In this episode, Dr. Joan Rosenberg discusses her book, 90 Seconds to A Life You Love, and the concept of living life by design. Many believe their circumstances dictate their lives; our guest asserts that one can design their life by having a vision or big goals and working towards them despite the circumstances.

Dr. Rosenberg shares the importance of paying attention to how thoughts and feelings are expressed and managing emotional states effectively. She introduces the concept of the “Rosenberg reset,” which involves choosing awareness by experiencing unpleasant feelings for 90 seconds and using insights gained from those feelings to make decisions or act.

Dr. Rosenberg also discusses how clinicians can apply these principles in their practice, including addressing difficult topics with patients and handling their own emotions. She suggests using a soft contract with patients to discuss sensitive issues and delivering information with well-intentioned kindness. Dr. Rosenberg believes confidence and resiliency can be developed when clinicians are able to confront difficult topics and handle the responses they receive.

Download and listen to this conversation to learn more about:

  • How to develop confidence as a clinician
  • Why emotional mastery is an important component of successfully collaborating with patients
  • The eight emotions we need to accept to feel more capable in our lives
  • Using “soft contracts” and offering observations tentatively to deliver difficult messages to patients
  • And much, much more

Joan I. Rosenberg, PhD, creator of Emotional Mastery™ and Emotional Mastery Training™, is a highly regarded expert psychologist, master clinician, trainer and consultant.


Health Care Post-Pandemic: From the ICU to Functional Medicine | Ep. 324


Dr. Joan Rosenberg: What I will tell the graduate students that I’ve taught is that when they will start to experience confidence as a clinician is when they’re actually able to confront the person in the room. You can be too supportive. Oh, oh, whatever, being, if you will, what appears to be nice niceness is not necessarily effective. But when you are willing to say, if I use the example that we’ve already talked about, when you’re willing to say, huh, well four drinks or better at night is already binge drinking, and you’re willing to put that out to the person you’re working with in whatever form it might sound like in your specific practice, that’s when your confidence as a clinician develops.

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs and health technology, as well as practical tools to help you transform your practice and the health of your community.

This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective functional and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

Kristen Brokaw: Hello, Dr. Joan Rosenberg. Welcome to the Evolution of Medicine Podcast.

Dr. Joan Rosenberg: Well, thank you so much. It’s fantastic to be here and to hang out with you again.

Kristen Brokaw: Yes. Well, we know each other from the personal development space, and one thing I’ll say about you is I always liked how you would sort of sit in the back of the room and then just very sage-like kind of add your 2 cents and everybody would be like, Ooh, that was really at the heart of it. So, I’ll tell everyone who you are. You are an author, you’ve done a few TED Talks, you are a speaker, you also are an educator and a clinical psychologist. So, what have I missed?

Dr. Joan Rosenberg: I’m also a consultant, and also, I do a lot of media. So, it’s doing consulting around corporate wellness, so…

Kristen Brokaw: We can use some of that.

Dr. Joan Rosenberg: Okay, good.

Kristen Brokaw: Well, like I mentioned, you’re an author and you have a book that’s called 90 Seconds to A Life You Love, and I want to start there. What kind of had you decide to write this and Well, let’s start there.

Dr. Joan Rosenberg: Well, you know what the truth of the matter is, is that I was doing the kind of work that’s expressed in the book for a good 20 years plus before the book ever showed, 25 years before the book ever showed publicly. And what I found is over time that the work that’s in it was always helping people and I started to talk about it more and more and the concepts were landing. So, it was like, I felt like I had something that would be beneficial for people to understand and to be able to apply for their own lives and potentially that it would have the potential to have big impact on their own lives. So, it was giving psychology back to the consumer.

Kristen Brokaw: Gotcha. Well, chapter one, you actually say Living life by design. What do you mean by that? We all hear that, but what does that actually mean to you?

Dr. Joan Rosenberg: Many of us go through life thinking that the conditions, the circumstances or the situations that we’re living in actually dictate our lives. Now, do they affect our lives? Absolutely, they do. We have to negotiate whatever the circumstances are. But when we can have a vision or big goals or big dreams, and we also go beyond the situation or the condition or the circumstance and keep on working past that to take the steps to achieve the goal, the dream or the vision, then now we’re actually designing a life. We’re going, I’m not at the effect of my circumstances. I can actually see a picture that’s much bigger and I can pursue that despite the circumstances. The key is learning how to negotiate them.

Kristen Brokaw: Gotcha. Okay.

Dr. Joan Rosenberg: I want people to have big vision so they can design their lives.

Kristen Brokaw: And I don’t think that’s a conversation any of us were handed.

Dr. Joan Rosenberg: Yes, but we’re not necessarily handed the tools to be resilient in the face of the upsets.

Kristen Brokaw: Interesting. So, how do we say more about the tools? Is that, so…

Dr. Joan Rosenberg: The way I break things down actually has to do with paying attention a lot to what people think, to how they think it. So, think of patterns of thinking, how they experience feeling, and so what they do to manage their emotional state, and then how they express feeling or how they express themselves. So, how they express what they think or feel. So, my focus goes into those four areas, and if people are messed up in their thinking or messed up in the way that they handle their feelings or that they don’t express themselves, then how they negotiate those difficult circumstances is going to be much harder. And if they have the ways of thinking and the ways to manage their emotion, and they are expressing themselves now, how they negotiate life circumstances and conditions is very different.

Kristen Brokaw: Absolutely. Okay, so let’s go into that. So, how do you teach your clients, or what do you speak about as far as negotiating sequence?

Dr. Joan Rosenberg: Yeah, no, I do this in the trainings too. Here’s the thing, our thinking can mess us up so we can get into all sorts of ways of faulty thinking, which we can tackle later. But what I’ve found over time is that if people don’t manage their emotional state well, they don’t manage their feelings well then that messes them up even more than kind of goofy thinking or faulty thinking. So, what I mean by that is that what I found over time is that if people did not deal with at least eight on what I call unpleasant feelings, not bad or negative, I don’t consider any kind of feeling we have maybe bar intentional aggressiveness as bad.

In general, the unpleasant feelings exist to protect us and the pleasant ones exist to help us connect and create. So, in that sense, no, if you will, bad unpleasant feelings. And so the idea then is to help people be able to manage those well, because if they don’t manage them well, they tend not to negotiate life well. So, one of the sayings I like to say is that the better you get at handling unpleasant feelings or the better you get at negotiating unpleasant feelings, the better you get at life.

Kristen Brokaw: Yes.

Dr. Joan Rosenberg: So, the feelings I specifically talk about are there eight feelings, and the ones I talk about the most are sadness, shame, helplessness, anger, vulnerability, embarrassment, disappointment and frustration.

Kristen Brokaw: And you’re saying that these eight are the main ones. You could probably, somebody could say, oh, well wait, what about this one? And you’re like, Nope, it’s actually really this.

Dr. Joan Rosenberg: Yes. So, if they say resentment or jealousy or envy, I would say that’s already contained in the sadness, helplessness, anger, and disappointment. If they say something like guilt, guilt to me is not a feeling. It’s actually a thought.

Kristen Brokaw: So, then you have thoughts and feelings.

Dr. Joan Rosenberg: So, I make distinctions between them, and some of ’em are more complex, like shame is a more complex experience and vulnerabilities is a more complex experience. But the notion here is that I chose the eight because what I found is that these eight were the most common every day spontaneous reactions to life. And so, if we could handle those on, if you will, on every day or every week or every month basis, we handled them well, then we would do better in terms of whatever thing we had to face. We’d be more resilient.

Kristen Brokaw: Well, exactly. I was going to say that’s kind of what you say in your subtitle is creating confidence and resiliency, et cetera.

Dr. Joan Rosenberg: Right, exactly. So…

Kristen Brokaw: What do we do with these? So, say more about this. So, you’ve identified these eight. Now what is it someone that experiences these should do something with them or…

Dr. Joan Rosenberg: Well, here’s the interesting thing, something that we do with them is we need to experience them.

But let me talk about that for a moment. I have what a colleague of mine, I mean I think of it as a, he called it the Rosenberg reset. So, the reset formulaic is one choice, eight feelings, 90 seconds. And the one choice I’m talking about with people is that we’re choosing to be aware and to lean into our moment to moment experience. So, we want to feel as much of our moment-to-moment experience as possible as opposed to distracting, ignoring, disconnecting from and denying that those reactions even exist. And a lot of people go that route and they go that route for in all sorts of different ways, but it’s still amounts to the same distraction. And it would be using drugs and alcohol. It could be using food, it could be sex, it could be porn, it could be having feelings about having feelings.

It could be geographic moves, could be anxiety, I mean can go, the list goes on. But that’s all about distraction and we want to get away from distraction and move towards awareness. So, what’s the one choice? The one choice is awareness as opposed to avoidance. That’s what I want people to lean into awareness. Then it’s the eight feelings I’ve just started to talk about them already. So, again, sadness, shame, helplessness, anger, vulnerability, embarrassment, disappointment and frustration. Those are the eight. Again, why? Because if you don’t experience them, if you don’t allow yourself to experience ’em and manage them well, then you don’t feel as capable in life of handling life. So, that’s why those eight and then the 90 seconds piece is really the method piece. It’s the lean in. It’s how do you lean into unpleasant feelings? So, again, for me, it’s like a couple step process.

So, with a touch of background, it wasn’t until the late nineties and the early two thousands that the neuroscience field just if you will, started to explode with research and research findings. So, if I draw from that period, then the first is to understand that we’re one interconnected hole. We’re not just a brain sitting on top of a body and the two aren’t connected. We’re one interconnected hole. The brain is always feeding information to the body. The body’s always feeding information to the brain. So, that’s the first thing to be aware of. And I know that those listening are very aware of that. Second is that most of us, it is coming with this understanding that most of us come to know what we feel emotionally through bodily sensation. So, bodily sensation actually moves a little bit more quickly through the body than thought does.

So, for instance, if I put my hand on a hot plate, I’m not going to want to go, oh look, my hand’s on a hot plate. No, I want to be able to pull off. So, the body just reacts in, just nanosecond quicker than our thoughts do. So, it’s not until our bodily sensations come into awareness that we go, oh, I’m feeling X, Y, or Z, and I’ll give you an example in a moment that relates to this. The third part then is I am drawing from Dr. Jill Bolty Taylor, who’s a neuroscientist who experienced a stroke, wrote a book called My Stroke of Insight. And then that book, she says, when a feeling gets triggered, there’s a rush of biochemicals into the bloodstream that activate the bodily sensations I just mentioned, and they flush out of the bloodstream in roughly an upper limit of 90 seconds. So, there’s the 90 seconds piece. And so if I weave a couple things together here, I was always looking for a way to understand why unpleasant feelings were so difficult for people. And what dawned on me is that it’s not that people don’t want to feel the whole range of what they feel. I believe they do. What they don’t want to feel is the bodily sensation that helps them be able to make that distinction on what they’re feeling emotionally.

So, for instance, let’s say embarrassment is very difficult for me and I feel the rush of the blood, if you will, into my face and my upper chest or neck, and you see that I’m flushed, but I’m feeling the heat in my face and my upper neck or chest, and that heat is my signal that I’m feeling embarrassed. Well, let’s say that’s horribly uncomfortable for me. And so I’ll do anything to not experience embarrassment. What I’m really trying to do is to not experience that rush of blood into my face and the heat sensation that comes with it, it feels so crummy to me or somebody who feels like a sinking in their heart or pressure in their heart when they’re sad or they’re disappointed and they go, Nope, not going to let myself do that again. What we’re not wanting to do is to experience the bodily sensation that helps us know what’s going on emotionally.

So, then it was like, okay, and I was always telling people to ride the waves. So, what I realized is I was telling people to ride the bodily sensation wave so that they could handle the feeling. So, how do you handle the feeling then? How do you lean into it? Again, what we’re talking about is leaning into this unpleasantness. Just have an idea that what you’re leaning into in the moment are unpleasant bodily sensations. And if you can stay with them long enough, then you get the awareness of what the feeling is, and then you get the benefit of being able to use the feeling. So, what I want people to do, per se, air quotes on that one, is to lean into the feeling. So, how do you do that? Well, think of it as the metaphorical or equivalent of stubbing your toe. Something happens, you react, it lasts for a little bit and then it goes away.

So, the same thing with the feeling. You have a reaction, you notice you’re having a reaction, take a deep breath, just take some deep breaths, just lean and then pause a little bit and just lean right into, as you’re breathing more slowly and more deeply, you just lean right into that experience and you go, oh, okay, I’m sad. That’s what I’m reacting to. Or I’m angry or I’m disappointed, or I’m whatever it is that I am. And you just have that awareness. You don’t try to back away from it. And then if you can pause and reflect a little bit longer, then you can go, huh, I wonder what this is connected to. Oh, it’s because of this, or whatever it might be. And if you have even longer and you want to reflect more deeply, then you can go, I wonder if there’s any pattern to what I’m experiencing, or I wonder if, because it feels so intense, I wonder if there’s something in the past that I didn’t deal with that this is connected to.

So, you can get into lots of reflecting upon whatever is that you’re experiencing in the moment, but the most important is you want to deal with what it is in the moment. So, deep breath or deep breaths to lean into it, ride one or more waves of those bodily sensations, and then you’ll have the awareness most commonly, then here’s the next step, because this is the thing that people don’t realize. So, why am I having the feeling anyway in my mind? What’s most important here is that you are joining feeling with your capacity for reasoning and thought.

So, you’ll gain insights, you stay present to the feeling long enough, you’ll gain insights in What you get to do then is to join your awareness of whatever the feeling is and whatever those insights are with other reasoning, with other thinking. And it’s going to help you make decisions about whether make decisions in general period or make decisions about whether you want to express yourself or do something. And so feelings exist so that you can join them with thought and reason to live a better life.

Kristen Brokaw: And make a decision, get into action, whatever comes with that. Right, exactly. Or after that.

Dr. Joan Rosenberg: So, there’s three big things people can do. They can use it for decisions itself themselves, use the feelings joined with thought and reason for decisions themselves, for decision-making. The second thing is they can use it to express themselves or they can use it to take some kind of action.

Kristen Brokaw: So, that’s excellent and that it sounds like if people understood that, like you said, they would live a better life, but they wouldn’t get so reactionary.

Dr. Joan Rosenberg: They don’t reactive, right.

Kristen Brokaw: Reactive probably do less destructive things in the distraction mode. So, the alternative is the distraction. So, this is obviously a podcast for practitioners and mainly functional medicine practitioners. And I’m going to guess that even you being a clinician and a lot of patients are coming in with habits all based out of a life of distraction.

Dr. Joan Rosenberg: Absolutely. A hundred percent true.

Kristen Brokaw: I guess I’m just trying to figure out the best way to say this. How does a provider take this little crazy gold nugget and give this to a patient or do you know what I mean? Yeah.

Dr. Joan Rosenberg: So, part of it is the practitioner’s willingness to listen to feelings in the first place. And in terms of practitioners, the less you deal with your own feelings and the more you try to distract from your own as a practitioner, the less you will listen to a patient’s feelings.

Kristen Brokaw: Ooh, that’s a good one.

Dr. Joan Rosenberg: Because you’re not going to want to hear what they have to say about what they feel. You’re going to only want to know the symptom, and you’re going to only want to know what they think or at best what they think. You’re not going to be listening for the feeling, but the feelings often bring the golden nuggets. And so one of the things practitioners can do is the first step is to get better at handling their own feelings so that they can be more present to the patient’s feelings. And then if they’re more patient and more attentive to the, I think I messed that up, so that they can be more attentive and more attuned to the patient’s feelings. If they’re more in tune to their own, they’re going to be more attuned to someone else’s.

So, what they can do at that point then is to help the patient understand that they may or may not be dealing very effectively with their own feeling state, and that might be a contributor as well as other things might be a contributor to the variety of symptoms that they’re declaring that the patient is declaring. That’s one thing. The second really big area where this comes in is that many times clinicians have to say things to patients they don’t really want to say, and what is contained in that. When they’re reluctant to do that, it has nothing to do with their capacity to speak. It has nothing to do with their capacity to communicate, their reluctance to say what they need to say to the patient actually has to do with their own difficulty. The clinician’s own difficulty with their own unpleasant feelings.

Kristen Brokaw: Let’s open this one up. This is the magic right here. So, have you worked with clinicians on this exact A lot? She said.

Dr. Joan Rosenberg: A lot. So, as you know, I’ve also had my foot in the entrepreneurial health space. I’ve been around hundreds if not thousands of health practitioners. Yes.

Kristen Brokaw: So, as you just said, their issue with not dealing with their own emotions is number one. But then couple that with now giving the patient some information or speaking up as you say, and telling them something that maybe they really need to say is more about the provider and less how they deal with their emotions around that, I guess, and less about what the patient. So, can you just dive more into that? Yeah.

Dr. Joan Rosenberg: Let me give you a very quick example, and it just happened today. So, I’ll draw from immediate experience.

I just met with a 22-year-old and the 22-year-old, I was doing a routine intake with the individual and I asked about drinking, and the individual said that sometimes drinking is hard and explained that situation and then explained when she goes out and she’s going out to have a good time and to party, she’s drinking four or more. Somebody might be reluctant to call that out, but I’m not. And so I kind of commented, I said, well, four’s binge drinking. And she goes, I know. So, she has some awareness. And so I said, and towards the end of the interview, the intake, I said, how about if we kind of make the drinking piece part of an overall goal that we talk about, that we don’t leave it off the table, and that we also pay attention to that as that being a potential contributor or effect of some of what you’re going through.

Kristen Brokaw: A distraction.

Dr. Joan Rosenberg: Yeah, exactly. But now I have it front and center for us, and I didn’t back off from addressing that as with the patient or with the client. It’s like, no, no, no, no, this is on the table. And I was very clear about that and she agreed. I was like, okay, great. So, now I have a contract with her that it’s okay for us to also talk about that and why? Because I made it. Okay, it’s okay for me to say and it’ll give me, and if she has a particular kind of reaction to it, it’s going to give me more information about how she functions anyway, right? Well, she goes, no, no, no, I don’t want to talk about it. That’s going to be one response. Or she goes, okay, you know what? I think you’re right. Let’s take a look at that too.

Then that’s going to be a different kind of response. It’s still going to give me information as that provider, as that clinician. But again, here’s my thinking about this. And for me, this was, I will tell you, it was probably one of the most, along with the feeling thing, and we just don’t want to feel the bodily sensation was probably one of the most important insights that I had around speaking, and that is anybody that has difficulty speaking up, and I’m talking about whether they’re in personal situations or we’re talking about this very clinical situation where you have difficulty as a provider saying the things you need to say to a patient that it has nothing or very little to do with the patient themselves. It has everything to do with you as a clinician. And that what I realized is that difficulty speaking up is not a speaking problem, and I just have to let that land difficulty speaking up is not a speaking problem, difficulty speaking up if you have difficulty speaking up.

It’s a difficulty with unpleasant feeling problem, right? Because in order for me as an individual to speak and to speak with ease across people, places, time, situations, whatever it is, speak with ease. One caveat in parentheses kind and well intentioned, there’s no license for maliciousness. There’s no license for hostility or meanness. So, for me to be able to speak up with ease across all those situations, I have to be able to deal with the unpleasant feelings I experienced within myself, and I have to be able to deal with the unpleasant feelings within myself simultaneously with the unpleasant feelings or what I call the discomfort of my emotional discomfort and the discomfort of your emotional discomfort simultaneously in order to have a conversation. And if I don’t with my own, I’m sure as heck not going to deal with yours, and then I won’t bring up the very thing as a clinician or a provider, I need to be bringing up with you, not because of you, because of me.

Kristen Brokaw: So, that’s so profound, and I like how you put the caveat that it’s kindness well intentioned. So, I guess if a provider is thinking I should mention something about the drinking, that seems like that’s probably a, to put it in your terminology, a distraction that’s not supporting what this patient is telling me, their desiring that if I deliver this with true kindness and well-intentioned that there’s got to be a way to say it or to preface it in some way that, and I’ve heard you talk about this on other podcasts where maybe you could say you could just identify the emotion like, oh, I would hate for you to get upset or I don’t know, do you know what I’m speaking about?

Dr. Joan Rosenberg: In terms of how to deliver?

Kristen Brokaw: Yeah, how to deliver this thing. You’re already very nervous about delivering.

Dr. Joan Rosenberg: So, sometimes what I’ll do is I’ll make a contract with somebody what I call kind of a soft contract. And what I mean by that is I’ll look at them and I’ll go, you know what? There’s a couple thoughts I have, or there’s a couple observations I made, or a couple things that I’m thinking about that I think would be helpful to you, except I’m not sure how you’ll receive them.

Kristen Brokaw: That’s good. That’s like a get out of jail free card.

Dr. Joan Rosenberg: I’m not sure how you’ll receive them. So, I want to be able to tell them to you, but I also need for you to be able to hear that what I’m trying to do is come from a good place to support what you’re asking for, but that might be stuff that’s a little difficult to hear. Would that be okay? Right. So, now the patient says, well, yeah, that’s what, I might not want to hear it, but that’s what I came for. And then now I have the openness. Now we have an agreement, and now I can say what I need to say, you’re obese by 70 pounds. We got to do something about your weight. Or you know what? I know you love sugar, but we got to do something about the sugar because diabetes numbers are through the roof. It doesn’t matter what it is.

Kristen Brokaw: It could even be an employee. I don’t want you to get upset or think that I don’t value you, but you’ve been coming in late or this has been missed, whatever.

Dr. Joan Rosenberg: Exactly. So, it is sort of what I call a preemptive bid. There’s two to it. One is this kind of soft contract thing. The other is, and my thinking here is that, and this is a much deeper level conversation, is that we’re having a conversation about the conversation before we have the conversation about the topic.

Kristen Brokaw: Interesting. Okay.

Dr. Joan Rosenberg: So, in me saying to you, I want to say some stuff to you, I’m just not sure how you’re going to handle it or how you’re going to react. I’m having a conversation about the conversation and now I have agreement on that. So, it’s preemptive. I have an agreement on that, and now I can talk about the topic.

Kristen Brokaw: Right. Boy, I bet that would go so far. Have you ever had clinicians say to you, that’s been a game changer for me?

Dr. Joan Rosenberg: Absolutely. Absolutely. Yeah. Once you learn how, and the other big thing that you can do is that you don’t offer things definitively. You offer them tentatively seems like your drinking is getting in the way because your liver enzymes are showing X, Y, and Z. Seems like your sugar numbers are right because of whatever, so that you can offer it up as a direct observation, but all you do is you attach something that’ll allow them to go yes or no, and typically they’ll lean into the direction you want to go because you’re not saying you drinking is doing X. Right?

Kristen Brokaw: It’s separate from the person. I see what you’re saying. Yeah.

Dr. Joan Rosenberg: Yeah. So, it’s not putting the stake. You might know that the stake goes in the ground, but you’re not putting the stake in the ground in that way. You’re offering it up to them in a way that they can absorb it and then do something with it as opposed to want to go, no pushback to it. Again, think about growing up. Think about how many times your parents said, no, you can’t do that in your head, you’re going, oh yeah, I can just watch me. So, you don’t want the patient on the other side to react that same way. I’m going to tell you exactly what you need to do in this definitive whatever, and that can work too. I’m not saying it doesn’t work. And in fact, you can become more definitive once you have the agreed upon contract with the client or the patient.

So, that will then depend on the nature of your relationship with the person you’re working with, and you’ll get an idea of whether you can be a little bit funny about it, or you’d have to be super serious, or where you have to be more definitive. But you’ll get that because you’re attuned to who they are, and you’re also attuned to their emotional state and your relationships develop more. You have better connection and better compliance when a patient feels like you care about them. Well, how do you show that you care about them? You attend to their feeling state.

Kristen Brokaw: I was just going to say, I feel like that’s coming back to the feelings part where I think those eight feelings literally should be in a framed.

Dr. Joan Rosenberg: Manifesto.

Kristen Brokaw: On every provider’s wall that’s like, well, actually this is more likely what’s going on for you kind of thing. So, yeah, they’re not addressing probably the feelings enough in some of their intakes.

Dr. Joan Rosenberg: Right? Right.

Kristen Brokaw: But how does a provider get someone to open up without taking the entire, you know what I’m saying, mean.

Dr. Joan Rosenberg: In terms of people kind of then running away with the interview.

Kristen Brokaw: Or just taking up so much time and it’s like the provider doesn’t get, because I’ve heard many providers say, gosh, that patient doesn’t, they just don’t stop sometimes.

Dr. Joan Rosenberg: But that’s not, again, what I will say to you is that is not the patient’s issue. That is the provider’s issue stopping the patient. Right? So, same thing, I had somebody that was, would’ve been involved in kind of telling me the story, and so I said, I know that. I think I said to her something like, I know that we can go much deeper into this. How about if we save that for later, we bookmark it for now, we save it for later when we meet again. And then, but let me get through the rest of the key questions I need to get through for today. So…

Kristen Brokaw: Say that one more time. So, you just say, I know.

Dr. Joan Rosenberg: I said something like, I know that we could go much deeper. Or if somebody’s into storytelling when they’re in your office, you just say to them, look, I know that you have a lot to say on this concern or this issue or this topic or this situation. I know you have a lot to say on that. I want to be mindful of our time today. I want to be mindful that you have a lot to say on this. I also want to be mindful of our time. Let’s bookmark this. Let’s save this for later, however you want to say it. And what I want to do for today is to make my way through the rest of the questions.

Kristen Brokaw: And you could get agreement on that.

Dr. Joan Rosenberg: You get agreement on that same thing. Soft contract, get agreement on it. And the thing that I want to say is this is not the patient’s problem. It is the provider’s challenge with setting a and setting a boundary and moving on to the next topic and doing it in a way that honors the individual.

Kristen Brokaw: If I go back to one of those feelings, it might be disappointment, right? They’re afraid of disappointing the patient. Exactly. Frustrating the patient being vulnerable.

Dr. Joan Rosenberg: Well, we have to be vulnerable. Here’s the key. We as clinicians, and I love to talk about this, it’s what I call, it’s a paradox of safety. We think that the patient will feel more safe or we will want to wait until they feel safe in quotes, until we say the difficult things. And my point of view is saying the difficult things is part of what helps them feel safe, right?

Kristen Brokaw: Mic drop. So…

Dr. Joan Rosenberg: They will feel more understood and more cared for when they know that you can say the things that you need to say and you’re not walking around or circling something instead that you’re saying something. So, again, if I give you an example, I can’t remember exactly what I said to the individual. I’ll try to remember it, but I said something that was really kind of in quotes, kind of interface. It was just, this is the way I see X, this is how I think through X. I’m not putting it on her. I’m just saying this is the way I think about it.

Kristen Brokaw: Kindness and well-intentioned.

Dr. Joan Rosenberg: Exactly. So, I was talking about centering her strength and something inside her as opposed to people pleasing and centering it in other people. And she goes, whoa. It’s like, wow, never thought about it that way. That kind of a reaction to it. And she goes, that’s really helpful. And then she said, well, I like it. I like your directness, like the truth or whatever. And I said to her, it’s the truth that actually calms you down. So, it’s the truth that actually provides the comfort. It’s the truth that actually provides that sense of calm because her system is resonating with the truth that’s being observed out loud. So, I said, someone’s observing your reality when your reality is being accurately attuned to, then there’s calm. So, on my end, for clinicians in terms of training this, it’s helping people be able to helping the clinician or the provider be able to say what they need to say from a kind and well-intentioned place where the person on the other side knows that you’re in their court and you’re saying it to them to support their growth and their wellness and whatever it might be. Is this making sense?

Kristen Brokaw: Totally. And I feel like for providers listening, they are going to be able to think of every appointment that they had that day where they could have done that, and hopefully change change. Because like you said, I mean the old adage, the truth will set you free. It is when you think about you’re in a hairy situation and someone comes in and takes charge and says, you go here and you do, then you have safety. There really is safety in that. I hear you. But you’re right. I think the opposite is what is thought to be true.
Dr. Joan Rosenberg: I can speak when the patient feels safer. No, no, no, no, no. It’s actually how you speak. And sometimes what you say that actually helps facilitate the safety for the patient in your room.

Kristen Brokaw: Which therefore to put a bow on things for your tagline on your book as well, this is where the confidence comes, piece comes.

Dr. Joan Rosenberg: Yeah. So, I’ve spent close to 40 years training masters and doctoral students how to do therapy.

Kristen Brokaw: Oh wow. Okay.

Dr. Joan Rosenberg: So, if you step back from that and you think about it, my role as a psychologist is actually, and my profession in the room is built on telling people what they don’t want to hear all day long. That’s what the profession, I mean in the room, that’s part of what it’s about. I’ve got to be able to identify what’s going on for you and say things that you may or may not want to hear consistently over and over and over again.

Kristen Brokaw: You’re like a big buzzkill.

Dr. Joan Rosenberg: With anybody that I’m seeing, and with anybody that I’m seeing over time, it doesn’t stop right now. Why am I going this direction? So, the thing is, what’s that…

Kristen Brokaw: Confidence?

Dr. Joan Rosenberg: Yeah. So, what I will tell, thank you. What I will tell the graduate students that I’ve taught is that when they will start to experience confidence as a clinician is when they’re actually able to confront the person in the room. You can be too supportive. Oh, oh, whatever, being, if you will, what appears to be nice niceness is not necessarily effective. But when you are willing to say, if I use the example that we’ve already talked about, when you’re willing to say, huh, well four drinks or better at night is already binge drinking, and you’re willing to put that out to the person you’re working with in whatever form it might sound like in your specific practice, that’s when your confidence as a clinician develops. That’s when your confidence is a provider or whatever, a doc in the room working with patients develops.

It’s not until you can say the difficult things and have the patient on the other side go, got it, okay, let’s work on it. Or, okay, I want to work on it. Or even if they get upset about it and then you deal with their upset. I didn’t want to hear that. I understand. You might not have wanted to have heard that, except I’m trying to stand firm in support of you in ways that you’re not doing it for yourself yet.

Kristen Brokaw: That’s just a good, that’s almost like a get out of jail free card too. I mean, you’re essentially, I love it.

Dr. Joan Rosenberg: So, it’s dealing with saying it. It’s dealing with whatever the response back is and still being able to stand firm in the truth that typically that both the patient knows.

Kristen Brokaw: I mean, that’s ultimate confidence is when I can say what needs to be said and absolutely handle my uncomfortableness with it and your uncomfortableness.

Dr. Joan Rosenberg: Absolutely. So, that it shows up when you can handle, when can say what you need to say, and you can handle the response you get, not the response you desire.

Kristen Brokaw: And I still love your caveat. If you are truly well-intentioned and you’re being kind and you can own, yes, I was concerned about one of those eight feelings. I was concerned about feeling embarrassed or concerned about your frustration with this or whatever. I mean, I just think that really says it’s a nice high emotional intelligence.
That you’re coming off versus just trying to be the provider that patients, or I once had a provider tell me when I was in my early twenties, and I had just gotten out of college, so I was definitely a little fluffier. And he said, well, you’re not the leanest cut of meat. And I was like, oh, wow. And then he said, you’re at risk for diabetes. And he just went down the list. And here I am, probably 24, and the next year I went in to see him. I was quite a bit thinner. And I told him years later, I’m so grateful that you said that to me. He didn’t say it to be mean. He said it to probably be a little funny, but also…

Dr. Joan Rosenberg: Right. But that’s also an example of somebody who could have said it better. That is right. So, he was trying to be a little bit funny with it and sarcastic with it because he wasn’t comfortable saying the thing he needed to say. If he’d been more honest, it actually would’ve been more effective. And if he’d said, look, I see the way you are right now. The reality is if you were leaner, your health would actually be better. Instead, he did it sarcastically because he couldn’t manage his own state saying it directly to you.
Kristen Brokaw: Right. Didn’t even think about it that way, but you’re spot on.

Dr. Joan Rosenberg: But that’s part of why he did it. Oh, well, you’re not the leanest cut of meat. I was like, dude, why don’t you not put it in something that ostensibly you think might be funny.

Which isn’t. It’s cutting, it’s hurtful because the message the brain hears is the hurtful part of the message. But if he had done it cleanly and been able to handle his own difficulties saying things directly, then he would’ve said something closer to what I said. It’s like, Hey, you know what? Your numbers are like this. Or I can see that you put on a little bit of weight, or you know what? You’re heavier than what your height would suggest. And I know that if you stay this way, it’s going to make it harder for you from the standpoint of X, Y, and Z.

Kristen Brokaw: And similarly, to what you said earlier is that when you talk about it kind of away from the person, it’s the numbers on the scale are indicative of these types of things happening potentially.

Dr. Joan Rosenberg: Potentially to you.

Kristen Brokaw: Yes. And so I really like how you said that. And so this is just such information I don’t think providers get, I think they need these little reminders they should have. Part of their CME is to go back through emotional training. I don’t know.

Dr. Joan Rosenberg: Happy to do that if somebody’s interested.

Kristen Brokaw: Wonderful. How can people find you, Dr. Joan?

Dr. Joan Rosenberg: Well, there’s all sorts of ways. Certainly if you just punch my name into the grand old Google, then I’m sure that I will be found so that they can reach out to me via my website, dr john rosenberg.com. I’m on a variety of media, so Instagram is probably the easiest way to find me. But there’s stuff on Facebook and an old Twitter account that I’m not really using so much right now. And LinkedIn, I can also be found there. And then I’ve done a lot, couple, as you mentioned, when you introduced me, a couple different TED Talks and also wide number of podcasts, podcast interviews and such, and the books. So, there’s lots of different ways to locate me to…

Kristen Brokaw: Find you. Alright. So, the book we talked a lot about today was…

Dr. Joan Rosenberg: 90 Seconds to A Life You Love.

Kristen Brokaw: A Life You Love. Awesome. Well, thank you Dr. Joan. They’re going to find this wildly helpful.

Dr. Joan Rosenberg: I’m so glad. Thank you so much.

James Maskell: Thanks for listening to the Evolution of Medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools, like the Group Visit Toolkit. That’s goevomed.com/lmrc. Thanks so much for listening, and we’ll see you next time.

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