Episode 110: How To Stop People Pleasing And Absorbing Other People’s Angst
Do you find yourself feeling miserable and worn down by criticism and complaints? Are you the person who always gets asked to take on extra work or stay late – and yet don’t seem to be able to say no?
There’s nothing wrong with helping people, but if your empathetic nature is taking you to the point of exhaustion, it’s a sign it might be time to take a step back.
In this episode, Dr Karen Forshaw and Chrissie Mowbray join us to discuss how our core beliefs shape the way we respond to situations. When taken too far, empathy and helping people can be a big cause of stress. In addition, we also talk about we can learn to reframe and reassess their core beliefs.
If you want to know how to help people without absorbing their emotions, stay tuned to this episode.
Here are three reasons why you should listen to the full episode:
Understand the connection between people-pleasing and stress triggers.
- Discover how to care less about what others think, so you can do a better job and feel fulfilled.
- Learn techniques like shadow work and develop a beginner’s mind for a happier life.
[05:29] What’s Happening in the Healthcare Industry?
Amid the ongoing threat of the pandemic, the healthcare industry has found ways to adapt to the current situation; these include offering teleconsultations and remote follow-ups.
- The pandemic has affected people’s expectations from medical professions, so they tend to take their frustrations out on them.
- Frontline workers also need to cope with their own struggles and personal life.
- Complaints from others have chipped away at medical professionals’ self-worth.
[07:42] How Core Beliefs Affect Us
Dr Karen reminds us that all of us are in different situations from each other. Underneath all these, our core beliefs are key to resilience.
- Core beliefs are influenced and founded through the environment in which we grew up.
- Core beliefs affect how you handle stress and anxiety.
- We need to acknowledge and reframe our core beliefs so we can change the way they influence our lives.
[09:34] What Really Causes Stress
People and situations do not cause you stress; it’s a matter of how you react to them.
[9:22] Dr Karen: “If we don’t reframe our core beliefs, or at least acknowledge that they’re there, then they are going to influence us and they will influence us in bright, unexpected ways.”
- When we keep blaming others for how we feel, we are giving up our locus of control.
- How you respond to the situation is more important than what others think or do. Regain your power and develop an internal locus of control.
[10:53] Dr Karen: “If you actually try to develop an internal locus of control — which basically then means that you accept responsibility for everything that you do, then you have all the power. Because it doesn’t matter what other people do, because you recognize that it’s your responses that are the key thing, and you are 100% in charge of your own responses.”
- The desire to please people also externalizes our control since we constantly look for external validation and approval.
[12:34] How We Develop People Pleasing
People-pleasing often develops from our childhood upbringing.
- This behaviour does not serve us well, especially when people tend to abuse you.
- The majority of healthcare professionals are conditioned for people-pleasing, which is why they entered the caring profession in the first place.
- While this behaviour can mean that you like helping others, it can also mean that your feelings are dependent on them.
- There will be times when you will get complaints even if you provide proper service.
[15:42] How to Respond to Complaints
It is always important to be able to admit our mistakes and apologize. However, you don’t need to say sorry when you know you’ve performed to the best of your abilities.
- Learn to discern whether you’re truly in control of the result of it’s unfortunate that the patient didn’t think it was good service.
- We often don’t think deeply about using the word sorry. Saying “I’m sorry, but” means that you’re not really sorry.
[17:32] Dr Karen: “…Asking yourself when you’re saying sorry, or when you’re being accountable for something, ‘Do I really mean that? Am I accountable? Am I sorry for what happened there? Or do I feel it was a good service, but it’s unfortunate that they don’t?’”
- We need to consider different ways to respond to complaints. We can begin with thanking the patient, instead of apologizing first.
- Think about your words, what they mean, and the intention behind them.
[19:33] Stop Absorbing People’s Emotions
Don’t be affected by criticism of those who are not even your patients.
- We often get affected by these kinds of criticism because we think that we’re not doing enough. Remember, we’re not responsible for the health of the entire nation.
[21:09] Rachel: “I think health practitioners take on too much responsibility. So we’re feeling dreadfully responsible for the health of the nation, but that’s completely out of our control and it happens out of control. But it hits a raw nerve when they criticize us, because we know we can’t do anything about it.”
- You can be compassionate without being over empathizing and absorbing other people’s stress.
- We’re all responsible for our own emotions and feelings.
- If you keep absorbing people’s emotions, you will have chronic high levels of cortisol and adrenaline, which is not healthy or sustainable.
[25:36] How to Turn Empathy to Compassion
First, be aware of your emotions and learn to stand back. Our emotions and experiences can project our needs and wants onto the patient.
- Ask yourself whether empathy is appropriate in the situation.
- Be more direct. Ask your patient what they need and you can do for them.
[29:04] Chrissy: “I think, in terms of being able to decide, it’s about observing it first, and then choosing to decide whether to let it run or not.”
[29:24] Link Between Triggers and Shadow Work
As you encounter people, you sometimes naturally absorb their emotions. You need to learn to let these go.
- We all have part of ourselves that we’ve learned to hide — our shadows that have been disapproved of as we grew older.
- When we get triggered by others, this often indicates a reflection of what we dislike about ourselves.
- Accepting that we are not perfect will help us see our own worth.
- Every time you get triggered, reflect on why you became bothered, and then shift the focus from others to yourself.
[31:57] How to Know What You Need to Work on
Generally, when you’re annoyed by something, it might be something you don’t like about yourself.
- These triggers may not be about the actual behaviour, but its underlying traits.
- For example, disliking child abuse does not mean that you have the capacity for it. Rather, you may be bothered by manipulation.
[33:54] Develop a Beginner’s Mind
When we’re stuck in situations where there are rigid expectations, it affects how we communicate with others.
- Chrissie recommends developing a beginner’s mind to experience situations with a fresh perspective without limiting beliefs or judgements.
- This mindset can also help us live in the present and be free to be ourselves.
[34:17] Chrissy: “…The benefits of beginner’s mind — it gives us the joy of experiencing every positive situation as the first time. That gives us a good boost of positive body chemicals. It enhances the well being. It allows us to come at every situation from a completely fresh perspective with no limiting beliefs or judgments.”
- You can develop a beginner’s mindset by cultivating the habit of re-assessing and re-framing your boundaries.
- Change interactions that drain you and set better boundaries. Listen to the full episode to learn more about setting boundaries!
[36:02] How to be Free from Triggers
We sometimes get stuck in past experiences and expect certain interactions. We can change this.
- Learn to recognize your triggers and remember that you’re not supposed to fix people, you should be empowering people instead.
- When dealing with a difficult patient, focus on them and remind them that they’re ultimately responsible for their health.
- Some people are difficult only because we perceive them that way.
- Experiencing triggers can help you set boundaries to ensure future conversations will not go there again.
[42:27] How to Do Inner Work
Inner work is being consciously aware of what we say, do, and feel. It’s a practice we need to do every day.
- When we’re aware of our reactions, we can choose whether to hang on to old patterns of behaviour or change.
- Start with observing how you respond to all situations. Then, process these observations through journaling or other activities.
[45:29] Chrissie and Karen’s Tips
Consider checking out the book, How to Rise: A complete resilience manual. It includes concepts for self-awareness and a gap analysis tool to help you develop skills for resilience.
- Observe yourself for a few weeks. Go on a complaint fast. Let go of your usual reactions to “annoying” situations and look at everything with fresh eyes.
[47:08] Chrissy: “So basically, I decided for one week to completely desist from complaining, because I was affirming how tired I was, that I was in pain, that people were being annoying. And the people in my life were absolutely delighted. And I know, my mood increased — everything was better.”
- Challenge cognitive illusions and don’t assume what others are thinking.
- Practice gratitude. Create a daily practice of writing at least 3 things you’re grateful for and 3 things you’ve learned.
- Remember to be physically active.
About Dr Karen and Chrissie
Dr Karen Forshaw is a GP Partner in South Yorkshire, a GP trainer, and GP appraiser. Her years of teaching and consulting have helped shape her holistic view of people’s beliefs and circumstances. People often ask doctors and medical professionals to “fix” them, but Dr Karen realized that people have the power to “fix” themselves.
Chrissie Mowbray is a physiotherapist, hypnotherapist, and psychotherapist at the Bell Lane Physiotherapy and Sports Therapy Clinic. She regularly works with people who experience PTSD, burnout, anxiety, emotional trauma, weight loss, low self-esteem, addiction, and phobia. Her practice taught her the value of the holistic approach in helping clients learn and cultivate the skills they need to take responsibility for their wellbeing.
Together, Dr Karen and Chrissie wrote the book, How to Rise to help others develop techniques to build resilience.
You can connect with Dr Karen and Chrissie on Resilient Practice.
You can also reach out to Dr Karen on LinkedIn and Twitter. While you can reach out to Chrissie on LinkedIn and Bell Lane Physiotherapy.
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Dr Karen Forshaw: If how you feel is dependent on somebody else, then you have no power over your own feelings, which therefore means that you are at the mercy so you can be as nice as you like, but you could do whatever you like. But if that person still chooses to think that you’re not good enough, is that how you want to be? Do you want your feelings of self worth to be defined by other people? Or do you want to define them for yourself?
Dr Rachel Morris: Are your feelings of self worth and self-esteem dependent on what other people think? Do you tie yourself in knots trying to please other people, only to find that it often makes absolutely no difference? Do you often find yourself triggered and irritated by other people because of past experiences, which might not have anything to do with what’s actually going on in front of your nose?
In this episode, I’m joined by Dr Karen Forshaw, GP, trainer, appraiser and mentor and Chrissie Mowbray, physiotherapist, psychotherapist and hypnotherapist to talk about those thoughts, prejudices and assumptions which keep us stuck, angry, and miserable in life and at work.
Our actions and feelings are shaped by our thoughts. But so often, our thoughts are shaped by our own self-doubt and fear, and are based on past experiences. Rather than an impartial analysis of the situation in front of us. We discuss how to become more aware of these unhelpful thoughts, beliefs and assumptions, and how they’re shaping how we behave. We think about how approaching a situation as if we’ve never met it, or the person before can be transformational in how we react when things get tricky. We discuss simple techniques, which can help you care less about what people think of you, and care more about what you believe about yourself.
This episode was a real eye opener for me and contains some fundamental principles, which I don’t think we talk about enough, and which if we were able to remember and put into practice will change the way we interact with our colleagues, families, clients and patients.
You can find links to many more resources from Karen and Chrissie’s Resilient Practice website in the show notes. You can also sign up to get my handout all about how to change these stories that you tell yourself. Listen to this episode if you want to find out why people pleasing will never make difficult situations go away in the long run.
The difference between compassion and empathy and why this matters, and how approaching every situation with a beginner’s mind might just be the key to fixing those tricky relationships.
Welcome to You Are Not A Frog, the podcast for doctors and other busy professionals, who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP, now working as a coach, speaker and specialist in teaching resilience. Even before the Coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water, we hardly notice the external days becoming the norm. Have gotten used to feeling stressed and exhausted.
Let’s face it, folks generally only have two options, stay in a pan and be boiled alive, or jump out of the pan and leave. But you are not a frog. That’s where this podcast comes in. It is possible to cross your working life so you can thrive even in difficult circumstances. If you’re happier at work, you’ll simply do a better job.
In this podcast, I’ll be inviting you inside the minds of friends, colleagues and experts all who have an interesting take on this. That together, we can take back control and love what you do again. We talk a lot in the podcast about the zone of power and other coaching productivity and resilience tools and principles, which I found made a huge difference to me personally, and also the teams which I worked with. I put all these principles and tools together to form the Shapes Toolkit. This is a complete package of resilience, productivity, tools and training for doctors, healthcare teams and other busy leaders.
We’ve been delivering Shapes Toolkit courses all over the country in the form of keynote talks, webinars, workshops, online memberships and courses and full or half-day live programs. We’ve been working with GP training hubs, new to GP fellowship programs, return to practice programs, trainers, groups, health and wellbeing projects and many more organisations. We’re now taking bookings for summer and autumn 2022 and have a few slots left for spring 2022. If your team is feeling overwhelmed with work, one crisis away from not coping, and want to take control of their workload feel calmer and work happier. do get in touch to find out how we can help.
Rachel: It’s great to welcome today onto the podcast, Dr Karen Forshaw and Chrissie Mabry, so welcome both of you.
Karen: Hello there.
Rachel: Karen is a GP trainer. She’s an appraiser and LMC mentor, and Chrissie is a physiotherapist, a psychotherapist and the Hypnotherapist. All those different qualifications Chrissie?
Chrissie Mowbray: Yeah, I wear a few hats in clinic.
Rachel: You’re both practicing clinically right now at the moment as well, aren’t you? Can I just start off with and in a minute, we’re going to get on to be talking all about control, and compassion, fatigue, and all these sorts of really interesting stuff that you guys talk about. But what have you been seeing in practice right now with with health care professionals and other people you’re working with,
Karen: I think we’re almost getting to the point where people are at breakpoint, really, there is a, unfortunately, there’s been a real downturn in the kind of, well, maybe patient’s perspective. I think people are really frustrated, they want things to go back to the way they were, I think we’re trying to brace the changes that came about since COVID.
Perhaps bring forward some of them, such as telephone consultations and remote follow up. Patients are finding that difficult because it is a big change in what they’re expecting. I think they’re cross because, you know, it’s going to take years for the NHS to recover from, in the hospital, from the kind of lists that they’ve got people waiting.
I think that they’re taking that frustration out on the frontline workers that they see in general practice, really. Though, you know, it’s just some days, it feels like, there are too many things to do. I don’t think I’m alone, feeling that rare that.
Chrissie: Yeah, it’s knocked everybody’s confidence. I think, basically, I think, whilst things are going well, and we feel like we’re on top of things, we can get to a point where we can practice confidently, we feel we’re at the top of our game, but it does not take an awful lot.
When I say it doesn’t take an awful lot, you know, sort of things that are happening at home or, you know, if you’re unwell or a spell away from work, and knock your confidence. I think a pandemic and a change in practice. A change in what people expect from the frontline that makes people take it out on the frontline, or complaints about the way that you’re delivering your service, even if it’s out of your hands, is going to chip away at your self worth. I think that all of us have issues around self worth.
What I’m seeing is that manifests in people’s ability to practice, and also just in mood and, you know, enjoying your job enjoying your life. It comes across that people are just generally less happy.
Rachel: Now you both sort of specialise in resilience training and you’ve written a book, and it’s something you’re really interested in. Do you think that there’s other stuff going on, apart from just this overwhelming workload and dealing with criticism from the public?
Karen: Yeah, absolutely. I think that everybody has their own stuff that we’re still, we’re still trying to come up with a better word for it than stuff. But, you know, as Chrissie mentioned before, people have things going on in their own lives. Some people may have, you know, experienced bereavement themselves.
We are human beings, and we’re experiencing all sorts of different things happening on all the different fronts, in those different kinds of roles that we have. Underlying all of that, we have the kind of conditioning that happens as you’re growing up, which is about whether you are, it’s okay to talk about mental health, whether it’s okay to talk about stress and anxiety, things like that, or whether they’re the things that we should push inside, and keep away because we shouldn’t, you know, have to, we should never experience them. Those kinds of things basically form us as a person, and we end up with core beliefs.
A lot of us actually have quite negative core beliefs. I think we’ve boiled it down humbly to not feeling worthy, or feeling broken in some way. If you have negative core beliefs rippling along underneath, they influence how you think, they influence how you feel, and that influences what you do and what you say. All of those things then go around in the cognitive behavioural cycle, thoughts, feelings, and actions, all being driven by core beliefs. If we don’t reframe our core beliefs, or at least acknowledge that they’re there, then they are going to influence us and that influence, they will influence us in quite unexpected ways.
Rachel: I love this, this idea of your core beliefs, I call it the story in your head and all the training that I do and it’s the one thing that just cuts to the heart of things because it is a bit of a revelation. Once you’ve sort of seen it, you can’t unsee it, can you? But all our stress, all our anxiety and worry is caused by our thinking, it’s caused by the stories we’re telling ourselves, not by what other people are doing to us. It can’t…
Rachel: It can’t even, it’s really hard to get that because like, that person is so flippin annoying, they are causing my stress it’s not, it’s not me. I think as healthcare professionals, we find it very hard to accept that it’s ourselves and our own thinking causing this because there are so many other things that are contributing to that. But when you are blaming other people all the time and think it’s because of their actions, and it’s because of this, that I’m feeling like this, it’s a pretty powerless place to be, isn’t it?
Karen: Absolutely. That’s when you are completely externalising, your locus of control, which is a term that we’ll talk about. If you have an external locus of control, it’s everybody else’s fault, there’s always a reason for why something’s happened, there’s a reason for why you’re feeling the way that you’re feeling it and as you say, that is completely disempowering, because it means you have no control over anything.
Whereas if you actually try to develop an internal locus of control, which basically then means that you accept responsibility for everything that you do, then you have all the power, because it doesn’t matter what other people do, because you recognise that it’s your responses that are the key thing, and you are 100% in charge of your own responses.
Now I teach this stuff to patients, and they don’t like it very much. It’s because I say to them, well, you’re anxious, are you anxious? Or actually, is that just what you’ve been choosing to think and feel and do up to this point in time, and, and some people are like, ‘Oh, my goodness, I can’t Oh, my goodness’, and then they come back nation, they go, ‘Oh, my goodness’, and other people don’t like it, and they’re not ready for that. But actually, yes, if we can all move towards an internal locus of control, that is a very, very, very empowering place to be.
Chrissie: I would say, conversely, the challenge to that is that we all have an inherent need for approval that comes from childhood. That follows us into adulthood, unless we make it conscious, and we’re aware of where it’s kicking in, then it externalises our locus of control, because we’re looking for external validation and approval, and that comes from the need to survive as children because without being approved of, we’re dead, aren’t we? Because we’re abandoned.
What tends to happen is we never really shed that survival instinct, and we look for it all the time. Even you know, when you’re the most resilient you can possibly be and you feel like your locus of control is entirely internal and that you’ve bought that all of your responses conscious and under control, you will still find yourself seeking approval occasionally.
Rachel: That people pleasing thing, it’s like you said it’s an existential thing, isn’t it? Because, you know, when our, when we were living in caves, you know, forget being kids, but as an adult, if you pissed everybody else off.
Karen: Absolutely, you’re out in the cold.
Rachel: Yeah, you’d be eaten by a bear, die by exposure or both. When people say ‘Oh, just stop people pleasing’ or ‘She’s such a people pleaser.’ It’s like, ‘Yeah, cuz I want to survive in this world.’ But it really doesn’t serve us very well does it?
Karen: Not at all, actually.
Chrissie: I think people actually described themselves as people pleasers as well. As soon as you you own up to that new what you’re wearing it on your, on your clothing, and people know who to ask then because you have designed yourself as this kind of, ‘I’m the lovely doctor’ and I will… then the lovely doctor that the receptionist will then actually ask to do the extra patients, five o’clock, because the one who should be doing it is a little bit less pleasing. It makes it easier for people to ask you.
If you are a people pleaser, you’ll be the one that people ask. It all comes down to that need for approval, and the need to be liked as well. I actually think that on the frontline, as healthcare professionals, we are a self selected group of people who have a need to be liked as well, because we were probably conditioned that we were carrying as children it was approved of that we, you know, that we cared for others and that we wanted to go into a caring profession.
That is within us, and it is very, very difficult to see ourselves in a different way. That we need to for our own survival, otherwise our resilience is at stake.
Rachel: But can I just ask you play devil’s advocate here, I mean, it’s quite a good thing to want to be liked because that means what you’re doing is trying to do things for other people that they that they are going to like, so it means you’re being a nice person and you’re not a psychopath, right?
Karen: Perhaps, but if you if how you feel is dependent on somebody else, then you have no power over your own feelings, which therefore means that you are at their mercy. You can be as nice as you like and we all have seen this patient, don’t we?
In fact, it’s the patients that you often feel like you’ve gone out of your way for, they’re the ones that tend to complain. You could do whatever you like, but if that person still chooses to think that you’re not good enough… Is that how you want to be? Do you want your kind of feelings of self worth to be defined by other people? Or do you want to define them for yourself? Do you want to say, ‘You know what, I know that I did the right thing in that consultation.’
I, you know, used my skills, and I shared knowledge and I was kind. I was compassionate to that patient, full stop. That’s why when you get a complaint, if you know that you did the right thing, you’re not bothered by it at all. It’s only if you actually think that you probably didn’t do what you should have done, that you feel bothered by complaints, in my experience, having had complaints.
Rachel: Haven’t we all? I think the thing that bugs me about that is that you get a complaint or you look back through the notes, and correct. What did I do? What did I do? ‘Oh, thank God, I did the right thing.’ Oh, it’s someone else? Yeah, I probably did that.
You know, sometimes, you don’t do the right thing, right? You just get it wrong for absolutely no reason at all, because you just got distracted or you were tired, or we all make mistakes. Remember that practice pharmacists coming up to me saying, ‘Rachel, did you mean to prescribe 280 diazepam?’ I did not. Let’s just change that prescription, shall we?
You know, literally finger slips when typing it. Yes, we all do things. We need to be okay, when we’ve made a mistake and get complaints, and it is our fault.
Chrissie: There’s a sort of a bit of a British thing about being sorry. I’ve patients who apologised on the couch or, you know, of bumping people who apologise when they bump into you. We talk about saying sorry, when we’re actually responsible for something that’s gone wrong. When you’ve made a mistake with the patient, and they complain, I think if you have made a mistake, it’s perfectly okay to say, ‘That was actually my fault and I am sorry.’
But I think we are also in danger of being sorry, when, as Karen said, a consultation has gone well, and we’ve done everything that we could possibly do. We know that patient is disgruntled, whatever we would have done, it would have been the same outcome. There are other ways to handle that.
We can say, you know, it’s unfortunate that you feel that you haven’t had a good service without saying I’m sorry, and taking responsibility that for something that is not your fault, or that that didn’t particularly go wrong, by the way, that you see it. I think it’s all about being conscious with your responses.
Asking yourself when you’re saying sorry, or when you’re thinking when you’re being accountable for something, do I really mean that? Am I accountable? Am I sorry for what happened there? Or do I feel it was a good service? But it’s unfortunate that they don’t? Can we explore how they would have, you know, how they would have liked it to have gone?
Rachel: I guess Chrissie, hearing you say, ‘It’s unfortunate that’, it immediately makes me think actually, if someone said to me, ‘It’s unfortunate that you feel that way.’ I’d get a bit annoyed because I think that this is just being fobbed off. But is it ever okay to say, I am really sorry that you feel that way? Because you can be genuinely sorry that someone feels that without being sorry about what actually happened? Does that make sense?
Chrissie: I think you can. Yeah, but I think we use the phrase I’m sorry, without thinking about it.
Karen: When you say I’m sorry, but it basically means you’re not sorry.
Rachel: Sorry, not sorry.
Karen: Yeah. Let’s think maybe try and think of a different way of doing that. The last time I got a complaint, I actually said, ‘Thank you for your letter.’ That made me feel quite good. Because I thought actually, ’I am really,’ because this letter is pointing out something that is highlighting I’m a bit unorganised, actually, and probably ought to sort that out, really. I started it off with saying, ‘Thank you for your letter.’
Actually, I think that really sets the tone. I wasn’t saying sorry. I didn’t particularly say sorry in the letter. I just a bit but I started it off. That’s because we said that’s about your intention. It’s about the intention that you have, when you say it and saying, ‘I’m sorry, but’ means you’re not sorry. Think about what you’re saying, think about what your words really mean. Think about the intention behind them.
Also think about why is this triggering you? What core belief, what negative core belief is it poking at? Is that the universe saying, ‘Here’s another opportunity for you to grow for you to actually change the way that you think about yourself internally.’ It’s win win, really.
Rachel: Yeah, that’s a really interesting observation. Because my observation is when the media are criticising doctors, and they’re saying you’re not working, you’re not seeing patients face to face. You know, looking at it, I’m thinking, ‘Why do people react so badly?’ Because we know it’s not true. I mean, it’s obviously not true.
I tell this story so many times, you know, one of my colleagues, you know, he’s saying Gandhi literally just finished examining a patient, patient is putting on his jacket, patient turns around and says, so when you’re going to open, doctor?
Karen: That’s hilarious. Yeah, we had exactly this on a course that we ran recently, didn’t we? When basically the first thing that somebody said was, ‘Oh, it’s really awful and depressing.’ I just laughed and I said, but we know that’s not true, don’t we? Actually, we know that. Why are we bothered about what other people think?
Rachel: That’s right. I think what you’re saying exactly like if someone came up to me in the middle of the street and said to me, ‘Oi you! You’re rubbish at what you do. You’re a rubbish coach, and you’re a rubbish trainer.’ They’d never met me or they haven’t seen it. I just laugh because to think? You have no idea.
If someone had been on one of my courses came up and said, ‘You’re really not that good,’ I’d really take that to heart. Yeah, well, it’s the same with the general public, you know, if they, they’re coming up to me and say, ‘Actually, you’re you’re, you’re useless and not seeing patients.’ they say. We are. The problem is, what it’s doing, the reason why we’re getting upset about it is because it’s hitting that raw nerve, it’s going maybe I’m not doing enough, maybe I’m not good enough, maybe we can’t provide the service we can.
This is back to your locus of control, because I think health practitioners take on too much responsibility. We’re feeling dreadfully responsible for the health of the nation. But that’s completely out of our control and what’s happens out of control. But that’s it hits a raw nerve when they criticise us. Because we know we can’t do anything about it when we get very defensive, because deep down, we’re telling ourselves we should have done. Is that right?
Karen: I think so. But again, that’s, that’s and it’s triggering core beliefs, isn’t it? If you think about us, as doctors, we are fixers, aren’t we? We like to think that we can make people better. Actually, really, maybe we ought to move away from that this is pushing us towards our compassion versus empathy argument.
Should we be taking responsibility for how our patients feel? Should we be absorbing their pain and their anxiety all of the time? We agree no, we absolutely shouldn’t be, because that’s really bad for us. When we think about horrible things happening. Or imagine how somebody tried to imagine how somebody felt when that happens. In fact, we will have a release of stress hormones in our own bodies, because remembered events trigger the same kind of flight-fight response in us.
If you’re doing that 10/20 times a day, when you’re talking to people who are upset or anxious, then you will at the end of that be drained and you will have high levels of cortisol and high levels of adrenaline in your system, which is not a good way to work. It’s really unhealthy for us. Stepping back from it a little bit, and being compassionate. The definition of compassion is feeling sympathy for somebody and wanting to do something about it. We don’t advocate just being served people, obviously.
But actually recognising the impact of a problem on a patient wanting to, to genuinely do something about it to help them is the definition of compassion. That is absolutely what we are advocating for clinicians, we have particularly young people coming through now, because it is overwhelming, isn’t it, because we know that the pandemic has affected the mental health of the population.
We can’t absorb all of that, ourselves. Actually, it’s bad for patients too, because if we’re absorbing all of that from them, they get the idea that they can calm and just offload on the doctor and leave it all there. Then they go away feeling better. Again, they need to take responsibility for what’s going on in their life. They need to take responsibility for their thoughts, feelings and behaviours just like we do.
Actually, then being compassionate, rather than over-empathising with people allows you to help them do that. You can bring your expert knowledge, they bring their expert knowledge of themselves, so they tell you what they can and can’t do. You give them a range of solutions. Together, you can come up with a plan that fits them.
Rachel: I was listening to episode three of the podcast, we recorded almost two years ago with Agnes Salzburg, and she was saying that when they put people in an MRI scanner and show and played them, sounds of people suffering their empathy centers lit up, and they and also their pain centers lit up. They actually felt that in the same way as you feel physical pain, is that right?
Karen: Yeah, absolutely. It’s true. This is absolutely what starts to happen. But actually, what we want people to think about is, do we know what that person is really thinking or feeling? Of course we don’t because we’re not them.
We have a different worldview. Yeah, because we were brought up in a different way. We were conditioned in a different way. We have different life experiences. When we are empathising with people, we are actually probably trying to guess how they feel. Yeah. Or we’re basing it on our own experience. Yeah.
We start reliving a lived experience and this happened to me in clinic not that long ago. My mum died in May and the patient came and she’d lost her husband. She was talking about it and I got really upset. I was like, Oh, I can’t believe I’m doing this because this is not me. Actually, it was me, it was my kind of grief about my mom came out.
Actually, the patient kind of looked at me, she was shocked. I could almost feel her thinking, ‘Why are you upset? This isn’t about you.’ I was like, ‘I’m so sorry. This is because of my mom. It’s nothing to do with, you know, I’m butting into your consultation, so just give me a minute. Then we’ll come back to you.’ It does go both ways, really.
Rachel: It’s very interesting that about, yeah, things that but, you know, if any of my children ever have friendship issues, for example, I talked to him, I feel absolutely agonising in pain after this. I know how I’d feel it, then often, it’s all resolved for them within half an hour. I’m like, Oh, almost like in the physical? Because, because of how I would feel if it was, if it was me as a woman of this age, not as a, you know, 10-year old child. It’s really tricky. I mean, Chrissie, how do you advise your clients to turn from this empathy bit into the compassion bit? Because that’s the bit that I don’t quite understand is how you get from this constant feeling of empathy, because that’s what we do as human beings, and you don’t want to have a complete lack of empathy, do you? Because that’s a psychopath, presumably.
Chrissie: No. I mean, I think the first thing to do is to make it conscious to be aware, I’m being empathic I’m starting to feel, and I have a kind of an almost an inner voice that says, ‘Okay, you you need to step back because you’re feeling this as opposed to observing it.’
It’s not that I don’t want to feel it. It’s just I want to be aware, if my emotions are getting involved, that really muddies the waters, because in actual fact, we project then our needs onto our patients. I’m assuming what they need, I’m thinking well, and actually to back from my own experience, and back, when I realised I’m being over-empathic, and I’m kind of feeling for the patient. To say, I can see this as distressing for you, what do you need?
Because if I ask them what they need, quite often, they will usually surprise me and say, ‘Well I need to speak to a GP and find out my diagnosis.’ Or I need to know what actually was on the X-ray report, or I just need you to do some physical treatment. But and I, I was thinking you needed a hug, because yo’re really sad! For me, it’s about standing back and being aware that I’m a human being, I am empathic, but I’m supposed to work as a professional, so and it is a self selecting profession, or group of professionals. That’s perfectly okay.
But to observe it and to ask myself, is empathy appropriate in this situation? Or is it going to cloud the issue? Should I actually stand back from my own emotions, and my own feelings about the situation, and that person described to me how they feel and what they need and what I can do for them, and in what way I can be of service to them.
It’s not really about saying, empathy is not the best way to be compassionate. It’s about looking at the argument and saying, in this situation, where do I sit, and also about being really good at switching on the observer part of the psyche, the part that does say, ‘tell me that you’re upset, but don’t end up feeling upset.’ The part that says to observe everything that’s able to notice my emotions without collapsing into them. If I’m a real, really good observer of my own consultation, then I can notice when that empathy kicks in, and I can decide whether it’s appropriate, let it run or not.
As Karen said, sometimes, you can’t help it, you’re already there. You’re already welling up and you’re already thinking wrong. That’s okay, that makes you an empathic doctor. But I think, from in terms of being able to decide, it’s about observing it first, and then choosing to decide whether to let it run or not. Then you can go to the question, you know, I can see your distress, what do you need? Then you can act on that.
Rachel: Do you have any particular tips or techniques that would work and I know, you’ve talked about Beginner’s Mind and Shadow Work. What’s all that about?
Karen: Our shadow, all those parts of ourselves that we just like that have been disapproved of, that have been kind of, you know, trained out of us as we grew up. The things that we felt we needed to hide, to avoid being abandoned as children.
When we come into contact with people, so actually, Shadow Work is a bit different. The compassion versus empathy, I would say is the tools are what Chrissie’s talked about, and also maybe even some visualisation exercises to think about protecting yourself from absorbing things from people when they come in and making sure after you’ve seen a patient that you literally do housekeeping. That’s not just about getting up and having tea, but it’s about, you know, really getting rid of feelings that were developed, or that came up in you, when you had that first consultation.
Visualise washing your hands and visualise all those feelings disappearing. Because you need to come to the next person fresh. Shadow Work is more when people ignore you, actually. When somebody does something, and you’re annoyed, or it triggers you in some way, it makes you cross or it makes you upset, it’s because they are reflecting back at you something that you really dislike about yourself something that is in your shadow.
If we can acknowledge that we’ve all got all of those parts, we can all be cruel, we can all be unkind, we can all be disrespectful, we can, you know, in the right circumstances, we can all do certain things. If we can acknowledge that there is a part of us that is potentially capable of that, then we stop judging ourselves. when we stop judging ourselves, then we’ll stop judging the people around us. Actually, then what they do doesn’t affect us.
Because what we’ve done is we’ve moved to a more internal locus of control, and we’ve gone ah, that person did something that annoyed me. Why was that? What is it about me that is making us bond in that way? Okay, I need to do some inner work here. It becomes not about that person, it becomes about you.
When it becomes about you, you have all the power, because you can reframe your core beliefs, you can think about your you can reframe your thoughts. You can alter your body chemistry by doing positive things. You can look at the things that you do, can’t you and actually act in a more positive way that you’re driving positive behaviour cycles rather than negative?
Rachel: That’s really interesting. Would you say then that the things that annoy you most are generally the things that you dislike about yourself
Karen: That you have pushed down as far as you possibly can? Yes, the more it annoys you, the more you’ve pushed it down, the more you can’t or can almost not face that you may have the capacity for that characteristic.
Rachel: Okay, that’s interesting. We thought it was the things that annoy you most of things you’re definitely not like, but actually, you’re saying no, maybe it’s the thing you really uncomfortable that super…
Karen: They’re no large parts and that tiny, tiny parts of your name. That’s why it annoys you so much, because you aren’t an unkind person, you aren’t cool, but in certain circumstances we can we all have the capacity to be all of those things where they, and don’t think about behaviours, think about characteristics, on a course of hours, just the people, people don’t like this, actually, it’s challenging, isn’t it? To think that there are dark parts of yourself?
Somebody said, so if I find child abuse abhorrent, does that mean that part of me has the capacity to be a child abuser? But actually, it’s about the characteristics and the traits that somebody who does that kind of thing has, and that is, broadly, manipulation, isn’t it and so it’s the traits that underlie a behaviour, not necessarily the behaviour.
Rachel: That makes sense. That’s really interesting. So you notice why they’re irritating you? Think about okay, what’s that hitting in me, that’s causing it? Yeah. Then you can, then you can change that because it’s about you rather than about them.
Karen: It won’t bother you anymore.
Rachel: Yeah. So many people are so focused on trying to change other people. That’s so stressful, isn’t it? Because well, isn’t that? Well, unless you’re married to them? No. I’m lucky because my husband doesn’t really listen to every episode, so he won’t hear this.
Chrissie: I was going to talk about Beginner’s Mind because you asked about it. This is a really brilliant tool for when we get into a rut with some of our what we term heart think patients, but also with people that we regularly interact with who our expectations become very rigid of them, because we have lots of experience with them, and it affects how we communicate with them.
The benefits of beginner’s mind, it gives us the joy of experiencing every positive situation as the first time so that that gives us a good boost of positive body chemicals. It enhances the well being. It allows us to come at every situation, from a completely fresh perspective with no limiting beliefs or judgments. That way, our decisions aren’t contaminated by past experience and others are free to be themselves without having our expectations placed upon them.
We’re not imagining the worst and expecting, again that that gives us the opportunity to learn from the current experience instead of expecting something and catastrophising about what’s going to happen and it keeps us present, allows us to live in the present moment, avoiding the fight or flight response and the negative chemicals that that invokes. The way to practice that is to cultivate the habit of reassessing and re reframing boundaries. Somebody has upset you or there has been an issue in the past with somebody and it has been repetitive, then you take that situation, and you decide how your boundaries will be affected because of it.
For example, if you’ve had an argument with somebody or got into a really heavy argument, I’m somebody who will say, after that experience, next time I see that person, these things won’t be on the agenda for discussion, I’ll keep it light. You set your boundaries at the time so that the next time you see that person, that those boundaries are in place that you’re not going to expect anything different from them, but you’re basically acting only on current information, how they are at the boundaries. In all situations that leads to different interactions, it changes things and people are different with us then as well.
Rachel: I do remember once I’d seen a patient, I thought very pleasant patient and wife was worried about him, problems with urine infections, was way to see a consult and had another one, we chased some things up. You know, they left happy, I left happy then I went to coffee. One of the people I was working with said, ‘Oh, my goodness, you’re seeing so and so this morning, such a nightmare, honestly dread seeing them.’
Every time she was obviously really triggered by- I just seen him. I said, ‘Oh, I just seen him,’ and it was fine. I was so grateful. I’d seen him before I’d been to coffee. Because if it comes into coffee, and you know, and I think either this this poor doctor had just been so ground down with the stuff that had gone on and stuff in the past. Maybe there had been a-. I don’t actually know what had gone on in the past.
But I was so grateful I didn’t carry that baggage. With the consultation, and I’m sure it’s much better because of that. But how do you avoid that? Because if that had been me, you know, we all we all have those people that your heart it genuinely thinks to the to boost. That person’s coming in. I guess a lot of it’s because you can’t help them and you’re feeling bad. You can’t people please and all that sort of
Karen: Exactly. Exactly. It’s about recognising what it is that it’s triggering within yourself. Yeah, so I can’t fix this person, therefore, does that mean I’m not a very good doctor, and actually letting go of that. Recognising that fixing people isn’t what we should be doing and actually just empowering people, giving them our knowledge, and helping them make sensible decisions. Yeah, is actually what our goal should be.
If you stop trying to fix somebody, then actually they stop bothering you. All you have to do is listen. Yeah, and a lot of what they talk about will be negative. But actually, all you have to do is listen. That’s what Chrissie is talking about with expectations isn’t that? Actually what I found with a lot of my patients that I did consider difficult is either we have better conversations when they come in, and then they just go, I don’t offer anything else. I just list it.
Then they say oh, right, okay, then thank you, and then go, or they start to go and see other people. But the trick, the tricky thing with that is that you’ve got to be careful that you’re not kind of having them accumulate all with other doctors, so everybody needs to be doing the same kind of thing, don’t they? When a patient is in that the right part of the cycle of change that’s the time isn’t it to get in and go?
Well, actually, we were aware that this might be useful, this is something that you could think about. Actually a really good language tool in a conversation with the patient that you find difficult is to try and not use the word ‘I’ and just try and keep it all about you so that the so that the whole attention is focused on them. They then start to get the message that actually it’s about things that they need to do, as opposed to coming in and asking you to take responsibility for their health and their health decision. I think it takes a long time to get there.
But no, recognising that it’s an issue is probably the main thing.
Chrissie: I think it’s useful to ask people what they need from you as well. You know, something brought them into surgery that day, particularly, you know, there might be somebody who, who, who does suffer with the negative thinking, as you say, Rachel, the story that they’re telling themselves is I’m in pain, I got this and actually something brought them in. If you can narrow down what it is they need. Again, it might be something that you haven’t, you haven’t thought, you know, might and it might just be that they need you to listen.
Rachel: It’s a very coaching-orientated technique, isn’t it? I remember going on a health behaviour coaching courses, just my first introduction to coaching I was just blown away. I was like, wow, it was the first time anyone had taught me to consult in any sort of a different way. It was wonderful because, you know, it was ‘Okay, I’ve got some ideas, but what would you like? What do you need?’ Just listening and do a lot of work with leaders in healthcare.
I think they feel a lot about their teams in the same way as we do feel apart seeing patients, you know, some of some team members are just really difficult. You end up dreading that one to one interaction with them or that appraisal, or that ‘Oh, no, they’re gonna just moan’, or whatever.
All this is, I think, useful for that as well. Because you then flip to the coaching approach. Okay, what do you need from this conversation with me? What would be the most useful thing? What do you think you could do about it? Yes. Focusing on you, you, you so I think it works not just with patients, but with, I think-
Karen: Everybody in your life.
Chrissie: Some people are really difficult, but it is our perception of them as difficult, we perceive them as difficult, and that’s it. That’s a me-thing. If I find somebody difficult, that’s my stuff. I need to find the tools, make conversation with that person more easily so that I’m not affected by it. I don’t go away feeling drained. That person is giving me real difficult interaction, really is about sourcing the right tools and the right ways to speak to people and also doing the inner work that makes me not be.
Rachel: I think there’s that idea of coming to things with a beginner’s mind is great. I was out with some friends the other week, and there’s one person I find particularly difficult, just because of a few things that have happened in the past. I’m always quite guarded, because I don’t want to, you know, I don’t want the conversation to go south or stuff. If I just came to it as a beginner’s mind going, Yeah, let’s just, you know, it’s no assumptions.
No, no sort of triggers. But also knowing that probably, let’s not go down that route of conversation. wise about this, it would just be a lot easier, wouldn’t it?
Chrissie: Because you don’t want to get your fingers burnt again. When you got your fingers burnt the first time, you would readjust your boundaries and say, That’s off the you know, so you can feel the conversation going down that route. That’s the boundary, we’re not going there or change the subject.
But you’ve taken all of the thinking and the emotional angst out of the interaction, because you’ve already decided what you will not talk about, or you know, the keep the conversation light, or whatever those boundaries are. Then you’re free to go and actually have her pleasantly or him pleasantly surprised you had a nice time.
Rachel: We’re nearly out of time. But I just like to get into some really practical application of this. Because, you know, we’ve had some really interesting stuff about identifying this sort of, your shadow, and thinking about beginner’s mind, being able to respond out of compassion, rather than your empathy zone. I’m just thinking, you know, and you’ve talked about inner work quite a lot. How does one go about doing that? It’s very well, knowing all this stuff, and it sounds brilliant, and I’m fully on board with it. But like how?
Karen: It’s an ongoing, it is an ongoing thing, really, it’s something that we all need to do every day. It’s about being conscious. Yep. Make everything that you think and say, and do and feel conscious. Because then you can choose whether you want to let something run an old pattern of behaviour. If it’s appropriate, that’s fine. But if it’s not, then you have the opportunity to choose a different way.
It really is all about choice. We have got a website, it’s free. So www.resilientpractice.co.uk. We post a blog every week on there. There’s usually a tool attached to it. That people can have a go at, there are a list of them. There’s a tool kit on there that people can have a look at. It’s a host of different kinds of things that people can try. People need to go out and explore and find the things that work.
Chrissie: The one takeaway thing I would say from today, people listening to the podcast is go away and observe your own responses and behaviours if you do nothing, but observe, this is what I say to a lot of my patients who are stuck, you know, what if you just for, say, three or four weeks, just observe how you feel and how you respond. In all situations, you’ll affect change without actually having to do anything else. That would be the takeaway thing. Start by observing your own responses and your own emotions and your own strategy for gaining what you need.
Rachel: It’s a bit like observing particles in the Hadron Collider, you know, the act of observation, changes, changes things. If you’re observing, do you recommend that people journal and write them down? Or?
Karen: Yes, very much. Journalling is amazing. You can process something that’s happened, you can unpack your day, a specific type of journal, a thought diary is what people using cognitive behavioural therapy if you want to actually start to reframe thoughts that you’re having. Yeah, absolutely journalling is a brilliant thing.
Not everybody likes to write things down, you know? Don’t be constrained by that. You can record it on your phone. Yeah, right. speak and tell yourself some notes. Some people can need to dance it out, you know, there are lots of different ways of processing and expressing yourself.
Absolutely find what works for you if that’s what resonates with you, and then do it. The other thing is we get really lethargic, don’t we, stop doing the things that we know are good for us. It is about making them become habits. That’s about doing them over and over and over again until they become a habit.
Rachel: In a sec, I’m going to ask you for your top three, top three tips, maybe top three each, because you guys have got so much. But if people want more, you’ve mentioned the website. I understand you guys have written a book as well.
Chrissie: Yeah, it’s called How to Rise: A Complete Resilience Manual. It’s published by Sheldon press, which is the imprint of Hachette books. You can buy it most of the major booksellers, you can get it on Amazon, and it basically talks about everything that we’ve talked about today. If you want to know more, these concepts are in the book.
But also, there’s quite a lot more that we go through the concepts of self awareness that you need to know about how you became who you think you are, and then some four skills which you need for resilience. There’s a huge toolkit in the back, which you can match your own Resilience Gap Analysis Tool, which you can fill in, and you can see where your needs are. You can map that, but there’s loads of ways to use it. Just dive into the tools you want.
Rachel: It sounds brilliant. When you’re saying, you know, observe yourself and you know, use some of these tools, you can just choose whichever tool works for you, presumably.
Karen: Yeah, as well. For each of the tools, we’ve basically listed the things that it will be useful for you so it’s well mapped out.
Rachel: Well, what a great resource. Yeah, we’ll put all the links to those in the show notes. But now, top three tips that start with you, Chrissie then Karen?
Chrissie: Observe yourself completely for a few weeks. That’s tip number one. Tip number two, do a complaint fast. This is an experience that I had, and I could not believe the results. I decided for one week to completely desist from complaining, because I was affirming how tired I was that I was in pain, that people were being annoying. The people in my life were absolutely delighted. I know, my mood increased, everything was better. Actually, I stopped observing that I needed to complain because I went to, I don’t have to complain about that. It was massively liberating. That’s a definitely on that I would suggest, understood when I would say come at everything from a fresh perspective, let go of your expert is still there, all the knowledge is still there. All the stuff you work so hard for is still there, it won’t go away. Look at everything with fresh eyes, but reset your boundaries.
Rachel: Brilliant. Thank you, Karen, what about you?
Karen: Okay, so I would say challenge cognitive illusions. They are those distorted patterns of thinking that we engage in regularly.
Assuming the worst, assuming that we know what other people are thinking in mind during adding emotional weight to things that people have said and done, when really there’s not there. i That’s my first one. Definitely. Second one is practice gratitude, this is the quickest way to get a boost of positive body chemistry. We would say write down three things that you’re grateful for, then write down three things that you learned that day.
Yeah, so it’s a step on from a gratitude journal, because it’s easy to be grateful for the good stuff. Actually, what we need to learn to do is live gratefully, which is about being grateful for everything that’s happened, even when it was a rough day.
That’s about the lessons that you learn. We always learned every there’s always gonna be to them. Then the third one, and Chrissie is gonna laugh at this one is physical activity. But actually, it is really brilliant. If you can weave physical activity into your day. It just makes such a difference. I definitely try for that.
Rachel: Great advice. Well, thank you so much for being on podcast. It’s really interesting. We have to get you back another time. I’m sure there’s so much more to talk about. People want to get a hold of you through the website.
Karen: Yeah, absolutely. So info@resilient practice.co.uk. That’s a direct email. We’ve had we have people email all the time. We’re happy to you know, chat to people to share advice. Have a look at the website. Absolutely. Yeah. Have a look at the book.
Rachel: Right. Thank you so much. Have a good rest of day. Bye bye.
Karen: Thank you very much.
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