How to Deal With EF Concerns in Healthcare

Okay, so today we’re getting real. Recently, a coworker shared with me how her friend has long struggled with working as a nurse while also having ADHD. This friend was lucky enough to find a position at a hospital that truly supports and embraces her, but many are not as lucky. And although ADHD is commonplace in the healthcare space, its challenges are often stigmatized and swept under the rug - creating an epidemic of shame that can feel isolating and overwhelming. After all, imagine what it feels like to constantly help others when you yourself are struggling everyday?

To help shed light on this subject, we reached out to an Executive Function coach of ours, Beth Malvino, who coaches two social workers, Lina and Cassie. Together, they bravely shared their stories about the difficulties they’ve faced in managing their own executive dysfunction while supporting others' mental wellbeing. Their stories are powerful and filled with important wisdom around the unique challenges that healthcare workers with ADHD encounter and what can be done to overcome them. We explore self-care, the limitations for neurodiverse people within the systems in which we work and live, and combating that negative narrative that runs through the heads of many people with ADHD. I am sure that anyone listening who has Executive function challenges and works in healthcare spaces will really relate to much of what you’ll hear on this episode.

NOTE: There is some very light swearing in this episode. If you’ve got any young kids with you who happen to be super interested in the impact of ADHD on healthcare workers, you might want to give them a heads up.

Finally, I also wanted to share that we have a podcast email now! You can reach out to me at podcast@beyondbooksmart.com. Send me your episode topic ideas! I’d love to hear from you.

In the meantime, here are the show notes from today's episode:

Tips For Nurses Managing Their Attention Deficit Disorder:

https://blog.diversitynursing.com/blog/tips-for-nurses-managing-their-attention-deficit-disorder

A Day in the Life of a Healthcare Professional with Executive Function Challenges:

https://www.worksmartcoaching.com/blog/a-day-in-the-life-of-a-healthcare-professional-with-executive-function-challenges

8 Tips For How To Thrive As A Nurse With ADHD | NurseJournal:

https://nursejournal.org/articles/how-to-thrive-as-a-nurse-with-adhd/

ADHD - Workplace Issues:

https://chadd.org/for-adults/workplace-issues/

Contact us!

Reach out to us at podcast@beyondbooksmart.com

IG/FB/TikTok @beyondbooksmartcoaching

Transcript

Hannah Choi 00:04

Hi everyone and welcome to Focus Forward, an executive function Podcast where we explore the challenges and celebrate the wins you'll experience as you change your life by working on improving your executive function skills. I'm your host, Hannah Choi.

Hannah Choi 00:18

Before I tell you about today's episode, I wanted to share that we have a podcast email now! You can reach out to me at podcast at beyondbooksmart.com Send me your episode topic ideas. I'd love to hear from you.

Hannah Choi 00:33

Okay, so today we're getting real, not like we haven't been real in the past. Talking about EF challenges is very real. But we're getting extra real today. Recently, our podcast team was having a conversation about how having ADHD impacts people at work. And someone shared that a friend of theirs is a nurse who has ADHD. And she had finally found a position at a hospital that truly supports and embraces her ADHD and all. We wanted to explore the idea of holding a job where you're constantly giving, giving, giving, and often supporting people with EF challenges. While also managing your own EF challenges. We reached out to a coach of ours Beth Malvino, who works as a coach for two social workers, Lina and Cassie. They joined me and Beth to share their stories about the difficulties they face in managing their own executive dysfunction, while supporting others. They'll provide insights into the unique challenges that healthcare workers with ADHD encounter and the work they do to overcome them. You'll hear Beth offer her valuable and rather touching perspective on Lina and Cassie's EF journeys. All three of them share the tools and strategies that Lina and Cassie have found helpful in supporting their executive function challenges. In addition, we explore self care, the limitations for neurodiverse people within the systems in which we work and live and combating that negative narrative that runs through the heads of many people with ADHD. I am sure that anyone listening today who has EF challenges and works in healthcare spaces will really relate to much of what you'll hear today.

Hannah Choi 02:29

And just to note that there is some light swearing in this episode. If you've got any young kids with you who happened to be super interested in the impact of ADHD on health care workers, you might want to give them a heads up. Okay, now on to the show.

Hannah Choi 02:46

Hi, y'all. I learned that from Lina. Lina and Cassie and Beth are joining me today to talk about executive function challenges for people who work in healthcare spaces. And Lina is from originally from Texas. And so we were talking about y'all, so I thought I'd try that out today. So, would you guys, would you like to introduce yourselves? Lina, do you want to start?

Lina 03:13

Sure. Um, hi, I'm Lina. As Hannah said, I'm originally from Texas, but I currently live in Chicago. I work in social work on getting my master's in social work with the concentration in mental health. But I have some background in public administration and policy work, particularly within criminal justice spaces, or like to say the criminal system of injustice just because that's what we have right now. And it's, uh, you know, I work within the realm of mental health and people who've been impacted by that system. So yeah, it's really great to be here with all of you. I'm excited to chat.

Hannah Choi 04:01

Thank you, and Cassie.

Cassie 04:05

Hello. My name is Cassie. I am a school social worker slash guidance guidance adjustment counselor. And I don't work at a typical school. I work at a therapeutic day school. So my kiddos have they range our youngest right now is seven. Our oldest is 20. And they range from all kinds of mental health diagnoses trauma backgrounds, emotional behavioral disabilities. So it's funny thinking about kind of our our topic of today is you know, having EF concerns while working in in healthcare but it's like I have EF concerns and I'm surrounded by children who also are very dysfunctional when it comes to EF and also kind of in general. Um, so that was kind of funny to think about that that juxtaposition.

Hannah Choi 05:04

So yeah, and I really want to get into that today because that is you two are not the only people out there who work in that work and also have executive function challenges. So I'm sure that there are other people who will hear this conversation and be really be able to resonate with or relate to relate with what you have to say. And last, we have Beth, who is, well, Beth, you explain how you know Lina and Cassie, and what your role is in, in the world?

Beth Malvino 05:40

Sure, sure. So hi, I'm Beth. I've been a licensed clinical social worker for more than 20 years, I have worked in lots of different healthcare settings, mostly hospitals, with different populations of people. I've been in psychiatry, medicine, hospice oncology, I had my own private practice for a while, I ran virtual support groups for grief and divorce during the pandemic. And now I am an executive function coach at Beyond BookSmart. I currently work with Lina and Cassie, they've been my clients for some time now. And so I'm really going to enjoy talking to them today, because they've had such an amazing journey. So I'm looking forward to sharing that and hearing their perspectives from that.

Hannah Choi 06:32

Yeah, great. I can't wait to hear this too. And Lina, and Cassie, why did you seek out executive function coaching?

Lina 06:43

Yeah, so I sought out executive function coaching, because I was diagnosed with ADHD as an adult in 2021. So it was like a year after the pandemic had started. And I didn't start coaching until last year 2022, like I had waited a while. Just because you know, when you're an adult, and you get diagnosed with something that you've had your whole life and things didn't make sense. And you finally got that, I like to think of it as like the lens that you can see through your life and look at all the pieces that didn't fit together. And now you have this lens of information, that you could see more clearly, all of the challenges and triumphs and really weird stuff in your life. It, you know, it can take a while to kind of like, figure out what you need and unmask yourself. And so I started coaching last year, because I really, you know, I read all the books about ADHD and what it's like, but to put things into practice is what really was hard for me identifying how my brain worked and trying out different things, I didn't even know where to start to do that. And so that's why I sought out coaching just because, you know, putting, like, you can rationally in your head know, all these things, you know, read all the books, but it's a whole other thing to put what you've learned into practice. And that's why I sought out coaching. And it's, you know, greatly improved my mental health to even though it's not a mental health service. You know, it's, you know, just being able to put things in practice and learn more and get more information has improved my anxiety a lot just because I know I have different tools and different strategies than I did before. And so yeah, it's it's worked in conjunction with therapy already. That has improved a lot of things in my life and has helped make my work. You know, both in and out of school and in and out of social work a lot better for me.

Cassie 09:10

So I went, I think I think we started in winter, like December 2021. I think, recently, I'm like, Oh, well, I have a different insurance. Like, let's see if there is a psychiatrist nearby that can like assess me and like, take over my meds and whatnot. So I'm actually hopefully going to be starting that soon. Which would be great. Because there's a number of things, not just the attention and focus and whatnot. But there's other things that I'm like, Oh, I think I want somebody who knows stuff about this to help me figure things out. And that's kind of the same thinking that got me here as well. I sought out coaching because I was miserable. I was As I felt like I was drowning in work. And I couldn't kind of wrap my head around it because I have always been a smart kid, I've never had to work too hard at school. And even like college was mostly fine grad school was mostly fine. But when I started my first big girl salary job with my MSW, I couldn't manage it. Like I knew how to do the tasks that I was supposed to do. That's, that wasn't the issue, the issue was actually just getting them done, starting them and finishing them. So I was always behind on things, I was staying really late at work. I had already gone to my supervisor who is amazing. And she, you know, had given me some suggestions for what works for her and, you know, tried to get me a new planner, and we're like, move my schedule around to see if that helped. And so it's probably been a good more than six months that I'd been like, really aware of the fact that I was just very unhappy at work. And then I finally was like, a kind of, I had to bite the bullet because again, like, I'm used to just coasting through things. I'm used to just being successful with not a lot of effort. And to be like, Okay, no, like, I need help. I'm struggling really, really bad. It got to the point where I was like waking up in the morning and hoping that I would get a text message that say that there was an actual gas leak on campus. And so I didn't have to go in like, because I worked at a residential campus. And so there were no, like, there were no days off. Like it was Monday through Friday, no matter what, no matter if there was a blizzard, no matter if it was a national holiday, like we, we went in. So yeah, so I was I was very, very unhappy and was like, alright, like, it's not, it's not a matter of not knowing how to do it. It's just actually getting my work done. It's not not not knowing how to do it, it's being able to make it happen. So that's why Yeah, and Lina, you said that it's not a it's not a mental health service. But like, honestly, right now, I feel like I have three different therapists in some way, because I have my actual individual therapist that I speak with, like once or twice a month. And then I have my supervisor at work, who is amazing, and supportive and wonderful. And then I also have Beth, and it's like, it's Yeah, I feel like having all of these supports in my quarter has been like, really, really helpful.

Lina 12:36

So yeah, I, I want to affirm that, like, I know, you know, they're supposed to be different difference between coaching and therapy. But there have been several times where Beth and I and I'm sure it's the same way for you Cassie word, the coaching session does kind of turn into

Cassie 12:54

Oh, yeah. Therapy. For five sessions, I was just like, crying to her. Like, I don't know why I do this. I'm Yeah. This is hard to like, why is it so hard to just type words into my computer,

Lina 13:12

Or even like, when the big feelings show up, because you have some big feelings about something and you're just crying about it, you're just like, I don't know how to emotionally regulate.

Hannah Choi 13:22

It shows you how closely connected our emotions are with our executive functions, and how it is you cannot separate them. And, and so it's really great that you're that you're working with a therapist as well, because then you're able to take things that you learn in each and, and bring them together. And it was also recommend that to my clients, who aren't seeing therapists already.

Cassie 13:50

It was also really important to me as I was in the process of like, signing up that like, you know, I am, I am a, an MSW, I, you know, I have my license, I like I want to work with somebody who has similar training, because like, I feel like, you know, I kind of like I've seen behind the curtain, like, I know, like, you know, I'm aware of the different theories and whatever and, and, like, I wanted to work with somebody else who also had that same background.

Beth Malvino 14:23

I have to say that, I think, and I was thinking about this last night when I was sort of preparing for this podcast today, you know, what, what has been really important in in the coaching relationship with with both of you, and I think there's been an element of relatability that I maybe didn't realize how important that was until we all started working together. Because I'm a social worker. I mean, there's there's that capacity to understand even though we We've all done different things like I've never done any of the types of roles that you both are in. But yet I can still empathize because I know what it's like to have to chart, you know, 50 notes in a week and have to, you know, feel to feel like there's 1000 emails that haven't been responded to, and just the whole concept of giving so much of yourself, because that's what we do, you know, we're helpers, we're healers, and feeling as if there's just nothing left, at the end of the day. And when you throw in things like executive font dysfunction and time distortion on top of that, it's just I can only imagine how difficult that must be. Because I know that I have felt that way, in lots of work settings, and I don't have executive dysfunction. And so I can only imagine how difficult that must have been. So I think there's definitely the the idea of being empathetic to that I think, has really helped us to bond as coach and client. And that's been an important part of the process.

Hannah Choi 16:12

Can we explore that a little, the idea of what you just said about how you have to give yourself all day to people who really, really, really need you. And also, you're giving yourself as a person who is struggling with executive function. And you're likely supporting someone who is also struggling with exec executive function. So how do you like what does that look like? For you? What is? What is? Is that a struggle? And when what does it look like?

Cassie 16:47

For me, it looks like being transparent, to some degree with my students, there have been so many times where, because in my role, I go into our classrooms, and I lead like group counseling. So we right now we're working on the zones of regulation. But what it looks like, sometimes for me is, like, kind of being explicit, and like, oh, like, that's a really good question, kiddo. But like, I you note, you know, that I want to hang out and chat with you about anything under the sun, but like, right now, I need to focus on finishing this lesson. Or like a kiddo will ask them like, Hey, Miss, can you know, can you come check in with me later? Or can we work on this thing? And like just being very explicit, like, Yes, I will try to remember or I will write it down. But like, like, just kind of like being honest about like, I this is important, and I want to do it, but like, if an emergency comes up, or if whatever, you know, it may not happen, and asking the kids like, hey, help me remember that next time we have group I want to do XYZ? Or, if you see me in the hallway, ask me about this, and then I can let you know when I find out the answer. So it's kind of in some ways, it's it's being honest, and kind of modeling for the kids. And then and then it's also working with my colleagues. Kind of in a more intentional way, also, one of the big benefits that I've noticed and started coaching is just the change in my kind of thinking patterns or my habits. Right now, I am very lucky that I have an awesome clinical intern who is working on her MSW as well. And so oftentimes, what we'll do is, she'll get there in the morning, and I'll be you know, answering emails or whatever. And we'll kind of sit down and like have like a kind of a planning session. We're like, Alright, so today for group, we're going to work on this thing. I don't think Anthony class has finished their worksheet, so we'll finish that up for them. But Dubois class, they didn't finish. So we're gonna move on to this one, we were kind of just like, make a plan for the day. And then we also were like, Alright, so after groups, like what's our priority, like, we really need to finish this assessment, we really need to finish planning for the next two groups. Like it's been really helpful for me to have that conversation with somebody else. until like, right, these are our priorities for the day. That's been something that's been really helpful for me because it's, you know, I can have that conversation with myself in my head, but it's just it there's no external accountability, which was another thing that I really gained benefit from. So it's, what it looks like is modeling it for the kids and then practicing myself, even when I'm not with the kids.

Hannah Choi 19:42

That's awesome. And then building in the accountability of having a partner and advocating for yourself that you need that partner and that you you know this like that. building that relationship with her I'm sure is invaluable for both of you. Yeah, what about you, Lina?

Lina 20:00

Um, so there's a few components for how I deal with it in my work. So right now I am working in substance use just to give some background, I work with adults in the west side of Chicago, who, you know, for various reasons, have used substances to cope with their life and their realities and their pain. And, you know, when I work with a bunch of people like this, especially people who are, you know, mandated to treatment by the justice system, or the criminal system of injustice, system, I, you know, struggle a lot with and just not even that, you know, I don't know how many people are aware of how recovery spaces are, but they're pretty rigid, you know, if you're in recovery homes, there's very, like I work with a lot of patients who are in recovery homes, and the rigidity of certain recovery homes just gives no flexibility for a client to have autonomy in their life and in their treatment, and in their program. And I take a harm reduction approach, where, you know, we look at recovery, and look at how do we manage reducing unnecessary harm without trying to eradicate the issue? Right? Because we know it's going to exist, we know it's going to, you know, it has existed for centuries, you know, people have been using substances for centuries, but how do we reduce unnecessary harm that can come from doing that. And what that also means is defining recovery, and however, the individual defines it, right. And sometimes, if a person comes in with a very rigid idea of what recovery can be, and trying to fit themselves into a box, that doesn't necessarily work for them. I resonate with that, because I tried to do that, my whole life, right, with having undiagnosed ADHD, I was just coping all the time and trying to fit myself into boxes that didn't necessarily fit for me, but I was working so hard. And so yeah, I was just working so hard for so long, in spaces that were never meant to fit me. Right. And so a lot of what I've done with clients, and with patients is just like a lot of validation of being like, yeah, this it's hard. There's no rulebook to how life could be. But we have all these expectations within these systems that we're in to meet, unfortunately, and I'm a very systems based person, I always have been, because I've always noticed, that's like one of my ADHD superpowers, I would say is, I've always noticed how systems really suck. And they don't allow people to have choice and autonomy, to do things that is actually better for them, you know what I mean? And so that's how I see it a lot with my clients and with my patients. And even for me, I have to, you know, I'm still in graduate school, I have all these expectations to meet for school, I have all these expectations to meet within my clinical internship, which is doing the substance use work. And one of the things that Beth and I did was, we broke down all the things that I had to do, like we literally wrote it out, being like, you have to do, CSRS T PRs, individual sessions, group therapy sessions, individual notes, group notes, case management, notes, housing notes, all these things. And when you really break it down, it's like, all these expectations, and for what, right? And for what, it's just so exhausting. And so I, you know, I even started doing that with my patients being like, alright, let's look at your recovery program and being like, look at all these expectations, and you're exhausted, like, there are hard things that add to your life, and there's hard things that don't. And then there's hard things that are a little bit of both, and how do we recognize those things that do add to our life? And try to minimize the things that don't and start making things that work better for you. So it's, yeah, I do it, you know, a lot of validation at my work and my job, especially with the clients who were within the criminal system of injustice, because those expectations are just out of pocket. I'm just like, Why does this have to exist this way, especially for this person that already has so many different systems working against them. And in a lot of ways, we as people with executive functioning challenges, work within systems that are working against us too. And that's really challenging and really hard. Yeah.

Hannah Choi 24:56

And something that I do I just this talk about systems is so interesting because as a person who has executive function challenges, I mean, all people need to build systems for themselves that they can rely on. And when you are a person with executive function challenges, your system is probably going to look really different, and not fit in well, to the existing systems that are already there, which I think is pretty much what you were just saying Lina. And, and it's, I don't know, it's just interesting that, that, that systems can be critical for success. And they can be really limiting when there is no flexibility. And there's no consideration for the variety of needs, that that people have. And that's what's so beautiful about taking the time and, and, and taking the time. That's what's so beautiful about discovering the aspects of yourselves that are strong, and that you can rely on, and how you can use those to support the areas that are that are more challenging for you, and how you're taking, taking the time to really think about it and to really say like, what do I need? And how can I create that for myself. And when you are spending your whole day, supporting other people and giving and giving and giving and giving? It's probably pretty difficult to stop and just really wait, why do I need? And how do I support myself in this time? So do you what do you do for yourself to recover from a really difficult day or manage executive function? I mean, other than, like what you shared already, like is there maybe self care that you do to, you know, to alleviate some of that pressure that I'm sure that you feel, trying to fit into these systems that that are there.

Cassie 27:15

Something that I have been doing, that my whole family has been doing, ever since the pandemic started. My, my mom, my dad, and my older sister, and I, just the four of us in my immediate nuclear family. We have weekly family video calls. And that actually evolved from way back when the pandemic very first started, my sister reached out to us and was like, I'm really worried about the state of the world can we just do a video call just to check in with each other. And then we really enjoyed it. So we did again, the next night, and the next night, and the next night. So we we I talked to my parents and my sister every single day for, I don't know, four or five months of the pandemic. And then, you know, once I finished grad school, and once I moved out here for my first big girl salary job, we did cut it down to twice a week. And now we're down to once a week. But because we had that kind of foundation of updating each other on every part of our days, because we talked every single day, we just have a much, I think a much stronger relationship and much more open and comfortable relationship just has a whole family unit. And so we talk about a lot of things like we are much more open about our mental health, about our needs. You know, sometimes my sister will talk about how she, you know, I'm feeling really down today, like my depression is pretty bad. Or, you know, we'll joke with mom about how like mom, like, you have undiagnosed ADHD, even though it's sometimes in a joking way, we're much more open about our own struggles and mental health needs and everything. And I think that's been instrumental. For me, I think it's been really, really helpful, just personally, but I also think that it's improved all of our lives just to have that regular communication and that comfort. So for me, family is a really big part of my self care. I know that that's not the case for everyone. For other for some people, like family creates stress, and that's totally valid. But for me, family time has been a really big part of my self care.

Hannah Choi 29:33

And hopefully for people that sort of their chosen family can step in, and Lina What about you? What do you do to take care of yourself?

29:40

Man, we're trying to figure that out to be honest. One of the things that my ADHD loves to do is not let me recognize certain bodily cues like eating because I get so hyper focused during the day am my work that I forget to eat, I legitimately don't get those cues to eat. And then it isn't until like three, maybe sometimes two o'clock to three in the afternoon and I'm like, why can't I focus? Oh, you haven't eaten since seven this morning. Like, like I like, it's those things that, you know, really begin to challenge. So lately, self care has been trying to eat more. And just trying to, you know, find certain foods or certain things that I will eat during the day or have access to or that is easier to manage and sort of time myself. That's been hounding me to set an alarm for lunch. And so yeah, like, that's sort of what comes to mind immediately. But, you know, I think for me, too, lately, I've been recognizing how I can't just push through certain tedious tasks anymore. Like I have to, like, in order for me to do the really hard thing that my brain really don't want to do, I got to do something fun before I do it, you know, so I gotta like, read a chapter of the book that I'm reading, or watch a stupid YouTube video or, you know, do something that I actually like doing before I get into this thing, or use the thing that I really like doing as the reward for doing the really hard thing. So I been trying to give myself space to have more fun. And to have more rest and play, and silliness and laughter and being with people that, you know, make me laugh and understand my humor, because as social workers, we got to very wild spectrums of humor. When you're with people who get that humor, it is the best, it's like wild, you would think work notes or need to go be hospitalized or something. But it's like really a good time being with the people that get it and understand the type of work that we're dealing with all day, every day, because it gets really hard. Like, I'm not going to sugarcoat and say that our jobs are easy, because they're not. And it's very, you know, we're in a profession that is severely undervalued. So we have to be very intentional about taking care of ourselves to deal with said systems. And I'm trying to be a lot better about that I will work working on it. It's always a work in progress, but it's a lot better than what it used to be.

Hannah Choi 32:49

So we're all work in progress, it works in progress. I just, I just had a wonderful experience. On the other night, I got to go to a presentation by a clinical psychologists called Dr. Allison Roy, and she's out in New Hampshire. And she she works she works in with from a perspective of trauma informed care. And she did a presentation on the brain which I'm a total nerd about so I was just like on the edge of my seat the whole night. And she talked about about how we can get out of our the fear center part of our brain like the you know, like the the fight and flight and freeze part and up into our prefrontal cortex where all of our executive function skills are so our thinking brain so we can use that. And she was talking about how this idea of flocking and how flocking is when you you have a flock you have you spend time with people who get you who understand you, you have social connection and and when you do that you're able to nourish the and support your limbic system the emotional part of your brain which really allows you to access your your prefrontal cortex and your thinking part. And she was just talking about there is so much value in finding a flock and so whatever your flock is, like you said, Cassie, your family is your flock and you get so much value from that and Lina, your you know, your fellow social workers who really get you and get where you're coming from. And so I'm just so glad to hear that you both put that in as an value that as part of your self care because according to the brain research, it's really what you do need to do so. And the other thing that she talked about Lina and I'm so glad you mentioned this was the idea of play. And she said it is so important. Why do we stop playing why do we stop having fun and, and and play is a huge component of As our mental health and of just feeling better about ourselves and, and enjoying our lives, and in staying out of that, like the the kind of like, primal part of our brain, and we're able to stay up higher in the in the thinking part. And so it's just glad to hear that you're too you're doing that too.

Beth Malvino 35:22

I wanted to just piggyback on what what you just said, because it really resonated with me that, you know, we get so what, regardless of whether or not you have any kind of diagnosable executive function challenges, I think we all get bogged down with things that we think we have to plan, you know, we have work and or, you know, parenting responsibilities or things that we have to do in life that we feel like we have to plan these things. And I think for a lot of us, we forget to plan fun. And sort of bringing that to the to the conscious and really, scheduling fun, I think is so important. And I talk about that a lot with with clients, because I find that they get very wrapped up as we all do and the things that they have to do, and not necessarily the things that they like to do.

Hannah Choi 36:25

Yeah, and I just I did that a few years ago to it all started where I, my sister in law wanted to go in the water and it was so cold. And I was like I don't want to go in the water is too cold. And she's like, come on just fun. Like, yeah, I need to have more fun. So I decided to try to be a lot more intentional about that. And I and I have noticed a big difference. My kids think I'm crazy. But grownups should not be having that much fun. But I think it really helps. That's a big part of my self care.

36:57

So I I mean, Lina and I talked about our self care. But I want to hear about from from you and Beth as well.

Hannah Choi 37:05

That's you want to go first? Oh, wow.

Beth Malvino 37:08

Self. Yeah, I mean, self care, is something that does have to be intentional for me, I have to remember to do it. Because just, you know, like everyone else, I have things that I have to do. And I try to get those things done. And there are days that go by where I haven't done any self like true self care. And I kind of get mad at myself, like, why didn't I you know, take a moment. And so I do try to be more intentional about the kind of self care that I do. So, recently, we took a trip to Florida, and that we were in Orlando, and they have these electric scooters that you can just kind of, you know, zip around town on and I've never done anything like that. And my kids who are you know, they're teenagers. And so there used to scootering around on different types of machinery. They were all just like jumping on and whizzing down the block. And I was almost like, oh, that I can't do that. Like that's not for me. That's that's not like, that's not okay, why why would I do that I'm not a kid. And then I kind of, I kind of forced myself to do it. The best? Yeah, I had the wind in my hair. And I was flying down the sidewalk and like ringing the bell. And people were stuck on the side. And I felt like a kid again. And that was a very intentional choice that I made to do that. And I'm glad I did it. Now I have those memories too. And now maybe I'm more likely to try that again in a different settings. So I really do try to try to make it an intent, like an intentional decision. Like today, I'm going to do something it doesn't even have to be big enough to be going to a spa like I'm not going to do. But it might be it's a really beautiful day. I'm going for a walk today. I'm just going to make sure that I get some sunshine in today. And I do try to make that intentional kind of schedule that around the other things that I had to plan for that day.

Hannah Choi 39:30

Yeah, that what I do for myself, though, sort of like main Self Care Act is similar in that I, I practice the strategies that I that I know work for me when I'm in a moment where I'm really having a hard time. So like I have some anxiety so I I make myself practice breathing when I'm not in an anxious state. So that when I am in that state, it's much easier for me to access that and I also Have, I'm working really hard on my negative self talk and, and so I try very hard to talk positively to myself when I'm just doing regular stuff. Like, like celebrating these like super small wins, it doesn't have to be anything big, but just practicing that, that more supportive talk to myself really helps so that when I have made a decision that I'm not happy with or something happens, that didn't go as I expected, it does come a little bit more easily to me to say something nice to myself instead of saying something mean. So that's the practice of it when I don't need it is is a huge thing for me. And then also, spending time with other people is absolutely number like probably like other than the practice, that's the most important thing for me. And exercise to I need to exercise if I don't exercise I always like why do I feel like crap this week? Oh, because I did not prioritize that. So yeah. Thank you for asking Cassie. It's a it's a it's a conversation that more people should have. Because in, I think because in having those conversations, you can really learn a lot from what other people do for their self care. And it doesn't always look like going and getting a massage. Like if I go get a massage, I feel guilty that I went and got a massage. And so now I don't feel good at all. It's yeah, it doesn't always look like bubble baths or whatever. So yeah.

41:27

Yeah, like I just wanted to piggyback off of that is just like, lately, I've been trying to intentionally remember that I can do things because I can like, and not because I have to justify it. Like, that's been really, you know, I've always felt like I've had to justify everything I do, like justify a feeling or justify needing to do this or just doing that. And I'm just like, No, I can go get an ice cream cake. Because I can I'm an adult, I could make that decision if I wanted to. Like if I want to, and I don't need to justify it, if I want a massage, I don't need to justify getting a massage. If I want to do this, I don't have to, I could do it because I can and not because I have to justify it. So I've been trying really hard to do that more often. And like, you know, if I want to make a nice meal for myself, I can do that and not feel like oh, you have to do it. Because you have to have a reason like, No, I don't have to have a reason all the time to do the thing I want to do

Hannah Choi 42:31

just giving yourself permission to just do it.

Beth Malvino 42:35

Because you deserve it. Yeah. And that's part of

42:40

that's another hard part to get your wrap your head around. Because, you know, when you're diagnosed with ADHD as an adult, you know, you were invalidated a lot as a child for things that, you know, you needed. But, you know, by, you know, oh, you're just too sensitive, or Oh, you're just too much or, or you're just this or just that and like, you know, going through this process of like, No, you do deserve good things you do deserve the things you need to play, it gets okay to have your needs met. That's, that's been a big part of this whole journey, I would say,

Beth Malvino 43:17

Yeah, we talk about that a lot. I think when you're diagnosed, as an adult, it kind of brings another layer of challenges. Because you have, you have to fight some negative narratives. And Hannah, you were just talking about, you know, the negative talk that goes through your head, you have to fight that, you know, sometimes you have to fight years of that, whether it was heard, you know, from other people, or whether it's things that you're saying to yourself. That's, that's really hard, it's hard to change habits, when what's going on in your head is still, you know, that negative loop of I can't or I'm not good enough, or I don't deserve or I'm broken. And so, you know, we talked about coaching versus therapy, sometimes there is that overlap of you know, how do I how do I get past? How do I change that negative loop in my head so that I can, you know, work with the brain that I have and Cassie we weave cast came up with one of the best I don't know if it's a metaphor, or just the best Phrases She came up with one of one of the best phrases and I still use it today with with all my clients is your, you know, part of coaching is rewriting the manual for your brain. And that act just really spoke to me when when she said that and I i still repeat it all the time because it's so true. It's not about fixing what's wrong. It's about working with But you have Yes. And so I think that, you know, it takes an awful lot of courage to ask for help. Yeah, yeah. So, you know, I really give a lot of credit to both Lina and Cassie for reaching out, because it's not easy. And we're, you know, they're both extremely emotionally intelligent women who, you know who work in the field, I think it's, I think that in some ways makes it harder, you know, people in social work, and maybe even in healthcare in general, we're there to help other people, and we're good at it, and maybe not so good at kind of looking back at ourselves or looking at ourselves in the mirror and saying, Well, what do I need help with. So I just want to acknowledge that it really takes an awful lot of courage to do what they've done, and to be on this journey, and to have to have been open to this journey, which both of them really are.

Lina 46:07

Yeah, I want to say something, too you know, because within the realm of, I don't know how many people know how the intricacies of healthcare works. But, you know, there's this thing called evidence-based practice. And sometimes evidence-based practice can be at odds with us people with executive functioning challenges, because a lot of times the evidence that they're basing their stuff off of doesn't include people like us in the research. So I have a hard time navigating, especially in mental health spaces, that rely on evidence based practices. But we're working with populations that were never included in the research for, you know, and I, as a person with ADHD, and you have challenges working with a lot of people with ADHD and you have challenges that have either gone overlooked, undiagnosed or invalidated. I'm struggle a lot, by even my own peers within the social work and mental health field, because not only do we have to navigate the challenges of working with our patients, but we also have to navigate the challenges of working with peers that don't see that. And just because our approach is different, doesn't mean that it's wrong. And just because it's, yeah, and just because it's, you know, you may not understand it doesn't mean that we are wrong in approaching our work differently in that way. So there's a lot of, there's a lot of complexities with that,

Hannah Choi 47:55

and you're doing all of that navigating, while managing your executive function challenges. You're not doing that in this vacuum, where you know, where you're just like, skipping around, remembering everything, and not finding anything stressful. So it's, it's a lot, and I commend you, all, all three of you for you know, the work that you've done and continue to do. And it's, it's, I'm just so glad that you are here today and talking about this. And, and, and I really hope that lots of people hear this and are able to really relate and hopefully feel validated, that validation is huge. And it's, it's, it's a right, Lina, I can imagine that maybe if you if someone validated your perspective, and validated where you're coming from, it would probably feel a lot better than

Lina 48:57

I probably would have gotten diagnosed as a kid instead of an adult. You know, yeah, I probably would have been heard. You know. So there's, you know, there's a lot of challenges and complexities within that. And I don't want to sound like a Negative Nelly, because I do think evidence based practices has its times in place, but, you know, that's where the creativity of meeting patients and clients where they're at, and truly validating their experiences in their life and having that relational approach rather than just purely scientific, purely medical, purely. Whatever bullshit they like to throw up.

Hannah Choi 49:48

The systems that that exist, exist, partially because there's not enough funding, and there's not enough people and there's not enough attention. There's not enough support. There's not had enough research, there's not enough validation of the troubles that there are out there. And so it is difficult to provide individual support when you are not supported yourself by

Lina 50:13

Oh, yeah. And that's,

Hannah Choi 50:15

I know we could talk about that for days.

Lina 50:17

Yeah, as a systems based person, you know, we have the resources to do those things, we just choose as a system not to do it. You know, and that's, you know, I know, I say, I'm in social work, but my first master's was in public administration, and, you know, we have a bunch of the resources to do it, it's just we, politically and power wise choose not to, and that's really, and we're working within that system all the time. I'm sure Cassie see's just how, you know, funding schools and funding children's programs affects her and her job and what she's limited and doing. And I know, I struggle a lot with I work with a lot of people who are on Medicaid, you know, like, it's, and that's, that's severely limiting to what they need, and they have a lot of my needs. So it's, you know, it's a system thing too, and we have to constantly navigate those complexities.

Hannah Choi 51:13

Yeah, that's a lot. And the people that you work with, I'm sure are so grateful that you have made the choice in your life to do the work that you're doing. And, and that you I'm sure your your work has been so positively impacted by that effort that you have put in, to reach out for help for yourself, and to do the work that you've been doing and will continue to do to support yourself, which just improves the support that you're able to give the people that you work with. So let's explore that a bit. I would love to hear from you, Beth, about your experience working with Cassie and Lina,

Beth Malvino 51:53

I feel so honored to have been part of Cassie and Lina's journey journeys. And just to me, they're they're huge executive function success stories. They blow me away with how they manage and navigate their lives, their work. And I wanted them to shine. And so I'm glad that I'm here to kind of hear to hear them talk about these things. Because it also validates the fact that they they've done so much work. I mean, I love talking about people's journey, especially when they when they come to the end. And this is by no means the end of a journey, not like they're still on the journey. But just having beared witness to it has been really, really wonderful for me, and I I just, I'm so glad that I could be here to, to hear them to, you know, to talk about it. And I don't know if it's okay with them, I'd love to share some of the things that I've seen just in terms of their coaching journey. Oh my goodness, I mean when I first started working with Cassie, I'll just start there. She She was really struggling, she was emotionally spent. She doesn't didn't understand why she why she was leaving late every day she couldn't plan or prioritize. I think structuring her unstructured time was one of the biggest hurdles she she was experiencing there was a lot of procrastination

Cassie 53:57

My own brain would distract me, I'd be in the middle of a task of like, oh, I wanted to do this other thing. And then I would do that other thing, and then not finish the original task.

Beth Malvino 54:06

So there was a lot of that going on. Transitions were also really hard and just getting distracted, doing one thing and being distracted by another. Even just simple things. And you know, this goes back to what Lina was saying about remembering to eat lunch, just basic needs, sleep, food, hygiene, you know, those kinds of things. I think sometimes people forget that without that your executive functioning kind of falls apart. And so you have to kind of go back to basics and say, you know, what do I need right now Why am I feeling this way? Could it be because you haven't had lunch or you didn't sleep well or you stayed up on your phone till three in the morning? Just Doom scrolling, you know, is there. There's there are reasons that these things happen. So It just in terms of Cassie's journey, you know, I've watched I watched her go from sort of this almost despondent person who was really not happy in her role in her life and felt just things were very much out of her control. And then she kind of shifted, she changed jobs. And that shift made a huge difference for her in everything, her demeanor her affect her mood, I mean, it was such a big change, because I saw her finally doing something that she really truly loved. And from that came so many other amazing changes for her. She she was, for a while she had been using a thought collector, you remember the thought collector. So the thought collector was like a is basically a notebook and just a sort of list, a running list of things that she had to write stream of conscious

Cassie 56:09

or even consciousness, it could because like I said, when I would be like, Alright, I need to write this note, I need to summarize a 45 minute individual therapy session, go. But then as I was having like, oh, yeah, my kiddo asked me to reach out to her mom, or my, you know, I have to send this email. And so in the middle of this hard job that I didn't want to do, I would remember a quicker, easier job. And then I was like, Oh, let me just do that real quick. And then I would get distracted by looking for a worksheet related to this topic. And then I would get, so my thought collector was kind of like a brain dump of like, okay, I know, this is important. I don't want to forget it. I'm gonna write it down. And then I'm gonna keep doing I don't want to do.

Hannah Choi 56:45

Yeah, that's great.

Beth Malvino 56:47

And a lot of that. I remember even during the early sessions that we had, it was kind of almost reactive, you would look at the thought collector and say, Okay, what, what have I not done, that I should have done this week. And let me get that done first. And so it was very sort of reactive in that in nature. Like, let me let me finish what I haven't done that needs to get done. And then after a while, things kind of shifted where you were, you could take a more proactive stance, and begin to plan ahead and begin to prioritize. So instead of looking back at what you hadn't done, you were able to look forward and look at the thought collector and say, What do I need to do? Going forward? What do I need to do this week? That was a big shift, the way you document and your notes even changed. And it was not a big change. But there was something that you had tweaked, that made it easier to document for yourself. It was the way that you were copying and pasting. Yes, some of your notes and just a small change, like that made a huge difference. Yes.

Cassie 57:53

Micro optimization. Yes.

Hannah Choi 57:56

Yeah. And I think that people don't recognize the, the, how that huge, that tiny, tiny, tiny little change can have such a huge impact. It's like, have you guys read Atomic Habits by James clear, he talks a lot about how like, if you just make like 1%, like a boat, if there's a ship, and it's going in this one direction, it makes a 1% change turn or one degree turn, I mean, then it's actually going to end up in like a really huge, different place. But if you never make that change, you'll just keep on going straight. And so that giving value to those small changes that can make a really big difference.

Beth Malvino 58:34

Absolutely. Yeah, I think just I've also just been really amazed at Cassie's ability, ability to self-regulate, when she because she works with a population that is really not regulated. And so I asked her all the time, I mean, she gets physically assaulted at work. And then she'll come to session and be like, oh, you know, I got hit today. And it's kind of like, just, it's almost like it's not, it doesn't affect her or she doesn't take it in. And she's still able to, to cope and do the things that she wants to do that day, and it doesn't get under her skin. And I've always been amazed by that. Because self regulation is one of the hardest executive function skills to master and especially if you're working with people who are not, not regulated, that can be a really big challenge. So she just has that amazing ability to do that.

Hannah Choi 59:38

That's great. So tell me all about Lina

Beth Malvino 59:40

and Lina, Oh my gosh. We, Lina says she's a verbal processor. I struggle because our sessions typically go way over and I did and I'm complete Part of that because, you know, I'm because I love talking to her. And because we end up talking about things that you know, are so relatable. And so it's not uncommon for us to go over our time limit. You know, I think, Lina we have, we have spent a lot of time talking about the inner narrative. Lina, I think I said this before that, you know, she was diagnosed as an adult. And so she, she brought with her some of those negative inner loops that tend to go through your head. And so we do spend a lot of time on that, which does bring a therapeutic component to coaching, but we're always able to relate it back to executive functioning. And so, but that that's all part of it, you know, we only have one brain, right, and the the toll that executive dysfunction takes on a person emotionally, has to be acknowledged, it can't be compartmentalized, you can't just talk about my challenges with EF skills, and also talk about the fact that I'm anxious, depressed and sad, they go together. And so there's a lot of overlap. And so we do talk about that a lot. And one of the things that I think she mentioned it, you know, remembering to eat, for example, it's just a basic need, right? We, I think a lot of us just take it for granted, like, Okay, you could skip lunch and feel fine. But when you have executive function, challenges, skipping lunch, could mean not functioning at all later in the day, and maybe not realizing how much of an impact that that has on you. So we do talk about that a lot. And remembering to put those things into her like scheduling fun, like, I need her to schedule lunch. I tell her, it's as important as breathing as if think of it as you know, medication, or insulin or something that you need. It's not just a nice thing to have, like you're not optional, to fulfill yourself and replenish yourself. So we talk about that a lot. And I'm also blown away by Lina 's ability to self-regulate, because she's working with some people who are seriously traumatized, and have, you know, dual diagnosis and a lot, a lot of stuff going on in their lives. And I'm in all of the fact that she is able to give so much of herself. To them, despite having challenges with with some of those same things like self regulation is is very hard, you know, big feelings are hard to navigate. And as a social worker, it's so much easier to navigate that with other people. Yeah. But not with yourself. And so it's, it's what it's a balance. And so we talk about that a lot, just being mindful of how she's feeling. Because it's very easy to distract yourself with how somebody else is feeling. One of the things that Lina has done in coaching, which is just incredible is she has utilized workspace sessions in a very unique way. And for those of you don't know workspace is one of the it's it's kind of, it's a website that Beyond BookSmart runs, where if you have something to do, and it doesn't matter what it is you sign up for a session and you have a person there, who is there to help pull you through it and to monitor how things are going and to be your cheerleader. And to give you some tips. And it sounds kind of simplistic, but it really does work. Having that external accountability of having another person there is very helpful. And so one of the things that Lina has done and I've talked to other clients about this because it's worked so well for her is she was able to literally master task initiate by scheduling sessions very carefully during her week. So on Sunday, she would use a workspace session to tackle chores or get all her cooking done. Can I talk about Mount Lina, is that okay?

Lina 1:04:48

I figured it was gonna come up. Yeah, okay, so we'll talk about Mount Lina. Yeah, you want to tell everyone what that lien is? Mount Lina is this corner of my bedroom. Where am I dresser is and you couldn't see the top of the dresser for months, because it's just a mountain of doom. Like just a mountain of doom lay like that's the best I can describe it just of clothes of random things that somehow made its way to the top of my dresser and I couldn't see my dresser for since I moved into this apartment, which was in 2021, up until earlier this year.

Hannah Choi 1:05:37

Congratulations!

Lina 1:05:39

Yeah. So Workspace helped me tackle Mount Lena. And it only took like, a day. And I was just like, Why? Why am I like this,

Hannah Choi 1:05:48

I had a client who, who had the same, she also had a mountain. And it was a desk at the bottom of her stairs in her living room. And so we did that I just sat with her during an entire session, and she cleaned it off. And she did it. And so that's the idea of body doubling, which, which Beth you didn't name but the body doubling is a super effective strategy for task initiation, especially for people with ADHD. And there's, there's like YouTube, you can go on YouTube, and just search for bodily to ebbeling. And they'll be like someone cleaning your closet out.

Beth Malvino 1:06:23

You know, one of the things with Lina that I've, I've really seen, because a lot of our sessions have been focused on that internet, you know, negative narrative that's been running through her head, is her ability to take risks. And to you know, for example, looking, thinking about relocating and going on job interviews, and just, I mean, it's, it's terrifying to think about moving from one city to another. And that can often be an obstacle to task initiation is fear. And she's really, really pushed past that. And she's, she's doing it,

Lina 1:07:05

you know, it sucks, having to really examine the things around you, and yourself, and your internal narrative to be like, Oh, this is what I've had. And this is what I know. And it's comfortable, but it's not working anymore, and having to do things differently, and having to really be like, No, this is what I really need. And that being at odds which with what you thought you needed. And there's a grief in that there's a sadness in that. And there's a lot of yeah, just because it's good to make these changes doesn't mean that it doesn't feel shitty, while you're doing it. So it's, there's been a lot of that, too

Hannah Choi 1:07:51

And, and it can, it can, I know, like for myself, like it can, making doesn't matter the size of the change, just recognizing like, this, this thing that I've the way that I've been doing, it has not been working, whether it's like, I don't know, I used to keep a grocery list on a piece of paper. And now I use any list. Like just recognizing like this system that I that I've been using for so long. It's actually not that great. And admitting that and not beating yourself up over it and saying, Okay, let me be open to something new, and then trying the new thing. Can really that's difficult work to do whatever the size, whatever the size is.

Lina 1:08:32

Yeah, yeah, like there have been definite things like, I was furious when I discovered that the dictate speech to text tool exists in Microsoft Word this whole time, that could have made my life so much easier if I had just known about it. Now, if I had known that I was a verbal processor, you know, I could have just spoken and wrote all my papers that way. But no, I didn't know that. Or, you know, I am so happy I have a Google Home assistant now because that thing helps me out so much. When it comes to like needing to verbally process I can just say hey, I won't say it now. But I can add this to this list, like when I remember it, and then I have it in my phone because it recorded it like my Costco list or Trader Joe list, my regular grocery list or my Home Depot list or this or that, you know, we're Amazon list like I can just remember. Like, I can just say it, it'll record it and then I don't have to remember it anymore. And I don't have to feel like I you know, because once it's out of the mouth, it just goes poof in the brain. Like it's just gone.

Cassie 1:09:41

Like, like your Google Assistant is like a digital version of my thought collector.

Lina 1:09:46

Yes. Yes.

Cassie 1:09:50

I use my Alexa more often for alarms and time-awareness. Yes, I do that to like, hey, in 30 minutes, remind me to take the stuff out of the washer or I do do that too times so that I can actually go and take the trash out before midnight, you know, that

Lina 1:10:05

Or remind me to put the wash or the laundry that's in the washer and the dryer so that I don't have to rewash it again, because I forgot. Because yeah, like I, I have to tell myself to do that, or, you know, it helps a lot with you know, I sleep with brown noise at night now

Cassie 1:10:24

Me too! Brown noise is better than white noise

Lina 1:10:28

It's so much better. And I it's so much more soothing to me. And so I listen to brown noise and that helps me out a lot. And, you know, I have a hard time waking up in the morning. I am not a morning person, I I've come to accept this fact about myself after years of trying to become a morning person. But what helps me wake up in the morning is turning on lights, like I'm very light sensitive. And so I tell my Google to turn on my bedroom lights at a certain time in the morning, like, Hey, turn on the bedroom lamp at such and such time, like at 6:30. And it'll do that and I'll turn the lights on before I put my alarm so that it's sort of like a wake, go Yeah, like a gradual thing. So it's not as terrible as the way I was waking myself up before getting a really loud alarm clock, putting it in my kitchen. And it it literally sounded like one of those loud school bells, like old 1950s school bells. And it was the worst way to wake up because it was just so abrasive, and it made me get out of bed, which I didn't want to do. And yeah, just like being more gentle with how you do things. Because all the harsh ways that I was doing number four just weren't working.

Beth Malvino 1:11:40

You know, what you're you're both of you are kind of capturing is that it's sort of the essence of what we try to do. And in coaching to in which both of you have really just navigated beautifully is the idea that it's not about trying harder. It's about trying differently. And I know I say that a lot. I still say that to both of you at times. But I say that just in general, that's sort of like a mantra that I have. Because that's really what it's about. It's, you know, the systems and the tools that you were using or didn't have before. You know, it's it's not about just working harder or putting in more efforts. It's about learning new strategies and new tools and finding what works for you and what works for you may not work for someone else. But that's okay. And to kind of become comfortable with that idea that I just need. I just haven't yet figured out what tools work for me. And both of you have worked so hard over the course of your journey in coaching to figure those things out, which has just been phenomenal and so amazing for me to witness.

Hannah Choi 1:12:57

Well, I could literally talk about this all day, but I actually have a client 12:30, speaking of being able to eat thank you so much for joining me and having this really really really important conversation. And it was really lovely for me to listen to hear to listen to your stories, and, and I appreciate your honesty and your openness. And I know that, that our listeners will really appreciate that too. And, and Beth, thank you so much for joining us. And then providing the coach perspective. And also social worker perspective. It's, it's been it was really, really enrich the conversation. So thank you so much.

Beth Malvino 1:13:40

My pleasure.

Lina 1:13:40

Thank you.

Hannah Choi 1:13:44

And that's our show for today. I really hope you enjoyed our conversation. As we talked about in this episode validation is a huge part of feeling better about the challenges we face. And we really, really hope that someone out there feels validated after hearing these shared struggles. You are not alone. Listen to what Lina shared about why she wanted to be on the podcast and why she became a social worker.

Lina 1:14:11

You know, I think it comes down to because I love people and I love creating spaces and holding space for people who don't feel like they belong or who don't ever feel validated just because I think most of my life, I felt that way. And yeah, it's, you know, it's really important, even if it's in the smallest of ways, or in ways that seem insignificant. Nothing is ever insignificant, I think.

Hannah Choi 1:14:44

If you know anyone who might really relate to Lina's and Cassie's stories, please share this episode with them. Thank you so much for taking time out of your day to listen. Please reach out to us at podcast at beyond booksmart.com You can subscribe to focus forward on Apple and Google podcasts, Spotify or wherever else you get your podcasts. If you listen on Apple or Spotify, you can give us a boost by giving us a five star rating. Sign up for our newsletter at beyond booksmart.com/podcast. We'll let you know when new episodes drop and we'll share information related to the topic. Thanks for listening!