By Toni R. Galace, Psy.D.
Faculty and Staff Assistance Program
As residents you constantly juggle different roles and expectations. The amount of hours you work each week, the clinical knowledge you have to master, and maintaining a work/life balance can leave you feeling overwhelmed and prone to burnout (McCray, Cronholm, Bogner, Gallo, & Neill, 2008). With your adrenals in overdrive, you may be asking yourself, “How do I manage all of this?” when no amount of medical training has taught you how to mitigate burnout within an extremely busy schedule. When pressed for time, it can be a battle to meet even the lowest rung of Maslow’s hierarchy of needs. That is, developing a self-care routine where you can eat properly, sleep sufficiently, and/or exercise begins to feel more like a luxury than a necessity. Perhaps you have been working around these basic needs by eating sugary snacks, sleeping less, drinking coffee or energy drinks, or walking the halls of the hospital and calling that exercise. But unhealthy eating habits and working with too few hours of sleep is not sustainable; keep at it long enough and it becomes ineffective at best and damaging at worst—to yourself and potentially to your patients.
Just to be clear: I am not writing to metaphorically preach to the choir of physicians who already know how to take care of the human body. I am reaching out to residents who, despite being seen by most others as Herculean, are actually stressed, tired, and also in need of care. That’s right: you are human, too, and you deserve to be treated with the same kindness, caring, and compassion you show your patients. However, is it possible to prescribe this kind of compassion to yourself?
To be where you are now—at a leading university that provides world-class care—means you are an extremely intelligent, passionate, and driven individual. By the same token, I wonder if some of your successes were fueled not only by self-sacrifice but also perhaps by being self-critical and hard on yourself. In the medical field you live in a culture where mistakes and failures are often internalized, eliciting negative emotions such as embarrassment and shame. Additionally, perhaps in order to get through medical school and residency, cracking the whip of self-judgment at times motivated you to succeed. As a resident, however, feeling stretched thin, ever pressed for time and under constant evaluation, that tough inner critic may now be doing you more harm than good. Instead of fighting against the negative emotions or just pushing past the discomfort (Germer, 2009), it is time to consider a different and more beneficial practice to deal with your distress: self-compassion.
First, compassion itself means to “suffer with” and entails the same feelings you have towards others. That is, you notice another person is suffering and then you are moved in such a way that your heart responds to the other person’s pain as a fellow human being. You consequently feel a caring and the desire to help ease their suffering (Neff, 2009). So, too with self-compassion: you notice the distress you are experiencing, the pain and discomfort it causes you, and then respond in a kind way that eases the suffering. More concretely, Neff (2009) described three elements of self-compassion: self-kindness, common humanity, and mindfulness. Self-kindness involves having warmth and understanding toward yourself when you fail, feel inadequate, and suffer; these experiences are inevitable and cannot be entirely avoided or made to disappear with either denial or harsh criticism. Common humanity reminds us that we are all connected and we all suffer; rather than personalize and feel alone in facing life’s difficulties, you can remember that you are not the only one to make mistakes. Lastly, mindfulness is a non-judgmental stance of observing your emotions and thoughts, without either suppressing things or building them up so that you get caught in the negativity. Mindfulness builds on compassion and self-kindness, allowing you to relate your experiences to the bigger picture and remain empathic to yourself.
Now, please do not make the mistake of thinking self-compassion is self-centered or selfish, as though paying a little more attention to yourself means caring for yourself at the expense of others or putting yourself above them (Germer, 2009). Nor does practicing self-compassion make you weak; on the contrary, practicing self-compassion benefits everyone. Indeed, the more empathy you have toward your own flaws and idiosyncrasies, the more empathy and patience you will have in caring for others (Germer, 2009). So let us try another path outside the usual fare of stoicism, criticism, and blame.
How to change your critical self-talk
(Adapted from Neff, 2009)
- Be cognizant of when you are self-critical. For example, when you feel bad about something, what do you say to yourself? Are there key phrases that come up again and again? Is your inner voice angry, distant, or condescending? Learn to become mindful of when your inner judge becomes active and harmful.
- Address the self-critical voice with compassion, not self-judgment. For example, when you hear the inner critic say, “You’re such an idiot, what were you thinking?!” respond with something akin to, “I know you’re trying to point out and help me overcome my shortcomings, but the negative attitude causes me more pain than comfort.” Negative self-talk feeds into feelings of anger, irritability, or exhaustion whereas compassion feeds kindness, forgiveness, and patience.
- Reframe the observations your inner critic makes in a more positive and friendly way. If you are having a hard time coming up with the words, imagine what a good friend would say to you. Following the example above, you could say, “This has nothing to do with your intelligence. You were really pressed for time. With your quick thinking and skills you did the best you could.” Furthermore, while engaging in this positive self-talk, gently stroke your arm or pat yourself on the shoulder. Yes, it may seem silly, but the physical gestures tap into the caregiving system, releasing oxytocin and reducing stress. Therefore, if you start to act kindly toward yourself, feelings of warmth and caring will follow.
Like going to the gym, this mental exercise to change your critical self-talk will take time and practice to develop. Putting in the effort will lay the groundwork for how you can relate to and take better care of yourself (Neff, 2009), and you will be particularly better equipped to take the difficulties of your rotations in stride. Additionally, if things start to feel overwhelming, reach out to your support system for help or contact the Faculty and Staff Assistance Program. Our services are free and confidential and we provide counseling for both personal and work-related issues. We also provide referrals to mental health practitioners in the community. Please contact us at (415) 476-8279 or visit our Faculty and Staff Assistance Program Service page for more information.
For more exercises and to test how self-compassionate you are, go to www.self-compassion.org.
- Germer, C. K. (2009). The mindful path to self-compassion: Freeing yourself from destructive thoughts and emotions. New York, NY: The Guilford Press.
- McCray, L. W., Cronholm, P. F., Bogner, H. R., Gallo, J. J., & Neill, R. A. (2008). Resident physician burnout: Is there hope? Family Medicine, 40(9), 626-632.
- Neff, K. (2009). Self-compassion: A healthier way of relating to yourself. www.self-compassion.org.