Circumstance: I'm a resident planning to apply for competitive fellowship. I have a specific family situation, where I'm REALLY trying to stay and match here. The fellowship program I'm hoping to get into hasn't been very encouraging, in fact they have been discouraging by reminding me of how "prestigious" they are and they generally do not keep many of UCO's residents, they like their fellows from "Hopkins and Duke." Cool. SO since learning their attitude, I've been incredibly stressed out trying to prove to them and myself that I'm good enough to match here and can eventually be a great fellow. It has involved picking up 1000 research projects, networking, and constantly trying to impress people I come into contact with. It is exhausting. I am still far away from fellowship but the rat race is constantly on my mind. I don't want to leave my family to go elsewhere for fellowship, and I don't want to pick a different career just to stay, because I think I'd always feel like I missed out on what I truly want to do for my career. It feels like there is no Plan B, and Plan A is currently kicking my ass.
Thoughts: I'm not good enough, no matter what I do they are going to think I'm not worthy of a fellowship position.
Feeling: overwhelmed, anxious
Action: signing up for a lot of extracurricular things, but also procrastinating with all of them because I feel anxious
Result: Continues to be stressed, probably will lead to burnout
Thank you Tyra and Adrienne.

ANSWER:
Whew! I'm feeling the rat-race just reading this- and I'm sure the others are, too. You are NOT alone in this my friend, thanks for sharing here.

Let's jump right into your unintentional model:
C: CU fellowship says: "we are prestigious and we like our fellows from Hopkins and Duke" (did they actually say these words? The circumstance is neutral. It might even be "Fellowship application".
T: I'm not good enough, no matter what I do they are going to think I'm not worthy of a fellowship position.
F: Overwhelm
A: Enter the rat race: i.e. stress out trying to prove to everyone that you're good enough. Pick up 1000 research projects, network, and constantly try to impress everyone. Procrastinate and don't deliver in a way you are proud of. Exhaust yourself with people pleasing.
R: There is no Plan B, and Plan A is currently kicking your ass. Yes, you are right that this phenomenon leads to burnout.

Ok, there are several "mind tricks" that your brain is playing on you here. The first one is this false dichotomy ("there's only plan A and B and they both suck"). The second is the arrival fallacy ("I'll get off the rat race and feel worthy when I match here"), and the third is that you can control what other people think ("If I do all the things I can get people to approve of me and then I'll be worthy"). These are all actually lies - constructed by your inner critic who is trying to protect you (from the regret and the fomo that you are already pre-experiencing).
Take a minute and sit with her. Maybe go back to month 4 week 1 and fill out the inner critic worksheet - what is she needing/wanting/feeling/saying to you? Can you look at her nonjudgmentally, even lovingly, and then let her sit down and breathe for a minute while you clear your head?

The first place to start gently moving past her is by questioning your thoughts here.
-Is it true that this fellowship only takes residents from ivy league schools? Have they ever taken a non-ivy fellow? Have they said that you are not a candidate?
-Is it true that there are only plan A (match here) and plan B (leave your family)? Can you define these a little differently? Is there a possibility where you work out a plan that works perfectly for you and your family?
-Is it true that if you work harder and overcommit yourself that you will win other's approval? Who is the "you" that's doing all the things here? Is it the real you? Is it a sustainable you?
-Is it possible that if you act authentically, accept projects that you actually want and have time for, and show up to rotations with your true intentions and self that CU may actually choose you? What's scary about this? What's amazing about this?
-Why not let yourself be an example of what's possible here? Can you set a new example of a healthy approach to fellowship matching in an otherwise "rat race" culture? If not you, who?

Now construct a new model working from the R up to the C

R- what result would you like for yourself regardless of the place you match?
A- what actions do you need to take to get that result?
F- how do you need to feel to take those actions?
T- what thoughts feel true and might generate that emotion?
C- Fellowship Application

Write us back with the model filled in! And don't forget you can bring those three tricks above to Tues/Thurs coaching, or request 1:1 longer session with us just by emailing...
Sending love <3

I think this one may come out as more of a thought dump than a concise download to start… hopefully I can actually make it to a call soon but here is this for a start.

I’ve been working in the U ICU this month and its been hard for many reasons. I’m not comfortable with critical care or emergencies and as a fresh R2 with only 1 prior ICU experience, I am still trying to wrap my head around a lot of the medicine and ICU basics. Additionally I am still trying to figure out how to senior my intern who feels similarly uncomfortable with critical care. On top of this there have been a lot of changes with call going to Q3 from Q4 and teams flexing up to caps of 15 at times from 10 before. I arrive early and leave late every day. I never have the energy or even just time to hardly eat let alone look stuff up during or after work. I feel like I’m at a point of losing my mind. I worry I am missing things, I’ve noticed I am second guessing everything I do, reading into situations with my attending to a degree of paranoia. I feel overwhelmed to say the least. And I feel like I am doing worse at my job as the month goes on.
C: overwhelmed?
T: ? I can't do this, I am not doing a good job
F: anxiety, fear, sometimes apathy
A: I worry constantly, become disorganized, become paranoid
R: vicious spiral of exhaustion, disenchantment

ANSWER
Thought dumps are the best! Perfect way to post. First - let's clean up your model. You want your Circumstance to be the facts of the situation - things external to you, that you haven't judged yet. Here you listed a feeling as your C (which sometimes does feel like the C!) But in this TD -
C: You are an R2 on a U ICU month
T: I can't do this, I am not doing a good job.
F: (try to pick one - what's the most poignant feeling when you think this thought? Is it Anxiety?)
A: worry constantly, become disorganized, indulge in paranoid thoughts, arrive early and leave late, second guess your decisions and knowledge, overthink your attending's actions, focus solely on the negative, tell yourself a story that you are doing worse, I'm guessing without evidence that this is true.
R: YAASS vicious spiral of exhaustion, disenchantment. You do "lose your mind" a bit here, yes?

Let me throw so much love to you. I know for a fact that I am not the only reader here who can completely empathize- I could have written this paragraph verbatim about my own ICU rotation a decade ago. Friend - I just want to throw my arms around you. But instead - I will help show you your brain and see if we can create even just a little space here to breathe (and maybe even eat?? <3).

The place to start is by questioning your THOUGHT. First, is it true that you can't do this? Or is it MORE true that you actually can do this? Arguably, you can (you are, in fact, doing it, right?) - but if you let your brain run wild with out challenging the "I can't" talk that is a lie, it will start to feel true.

Second, are you sure you aren't doing a good job? Has anyone told you this? How would you know if you were doing a good job? What would "doing a good job" look like? Is it possible that feeling anxiety in this circumstance is PART OF doing a good job? Maybe even necessary? Get really specific here. Remember, if you don't take the time to define "doing a good job" in THIS situation (of being new R2 in a constantly changing and challenging rotation that is relatively new for you) you will never know when you make it. This is the crux of the Arrival Fallacy (thinking "I'll feel better when...." but never actually getting there).

Finally - I want you to know that this is all totally normal. This is a clear example of your INNER CRITIC (or negative self talk) running the show. The inner critic thinks that if she tells you constantly how bad of a job you are doing, you will somehow be motivated to "be better" but in fact the opposite happens (look at your A line, right?). This is good information - to know what circumstances trigger the inner critic. The place to start is noticing the thoughts that she gives you. The more you can go into observer-mode, the better. What does she sound like? What does she want for you? What is she worried about? The more you can distance yourself from her, the more you can see these thoughts as not true, but rather just sentences in your mind that you get to choose to believe or not.

Try doing some of these suggestions, and if you're not getting anywhere please post again, ask for a 1:1 session or bring it to a T/Th call - I guarantee you are the norm, not an outlier. SO. MUCH. LOVE.

Hi There! We see this post, but looks like a duplicate request. See response below 😉

Adrienne and Tyra <3

Hi Better Together Coaches! My ask for coaching is due to a lot of recent clinical things that have come up that I'm continuing to perseverate on. I just rewatched the Enough video (week 1 of month 2), and I'm really trying to internalize that but keep getting caught back in the cycle of the feeling inadequate and that others are thinking I'm NOT enough (not smart, not worthy of being here, etc.). I know that is the opposite of the thoughts that are serving me and I tell my girlfriends all the time to stop it, but here I am doing it still. I'll try to go through a model and see if I can apply it to one scenario.

C: Morning report
T: I want to participate and "show my stuff"
F: I am worried I will feel dumb
A: Speak up one time and get asked a follow up question and freeze and just say "I don't know" then proceeded to be lectured at about ordering labs without knowing why.
R: Don't speak up again in MR

NEW MODEL

C: Morning report
T: Great time to learn and ask questions.
F: Less anxious, more calm and at peace
A: Speak up and when I get asked a follow up question, actually put together an intelligible thought process (even if wrong that's ok, at least I've thought out loud!)
R: Speak up again, ask more questions, learn more

This seems very idealistic in my head, but maybe I'm on the right track? I am enough, and I am trying to believe that to my core but I feel like I can get thrown off so easily. Sounding familiar? Any pro-tips to make the "I am enough" more of my MO vs. a once a week sort of mindset?

Thank you!

ANSWER:
Hello Friend! You are totally on the right track here. I love how you have gotten your current model written out, and you have come up with what we call an "intentional model" or the model you want to move into. It is TOTALLY NORMAL that the new model doesn't come naturally yet. Sometimes we have to work into it.

A little feedback first. I think you have two models going on within that first model. let's see if we can tease them out.

C: Morning report (YES! This is neutral. Perfect)
T: I want to participate and "show my stuff"
---- Does that T create a F of WORRY for you? My guess is that that T probably leads you to BRAVE or EXCITED, then you speak up once, and THEN you have a thought like "That was dumb" or "They think I'm dumb", and then THAT thought leads to the feeling of WORRY. Does that sound right?

So the revised first model is:
C- Morning Report
T- I'll say something dumb
F- Worry
A- freeze when asked follow up questions, don't raise hand again (other actions? dread morning report, make excuses not to go, look for evidence that you are being "lectured" about things you don't know, miss the learning points? What else?)
R- the result for you is that you don't maximize your learning at morning report

I love your new model! Morning report IS a perfect time to learn and ask questions! This thought won't be top-of mind for you, and that's OK. Sometimes that sneaky original thought will pop up first "don't say something stupid..." and you can just start by acknowledging it. "Oh! There that thought is. I'm worried about looking stupid. But, I know that morning report is my time to ask questions and learn, so I'm going to focus on that". Really the first step here is just finding awareness when the unhelpful thought pops up and then deciding if you want to believe it or not. If you don't, then you can try your new thought on for size.

Here is the way I think about worthiness
I can either believe that worth is something I have to hustle for- that I don't have it now, and that I need to work my ass off to prove i deserve it, and I'll probably never be deserving of it.

OR

I can believe that I have it to begin with and everything beyond that it is me free to reach for my highest, fullest, most vibrant potential.

Both thoughts are on the table. One of them makes me feel small and exhausted already. It makes me want to give up. One of them makes me look ahead along the road and smile, connect with people and try new things. If both are available for me to believe, which one serves me best? Why would it be worth believing the 1st one? OF COURSE even when I feel worthy I will still want to learn, and grow, and change, and evolve. These things feel SO MUCH BETTER when I love myself through them instead of beating myself up through them.

This is a practice. It is not a switch you can just switch one day (for most of us), and that's OK. Just consider that it MIGHT be possible that you are worthy to begin with. Because you are here on this earth as a beautiful and whole human being with unlimited potential. How amazing is that?

XOXOXOXO

I may or may not be procrastinating writing notes this minute by asking for coaching... but I realized I need to come ask for help here because even though this seems like a small problem, it's caused me a lot of anxiety, sleep deprivation, and everything that goes along with that (snacking until I feel like I'm going to explode, feeling disorganized, running late, skipping workouts, etc). This only seems to become a problem for me on months when the clinical work I'm doing requires me to write all my notes from scratch and there is no protected time set aside for note writing, i.e. ED and clinic months. I'm going into primary care so this feels like a problem I need to fix sooner rather than later, and plus getting to the bottom of it might help me with other organizational and time management challenges.

I used to have a problem with everything related to efficiency and time management and I'm very proud of the progress I've made in terms of seeing patients more quickly without compromising care, finding ways to keep track of all my tasks and getting them done in a timely and prioritized manner, and carrying more patients than I thought possible intern year. But those damn notes... I've noticed many of my colleagues find a spare minute here or there to complete most of their notes during their shift or clinic day, and bust out the last few in under 30 minutes at the end. I, on the other hand, find it very challenging to switch my focus quickly, so when I only have a few minutes between patients it takes me that long to organize my thoughts and figure out if I've forgotten anything else more time sensitive, which prevents me from making any progress on notes (ADHD spectrum, anyone?). Then, when the shift is over, I'm exhausted and just want to go home, and I've found that if I stay at the hospital to try to force myself to write them quickly, the self-battle and procrastination can drag on for literally hours, and if I go home I can't get myself to focus and end up staying up too late or just leaving them for the next day at which point they pile up. Even at my best - early morning rested and caffeinated me - it takes me ~15 minutes per note, which already seems unsustainable, and then you swap that for sleep-deprived unfocused me and I've got hours and hours and hours of extra work after my shift is done. I like my job! And I hate resenting it as soon as I leave the hospital because of what it does to my free time! I find it very frustrating that I haven't found a way to move the needle on this at all despite making progress in other areas of time management.

There was a lot of ranting going on there but my best attempt at a model is:
C - I have notes to write without protected time for them
T - I should be faster at this. And often: I need to finish "X" number of notes before I can do XYZ thing that's important to me (which does not seem to be a helpful/productive thought for me - I end up doing neither and feeling anxious)
F - Frustrated, resentful of work, exhausted, anxious
A - Procrastinate writing notes, lose focus writing notes, avoid the other activities in life that bring me joy until I've finished my notes (and I've thought about just doing those activities instead of doing neither, but the strict notes deadlines and grumpy attendings that email you the second they're late cramp my style)
R - Perpetual cycle of feeling behind/anxious, staying up late to write notes, not doing fun things, being even more sleep deprived making it harder to focus the next day, etc

Is there any way out of this cycle?

ANSWER:
Hi Friend!
Great job on your thought download and bringing this here. I KNOW you are not the only one in this boat.

First, a little feedback on your model.

C- Notes
(your C line isn't quite objective or neutral. I can tell because you think you should "have protected time" to do your notes. Someone might think you DO have protected time, such as those moments between patients, etc. Different people think different things about notes and the timing of doing them)

T- Choose one thought.
"I should be faster at this"

F- Choose one feeling.
"Anxious"

A- YES, great job here.
- procrastinate notes, distract yourself with food/overeat, avoid doing things you need or want to do, skip workouts, etc.

R- Great job here. You perpetuate the cycle of notes/anxiety/dread/inaction/ and self-judgement. AND you withhold the feeling of joy from yourself,

OK. So how to get out of this cycle? The first step is to see that it's your thoughts about notes that are driving your feelings of anxiety/frustration etc, and not the notes themselves or the time you have to do them.

A few questions for you:
How would you like to feel about note writing being part of your job? (we know you don't want to feel anxious, do you want to feel ambivalent? acceptance? neutral? what would feel better?)
What is the best part about writing notes?
What is the purpose of a note in the medical record?
what is a "good enough" note? (hint: you get to define this)
how would you know if you were "fast enough" at note writing?
You say this isn't a problem on other rotations with more structured time for note writing. What thoughts do you have about writing notes on those rotations? What feelings do they generate, and actions do you take in those rotations that make note writing seem easier?
What's the worst that could happen if you gave yourself 10 minutes per note instead of 15?
You are PROUD of progress you have made in other domains (efficiency in clinic). What thoughts did you have that helped you make those strides?
Can you guess at some thoughts that other people have about notes that may be different from the thoughts you have about notes?

Choose any of those prompts and write for a few minutes and bring it back here. This is good work to do! Notes aren't going anywhere 😉

XOXO

This is a follow up on group coaching tonight. Tyra said that people with strong negative inner monologue don't excel as much as those who have more positive self talk, this is seen this in medicine. hearing that really triggered some feelings of panic as I feel like I have a constant inner monologue of negative self talk while I'm in the hospital. I don't want to be held back in my life and career because of negative self talk but I almost feel scared to let them go. I think I've operated like this for so long that I don't know how else to work. Saying nice things to myself feels physically impossible. I'm trying to think about why I have such a hard time thinking nice things about myself. I think that if I already point out all of my flaws it takes the power/hurt out of other people pointing out those flaws. I also think I do feel like negative self talk serves me in that if I start thinking good things about myself I will stop pushing myself to be better. I'll make more mistakes because I won't be double/triple checking my work out of panic. I think I've convinced myself that I will learn lessons better, the lessons will stick more if I beat myself after making a mistake. I would never teach someone else in that way so I don't know why I think that is the best way to teach myself.

How can I convince myself that these thoughts are not helpful?

ANSWER:
Hi There, Thanks for bringing this here.

OK, so you have a normal human brain. Your normal human brain has a negativity bias or "inner critic". This is meant to protect you- it wants to protect you from being rejected (and other painful things). Sometimes, we learn it's easier to reject or hurt ourselves than it is to wait for someone else to do it. So we learn to say the worst things to ourselves. You are not broken.

Our negativity bias also helps us sometimes! It helps us think about and plan for the worst things. This helps us take care of our patients, and people we care about. It helps us keep ourselves and other people safe. We don't need to get rid of it all together, but we can ask if the way we are using it is helping us grow or holding us back.

Let's take a second though and take one of your thoughts above and put it into a model.

C: self-talk
T: If I start thinking good things about myself I'll make more mistakes
F: Panic
A: What actions do you take or not take from the emotion of panic?
- double/triple check your work
- double down on negative self talk/beat self up when you make mistakes?
- what else do you do?
- What do you not do?
- do you look for opportunities to grow?

R: you perpetuate your critical self-narrative.

Is it true that if you start thinking good things about yourself that you will stop pushing yourself to be better? In do you have any examples to prove that is true or not true?

Is it true that you will make more mistakes if you are kind/gentle with yourself? What evidence do you have to support this?

What lesson does beating yourself up keep you from learning?

Bring your thoughts back here for more!

Hi! I recently got coached by Tyra about angst and anxiety associated with the thought that I had missed a diagnosis in a patient. As a brief overview:
C: A patient with history of well controlled HIV presented with a cough and SOB and was initially treated for a community acquired pneumonia. He didn't improve, and I later broadened his coverage to include PJP pneumonia.
T: I missed a diagnosis of PJP pneumonia
F: I am a bad doctor, guilt, anxiety
R: poor sleep, stuffing my face with pasta, perseverating, chest pain, stomach pain, embarrassment.

As an update - the patient didn't have PJP pneumonia! So this was all unnecessary. BUT, the point of this exercise for me was to try to cope with the possibility that I COULD have missed a diagnosis and develop the skills to not spiral out in the future. Some reflections (and hopefully planning for the future when I have a near or real miss).
1) I totally catastrophized the situation. I framed it as "I missed this diagnosis" (and therefore am a bad doctor) even though I didn't even yet know if I'd missed the diagnosis and the patient was totally fine and safe in the hospital.
2) I completed framed it as 100% on my shoulders. It literally didn't occur to me that if I was really missing something, my attending should have helped, or my intern, or the nurses, pharmacists, consultants, etc. It was all on me. maybe not necessary.

Tyra asked me to reflect on why this situation was the perfect thing to happen (instead of framing it as a crisis!). I think it opened up the space to have these reflections without any harm happening to anyone. I'm specifically NOT taking it as a chance to "grow as a doctor and not forget about PJP in the future" cause I just don't think that's what important. More just trying to find the space to forgive myself in the future.
Ok. that's all! thanks for the coaching!

ANSWER
So happy you posted follow up here! What a fascinating place to get to reflect and untangle what your brain did with that C - and see how convinced you were that your T was "true"- which now was proven false. Great insight to really dig in here. I'm just going to clean up your model a bit- you did a fantastic job, but forgot your A line.
C: Pt w/ well controlled HIV presented w/ a cough/SOB; initially Tx for CAP, didn't improve, and I later broadened his coverage to include PJP pneumonia.
T: I missed a diagnosis of PJP pneumonia, so I am a bad doctor.
F: Anxiety
A: stuff my face with pasta, perseverate, poor sleep, obsessively check EMR even on off time, ruminate in spinning thoughts so much that you don't sleep, visualize yourself missing bigger and bigger things in the future.
R: you catastrophize and twist this situation to the point of MISSING how you are a good doctor, now.

First - look at that R line. Does it resonate with you? What does your brain want to do when it reads that you are a good doctor? What is your first inclination when you get positive feedback? How much time do you spend there, absorbing praise? Do you get curious about what went well? Compare that to how much time you spend with negative feedback (real or imagined, and from someone else, or just the inner critic in your head).

Often, our brains are convinced that we need to spend more time on the negative and feel terrible to improve. Your brain likely went nuts with this made up story of missing a diagnosis since it thought that if you felt guilty enough about it, it would be burned into your psyche and you'd never miss anything again. It's the same pattern as beating yourself up in hopes of eating healthier, or working out, or meditating, or literally any other habit you want to change in your life.

But this method doesn't work. Not only do you miss out on a reality in which you allow yourself to feel good NOW - but you make up a fake reality that doesn't serve you at all. This method of being harsh with ourselves seems enticing, but is simply misguided and ineffective. Sometimes a behavior changes for a small period of time, but it's almost never long term, and the cost of the negative narrative you cement into your brain is large and unpredictable.

Questions:
-Do you think a "good doctor" doesn't make mistakes?
-If a great doctor made a mistake, is it something that they need to forgive themselves for?
-Could mistakes/misdiagnoses be a part of doctoring, including good doctoring?
-What does it even mean to forgive yourself? Try plugging this result into a "reverse model" (hint start at the R line and work your way UP) and bring it back here:

C: missed diagnosis
↑
T: what thought cultivates this feeling that is believable now?
↑
F: how would you have to feel to do these actions?
↑
A: what actions does a person who forgives herself and shows up authentically do here? What does she not do? What does she have to do to support herself in this action?
↑
R: Forgive myself and have my own back

I am in early pregnancy while also applying to fellowship. Being pregnant this year is something I hoped for and wanted, but now I just feel scared and guilty. I have known for a very long time that I want to be a mom, and also for at least a few years that I wanted to pursue further training. I have plenty of role models who are great physicians and also great parents, but I can't shake the thought that I will
1. Be a worse mom because I will be a fellow
2. Be a worse doctor/trainee because I will be a new mom

I feel guilty about this. I question whether this was the right decision for us at this time... a little too late for these thoughts! And I know the alternative was either having a child during residency (also hard), during fellowship (also hard), or as a new attending (also hard, bordering on trying to defy biology given my age). I worry about how difficult this will be and question my life choices, even though I know I want both of these things.

ANSWER:
Amazing topic to bring here - thank you! Let's first put your thought download into a model:
C: Pregnant while also applying to fellowship
T: I will be both a worse mom and a worse fellow because of this
F: Guilt
A: question the decision, WORRY, focus on the negatives of the situation, indulge in black and white thinking (I have to either be a bad mom or a bad doctor....), question your choices despite the inner wisdom that guided you here
R: You make this situation lose-lose

First - let's all notice how NORMAL your brain is. You have been in the mode of "I-must-make-the-perfect-decision-at-all-times" for many years now with increasingly high-stakes situations because of your career. Your brain is just doing it's normal thing of trying to be 100% sure it's made the *right* decision and then preparing for all of the impending possible doom since that's what you've been trained and socialized to do. Thank you, brain. Except - in this situation - it's NOT HELPING. Your result is that you question your very being and set yourself up to be a lesser version of what you think you could be in both roles. No thank you, brain.

Some questions to ponder:
-How is it perfect that you are becoming a mother in the midst of becoming a specialist?
-How are both of those "becomings" actually synergistic?
-Is it possible that you might be a better mom because of the timing of this? Maybe also a better doctor? Why?

You point out some insight here into how having a child anytime is hard.... so why resist the hardness? What if you let it be hard, and then also make room for that hardness to include growth, connection, love and amazing other feelings too? The trick here is not to fall into "toxic positivity"...you don't want to just put a positive spin on this. But, if it's going to be hard (and of course becoming a parent is, and also medical training also is....), why is it bad to have a hard thing be connected to a really amazing thing?

Are there other times in your life when you intentionally chose something really hard because you ALSO knew it might lead to amazingness, not in spite of the difficulty, but also because of it?

I have just started back as a full-time clinical resident after several years of research time. I have a toddler who is medically complex/special needs, and my husband is full time at home with him. My program has been really supportive and they understand that there will be times when I need time off for emergencies, important medical appointments, they have kept my spot and let me do extra time for research, etc. I was supposed to start back last week, but my son was admitted to the hospital literally the night before I was supposed to start and had to have emergency surgery, was in the PICU, etc. I took three days off including a day when I was supposed to be on 24 hour call. Even though I took "vacation time" I basically have been at the hospital 24-7 either at work or with my family, so it hasn't really felt like a break.
Because I have to ask for all these "necessary" things it makes it feel impossible to ask for any time (from anyone - work, family, friends etc) for things that would just be "nice". I think I'm going to end up needing all my vacation days this year for things like this, and that I shouldn't waste them on unnecessary things like an actual vacation, a specific day off that's not for a medical appointment, time to go to an educational conference. I also feel behind because of how much time I have taken off doing research. Like I won't be able to catch up with clinical or technical skills, learn what I need to learn. And that my co-residents will be frustrated because of extra burden of call that fall on them. I already offered to my co-resident to make up the 24-hr call that he took for me later in the month, so there goes another weekend. I end up feeling fatalistic about how it's going to be impossible to complete residency under these circumstances.

ANSWER:
Hello, friend. Thank you so much for being here, and welcome to Ask for Coaching. You have already begun to make time for your self by being in this program and asking for coaching tonight. I am so proud of you.

You have provided an excellent "thought download" above. There is a lot there and we will work through all of it together. We can take it at your pace. OK?

I want you to know that I wholly see and empathize with you and your experience as a mom and resident with a medically complex child. It would be very easy for me to jump "in the pool" with you and commiserate in how hard this is and how impossible it all feels. I know that those feelings and your experience are very real. As your coach though, my job is to sit with you while we observe your mind so you can move forward to a place that feels better. Everything I say here is with so much love and compassion for you and your family. OK?

What you are experiencing is pain. Things have happened to you and your family and your brain is trying to make sense of it all.

It can be tempting to resist or react to the pain. You know you are doing this if you are negotiating with yourself what it's OK to do or feel, arguing with the injustice of it all, worrying about what other people think, or blaming or judging yourself or others. This is a totally normal reaction, but it doesn't feel good, or at least it doesn't feel good for long.

What would it be like to allow this pain to be there without trying to make sense of it or fix it? Watch where this pain is for you and notice how it feels. Notice the heaviness, the ability to rob you of breath. Just notice. It can be helpful to repeat the sentence "I am processing the pain" over and over again.

Can you let the pain be there with you?

What else are you feeling right now?

Do you believe you deserve to create time and space for yourself? What is at risk if you don't?

When this wave of pain has ebbed away and you are ready, we can begin to tease apart the Cs from the Ts in your story, and create some space for YOU in there. Can you try to pull one C and one T from your story above and fill in a model and post it back here?

Come back here as much as you need. So much love, sister.

Hello friends,
Welcome to Better Together! We are so happy to have you here.

How to use this site:
1. Start on the introduction tab above. Watch the intro video and try writing a thought download on the accompanying fillable PDF worksheet.
2 . If you want to jump right in, post your thought download (or anything else you want coaching on) Here in "Ask for Coaching".
All posts here are not identifiable by other members as you unless you place your name in the question title.
3. You can post in "Ask for Coaching" ANY TIME, and with ANYTHING you would like coaching on. One of us (Adrienne or Tyra) will post your request and our response here within 24 hours so that you and the other members of Better Together can benefit from your coaching.
4. There is no limit to the amount of times you can post here. Want to challenge yourself to post every day for the first 30 days? Great! Do it! Want to challenge yourself to ask for coaching at least once per week for the duration of the course? WE ARE HERE FOR THAT! Are you more interested in working through things on your own? That's totally fine too.
5. Check in on this page every so often to see how you might learn something or benefit from the coaching of others that happens here. You will be surprised to see how often the challenges we face are very similar, and that it's often easier to see the forest for the trees when you are sitting on the outside observing someone else's thinking and coaching.
6. Join the Live calls on Tuesday or Thursday at 7pm. Raise your hand and ask for coaching LIVE! We don't bite. We promise. You won't regret it.
7. We will guide you through the monthly modules (broken down into brief videos and reflective writing prompts). You can take these at your own pace. Some of you may do every reflection exercise, and some of you will do none. That is totally fine! We are confident that you will get exactly what you need from this program.

Know that we are here FOR YOU. This whole program is built to provide you with the space and the tools to practice creating exactly the experience you want in training and equip you to be able to handle anything life throws your way.

We can't wait to walk alongside you for the next 6 months.

Feel free to explore the site, and read some of the old ask for coaching questions below. We can't wait to get started with you next week!

Sincerely,
Adrienne and Tyra

PS. January members who are sticking around- help us welcome the new members by sharing anything you think would be helpful for them to know here and we will post it for them to read. Much love!

I have trouble enjoying my days off unless I 'accomplish' something, even when there's nothing to get done. I feel like if I do 'nothing,' then the day is wasted. I'll do laundry, clean my apartment, or do anything to make sure the day doesn't go by, otherwise I feel like a couch potato and feel guilty/Sunday scaries at the end of the day. I've tried to work on this by doing yoga / meditation to increase my comfort with doing nothing but still feel the need to do something.

C: Day off
T: I don't want to waste today
F: Restless
A: clean, do laundry, cook, work out, run errands, guilt trip myself when I don't do enough, not relax
R: exhaust mental energy when I could be relaxing

ANSWER:
So fascinating that your first line "I have trouble enjoying days off unless I accomplish something" is in direct contrast to how your brain works in the model~ that's why it's so important to do this work! You've set up quite the conundrum for yourself by saying that you need to relax AND you shouldn't relax....

In this case, what if you just flip the thought completely on your next day off:
"I WANT to waste today" (write a story about how this would be amazing. practice just fully embodying it. What might you learn about yourself? What might you inadvertently accomplish in this space?)

Might also try writing out exactly what wasting you day means to you. Is it vague in your head right now? What exactly do you need to do to feel that the day is not a waste?

Why are cleaning and cooking not relaxing to you? Is there another way to think of these activities that might serve you better?

Finally - try this result model (I'm assuming this result is what you want since you mention it's what you don't have in your unintentional model):

R: Relax, replenish
A: what does this look like for you?
F: what do you have to feel on the day off to do these things (with zero guilt)?
T: what do you have to think on purpose to cultivate this feeling?
C: Day off

What if NO body is perfect? true
What if EVERY body is perfect? <-- love this
how would you know if a body was perfect? good question.
how does it serve you to believe yours is not? maybe it motivates me to exercise?

What comes up for you here?
Immediate reaction is - well I don't need to be perfect but it would be nice if this feature of me was better, ie I had rock hard abs or at least less of a tummy......... I theoretically understand it's a lose-lose game because even if that was perfect, there would be something else about my appearance I disapproved of, but wouldn't it be nice if I could correct this one? How do I approach this? I'm still stuck in the model above.

ANSWER:
OK. Good work here.

Why would it be nice if "that feature of [you] were better"?

When you think the thought "My body is not perfect" do you feel motivated?

Let's say you decide that you would like to be "in better shape" (whatever that means) for your Weddiversary 🙂

Can you get clear on the result you want? How will you know when you've reached it? Do you like your reasons for choosing that result?
What actions do you need to take to achieve it?
How do you need to feel? (feelings of motivation? self-love? Self-appreciation? how are the actions that come from those different from feeling ashamed/disgusted/critical?)

Here are the facts
- you have a body
- you are going to have a body on the day of the celebration
- the number on the scale is neutral
- the size of the dress is neutral

you can choose to celebrate and enjoy yourself and your vows on that day.

What would feel better than "I'm not perfect"?

SO MUCH LOVE TO YOU!

My original wedding date was 9/5/20 - we got married anyway but nixed the original plan of a large reception and did a tiny mountain ceremony at which I wore a less formal wedding jumpsuit. We will still be having our originally planned reception this October with my wedding dress that I had already bought before COVID, so the other day I tried it on to see if the old gal still fits. When I shimmied into the dress, I noticed my tummy and felt the need to suck in for it to look "perfect."

C: I have a wedding dress
T: I can see my tummy
F: imperfect
A: question whether this is the right dress, do an intense ab workout, watch unhelpful YouTube videos about how to lose belly fat, try hard to resist eating a slice of cheese and then giving in, feel guilty, compare my dress to my friend's who looked perfect in hers, promise myself to start doing ab workouts again
R: body shame?

ANSWER:
Hello friend. Congratulations! I love a good wedding jumpsuit 😉
Thanks for sharing this here- I know these thoughts and feelings (and actions) too.
The result in your model is that you shame yourself and continue your search for proof of your imperfections. Here are my questions for you. Would love to hear your thoughts about them.

What if NO body is perfect?

What if EVERY body is perfect?

how would you know if a body was perfect?

how does it serve you to believe yours is not?

What comes up for you here?

So much love, sister.

I've noticed that when I am tasked with certain decisions, they become so overwhelming that I freeze and avoid them. For example, I love gardening and want to turn my backyard (which is plain and frankly boring) into a garden paradise. But because it is so blank, I have no idea where to start. And there are so many decisions to be made (would planter boxes here or there be better? What color? Should I line the garage with berry bushes or just keep the mulch?) that I am paralyzed and don't do anything. This has also shown up with wedding planning to the point where I've voiced to my family/partner numerous times that I do not want a wedding (but deep down I do and am excited for the day). It is planning and making final decisions when presented with a sea of options that seems to drag me down but I can't seem to figure out WHY that is.

ANSWER:
Ooo- such a perfect and common topic! I'm going to plug your garden example into a model:
C: Your garden
T: There are so many decisions to be made, I have no idea where to start
F: Overwhelmed
A: Freeze, avoid making decisions, become paralyzed, and ultimately don't do anything
R: You don't start, and don't honor your desire to have a garden paradise!

The way you describe this scenario puts blame on the blank garden for your lack of activity (you wrote "because it is so blank, I have no idea where to start"). It's also interesting that you introduce your action/inaction as something you've noticed just happens around "certain decisions." This creates a story about yourself that you somehow just came upon the news that you aren't the type of person that can easily make decisions, right? Just a fact....
But really, you have completely created it all with your thoughts.

Let's start questioning them. How many decisions are there to be made about the garden? Can you set aside 20 minutes and write them ALL down? Every little one? Write back and tell us how many.... let's pretend there are 40 decisions to make though, just for the sake of the argument.

Ok - now... doctor, have you ever made 40 decisions before? About things more and also less important than your garden? My guess is you have, and do every day. Your brain just doesn't stop to note all of them, because it's on autopilot. But what if you did for a day? You'd probably catch yourself making thousands of decisions, and then poof! You are all of the sudden the type of person that makes a lot of decisions, fast and well, right?

Finally - is it true that you have no idea where to start? You have no clue what you like and don't like?
I hear your brain... "yes, but I don't have any expertise in gardening! What if I start on a path and it looks terrible because I didn't know what I was doing!?" Hi, lovely brain! I see you. I hear you. And I say.... so what? What if all that happens? Will it be worse than your garden right now? What will be better about that scenario? What would be funny about it? Fun? Interesting? Once you see that it's ok to start something and change directions, you prove to your brain that there's no problem if it happens.

But first your work is on the story you've created about yourself being a person that becomes paralyzed with some decisions.... just. not. true. Come on and coach live tomorrow night at 7 about the wedding - I promise it'll help!

Hello! My best friend from high school's wedding is coming up in about a month which I am very excited for EXCEPT for the fact that my ex-boyfriend who I haven't seen or talked to in ~7 years will be there. We dated for 5 years including all of high school. It will sort of be like a mini high school reunion, and everyone in my high school associates me with my ex since we were together all 4 years of high school. I'm hoping to find a thought model that allows me to enjoy the event and focus on celebrating my friend and enjoying a lovely summer wedding with my husband and old friends rather than being distracted by his and his wife's whereabouts or other people's comments throughout the weekend.

Unintentional model
C: A wedding is happening at which my ex and his wife will be present
T: I must have the upper hand
F: competitive
A: worry, spend more time/money than usual finding the perfect outfit, dream up every possible scenario, wonder how I should greet vs. ignore them, not be my true self
R: pre-suffer before the event happens

I have compared the above reaction to other ex-boyfriends, i.e. how I would feel if I ran into them at a wedding, and realized I would barely notice their presence, say a quick hello and not think about it again. How do I get there with him? This guy was an important part of my life and I'll probably never see him again so I want to leave a good impression, but I don't know why I can't discard him as someone whose opinion of me I don't care about. I realize that my goal is to control how others perceive me, but I can't help it!

Thanks in advance <3

ANSWER:
Thanks for posting this - truly the stuff of life! Excellent insight in your model. I would also offer an additional result which is that your lower/lizard brain has the upper hand with YOU right now. Yes?

You also excellently pulled insight into your creation in this by comparing this situation to other ex's where your brain doesn't go crazy with competitive thoughts. This realization is proof that it's not the fact that THIS ex is coming to the wedding, but simply what your brain is doing with it. Phew - now we don't have to control the ex and his thoughts to feel better, we can just control your mind (way easier).

One place to start questioning is the T - why do you HAVE to have the upper hand? First of all, what would it mean to have the upper hand? What IS the upper hand, and what does it mean to have it? How would you *know* if you did? Could you ever be sure you did?

Then, dig deeper. What if you don't have the upper hand here? What would the feeling be? Sad? Embarrassed? Self-deprecating? What exactly would be so bad about that feeling? What if it's totally fine that this guy brings up thoughts and feelings in you FOREVER - is there any way that it's supposed to be this way? What if this is the perfect lesson to help you learn to handle/process these feelings in a way that serves you?

Go further. Write down how not having the upper hand (in whatever way you define it) is actually *for* you. Seriously. What would the good be in that story? How would you grow? What could you let go of? What thoughts would you de-power?

The point here is to prove to yourself that alllllllll of this is created in your head - and it's actually no problem to let your brain go wild for a while with it. Probably, you have held on to some thoughts about this person out of a story you created from your past that you haven't fully cleaned up yet- and that's fine. There is zero need or rush to wipe it clean, just let it be. What you DON'T want to do is resist your brain, or pretend it's different than it is. You are already onto your brain running with this story in a way that pulls you out of the result that you actually want which is:
"focus on celebrating my friend and enjoying a lovely summer wedding with my husband and old friends."

Write out all the answers to the questions, and try a result model with that last one.... keep us posted!

TD: Don't get me wrong, I love hanging out with my friends, but it gives me some post-hangout anxiety. Over the past year I have grown closer to a group of girls who are loving, supportive, and just all around good friends. We are all residents/APPs so we often get dinner and chat about work or residency or life over drinks. I love that we are doing this, but need to fix some of my thinking around it. Even if I have the best time, like cheeks hurting from laughing so much, I still overthink the night when I get home. I think things like "what if that one thing I said came across weird or abrasive or wrong" or "what if I was too loud or too annoying tonight" or "what if they don't actually like me or like hanging out with me."

C: I went to a friends house last weekend
T: What if they don't actually like hanging out with me?
F: Insecure
A: Overthink, perseverate, replay the night in my head, put myself down by overanalyzing things I said or did, try to ignore the feeling
R: I kind of ruin some good memories by overthinking them

I guess I'm just kind of stuck here. Like I can tell myself these thoughts are irrational (because they are). Why would they continue to hang out with me if they didn't like me? Why do I think it's so bad to be myself and create authentic relationships? At the same time, I just listed a ton of good things in my thought download...I have been spending time with and having fun with a new group of friends. That should be exciting. I just can't shake the post-hangout anxiety party I throw for myself every time.

ANSWER:
Hi Friend,
Thanks for bringing this here. I feel this one for sure.

Let's start by completing the question you asked in your T line. Whenever your T is a question, the actual T is the answer it it. It seems like the thought here is actually "They don't actually like hanging out with me". The rest of your model is spot on. Does changing the T to a statement change any of the other part of the model for you?

So we have evidence to suggest your friends actually do like hanging out with you (because they hang out with you), and you know rationally that the thought "they don't like hanging out with me" is not true. The trouble is when it pops into your head, you hold onto it so tightly and really let it take you down this well rehearsed path in your brain. You then try to convince yourself that it's not true and use it as another reason to beat yourself up.

What if it's no problem for that thought to pop up?
What would it look like to hold that thought a little further from you next time?
What would it be like to think "Oh! This is the part where my brain does that post-hang anxiety party again. I don't have to buy it, though"
What would it be like to have your own back?

Do you like hanging out with you?

So much love, sister.

Hello! I got coaching in Month 1 from Tyra about being less worried about falling behind in clinic. After our session I've started keeping tabs on how many times what I expect to happen -- disaster -- actually happens versus non-disaster, and I'm happy to report I haven't had a disaster day since. I've even found joy (!) in some interactions by taking the extra few seconds to chat with patients. I define disaster as falling >40 minutes behind and having no no shows so that patients have to wait, and then I rush through things, the MAs are mad at me, the patients are mad at me, I'm mad at me, I don't do any of my notes, and I give incomplete presentations to preceptors.

I'm writing to try to take the next step because I feel like I'm waiting for the other shoe to drop in clinic still, and I have thoughts that each clinic day that doesn't go terribly was an exceptional day and that eventually I'll have a day where I run so far behind. A similar feeling emerges when I’m about to start a night shift, but instead of falling behind it's just that I'll be called constantly and have 5+ admissions and someone will die and I'll be stressed the whole time.

C: I have clinic ~or~ I have a night shift
T: This may or may not end in disaster
F: anxious
A: worry, not enjoy my shift or only enjoy parts of it
R: expect that next time will be terrible

Thank you!

ANSWER:
Hi friend 🙂 First of all- serious congratulations on your insight, work and shifting thoughts around "clinic disasters." So fun to see you create your own joy!!
Let's take this a step further than we did live tonight (for those of you that missed it - she is working on the bridge thought "Maybe I can handle this without catastrophizing" for her C of night shifts. This created a feeling of curiosity and/or capability and an action of breathing, learning, being in the moment, and not reacting to the urge to look at the ED and prepare for "disaster scenarios". Let us know how this goes tonight!

The next step is to get curious about your so-called "disasters". Let's stick with your night shifts - where you worry: "I'll be called constantly and have 5+ admissions and someone will die and I'll be stressed the whole time."
Take each one of these and ask yourself "so what"? Not nonchalantly or judgmentally, but just with curiosity. Maybe even do a model for each one.

When you have time, sit down and answer these questions. See what comes up and bring it back!

-I am paged 50 times tonight. ----> So what? what's ok about this? What will you feel/think/be in-between calls? Can you find any mindful moments in this? Any peace? Any humor? Any.... FUN??? Put your brain to work.

-I have 6 admissions. ----> So what? Knowing that you are one human doctor and can do only what is reasonably possible in a night, will you do the work? Will you ask for help if needed? Can you trust yourself to triage the most important ones? Is there anything good about this? How is this happening *for* you instead of against you?

-Some one dies. ----> So what? No, really... so what? Do you think that shouldn't happen? How is this not a bad thing? How might this be an ok thing? How is this supposed to happen?

-I am stressed the whole time. ----> SO WHAT? Really "so what" here... aren't you ALREADY STRESSED THE WHOLE TIME??? Can you rely on your past experiences to help you know that if anything, you of all people can handle feeling stressed? What does stress feel like in your body? What temperature is it? Where is it located? What is it's quality? How long does it last each time you notice it? Get really curious here. The result of processing an emotion like stress is that you prove that you can handle it, and then you don't have to be afraid of it.
Can you do your job and be stressed and it's not even a bad thing? Is that possible? Is there any humor/relief/excitement/learning/peace IN the stress?? How is this part of it?

Hello- I have this habit of eating when I am anxious. I think I have been using this for a long time, and it always works temporarily- like eat cookie feel happy. But then of COURSE doesn't work in the long run, after about 10 minutes I start to feel bad and guilty and sick (oftentimes it's much more than a cookie). I was thinking about this today because I was supposed to be doing some work on a project, and the project is a little challenging meaning I need to really think about it and make some executive decisions and I really worry that my attending will look back at the project when it's done and not like what I chose. So instead of working on the project I am filled with the urge to go snack. So I start snacking. But I can't stop. It's like by snacking I am trying to quiet the anxiety, it feels truly like a restlessness or a fluttering in my body. Unfortunately (or fortunately) I am on a healthy eating plan so I only have healthy snacks around and I eat a lot of those (still not good to eat a ton of them- like nuts etc)- but the issue I'm running into is that they don't satisfy my cravings so my anxiety doesn't go away even temporarily (naturally I keep eating them hoping it will change or opening the cupboard 7 billion times hoping I'll discover a new fun snack that's on my plan).

That was very long winded but it feels like a huge and deep seated problem. I have started listening to the podcast by Katrina Ubell weight loss for busy physicians, and she talks a lot about this stuff and the thoughts you have around food. I really like her work but I feel like I do well until I hit these anxiety walls. And then I don't know what to do.

C: Snacking
T: I am doing a bad job with ___ (project/life/residency), why am I so weak I know I am eating for the wrong reasons but I can't stop!!
F: Anxious
A: Snack more to try to stop the anxiety, get no work done because I feel sick, get no work done because I avoided it
R: Worsened anxiety, feel like a failure, wonder what's wrong with me, get way behind on my work, stay up late to try to catch up

ANSWER:
Hello, friend. Thanks so much for bringing this here. You are not alone.

So what you described in your TD above is what we call "BUFFERING". Buffering is an action we have an urge to take when we are experiencing an uncomfortable emotion. We do that action (it can be snacking, online shopping, scrolling instagram or twitter, etc). We do it to AVOID feeling something else. This works initially because you get that little dopamine hit from the snack. But we now know the ultimate result is net negative for you (you don't complete the thing you wanted to do AND now you feel full/disappointed/bad/guilty/sick).

Now that you know about urges and buffering, your brain is like "Whaaaaaat? Snacking is MY THING! Why are you taking this from me? Waaaaaaa!"

OK. We can handle that.

You described a feeling of anxious that precedes your urge to snack. This feels like a fluttery feeling and also a restlessness.
What else do you know about that feeling?
If you just let it be and didn't answer the urge to eat, what would happen?
Why is it hard to feel it?
What do you escape by snacking?
How long would it stay if you let it be with you for a time instead of shoving it down with a snack? How could you create a space between the restless feeling and the snack?
What could you offer yourself in that space that is not food? A gentle reminder that this feeling will pass? A word of compassion like you would offer to a child or a friend? "Of course you want a snack right now, but I don't think that will help."?

When we stop buffering ALL the uncomfortable feelings that we have been masking for years and years with food will come up. Sometimes we see we have even been buffering happiness, joy, and hope because they can be uncomfortable sometimes too. What would happen if you decided to feel them instead of eating them away? That is where you will find freedom.

Keep bringing this here, my friend. This is the work.

XO

I have a faculty member who, more often than not, shows up 20-30 minutes late to rounds with a coffee in his hand. He acts so cavalier and doesn't even bother to make excuses anymore. My first thoughts are that this is insulting and disrespectful to residents, who spend 12+ hours a day in the hospital, and to our patients as it delays their care. He usually texts that he'll be somewhere at a certain time and I can reliably expect it will be 20-30 minutes later than that. How can he be held to such a low standard when we are expected not only to be on time but to do all the work for him and be examined under a microscope?

C: Attending physician is repeatedly late to work
T: Of course
F: Resentful
A: Pout, complain to colleagues, dread our time together, lose respect for him as a colleague
R: Burnout

---
Intentional model:
C: Attending physician is repeatedly late to work
T: ??
F: Neutral
A: Go on with my day, no pouting
R: Less burnout

I'm hoping you can help me with a bridging thought here.
Thanks! <3

ANSWER
Thanks for bringing this here!

Good news. The way you are feeling is a signal of your values of professionalism, timeliness, and respect for others.

Just a few notes on your model. I can tell your C not neutral for you because it has judgmental wording like "repeatedly" and "late". Something more neutral would be "attending" or "Attending arrived at 08:20 on X day and 08:30 on Y day". Can you see how that is more factual and slightly less emotionally charged than "repeatedly arriving late for work"? This is important because then you can more clearly identify your full thought which is probably the longer one in your TD "This is insulting and disrespectful". While it is possible that this model is creating an experience of burnout for you, it is also causing YOU to act disrespectfully.

I get it. I've been there. If he would only do his part, you wouldn't be so mad, right? The trouble with this is that it give him all the power over how you feel, and that feels awful because now YOU are acting contrary to your values.

Before we get to a bridging thought, it is important to see that it is your thought about him that is creating resentment for you, not the circumstance of the time he arrives for rounds. You have a thought about him, you feel resentful, resentment drives your actions and you spend your day upset- pouting and complaining. You feel burned out. Of course you do! It feels crappy to pout and complain.

Is it possible that him showing up 20-30min late is unprofessional? Sure! You probably want to keep believing that people should show up on time and be respectful of each other. Great! Even if we all agreed that it was unprofessional, why does that mean that YOU should show up unprofessionally as well?

The reason bridging thoughts aren't working for you is that you still think he should be acting differently so you could stop thinking these thoughts about him, so you could feel better! But he doesn't have to change for you to feel differently.

So. How would you want to show up in this relationship differently knowing you are only responsible for YOUR thoughts, feelings, actions and results? What way could you honor your own values of professionalism and respect for others' time?

Here are some ideas for bridging thoughts you could try on:
Start: "He is being insulting and disrespectful"
"He is being disrespectful, but that doesn't mean my day has to suck"
"He is being disrespectful, but I will utilize my time wisely no matter what"
"I can take good care of patients no matter what time rounds start"
"I take good care of patients and am a professional"
"I am respectful and professional, no matter what"

What is coming up for you here?

Much love, sister.

This is a follow-up thought download I wrote after my recent coaching session.

Choosing what to prioritize. That’s how I framed my decision about where to live, what job to do, and who to do it with. I think I could be really happy living and working somewhere rural (dreams include northern New Mexico, Idaho, Montana), either has a general internist or as a subspecialist. This prioritizes my interest in working in an underserved area, my desire to live in the mountains, and my family’s happiness (current family = 1 husband who really wants to not live anywhere in/near a city + 2 dogs who feel the same way). Alternatively, I think I could be really happy continuing to work in academia in something pretty specialized, maybe in lung transplant or BMT. I feel like this prioritizes my past happiness in academic settings and maximizes my ability to choose any degree of sub-specialization I want, and leaves the research door more open than the rural alternative. I suppose there is a spectrum in the middle of academic centers that are near the mountains and would work okay with a commute in from a spacious farm for my partner (&dogs) but the list is short and it stresses me out that I might have to compete for a job at one of these places. I want to feel like I have options!

I’ll also reflect on the idea we discussed that a job is, once it’s really stripped down, exchanging time for a paycheck. It doesn’t need to also provide happiness and a sense of meaning because those things come from within. I understand the point, but in the past I have been really down or sad in all aspects of my life when I’m not clicking with my work. Some of that definitely has to do with tying way too much of my self-worth in feedback and approval at work, so that if I’m feeling good at work I feel good at home. But I think some part of it was really that I didn’t like the subject matter and didn’t find the work meaningful and important (examples here are some of my projects during my PhD that felt really far removed from actually helping anyone, which I was working on even when I was getting more approval from my mentor). Aren’t there people who choose the “wrong” career and then are happier doing something else once they make a change?

Fear of making the “wrong” choice has been keeping me from committing to goals, and even seems to keep me from dreaming them up. Thanks to the coaching work from this month I am moving forward on little goals, like picking a research project and subspecialty clinic. But I’m really struggling to find my long term and/or impossible goals. My vision statement for 5-10 years is SO specific in terms of who is there with me and what I like to do in my free time and the kind of person I am, but SO vague on what my work is.

ANSWER:
The best news is that you're aware you can be happy in many different places (you list 3!). Let's look at your Ts about the "wrong" choice by plugging some things you wrote into a model:
C: Career choices exist
T: I could make the wrong choice and be unhappy in the future
F: Fear
A: Not commit to any goals, not dream up ideas for the right choice, tell yourself you are struggling to find an impossible goal, indulge in confusion and all or nothing thinking.
R: You don't make any decision, and are unhappy NOW.

Go back to your vision and get as specific as you can about work (knowing you can change it later). What do you want (just for the fun of it) right now? What if others weren't in the equation? What if any of the options (rural, urban academia, or in between) could align with your value of helping people.... how would each look?

You ask "aren't there people that choose the “wrong” career and then are happier doing something else?". Truthfully, no. Careers don't cause happiness, thoughts about careers do. Yes, some careers make it easier to have happy thoughts, but you can coach yourself to happier thoughts in any circumstance. What if there was no such thing as a wrong choice, just choices that helped you learn about yourself and guided your direction at each phase of life?

Finally, what's wrong with changing your mind? What's your rush to get out of this 'figuring it out' phase? Can you find joy in this phase along with the discomfort?

The key to making a decision is to just DO IT, then support yourself in it and move forward. That means stop questioning if it was "right" since by making it, you make it "right". Doesn't mean you won't change directions later, just means this is what you decide for now. You mentioned a belief that if you aren't working within your values (which you write are 'to help people'), you might be doing it 'wrong'. What makes you think you are at risk for not helping people in your career? What comes up for you with this?

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

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

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

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

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

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

The first step is to bring awareness to your thoughts.

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

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

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

XO

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

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

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

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

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

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

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

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

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

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

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

How do I get there? Thanks!

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

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

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

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

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

what's coming up for you?

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

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

XO
- Adrienne

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

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

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

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

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

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

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

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

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