Monday, May 17, 2021

Helping our patients with better empowerment for change

In counseling/CBT, sometimes we say in the right context, that our emotional reaction may be more about us, than it is about the trigger that has caused that emotional reaction.


Because of the ABC of thinking and feeling.

A=Antecedent event or trigger

B=Belief. This refers to the underlying belief that leads to the emotion reaction e.g. Life should be fair. I am not good enough. Things have to be done properly or not at all. People who have done wrong need to be punished.  Everybody will leave me in the end. You can’t trust anybody. I am only significant if I achieve. I am insignificant if I fail. 

C=Consequence or our emotional reaction

Some may view this perspective as “victim blaming”, and it certainly can mean that, especially if that is the intention of the person who states it.

And at the same time, it can be also be a very emotionally empowering perspective. It allows us to own that emotion, and have more “control” of it through defusion, mindfulness, or change of those beliefs that lead to that reaction. 

If we can help our patients change the beliefs or their experience with those beliefs, we can help them change their emotional reactions and move towards a life that they want. 

It can empower them to escape from the Karpman Drama Triangle of victim, persecutor, or rescuer.

It may help us too. 

Saturday, May 15, 2021

As a Doctor, are you a “zoom in person” or “zoom out person”

A “zoom out person” is one who tends to zoom out and are biased towards seeing things in lower resolution but bigger picture. They are less interested in dealing with the small finer details.

“Zoom in person” on the other hand prefer to zoom in and see things through a microscope with great detail, but may fail to see the bigger picture at times.

I see General Practice more as a zoom out person’s domain.

Specialty is more of a zoom in person’s domain.

For great outcomes, zoom out-ers need to collaborate with zoom in-ners, and zoom in-ners need to collaborate with zoom out-ers.

Of course, we have both the zoom in and zoom out aspects in all of us, but some are in ratios of close to 50:50, and others are more like 90:10 or 10:90.

The problem I see is that if one is an extreme zoom inner, then General Practice may prove a bit difficult for you as the GP domain is probably more suited to a zoom outer.

You may not be in your element.

So what’s the solution?

1. Find a niche area in General Practice to “zoom into”.  
2. Learn how to “zoom out” more through defusion, mindfulness, and being more present. 
3. Collaborate with more zoom outers so that you can focus on what you do best... the zooming in. 
4. Find the emotional acceptance of what is IS.

I am zoom out person predominantly. I like to see things in lower resolution but bigger picture. With that in mind, I need zoom inners in my life to complement me. So I partner up with zoom inners. I work with zoom inners. I hire staff who are zoom inners.

If you find my posts lack direction or details, then that may be a sign of your “zooming in tendencies”.  And if you reflect on your partner, then they might be more of a zoom outer to complement your zooming in. 

Exposure to our opposites will give us the best contrast to better see and understand ourselves, and that’s a good thing. 

So time to reflect ....

Are you more of a zoom out person or a zoom in person?

Helping our patients through a balance between validation versus challenge

A lot of counseling and Family Medicine work involves a balance or integration of both the authentic validation, and the challenge of our patients’ thoughts and beliefs with facts, evidence and science. Often what’s required is the authentic validation or acknowledgement first, before the challenge can be explored more effectively without resistance.

There lies the “art” of medicine. The timing can be difficult to get perfectly right isn’t it?

If our patients resist, then it’s probably an over-challenge.

If our patients are making no progress or getting worse, then we may have over-validated. 

Over the years, I have observed and wondered if “mainstream medicine” have moved a little bit too much towards the “overchallenge”, and risk losing the connection with some of our patients, and the “alternative therapies” are moving too much towards the “over-validation”, which then have its own set of negative consequences.

How can we get the balance right?

I think being more aware is a good start.

So the real question is....

Are you an over-challenger?
Are you an over-validator?
Or have you got it just right?

For me, I have a tendency to over-challenge and hence, trying to be a better validator. Validation doesn’t mean that we agree or condone, it’s simply acknowledging an understanding, appreciation, and respect of the other person’s position and point of view.

Friday, May 14, 2021

Helping parents to repair when mistakes occur

When working with parents, it’s not unusual to see parents who have very high standards for their kids and also for themselves.

They can be very hard on their kids, but can also be very hard on themselves. If not careful, guilt and shame may show up often, and that can make things worse.

The trouble is, mistakes will occur. It’s inevitable. Parenting is very very hard.

The key is to have a way to repair it.

I usually try the “take two” approach.

When mistakes happen, we reflect and acknowledge that, and ask for a “take two”.

“Johnny. About what happened before and dad got really really cranky. Can we have a “take two” and try that again?”

Ideally, the earlier the repair, the better. 

Having said that, repair can happen at any time.  Sometimes days later. Sometimes years later. There’s no “statutory period”.