Performance Psychology for Physicians
Are you looking to achieve optimal performance?
Performance psychology is the next wave in physician wellness.
I am a practicing counseling psychologist who specializes in treating physicians and medical learners. After years of providing psychotherapy to doctors within traditional outpatient behavioral health contexts, I developed a growing dissatisfaction with how the field of medicine (and medical education) approaches conversations about "physician wellness." While traditional psychotherapy is unequivocally beneficial for a certain subset of physicians who are struggling with difficulties such as pervasive anxiety, mood disorders, unprocessed trauma history, or other acute psychiatric issues, it is not the right tool for every "wellness" concern that doctors face. Many of my physician psychotherapy patients were seeking something that did not quite jibe with the template of intervention that therapy provides. Rather than needing treatment, they were seeking guidance to facilitate their growth or avoid further entrenchment in maladaptive habits that fostered distress, impeded performance, and dampened their feelings of satisfaction in their accomplishments. Achieving Optimal was born out of recognition of this deficit in our current narrative of "physician wellness," with the intention of building a more expansive paradigm that better encompasses the full scope of physicians’ needs for psychological support.
What's wrong with "physician wellness"?
At present, the prevailing paradigm underlying conversations about physician wellness is rooted in a medical model, wherein well-being is understood as the absence of impairment or illness. It focuses on intervention at the secondary or even tertiary level, typically addressing physicians’ distress after it has already manifested. It is prevention-oriented only to the extent that it seeks to instruct doctors in how to avoid onset of impairment. Missing from this narrative is not just an emphasis on primary prevention interventions, but rather any interventions that are not based in a pathology-focused framework. After years of practicing as a counseling psychologist in contexts that were explicitly focused on physician wellness, I developed a nagging feeling that there was something off about this paradigm. Despite work by so many amazing people who are passionately committed to the mission of physician wellness, it seemed like our efforts to prevent burnout and encourage doctors' flourishing were accomplishing little in catalyzing real change. Eventually, I realized that education and outreach to doctors on all things under the umbrella of "physician wellness" seem to inadvertently, implicitly communicate this message: "you're fine, so long as you haven't shown these red flag signs of actual, full-on illness or impairment. You should keep grinding it out until you see these signs of impairment, at which point the responsibility is on you to avail yourself of mental health treatment.” In essence, "wellness" is something physicians should maintain on the periphery of their attention, only to be centered when its erosion begins to impede effectiveness in pursuing other priorities.
I have thought a lot about why doctors seem to be so comfortable with that paradigm, and why it has failed to yield the sort of widespread changes in the culture of medicine that those of us who specialize in treating physicians would like to see. Why is it that so many doctors give full-throated endorsement of the importance of physician wellness as an aspirational ideal of the field, yet fail to apply that ideal to their own lived experience? And then I realized: very few physicians are going to be passionate about their wellness. Being well (meaning functioning effectively and free of illness or impairment) is basically like earning a grade of "C" in life -- it's the bare minimum of what is passable. It is expected. It is wholly unremarkable; it is by no means a hallmark of achievement. Thus, interventions that use the framing of "wellness" will likely always bear some degree of stigma for the high-achieving individuals who pursue a career in medicine. Many doctors will avoid engaging with that narrative because they find it lacking in salience to them (because they rightly see themselves as the high-achievers that they are), and others will actively disavow it -- because engaging with interventions employing that narrative is tantamount to admitting that you don't know how to take care of yourself, that you don't know how to be effective at pursuing your goals, that you can't figure out how to enact the most fundamental problem-solving necessary to be a functional human. The extant paradigm of how we talk about "physician wellness" is great for reducing stigma around help-seeking for those doctors who are struggling with diagnosable mental health concerns and need treatment. For the rest of the doctors out there, the ones who haven’t (yet) experienced any signs of illness or impairment, that model does not resonate at all. The paradigm of “physician wellness” needs to speak to doctors at all levels of functioning in order for prevention-oriented efforts to be effective. Otherwise, we're just waiting for people to go off the rails before we offer any help -- and by then, some damage (to self-worth, to confidence, to career trajectory, to relationships, etc.) has already been done.
So, what is the alternative?
Simply put: in my experience, many doctors typically aren't thinking about their "wellness" until it becomes a problem, and unfortunately the prevailing narrative in the realm of physician wellness has only served to reinforce that mindset. If we truly want to foster wellness as a more expansive concept – something beyond the absence of illness – then we need a model of physician wellness that centers the mindset, worldview, self-expectations, and cognitive habits that prime doctors to THRIVE. This is not just “the power of positive thinking.” It is the application of principles of psychology from outside of the clinical realm, with particular emphasis on performance psychology. There is also value in including principles gleaned from other branches of psychological practice, such as liberation psychology. I am deeply devoted to the ideal of physician wellness, and I believe that the way to make true progress towards this ideal is to abandon the pathology-focused paradigm and replace it with an achievement-focused alternative.
My approach to practice centers on assisting physicians in attaining and sustaining purposeful, effective and meaningful engagement in their various roles (across both professional and personal contexts) via strategic shaping of performance mindset. In many ways this looks like traditional psychotherapy (e.g., talking with a trained professional in a confidential context with the intention of obtaining some change in functioning), but it is markedly more structured and goal oriented. I provide consultation, not counseling.
More FAQ, tbd
How is consultation different from counseling?
Counseling or psychotherapy is usually about fixing a problem or ameliorating some impairment in functioning. Consultation is more similar to coaching, in that it is intended to actualize growth and assist with attaining specific outcome(s). I characterize my work as consultation, as I feel that this term connotes the expertise I bring as a trained psychologist and implies the full scope of intervention that I am qualified to provide (i.e., coaching tends to be more narrow in focus).
Very generally speaking: therapy is intended to offer healing. Consultation is intended to foster growth. Often this distinction is not so clear cut in practice. However, because of my training and experience as a psychologist, I can help to tease apart if there appears to be a clinical element to your performance concerns and assist you in accessing care for that piece of the puzzle if needed. Ultimately, my focus is not on pathology; it is on helping you to add to the tools in your toolbox, sharpen the tools you already have, and assist you in determining if you’re currently using the right tools for the job (because humans have a tendency to keep using what has worked in the past, even if it has stopped being as effective as it used to be or if a different strategy might work better).
What do you need to bring to this process to get the most out of it?
For consultation to be fruitful, you should come in with a basic conceptualization of the concern with which you need support. As in: how do you want things to be different? It does not have to be tremendously specific – getting to that level of clarity is often a major initial step in this process – but it does have to have some level of awareness of what or how you want things to be different.
You should also have a sense of personal responsibility for making the change you want to see happen. This does not mean blaming yourself for things that may feel like they are going wrong; it means having some sense of ownership of what you are bringing to the situation. In my experience, most physicians do not have difficulty with this piece. If anything, they have too much of a sense of personal responsibility.
A significant part of what makes intervention effective is that you bring with you some level of cognitive and emotional resources that you feel able to allocate towards change. It doesn’t have to be a lot, but change requires resources. The more resources you have to put towards your goal, the faster you will make it happen. There’s nothing wrong with having limited resources – you just have to have some small amount of time and energy to spare. If you are already feeling burnt out and exhausted to the point where you are unsure whether you have the resources to allocate towards change, I would highly recommend pursuing counseling first before initiating the process of performance consultation. There is no shame whatsoever in prioritizing the bolstering of your resources, and those self-care (and related) skills will also be instrumental in the process of performance enhancement.