How To Defeat Your Inner Critic
I was recently discussing my work in physician burnout with one of my colleagues, and he inquired about the most common factors leading to burnout. While there are factors unique to each physician along with more widespread systemic factors (which I discuss regarding primary care here), one of the individual factors I see most often in burned out physicians is some degree of perfectionism. Perfectionism is one of those traits, like anxiety, that we often learn to feed off of. It’s like having your own personal drill sergeant in your mind. We think that without constantly beating ourselves up over needing to do something more, or better, or faster, we’d never accomplish anything, or at least not to the degree that meets our impossibly high standards. However, one of the drawbacks of perfectionism is that it often coexists with other distorted thoughts, such as “if I can’t do this right, I’m not going to do it at all.” How many amazing opportunities have been passed over because of all-or-nothing thinking?
One of the things I love about coaching is that we use creative focusing or redirection in order to help clients bring about the change they want in their lives, and this can be incredibly useful when working with perfectionism. I first learned about the power of reframing when working with primary care patients about lifestyle changes. I would ask about diet and exercise, and invariably patients would tell me about all the things they weren’t doing and why: “I want to exercise more but I feel way too tired after a long day at work,” “I tried giving up sodas but I really don’t like the taste of water,” or “I wish I could stop eating so much fast food but I don’t have time to cook.” A question that I was hoping would lead to a positive conversation about behavioral change ends up being a litany of ways that they’re not meeting their goal. This emphasis on what isn’t working is often very similar to perfectionism - we may accomplish a lot but find ourselves focusing on the one thing that didn’t go as well. If this sounds familiar to you, in this article I’ll share three reframes that you can use to combat perfectionism when you’re feeling down on yourself for not doing enough.
The Present: What are you already doing?
Before my coach training, lifestyle counseling with patients could be frustrating for me as I would reiterate the negative impacts of unhealthy lifestyle choices or find myself locked in an argument about whether they really don’t have time or energy to make a change. But now, I relax and let patients do the arguing for me with one simple question. When they tell me they can’t run like they used to ever since their knee injury and it feels like the conversation is shutting down, I ask: “What other ways are you getting physical activity?” Suddenly they light up and share how they try to park farther away so they get in more steps on their way to the mall, or how they do some hand weights a few times a week, or how they get some steps in with a colleague during their lunch on Mondays and Fridays.
When I coach physicians who are their own biggest critic (which, let’s be honest, is fairly common in medicine), having a realistic conversation about what you’re already doing can be eye-opening. Perfectionism has a way of distorting the reality of the situation such that we discount everything we do well and become laser-focused on the one thing we’re not doing. When I was going through the worst of my burnout, I did a daily exercise inspired by the “three good things” gratitude practice, but I changed it to “three amazing things I did today.” Some days, the bar was pretty low for what constituted “amazing,” but I made myself write down three things each day that I either did well, did despite my fears, or did to create a general positive effect in my life. It may sound conceited, but doing this over a period of months helped undo a lifetime of internal self-criticism and gave me the confidence to start putting my life back together.
The Past: What has worked for you before?
Sometimes it can be difficult to find the ways you’re showing up for your goals in the present, and that’s when it can be useful to discuss best past experiences. I love using this tactic with people who are trying to quit smoking. Rather than getting mired in how hard it is to quit right now, I ask if they’ve quit before. The answer is often yes, so I’ll express curiosity about that experience. People will smile and shrug as they talk about how they did it cold turkey, or with gum, or with a friend who helped them be accountable. Then you can explore the key features that helped them be successful for that period of time, which is all about reinforcing the strengths they can leverage the next time they quit. I often ask patients how many times they’ve quit and reflect that it takes 6 to 30 times on average, so their prior temporary cessations are moving them closer to their ultimate goal of quitting for good. It’s not that they can’t quit for good; they just haven’t yet.
The mantra of not yet goes hand in hand with the concept of growth mindset. Often as perfectionists we expect to be experts at everything from the moment we start doing it, and we can be impatient with ourselves when we need time to learn and practice. This is where looking at past experiences can provide encouragement and perspective. Maybe thinking about a way you approached this problem in the past will lead to the strategy you’ve been looking for. Or maybe you’ve never faced anything like your current challenge, but you can reflect on obstacles that felt similarly insurmountable in the past and how you persevered despite your anxiety and doubts. Whatever your strategy, use past successes to boost your confidence and be patient with yourself as you experiment and learn.
The Future: Why do you want to do this?
For almost any lifestyle change, whether it’s adding a healthy habit or quitting a detrimental one, I love asking why someone wants to do this. It may be important to them to start exercising because they’re expecting their first grandchild and want to be able to take them camping someday and share their love of nature. They may want to quit smoking because they watched their parent suffer with chronic illness as a result of years of tobacco use, and they want to have a better quality of life in their senior years. We often tend to focus more on the obstacles than the “why,” but focusing on tangible ways that someone’s life will improve can help reinforce their willingness and determination to overcome those obstacles.
Focusing on your “why” can help with perfectionism as well. While it may feel that your motivation is already in overdrive and doesn’t need any more fuel, recognizing your values as a perfectionist can be experienced as a moment of compassion. “Ah, I’m pushing really hard for this promotion because being seen as competent at work is a big part of my self-image.” “I can see why this negative patient outcome has been so stressful for me - I have a lot of empathy and treat every patient the way I would want my own family to be treated.” Taking a moment to recognize the values that underlie your striving can ironically help shift the focus away from outcomes we can’t control. It opens a dialogue that perhaps the situation isn’t as black and white as it may have seemed, and there may be other ways to uphold what’s important to you without needing to control each detail.
By realistically acknowledging your current efforts, drawing encouragement from your prior successes, and reflecting on your values when the outcome feels out of your control, you can effectively combat your inner critic. This reframe will allow you to take back control over your internal dialogue in a way that supports not only your emotional health but your continued growth in your career. If you found yourself resonating with these descriptions of perfectionism and would like the benefit of a coach as you learn to retrain your thoughts, please sign up for a free consultation with us today for personalized support from like-minded physicians.