By Joseph Zamaria, PsyD
Faculty and Staff Assistance Program
The time that you spend in residency is likely one of the most challenging periods of your career as a physician, and these challenges can seemingly come from all directions. A high workload, learning on the fly, and constantly being evaluated are all par for the course. These difficulties may arise during the early stages of training, while transitioning from medical school to internship – and coincide with the stresses of potentially having to relocate and coping with the change in role from student to physician. Some challenges arrive at later stages, such as job searching or preparing to apply for fellowship. The fact remains, however, that the expectations placed upon you during residency are particularly demanding.
High expectations may certainly come from external sources – from supervisors and attending physicians, and from the reality of having to deliver optimal patient care and safety. On the other hand, another source of these expectations may be from within. High achievers naturally have high expectations for themselves, accompanied by an inner critic that preaches the importance of success. This can be useful – you would not have gotten where you are today if not for your drive and your ability to achieve. However, if those high expectations turn into excessive self-criticism, demanding success to the point of perfection, they may be adding more to the problem than to the solution.
Enter self-compassion. This construct, new to the field of social research, was coined by Dr. Kristen Neff, Associate Professor of Human Development and Culture at the University of Texas at Austin. Neff states that feeling compassion for the self is very similar to the feeling of having compassion for others (not an uncommon experience for physicians). That is, self-compassion comes from validating your own experience (e.g. “this is indeed so stressful right now – most anyone would be having a hard time!”) and with addressing it in a kind manner (e.g. “what can I do to take care of myself at this time?”).
According to Lars-Eric Petersen from the University of Halle-Wittenberg’s Department of Psychology, “self-compassion is a self-regulation strategy for countering negative self-directed feelings and emotions.” He goes on to state that “highly self-compassionate people treat themselves with kindness, care, and concern when facing negative life experience.” In other words, those who exhibit the highest degree of self-compassion are those who can most adaptively cope with external life stressors through the use of kindness.
So, how does one operationalize this concept? How to put rubber to road? There are a variety of techniques that can be used to cultivate self-compassion. Neff has techniques and exercises, as well as more resources, available for free on her website, selfcompassion.org. Most of the exercises, such as “Changing your critical self-talk,” can be completed in just a few minutes, with little more than a sheet of paper. She also provides seven downloadable guided meditations, each approximately 10 to 20 minutes in length, which can help to recognize critical emotions and thoughts and to develop a more self-compassionate mindset. As with the development of any new coping strategies, it may take consistent practice over the course of a week or two to begin to feel the benefits of the self-compassion exercises.
One exercise to try is the “Self-compassion break.” For this exercise, follow these steps:
- Sit down, and think of a situation in your life that is causing you anxiety or stress. Really try to bring this situation to mind, and see if you can feel the discomfort of this in your body.
- Acknowledge the stress (e.g., “Yuck.” “I can’t stand this.” “This sucks!”).
- Acknowledge that stress and suffering is a common part of human experience (e.g., “I’m not alone in feeling this way,” “I’ve struggled before in my life.”)
- Express kindness to yourself, in the face of the challenging or stressful situation (e.g., “I’m doing the best I can with this,” “I accept myself as I am,” “I commit to giving myself the compassion that I need to get through this.”)
Another exercise to cultivate self-compassion is “How would you treat a friend?” In this exercise, follow these steps:
- Consider a time when a close friend or family member was struggling with something, and is “beating himself/herself up about it.” Imagine how you’d respond in this situation, what you’d do or what you’d say to your friend, and write it down.
- Next think about times in which you have struggled or have “beaten yourself up.” Think about what you do, or what you say to yourself in these situations, and write it down, including the tone you use to speak to yourself.
- Note any differences between what you’d say to your friend and what you’d say to yourself. Try to think about why there is a discrepancy, if there is one.
- Finally, write down how you think you would respond if you treated/spoke to yourself the same way you would to a friend.
With both of these exercises, practice and consistency are important. Try doing one of them 2-3 times per week, for a couple of weeks, before making any judgments about whether it is helpful. It usually takes about that long for the effects to sink in. If you would like to hear more from Dr. Neff, she also has brief and full-length lectures available online, including a full-length TED talk. Most are available on YouTube.
High achievers, prone to negative self-talk, may also be reticent to ask for support, especially professional help. Concerns may abound, such as worry that peers or supervisors will find out that they are struggling. Sometimes, all it takes is a brief conversation with a co-worker, friend, or family member to feel just a little relief from the stress of overly high expectations. However, it may take more. One resource available to all faculty and staff, including residents, fellows, and postdocs, is the Faculty and Staff Assistance Program (FSAP). Staffed by clinical psychologists and clinical psychology postdoctoral fellows, FSAP provides no-cost and confidential counseling for personal and work-related issues. For more information or to set up an appointment, please call us at 415-476-8279 or visit our Faculty and Staff Assistance Service page.
- Kristen Neff (www.selfcompassion.org)
- Neff, K.D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85-102
- Peterson, L. (2013). Self-compassion and self-protection strategies: The impact of self-compassion on the use of self-handicapping and sandbagging. Personality and Individual Differences, 56, 133-138.