is that I need to be more empathetic, patient, less selfish (my own observations), communicate more clearly with partner

I guess this is a bit of a ramble, but I want to work on being a better wife, not bringing work issues/frustrations home, have more patience, trust that my partner's intentions are good for me (if he was late it's not because he's ignoring me, something may have come up), and be able to have a "tank of energy and happiness" reserved for home life instead of letting what happened during work day or left over work from the clinic day consume me into the evening hours.

Lot of goals, I know - end thought download!

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

Great awareness in your first thought download- you are doing it!

LADIES- I am almost 100% certain that this coaching will apply to all of you too, so read on!

Reminder: the C line is OBJECTIVE (everyone would agree on this, including your husband). Only 1 thought goes in the T line- if it's a question, answer the question. Only one Feeling in the F line.

C- I did not eat from x-y time, and was picked up by husband at z o'clock
(do you see how that is more factual than "I didn't eat" and "2 hours late?")
T- Probably the thought in this model is the answer to the question "What the heck is he doing that he hasn't answered for an hour?" What is your brain's answer to this question? It's probably something like "Ugh! He is probably__________________"
F- Annoyed? is that how you feel when you think that thought?
A- GREAT JOB on your list of actions:
- you snap at him.
- you give the silent treatment
- you look for all the ways he is doing it wrong and all the reasons he should apologize to YOU
- you don't apologize for or own your part
- then, you judge yourself for not being a "good enough" wife, and have perfectionist fantasies about what that wife would be like (always empathetic, patient, less selfish, not bring work home, etc.)
R- You disconnect from the relationship and don't have empathy or compassion for either yourself or your husband.

This is all very good to know and nothing has gone wrong here. Your brain is doing exactly what it always does to protect you from something. From what, do you think?

So the very first thing to do is to notice and then understand that it's not your husband, or the fact that you skipped lunch or that he came after you expected him to that you are annoyed. It's your THOUGHTS about it that is causing your feelings which are driving those actions and creating the result of disconnection in your relationship.

Before you can change anything about this, I want you just build awareness of when you're blaming him (or that you didn't get lunch, or x, or y, or z) for the reason you feel angry/annoyed/frustrated and the actions you take as a result.

just notice.

Then, I want you to tell me about that perfect wife fantasy. What are all the things you should do or not do to be the kind of wife you want to be? Can you make a list?

Bring it back here!

So much love, sister. This is THE WORK to do. We will walk you through it.

XO

C- I am an MD/PhD in a PSTP track residency program who applied to one fellowship program (here) as intended by the PSTP track. My intentions to stay here for fellowship have been transparent to this program and its leadership since the first week of my intern year. Then, I didn't match, and I could not scramble to positions at many other prestigious institutions because family circumstances keep me in Denver (spouse with very good, flexible job that makes providing for our two children while I am in training possible). Then, I was informed by close mentors of mine within this department that the PD told them that the reason I was not ranked to match was because "everyone was very impressed by her application, track record, and interview, but a person, who is not faculty, provided feedback that questioned her collegiality and that she may not be a good colleague". I have since secured an unmatched fellowship position at UCO within an incredibly supportive program who is thrilled to have me, and I excited about the possibilities that lie ahead for me in this field.

T- What?? What did I do wrong? Who did I offend? I've been working towards a career in this sub-specialty for over 12 years (since starting medical school in 2009), and I've been discarded without a second-thought? Can I trust anyone I work with directly or indirectly when they can provide feedback that has sabotaged my career but wont give this feedback to me directly? Maybe I am a bad colleague? Am I annoying? Maybe I didn't work hard enough? Is this because I am a woman? Am I not "nice" enough? If only *I* was the primary breadwinner, this wouldn't be a problem.

F - Anxiety, anger, sadness, embarrassment

A - Proactively pursue feedback from mentors/colleagues (but worried now they wont tell me the truth, or havent been), trying to dissect nearly every interaction I have had since residency started to figure out what went wrong, but also trying to go forward based on what I know objectively to be true based on conversations and feedback I have received directly from colleagues and superiors. Throwing myself head first into this new sub-specialty that I feel like an impostor in, but that I am genuinely excited to be a part of. Doing my absolute best not to be reactionary or impulsive when interacting with members of the department that rejected me while feeling that I still have something to prove. Also, still deciding upon asking for feedback from the PD directly. I feel that I am owed this given my extensive relationship with the department, but also because if I have a deficiency that needs to be addressed I desperately do not want to truly be a "bad colleague".

R - I have strengthened relationships with my mentors, I have learned to advocate for myself. Learning more about myself given this intense introspection, but am also fueling the fires of imposter syndrome, self-doubt, and long-standing, pathologic anxiety.

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

First, I want you to know that our job as coaches is to sit with you and look at your brain. Just as a lifeguard stays out of the pool and throws someone a life raft instead of jumping in and drowning with them, our job is to stay "out of the pool" and show you your thinking so you can help yourself out. This is meant to be different from the engagement you might get from a friend or a parent or an advisor. We won't have an opinion on whether what happened was right/wrong, good/bad, fair/unfair. We will just sit with you and help you decide how you want to think about this moving forward. OK? Let's dig in.

I love how you've separated everything into the different components of the model. I'm gong to help clean it up a little further. What is contained here are all the simultaneous "models" you have running in your head. We want to try and look at just one at a time. Because of that, we put just one C, one T, and one F per model.

Here are the circumstances. These are 100% objective, everyone would agree on them, right?
- You are MD/PHD in PSTP Track
- Applied to fellowship here only
- Did not match.
- You have a spouse and two kids.
- Spouse's job is in Denver
- PD said words to your mentors
- your mentors said words to you. If you have a quote it could be, Mentor said "PD said that someone else said___"
- You took a position outside the match.

For our purposes here, we will put the "C" as "Fellowship". That is neutral, and everyone would agree that the fellowship process is one you are going through. And you have so many thoughts about this process, OF COURSE!

From there, we pull out ONE thought to put into the model. If the T is a question, make it a statement or answer it.

C- Fellowship
T- " I can't trust anyone I work with when they can sabotage my career and not give me feedback directly"
F- What is the strongest feeling you feel when you read that sentence? (anger? betrayal? rejection? can you get specific on how this exact sentence makes you feel?)
A- Come from THAT feeling.
- 2nd guess feedback you get from mentors, worry they're not telling you the truth
- dissect every interaction since the beginning
- imagine the ways you're already an imposter in the new field
- hustle to prove yourself to people you think are wrong about you
- equivocate on asking PD for direct feedback
- do you get defensive about feedback?
- do you listen to understand or to respond?
- What else do you do? Do you take it out on your family by being short with them? Do you eat or drink or shop or scroll on social media to feel better? get really juicy here.

R- the result for you is that you don't trust those around you AND you don't trust yourself to hear what the real feedback/opportunity for growth is; because of fear it will confirm what you already believe about yourself- that you don't belong.

Phew! It's no wonder you are struggling with this. Your brain is using it as proof of a belief that you don't belong, so you are doubling down on the experience of rejection and pain.

But there is some good news here too! You also have models going in here that are leading you forwards and through this experience. What do those models look like?

C- Fellowship
T?
F?
A- Ask for coaching here
- talk to mentors who you trust
- Get excited about new fellowship
- Reflect thoughtfully on constructive/positive/helpful feedback you have received in the past
- Imagine life in the future in this specialty
- What else do you do or not do?
R- ?? will be proof of the T in this model. You learn, you reflect, you grow into the next version of yourself.

OK sister, there is a lot to unpack there, and we have plenty of time to sort through it together. I am SO GLAD you brought this here. Though this is a very specific experience you have had, you are not alone in feeling this way.

can you take a few minutes and fill out those two models?
What is coming up for you now?

Sending so much love your way!

This is the forum for written coaching. You can write here for coaching on absolutely any topic. Just dump your brain out here and do your best to take one thought and enter it into a "model". We will respond back within 2 business days with some help with your model and some questions for you to consider. There is no limit to the number of times you can ask for coaching here. The more, the better! Feel free to scroll through the older posts below, and see in what ways they are relevant to your experience.

Can't wait to get started with you all!
Adrienne and Tyra

I walked away from a peds/PICU call shift this morning feeling anxious and disappointed. I know which circumstance had me feeling this way, but I can't figure out the rest of the model. Going over the possible thoughts that could be making me feel anxious, I didn't find any that rang true, so while I could tell myself there was literally nothing to be anxious about, I couldn't make the feeling itself go away for several hours. What's up with that??
C - Took care of a patient in the PICU as the senior resident (no attending on site overnight), and was part of a decision-making team that escalated her care.
Some other relevant factors are: 1) we were at the bedside much of the night and I was feeling increasingly fatigued 2) I had a nagging feeling that if the attendings were there, they would have told me not to escalate care as much 3) on rounds this morning, the attending said that everything we did overnight was completely appropriate but, also, that we could have chosen to do less and that "waiting it out" is probably the path she would have taken. Lots more conversation about the possible clinical approaches to this child's care ensued. To be clear, the patient is now better, no harm came from any interventions, and everyone is happy with how she looks this morning.
T - I honestly don't know. Do I think the choices I made overnight are "wrong"? Don't think so... because it seems objectively not wrong given that the patient is better, and also the attending herself said not wrong, just a different choice than she would have made. Do I think that I should know how to approach every patient in a way that I won't second-guess later? That seems crazy because I am in training and the whole reason that I am given autonomy overnight is so I can learn from my experiences and choices. Do I think the other people on rounds were judging me? They are tired residents just like me who are almost certainly focused on themselves and do not care even a little bit about my decision-making process. Am I just tired, and that messes with my emotional stability? I mean yes, but that doesn't help me get over these feelings in the moment so it's not the most helpful thought.
F - anxious and disappointed. Dunno why.
A - trying to reflect on what's making me feel this way, writing this post, actively working on positive self-talk, finally going to sleep knowing that no matter what I will feel better after I've slept.
R - a few hours of uncomfortable feelings, otherwise not much? I do feel like I learned from the clinical experience given how much I tried to dissect it. I guess I did a good job of mitigating the possible negative As and Rs even though I never figured out the T.

ANSWER:
Hi Friend. Thanks for bringing this here.
I love the discussion you have with yourself while working through your model, asking questions and being curious. Great job. I can tell that you can see yourself spinning and you're trying to put on the breaks. It is really hard to do that, even when you haven't been up all night managing complicated and high-stakes care of children. OF COURSE managing your mind is harder when you are fatigued. Let's hold a little bit of space for you right there. This is hard. That's OK.

After you've slept for a while, had some water to drink and maybe a plant or two to eat, walk through some of this with me:

OK. So during the period at the bedside last night, you had a thought "If the attendings were here, they probably wouldn't escalate care this much".
- Why do you think they wouldn't have escalated care the way you did? What might they have thought instead?
- So what? What does this mean about you if you do it differently than they might?

Then, an attending came in and said she "would have waited it out".
- so what? What are you making that comment mean? Does it confirm the thought you had earlier in the night?

For your models, Let's get a little cleaner. We can only have one T on the T line, and one F on the F line.

Here are the circumstances in your story:
- overnight call
- Attending said words in the morning
- I'm going to say "We escalated care" isn't really a C because I don't know exactly what you mean by that. Something more specific like "we transferred a patient to the PICU from the floor" or "we did X procedure" or "we started "Y drug" would be more clear circumstances.
- You spent X minutes at the bedside coordinating care

So let's clean up your model(s):
C- Call night
T-???
F- Anxious
A- replay the events of the evening, read into attending comments, what else?
R- ???

C- Call night
T- attending would have done it differently and that means___________________
F- Disappointed?
A- what actions do you take from disappointment? beat yourself up? How?
R- you reinforce your belief that ________________(probably the same thing as the blank in the T line)

C- Call night
T- I'm going to figure out why I feel anxious and disappointed!
F- Curious?
A- do this TD, ask for coaching, write out your model
R- you practice gaining insight into your thoughts about your work. You learn from the clinical experience, and gained awareness into how feeling anxiety and disappointment colored your resultant experience of the night.

What is coming up for you? Bring it back here.

Sending restful thoughts to you, sister,