[00:00:00] Welcome to the Holistic Physician Coaching Podcast. I'm your host, Dr. Jessica Singh. This podcast explores physician health, wellbeing, and fulfillment, embracing all aspects of the human experience. Just as in medicine where a single interaction can transform a life, this podcast is grounded on the belief that each coaching conversation has the power to inspire, heal, and bring about meaningful change. 

[00:00:35] In this podcast episode, I will be debriefing my second coaching session with Mary. In preparing for this debriefing session, I realized how much not only vulnerability debriefing requires as a coach and honesty, but it's really interesting to do this in a podcast format where your coachee can hear you debrief.

[00:00:58] And so my intention for this podcast episode is to come from a place of self awareness as a coach, just to speak objectively over the events of the coaching sessions, to raise my own self awareness and see how I could best serve the person being coached.

[00:01:21] Mary and I were supposed to meet actually a week before our second coaching session happened, but unfortunately Mary had to cancel at the last minute. This brought up an interesting point for me for debriefing, because I've had this happen before with other physicians, especially where they cancel at the last minute. I have a coaching session cancellation policy where in the coaching agreement, I do require 48 hours notice. And I've been thinking about modifying this. I have seen other coaches have two different cancellation policies: one generic cancellation policy requiring 96 to 48 hours notice of cancellation; with a second policy, which is an emergency policy to allow for an absence. if there's a shorter notice of cancellation given. And I've seen many coaches, including myself not issue a refund for cancellations that happened outside of the cancellation policy. And this is extremely important. As a coach, our job is to provide structure, and in upholding that coaching agreement, it's really important that we establish boundaries, and so that the coachee also values and respects the time together. As a coach, it's also not just the time that we show up in coaching. It's the preparation, the presence, the effort. It's such a different interaction than these other interactions we have where our full presence is really what's required.

[00:03:06] And so how do you prepare for that? And so for me, when I schedule coaching clients, I'm really careful that day about the other things that I do. Make sure that I keep my head in the right place, state of mind, wellbeing so I can just fully be there with the person that I am coaching. Also with scheduling things get busy and it's not so easy to cancel at the last minute and reschedule it requires a lot. And there's a lot that goes into scheduling. However, I thought this was important to debrief because for the last coaching session, I was given about five or 10 minutes notice of cancellation.

[00:03:46] And a reason why was just having a lot of emotions show up, not being ready to be coached at that time. And I have seen this again, not just with Mary. It commonly comes with physicians especially when people are feeling emotionally overwhelmed or really tired. And I almost feel like it's this inner resistance to doing the deep work of coaching and just not needing that at that time. Having the physician being coached realize, "hey, maybe I'm not ready to be coached at this moment and show up and go there because emotionally, I'm not there." And so I find myself breaking my own cancellation policy because medicine is, the environment can be really traumatic in terms of expectations, a lack of forgiveness for personal events. And while that fosters discipline when needed and the ability to be present with a patient in life or death, it doesn't really allow much room for self compassion or just acceptance of being human. And so after I did my trauma informed training and became a trauma informed coach, I feel like I have become more gentle with this, at least for the first time to give forgiveness and space and understanding and really empathize with the person who is being coached when they schedule at the last minute.

[00:05:19] And I'm not sure if it's the right or wrong thing to do, but it feels right for me. If I noticed that there is a pattern that forms, then obviously that's a different issue and that has happened to me before. And I always just gently remind the client, "as per the coaching agreement can you please give me notice so I can plan?"

[00:05:42] But the thing is, when you're really busy and working really hard, especially with physicians and they're on call, sometimes things just come up. And so I don't really think it's possible to coach physicians without embracing the unexpected and realizing that they also, when you're own call and you're working clinically, things happen.

[00:06:04] How much control and autonomy do we have? So I am trying to figure out for now, at least. So I thought that was important for me to debrief because on the one hand, there's this, by the book, you know, this is what the coaching agreement is, and policies are, and yada yada.

[00:06:21] And coaches were supposed to follow these guidelines, and all of these things, but when you coach, it's very different. It's such an art of interpersonal communication and really also providing psychological safety.

[00:06:34] And so I've changed. I have changed and I'm evolving too, in terms of my policies and showing up. That doesn't mean that for anyone listening to this, I allow a freebie all the time and, you know, maybe I should be more strict with it. But I at least have noticed for a few people when they really need that space, I've met them there without judgment and provided space for them to be flexible.

[00:07:04] The thing that was interesting for me also in this case was, how do you set boundaries after somebody cancels? And so that's something I've also been more aware of. Because for me, especially, the scheduling, it takes planning a lot of different responsibilities and demands. And so I found myself in this case with Mary, almost trying to make it work even when it wasn't right for me, like trying to initially say, "Oh, I can do it on a Sunday" and Sundays are usually not coaching days for me. And whether it's temple or whether it's doing other work or spending time with family, I've tried to have very strict boundaries for myself, at least on Sundays. And I was also initially going to try to squeeze or make this session work wherever it could. And I realized, what am I doing? If the person being coached misses a session, I am to work them out at a time that is mutually beneficial. I'm not going to push myself to accommodate a last minute change in schedule when it's not right for me, because then I don't feel like I'm going to be able to show up fully and I won't feel valued or respected.

[00:08:16] I also don't think it sets the right tone to cancel out the minute last minute and then for me to put all my boundaries out the window to try to make things work. And so that's part of mutual respect. And I do believe in that. And so I make myself available, but I had to remind myself to really do it at a time that I could fully show up so I could best serve the person that I'm coaching. It turned out the day that I did coach Mary for the second session, I actually had a really hard emotional day just with family dynamics and things at home. And so an hour and a half before the session, I wanted to take a nap, but I actually realized it would be much better for me and for the person I was coaching to give healing to the relationship that required healing.

[00:09:12] And I spent time doing that because I realized I didn't want to carry any clouds over my head going into a coaching session with someone. And so it was worthwhile, really worthwhile to stop and make that effort. It was better than sleep because it put me right in the mindset to be able to coach. 

[00:09:32] The final thing that came up for me before my second coaching session with Mary was that I administer the Maslach Burnout Inventory Toolkit, which consists of the Maslach Burnout Inventory and Areas of Work Life Survey as a baseline pre-coaching assessment when I coach physicians. I administer this in conjunction with my own free text holistic coaching assessment, because I find it's nice to have objective pre and post data. The MBI toolkit is widely used, it's affordable, and this does require getting consent from the coachee so they understand how their data is used and stored by the assessment vendor. I realized though, that in coaching for this podcast, that I would have to talk to the vendor to see if they would give me permission to debrief the assessment on this podcast. And so that's pending. 

[00:10:29] There's so many things that come up. I was thinking initially, because this is my first time doing this podcast. So when I thought I should debrief each episode, initially, some part of me was wondering, will I have enough to debrief. And oh my goodness, there's a lot to debrief, and this is only my second coaching session debriefing in this format. And so it really is eyeopening because when I think about all the coaching sessions that I have, yes, I reflect on them. I think of them, but not in this depth or in the depth that I would when I'm being mentored. And so I'm actually really grateful to be doing these episodes to go more into depth with these things that are coming up, because I know they're so relevant for coaches and it's great to raise awareness.

[00:11:19] So those were three things that came for me before my second session with Mary. Now, I'll go into some points that I'd like to debrief after my second session with Mary. Before the formal coaching podcast episode started, we checked in briefly. I meet with the physicians who are being coached about 10 to 15 minutes before we record the podcast. And we very briefly check in and do a grounding activity to get centered for a time coaching together and for recording and just setting the intention to share and creating that container. In our brief check in before grounding and centering, Mary did apologize for the last minute cancellation.

[00:12:05] And it actually made me feel better, because I felt like my boundaries were being acknowledged, and that my schedule was being acknowledged. And I did explain to her that I wanted to give grace and acceptance for when things happen, and I understand how demanding it can be to be in a culture where we are expected to show up all the time, despite how we're feeling inside. And so that was a nice closure to that. I also did try to make the point that, you know, if it comes up again in the future, can you please give me notice? And so that, that was, I think it was well received. 

[00:12:43] In terms of the coaching session, we were getting into the conversation, but at the beginning, there was some like scratchy background technical noise. And so I was wondering whether it was for a podcast or not, do I say something to her? I didn't want to ruin the flow of the conversation, but I needed to hear her in order to coach her. So I did have to stop and interrupt her. And that's something as a coach, I'm trying to get more comfortable with is when to interrupt in a way that maintains that psychological safety and trust. For this case, of course, I had to interrupt so you can hear someone more clearly. But even the interrupting to redirect and get back on track so that there's space and time to facilitate shifts into new thinking during the coaching session. In this case, the internet actually went out. And so we had to restart and she moved to another section of her room and the internet was much better and the sound issue was resolved.

[00:13:43] One thing that came to me as I was preparing for this second coaching session with Mary and that came to me afterwards as I was debriefing was: technically in the National Board for Health and Wellness Coaching outline, in terms of competencies, they distinguish early coaching sessions from routine coaching sessions. And how early in the coaching relationship we are still exploring ideals versus gaps, meaning how things are in reality versus how people would ideally like their situations to be exploring their values, beliefs, and where to even utilize coaching or how to optimally utilize coaching and even just figuring out what questions to ask to be coached on. It was the second session and so I was torn between going through her assessment, continuing the assessment from last time versus just asking her "what would serve you the best today?" And so I realized there's a lot of gray and so I'm thinking that having formal feedback from a second session could be really beneficial. 

[00:14:56] I think it turned out well in this episode. By checking in with Mary, she was proactive and she was reflecting on the items we explored from the week before, how she was more aware of her support system and the impact that that has had on her. And so I didn't go into setting an agenda right away because we were exploring her reflections and it related in the big picture to everything she wanted to initially discuss during coaching.

[00:15:27] I think it took us about 15 minutes before I really started setting an agenda and asking what would be most beneficial to Mary in the 30 minutes we had left together. And I think that worked out well. With the pauses I could tell her active engagement. And she decided what she needed most, which was to come up with an action plan to support her, especially as she's going back to work, to keep herself emotionally grounded and to stop the 'spirals.' I'm using 'spirals' in air quotes because those were her words.

[00:16:05] And so I did like that approach. And it's something that I'm just going to continue to practice and see in the earlier coaching sessions what may be the optimal way to do this, which is to ask someone if they have a topic to go over, or do you start just by exploring holistically based on any assessment or information you were given in the first session, or like this one, a combination of both; which is usually what ends up happening for me, it's a combination of both.

[00:16:34] I also noticed that I question stacked in a couple of places. There was one time where I commented in the episode that I knew she had to go back to work in a week and asked her if mindful breathing is a practice she wanted to start and then without giving her the opportunity to respond, I asked her when she thought she would like to start.

[00:16:57] So I am going to be more mindful of myself to just ask one question at a time. I think sometimes what happens is in the moment when you're there coaching, I feel like I want to ask the right question and I'm still formulating it. And so sometimes things don't come out in perfect English and sometimes I'm refining my question as I'm speaking, which is why I think the question stacking is happening.

[00:17:25] But I think it might be more beneficial during that process to allow that to happen organically. But just to stop myself after one question, without refining it so much, unless I feel like the person being coached wants me to refine the question, or that they ask me to, or they just prefer to answer a different question or variation of it. 

[00:17:47] There's one last important topic that I'd like to debrief from this coaching session. It was regarding my response when Mary had made a comment about I'm not sure if this is appropriate for coaching or counseling and how she shared when she wanted to make an action plan so she could support herself when she emotionally spirals.

[00:18:08] And I realized that even though I clarified coaching and counseling and how that action plans are completely within the realm of a coach, I didn't fully distinguish between coaching and counseling, in the sense I didn't do it in the best way possible, in a way that I feel like I normally do. And maybe it was because this was recorded and I was somewhere in the back of my head thinking about mental health stigma and not wanting to ask these questions out loud. But I realized that I need to. And so Mary had shared that in the past, she had experienced counseling. And I did not ask specifically what type of counseling it was, how the counseling had benefited her, and if she'd ever sought any other mental health support. I recognize, and coaches are supposed to recognize this, especially as a National Board Certified Health and Wellness Coach, and as a physician, that she is only maybe a couple months postpartum, and it takes time for hormones to go back to normal. And having big transitions like having to go back to work does increase the risk of mood fluctuations and postpartum depression in physician mothers.

[00:19:30] And so I should have, and what I will do before our next coaching session is really emphasize and clarify that the role of a coach is not the role of a mental health professional. But that being said, it's important to know when you feel like you need support from a mental health professional. 

[00:19:50] And what I realized was the way I explained this doesn't really make much sense to me. And so I told Mary that: when do we need to refer to a licensed healthcare provider for mental health support?

[00:20:05] It's when someone's experiencing some symptoms or something that are actually interfering with one's ability to function. And I realize this language is not ideal using. It's when symptoms actually become really distressful because it's dismissing what this person is telling me about their anxiety.

[00:20:25] And obviously, if someone is experiencing anxiety, is preoccupied with certain thoughts or worrying, then they may be, to an outsider, very functional: able to do their job, very intelligent. But if they didn't have these thoughts, and they didn't have any worries or preoccupations, how much different would their performance be?

[00:20:48] So when you think about are symptoms actually interfering with someone's ability to function, I feel like that's on a spectrum. Because as long as someone's experiencing worry or doubt or overwhelm or fear, isn't it going to show up in everything that we do? And so where is the line where it's interfering with someone's ability to function? Where is the line where someone has to go forth and seek mental health care support? 

[00:21:16] So the red flags to worry about if their thoughts of self harm, harm to others and any clinical signs or symptoms of depression or anxiety disorders, things like that. It's not up to us as coaches to diagnose. And so I really want to make certain points clear with Mary, to make sure that they understand that if they need more support than what coaching can offer, it's okay and coaching can also help you figure that out. And when do you know that you actually may benefit from seeking mental health support? And so those things were really interesting to me because before this debrief,

[00:21:58] you know, I've written about when do you refer, I teach about it all the time, I discussed it in a podcast with a coach who's also a counselor, Lynn Lebowitz (thank you so much!) in the podcast episode for the Health and Wellness Coach Journal which was discussing the differences between counseling and coaching.

[00:22:18] And usually when you read, it's that same thing: when symptoms interfere with the ability to function. Well, who's to judge? Who's to judge when that line is crossed? And that's really where the empowerment and self awareness of the person being coached is key, because outside of having really clear objective data, they're the only person who's going to know when they need more support.

[00:22:43] And so it's really important that all of our coachees, the people we're coaching, understand the difference between coaching, counseling, when seeking advice, guidance, care from a licensed mental health care provider is necessary so that way they can put themselves in the best situation. Another thing to be mindful of is how the coaching space, a coach can also support someone in figuring out if they do need to seek further care or support from a licensed healthcare professional. 

[00:23:18] Many people don't have access to therapists, counselors, psychiatrists especially. So sometimes the coach may be the first point of contact for someone to seek care. And so as coaches, it's extremely important to empower yourself, be comfortable with these conversations, very open, transparent, and make sure that at least in the coaching space, there's no stigma, no judgment, and that there really is a psychological safety.

[00:23:48] And that confidentiality is upheld in exploring these issues while staying within our coaching scope of practice. And so for me, my action plan with Mary is before the next coaching session, I want to make sure that I bring it up and have this conversation with her in more depth so she can really empower herself. I think another thing I can do even before the next coaching session is maybe send an article or a resource to Mary so she can read more about the differences between coaching, counseling, and when referral is needed.

[00:24:28] And so that way she can empower herself. And so with that, there is a lot to unpack in this last coaching session. And so these issues come up very frequently with coaching, especially with coaching physicians. 

[00:24:43] My biggest takeaways from this debriefing episode are (1) the importance of debriefing and taking this time to really go through the topics that come up and to take this time to really process the events of a coaching session for every session, because there really is so much that evolves. And (2) it's really important to know who to go to as a coach or to start building a support community of mentors and resources and people you can ask the tough questions to, and so that way you're not alone, and you're practicing as ethically as possible.

[00:25:26] Thank you for listening to the Holistic Physician Coaching Podcast. This podcast is dedicated to making coaching more accessible and to support both physicians and those who coach them. Subscribe to access exclusive subscriber-only episodes, including physician coaching sessions, coaching debriefs, and coach mentoring sessions that offer valuable insights for professional development for coaches.

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