This blog post is PART TWO of a two-part series. The first post was published on March 14: click here to read!

In Part One of this series I established that the physician population is need of robust, specialized, and effective behavioral and relational health interventions, and the lack thereof can have dire consequences—as demonstrated by remarkably high rates of suicide among doctors and surgeons (webMD.com, 2018). In Part Two, I will explain how to adapt to and mitigate several core problems that I encounter when working with physicians in therapy, as well as how to access and harness the dormant strengths that lie beneath.

As mentioned in Part One, you may find that these core problems apply to your situation even if you are not a physician nor do you have a physician in your family. Other individuals and professional populations can certainly encounter these problems as well, and therapy can be just as useful for them and their relationships:

1. Work/Life Inseparability

“Maintaining geographic and temporal boundaries between work and life is always difficult and sometimes it is impossible: if someone collapses in a restaurant, the doctor on a date at the next table is back on the clock.”

A hidden, and perhaps shocking, strength of Work/Life Inseparability follows from the choice to consciously reject the hegemony of work/life balance. Despite its ubiquity and seeming unassailability, work/life balance is a relatively new concept for humanity—and evaluating life through that lens does not work for every individual or population.

Instead, physicians in particular may benefit from a “unified life”: embracing life without compartmentalization and inviting opportunities to grow and evolve the professional identity concurrent with the personal identity. For example, physicians can learn to view rest and self-care as essential to professional performance—which they are, especially over time.

Pursuing the goal of a unified life will likely result in the same kinds of healthy behaviors espoused by advocates of work/life balance: good self-care for almost everyone includes some version of sleeping, eating, hygiene, exercise, enjoying beautiful things, and forging meaningful social connections. However, physicians may find that they are much more likely to make these healthy choices if they understand that self-care is equally valuable to their professional selves as to their personal selves.

2. The Deceptive Appeal of External Validation

“Medicine tends to attract and retain individuals who thrive on high expectations… faced with such massive and pervasive external demands, physicians may fall prey to the illusion that external validation is a reliable source of emotional gratification and self-esteem.”

An individual who effectively adheres to rigid external structures over time probably demonstrates commitment, determination, courage, and self-sacrifice in other areas of their life as well. In the right dose and context, these are not bad qualities. Therapy can help physicians stop undermining their own efforts by performing their good qualities compulsively—and, by contrast, teach them to apply their good qualities precisely and intentionally.

Seeking external validation typically goes awry because: A) an individual will neglect their loves ones to meet external demands, and/or B) an individual will neglect themselves to meet external demands. Therapeutic interventions can interrupt maladaptive cycles of seeking external validation by directing physicians to identify and validate their own emotions, their own values, and their own preferences. Often these values are more aligned with the desires of their partners and family members that their current behavior, so helping them to prioritize their own needs can serve the physician individually, as well as the couples and families to which they belong.

 3. Hyper-Accountability

“[Hyper-accountable individuals act] with the intention of sparing others bother and concern, but with the long-term effect of denying themselves help and support—and denying loved ones the opportunity to provide it.”

Hyper-accountable individuals tend to withhold information about their emotions and preferences, opting for a mindset of “I’ll take care of it” or “I’ll fix it myself.” As a result, their loved ones often do not feel as engaged in problem-solving or emotionally close as they would like to be. Conversely, effective communication—that is clear, frequent, and inclusive of emotional as well as logistical content—allows everyone involved to feel more empowered and more connected.

In some cases, increasing effective communication is as simple as carving out time and space for regular conversations. In other cases, there are negative emotions associated with asking for help or talking about problems: fear, guilt and shame can be powerful deterrents to effective communication, particularly for high-functioning individuals. These emotional experiences may become incorporated into an individual’s core beliefs, i.e. “I Am Weak if I Ask for Help,” or “Talking About My Problems Feels Bad and Should Be Avoided.” Therapists can offer insights and strategies to help these individuals rewire thoughts and beliefs that oppose effective communication, and clear a path for more satisfying interactions in the future.

4. Problem of Prestige

“The problem of prestige refers to the recursive interaction between [society’s] collective admiration of and alienation from physicians: they seem superior, and therefore impervious to criticism or derision—and feeling inferior to someone or some group often engenders criticism or derision.”

Some individuals chose to pursue careers as doctors or surgeons because of the promise of prestige; these individuals probably have struggled with self-esteem throughout their lives, and they might recoil at the idea of revealing their emotional vulnerability to others. For them, the most effective way to circumvent the Problem of Prestige will be to increase emotional self-awareness and to master skills of emotional self-validation. Therapy is a safe context in which to begin this work, and individuals who do will find that they are both more tolerant of their own negative emotions, as well as more adept at naming and expressing their negative emotions in a way that will illicit tolerance, comfort, and validation from others.

Desiring prestige is not necessarily a bad impetus: therapy can help individuals to decide consciously whose opinions they wish to empower and consider, and whose opinions should have less power and influence over them. For some, this process will be an opportunity to re-prioritize the needs and opinions of their partners and loved ones, and to redefine prestige as something that can be gratifying not only on a large scale, but also within individual relationships.

Physicians who never considered the issue of prestige in deciding their career may be shocked by what can feel like a lack of compassion from those who cannot relate directly to their very specific experiences. These individuals can also benefit from increasing emotional self-awareness and self-validation, as well as actively seeking emotional support from professional mentors and loved ones.

5. The Hazards of Co-Suffering

“Having to focus on physical suffering at work day in and day out can lead to feelings of cynicism or hopelessness among physicians. Furthermore, draining all reserves of compassion at work may contribute to compassion-fatigue at home.”

As with many of the other core problems, overcoming the Hazards of Co-Suffering begins with educating physicians to recognize their couple and family relationships as resources of hope and pleasure and comfort rather than just another area that drains their time and energy. Helping physicians identify and express their emotions and preferences can aid in this re-education by a) emphasizing to what extent physicians often neglect or fail to advocate for themselves, and b) informing physicians’ partners and family members how to best direct their efforts and affection.

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