S3-E63-The hidden way we sabotage clinical growth + 4 psychological defences that keep us stuck

Welcome to the unleash, your best clinical self podcast.

I'm your host, Andrew Koppejan.

If you're a physiotherapist or other movement professional,

who feels like you're stuck in a rut, then my podcast is for you.

This podcast is focused on helping you move from frustration to flow

in your clinical practice and each episode I'll share strategies,

approaches, and my latest thinking on how to improve your clinical

performance and keep loving what you do.

This is episode number 63 and in this episode, I'm going to be talking

about the hidden ways that we can sabotage our clinical growth.

I'll also walk through 4 psychological defenses that can actually keep

us stuck in our clinical practice.

Before I dive in, though, I want to let you know that I have a newsletter

where I write about topics relating to improving clinical performance

and achieving clinical flow head over to 360 clinician.com to sign up.

I want to start off with a little story that was from when I was very young

and I got thinking about this story.

We were doing some reminiscing with family and I, and when I was around

seven or eight years old, for some reason, I don't know why, but I was

convinced that the word couple could mean two or three, not just two.

And so even though I have older siblings that would correct me, I

was very adamant that I was correct.

And I just think back to that time.

I'm like, I'm not sure how I really wrap that around my head but it

wasn't really open for discussion.

In my mind it was settled and thankfully I moved past that and got a little bit

better command of the English language.

I was thinking about this story when I thought about how often I can be blind

to learning something new because of my need to protect my sense of self and my

sense of feeling that I'm right about it.

It wasn't until I was exposed to a concept called the psychological immune system.

That I began to understand why I avoided uncomfortable learning experiences.

And this concept of the psychological immune system was first introduced by

psychologist, Wilson and Gilbert, in their research around decision-making.

They shared about this concept of the immune system in that article

and I can put it in the show notes and they said the physiological immune

system is one that fights threats to physical health and people have

a psychological immune system that fights threats to emotional wellbeing.

I think it's a, it's an interesting concept and one that I think helps

explain some of the ways that we will try to protect ourselves from threatening

events and experiences in our life.

But the rub is that learning and growth can actually be very challenging,

uncomfortable and even at times, threatening to our sense of self.

Our psychological defense system helps maintain our sense

of equilibrium emotionally.

But it can actually work against us when we're trying

to look at learning and growth.

If it, sees some of these events as threatening to our sense of wellbeing.

So this concept has really helped give me some language and a framework to

understand how I've protected my own ego at the expense of my growth at times.

When our ego feels threatened, it's easy to deceive ourselves.

We can misplace blame and we can trivialize new information.

But it's in our effort to actually defend our ego and protect ourselves,

we actually miss opportunities for learning and growing as clinicians.

I think that there's always this balance that we have to achieve right.

On one side we have self protection and on the other side we have growth

and our ego is always working to say, okay am I feeling threatened right now?

Or do I feel safe?

And this sort of oscillating between these two ends of the scale, I think

that it's when we can get a better sense of how to manage our own sense

of self so that we can actually move into some of these learning situations

that may feel a little uncomfortable.

We can actually be open to that rather than shutting that down

and trying to protect ourselves.

And so there are some traps of the ego that I've identified in my own

life and I wanted to share with you and hopefully you find this helpful.

But I think there are quite a number of ways that we can sabotage ourselves.

Whether that's conscious or subconscious, and I think these different ways

that we try to protect our ego and maintain that internal equilibrium.

So here's four that, I found for my own clinical experience that I've

realized can actually work against me.

The first trap I've discovered is just isolating myself from outside help.

I find that when I'm my ego defenses are active it's hard to reach

out to somebody else for help.

I thought back to when I was a student.

And there's always this expectation as a student that you would ask for help.

There was definitely a safety in the role of being a student, that you could ask

questions and that was expected of you.

But the longer that you end up being out of practice the harder it

becomes to have that beginner's mind.

That place where we can actually be humble and we can accept this idea of

not knowing but also having that courage and openness to ask for help from others.

Trap number two is avoiding learning because of the

challenge to my sense of self.

I've thought about this.

When I think about topics that I maybe need to learn more about, I have

this intention to look it up but then oftentimes I don't follow through on it.

And it's something that we can think, oh, well, I'm busy and so I don't have time.

But I also noticed that there are times when it's not about a time

issue it's more actually about my ego.

And sometimes when we look things up, it actually requires us to confront

our lack of knowledge about a topic.

I think part of it too, with this psychological defenses, is that

they can oftentimes be unconscious.

We can remain largely unaware of how they're operating in the background.

I think back to a clinical case that I had a while ago where the patient

was complaining of a persistent shin pain and I was treating

actually other areas of the body.

And so I put off looking at this area for this patient and

really it was something that I should have put more attention to.

I think that I would have referred her out for further workup and imaging

because of some of the symptoms this patient was complaining about.

I was disappointed with myself that I wasn't more prompt with my referral.

I felt my anxiety increase and I felt my sense of competence

in some ways be threatened.

And I knew that I needed to do a thorough case review and really think through how

to avoid this in the future and how I could have approached it differently.

I actually found myself really struggling to go deeper with this

topic and spending the time on it because it forced me to confront this

ego threatening experience to me.

And so it can be helpful to look back at cases in your caseload to look

at okay, well, are there situations that I'm actually avoiding looking

up something or I'm learning about something because of the fact that it

actually makes me feel uncomfortable.

I have to face the fact that I didn't know something about that topic.

Trap number three is avoiding acknowledging our limitations.

Something that I've noticed myself is this tendency to avoid referring to another

provider, especially when it's, you know, could potentially effect my ego.

Sometimes it's hard to acknowledge and accept that I may actually not be

the best person to solve that person's problems and they need another type

of treatment or another provider to provide a different perspective.

Confronting that reality can definitely be an a front to the ego and can

threaten the psychological immune system.

Now, knowing when to refer to another provider can be a challenging decision

and there's a lot that goes into it.

But I think it's important to look at okay, well, what's the

reason for avoiding the referral.

Is it because of the fact that it is a threatening my

psychological immune system?

Or is it because I am just giving up too easily.

Whatever it is, I think really looking at that reason for avoiding referral

will help to give some clarity in terms of what's actually holding

you back from taking that next step.

Trap number four is distracting ourselves with shiny objects.

I've found that it's really easy to distract myself with new information

or experiences and really falling prey to the shiny object syndrome.

We learn new information or take a course on a new topic.

In some ways it doesn't threaten our sense of self it's, new it's fresh.

We're not really having to go back and look at how we've performed or look

at the gaps in our existing knowledge.

I think that learning new information is good but it's not growth producing if it's

an avoidance response to placate our ego.

I think it's a lot more exciting and dopamine producing when we're

exposed to new ideas and information.

Working through a past patient case where we've missed a diagnosis is

going to be a lot more important and a lot more growth oriented.

I spent a number of years practicing piano, and I was often working on

classical piano pieces for months on end.

Oftentimes I just got tired of working through a section of music and I wanted

something new and exciting to work on.

The crux of it was that I needed to spend the time focusing on the stuff I needed

to work on, because that was really what was going to help me move forward in terms

of be able to master that piece of music.

Another shiny object distraction is consuming social media content.

A situation where we feel like, oh, I just need a new exercise or

I need something new to go with.

I think that a lot of times we have to be honest in terms of these are just

small dopamine hits that help us feel good and they really are a distraction

from maybe something that we do actually need to dig into a little more.

So in brief, we have four traps of the ego that I've just talked through.

The first is we isolate ourselves, we avoid asking for help.

Number two is we can ignore what we need to actually focus on and we

avoid learning things that are really going to help improve our growth.

The third is we avoid referring out because it is a threat to our ego and

then four is distracting ourselves by moving on to new information when in

reality, we should actually be focusing on what we're already looking at.

So the thing is, that if we engage in these traps of the ego on a regular

basis, I can definitely stunt and stagnate our professional growth.

When we look at our egos and our psychological immune system

it can be challenging work.

Because we're dealing with motions and established beliefs and really some of the

things that can even impact our sense of who we are as people and our identities.

With all of that said I do believe that it is necessary work to engage in,

especially if you are committed to a deeper growth and improvement in terms of

your skill and ability to help patients.

Alright let's dive in to some ways that you can start to navigate the

psychological immune system and give less power to our ego protective strategies.

First off, I think it's important to understand your ego protective traps

or the patterns that you fall into.

Getting comfortable with understanding what's going on

inside is really important.

I've found that writing things down can be such a powerful way to bring

clarity to what's actually going on.

Sometimes things can feel really confusing and messy.

I found that just journaling and writing this stuff down can really help

to bring clarity and perspective to some of the emotions and thoughts that

are swirling around in my own head.

What I've done is I've put a little a worksheet together that you can head

over to the blog to check out and it's just really meant to be a starting

point to get some things down on paper.

And it's a place where you can identify the feelings, are you

feeling discomfort, overwhelmed?

What's triggering this ego response?

What's the response that I'm defaulting to?

What do I feel most comfortable in terms of trying to get

myself out of the situation?

Am I trying to isolate myself?

Am I trying to ignore it?

Am I trying to avoid by trying to distract.

Then I have another column that's how can I respond instead?

Is there something that I can do to reach out?

Can I lean into this topic?

Can I refer out?

Is that going to be the best thing here for that patient?

Is there a way that I can stay present rather than just distracting myself with

new information or with social media.

The second strategy is to start to get comfortable with

discomfort and vulnerability.

And I think an important, but often really hard step is embracing that

discomfort and vulnerability that's present when our psychological

immune system has been activated.

The challenge is that negative and threatening events can really challenge

our perception of ourselves and how competent we feel about ourselves.

And what's interesting is the research shows that negative and threatening

events can actually increase the energy we put into analyzing our situations more

than neutral or positive experiences.

I think it actually can act as a catalyst for deeper learning and growth when we

can bring that increased attention during those stressful or threatening times.

Instead of seeing these triggering events as something to run from or

avoid, I'd encourage you to try to reframe them as opportunities for growth.

I find for myself, this really helps me to better cope with the discomfort

that those situations can often bring.

Just trying to remind myself that okay, this discomfort may be temporary but the

growth and personal development I can engage in here by facing these challenges

can actually be really long lasting.

So just what I've been trying to do is just really trying to reframe how I look

at these experiences and just recognizing what's temporary and what's really my

outcome or goal that I'm looking for.

Number three is to actually challenge the self-talk.

And in one of my previous episodes, I talk about the importance of

self-talk and how that affects our ability to perform well clinically.

Oftentimes we end up dealing with various cognitive distortions like all or nothing

thinking or overgeneralization can actually keep us isolated and can prevent

us from taking a growth focused action.

So I'd encourage you to check out some of my previous episodes where

you can learn more about that.

The fourth strategy is to be your own coach.

And I've found that whenever I've encountered clinical situations where

my ego is being challenged and maybe my defense mechanisms start to kick in.

I found that it's actually helpful to take on this role of being my own coach.

I'll explain a little bit more of what I mean by that, but it's really a

process where I take a step back from the situation and try to create a little

bit more emotional space to allow for deeper reflection and processing.

Here's some steps that I've jotted down that I found myself going through when

I'm trying to take on being my own coach.

So first off is, I try to acknowledge my own discomfort.

It's important and this is what I try to do for myself as I

acknowledged that, okay, discomfort and threat to the ego is real.

And I want to acknowledge that for myself.

I'm not trying to minimize the experience.

And I find that first step really just helps me to not just try to stuff

under the rug, minimize what I'm going through, but just to acknowledge,

okay, this is yeah, this is real right.

That first step I find is a really good place to, to get

grounded in what's going on.

Then second step is to recognize my own ego driven action.

So I want to then reflect on, okay, well, what am I trying to do here?

What's my default to keep things in balance.

Do I want to isolate, do I want to avoid, ignore, distract?

Typically, I find it's actually pretty easy to identify what that is because

it's the action that I feel will be the easiest and the fastest to get

out of this state of discomfort.

Then number three then I'll do is I'll review how that threat impacts my ego.

I've found that understanding what the threat can mean to

my ego is really helpful.

So if it's exploring a clinical case where I missed the diagnosis, what

is it that I'm saying about myself?

Am I telling myself that I'm incompetent?

That I'm no good.

How does this situation threaten my identity as a person or

in my role as a clinician?

Taking that next step to say, okay, what is this threatening situation?

How is that impacting my sense of identity, who I see myself, the

role that I'm playing as a physio.

Really looking at that and then what I do is I, then I challenged

myself with a small growth action.

Something that's small and doable just feels a lot less daunting and less

threatening to actually take action.

I think the nice thing with small action and something I'd talk

about with my patients is it just requires less motivation.

And I think, okay, what's that initial action that will get me

comfortable with moving into a place of learning and growth.

For example, it might be just taking a look at one chart note for a

case that I really need to look at.

Or it might be sending an email to a colleague to just set up

a time to connect by phone.

Or it might be printing off a journal article that I've been

holding off on because of the fact that it threatens my sense of

understanding around a particular topic.

The last part is to just celebrate that small action.

From some of the stuff that I've read around motivation and habit building

is a small win helps us feel good and we do more of what we feel good doing.

So those little steps there are really meant to help you coach yourself and

that's what I've found helpful in my own practice to be able to move past this

place of being stuck when it comes to kicking in those ego defense mechanisms.

The last strategy is to expand your sense of self.

In my reading around psychological immune system, I came across this

theory in psychology called a theory of positive affirmation.

It really talks about how when we can define our sense of self worth outside of

an area of threat, it actually bolsters our sense of self and protects us from a

threatening information and situations.

Really, what it does, it allows us to respond in healthier ways and we haven't

put all our eggs in one basket in terms of in our role where we're feeling threatened

and we can start to see ourselves having multiple roles that really aren't being

threatened by that particular situation.

So it really means looking at our value of who we are outside of our clinical work.

What roles do we have outside?

Like, The role of a spouse, or a friend, or a parent, mentor.

Exploring those roles, I think can really be helpful to start to have a

more robust sense of self that isn't going to be terribly disrupted when we

have a threatening situation affect us.

I think the other thing too, is that we can also look at engaging in activities

that reinforce values that we have unrelated to the threatening event.

So in essence we're getting that robust, multidimensional understanding

of ourselves, that means that the threatening experience just

has less weight in our lives.

I hope those strategies are helpful.

I'll just do a quick review here before I sign off.

In terms of ways to get unstuck around avoiding learning and growth

because of our ego protective system.

I think it's important to look at what traps we tend to fall into

most frequently or most comfortably.

Getting some stuff down on paper can really be a helpful

way to better understand that.

I talked about the importance of embracing discomfort and vulnerability.

And really trying to reframe some of these situations as

opportunities for learning and growth.

Talked then about the importance of challenging our self-talk and

then being our own coach and really supporting ourselves and having a

bit of a process to be able to create some space emotionally so that we can

actually understand how we can respond in a more growth oriented fashion.

Lastly, I talked about the idea of expanding our sense of self looking at

the roles that we play outside of our clinical work, as well as activities that

we can engage in outside of our clinical work that can help to give us a little

more multidimensional understanding of ourselves so we aren't as negatively

impacted by situations that we may perceive as threatening or challenging.

Thanks for hanging out with me today and hearing about how to improve your

clinical performance, make sure to subscribe on iTunes or Spotify to

stay up to date on future episodes.

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Here's to less frustration, more flow and better clinical results.