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The Physician Philosopher Podcast

TPP 55: The Therapeutic Index of Physician Thought Work

Editor’s Note: Are you a physician who is looking to get coaching of your own? Make sure to join the waitlist for the Alpha Coaching Experience to be the first to hear when the doors open next: thephysicianphilosopher.com/waitlist 

Larry Keller

In medicine, we have a concept known as the therapeutic index.  The therapeutic index describes the safety of the drug.   Every medication has both a potential benefit and potential risk.   The goal, of course, is to find the therapeutic window of a drug where we maximize efficacy while limiting side effects. And that is exactly what I want to discuss in this post.  The therapeutic window of coaching. 

The reason is that self-coaching can save people from suffering, but it can also lead to a slow and painful road to shame, if not wielded correctly.  This is when we have overshot the therapeutic window for coaching.

The Thought Model Changed My Life

The first time someone gets exposed to The Thought Model it often changes their life.  In fact, that is exactly what happened to me.  This thought model is a modern-day tool created by Brooke Castillo at The Life Coach School that captures much of what the ancient stoic philosophers taught – that it is up to us whether we let external events determine what we think, how we feel, and how we show up in this world.  

The model is simple.  It follows an acronym – CTFAR.  C is for circumstances (externally verifiable events two lawyers would agree on in the court of law, even if on opposing sides). T is our thoughts about these events.  These thoughts then determining how we feel (the “F”), Act (“A”), and the results (“R”) we produce in our life.

CTFAR.  Simple, and beautiful.  And completely empowering. 

From Solution to Problem

The fundamental transition that happens after being exposed to the model is that people realize that what they have previously focused on – their circumstance, which they often cannot control – does not lead to their feelings, actions, and results.  It is the T line… or their thoughts.  

 

Therein lies the beauty and power of thought work.  When we get coached and uncover the thoughts that are leading to our feelings, we better understand not only how we feel.  We also realize why we feel that way.  Then, we can determine the next course of action.  Including whether to change our thoughts in order to feel differently, if we want.  

 

Yet, it is this exact realization that later leads to problems for many.  We become trapped in models of shame and blame.  On what we “should” and “shouldn’t” think… we “should” ourselves into shame. And when we have trouble fixing the problem, we blame ourselves – because it is our thoughts that are leading to how we feel, act, and show up in this world.

If you drink, eat, or procrastinate more than you “should”… it can become a devastating blow to your self-esteem and self-worth.   

Physician Self-Coaching

When doctors first get into thought work and they are exposed to this sort of idealogy taught in the model.  Suddenly, they realize that while the medical system is completely and utterly broken… that they don’t have to wait for that system to get fixed in order to have some reprieve from their suffering.  In this way, physician coaching can empower burned-out doctors.

There is hope on the horizon.  Light at the end of what had previously been a pitch-black tunnel.  They start to see that – while they used to feel trapped in medicine and completely powerless in their situation – that they have more power than they previously realized.  

Doctors who start doing the hard thought work transition from being the victim of their story. And, finally, become the hero.  This is why we do what we do in coaching.  To help end suffering for doctors who are burned out and feel completely trapped in medicine. 

Surpassing the Therapeutic Window

While coaching has massive benefits, those exposed to thought work can also use coaching tools against themselves.  They take the very tools that help them end their suffering, and turn them into self-inflicted weapons.  

In fact, the very last call I had during my six-month coaching certification involved my amazing master coach instructor, Martha, warning us of this very phenomenon.  Warning us not to use the tools we have learned against ourselves.

Let me give an example of what this might look like.

Intentional Planning Gone Wrong

Historically, my brain has not done well with uncertainty.  In fact, I hate it.  So, when faced with decisions about what to do with my time, I would do what most people do. Put out the fire right in front of me.  There was next to no intentional planning for my week.

Then, I was exposed to the process of taking unintentional time management and making it very intentional.  For those who have followed my work for sometime, you’ll notice shades of Kahneman and Tversky in there.  Going from System 1 thinking to System 2 thinking when it came to my schedule.  

Initially, this solved so many of my problems.  I’d sit down on Sundays and do my A Priori Planning that we teach our clients in the Alpha Coaching Experience. I’d label my maker and manager tasks.  Then, I’d fill up my calendar with those tasks until everything was accounted for in my schedule.

Suddenly, there was no more uncertainty. The decision fatigue I’d deal with each day was gone!  

Yet, this is also when a problem surfaced.

“Should-ing” Into Shame

After making my schedule, I felt a fierce need to keep to it.  Otherwise, I’d get derailed and the train would go off the tracks. So, I’d prioritize my schedule over just about everything.  

Why? Because if I took a break or something came up, I would tell myself that I wasn’t doing what I “should” be doing.  I started to “should” myself into shame.  

Remember that thought model I mentioned before?  Well, this is what it would look like…

  • C = Summertime. My family decides to go to the pool, but I have a podcast recording on the schedule during the same time.
  • T = (Either way) I “Should” be doing whatever I didn’t choose (going to the pool or recording).
  • F = Shame
  • A = Ruminating, perseveration, trying to figure out how I could make up for what I “should” be doing.  
  • R = I wasn’t present whether I decided to go to the pool or record.  

Either way, it was a losing battle.  Why? Because of shame.  And because of the way the thought model works, guess whose fault that was?  Mine.  They are my thoughts after all.

A New Model of Self-Compassion

It took me far too long to realize that it didn’t have to be this way.  I’d beat myself up unnecessarily for far too long.  The way out of this was to start practicing self-compassion.

For those unfamiliar, self-compassion is the idea that you provide the same kindness, forgiveness, and grace that you’d provide to a friend or loved one… but that you then provide it to yourself.

So, instead of choosing shame, I started to choose curiosity over shame (Episode 21).  I did this by thinking through the circumstance as objectively as possible, and then asking myself what I’d think about someone else I loved in the same situation.

“What would I think if someone told me that they went to the pool to hang out with their family instead of recording their podcast?”

“What would I think if someone stayed home to get their scheduled work done instead of going to the pool with their family?”

Self-Coaching with Self-Compassion

It turned out… that either way, the choice was up to me. And that I wouldn’t judge anyone who chose either of those things.  

So, if you are in a revolving door of shame… whether that has to do with drinking alcohol, pornography, overusing your cell phone, overeating, working too much, or not being present at home. Regardless of what it is.

The answer, my friend, is self-compassion.  What would you think of someone else who is in the arena battling their demons?  If you saw someone fighting valiantly – and getting knocked down, but getting back up… would you judge them?  Or would you respect them for fighting the good fight?

This is what we need more of inside of medicine. We need more self-compassion.  And that is one of the fundamental changes I see when physicians get coaching.  A renewed amount of self-compassion and loss of self-judgment.  

The Journey through Self-Coaching

So, whether you are at the very beginning of your journey in thought work.  Or you are in the midst of “should-ing” yourself to shame… know that the journey doesn’t end there.

You have a choice to choose self-compassion.  To look for all the reasons you are the best spouse, parent, and physician.  Instead of coming up with all the reasons that you aren’t.  You can choose to re-write your story and to reinvent yourself without the shame that comes along with being in the arena.  

Know that you aren’t alone. That you are worthy. And enough. Right now, just the way that you are. And that there is nothing else that you “should” be doing that will make you any more worthy than you currently are at this very moment. 

Because only when you truly love yourself can you really ever love other people in your life. THAT is how you stay in the therapeutic window of coaching.  By doing the hard thought work. Recognizing that you are in the arena. And then choosing self-compassion for yourself, just like you would for anyone else who is valiantly fighting to simultaneously love themself while they work on who and what they one day hope to become. 

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