When are you at your happiest? A good way to tell is to look back at the ‘happiest times of your life’. What do they have in common? Probably you were part of a group, a group undergoing the same experience and undertaking a common endeavor. It was a time that, at that time, probably seemed filled with hard and challenging experiences, failures that only in some cases led to successes. You probably remember it as a time of growth and transformation, in which you gained a deepened understanding of the world and yourself. And if it was a time of deep happiness in hindsight, it was a time that probably led you to become more confident in who you are and in what you can do. You felt you belonged and had a role to fulfill, a job to do, one you were able to do well because of the knowledge and skills you had acquired from all those challenges you faced and surmounted.

And now, here you are. Are you as happy now? If you are, you likely are living within an environment that offers that same sense of immersion, belonging, hard yet surmountable challenges, and a sense of growing mastery and confidence.

If you are not as happy or are frankly unhappy, then you’re likely living in an environment that does not offer those same types of growth experiences. And although it isn’t as happy of a time now, it still may become one—but only if you make it so. There are many directions to go here in exploring what needs to and is possible to change. Today, I focus on establishing a certain comportment towards your work with patients, a comportment to make the flow state more likely. The shortest route to happiness is to set up one’s life to experience flow states as frequently as possible. Flow states can be defined as states of mind that occur under certain conditions that lead to an intrinsically rewarding state of effortless attention and action. Setting up one’s life to be in flow every day is easier said than done. But it can be done, first slowly, and then with increasing speed. First, I summarize the characteristics of flow states.

Flow States

The state of flow was defined, researched, and popularized by psychologist Mihaly Csikszentmihalyi, who wrote the best-selling book Flow in 2008. Flow states share the following six characteristics.

  1. Intrinsically Reinforcing Experiences: The experience of doing the activity is intrinsically rewarding. It feels good and the good feeling is often characterized as one of a calm excitement, an intensity coupled with being at peace, of trusting oneself and the other people involved and the world around you. This type of experience is sometimes called an autotelic one. Telos refers to the goal of an activity, the reason something is done, and auto means that the goal is contained within the activity itself. Thus, it is self-rewarding, the end is contained in the means. Extrinsic rewards may be present, but they are unnecessary to the desire to engage in the activity that brings on the flow state.
  2. Intense Concentration: The intense and focused concentration that occurs focuses on the present activity occurring in the present moment. A person feels a sense of anticipating the upcoming moment, what the other participant will do and also what oneself needs to do.
  3. Merged Action and Awareness: The person in the flow state gains ability to perceive the situation as a whole, not only of the other actors and of oneself, but also across time. Temporality compresses so that what occurred earlier, what is occurring now, and what is about to occur seem to present themselves to consciousness as a whole, without a sense of sequence or of switching among points of view. Commonly, the sense of perceiving the next move while already undertaking it occurs. Much of the flow of perception and action-taking proceeds effortlessly and outside of active judgment and deliberation.
  4. Agency: Within a flow state, a person often feels an effortless ability to act, of being unconstrained by outside factors nor by limitations in skill or knowledge. What one wants to do is done without encountering friction and frustration.
  5. Unself-consciousness: In flow states the person feels grounded and their actions flow onwards and outwards. This occurs without self-reflection. There is no thought given to, “How did I come off looking?” Because flow states are characterized by cybernetic self-correction, that means there are instances of reflecting on one’s performance to ensure it remains on target, so that effective action can continue apace. Often this course correction, as mentioned in previous points, is done automatically, in which perception merges with action effortlessly. Sometimes, though, especially when the situation unfolds in an unanticipated direction or the limits of knowledge and skill are encountered, a conscious reflection on one’s behaviors and current trajectory needs to occur. This does not mean, however, that the reflection is on the self, the ‘I’ that can feel shame or pride or any other interpersonal emotion.
  6. Altered sense of time: The experience of the passage of time differs in flow states in comparison to non-flow states. Often, while in the flow state, the passage of time remains unnoticed. The feeling that is described in hindsight when reflecting on the flow state is that it is an experience of timelessness, of having stepped outside of the passage of time. Then, when the flow state concludes, the person may be stunned by how much time elapsed during the flow state.

How to Increase Flow States at Work

I hope flow states seem like a hoped-for achievement. But how do they occur at work, especially when thankless tasks like filling out paperwork are such a large part of the day?

The answer is that there are no guarantees but making changes to one’s mindset and behaviors can increase flow states and near flow states. The work we do as clinicians includes many components that lend themselves in actuality or potentiality to development of flow states, in particular, the fact that the work we do is worthwhile.

Above I described the features of flow states. Now let me focus on what factors can bring them on.

Mastery: The person experiencing flow states has the ability to do so because of confidence in their ability to successfully engage and complete the job. They not only have the knowledge and skill to deftly engage in most of the tasks they face, but they also have the meta-skill of engaging with novel, unexpected, and challenging situations and discovering strategies of succeeding in them. This way they do not need to think, “Sure I can handle regular kinds of patient interactions, but what happens when something surprises me, and I won’t know what to do?” The person who is able to maintain flow despite the ever-present possibility of a novel situation arising is a person who has the confidence that 1) they have already identified likely ‘unexpected’ situations—because most unexpected situations are actually foreseeable—and have planned and prepared for them, and 2) that they will also know what to do even when the truly unexpected occurs.

So, what you can do is to increase your mastery by 1) acquiring deeper knowledge about the interventions (including medications) you already use regularly and expanding your armamentarium of interventions that will allow you to treat increasingly challenging patients, such as those with a history of multiple treatment failures; 2) gaining skills in handling difficult patient interactions, including verbally abusive, physically intimidating, or highly unstable and immanently suicidal patients; and 3) identifying strategies for skillfully coping with novel and, at times, hard and dangerous situations.

Mindset of Open Curiosity: With a curious mindset you can greet every patient encounter as an opportunity to learn, to better discern patient states of mind and features that help predict outcomes, identify nuances in your behavior that tend to deepen or to interfere with therapeutic engagement.

Complexifying and Increasing Difficulty: You are, no doubt, at the very least good enough in the care you provide your patients. You may even be outstanding. In either case, there may be no extrinsic pressure on you to get better. In fact, getting better may cost you time and money. So, really, who in their right mind would want to take this road of doing what is harder when doing the easier is just fine? Maybe no one. But maybe you. Why you? Maybe you’ve got the career blahs. Maybe you’re bored and frustrated, and in your work—since it doesn’t offer much intrinsic reward—the unavoidable hassles loom ever larger. Maybe you’re even at the point of burnout. Not beyond the point of no return, but noticeably so.

What you can choose to do is to complexify. Maybe step back and ask, “What am I missing? What more can I learn? How can I become the best?! My very best? Why not? Why not live it on a higher plane?”

The first steps will likely be hard and maybe not all that rewarding. But this is what might happen: You may reach a point where every human interaction becomes imbued with meaning, a dance, a ritual, a unique unrepeatable event, an encounter. You may be able to perceive the meaning behind every interaction and see its origins. You may feel you can see inside your patients’ minds so that you know what to do and say that will perhaps trigger a breakthrough.

Can you be the person who will leave an indelible and positive mark on a person seeking help after one brief encounter? You can, but not always and not with everyone. But for some, you will be able to. One caveat to remember: never get too full of yourself. Be humble in your skills.

Incorporate the Tedious into Your Circle of Mastery: So, maybe you’re now intrigued. But you quickly remind yourself that there is too much nonsense at work, too much chaos, too much that doesn’t work. If the situation is really bad, explore your options. You might do better. It’s hard to change jobs and I don’t want to be flippant, but sometimes saying goodbye in order to say hello is the road to take.

But if you just have to deal with the same hassles that everyone working in any mental health setting has to deal with, then there is no reason to escape from your current job. So, what do you do? You take those hassles, especially the paperwork ones, and you master them. Let’s say you hate your EMR system. You are literally pissed off at the powers that be for making you use it. Well, if you’re staying at your current job and will still need to use that EMR, take a different tack: master the darn thing. YOU become the power user. Luxuriate in your newfound power. Laugh in the face of poor coding and user experience design.

Last point: although flow states are intrinsically rewarding, the path of getting into them is through what is already compelling to you and/or what you believe is worthwhile. Treating patients, helping them get well, is certainly a worthwhile way to spend the days of your life. That motivation to do what is worthwhile is your entry point to the happiness found in the flow state.

Good luck,

Dr. Jack

Language Brief

“The best moments usually occur when a person’s body or mind is stretched to its limits in a voluntary effort to accomplish something difficult and worthwhile. Optimal experience is thus something that we make happen.” ― Mihaly Csikszentmihalyi

“Everyone has been made for some particular work, and the desire for that work has been put in every heart.” ― Rumi 

“Suffering is people not caring about your work. Pain is you not caring about work.”― Dragos Bratasanu

“Don’t pick a job with great vacation benefits. Pick one you don’t need to be escaping from.” ― Unknown

“Pleasure in the job puts perfection in the work.” ― Aristotle