First Published in Dutch on the 16th of May 2017
Simon is a dentistry student in his fifth year, whom I’ve tutored a year ago in the course Professional Behavior. I give this course—together with a tutor from that study—a few times a year to senior students. It is focused on helping students with being able to manage their activities. For students starting their fourth year this can be quite hard because they become responsible for the management of their patient files. They have to invite, call, make and change appointments, outline a treatment cycle, establish priorities, etc. In addition, all other activities continue, such as making assignments, attending practicums, writing papers, and so forth.
Recently, Simon came by my office, telling me that he had worked very hard on the course, but that his problems were deeper. He had a lot of stress and anxiety, alternated by depression and despondency. This emotional rollercoaster influenced his ability to function, making it hard for him to manage his activities.
Did I forget something?
In such conservations, I think it is very important to ascertain the concrete situations that the student struggles with. It soon turned out that there were two kinds of activities: Simon had no trouble with treating a patient, attending a practicum, or carrying out a concrete assignment in real time. These were activities that only require to be carried out.
Activities that required strategic decisions for the future were entirely different. Because he had a lot of different activities on his plate, he also had to be able to make an action plan that took several variables into account (patients, treatment plans, personal wishes, schedules, deadlines). This led to a lot of stress. When I asked Simon what made certain activities so stressful, he said he was constantly asking himself: “did I forget something?” We came to the conclusion that the stress was due to him not even knowing how to answer that question.
When it comes to self-management, you could say that this question is of genuine importance. For people who have great self-management, the question is a logical control question for ongoing matters. The question is an expression of the reflection we need in the analysis and adjustment of our work processes. For people without control—and therefore defective self-management—the question is more a sort of rhetorical expression of panic. It is comparable to the question “Is anyone there?” in a horror film. Many different things impel the question to be asked, but the answer “yes!” is about the worst prospect possible.
I primarily receive students who don’t experience overview and control. Some of them have an illness or different kind of handicap. Even though the clinical picture can vary strongly, these people almost always struggle with the feeling of being subject to totally unpredictable periods of physical and/or mental problems. They often think that they are very different from “healthy” people, but this is wrong. I often get students without demonstrable ailment who struggle with their concentration or energy level and are desperate about why “it” sometimes goes well and other times not at all. They experience a comparable sense of unpredictability.
Both groups are totally unable to estimate how the days will go and—as a result—don’t know whether they will be successful in meeting their goals or deadlines. When this lack of agency becomes chronic, the continual insecurity leads to an extraordinary miserable feeling with the person in question.
Powerlessness and Power
One by one, all of these students feel awful. One is depressed, the other aggressive, a third has panic attacks, and a fourth is chronically sleepless. Powerlessness is the most awful feeling we can have. It is therefore imperative to give their sense of power back. This does not mean, however, that we can tackle the feeling directly.
Simon drew a well-known but—in my view—wrong conclusion by thinking that his feeling caused him to function badly. It is precisely the other way around! His defective functioning creates his misery. The inability to answer the question “did I forget something?” creates the emotional stress he experiences. I therefore think that there is no reason—at least initially—to dig for “deeper” lying problems. He just has to be made capable of answering the question. In principle, it is quite easy to develop the personal power in question.
Step 1: Create Overview
There are three successive steps that lead to personal power: creating overview, creating insight, developing control. In the first step, one ought to get an overview of his situation. This means that all relevant factors must be made visible. I generally make the student write time. He has to take notes of everything he does, when he does it and how long it takes him to do it.
The more unpredictable our life seems, the more accurate we ought to record what is happening. Everything, even the most senseless activity, can be relevant (also see my essay Tip of the Iceberg). The goal of this first step is to visualize your situation, how you react on certain events and make decisions.
Step 2: Create Insight
We often experience chaos even though clear patterns can be discerned. Our reactions to a situation are especially more predictable than we think. There are many students who always react to every whatsapp, tweet, and facebook message they receive on their smartphone.
Such insights are typical of the second step. On this level we discern patterns from exceptions and connect causes to effects (“whatsapp takes up several hours a day and contributes to me missing deadlines”). The result is almost always that a student recognizes that there’s no uncontrollable chaos that they are the victim of, but that they create that chaos themselves.
Step 3: Develop Control
When someone gets an insight about the cause-effect relations of their circumstances and the part their own behavior contributes to this, they often also automatically become able to exert influence on those cause-effect relations. When the first two steps have been passed through sufficiently, the possibilities (experimenting with new behavior) come within range.
People often think that they have tried everything to get out of the negative spiral but in reality, they kept operating within a very narrow bandwidth on their behavior. Our feeling of powerlessness is largely caused by the blinders we have on.
Self-management is the ability to go through these steps and improve your functioning every time. They lead—through the learning cycle—to increasingly higher levels of competence. This competence has two clear manifestations. Firstly, we are able to prevent problems. “I see that I wasn’t able to meet my daily target three times because I immediately answered emails. I have to close down my mailbox for the coming days so I can meet my deadline this week.”
In addition, we can solve problems that we had not foreseen. “Due to my car trouble I won’t be able to be there for an appointment. I won’t get the information I need and will have to make a telephone appointment instead. That will mean working an hour longer. I’ll call home to inform my girlfriend.” The examples do not differ in essence from each other; you could say that real self-management is a practical ability to solve problems.
It is clear that a chronic lack of personal power and control severely affects someone’s self-esteem. It is a misconception, however, to think that competent people (those that have power and control) are competent because they are self-assured. Confidence is often seen as something elusive that you either “have” or “don’t have.” But confidence comes after control and initially requires something that is especially tangible, that is, a reliable registration system.
Simon felt incompetent because he continually struggled with his negative feelings. He didn’t see that the practical approach of the course, Professional Behavior, was focused on improving his self-management which would actually make him more competent and—as a result—would salve his negative feelings. Overview, insight, and control are essential steps in every shape of management, whether it be self-management, time management, project management, or life-management.
It is a pity that my work is sometimes considered vague psychological babble. I consider our psychological processes to be equally concrete and logical as our physiological ones. It is possible to make everything easy to see and insightful without having to go much further than asking the—ostensibly—innocent question whether “I have forgotten something.”