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[00:00:00] Hey, guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kindra. And we have a fascinating topic today. Laura, tell us about it. All right. So we have talked to you guys in the past about the concept of the different ways our brain helps us show up, whether we might be showing up in our wise adult selves versus our adaptive child selves.
And I ran across this this therapy modality, which I found so fascinating. Now, obviously we're not doing therapy here. This is for educational entertainment purposes only. But it was so interesting to me the different ways that our brain may have learned to adapt when we were kids and how those can show up for doctors.
So today we're gonna do a five-part series on schema therapy and patterns that often live underneath physician burnout And I just wanna be clear from the [00:01:00] beginning, this is not a series about blaming your childhood. It's not about pathologizing any of us, including our parents, and it's not about diagnosing everyone you know.
And it's not deciding, like, everything that's hard in your life is because of things that happened when we were kids. you know us well enough by now to know that that's not how we roll. This really is just more about more awareness, more understanding about the patterns regarding how we show up.
And You know, th- sometimes we think things should be simple enough as, as changing a thought will help us create something completely new, and a lot of times that is true, and sometimes it's, it's a little more complicated than that. And where Amanda and I trained, that really was the focus, was it was a cog- it was a cognitive behavioral therapy based modality that we learned, and [00:02:00] that is very much your thoughts create your reality.
And occasionally we will recognize that there's some patterns that are just so deeply rooted that it's hard to use that framework. So this is more understanding about why, why we get stuck even when we try to change our thoughts about things, and why those patterns can be so hard to change. Even when we're really smart, we're really high-functioning, and we're insightful, we're willing to be reflective and genuinely try, there's still some things that can be hard to change.
Most of us, as doctors, don't have an information deficit. We know we should rest. We know we should have boundaries. We know we should not define our worth by patient satisfaction scores or productivity or chart completion or everyone else's approval. And yet many of us keep [00:03:00] doing the same things that we've been doing Overworking, overgiving, overfunctioning, smashing down our feelings, avoiding our own needs, and feeling like we're never quite enough.
This schema therapy framework is gonna give us a way to understand why we're doing all that. I love it. So let's talk about the background and history. If, if you're like me, you gotta do a deep dive and be like, "What is-- what even is this?" So schema therapy was developed by psychologist Jeffrey Young in 1990, so relatively new.
He'd been trained in cognitive therapy, but he noticed that some patients could understand, like cognitively, their thoughts, but a-and they can even challenge the distorted thinking but still stay stuck. In other words, the insight was not always enough. And I think physicians understand that on a very deep level.
We can understand something logically and still not free from it emotionally. We certainly see it in our patients where [00:04:00] there's an awareness and even a desire to change, and yet they can't, right? So schema therapy grew as an integrated model. It includes pieces of cognitive behavioral therapy. There's also parts of atta-attachment theory and also parts of experiential work.
There's gestalt techniques, psychodynamic thinking, and emotion-focused work. So it's an amalgamation of all of these really good modalities into one. So rather than only thinking, "Is this thought true?" Schema therapy can also ask, "Wait, where did this pattern begin? What emotional need is this attempting to meet that wasn't met before?
How did the younger part of me learn that it had to do this as a protective strategy? How is this pattern being triggered now, and what would a healthier adult response look like?" So that's why this model can be so useful for doctors because in medicine, many old coping strategies that we picked up [00:05:00] got rewarded.
So of course you're keeping it. So if you learned to need nothing, if that was like really, Like, "God, that guy's so awesome. He is, like, completely independent, never asks for help," all that sort of stuff. Well, then medicine might have called you to be resilient. If you learned to be perfect, maybe that was reinforced in, in wherever it came from in your life, medicine may call you to be excellent and flawless.
Like, there is no allowance for anything other than perfection. If you learned to suppress emotion, then medicine may tell you to be professional always. If you learned to sacrifice yourself, then for sure medicine can take advantage of that and call you dedicated. The problem is that a coping strategy can get you praised and still cost you your best life.
yes. Ouch. Okay, so what is a schema? A schema is an old emotional template. It [00:06:00] is a deeply learned pattern about yourself, other people, and the world. It is more than just a thought. A thought says, "This person is disappointed in me." A schema says, "If someone is disappointed in me, I am not safe." A thought says, "I made a mistake."
A schema says, "If I made a mistake, I am a failure." A thought says, "I need help." A schema says, "If I need help, I am weak, burdensome, or alone." So if you can kind of think about in your brain the differentiation between the two. Schemas often begin early when normal emotional needs were not met consistently enough, and that does not always mean something dramatic happened.
Sometimes it means a child was loved but not emotionally seen. Sometimes it means achievement got more attention than vulnerability Mistakes were criticized, or the child learned to become low-need and high-performing.
Ugh. [00:07:00] Ooh, yes. This is getting a little... I feel I'm getting a little flushed. I feel like we've had a series of incredibly rude podcasts lately. It's getting a little rude. Okay, so the child adapts, yes. And the child becomes responsible, impressive, agreeable, invisible, self-sufficient, funny, useful, perfect, or easy.
Oh, dear God. And then that child grows up and becomes a doctor. Okay. Welcome. Explains everything. Okay. Come on in. I'm getting clarity today, people. At least I'm getting clarity. This is where it gets complicated because medicine may reward the adaptation before it reveals the wound. The child who learned, "I am safe when I am perfect," becomes the doctor with unrelenting standards.
The child who learned, "My needs are too much," becomes the doctor who never asks for help. The child who learned, "I am loved when I achieve," becomes the doctor who cannot stop achieving. The child who learned, "Conflict is [00:08:00] dangerous," becomes the doctor who says yes to things they do not have capacity for. Hmm.
The child who learned, "No one is coming," becomes the doctor who looks incredibly competent and feels profoundly alone. And again, we're not trying to blame here. We all have a past, but it's more about understanding the pattern because until you can see the pattern, you may keep trying to fix your personality.
Okay, so let's talk about how schema therapy works. Again, we're not doing therapy here, but just for our informational purposes only. I'm sure this doesn't apply to anyone here listening, just- No. I don't-- didn't think that, no. Interesting. Touche. Yes. So fascinating, these- Yeah
examples. Fascinating. Okay. So in a simplified way, there are four steps that are useful for our intellectual purposes only here, right? First, I will say in full transparency, when I first learned about this, I had an experience where I could feel [00:09:00] myself becoming emotionally flooded, and I was able to name the schema in the moment.
I was like, "This is my emotional deprivation schema." And oh my goodness, like we've taught you guys to name emotions before, but this was... I don't know. It was very, very helpful. So here's what, what is suggested. First, you name the schema. Is this unrelenting standards? Is this self-sacrifice? Is this emotional deprivation?
Is this defectiveness or shame? Is this approval seeking? Is this subjugation? Naming-- We've talked about naming emotions, but naming what is happening creates that space where we can choose. we've told you before, it helps divert blood flow out of the limbic system and up into the prefrontal cortex, which is always gonna give us a better shot at being our wise adult self.
So instead of saying, " This is just who I am," you can begin [00:10:00] to say, "This is a pattern getting activated in me." Next, you can notice the trigger. What was it that brought this schema up? Maybe it's a patient complaint, a bad outcome, a consultant being dismissive. Maybe your partner is irritated at you. Maybe it's your chart hole that you're in or a full inbox.
Maybe it's a child who needs something when you're already feeling empty and you just, you just feel terrible 'cause you don't have what you want to give. Maybe it's an administrator making some ridiculous request that has nothing to do with patient care. The present day event, like whatever's happening right now probably doesn't look huge from the outside, and this is another clue.
Like, when something minuscule happens and it feels like Mount Everest just landed on top of you, that is a clue that this is old energy. It's [00:11:00] not just the event happening right now. It is your brain recognizing something that felt familiar, felt like a a past situation that wasn't safe. So it's touching that old wound, that old schema.
That emotional reaction can feel enormous. Okay, so then third, what is the coping style? Identify your coping style. schema therapy often talks about three broad coping styles: surrender, avoidance, and overcompensation. Yep, I, I, I see all three of those in my, my... I don't know. I do it all the time. I remember the the avoidance is like the numbing behaviors we've talked about.
Surrender is just that martyr complex of just, "Okay, I'll just do it." And overcompensation is, "I'm doing it to prove my worth." S- so all of these are so common. If you're feeling [00:12:00] called out right now, I want-- I just want you to know this is, like, you and 99% of other doctors. Yeah. For real. Surrender means that you're giving into the schema.
If that schema says, "My needs do not matter," you act as if your needs do not matter. Not helpful, especially for longevity. Avoidance means you try not to feel the schema. You stay busy, numb out, intellectualize, scroll, eat, drink, shop, work, emotionally disconnect. How much more helpful might it be to just greet the schema?
"Oh, hello, emotional deprivation schema. Hello, it's good to see you. I don't have to eat a bag of candy to, to put you back in your box. Let's just... Let's look at this. What's going on?" Overcompensation means that you're fighting that schema by going to the opposite extreme. So if [00:13:00] someone has intense shame, they might go to grandiosity.
So we might see this in some of the people we interact with who have narcissistic traits, who are always talking about how all the good things that they do and how amazing they are, it's possible that they are overcompensating for this inadequacy schema. If-- Another way that shows up is if you're feeling inadequate, you may become more controlling or perfectionistic or critical, or if vulnerability feels like garlic to a vampire, that could be a c- a clue as well.
So here, here's where we can have some compassion on ourselves. These coping styles, it's not... You know, this is, this is our brain. Our brain is here to help us stay alive. There's reasons that it does these things. It is not a character [00:14:00] issue. They're protection strategies, and they probably made sense at some point, and sometimes they may make sense now too And there's probably some times where they're not serving us now.
So it's helpful to be aware of them, to be able to examine them and make a decision about them. The fourth step is practicing a new response from the healthy adult or wise adult self. So that's where we have diverted our blood flow back up to the prefrontal cortex and make a choice. This is the part of you that can say, "Of course, this makes sense." This is old, old energy. I am not in childhood anymore. I can care about excellence without abusing myself. I can be compassionate without erasing myself. I can tolerate someone's disappointment without betraying myself.
I can make a mistake and still be a good doctor. So that's the work. It's not shaming ourselves [00:15:00] for having these schemas come up. It's not letting the schema drive our lives, but noticing it, understanding it, and responding from the adult self who has more choices now. And a lot of times it is just coming back and saying, "I'm safe."
I love what, Mel Robbins does, and she just puts her hand on her heart and tells herself, "I am safe. I am loved." And that's likely addressing these schemas. I wanna just give you guys a few reflection questions, and then Amanda's gonna give you a case example. I want you to think about these, these questions and just ponder them.
You don't have to do anything else with them, just allow yourself to just kinda mull them over. What pattern in your life feels older than your career in medicine, but has been reinforced by medicine? What trait gets you praised professionally but really it costs [00:16:00] you a lot personally?
When you are triggered, do you tend to surrender? Meaning like, do you tend to lean into that emotional reaction? Do you avoid it or do you overcompensate, go to the other direction? What would your wise adult say to the younger part of you that learned this pattern? So I just invite you to really think about these things as you're looking at, I am being praised for this thing at work, but it is-- my family is hating me because of this thing at work.
What's going on there? What's the deeper pattern Okay, so let's do this, like an, an example in a physician's life. So let's say that a physician receives a patient complaint. The event, the technically neutral even though it doesn't sound like it, is that there was a patient complaint, meaning some patient filled out a form, a form was [00:17:00] submitted by a patient.
So the schema might be defectiveness or unrelenting standards. The old template in this physician would say, "I fa- I failed. I'm not safe. They're gonna find out I'm not good enough." If you surrender to the schema, you might spiral into shame and believe the complaint means that you are a terrible doctor.
The fact that somebody filled out a form and hit send equals awful at your job. If you avoid, you may refuse to open the message or just completely emotionally shut down. It mi- I'm also assuming that it could be something like, " I'm quitting this job." Yeah. You know? If you overcompensate, then you may become defensive, obsessively review the chart.
When I'm overcompensating, I'm also, like, trying to give it back, "Well, that patient sucked in the first place," you know, or whatever. You know, like, like shoving right back at them what they gave at me. Mm-hmm. Or maybe you need to prove that you did nothing wrong, but the healthy adult response sounds a little different.
It says something [00:18:00] like, " Oof, this is painful. Well, what I can do is review the facts. I can be accountable for anything that I need to be responsible for, and I also do not have to turn this into a global verdict on my worth or my performance as a doctor in general." That is what schema work looks like.
It's not bypassing accountability, it's removing the shame so that true, clean accountability is actually possible. Yeah, and I will add too that we're gonna go, in the following episodes, we're gonna kinda do a deep dive on-- Like, so if you're like, "What, what defectiveness?" What am I? Yeah. Right. Exactly. So we're gonna go into a deep dive on there's 18 maladaptive early childhood schemas that Dr.
Young identified, and we're gonna go through the ones that most show up for doctors in the following episodes. I feel like I'm getting the impression we're g- about to have several more rude episodes coming up. Sorry. I need it, so that's good. [00:19:00] Yeah. Okay, so as we begin this series and painfully move through it, I want you to listen with curiosity, not self-judgment.
Don't ask, "What's wrong with me?" Ask, "What pattern did I learn? How did it protect me? Where does medicine reward it, and what is it costing me now?" Because the goal really isn't to become schema-free. That is not how human beings work. The goal is to notice when an old pattern has taken the wheel and to begin strengthening the part of you that can choose something different.
So this really will give you your agency back, honestly. Like, at the end of this, if you can go in and just listen and understand, this is actually allowing you to choose, and we're gonna teach you how to choose something different. So in the next episode, we're gonna talk about one of the most common physician schemas, unrelenting standards, or as many doctors experience it, the belief that no matter how much you do, it's [00:20:00] never quite enough.
Yes, I've said that several times. Dang it. Okay. Well, that's it for today's painful episode, friends. If you found this conversation uh, extremely painful... No, just kidding. If you found it helpful and if you're willing to stick with us through the next four or five episodes, the best way to support us is to subscribe.
So click that button now and leave us a rating, five stars of course, and a review. 'Cause it helps other physicians find us, which is the point, and it moves us up on the list. And if you do leave a review, go ahead and take a quick screenshot of it and shoot it over by email to [email protected].
And just for doing that, we will send you a free e-book on emotional regulation. Yeah, we're touching on everything today, people. It is actually one of our most requested and impactful topics. So one... Before we go, though, give... We wanna invite you to, Before we go, we have a little gift for you. We've created the Podcast Fast Track, which is [00:21:00] a handpicked collection of our most high-yield episodes.
We have over 200, getting, getting lots and lots of episodes, so that can be really overwhelming. So this Podcast Fast Track is actually designed to help you jumpstart your journey to freedom from burnout. So we've done the hard work for you. We've picked out, picked out our most high-yield episodes, and you can get that at www.thewholephysician.com/fast-track,
and you can discover your personalized path to wholeness and healing. So thanks for spending time with us today. Until next time, you are whole, you are a gift to medicine, and the work you do matters.
