1 on a Friday + Work

February 18, 2022

I just found this post fascinating:

What I Learned in My 3 Days Offline” — Raptitude

If I were to spend 3 days offline, I would probably read more, sleep more, and (admittedly) interact with my kids more. I would probably do more physical work (organizing, housework). I would probably feel lonely without the text chains I frequently engage in, though I have never felt that time texting others — either individually or in small groups — is a bad thing for me, personally.

3 days off of email / electronic medical record wouldn’t fly on work days, obviously. But I guess actually doing the experiment would be worthwhile someday. I have spent a weekend offline before, but it’s been a while.

Some of you have posed the question in the comments — with all of this discussion of overwhelm, why don’t you work less?

It’s a reasonable question, but a complex one to answer.

First, I am having a hard time deciphering if my general feeling of blah is impacting my feelings about work, or whether it’s my feelings about work that are driving some of my blah-ness. Direction of causality unclear.

Second, deciding to work less would be an incredibly high impact decision for a) me and b) our family. I did not love being at 90% (with GME) in particular because I found that I’d end of working on days I had demarcated as ‘off’ and was resentful. This was no one’s fault, just the nature of a knowledge work job like that with a large network of people that depend on you.

I bring home ~40% of our family’s income (slightly higher with podcasting revenue). Absolutely we could live on one salary (either one, really)! But it would drastically change our ability to save, and would mean compromising on some of our goals, like wanting to save for college and taking fun family vacations and having more flexibility to perhaps both dial down (if we want to) in ~10-15ish years. I also don’t necessarily want to take on the housework that I currently am very privileged to have taken care of for me – although on some work days, the idea of prepping dinner + peacefully folding laundry sounds like heaven.

As for the blog/pod, I remarked to Laura recently that our recording sessions bring me a lot of joy. Doing my podcasts (and writing here) is just . . . one of the ways I get to have fun. So it’s hard for me to want to remove an activity like that.

Finally, there are many elements of work that are very rewarding. My colleagues are great and I value those relationships highly. I enjoy learning (though I miss going to conferences – hoping to do this again soon). Some patient interactions are wonderful and there are families I have gotten to know well — I love that. Working alongside an enthusiastic resident is really fun. On the GME side, I have loved watching the residents grow, and the ‘highs’ in GME (match days, seeing residents achieve their goals) really are just amazing. It’s a career I feel very lucky to have gotten into, and one that would be hard to get back (ie, not easy to just ‘take a break’ and return later).

So — probably more than the internet needs to know about why working less would be really complicated for me.

random Animal Kingdom pic!


  • Reply Sue February 18, 2022 at 7:19 am

    Thank you for sharing! I was curious about whether you could somehow reduce your hours or just do the clinical side of your job for reduced hours per week.wishing you well Sarah!

    • Reply Sarah Hart-Unger February 18, 2022 at 7:22 am

      I could. If I did clinical only and 50% (if they even let me do that) it would be a more than 50% pay cut and I’d still need some childcare. It’s not entirely off the table, but would not be a decision to make impulsively.

  • Reply Grateful Kae February 18, 2022 at 7:37 am

    Well, if the job can’t go…and the hobbies can’t go….and exercise can’t go….then the obvious answer is to give up a couple of the kids!! LOL. 🤣 Joking!!! obviously. haha. But in seriousness, I get what you’re saying. This stuff is really hard to sort out. You actually sound like me when trying to make a hard decision- I go around and around about all the (valid!) reasons that I just absolutely can’t change something. Drives my husband nuts, because he’s much more pragmatic. He will basically tell me, Well, something’s gotta give. It’s not going to be a “perfect” solution, so you have to stop trying to justify “everything” as being non-negotiable.

    For example, years ago now when I was totally burned out on my inpatient nursing job (12 hrs shifts/ every other weekend and holiday schedule/ super stressful and busy unit) and I was looking for a new job, I kept finding problems with every single one. Because in reality, I really liked some things about my old job! Yes, the shifts were very long and very hard. But, I also got a ton of days off! I could take extended stretches off with minimal vacation days. I could take the boys to the zoo on a Tuesday or story time at the library, or go get groceries on a Wednesday morning. It was great, in so many ways. And I really liked my co-workers and my patients and the specialty I was in. So every new job that came up, I would start picking apart…”This one is monday-friday, so I’ll barely see the kids (compared to old schedule). They’ll have to be in daycare all summer instead of out with me. The pay is less without all the shift differentials. My vacation hours won’t stretch as far and I won’t get all those days off. I’ll have to commute every single day! More gas, more time. etc etc.”

    Ultimately, I wanted to have my cake and eat it too. I wanted to be off during the week some days to be with the kids, especially in the summer, but I also didn’t want to work evenings or weekends anymore as my kids were entering school age years. Oh, and I wanted at least my same pay! (Working very part-time wasn’t really financially super feasible for us back then.) In the end, I DID have to make some sacrifices. I ended up going to a M-F daytime position- but found a flexible/remote one which has been amazing and kind of the “best of both worlds”, for me. Took a couple YEARS though at least to find the right job that ticked (most of) my boxes. But it’s true- I don’t get any weekdays “off” anymore (which was soooo lovely!!), I have to use more vacation days, etc. I basically had to suck that up and trade in some things I REALLY liked, for some things I like even better (being free every single weekend and evening with my family, way less stress, flexible schedule/ set my own hours).

    Anyway, I know it’s not exactly the same situation you have, but I remember feeling extremely, extremely stressed out back then yet felt trapped/paralyzed for a long time.

  • Reply Rachel February 18, 2022 at 8:57 am

    I work part time and I’ve found that having shortened hours daily, in my case 9-2 rather than having days off has been much better. That way, I can attend to whats urgent every day. I also work from home a lot and only go in 2x week. The benefit of working part time is that expectations are way low so I have the ability to exceed expectations and have no problem saying things will take longer or say no. I’ve found that minimizing professional stress while still being intellectually satisfied has been the best of both worlds for my and my family’s overall well being. I’m not sure if that works in medicine.

  • Reply Diane February 18, 2022 at 9:29 am

    These are such good points about why it is hard for anyone to pull back on work. I feel like women especially think about pulling back on work and it is so complicated an issue.
    I do wish that temporarily stepping away from work was easier and more accepted, that sabbaticals were a norm across the board.
    When my second child was born, I went back to my freelance theatre job five days after leaving the hospital and worked for the next four months. When I asked my summer gig (where I had been going every summer for ten years) whether I could take that summer off and return the next summer since I had been working since post partum without a break, I was told no. “It would not be fair to your replacement to only hire them for one year,” I was told. Even though everyone else I talked to in the industry said that companies can absolutely find temporary replacements for just one season. I understand that temporary replacements (such as with with maternity leave) are inconvenient, but there is kind of a bigger picture burnout/ mental health aspect that gets ignored when companies make it difficult for employees to step away. Or when the work culture makes workers feel that way.
    One of the points that struck me when I read Wintering is how stepping away from her teaching career really helped her clarify certain priorities in her own life. It would seem kind of a chicken and egg situation …. Space lets your focus on priorities, but space needs to be able to be a priority for one to be willing to take it.

  • Reply omdg February 18, 2022 at 9:30 am

    Our former chair used to say he loved it when women would work part time because, “I get so much free labor out of them when they have days off! It’s financially a huge win for the department.” So, yeah. If I worked less, the only way I’d consider doing it would be a 100% clinical job with limited admin responsibilities on the side, because that would make me feel resentful too. Though maybe I should feel that way about the near constant spillage of my current job into nights and weekends. Hm.

    • Reply Bridget February 18, 2022 at 4:02 pm

      Did you actually hear him say this? Disgusting.

  • Reply Lisa of Lisa’s Yarns February 18, 2022 at 10:22 am

    I bet writing out this answer was maybe helpful for you to think about why/whether you like your job. Moving is a stressful life event so hopefully after it’s behind you and you feel settled in, which I know can take months, you will feel less stressed. I do think therapy will help so hopefully you find a good match. I went to therapy last fall and it was so helpful to talk to an impartial 3rd party who would acknowledge that what I was dealing with was difficult and she helped me work on setting boundaries and reducing the guilt I was feeling about what others thought about those boundaries (for me it was related to Covid and family not agreeing with how I was protecting me and my family from it).

  • Reply TAS February 18, 2022 at 10:48 am

    Thanks for sharing so much here Sarah. What surprised me most is that you bring home 40%+ of what Your husband is making. As a long time reader it has always sounded like he’s working much longer hours comparatively so I assumed his work was untouchable. Now I wonder whether he could make adjustments on his side they would help you? I also wonder about an extra layer of childcare. When I was a young teenager in a neighborhood full of kids I had a consistent job where I would be paid to do active things with the kids, like a mother’s helper but for playtime. I wonder if just a bit more outsourcing would give you some consistent time to focus on work. I know Laura wasn’t a fan of the book that talked about women’s time as “confetti” but that is my experience. Accepting longerhours but with better boundaries around that has been my solution. Anyway, hang in there. I have appreciated your daily voice throughout the pandemic to help reflect on my own challenges. I am cheering for you.

  • Reply ch February 18, 2022 at 10:56 am

    I don’t think it’s necessarily true that working on your days off is inherently (or eve often) required in high value knowledge work. I’m in a very specialized technical profession working in consulting and I see professionals at my level and above split over whether they embrace this opinion or not… and even at the same level of responsibility/compensation the ones who think its true seem a lot more burn out and unhappy. The happy ones are more ruthless (and I mean in the most positive, professional way) about setting boundaries regardless of how much other people try to impose “need”. Your family needs you, your life needs you. Your clients/patients/whatever need a prescription refilled, a problem solved, a call returned. They need systems in place to address such situations. They don’t need *you* even if they might expect *you* (even if your workplace/industry culture reinforces this. It could be borne of tradition rather than reason. Important difference). Reasonable clients and colleagues in a “large network of people that depend on you” respond to confident, rational boundaries. It’s a delightful privilege of achieving higher levels of professional respect/competence/specialization to have more freedom to chose how you work and with whom (ie: to walk away or simply ignore unreasonable organizational culture/colleagues/clients/etc). It’s valid to feel frustrated and some friction at implementing this, but it’s such a handy professional muscle to build. I do recognize, as a fellow upholder, it can feel fraught to cherry pick which external expectations are worth recognizing.

  • Reply Katherine February 18, 2022 at 11:05 am

    Work makes the off-ramp very accessible to women, but that on-ramp? It is far harder to find. You are asking all of the right questions.

    Moving is so hard – it takes a huge amount of physical and emotional energy, costs a lot of money, and generates lots of errands and tasks. It always makes me feel depressed and overwhelmed. What if you focused on getting through the move, finding a therapist, and taking your accumulated PLO? The move could also be a way to talk with your nanny about adding more childcare in the evenings, at least until the move is done. If it works well, you could extend the extra care. If it is not the right solution, there is a non-awkward end-date for the experiment. Take good care.

  • Reply Primary care mom doc February 18, 2022 at 11:16 am

    I love reading your blog and have some similarities to your life (dual physician household, now 3 kids). I wonder if your husband is significantly underpaid in his current job or your current location. On average, vascular surgery should pay more than double what pediatric endocrinology does. My specialist husband is well compensated where we are in the Midwest and cost of living is low, so finances are not a factor in my work choices. I work 0.5 FTE in outpatient primary care, all clinical. I definitely would not enjoy my job if I had to do it full time.

  • Reply Diana February 18, 2022 at 11:19 am

    I will add that it is easy to feel “stuck” in a situation when you’re living in it but there really are viable solutions. Solutions don’t come without trade-offs but there are solutions so if you truly aren’t happy with your life right now you have the power to change aspects of your life. Maybe being honest with yourself about what your “ideal” looks like will help. It’s easy to get caught up in the consequences of a single change but if you paint a bigger picture and then have a plan to make it a reality maybe it would be easier to accept trade offs?
    And for what it’s worth, I’m currently on a career break, which is much easier in my field than yours! So I’m a stay at home parent, I outsource laundry, I pay for about 6-8 hours of childcare a week (just for ME time!) and I get groceries delivered. My husband is a physician so he’s paid well but even if you step away from work (or go part time!) I imagine you could still hire out quite a bit.
    You have all my love and support in the process of figuring this out 🙂 hugs!

  • Reply A. February 18, 2022 at 11:27 am

    I too applaud your vulnerability in sharing all these feelings that are sometimes difficult to express and sometimes even contradictory. But there is one thing that « bothers » me: the question of privilege. When you are so privileged in life, surely less than 1% of the world’s population being in the same situation, the main objective here in my humble opinion would be to find a way to recognize this privilege and to be fully satisfied with it. If not, there is something obscene or sad about expressing dissatisfaction over and over again, even if it comes from a very very authentic and vulnerable place.

    • Reply Sarah Hart-Unger February 18, 2022 at 11:30 am

      Sorry it bothers you – you are 100% free to stop reading.

      • Reply Kim L February 18, 2022 at 6:59 pm

        Sarah, I really appreciate your honesty. While my husband I are not physicians, we are a two parent working family. I have a 17 and 15 year old, and just quit my job after being a working mom for all of my children’s lives on Monday.

        It’s complicated, but ultimately found trying to do it all for all of these years unsustainable. Most of my extended family think I’m crazy for quitting, but I could not keep all the balls in the air. You think it gets easier when the kids get older, but in our case it just got busier!

    • Reply Rachel February 18, 2022 at 11:38 am

      This is such an unhelpful comment. I applaud shu for sharing all of this when so many of this feel the same way. It helps to read the comments and brain storm. I love how authentic shu is and hate reading blogs where it’s like I love my job and it’s the best! My kids are so easy and amazing! I have the best marriage and body etc. So I don’t read those. Feel free to not read and definitely don’t comment when she’s being so real and it’s helpful to so many of us.

      • Reply Irene February 18, 2022 at 11:51 am

        Agree that if you don’t find this helpful you don’t have to read! I love Sarah’s honesty and so admire her bravery putting these thoughts out there. So many of us have been fed the lie that we can effortlessly raise multiple children, have big jobs, perfect bodies and support our husbands in their demanding jobs no problem! And maybe some people can but I can’t. So good for you Sarah for really thinking through what is worth your time and thanks for sharing with us. I also think that it’s brave to be open that $ does matter- you guys pay for private school for three kids plus a nanny! Yeah money does matter! We are trying to keep our kids in public partly to have more flexibility around jobs and I appreciate when people acknowledge that tuition is really expensive! Even if you think it’s worth the cost. Anyway Sarah I will stop now but I appreciate everything you share.

    • Reply M February 18, 2022 at 11:45 am

      Hey, this isn’t cool. Sarah frequently acknowledges her privilege, and privilege doesn’t make someone immune from challenges. Remember there’s a real person sharing real feelings behind her blog – I think you meant well but it comes across as judgmental rather than supportive.

      • Reply Jessica February 18, 2022 at 12:43 pm

        Very well said, M, and I entirely agree! The idea that being unhappy is unacceptable if you are privileged is really harsh, and honestly harmful to people who have mental health problems and likely already feel guilty/etc. about them.

    • Reply Sharon February 18, 2022 at 3:22 pm

      What a cruel and unhelpful comment. As a working mom who has struggled with anxiety and depression since my teens, I am so grateful that there are people like Sarah who write transparently about their feelings. Privilege, whether in the form of wealth, beauty, education, etc. is not synonymous with happiness. The ability to take a step back and look at your life, to evaluate what is bringing you joy and what is draining, is absolutely a privilege that not everyone can do. But if you are able to do so, isn’t this part of living a well-intentioned and thoughtful life?

    • Reply Tierney February 19, 2022 at 10:36 am

      This comment is pretty tone-deaf since SHU has, in part, linked some of her current issues to potential mental health contributing factors. Telling someone who may have anxiety, depression, or really, anything mental health related that it is “obscene or sad” that they have repeated sadness and dissatisfaction in their life reflections has no positive value to add to the conversation. In my humble opinion.

  • Reply Chelsea February 18, 2022 at 12:18 pm

    Another thought… What if you viewed the program directorship as a term appointment (maybe a 3-year or 5-year term?) rather than a forever job? Do you have a colleague who would appreciate the opportunity to take over the role to gain that experience? I know going back to 100% clinical would mean more call, but would that be balanced out by not having the constant stress that an admin role can bring? I know you don’t want to “give up” being PD, but framing it as allowing someone else to have that opportunity (and that’s exactly what you would be doing) might make it feel a bit different.

  • Reply Keren February 18, 2022 at 12:27 pm

    From reading your blog it sounds to me that you love your job, we all have times in our life that are more stressful and on those time everything feels harder. From your experience reducing your hours is not beneficial and I’ve seen it in other fields as well(I work in IT) where moms work part time job, getting less money and their benefits are cut,but they still have same amount of work to do which can be more stressful and also leads to situations where they work overtime without being compensated.

  • Reply gwinne February 18, 2022 at 1:34 pm

    I feel like I have a similar problem. I am mostly doing the things I want to be doing but do not have enough time to do them as well or as “deeply” as I’d like. It is actually possible to have too much to do, and no amount of planning is going to solve the problem. This was my major takeaway from Burkeman.

    What would it mean for you to go down to 50% in your day job and commit more to the book writing / podcast, since that seems to be a major source of pleasure?

  • Reply Megan February 18, 2022 at 1:59 pm

    As always, appreciate the transparency so keep it up! One thing that can help in my decision making is to give myself a timeline of reassessing in say 3 months to see if I feel different. It helps because I know I will decide or at least reevaluate at a specific date so I can stop ruminating on it for a bit and it keeps me from making decisions at a time that may end up being a “phase”. We talk about with kids everything being a phase, but I’ve had the experience of work phases too: being overwhelmed, being unmotivated, etc. and then it passes bc something changes or I do.

  • Reply Erica Sparky February 18, 2022 at 2:21 pm

    I think in general, Jan-Feb is a really rough time of year for everyone, even if you live in South Florida where the weather doesn’t preclude you from getting outside or seeing the sun. Even if we’re not in our third year of a pandemic. I find myself in the blahs a lot this time of year. We even had a 4 day weekend in the mountains and I’ve had no desire to be at work this week, I still don’t feel rejuvenated. My work interest goes in phases as the above commenter mentioned, and right now I’m just trucking along with no big deadlines or exciting conferences looming, so it all feels kind of pointless right now. I don’t know what else to say other than I think the phase you’re in is pretty normal, collectively, yet it still stinks. I hope the planned fun, rest, and retreat help you!

  • Reply Amanda February 18, 2022 at 3:05 pm

    Love this post. It’s funny how our solution for a woman/mom is almost always “work less” when that might not really be the root of the problem. If you really don’t want to give up the GME stuff/can’t give up the clinical stuff I wonder whether just saying no a lot more often/lowering standards in general would take care of a lot of things. Lots of people just do their jobs and say no to things not in their job description, and maybe this is a season of life for that. It seems that in academic medicine there is a VAST difference in the things that people with the same job description (and same pay) take on purely based on the person’s personality. Seems like if you keep saying yes, people will simply keep asking for more.

  • Reply CNM February 18, 2022 at 3:35 pm

    I wanted to comment that I have sometimes felt this way in my life. I’m a “Big Job” lawyer and my spouse also has a “Big Job” running his own accounting firm. We also have 2 young children. When I get overwhelmed– maybe there is a particularly intense work period, or a kid has having a challenging time and needs extra special attention — I often begin blaming my job and feel like I need to step away. But that rarely is actually true in the long run; I just feel that way in the moment or for a season.
    So, perhaps framing this period as a difficult season and getting through it is the way to go. I’ll also say that I often get a lot of benefit, when I feel this way, of doing a daily meditation. I do not usually mediate, but when I get overwhelmed it helps.

    • Reply Perfectly Cromulent Name February 21, 2022 at 6:07 pm

      It’s not even always possible to work less! Unless I go fully freelance, (….I’m not great at hustling!) there’s very little part time work in my field. People act like everyone can just drop to 30 hours a week or whatever. Same with my husband- although men don’t seem to get this pressure. I am not sure there’s much part time work in his field even if he wanted to do it. How does one just work less? I’d consider if it I could 1) find a job that I *could* work less hours and 2)keep things like health care benefits and retirement matches.

  • Reply Linda M February 18, 2022 at 3:56 pm

    Hi Sarah. I’m 20 years older than you so I’m in a completely different stage of life. I started following you for the planning tips and stayed because I find it fascinating to read about you and your commenters careers and lifestyles which are so different from my generation’s experience. (At least me personally) I just want to encourage you. You are doing amazing things and your kids seem to be thriving. Maybe try to keep your weekends less busy. I get tired just reading about all the things you do. I’m cheering for you. I hope things get better. Thanks for sharing your life with us.

  • Reply coco February 18, 2022 at 8:24 pm

    I really appreciate honest writing. it doesn’t matter whether we are privileged or not in other eyes, we all have our struggles in our view so it’s really good for us to be honest in our space and share. it takes courage to show vulnerabilities and authenticity, which makes me keep reading your blog. I don’t read those bloggers that just show the “perfect” life in social media when I know nobody’s life is perfect in their own view. keep up and hope you find the way to reverse this blah episode. only you can find the way, probably when you are least expecting. run more… those moments always pop up during my runs.

  • Reply Mars February 18, 2022 at 9:17 pm

    I’m currently a SAHM of 3 kids similar in ages to yours & a long time reader. I honestly DO NOT know how you do all that you do. The thought of keeping together everything at home AND having a job on top of that terrifies me. The plan was for me to go back to work in the next year or so but I don’t see how that would be possible. Raising 3 kids is a full-time job in and of itself. I understand your concern with cutting your hours and I also understand you have a big job that you’ve worked so hard for. I have to wonder though if something doesn’t give, will you burn out quickly? I’ve found that sacrificing some of the money (ie-my salary if I were working) has led me to be so much more at peace. It was a tough transition at first going from full time work for 10 years to being home. I know I’d be much more snappy (& unhappy in general) though with my family if I were trying to do all the things! Just some food for thought. My physical therapist told me today, “We gotta take care of Mom or no one else will get taken care of.” I think we, as Moms, have to give ourselves permission to step back and make changes when necessary.

    • Reply CBS February 20, 2022 at 5:41 am

      I think I’d probably wait 6 months after your moving date before making any drastic changes. I think you might be underestimating the mental toll preparing to move is taking? I found the month before leaving like having another full time job on top of my actual job. And I wouldn’t have wanted to make major decisions about my career path and finances.

      Also, would you feel more obligation to have less help / do more childcare? I’d rather a rough day at the office than spending my day cleaning bathrooms or making endless snacks. I think being a SAHM or a very part time worker looks really hard.

  • Reply Sade February 20, 2022 at 1:23 am

    Rather than work less, I would have thought trying to earn more & outsource more is one potential solution. Eg with interior decorating the new place / project managing the move. Assume you have considered it, but just wanted to support an alternative way of looking at the issue.

  • Reply Sharon February 20, 2022 at 8:02 pm

    You’ll feel better after the move!! Moving is infinitely complicated and stressful, regardless of how organized it is!

  • Reply Alyce February 21, 2022 at 6:52 am

    I’ve been amazed by the number of recommendations to step back from work you’ve received in your comments. You don’t just have any old job, you have a career that you have spent decades building. Perhaps you even see your work as a calling. It may not be perfect, and there are some obvious ways it can be improved, but to just jettison it when you’re in a rough patch, and before exploring changes you can implement on your own (like therapy, antidepressants, establishing and enforcing stronger boundaries at work, reconsidering how your time is split divided between administrative work vs clinical care, etc), well, that would make no sense to me. Especially since I totally agree that trading working less outside the home for working more inside the home is a super shitty tradeoff. And the finances piece you raise – like sure, you can live off of Josh’s salary, but if it doesn’t give you the lifestyle you want, it’s not really a viable option at all. I get it. I like expensive shit and I like not having to worry about money ever. I wouldn’t be willing to give either up. Truthfully, I can’t help but wonder how white the quit your job camp is. From my perspective as a black woman, white women in the US seem to commonly fall back on the notion that someone else is going to save them financially.

    Anyways, I just wanted to say that you shouldn’t underestimate the power of therapy. I started individual therapy in November and couples therapy at the end of January and the amount of relief I’ve gotten cannot be understated. All of the stressors in my life is the same – demanding work, disabled kid, pandemic, not enough fun – and yet with the help of therapy, I no longer feel like I’m slogging through it all. I got my therapist recommendation from a friend – if you have friends who are therapists, I highly recommend getting recommendations from them, because they can direct you towards people who are really good. And if you’re willing to share some of your struggles with them, they can direct you towards people may specialize in your issues. An alternative approach to finding someone my friend recommended was to look at faculty for local schools – people who teach will often be better therapists, so it can ensure better quality control than choosing blindly. Also be willing to explore different therapeutic approaches. Although CBT is often held up as the gold standard, there are so many other approaches out there that may be better matches for you. My therapist is trained in ISTDP, and the approach doesn’t let you fall back on typical defenses to therapeutic treatment. When you do it – and you will do it because it’s only natural – the therapist will stop you. I recently had a session where my therapist kept me from doing that and it was frustrating, but I also recognized that I could have easily wasted weeks/months/buttloads of money since I’m paying out of pocket for this on those rabbit holes that were never going to address the emotional reactions underpinning the rabbit holes. Anyways, that example was to make the point that I have made more progress with ISTDP in a much shorter period of time than I ever made with CBT. My perceptions of the difference between the two is that CBT is great if you have a lot of negative self talk and you are trying to come up with behavioral modifications that override that negative self talk. Whereas ISTDP goes further in helping you process the underlying emotional issues that we’re really terrible at processing and that get stuck inside of us – literally stuck – that weigh us down and come out in untoward ways. So much of my emotional reactivity was coming from these stuck emotions that I’m really working through now. Also, my back pain – that was actually anger. After nearly two years of back pain, it finally started to ease and eventually went away just because I could recognize how angry I am at so many things. But it’s clear from my experience that it’s reasonable to expect to have some relief immediately from therapy, and if you don’t, it might be that you don’t jive with the therapist or their therapeutic approach, and if that’s the case, switch therapists! (Also, it helps to reach out to a lot of therapists at once to find a good fit/availability rather than to reach out sequentially. I reached out to five or six, got calls back from and had an initial consult with two before picking my therapist.)

  • Reply Nikki February 22, 2022 at 3:11 pm

    Long time reader, just quickly wanted to chime in and comment on how valuable the brainstorm and conversation in the comments consistently is – I’m in a very similar career/life spot and just really appreciate all the valuable input and ideas! Thanks SHU, and your incredible community of readers!

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