I think the feeling is shame....

To answer your questions (copied below)...

- My negativity bias is protecting me from other people surprising me with or "discovering" my weaknesses and failures. I feel more in control if I am aware and choosing my weaknesses and failures. But then I focus and ruminate on them, and am at risk for overestimating them/focusing on the wrong ones/having blind spots.
- Turning toward other people's evaluations of me. On one level, no. I want to be responsible for setting my own expectations and competencies for myself, I don't want to put them in somebody else's hands, especially when I'm not sure that I trust or value their feedback/evaluation. But I also want to elicit helpful feedback, value the feedback of people I respect, and learn from others.
- I'm not sure I would phrase it as difficulty = personal deficiency. I'm okay with things being hard, and I've demonstrated that in my life and choices again and again. I think it's more "giving anything less than 150% = personal deficiency." That's a belief both my parents modeled growing up, for sure, and is a recipe for feeling shitty (either I'm giving less than 150% and feel personally deficient, or I'm giving 150% and feel deficient because I'm running on fumes).

Positivity Bias Model

C: I have institutional investment and protected time for research in an area that prompted me to pursue a career in medicine. I have been doing work in this area for 17 years with multiple abstracts presented across that duration. I have a mentor in my area of study who has an R01. I heard back this week that my manuscript received extremely minor revisions only. I submitted multiple abstracts to conferences this year. I am presenting a nationwide study protocol at a society conference this month after receiving society endorsement for the study for which I am PI. I have awaiting IRB approval, a request in for data extraction, and a plan for a scoping review. I am ready to submit a small grant proposal and in a writing class to create the materials for my K. I'm a good writer. My mentors gave me feedback from my LOI that said, "This looks really great," " I really like how this is evolving" and "Oooh this is good!"

T: My career trajectory demonstrates an unusual and impressive longitudinal interest that captures my commitment to this work more than any single publication ever could. My manuscript will get published if I keep working at it. I can turn my recent abstracts into publications. I am building a national reputation by presenting at this conference. I am moving forward research projects that would reasonably be anticipated to take time to complete and am learning the structure and resources of my new institution. Delays on projects have pushed me to expand my network to find opportunities, which will set me up for future projects and build my reputation. My small grant proposal is a relatively low-stakes opportunity to build my skills at writing and preparing a grant submission, and to refine my ideas. I have more time and thought to put into my K submission than many people do, setting me up for success. I can enjoy the writing process rather than seeing it as an albatross. My mentors are genuinely on board with my ideas and execution.

F: Hopeful

A: Do what is in my control to publish and submit an excellent grant, while basking in the time I have to do other things that aren't work instead of worrying about what is going wrong or could go wrong.

That sounds nice 🙂

===================================================
What incredible insight here! Your C line contains an enormous amount of evidence of competence, so interesting to see how your brain wa weighting the absence of publications as the only valid signal. I'm so inspired by you and your work here!

This nugget is pure gold: "I *feel* more in control if I am aware and choosing my weaknesses and failures. But then I focus and ruminate on them, and am at risk for overestimating them/focusing on the wrong ones/having blind spots."

That makes so much sense. Your brain learned that if you identify the weaknesses first, no one else can surprise you with them. In that way, your negativity bias is trying to protect you from the sting of shame or exposure. It’s an intelligent strategy. And at the same time, as you noticed in your model, the strategy has a cost. When your attention is consistently scanning for weakness, your brain starts treating those data points as the most important or most representative ones, even when the full picture is much larger and more balanced. So- while you feel in control, you actually are not (as the rest of the model shows).

Often, what we call “control” is really just predicting the worst-case scenario ahead of time so we don’t feel blindsided. But that prediction, if you don't direct your mind on purpose, can mean you end up living inside the worst-case scenario emotionally, even when the reality (as your C line shows) is much more promising.

The way through is to get comfortable with uncertainty, or "letting go of control" (I put quotes since you never actually had a grasp on it, only the illusion of one).
Your intentional (reframed) model illustrates this perfectly:
--> In practice, this means trusting that you can and will handle criticism if it came, instead of trying to pre-experience it now.

Finally, great job identifying your adopted belief that “Anything less than 150% = personal deficiency.”
That is a belief worth slowing down on, because it’s the real engine of the model. When life slows down for you or you feel motivated to dig here, it would be interesting to unpack this belief: What is it protecting you from? I.e.: in the environments where you learned the 150% rule, what happened to people who gave 100% (or less)?

I am a fresh out of fellowship surgical attending. My son who is six has complex medical needs requiring specialized care 24-7 and while he is mobile, verbal and often healthy he has chronic lung disease and will often be hospitalized for what would otherwise probably be relatively minor respiratory illnesses. My husband and I used to travel, love international travel and used to love doing outdoor activities, camping, hiking in remote areas and this has pretty much felt inaccessible since my son was born. I am overall really happy with my current job and my partners but we are stretched very thin and very busy clinically right now. With a move to a new area it has been really challenging to find caregivers or nurses for my son and so a lot of that falls on my husband. My son ideally should have someone awake overnight with him, but we have had to resort to having him sleep in our room and taking turns waking up for alarms and checking on him hourly on nights when we don't have that. We have wonderful neighbors who will sometimes help us out on weekends when I am on call and can come hang out with our son for a bit so my husband can take a nap or do other work, but we live far from family and we basically don't have anyone local who we can leave him alone with except his school nurse on days when he has school. So there is basically no redundancy - recently my husband had a peri-tonsillar abscess and came into the ED and they wanted to admit him overnight for antibiotics, and it was eye opening since I am the only person who can fill in if my husband isn't available, It's not like we can just ask someone without extensive training and prep to drive him to school or babysit. So we have had this idea of wanting to travel internationally as a family and that just feels impossible. We do some travel to see family and we have even flown when we used to live far from family. Right now my parents are traveling internationally and sending pictures and it is really hard. Also, my partners at work have international travel planned for the next few months.

This is very rambling but I have tried to work it into a model:
C: My son has complex medical needs, we don't have nurses or other childcare to consistently watch him at night, or to help during the day time. My husband and I are the only people who are currently trained on his medical care who live locally. We have a nanny who helps us with nighttime care ~3 nights per week. We have travelled including short plane flights in the past. Other people travel internationally.
T: International travel is impossible. Not just that, it's frivolous and not really something we should be doing because we can't even keep up with the more critical issues of trying to hire or find more people to help us with his care right now. Also, if our son was to get sick when we were somewhere without good reliable medical care he could have a complication or bad outcome. We would have to bring someone with us, pay for their travel and for them to take care of our son, and so it also can't be a vacation with just the three of us. Even if we do something pre-planned like a resort experience usually our son can't participate in some of the activities and one of us would have to be with him, so it wouldn't be fun. We can't even make arrangements for much more necessary things like tonsillectomy that my husband needs, so I really should be taking my vacation time for things like that. If we are sick we just have to work through it. Traveling is a luxury we don't have and is for other people.
F: Resentment, jealousy. Hopelessness. Sadness, because it brings up a lot of thoughts about experiences it feels like my son can't and might never have.
A: Basically put this dream in a "can't have it" category. Resent and not take actions to make this happen. Also rule out possibilities for things that aren't this big goal, but might actually be more feasible, like possible ways to have a date night or even a weekend travel someplace more locally, because it just doesn't feel like it will be worth it.
R: Don't travel internationally, also miss opportunities to travel places more accessible as a family. I have a lot more free weekends than I did as a trainee including long weekends and even though we talk about going places out of town more often than not we don't actually do this.

ANSWER:
Hello friend! So glad to have you back <3

Great work here. let's dig in.

A few reminders about the model.
- we want to have the C line be as emotionally neutral as possible. Sometimes it's helpful to have it just be "life" or "Life with a 6 year old kid". Could have "life with 6 year old medically complex kid who requires 24h care" if that feels neutral
- Each model should have only ONE thought and ONE feeling. so your model above is probably like 5 or 6 different separate models.

For example
C- life
T1- international travel is impossible
F1- resentment?
A1- ???
R- ???

C- life
T2- Travel is frivolous, and a luxury we we don't have.
F2- jealousy?
A2?
R2?

C- ife
T3- We can't even keep up with finding reliable help at home.
F3?
A3?
R3?

breaking it down like this just helps us look at each model like a facet of a gemstone, different ways of looking at something.

OK zooming out a bit. A lot has changed over the past few years- new job, new city(?), kiddo getting older not in training any more (!), attending money (!), more flexible schedule/hours than training (!!!). A number of things haven't changed as much- kid has medical needs, you and your husband are the primary do-ers of the care, among other things.

I hear some things breaking through here following this transition out of training. Travel, something that has felt entirely out of reach during training, now is something you can imagine, and long for. It's a part of something you and your husband miss. The idea and logistics of travel are very different for you than they were during other phases of your life.

What is the primary emotion (choose one) that comes up when you think about these changes and constants in your life?

Why do you feel that way? (one sentence, this is your T)

In what ways does it make sense to feel that way? In what ways is it taking care of you/yours to be in this model?

In what ways does it not make sense?

Let's keep pulling on this thread (or any other that feels OK to pull on right now).

Hi, I am early-career faculty (instructor) and have the privilege of being 65% research/35% clinical for 2 years while I submit my K. I feel good about my application and mentorship team but have no first author publications despite a good number of abstracts. I know this is a weakness and have one paper re-submitted and under review so I'm hopeful about that but feel like I need more to successfully get funded. But my efforts to get other things in the work keep getting delayed by institutional barriers (getting through the IRB, getting EHR data pulled, completing DUAs, getting a librarian to help with a scoping review...) I feel like every time I come up with a way to get data that seems like it should be easier (retrospective, review, from my mentor, etc.) I still encounter roadblocks and feel like I'm running out of time. I start spiraling about how I should have used residency and fellowship more effectively, but also recognized I was stretched to my limit with clinical obligations, the pandemic, pregnancy/baby... but then I think, those are weak excuses because other people experienced those same things and got publications. I must just not have what it takes to be a successful researcher. I try and remind myself that's not true because otherwise, why would my institution give me protected time and start-up funds (that other institutions laughed in my face about giving me) if they didn't believe it was possible? But I'm scared I'm blowing my opportunity.

C: I have 65% protected research time and start-up funds for two years. I don't have any first-author publications, but I do have one under review and multiple abstracts. I have initiated processes for multiple study ideas.
T: My lack of publications is a weakness. F: inferior A --> Don't bother working on more publications. --> R : Stuck in a spiral, back where I started
T: Moving these projects forward is out of my hands. --> F: hopeless --> A: Don't follow up, don't try to push things through, don't come up with new ideas --> R: lack of progress becomes self-fulfilling
T: My excuses for not having publications are weak since they didn't slow other people down. --> F: alone --> A: Don't try to connect with others --> R: isolated
T: I must just not have what it takes to be a successful researcher. --> F: scared --> A: paralyzed, thinking about the future instead of intellectual work --> R: no progress made
T But maybe I do because this institution is investing in me. --> F: valued --> A: working on the things that are in my control --> R: make progress, can defend how my time is used even if I don't have a deliverable
T: Also fuck that department head who told me to go into private practice and that nobody would consider funding me to do research! F -> indignant --> A: rant about how academic medicine acts confused about why women don't stay when this is how it treats us --> R: feel stuck in a shitty system AND F -> determined A -> find creative solutions R -> make progress on my research because I want to prove [LONG ASS LIST OF PEOPLE] wrong

=========================================
ANSWER:
Ok my friend, this is incredible awareness work here! I could title your pattern here in allllll of these models "looking at my life through a negativity lens" - and create one meta-model:

C: protected research time + start-up funds, no first-author publications currently. Initiated processes for multiple study ideas.
T: Everything about my past, present and future is a weakness. It's not fair, not my fault (but omg it might be).
F: (what's the core feeling here??? shame?)
A: mostly inaction. Don't bother working on more publications, don't follow up, don't push things forward, don't act on or create new ideas, spiral downward, catastrophize, Isolate myself, avoid connection, avoid showing up authentically, rant about how academic medicine exploits us and stew in justified indignation. Tell yourself a story that "this should be easier" - create a world where it's unfair if it feels hard and unfair for your to get the data, instead of expecting difficulty. Call institutional processes "barriers" and perceive them as road-blocks instead of what they are intended to do. Perceive a "no" answer as "laughing in my face". Regret your past, create a narrative about how you did it wrong. Compare yourself to others, and come up short. Call yourself weak and unsuccessful at every chance, and create chances to do this when there are none.
R: lack of progress becomes self-fulfilling, you blow your opportunity to truly support yourself here.

I see that you do have one reframed T available: "But maybe I do because this institution is investing in me" - My guess is that it might feel true, though pale in comparison to the others up there. And watch out for that "determined" one at the end.... Does proving them wrong move you toward your long-term vision… or keep you tied to them?

Ok- DEEP BREATH.

Reminder here that this reaction you are having is completely normal, and also completely COMMON to all of us. This is the literal, EXACT state that both Tyra and Adrienne were in for most of the time during the creation and pilot of this very program - SERIOUSLY. In fact, I would go as far as to postulate, that this very painful, very stressful, very existential questioning of your being.... could be a necessary ingredient to success. IF. If you can open to it instead of resist it.

Answer me this:
-What is your deeply entrenched negativity bias doing for you here? What is it protecting you from?
-Are you willing to turn towards the very thing it's trying to protect you from? Why or why not?
-When did you first learn or adopt the belief that difficulty = personal deficiency?

Next steps:
Once you sit in and with the pain of this unintentional model - I want you to "play" with a different version. Can you please rewrite your past, present and future with a positivity bias, just to see what that might be like? Don't change any facts at all (here are some actual facts: Your institution invested in you. You secured protected time. You generated ideas. You submitted a manuscript. You are still here.) but I want you to only document the good things about the decisions you have made, the benefits of your exact stage right now, how having no publications yet could end up feeding a superpower, what previously invisible good things could exist. What skills are you building right now that fast success would never teach you?
How is this all for you? What would someone who expects difficulty, bureaucracy, and struggle as normal, and not evidence of inadequacy do differently?

This is likely to be very disjointed but here goes. After fellowship we moved closer to our respective families, since then I have had a second child and my parents moved from PA to CT and now live 20 min away. My mom and husband wanted to manage childcare on their own, and although I had my doubts I went along with the plan. My son is now 9 months old and still not in daycare. My mother "retired" but still essentially works full time, my husband works full time from home and I am 1.0 FTE clinical and still have other responsibilities when I am not on clinical service (don't we all). There are a few issues that come up for me, I'll put them in the models below

C- my mother is doing the majority of our infant childcare
T- I can't disagree with her or have my own rules because she does this for free, and she is my mother
F- frustration
A - getting into small arguments with her that blow up, our last argument started with me asking her to use different bread and ended with her not speaking to me for a week
R - resentment, and more frustration and spiraling

C- my mother is our childcare
T- she doesn't understand that my meetings are equally important as hers
F - frustration
A- looking for daycare, then ending up in an argument with my mother about said daycare
R - nothing happens and we are all annoyed

UGHHHH. I think the ideal situation would have been to get daycare from the beginning, but now we are stuck struggling to find a place which will take our son.
====================
Hi there!! Wow is this a perfect example to dive into this month's work with! For this purpose, let's really dive into your first model, which you've written perfectly. This is an iconic example of how crossing our own boundaries (for whatever reason) is a fast train to resentment.

The work here is alllll in the T line. There are the obvious questions to ask (gently) here
-Why can't you have rules for unpaid work? (can you come up with examples of other unpaid work where there are still rules of behavior? (like, for instance, volunteering organizations often have a lot of rules.... there are rules for kids at school even when the kids aren't being paid to be there....what else?)
-Why can't you disagree with your mom? (Can you come up with examples of when you have been aligned with yourself disagreeing with her and it was "ok" before? When?)

And then maybe some deeper questions getting at core beliefs running these thoughts here:
-What does it mean if you disagree with your mom?
-What is at risk if you speak authentically to your mom?
-What do you believe about what you do or don't deserve for child care?

Re- the second model (just to get you going):
You have a "manual" in your head for your mom, that you may have shared with her or not (I'm guessing not since the first model shows us that you think you aren't allowed to communicate your rules out loud). I'd encourage you to write out allllllll of the things that your brain tells you your mom "should" do in this role (let your brain go wild here! Unsavory thoughts welcome on the page). Documenting your manual is just good data to have about what kinds of expectations your brain is subconsciously making for your mom, and then you can ask yourself if you want to continue to have that expectation. Likely, some will be yes (like keeping your kid safe), and some may be no (like "should never ever cancel"). The problem comes up when you put your mom fulfilling your manual in charge of your feelings (other people being in charge of "doing it right" is just never going to work out for us, I wish it was possible! But I promise it's not). The good news is that if you can start this work on yourself now, it will benefit you so greatly in every single relationship you have for the rest of your life.

Ok- NOW, the work is in communicating the requests to your mom, with a consequence of what you will do if not met to get your needs met.

I am at a conference that I go to annually where most of the people in my field also attend. I have a tendency to get insecure and feel bad about myself at this conference from comparing myself to others, and I was hoping that this year would be different because I have been feeling aligned with my purpose at work recently and things have been going well in many ways. Also I'm generally a confident person! But literally within minutes of being at the hotel and seeing people in the lobby, I have started to feel badly again. Like- I didn't get invited to this working group meeting today and feel like I'm being excluded intentionally, or I ran into someone who we were supposed to touch base about a talk we are giving in April and she acted like she wasn't sure why I was talking to her about it and then got immediately distracted when people ran up to give her a hug, including one person who turned to me in what felt like a dismissive way and said "sorry, I don't know you, but I just had to say Hi to so and so" Here is my attempt at putting together a model, although I feel like I'm having a hard time pinpointing exactly whats underlying why I'm feeling this way.

Circumstance: I am attending an annual conference where the majority of my relatively small field is
Thoughts: I don't belong here, I'm never going to be part of the group of people who are leaders or decision makers in the field, People don't want me around.
Feelings: Sad, lonely, insecure
Action: Avoid putting myself out there
Result: Reinforces that I don't belong and don't give people the chance to interact with me

And honestly even writing that makes me feel pathetic (hi self-critic!) because I feel like I can acknowledge that these thoughts aren't helpful or even particularly logical but am having a hard time getting out of it.

ANSWer:
Hello! Great work here.

For what it's worth, (my coach hat is off), I feel the exact same way at conferences. Turns out this is a big social anxiety thing for me (and I have learned), a lot of other people too.Just wanted to say you're not alone in having this particular spiral. I'm right there with ya.

OK coach hat back on.

A few tiny notes on your model.
- I can tell your C line isn't really neutral to you 😉 we try and get this as factual and objective as possible. something like "Annual conference"
- on your T line- YES these are all Ts nice job. Each of these is a separate model. with a different F/A/R. I know I'm being nitpick but it really helps us to look at just ONE at a time.
T1- I don't belong here
T2- I'm never going to be part of leaders or decision makers in this field.
T3- People don't want me around.
- One FEELING/Emotion per thought (per model)/
- Make the A lines SUPER juicy, LOTS of verbs. "I don't submit my work" "I don't sign up for committees", "I compare myself to others, I hide in my room", whatever you are doing or not doing goes here. It should be the biggest part of the model.
- R- you are correct that probably the end result of each of these models is that you don't give yourself (or your colleagues" a chance to see your contributions.

OK now we don't need to use this information to beat you up. This is just one sliver of what is happening in your head.

You also have other models going on. one was
T- I'm feeling aligned with my purpose and things are going well
F- Confident
A- Arrange to go the the conference, think about who you want to connect with etc.
R- You put yourself out there a bit beyond your comfort zone.

So, A LOT of different models happening at the same time, of course. and none of them are "good" or "bad" we are just bringing awareness to them.

As humans, we get to feel sad, lonely, and insecure sometimes. You've noticed that these feelings tend to come up at conferences. And you wish they didn't.

Why does it make sense that these emotions come up sometimes?

Do you judge yourself for feeling these things? Why or why not?

What would it look like to allow these emotions instead of resisting or avoiding them?

Bring it back, friend!

Thank you! I have been reflecting on your response for a few weeks and here are my thoughts:

New model:
C: I am in my 2nd year of being an attending. I am a human being. I will get things wrong sometimes. When I miss things, have a different management style than a colleague, am slow or have a complication, my inner critic automatically offers me the thought that "colleagues will think I am a bad doctor" which naturally triggers anxiety.
T: I don’t like feeling this way, but I know it is normal, happens because I care about being a good doctor and is a feeling that I can handle.
F: acceptance (or at least partial acceptance)
A: try to allow the anxiety to be present, process situations that turn up my inner critic’s volume either with colleagues/loved ones or with myself through journaling and reflection, remind myself of clear examples of when I was a “good doctor”, practice meditation skills
R: hopefully with time have more self confidence and an inner critic that is still present but less dominating

Attempt at a result based model:

R: Show up as a doctor committed to service, connection and growth who learns from mistakes rather than being bogged down by the fear of others’ judgement
A: (I still had some trouble with this, but here is what I have come up with so far)
- Remind myself of my core values before a work day
- Visualize how I want to show up on my drive to work
- After each day, reflect on how my core values guided my patient care
- Speak to trusted colleagues about mistakes/different management styles
- Be open about gaps in knowledge
- Invite different perspectives, demonstrating that there are many ways of doing things and that one person’s potential judgement may not even be correct
- Acknowledge when fear of judgement arises and allow that feeling rather than try to suppress it
F: confident
T: I know this journey won’t be easy, but I have evidence to show that I am a good doctor and am capable of navigating a loud inner critic and the ensuing anxiety.
C: I am in my 2nd year of being an attending. I am a human being. I will get things wrong sometimes. When I miss things, am slow or have a complication, my inner critic automatically offers me the thought that "colleagues will think I am a bad doctor" which naturally triggers anxiety.
==============================
ANSWER
This is incredible work!! I really love the radical acceptance in your intentional model thoughts "I know this won't be easy" - that's exactly the place to dig in this week. If you are up to play in this thought-line, then would be interesting to explore areas that you are actually grateful for the "hardness" of this work... in the spirit of welcoming uncomfortable emotions since we know they are the very cost of growth - can you turn towards the "this won't be easy" with a mindset of gratitude or even love?
What other hard things have ended up benefitting you greatly?
Can you find ease in surprising places in this journey? Where might it show up that you didn't expect?
Food for thought.

Let us know how this thought goes for you in the wild!

I’m having discomfort about how a meeting went yesterday where a pregnant NP shared her grievances about her part-time schedule, not being approved by our department. I am one of the leaders in our department.

Although I’m not the one who officially made the decision that she can’t be part time, I was involved in the leadership conversations

I found it very hard to stay neutral and wanting to be her friend during the conversation. I’m just disappointed because when she asked me for who made the decision I gave her the name and I feel like I shouldn’t have done that. I want to be able to lead conversations and situations where I’m “managing down“ without trying to be friends with a person in front of me. Instead, I want to focus on the overall message as a department and present things as neutral and as firm as I can.

I think I approached the conversation trying to be understanding, trying to be her friend, trying to validate. Some of those things like validating her is fine, but I just have a regret of having name dropped and also making it seem like it’s not my fault and it’s someone else’s when really I was involved in the decision discussions as well.

ANSWER:

Great thing to bring for coaching!

OK. You said something you regret. You have an idea of how you want to be/act as a leader, this conversation went a certain way, and you wish you had done something different. This happens sometimes. You are human.

Humans feel regret sometimes.

What is the problem with feeling regret around how this conversation went?

Part of what I'm seeing you do is rehash/review the conversation over and over. Is this helpful? In what ways? In what ways is it not helpful?

Bring it on back!

Just wanted to share that this was supposed to be conversational coaching via Slack that’s why I was expecting a response because that’s how it’s been going so far

ANSWER:
Roger that. See my previous answer below.

Sometimes Clints answer written coaching, sometimes they won't.

What things might influence whether or not a client responds in Slack? make a list of at least 10 things.

I am working to certify in coaching right now. I did my first peer to peer coaching, and the conversation was written and the client stopped responding.

I did a second peer to peer written coaching, and found myself a little consumed and losing sleep over it. Again, this was written coaching.

I have noticed that I tend to ask a lot of questions, I’m not sure what the best or good question is and perhaps a client gets overwhelmed?

Once I noticed that I made it just one question on purpose and I STILL didn’t get a response on the written coaching from the client

It’s a little defeating/deflating. It makes me think Maybe I’m not good at this and also thoughts about maybe I made their situation worse rather than help them.

ANSWER:
Hello! So cool that you are getting certified as a coach- we are biased, but it's a great investment in yourself.

Learning how to coach is a PERFECT time to practice coaching yourself. 😉

Right now, you are making what the client does or doesn't do mean something about you.

C- In coach certification. Written peer coaching. Client no response for x days.
T- Maybe I'm not good at this
F- Defeated
A- ____________(what do you do or not do when you are feeling defeated?
R- You second guess and undermine your growth by looking to your client to prove your potential/value

What is your job as a coach?

What are YOU responsible for?

let's keep digging here!

Hello! Thank you for responding.

I will try to observe my mind with curiosity.

1. "Is this a rational response that a person might have to [working in] a broken system?" Why and why not?

-I think some people might choose to say the system is broken and leave it. Some justify it as “the way it is” based on what I see, and stay because they are doing some good inside the system, even if maybe it’s not exactly what they expected. I think many people stay for financial ties or other reasons. I do see colleagues who see a dysfunctional system and want to fix it/feel they can fix it, so clearly this is also a reasonable response (even if I observe minimal success in actually fixing it.)

2. How might a person know if they are escaping into a fantasy? What signs would there be? What signs would there be that a person were being practical/pragmatic or honest if they were doing the same things?

Signs of escaping into a fantasy: untethered from reality, grandiose delusions, no practical stuff behind it.

Practical planning: it works? It has math/rationality/a real workable plan behind it. The person has thought about what it looks like on the other side and is ok with that (I don’t meet the last one.)

Let's look at your model.
We want to keep the C line NEUTRAL. I can tell your C line is not neutral for you.
C- You are a hospitalist. You work at X hospital. You are 4 years out of training. You have a financial portfolio/plan.
T- This [job] is temporary, I have an escape plan.
F- In control
A- When I feel in control I feel that all the crap around me matters less. Like, I am less likely to tell my boss, no I really need to be 0.8-0.9 FTE if you want me to be here longitudinally, because I know I don’t have to be here longitudinally. I sometimes pick up shifts but honestly I don’t have to anymore. I do obsess over eating-out food bills which is not healthy. But mostly, I feel that I am stable and lucky and in control.
R- Your thoughts give you a sense of agency and control over your future.

You have another model somewhere that might be something like this
C- same
T- what If I'm running away from something and I never let myself "arrive”? OK: HERE IT IS: I am afraid that I will retire and then realize it was a mistake, that I have no purpose, that nobody respects me and I belong nowhere. I don’t like being dictated patient loads and RVU/LOS. I LOVE working with residents/students/hanging with the nurses and gossiping. I help the nurses with their personal stuff and write occasional antibiotics and they take care of me and bring me tea on bad days. Someone just brought me a basket of avocados!! If I leave the hospital IDK where I will feel belonging and team-ness like this. My family (who know me better than anyone!) say I’m too go-go-go to retire and I’m wondering if they are right. My worry that this is a fantasy is bc I have no plan of what “retirement” eg leaving hospital medicine DOES look like. I only know what it DOESNT look like - that nobody will give me an RVU target and a “discharge by noon” goal.”
F: unsettled, aimless, restless, unsure
A- I still pinch the occasional penny becuase having some way out seems better than 0 ways out. Even if I don’t actually have a concept of that “out” means?? It still DOES allow me to be less stressed (like when they were laying off MD faculty in summer 2025 I basically was like, ok worst case scenario I get to spend all the time I wanted with my family and traveling anyway and then eventually I’ll find another job.) But it’s hard to commit to a solid exit plan if I don't know what the AFTER looks like or if I want that.
R- you are correct. Many things HAVE gone right. I am early career but still past the point where I have to worry about normal money things that people at my stage do. I do feel a bit adrift and that I need a plan for post retirement. And I question if this is a realistic plan because it has not been fleshed out in the way that I am used to life plans being fleshed out (you do college > med school > residency> etc in a really mapped out sequence - but maybe also having a life map is not realistic??)

I think you are correct that autonomy/control/independence are really important to me and most of my financial planning has been in service of these. I just DO value meaning in work and feeling respected as part of a community also, and I feel like leaving medicine would take these away from me. I am not sure how to square this out (where medicine is by far the biggest stressor in my life but also probably one of the biggest contributors of “a place in the world” and "meaning.” Which I also value. How do I even think about this??

ANSWER:
Really nice job here, friend.

Your 2nd model up here is so revealing about what's going on underneath the surface. Each of the Ts are different models you could look at

C- career
T1- I'll retire and realize it was a mistake
F1- FEAR

T2- I have no Purpose
F2- Aimless?

T3- Nobody respects me
F3-?

T4- I belong nowhere
F4- Unsettled?

Each of those will be slightly different feelings/actions/results, but none of them, I'd imagine lead you into trust, purpose, belonging, or security with yourself.

The really good news is that you're doing this work now and this work is how you set yourself up for a smooth landing on the other side. you've done a LOT of the physical work (working, saving), and now you're doing the emotional work. Don't stop.

You said "medicine is by far the biggest stressor in my life but also one of the biggest contributors of [belonging] and meaning"

You seem to think that it shouldn't be this way? that you shouldn't have to feel the stress.

Do you think you shouldn't feel stress? or that it's something to be avoided/suppressed/escaped? Why?

In what ways is experiencing stress part of human life?

Do you imagine work should be stress free?

Should retirement be stress free?

Let's keep digging here.

Bring it back.

I'm working on the impossible goal worksheet, and it seems focused on a goal that we haven't pursued yet- but my impossible goal is something that I am pursuing but haven't achieved yet (/have not gotten even after attempting). What would be an alternative thought model to work on (i.e. instead of 'whats the main reason you haven't pursued your goal yet'). I have thoughts around 'maybe I will never get the thing' so I suppose that could be a place to start even though I do feel like I'm putting myself out there?

ANSWER:
HELLO!

Gongrats on being persistent in your impossible goal!

YES! Let's explore this thought and see what it's delivering back to you:

C- the goal
T- Maybe I will never get the thing
F- ? (ONE feeling)
A- ? (list ALLLLL the things you do or avoid doing when you're feeling that way)
R- _______________

You're putting yourself out here right now, but you're doing that as a brave thing because you WANT this goal. Let's get curious here. We are right alongside you 🙂

I did the thought download that you recommended around time with family. Just to clarify, really what I am referring to are weekend trips or weekend stays with my parents and siblings (outside of day-to-day life). My husband is very supportive of my marathon training and I have found it easier to fit runs and workouts into our weekly routine together. Where I get stuck is when I am visiting home and I want to maximize time with my loved ones who I don't get to see as regularly. So here is my thought download:

Main examples of when I have fallen "short" of my ill-defined quality time with family:
- when I spend 1/2 day of a 2-day weekend at home doing a long run instead of getting breakfast or coffee with my sister
- not being able to relax or "go with the flow" because I need to get my run or workout in, but my family has no routine and in general is very chaotic so I never know exactly when I will be able to get my workout in without missing out on some fun, family activity
- I think I've just learned over the years that it's easiest and most enjoyable to be with my family when I can put everything else aside, be 100% present, and have no agenda or expectations for how the time will go (because inevitably it never goes to plan). However, this just doesn't feel possible when I need to get a certain # of miles or runs in that week.

How does keeping my commitments to myself serve my relationships?
- My sense of pride in my hard work makes me feel at peace and calm, which in turn allows me to be more present with family
- Conversely, when I don't keep commitments to myself, I feel anxious and less present with family

I think knowing that this is a temporary problem and prioritizing my personal goals over spending every minute with my family is ok for now. I won't be training for a marathon forever and I can adjust my training schedule ahead of time to maximize time spent with them when I am on vacation, etc.

Throughout this thought download, I also realized that I am not training for the marathon to satisfy my ego. Sure, my ego might benefit, but I don't need to run a marathon to feel good about myself. I think my main motivation is just to see how I transform during the process. How will my mindset and organizational skills change to accommodate a rigorous training schedule while continuing to work full time? What new skills or new level of discipline will I discover? How much stronger can I become physically? I love feeling strong.

I think my motivation is similar when it comes to my second impossible goal of one day running for office. I think that deep down I know that I have unique gifts that could be honed and transformed into agents for important socio-political change. I think the reason why my brain keeps coming back to this dream is because it doesn't want me to let my talents go wasted. This doesn't feel bad or ego-centric. It feels grateful. Almost spiritual.

===============
ANSWER
Love this ego work!! Step into your power here!
On the time prioritization, let's look at a model:
C: You are training for a marathon. You have a mileage plan. Your family weekends are spontaneous and unstructured. Sometimes you spend ½ day on a long run and miss activities.
T: I have fallen "short" of my ill-defined quality time with family, I should be able to relax or "go with the flow" since it's easiest/most enjoyable when I can put everything else aside, be 100% present, and have no agenda or expectations for how the time will go.
F: ???? (guilt? Pressure? Obligation? Schmilt?) **schmilt is a new feeling I'm working on coining.... see below!
A: ruminate, question your choices, when you don't keep running commitments, feel anxious and less present with family
R: You get stuck, and fall short in both areas

**I'm questioning the feeling of guilt (which comes from a thought that you've acted out of alignment with your values) vs. schmilt (the discomfort of violating someone else’s unspoken expectations) because if we are dealing with schmilt here - then the actions make sense. When we’re out of alignment with our own values, guilt is clean and often corrective, even if uncomfortable. But when we’re out of alignment with an imagined expectation, the result is usually trying to "fix" their feelings with oscillation: we overcommit, then resent, then question ourselves, then try to compensate, occasionally cross our own boundaries or needs at the expense of others, and then end up resenting them more (in the long term if this continues).

The way forward is to allow others to experience disappointment (or yourself!) and not try to fix it for them.

The question becomes: Is 100% unstructured presence actually the highest form of love?
Right now your brain is equating: “No agenda = best connection.” But that may simply be the most comfortable version of connection.

As you point out, this is a temporary chapter. And you’re allowed to be in a chapter where discipline and structure coexist with family chaos. So what if you are not choosing between family and running, but instead choosing how you want to show up while honoring both?

I am feeling dysphoric after constructive critical feedback. Context is that I am applying for a young investigator award/grant that I have already applied for three times and been rejected each time, so this will be my fourth try- the deadline is normally end of April, but we found out in January they were moving it to end of February, so timeline was shortened. I'm excited about my project and feel like it is my strongest proposal so far, and I tried to strategically put together a team of mentors outside of my own institution that would be helpful for the grant and helpful because they are "in the club" with the organization. I sought out feedback from a senior person at another institution after he had offered to read my grant when I met him at a conference a few months ago. He called me this morning and said that he thinks it won't get funded because where we are in the clinical trial process is too early and reviewers won't think it is feasible. And then he said that for my two translational aims based on the trial correlatives that they lacked specificity/sophistication and right now sound like a resident could have written them. So I actually do appreciate the constructive feedback because it is hard to come by, but it feels too late to drastically change the grant proposal (its due in a week) and the comment about it being written by a resident stung, and played into this loop I have in my head about how I'm never going to "make it" as a clinician scientist, I'm not at the right institution, I don't have the right mentors/sponsors, I don't have the right skillset, etc. And I think this brings up shame and disappointment and exposure fear, and I try to sit with those feeings but they aren't just "passing through" and I wonder if maybe at some point if you get rejected enough it means it actually is true that you shouldn't be doing this?

C: Senior expert provided constructive but critical feedback on a proposal that means a lot to me
T: This is evidence that I can't be taken seriously, I'm not good enough to be a clinician scientist, I put myself out there and now he knows that I don't know what I'm doing, Everyone else who still has to give me feedback on the proposal is also going to see that I'm not sophisticated in my thinking
F: Shame, guilt, grief/disappointment, embarrassment
A: Withdraw, not think about how I can use pieces of the feedback to help refine my proposal
R: No forward progress, potentially backward progress?

==================================
Answer:
Ohhh I've been there! Feedback, no matter how growth-minded one is, is such a common trigger for dysphoria in the exact way you are describing. But the dysphoria is not a negative thing, necessarily, until we react to it with techniques that get in our way.....
When looking at your scenario in a model, let's stay *even* more neutral in your C line. Can you fill in the blanks?
C: Applying for an award for the 4th time, senior expert said the words "______________________" about it.
T: This is constructive, critical feedback on a proposal that means a lot to me, so I can't be taken seriously.
F: (Pick the ONE most predominant F here: ______ is it shame??)
A: Withdraw, spiral into "I'm not good enough" circular thinking imagine that the expert now "knows" that you don't know what you're doing, imagine that everyone else is judging your lack of sophistication, and block out anything helpful in the feedback. Try to “process” feelings in order to make them go away. Get frustrated when they don't seem to be just "passing through" and then question if proposal rejection actually means you don't belong where you are (rather than the stated meaning of "the selected people on this committee think a different proposal should get this money this time").
R: You don't take yourself seriously. (lol or yes "backward progress")

Ok- so interestingly here, you also have access to a plethora of thoughts that range from excitement about your project, and gratitude for this senior expert's candor- yet for some reason, this one about you not being right for this career is the sticky one.
Why do you think that is? What does this thought pretend to do for you? What type of protection does it offer? It's clear that despite your inner critic here, you are still experiencing shame, disappointment, embarrassment, etc - so what else could it be trying to protect you from? Is it relief in the form of "If I conclude I don’t belong, I can stop trying."? (a type of certainty over vulnerability?)

But here’s the deeper truth: You don’t need protection from shame. You need trust in your ability to survive it....and you already have evidence that you can! You’ve applied four times. You sought feedback. You got on the phone with someone who could sting you. You’re still revising. That is not someone who collapses under shame. That is someone who feels it and continues.

Interestingly, the way I am reading this reflection made me think that this senior expert takes you very seriously! This type of critical feedback is usually not given out with free time - my brain offered me the thought "wow- this person's proposal really made this senior person sit down, take time out of their day and put together reflections" - (i.e. "they are taking them so seriously!"). Now, there were some, perhaps unnecessary parts of the feedback that you get to decide if you take or leave. Nothing makes this person an expert on your proposal, only you hold that title. So if they give you a piece of feedback that feels frankly unhelpful (like calling you a name or rank that you don't have, for instance)- then you are allowed to DROP THAT PART OF THE FEEDBACK IN THE TRASH. Simply because it doesn't help. (yes, even if it's true!).

PS: A note on processing feelings - while it's true that doing this practice of sitting with them, allowing them (even inviting them in) does decrease the frequency and intensity, it does NOT mean they won't come again. Over an over again. You are obligated to experience some amount of shame, embarrassment, disappointment etc with some proportion of your life because you are human, and your time for these is now. And, ironically and tragically, the more we WANT these feelings to pass through us, the more they will stick around. If you have an agenda in your feelings processing of getting the feelings to go away - you are missing the point (you are not alone, even us seasoned coaches want unpleasant feelings to go away! If we could get them to though, I promise I'd tell you how!).
What if instead of even working to decrease the intensity or frequency with this work you had a different goal? Could it be to learn from the shame? To ask it what it wants to say? What else? What else?

What if nothing worse is waiting for you on the other side of shame? What if the thing your fear is warning you about… is just the feeling itself?

Shame says: “If this is true, you will be annihilated.” But what actually happens when shame is allowed?
Your chest tightens? face gets hot? mind loops? feel exposed? What else? And… you are still here.

The fear is not protecting you from professional extinction, it’s trying to protect you from feeling shame.
But you are already feeling shame. So what is it doing now?

Frustrated that I cannot lie in bed too long. How do I Instead allow the day pass .(accept the red tape of life).
I work a full time job. I am trying to use my 10 days of bereavement intermittently (law in in my state ) but can not grieve as have to deal with processing mistakes or I need to submit documentation for my 10 days of bereavement .
For example I did not get half my pay check as HR used the wrong code to notate leave of absence ( not just PTO) . I had to spend my day off calling and writing to HR..
I wish I could just have a day off work/paperwork to grieve.\

ANSWER:
Hello Friend. Thanks for bringing this here. I"m so sorry to hear about your mom's passing.
All these feelings are coming up. Frustration, grief, I'd bet also overwhelm, anger, resentment, sadness, and exhaustion.

Your to-do list has a million things on it. Work administration is hard to work within.

You are a human being who is doing her best at navigating all of this while driving the loss of a parent.

When these feelings come up, what do you see yourself doing?

Do you think you're resisting feeling them?

What happens when you resist them? do they get bigger? Do they prickle your throat?

I want to invite you to close your eyes and take a deep breath and ask "What am I feeling now".

Can you name the emotion?

Where is it in your body?

Does it have a weight, a shape, a color, a size?

How does it change as you envision it within you?

Can you sit with it for a minute? maybe more?

What happens?

We are here with you as you navigate this time, friend. Bring back anything that feels important to bring to light.

<3

Hmm, these are tough questions...

I would agree that the resistance you are hearing in my 'should' is probably my perfectionist coming through. On a practical level, I know that everyone struggles through things and that it is OK. I am working on telling myself that this is OK for me too, but some days I still get frustrated, like I should be able to rise above it. But I'm working on it!!

What does it mean to you about your relationship that you process things differently? We have always had very different personalities so I am not sure that it means anything special to me that we process things differently. However I do think that it DOES mean that we should spend more time talking things through so we can understand each other better and not get misled into thinking, for example that we don't care about each other.

C- you are a human and you notice you prefer processing life through talking, commiserating, and connecting with people. He is a human and has his ways or processing life.

T- We should talk to each other more so that we still feel connected, but why can't he talk to me??
F- Frustrated, worried, alone
A- Oscillating between silence and pressuring him to have conversations when it's not a good time for him.
R- Still disconnected and continued frustration and worry.

In your mind, what does communication look like in a "healthy relationship"? Regular (maybe even just once a week) deep communication about things that matter, not just the day to day tasks that need to be done.

What evidence do you have that people can cope in different ways and that's OK? I can think of couples who cope like this (like my own parents), but I don't think they are flourishing and I want to have a flourishing loving relationship.

Is it possible to process life in a different way from someone else and still feel connection with them? How? I think so, but I think we need to find a common hobby or some other way of connecting (if it is not talking)

What does "connection" feel like in your body? What are you thinking about (your partner, your baby, your family, your friends) when you feel it? be as detailed as you can. When I feel connected to someone, I feel a deep sense of joy. My tummy is warm and my heart is full, my face, brain and whole body is relaxed and I feel content for time to stop. I feel like I can open up about anything and there is a lightness in the surrounding.

ANSWER:
Welcome back. You're doing such good (and important) work here. I know it's a bit tender to dig into this kind of work, so well done.

OK Whenever we ask ourselves a question on the T line, the underlying thought is the ANSWER to that hypothetical question.

C- Relationship. you are humans.

T- He can't talk to me because __________________

F- ________________ (ONE feeling)

A- ___________________ (this is the juiciest section. as many verbs as you can here. list alllllllllll the things you do or don't do when that feeling is driving the bus)

R- _____________________ this is the result/return FOR YOU of the sum of those actions.
I suspect that the result for you here is that you DISCONNECT from him by wishing he were different.

Can you fill out that model?

I really love your exploration of how "connection" feels in your body. I can tell that right now, you think he has to do something different, or he has to change for you to feel connected to him. -->
" If he would have deep conversations with me then I could feel connected with him"

You want him to show up differently on your C line, so you can feel differently. CONNECTED goes on the F line of your model. Think back to a time where you felt connection in your relationship. What beliefs/thoughts/narratives contributed to that?

C- Relationship. You are humans.

T- ?

C- CONNECTED

A- _____________________ what would YOU be doing differently if you felt connected?

R- ____________________ ?

What might that model look like?

OK. Listen, all of us, from time to time, wish people would be different so we could feel better. It's not a problem necessarily, except for when that wish brings you AWAY from what's important to you. How is that happening here?

As an exercise of radical curiousity and perspective taking.... I want to invite you to imagine what a model of his might look like. If you can, do this from a place of as much generosity and curiosity as possible. What thoughts/feelings do you think are driving him? We will never know if this is actually what is going on for him, but it can be powerful sometimes to imagine what it might be like for them.

C- relationship. humans.

T- _________

F- _________

A___________

R___________

What comes up for you here?

This is REALLY important work you are doing, and I commend you for it. I'm here as you keep working through this.

Keep it coming, friend.

On the last coaching call a very lovely surgeon talked about making it to an attending position and then dreading work and feeling "is this all there is for the rest of my life?" And discussed that when you are in med school or residency, that there is some sense of "I just have to get through X and then it will be better" but then once you get to being an attending you realize you got there and....now this is the rest of your life. I had a mini crisis listening to her and now I have a lot of questions about my life

Some part of me has been burned out since med school. I vividly remember visiting family and then having to leave and go back to school alone. I sat in the airport and cried, and thought, I never want to sit in an airport and cry again bc I don't want to leave my family. This (somehow) led me to early retirement blogs and the FIRE movement back in 2013. Long story short, I got really good at finances, lived frugally, took side jobs and saved a lot of money even during med/grad school and residency, and invested successfully. I've been an attending for 4 years now and I'm set to retire at 45 (in 7 years) and the math works (the financial guy confirmed this.) My family all know about this but I've kept it really quiet otherwise because obviously it's professional suicide to say any of this out loud. I must be hiding it OK because I got a bonus and was asked to be APD of the residency program recently.

Having this as a secret escape plan in my pocket all along has made every stage of my life, including attending-hood, so different. Residency sucks? That's why I'm saving money to escape! The hospital is squeezing me to make more RVUs? yeah that's corporate medicine but I have a plan to get out! My boss denies my request to go down to 0.9FTE from 1 due to burnout? Welp of COURSE the job only cares about getting the work done, this is why I'm GTFO'ing and then I won't have to answer to anyone. The ability to not really care much about this stuff is great (whereas if I thought I was going to deal with it for the next 30 years that would suck.) But the bigger question that flashed through my head on that call was, oh no, did I just make attendinghood another "residency" stage where I keep telling myself, i just have to work for X years and then it will be better bc I'll retire?? Am I not having the crisis that this other person had re: attending life frequently sucking because I've already conceptualized this part of my life as a stage I ALSO have to get through and then it will be OK? I don’t even really have a plan for how I would spend my time in early retirement. It’s just….this fantasy land that doesn’t have any of the current elements of suckage that work carries. It probably has its own pitfalls and all of those are just new to me so IDK what they are yet. (I imagine lack of meaning/belonging and respect would be a big one.) I’ve saved/worked for this for so long that I think I’m actually making it happen but now that it’s getting a bit closer there’s a voice in the back of my head that’s like…….are you really going to do this?

Is this a rational response to a broken medical system where I feel (as a hospitalist) that 10-20% of what I do is connecting with patients and taking care of them and 80-90% of it is optimizing hospital throughput and improving LOS and documenting correctly so that patients can move through the hospital faster and we can bill more RVU’s with the same number of beds bc the hospital is in the red? How do I decide out if I’m just escaping into a fantasy of retirement/leaving medicine, or if I should try to find the kind of job I wouldn’t mind doing long term? If/when I leave medicine am I going to have the same crisis that this other caller had, and suddenly realize that “early retirement” is now “the rest of my life” that I’ve fantasized about as the promised land and realize that it doesn’t measure up?

I don’t even know how to fit this into the model. I just felt myself so vividly in that other caller (and I’m so thankful to her for her courage in sharing) so wanted to put this out there and maybe ask for some direction.

Here’s my best shot

C: challenging job focused on productivity
T: this is temporary
F: feel like I’m in control bc I have a secret escape hatch
A: less likely to change things that I think should be changed (unclear if I have the power to do this?), sometimes I do think I get a bit more neurotic about money because it’s such a lever of control to me
R: work chugs along but I am not as deeply invested? Still got promoted so apparently it’s going ok…Presumably I eventually leave for reals.

I feel like the alternative “ideal” thought model would involve me working to change a dysfunctional environment and investing more in it to make it better but please believe me when I say, I cannot give work more of my life than it already has, and I firmly feel that within a hospital system I cannot change the profit model. Maybe I could if I hung out a shingle and didn’t have to make a living doing it and this is one of my intermittent “retirement” fantasies but I get that something has to keep the lights on and apparently its RVU’s. Sorry if I’m rambling.

ANSWER:
Hello! This is a great thought download.

Take a deep breath, this does not need to be a crisis. I want to invite you into to observe yourself and your mind with curiosity. Is that available to you right now?

Nothing has necessarily gone wrong here. From an outside perspective, some may think a lot has gone RIGHT! You have been proactive in taking care of yourself financially, you have worked hard professionally and are experiencing the products of all of that hard work (a secure retirement plan, professional opportunities, for example).

Then, You observed someone be coached, and you are making this mean that you can't trust the reasons you have done all of this, or trust yourself to be OK on the other side. That maybe you won't let yourself relax even in retirement. Is that right?

You asked a few hypothetical questions. I invite you to zoom out a bit and try to answer them from a place of curiosity. It might feel hard to answer them as yourself so let's move them to a 3rd person.

1. "Is this a rational response that a person might have to [working in] a broken system?" Why and why not?

2. How might a person know if they are escaping into a fantasy? What signs would there be? What signs would there be that a person were being practical/pragmatic or honest if they were doing the same things?

Let's look at your model.
We want to keep the C line NEUTRAL. I can tell your C line is not neutral for you.

C- You are a hospitalist. You work at X hospital. You are Y years out of training. You have a financial portfolio/plan.

T- This [job] is temporary, I have an escape plan.

F- In control

A- (this section is all verbs. What do you do when you feel in control. Do you sign up for shifts, save money, learn about investments? what else?)

R- Your thoughts give you a sense of agency and control over your future.

You have another model somewhere that might be something like this

C- same

T- what If I'm running away from something and I never let myself "arrive"

F- (fear? worry? what is the feeling here?)

A- ?

R- ?

There is no such thing as an "ideal" model. There are just thoughts and feelings in your head and the model helps us see them.

Some of the values that seem important to you based on all of this is
- agency
- autonomy
- control
- independence

You have been working very hard for many years to honor and live in alignment with those values.

There are some other ones that I think are a little less tangible or clear to you but are still there, and these are what you're trying to reconcile here.
- meaning in work, and meaning after you've left this career
- ability to be present
- ability to allow yourself to be satisfied and at peace with where you are, even if where you are is't perfect or always comfortable.

What comes up for you here?

Hi BT, I’m working on week 1 and my “impossible goal” is having a life outside of work. For this exercise, I’m focusing on wanting to host friends more often. It feels impossible because I usually only see friends when they suggest plans. It feels easier to be passive than active in my relationships outside of work.

I’ve done a CTFAR and would love your guidance. As always, thanks for your help!

C – Circumstance:
My free time is usually filled with work-related tasks (Epic in-basket, pharma consulting) or passive relaxation (Netflix). I rarely plan social activities myself and usually go along with what others suggest. I host or initiate social plans only 1–2 times a year.

T – Thought:
“I’m too tired after work to plan or host anything.”
“It’s too late to start planning dinner or inviting friends; I don’t have time—even though I only see patients 3 days a week.”
“I might get rejected if I suggest plans.”
“It’s easier to do low-effort, comfortable things than create social plans.”

F – Feeling:
Tired, anxious, frustrated with myself; sometimes lonely or regretful when I look back.

A – Action:
Watch Netflix instead of planning social activities, let others dictate my free time, delay hosting friends or planning events, work extra hours or do low-effort tasks instead of personal projects or hobbies.

R – Result:
I feel like I have no life outside of work, regret not spending more time with friends, and experience a sparse, passive social life. I feel like others are making decisions for me and reinforce the idea that work-life balance is impossible.

==================
Hello there, I love this goal! Especially since it really feels impossible for you. However, I'm going to push you to get more specific about the goal- in particular, when will you know if you have achieved it? What number of times do you want to host friends at your house? How frequently? What kind of gatherings? By when? Visualizing yourself doing the goal, with DETAILS, is a really important preparatory step, because what you are doing here even more than taking the steps to host your friends is BECOMING A HOST version of yourself.

Now, let's get specific with your unintentional model. Be careful to get really neutral with your "C" line, no adjectives or impressions here. Also, I want you to pick the one predominant thought and one feeling (I'll choose one for you below, but please correct me!)

C – Currently, I do XX hours of work-related tasks and XX hours or passive relaxation (Netflix) in my non-working hours. In the past year, I have planned/hosted 1-2 social activities myself, and attended XX number of social activities planned by others. I have a goal of hosting XX number of friend events per month by XX (date).

T – This goal is going to be hard, make me feel tired, and has the potential for social rejection.

F – Anxious

A – Watch Netflix instead of planning social activities, let others dictate my free time, allow others to make the decisions, delay hosting friends or planning events, work extra hours or do low-effort tasks instead of personal projects or hobbies. Then regret choices. Theme = seek easy, comfortable, dopaminergic activities, at the cost of your goal.

R – Your thoughts about your work and life have reinforced the idea that work-life balance is impossible.

Ok. This is a beautiful and critical place to be in- because the work here is to get really honest with yourself. Do you really believe that the way you are thinking about your life is creating this result for you, or are you secretly hanging on to a belief that because you are a busy clinician or there is some flaw about you that is creating this result for you? It's not until you fully see that your thoughts are driving this train that change is possible.

Aaaaandddd.... I want to be really clear, your current thought (the one I summarized) - could be absolutely true! If you try to grit your way though an action line of a result model (i.e. if you tell yourself what you need to do without doing deeper thought work) like "make dinner reservations on Monday, then call 5 friends and invite them on Tuesday, then send reminder texts, then when Friday rolls around make sure you are home in time to change and get ready, etc. etc." or whatever your action line looks like.... that probably will feel hard, scary and energy consuming.

However, it doesn't *have* to. Even if you are the most introverted of introverts, it seems that you do believe there is something to gain in social interaction, that there would be something fulfilling in the connection for you to counterbalance the energy it would take to coordinate. So knowing this value exists inside you, how else can you look at this circumstance? What we want to build is evidence that you can create your social life, and that work-life balance becomes something you create, not something that happens to you.

C –My free time is usually filled with work-related tasks (Epic in-basket, pharma consulting) or passive relaxation (Netflix). I rarely plan social activities myself and usually go along with what others suggest. I host or initiate social plans only 1–2 times a year.
T
F
A
R

(Fill this in and bring it back with whatever comes up!)

Here are a few bridge thoughts to get you going:
"Planning something small is uncomfortable, but discomfort isn’t danger.”
“Netflix is easy in the moment, connection is nourishing over time.”
“Even one invitation per month is a completely different identity.”
“Energy follows meaning more than it follows comfort.”
“I am building social muscle, not throwing the perfect dinner party.”
“Avoiding anxiety has cost me more than risking it.”

And here are a few questions to ask yourself as you shift your mindset:

-What identity are you protecting by staying passive?

-Right now, your brain believes that Netflix restores you, but I'd like you to get curious about this: can you document how you feel the morning after connection vs the morning after avoidance? (What if social planning and connection creates more energy than watching netflix?? Let's find out!)

-Sometimes we mislabel the discomfort of growth as exhaustion. Let's find out if you are actually tired or if you are inexperienced at tolerating social vulnerability... and if it's the latter, that's great news since you've taken an amazing step simply by showing up here to explore this in BT! (tolerating social vulnerability is something most people are afraid of, you are not alone!)

Thanks for the encouraged reflection

How would you rank these values? - so I did add one value at the end (higher scores better)
- Stability 6
- Clinical competence (or excellence?) 4
- Research Competence (or excellence?) 7
- Leadership in your field 6
- Novelty 6
- Accomplishment 8
- Family happiness 9

deeper dive on these questions

Then for each of those values. ...
a) In what ways is applying to Chair position aligned with that value?
b) In what ways does applying feel in conflict with that core value?
c) What is the downside of applying?

Family happiness – I like my spouse and the work goes well when we have low stress, has helped me extensively as a colleague to write papers, grants, discouraging wasted time and effort. Kids also like where we are, even though they are away in college
a- chair is not aligned at all, although we have great friends in that area
b- Spouse has great job (its not the primary revenue source for us though) and will not want to move, but looking at this makes me realize, I might be asked to be chair somewhere in our current city somewhere one day, so might as well start prepping
c- wasted time from my current research and local division initiatives, mentoring my current partners; might accidentally decide to take this job if offered in another city and force us to move. Engaging OB would make me pretty grouchy, it’s quite a stressful part of our discipline.

Accomplishment – I don’t like to be bored, its satisfying to get meaningful stuff accomplished, you get positive feedback from people, and its better than just holding the status quo only doing the same task again and again each day like on a gerbil wheel, I associate having good finances with always making progress-- hard to fire or leave someone in a lousy work spot who is constantly succeeding and innovating.
a- chair is certainly a fresh accomplishment
b- it is quite coherent with that value, and gives me the department pursestrings
c- it could limit other avenues for accomplishment that I specifically care about, especially having to deal with the OB side

ANSWER:
Really great reflections here. Let's keep going.

I'd like to play a game called "Is it true?".

In this game I'm going to pull a few lines from your reflection above that you think are facts ;). For each, I invite you to ask yourself "Is it true?". See if you can find at least ONE piece of evidence for each that might prove the statement is NOT true.

You game?

IS IT TRUE? (imagine a groovy theme song here)
1. [time spent pursuing chair position is] wasted time from current research and local initiatives.
2. [I could end up] accidentally deciding to take this job in another city forcing us to move
3. Engaging OB would make me pretty grouchy
4. OB is a stressful part of our discipline
5. [ pursuing chair position] could limit other avenues for accomplishment.

OK and this line
"Engaging in OB would make me pretty grouchy..." that goes in a model like this
C- OB exists
T- ?
F- Grouchy
A-
R-

I am pointing out that it's not OB in and of itself that makes you grouchy, but your thoughts/opinions/beliefs/perspective on OB that makes you feel grouchy.

You can fill out the rest of the model to see what that delivers back to you.on the Result/Return line...

Keep it coming, friend!

A goal I have that feels impossible is to let go of my fear that others will judge me and find me lacking. This goal seems less tangible than some of the examples of impossible goals, so I am not sure if it works with this exercise. But it’s something that has been affecting how I feel and how I show up in the work setting recently, so I would love some coaching!

Thought download:
I’m in my 2nd year of being an attending. I know that I will miss things, make mistakes and have procedural complications because I am a human and not a robot. I am trying to give myself grace and practice self compassion when these things do happen. But I often find myself stuck on the thought “what if my colleagues think I am a bad doctor”. This thought makes me feel anxious and inadequate. When an OR case takes longer than anticipated because I am still learning the procedure (but everyone is safe with no complications), I find myself spiraling that the other surgeons will be mad at their cases are delayed, that the OR staff are gossiping about what a bad, slow surgeon I am, that my colleagues will be upset that they have to spend time training me. I start apologizing to people and fantasize about not doing this component of my job (which is something I worked hard to be able to incorporate into my current role). After having a case discussed in peer review, I find myself anxiously overdocumenting to make sure I’ve clearly explained my thought process/recommendations, which makes note writing more arduous. I think my result is that I am not present as my favorite self at work – rather than focusing on the things that bring me joy and help me connect to my core values of service, connection and growth, I am approaching work from an anxious, CYA standpoint. And it makes me not like my work as much.

When I take a step back, I can recognize that I know I am often actually a good doctor – I care deeply about my patients and strive to listen to them/care for them with empathy, I try to stay up to date on the evidence, I am humble and willing to ask for help and learn from mistakes. But feeling that I constantly need to prove this to other people (and myself in my anxious/inadequate moments) is exhausting. I’d like to not worry about others’ potential judgements so much because I will never be able to actually know or control what they think and I don’t think it is serving me in any positive way to spend so much energy on it.

C: I am in my 2nd year of being an attending. I am a human being. I will get things wrong sometimes.
T: When I miss things, am slow or have a complication, my colleagues will think I am a bad doctor
F: anxiously inadequate
A: catastrophize, imagine all the critical thoughts someone could be thinking about me, overdocument, beat myself up for any potential mistake or thing I could have done better, apologize for perceived issues, fantasize about a different job, spend time and emotional energy outside of work worrying about things I may have missed or missed documenting
R: don’t show up as my favorite self at work, disconnect from my core values, have difficulty accessing self compassion

Result I want: To show up as a doctor committed to service, connection and growth who learns from mistakes rather than being bogged down by the fear of others’ judgement

I don't know how to approach the actions in the reverse model that will get me there!

================================== ANSWER
Hello there, thanks for bringing this here! I love this aim, which is essentially to change the volume of your inner critic. It's your inner critic, or "negative-self-talk center" in your brain that is offering you all of these thoughts about how critically you may be perceived by others. This is VERY NORMAL inner critic stuff, we all have it, though we all have different volumes, frequencies, and strength of belief of our inner critic.

The way you phrase it, it sounds like you'd like to put your inner critic on MUTE, or abolish it all together, which I am going to say is not a great impossible goal, since from what we know about neuroscience and physiology, this is *truly* impossible, something you don't actually have control over. We use the term "impossible" a bit facetiously here - we don't actually want to try to do something impossible (like throwing a ball 1000 feet, or becoming a professional football player at age 80), but something our brain tells us is impossible but is actually theoretically possible.
I have fantasized about the perfect stroke that would abolish the negative self talk center in the amygdala, but I don't think the circulation actually works that way - and also, if it did, that stroke would probably leave the person pretty strange!!

Ok- so if we can't get RID of the inner critic, then the question becomes how can you relate to it in a way that moves you towards the result you want? Knowing this, I would suggest moving your inner critic's thoughts to the C line:

C: I am in my 2nd year of being an attending. I am a human being. I will get things wrong sometimes. When I miss things, am slow or have a complication, my inner critic automatically offers me the thought that "colleagues will think I am a bad doctor" which naturally triggers anxiety.
T: ??????
F: ?????
A: ??????
R: ??????

If you want to try a result model, let's put your beautiful R at the top and work our way down. I recommend only filling in the very next step (i.e. don't think about the thought yet, focus only on your A line first. You could even ask yourself what would SOMEONE do to get this result, even if it weren't me? What could I imagine needs to be done or not done to get this result:

R: Show up as a doctor committed to service, connection and growth who learns from mistakes rather than being bogged down by the fear of others’ judgement

A: ????? (what goes here for you in this C? get really juicy here, what are all the things you need to do and not do in THIS circumstance to get your result? what things does your favorite self do differently than your anxious self?)

F: ????? (what feeling would you need to cultivate to do these things?? Pretend all feelings are possible here, which would you choose?)

T: ??? (here's the money shot: what T can you think, about this C, on purpose that you believe and creates this F?)

C: I am in my 2nd year of being an attending. I am a human being. I will get things wrong sometimes. When I miss things, am slow or have a complication, my inner critic automatically offers me the thought that "colleagues will think I am a bad doctor" which naturally triggers anxiety.

Some Qs to ponder as you do this work:
-If the inner critic is a natural and neutral part of the circumstance rather than the problem, what does that change about how you relate to it? What do you notice feels different when you expect it to show up?
-If you believed your colleagues also expect you to still be learning, how would you show up differently?

Here are some bridge thoughts to get your creative juices going:

"Ah yes, my inner critic is looking out for judgement again, sigh. I will need to be extra kind to myself today to take care of us both and show up how I want to."

"Ohhhh, right, hello inner critic, thanks for trying to protect me from embarrassment or failure, you are really looking out for me! But, unfortunately, you got your tactics wrong, and you are creating more suffering for me, not less so I'm going to take the reigns right now."

"Huh, how interesting, I remember that when I take a step back, I can recognize that I know I am actually a good doctor – I care deeply about my patients and strive to listen to them/care for them with empathy, I try to stay up to date on the evidence, I am humble and willing to ask for help and learn from mistakes. Maybe nothing has gone wrong here, and me taking extra time in the OR has actually led to these qualities that I love about myself."

"This is what my brain does when I’m learning in public, but right now my job is service and safety, not speed."

First guided thought
C- Work, research/clinical components, change will always be a part of our systems.
T1- It's important to not get complacent.
F1- I don’t like to get caught unprepared so I should pursue this national chair opening, and I want to have a career that I dictate terms to work until I finish, not the other way around (what feeling does this bring up in you? can you name the emotion? – that would be ANXIETY)
A1- This drives me to pursue a job that seems like a promotion, even though it takes me away from a trajectory of relentlessly building skills as a surgeon and researcher that I have worked on for decades, while the administrative stuff is more stuff I’ve casually picked up by necessity during those times. It also seems reactive to avoid changes that I cannot even envision, but that will be happening, as we tighten budgets and potentially research funding gets tighter (what does that feeling/emotion drive you to do or not do?
R1- The return is like the cost of buying insurance, it’s not investing in what is important to me, but maybe limits the risk of a lot of what I currently have (what is the return on these actions for you? does it bring you closer or further away from what's important to you?)

Ok, that's an outline for a model of your first thought there.
See if you can fill out the F, A, R lines and see what comes up.

Second thought
Does one of those other thoughts (T2-T5) feel louder or more pressing? Which one? Why?
Can you build a model out of that?

C: If I take on a chair role, I will be overseeing obstetrics in a department
T: T2- I don't want to manage an L&D that is a core responsibility of any Chair position
F: I am annoyed that I would have to lose sleep and invest time from other objectives to help manage an inherently flawed philosophy of care in American L&Ds.
A: This drives me to avoid seeking this chair promotion, which might also reduce my access to being able to build many interesting domains elsewhere in the department, and continue to allow career advancement/security
R: I can stay where I am, and just build on my current interests, while leaving me vulnerable to the plans of other more senior leaders.

ANSWER:
Hi there. Great work here and thanks for bring it back.

Quick feedback on your models your F line is only ONE word and it's a feeling/emotion. In both of these models you have extra Ts. No problem, but to keep it clean we just look at ONE thought and it's corresponding feeling at a time.

In your first model you name the emotion of Anxiety
T- It's important to not get complacent
F- Anxiety
A- (VERBS)- pursue a job you're not REALLY interested in
- focus moves away from surgical and research skills
- spin in circles arguing one thing and the other
- imagine worst case scenarios
R- You are moving around in circles, but without identifying what is truly important to you.

To move through this, let's see if we can get in touch with some of your core values.
In your reflections above, a few things jump out at me as ideas that are important to you

How would you rank these?
- Stability
- Clinical competence (or excellence?)
- Research Competence (or excellence?)
- Leadership in your field
- Novelty
- Accomplishment

Are there core values that you hold that I haven't picked up on here?

After you've ranked them, I invite you to take the top 2 and write for a few minutes about each one. Why is this value important to you? How has it gotten you to where you are now?

Then for each of those values. ...

In what ways is applying to Chair positionsaligned with that value?

In what ways does applying feel in conflict with that core value?

What is the downside of applying?

Would love to keep digging here with you. Please bring back anything that comes up for you in these reflections.

Thanks for the clarification-- the model is a bit rusty! I do have to say was helpful in turning off the ruminating thoughts and being more present for my family.
yes, I care a ton-- not that much about research but about creating that support structure for the residents to get their projects done. I care that I'm supporting them to meet their requirements and supporting an overall environment of clinical curiosity and improvement for our patients.

1. being someone who ruminates... I think that diffuses a lot of self judgement already--so what, you're right. I think what I'd like is to be able to control when I'm spending time and energy in non-productive ways. I think it means that I'm deeply invested and care a lot. It means I want to analyze situations and improve things. I also means I'm sensitive to the feelings/thoughts of others. None of which are as negative as my self-judgment on them makes the out to be (though I do still desire more control on who/when I feel so sensitive). I think that sensitivity can help me be attuned to things but it also contributes to negative thoughts about myself.

2. Yeah brain goes quickly in that thought cycle, My husband notices quicker than I do though I notice changes in how I feel pretty immediately. It's like a broken nail where that jagged edge just grabs your attention and it can pop up suddenly. I am not as aware of the off-ramp. Like with this I noticed but kept going back to it, composing the reply email, debating the tone, texting the PD to discuss the hard vs flexible boundaries, planning out what that might look like for other residents. I think this one I really had trouble letting it go which is what prompted me to seek the coaching. the process of organizing those quick and interconnected thoughts into the CFTAR model helped quite a bit and then it was dinner time and so that transition helped. Venting helped. In general, I schedule things to help with day-to-day "running my list" -- maybe an EM metaphor but thinking through what all I need to do -- if I schedule time to do it I can put it in a better container and worry about it when it's time to do that task rather than keep using my current thoughts about it. I think there's always some background noise or thinking about things I need to do (birthday present for nephew still needs tissue paper, this kid needs pants, this one needs to pee, we have 30 minutes until we need to go so I can only work for another 10 minutes) or, on shift (this one's waiting on labs, this one needs to go to CT, I need to check this one's resp status after that breathing treatment but they just started so I'm going to finish this note first then breathing treatment and talk to nurse on the way etc etc) So I don't find those too bothersome but it is like it's always going.

3. Success to me=connection and support

============================
ANSWER:
Wow, great reflections here! Fantastic description of your rumination signs/signals.

I notice the word "control" pop up a few times in here.

What do you think about that?

How does the idea pf "control" show up in your life and work? For better and for worse?

I love your definition of success= connection and support. In what ways can you offer those things to yourself right now?

C: new role offered to me
T8 - I don't know what I really want.
F: wishy washy, not confident
A: creating lots of scenarios, asking for more but also considering role as is., worry that i wont grow
R: confused and still dont know what i want

How would you know you'd done enough to advocate for yourself here? I think i have done enough here, this was my last attempt
What would the offer have to be for you to say yes, and trust your yes? reduced rvu
What would the offer have to be for you to say no, and trust your no? current offer or less

ANSWER:
Good to know all of this. Of course feeling "wishy washy" doesn't help you move forward with confidence or clarity. That makes sense. In the end of this model you said "I still don't know what I want". So let's see if we can get clarity on that.

If you didn't have to censor yourself, if you could be honest with yourself and everyone around you and not be judged.... What would you want?

Be as granular and specific as possible. If your brain says "I DON"T KNOW", sorry but that's not an allowable answer 😉

If you DID know.... what would it be?

Keep it coming, friend.

Thanks for the support and interesting questions!

Yes, I think it is totally normal for humans to experience exhaustion, disconnection, overwhelm and frustration. Therefore, these feelings should be OK for me and my husband too. Perhaps more root to the problem is that when I experience these things, I like to talk them out and commiserate with close friends and family. Whereas for him, I think he is at the state where he just wants to shut out the feelings, do the things, then move on with his hobbies/personal time. When this happens, I have also been retreating back to my defaults of scrolling or watching TV, or frankly, taking a nap! But I don't think this is healthy for our relationship long term... Or maybe that's just my "old way" of thinking and that it could be OK during this phase of life? Maybe if I can convince myself that it is OK for us to cope in different ways, then I will find clues of our closeness in other ways in our day-to-day?

I think I'd love some guidance on how to work the model backwards to reach a result of feeling connected to my husband during this trying time. Thanks!

ANSWER:
Welcome back! I know you want to move into a better feeling model here.

You said "these feelings Should be OK for me and my husband too".
I sense the tiniest bit of resistance here, like "they SHOULD be OK, (but they really AREN'T OK, at least not for me"). Am I off base here? Let me know?

You mentioned that you know some things about yourself and how you process things- talking them out, commiserating with friends and family.

He is a different person, so his approach will probably be different. our coaching here won't be changing what he does or doesn't do. We are here to look at you and what you think and feel and do, OK?

What does it mean to you about your relationship that you process things differently?

C- you are a human and you notice you prefer processing life through talking, commiserating, and connecting with people. He is a human and has his ways or processing life.

T- ? (what does it mean that you process life differently?)
F- ?
A- ?
R?

In your mind, what does communication look like in a "healthy relationship"?

What evidence do you have that people can cope in different ways and that's OK?

Is it possible to process life in a different way from someone else and still feel connection with them? How?

What does "connection" feel like in your body? What are you thinking about (your partner, your baby, your family, your friends) when you feel it? be as detailed as you can.

Let's see what comes up here!

Thank you guys!
I am core faculty and have been research director for a couple years now for our program. I re-vamped the research rotation which had previously been a vacation with another name. July 2024 I reestablished handbook guidelines which were previously not enforced but would be from that point on. July 2025 we changed the timeline requiring them to *complete* the project before their 3rd year research rotation or else have M-F 9-5 schedule expectation during that roation. (this was in response to two seniors requiring extensive faculty support to get theirs done at the last minute). This was faculty approved and distributed to the residents in July. This particular resident pushed back at the time, so I know he was present when it was presented in July. I touched base with him in August and in Sept. Now he sends a huge chat gpt generated email about how he was not given any written notice of this, he won't be able to change his moonlighting (though that's explicitly written into the rotation requirements that you have to check in before scheduling any) and that he will likely not be able to complete his research in the provided time (a bold assertion in this context). I feel ok setting boundaries and also very supportive of residents in general. I am even ok working with him around the moonlighting IF he can still get substantial work done. My PD is supportive and commiserating offline which has been helpful to me.
I would like some help in how to not let this get to me so much. Like, it feels like rejection and thoughts include he doesn't like me, the residents don't like me, to even he's actively gaslighting me because I have had multiple conversations with him by email and text as well as in person. I want to balance making accommodations and being supportive with not undermining the clear guidelines other residents have been able to follow at this point too.
Biggest thing is working on separating professional requirements/boundaries with the rumination primarily seems to be around wondering how/if I should have been more clear and probably just wanting people to like me lol

C- resident didn't complete the requirements,
F- I’m a failure
T- I should/could have done more
A- rumination
R- distracted time with family, not working on lectures I should be prepping, hours spent re-reading communications instead of more productive things.

C- same
F- obligation
T- It's my job to facilitate research
A/R 1- I could do too much and the R is residents expect me to carry largest load of their projects and I have less time for my family and my own professional work, other option is
A/R 2- I just re-communicate the expectations and allow him to fail or succeed on his own (with support as asked for) R2- he may fail or succeed, residents understand culture of professional accountability and I'm not drawn into additional work I didn't choose for myself (I prefer that one😊)

C- claims he didn't know about them
F- frustration
T- I don't know how to communicate more clearly
A- more rumination! thinking about this when I could be engaged with my kids in bath time, school drop off, and now when I have other lectures to do haha
R- haven't yet but I'm worried this may make me more overbearing in communication in the future, probably helpful- all my communication with him is going to be in writing going forward so things are documented

C- same
F- sad/rejected
T- he doesn’t like me, residents don’t like me, he/they don’t listen or respect me (I know not one thing but all so related)
A- ok, I swear I do more than ruminate but that’s why I’m here now because that’s the main thing I’m doing about this. I could also overcompensate and “try harder” to be liked (sounds lame to write that out but I digress)
R- act insecure by “trying” harder to be liked (likely to backfire)
A2- somehow put this in a better brain compartment so it’s not taking so much time/energy, R2 – accomplish more connection with family and progress on lectures
a3- withdrawal
r3- less engaged with the residents and not do my job as well.

Alright, thanks for your perspective on this! Really appreciate you guys T-> F->
"It's my job"-->obligation
"I could have done more--> failure.
"I don't know how to communicate clearly"--> frustration
"He, and therefore maybe other residents, don't like me"--> rejection
3. Everything on the A lines should be Verbs that are driven by the feeling on the F line. and this section is the JUCIEST
- ruiminate
- disconnect from family
- judge myself
- judge the resident
- look for evidence I'm doing a bad job
- look for evidence they are lying
- verbs verbs verbs.
4. The result is the return or result FOR YOU of all of those actions.

Make sense?

OK

Nice job identifying rejection as a core emotion in your experience of this whole thing. Also so good to see how you make this person's actions/inactions around this assignment mean something about YOU.

It's clear to me that one of the reasons this bothers you so much is because you CARE, right? You care about the residents, you care that you do a good job in your role, you care that you communicate your curriculum clearly, you care that you model what you want from them (professionalism, accountability, what else?). You also care about how you show up outside of work, connecting with family

What comes through to me in your models above, is that when you get in your rumination cycle, it actually takes you AWAY from those things you care about.

A few questions for you to reflect on and bring back here for more.
1. You're a human being who ruminates sometimes. So what? What does that mean about you?

2. Some of these models probably happen in your brain very quickly, maybe before you're even conscious of them. I'm thinking of: T"He doesn't like me"--> F rejection--> A rumination. About how long does it take for you to notice that you're in it? Once you can identify the on-ramp of the thought habit (or similar ones), can you diagram your usual off-ramp? (I presume you stop ruminating eventually, right? what is THAT model?)
3. If you could zoom out to a 30k foot view, how do you define "success" in your role as an APD? Use as few words as possible 😉

Ok bring it on back for more!

Hi there Adrienne and Tyra! First to say that I loved the BT program and am so psyched for BT2, thank you so much for all the time, energy and love you pour into this program every day!!

The main problem I have been struggling with these past few months is balancing work/baby and the complete lack of 'life', which I think I have been handling OK because I love my job, but it has been really hard on my husband and our relationship. I became a mum to a beautiful baby girl 9 months ago. Both my husband and I work full time (our schedules are somewhat flexible), we do not have any family in the US, and she currently goes to daycare parttime. Unfortunately since we both restarted full-time work, we have been going through illness after illness, sleep regressions, clingy baby... I am sure all parents can relate. This has led to minimal time to ourselves and no time for our relationship- Weeknights, we are dead tired and just want to go to bed at 8pm, and weekends are consumed by cleaning and resetting the house, shopping and meal prepping for the week ahead, catch up work etc. I keep telling us that this is only a phase and that we will survive. We do make a good team in splitting the nights and pickup duties etc. But it's been really straining on our relationship, especially for my husband who needs time alone to recharge. I feel frustrated and sad that we are not more thankful and enjoying this new life with our adorable and healthy baby. I am quite an action-driven person so it's been particularly frustrating for me and am at a loss as to what to what I can do to improve our situation so thought I would bring it to coaching!

C- We have a 9 month old baby. We do not have any family or support system near us. Baby has been getting sick and waking up frequently at nights. Both my husband and I have full-time jobs.
T- The pile of laundry, the list of to-do's and the work never ends. We are all exhausted and our relationship is suffering. I don't know what I can do about it.
F- I feel frustrated that I don't see a solution except to push through. I feel a bit sorrowful that we are not enjoying parenthood as I thought we would (and know that we will probably look back one day and regret how negative we feel about everything right now instead of enjoying every detail of her smallness). I am worried about my relationship with my husband deteriorating further.
A- Because of these overwhelming feelings, I've just tried to shut them out and buckle down to get more tasks done. The few heart-to-heart conversations we have had have not been helpful as we are both so tired, down and negative.
R- We continue to provide the best care we can for our baby, but cannot find ways to increase closeness and improve our relationship.

ANSWER:
Hello friend! Thank you so much for your kind words about BT. We are so glad to have you here!

Oh man, you are in the thick of it right now. I can relate viscerally to your thought download, and have felt so much of what you describe here before! But for the purposes of our coaching here, I'm going to "stay out of the pool", and try and throw you a life preserver, OK?

Ok let's work to clean up your model a bit just so we can see one thing at a time.
Some pointers:

--- try and keep the language in your c line as neutral and objective as possible. ---
C- You have a 9 month old. You do not have family in the US. You have a partner. You both work outside the home.

--- T line is ONE sentence---F line is ONE Feeling--- Each T is it's own model with a F/A/R--

T1- The pile of laundry, and to-do list never ends
F2- Exhausted
A- (what do you do when you're exhausted?_ disconnect? scroll? bare minimum connection?
R-?

Another model might be
C- same as above
T2- I don't see a solution except to push through
F2- Frustrated
A- look for the negative, don't extend much grace or patience to your partner or yourself, shut down
R- Focus locks in on the hard stuff and drives you away from connection and closeness

I am not going to try and offer a positive spin on this at all. It won't work to try and convince yourself that "I'm going to miss this!" or " all I have to do is X, Y, X to fix this problem".

What you are doing, raising an infant human being and being in partnership with another adult is hard work. And it is around the clock. We can acknowledge that.

I want to do an experiment where we add the fact that you are human to the C line. We can also add to the C line that human beings feel exhaustion, fatigue, disconnection, overwhelm, frustration, and sorrow sometimes. They also feel fulfillment, love, closeness, joy, satisfaction, intimacy, and a million other feelings.

What would it look like, instead of shutting down those feelings, to acknowledge them?

What might connection or closeness look like during this phase of life?
- with yourself?
- with your partner?
- is it OK that that might look different now than it did before? than it will in 10 years?

What comes up for you here?

Bring it back, friend.