Therapy for Doctors

You look like you’re fine. You’re really good at giving that impression. But in reality, you’re not coping. Anxiety has become your state of existence, your sleep is broken, you can’t switch off, your confidence is tanking, your brain is getting really chatty, and you’re constantly exhausted.

When people think of therapy, they typically think of it as for people who can’t function. Whereas for doctors it’s the exact opposite, it’s a problem with over-functioning, over-thinking and over-doing. This is what Therapy for Doctors focuses on.

Coming up in this article I’ll cover:

The early warning signs
How CBT helps doctors
Tackling confidence & self-criticism
Handling responsibility, empathy & guilt
Learning to switch off and be present
The reality of balancing medicine with family life
What it means to question your career when you’re exhausted
The different therapy routes available to doctors, including funded support

Topics explored in more depth

There’s a few topics I felt deserved an article in their own right.
Therefore I’ve written 5 additional articles on topics regularly explored in Therapy for Doctors.
The links for these are at the end of this article.

Burnout in Doctors
Therapy for Junior Doctors
Decision-Making Anxiety and Managing Uncertainty
PTSD in Doctors
Return to Work Support for Doctors

Why doctors keep pushing

To do your job well, you have to be able to put your own emotions and problems to the side. A great professional skill. But it also means that you’ve gotten a bit too good at ignoring what’s going on for yourself, and at prioritising everything and everyone else before yourself. Most helpers are not good at asking for help.

For many there’s also a shame for struggling to cope when from the outside your life looks good. You tell yourself you don’t have anything to complain about, that you’re lucky, that you should be more grateful. But it’s not that simple. Anxiety and Depression don’t only come from having a difficult life, they also come from having the constant noise of overthinking and using ways of coping that are unfortunately making the problem worse.

Most of your life, pushing hard has resulted in praise, achieving has been celebrated, and having no boundaries has been normalised in the NHS. You start to connect your worth to what you do for others and your success, and your whole identity accidentally gets absorbed in being a doctor.

Therapy will give you the time and space to step back from all of this. CBT could help you to disengage with thoughts, get good sleep, reduce anxiety, improve happiness, develop confidence and more.

1. The early warning signs

Here are the top 10 signs you might benefit from therapy:

Sleep
Trouble getting asleep
Trouble staying asleep, those 2am wake ups becoming frequent
Poor sleep quality & feeling knackered still the next day

Physical impact
Feeling exhausted
Always on edge, feeling panicky
Headaches, tummy ache, getting sick more often

Not switching off
Re-playing work scenarios at home
Checking emails on days off
Working beyond work hours all the time

Poor eating/drinking
Skipping meals
Eating more takeaways or snack food
Drinking more alcohol & caffeine

Disconnecting from life
Reduced socialising
Reduced hobbies
Staying in the house more

Unhappy
Feeling as if you’re just existing not living
Reduced motivation & interest
Not looking forward to things

Not present
There, but not there
Going through the motions
Distracted all the time

Declining confidence
Questioning your decisions
Needing more reassurance
Being excessively risk adverse at work

Feeling anxious
Worrying about making mistakes
Double checking & redoing tasks
Looking things up more than previously

Self-criticism
Blaming yourself for patient outcomes beyond your control
Telling yourself you’re not good enough, that you’re a bad doctor
Criticising yourself as a parent, partner, friend etc

If quite a few of these sound familiar, therapy could be exactly what you need.
Maybe it’s time to stop pushing and pretending and get some expert support.

I’m ready to find out more
Chat to Hannah hannahpaskintherapy.co.uk/book-now/

2. CBT for doctors (how CBT can help)

CBT can work on all the signs listed above. But therapy isn’t just about resolving the impact you’re experiencing right now, it’s also about better understanding ourselves and tackling the things that stop us being the version of ourselves we are hoping for.

CBT can help you to:

Relax, switch off & enjoy yourself
Being able to relax and slow-down is a skill that can be learnt
There is strategies to help you switch off from overthinking and worry
Both of these help you to be better able to enjoy yourself

Tackle People pleasing & boundaries
Tackling the guilt for considering yourself
Helping you to learn to say no
Introducing the necessary boundaries to keep you well

Overcome burnout
Understand what burnout is & how to recover
Lean to spot the signs in future
Have a plan in place to prevent it happening again

Develop Self-confidence
Teaching you how to trust in your knowledge & decisions
Move away from unnecessary reassurance seeking
Stopping the double checking and avoidance

Challenge Impossible self-standards
Learn to recognise what’s possible, and what’s not
Move away from a black and white approach to everything
Improve self-praise & reduce self-criticism

Overcome low mood
Get back to enjoying life
Return to hobbies & social life
Be more present in life

CBT does this by looking at:
> Our ways of thinking
> How we behave or cope
> Our history & reasons why

The ways we cope are all about trying to help ourselves. But often this is by trying to avoid the feelings that are uncomfortable – feeling anxious, feeling out of control, feeling uncertain, feeling not good enough. It makes sense that we’d want to avoid all that right? But unfortunately, efforts to avoid these feelings, rather than learning how to overcome them, mean that we keep the problem going, and over time it gets harder to deal with.

CBT therapy for doctors doesn’t ignore the reality of the job. Instead, it looks at how to better equip you to manage your work without it impacting your life and happiness.

3. Tackling confidence & self-criticism

Confidence at work
Working as a medic is full of uncertainty. You are often making best guess decisions, whilst having gaps in information, and relying on details from the patient (who at times can be an unreliable source). You have to follow a path, wait and see, and re-assess as and when new information comes to light.

Managing this reality, without becoming anxious is a regular challenge for doctors.

The temptation is to try to seek more certainty by:
> Seeking reassurance from colleagues/seniors
> Doing extra research
> Double and triple checking what you’ve done
> Ordering extra tests
> Making just in case referrals onwards
> Writing more detailed notes than needed
> Re-reading all the past written notes
> Staying late to finish work with the patient rather than handing over (hospital staff), or doing extra follow up steps to check in (community staff)
> Exploring all their symptoms/problems, rather than just the ones they are booked to deal with
> Delay discharging them

All these behaviours are done to try to increase your confidence/certainty when dealing with patients. But unfortunately, the reality is the more we act like we can’t trust ourselves, the more we start to believe that to be true, and the longer you do these behaviours, the more anxious you will become.

Therapy explores all of this and more teaching you a different way to approach uncertainty and anxiety.

Self-criticism
The medical profession encourages self-reflection. Serious incident reviews try to identify learning and what could have been done differently. The threat of coroner’s court or being sued by someone creates additional fear of making a mistake. All of this increases the likelihood of a skewed way of thinking about yourself.

Here are 4 of the most common thinking traps:

> Black and white thinking
This is when we see things in extremes. It’s either good or it’s bad. It’s either right or it’s wrong. We are either skilled or incompetent. We filter information to be one end of the scale or the other. We disregard any option in between.

> Never good enough
This is where we tell ourselves that it’s not enough – that what we are doing is not enough, what we know is not enough. You criticise yourself for what you ‘should’ have done. You downplay anything that you did do.

> It’s my fault
You take on a dis-proportionate amount of responsibility for the patient and their outcomes. In reality you are just one cog in the process, and the patient (if they have mental capacity) has a significant role in their own healthcare management too. You are also not responsible for the impact of a failing NHS service that is under-resourced.

> Catastrophic thinking
This is where we are stuck on thinking about the worst possible outcome. Constant worrying about what could happen (even though it likely won’t). You’re 10 steps ahead of the reality, imagining your patient dying, getting sacked, and lots of other disasters – an exhausting process.

Cognitive work is a huge part of therapy, helping you to intercept these unhelpful thinking styles and find a new way forwards.

4. Handing responsibility, empathy & guilt

Medical training instils ideas such as ‘it’s a calling’ ‘it’s a vocation’ ‘born to help’ and many others. The example set by seniors and colleagues during your career will have rarely been one of boundaries, and often a precedent of giving your everything, normalising this as a way to be as a doctor. Many doctors are also naturally empaths – feeling the suffering of their patients as if it’s their own.

All of these factors lead to a greater chance of taking on too much, making yourself responsible for things outside of your control, and essentially carrying the weight of the whole system on your back.
It can lead to feeling guilty for not doing everything possible for all clients (which often includes working well over hours, on your days off, not taking your annual leave and much more).

This can also show up with people pleasing with colleagues – taking on more than your fair share of tasks, taking on the harder tasks, helping others with their workload a disproportionate amount, not asking others for help and more.

In CBT, we work on how to separate yourself from carrying what isn’t yours. It’s not about caring less, it’s about caring in a way that doesn’t consume you and burn you out.

Read more about People Pleasing – hannahpaskintherapy.co.uk/understanding-people-pleasing

5. Learning to switch off and be present

For many high-achievers, rest and relaxation is something that’s uncomfortable and unfamiliar. You’re very good at being productive, at achieving. But stillness and restoration might not be in your skill-set. These things can feel like a waste of time when there’s so much that you ‘could/should’ be doing. Perhaps it feels like you have to earn it, not take it as you need it.

Your nervous system only knows how to be switched on. And that’s a problem. It stops you from getting a good night’s sleep, it stops you enjoying your annual leave fully, and stops you being present when doing your hobbies or spending time with loved ones.

Therapy can help you to learn how to switch off, learn how to relax without feeling guilty, to set much needed boundaries and create balance.

I’m ready to find out more
Chat to Hannah hannahpaskintherapy.co.uk/book-now/

6. Balancing medicine with family life

Being a medic is a demanding job. You can’t sit in the back office or have an easy day. When you’re at work, your brain and energy is being used to its full capacity. Work hours are also long for most doctors, with 10+ hour days, as well as on call or shift work.

The result – not much is left for us when work is done. Yet there are often duties waiting for you – being a parent, supporting ageing parents, managing a home etc. When work is already consuming, home life can feel like another shift.

An increasing number of doctors are choosing to work 80% hours. And an increasing number hire in help at home for tasks you don’t have time for – cleaning, meal prep, laundry, childcare etc. This isn’t about being lazy, this is about managing your capacity by outsourcing (when financially viable) as a way to free up time and energy for the things you need and for rest.

We can’t change the realities of a demanding job, or the duties waiting at home. But what we can look at is when you are trying to do too much, guilt tripping yourself for what is not possible, and struggling with setting boundaries or in making time for the necessary things to manage your wellbeing.

7. Questioning your career

If you’re anxious, overwhelmed, exhausted and feeling fed up, it’s understandable that you’d question if this is a job you want to keep doing. But for most it’s not that you don’t want to be a doctor in future, it’s that the emotional struggles you are experiencing right now don’t feel possible to keep going with.

Therapy can help you to tackle the problems getting in the way of the job feeling possible and enjoyable. Learning how to get a good night’s sleep, to stop the self-doubt, stop the burnout, stop the overthinking, stop the anxiety, restore enjoyment and all the other aspects talked about in this blog and within the series.

Once those aspects have been cleared out of the way, and your nervous system is calmer, it’s then possible to make a decision on your career future from a healthy place. For this to be possible, many will take time off work in the meantime, to allow them to focus on their emotional wellbeing.

Sometimes therapy supports people to stay in medicine with better coping strategies or boundaries. Sometimes it supports a planned transition. The important aspect is that the decision is made based on what is right for you, not from a place of fear and hopelessness.

If you’re off work and in the process of planning your return, take a look at my blog on this topic, link at the end of this article.

8. Therapy for Doctors with me

I’m a BABCP-accredited CBT therapist and I work privately with doctors across the UK online via video therapy, and in person in Cheshire.

My style is straight-talking and structured.

Read more about Hannah – hannahpaskintherapy.co.uk/about-hannah-paskin-therapy

Occupational health
I can work alongside occupational health in making suggestions for adjustments at work, and for phased returns, to ensure you get the most from OH input.

Therapy options
I offer private therapy for self-funding clients.
I also provide limited availability for funded therapy under the Practitioner Health scheme (via OneBright). Message me to find out more.

FAQs

Do I need to be at breaking point to start therapy?
No. Although many do refer at this stage – when off work or ready to quit. Therapy is really helpful before this stage, when you are still functioning, but your life and emotional state is being impacted. The earlier the better from a therapist perspective to prevent burnout, panic attacks and such like developing.

Is CBT appropriate if the job is genuinely stressful?
Yes. We don’t pretend the job isn’t stressful. I know the realities of the job from years of supporting doctors (and my time working in the NHS too). Solutions factor this in. The experience of being a doctor can be significantly improved by learning different ways to cope and think.

How long does therapy take?
This is a bit of an unknown, as it depends on what you’re coming to work on, and how easy you find making changes. However most clients will come for between 8-12 sessions, with a smaller number coming for up to 20 if they want more maintenance support or to work through more past issues.

What if I’m worried therapy will make me less driven?
Therapy isn’t about reducing your ambition. It’s about finding that sweet spot of achievement without un-sustainable impact. Most doctors who engage in therapy find they work better afterwards, as well as having a better life outside of work.

Next steps

1. Book a free discovery call (this is optional)
2. Book your therapy assessment appointment
hannahpaskintherapy.co.uk/book-now/

Links for 5 more articles in the series

Burnout in Doctors – hannahpaskintherapy.co.uk/burnout-in-doctors
Therapy for Junior Doctors – http://hannahpaskintherapy.co.uk/therapy-for-junior-doctors
Decision-making anxiety & managing uncertainty – http://hannahpaskintherapy.co.uk/doctors-with-anxiety
PTSD in doctors – http://hannahpaskintherapy.co.uk/doctors-with-ptsd
Return to work support for doctors – http://hannahpaskintherapy.co.uk/return-to-work-doctors

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