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Type at the Family Conference Table: Introverted Intuition

May 25, 2016 in MBTI Talk | 1 comment

Written by Mathew David Pauley, JD, MA, MDR INTJs and INFJs, Introverted Intuitive types, tend to be big-picture, well-organized individuals who can bring both qualities to bear as they work toward their goals. They are often known for their uncanny insight and ability to anticipate things before they happen. However, unlike individuals with a preference for Perceiving, who typically are ready to respond to the unexpected and flex to meet new challenges, INTJs and INFJs would rather diminish the pool of likely unexpected possibilities. Unexpected events such as medical emergencies can stress out anyone, but especially for the normally in-control Introverted Intuitive types, who find themselves suddenly required to both express their less used Extraverted side (engaging the medical team as well as family and friends) and respond to an array of minutiae associated with the emergency. INTJs or INFJs in the grip of their least favorite mental process, Extraverted Sensing, may be trying very hard to control the current circumstances. Normally, their dominant preferences allow these individuals to engage a situation supported by the safety associated with being prepared for it (whereas Extraverted Sensing types would tend to be more comfortable being “in the moment”). So, for example, INTJs or INFJs who arrive at the hospital after their loved one has been rushed into surgery after a car accident, and are left sitting in the waiting room—without understanding exactly what happened, what is currently going on, or what is going to happen—would try to reestablish their normal sense of control amid the chaos. Using their least favorite process, Extraverted Sensing, to regain that control requires them to focus their energies on dealing with the here and now, which they were unable to anticipate, and can seem to others as focusing obsessively on external details. Often the most helpful thing a care provider can do for people is to help them regain balance, or give them the space to get there on their own. Introverted Intuitive types indeed tend to want to get there on their own, and to be allowed time alone to recharge. Recall, the overriding theme of this series of posts is that people in times of stress can be showing you the worst side of their personality type. The person obsessively trying to control every little detail happening around him may be a “big picture” person trying to regain perspective, and the person experiencing a crisis over frightening...

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Type at the Family Conference Table: Extraverted Sensing

May 19, 2016 in MBTI Talk | 0 comments

Written by Mathew David Pauley, JD, MA, MDR Leaving the hospital is often wrought with anxiety for family members faced with numerous things they must address for the patient. Hospitals are staffed with highly trained and highly attentive teams of caregivers, so the prospect of a loved one leaving the relative’s safety with the hospital can be nerve wracking. Even moving from one unit to another within the same hospital is often cause for concern. That said, everyone who enters a hospital should have a well-thought-out plan as to how to leave the hospital. Discharge planners meet with patients (and more often family members) to discuss everything they’ll need to go home, or to a nursing home. ESTP and ESFPs, whose favorite mental function is Extraverted Sensing, are often described as hyper-present (being in-the-moment) and aware of what is before them. Consequently, they can adjust, flex, and move tactically as the situation dictates. For example, an ESTP son or daughter may not even balk at the series of obstacles they may have to face to get Mom back home—from checking out nursing homes to procuring medical equipment to reacting when discharge is delayed for two days due to an infection. At their best, they easily engage both the problem and the people, they need to in order to get to where they want to be. However, healthcare can overwhelm anyone, regardless of their favorite mental function. It often requires people to constantly think about the future, and attempt to have contingency plan on top of contingency plans. Mom may fall. Mom may need CPR. Should CPR be performed? Mom’s disease is only going to get worse. She may stop being able to swallow. She may forget who you are. And so on. And possibilities compound upon each other. Whereas INTJs and INFJs, whose favorite mental process is Introverted Intuition, tend to be effective at anticipating and planning for what may occur, that can take ESTPs and ESFPs away from the present, where they are most effective. It may also lead them to focus too much on what needs to get done and how, and ignore or misconstrue why they are working so hard. Healthcare decisions can be divided into immediate (or urgent) decisions and long-term decisions. Immediacy is where Extraverted Sensing individuals tend to prosper, and their responsiveness in those situations is invaluable. In addressing those long-term and future-focused decisions that...

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Type at the Family Conference Table: Extraverted Feeling

May 17, 2016 in MBTI Talk | 0 comments

Written by Mathew David Pauley, JD, MA, MDR The image of a family conference in a hospital is typically one of high emotion, even when no apparent conflict is readily identified.  Physicians might be giving bad news, chaplains might be leading families in prayer, or nurses might be leading children into their mother’s room to meet their new sibling; in all cases, lots of people are bringing lots of emotions to bear on a panoply of circumstances. ESFJs and ENFJs, whose favorite mental process is Extraverted Feeling, are generally at ease in expressing their emotions and being with others who are expressing theirs. Accordingly, their strengths lend themselves well to hospital culture—so much so that healthcare culture itself is described as having ESFJ preferences. For ESFJs and ENFJs, who often see themselves as peacemakers, sustained conflict can nevertheless be a huge stressor. They are attuned to and respond to the needs and values of those around them, so it is understandable that a conflict that is growing within their family, shutting down communication and proliferating negative interactions, can lead to an eruption of their least used mental process: Introverted Thinking. Unfortunately, critical illness and a prolonged hospital stay have often caused deep wounds in the relationships within loving families. For instance, a 22-year-old college student with ESFJ preferences has taken a leave from her studies because her grandfather has been in the intensive care unit for the past two weeks. Her mother has asked her to come home and help run errands because she refuses to leave her father’s bedside. Over the next week, this young woman feels that “things are off” and that her aunt and uncle are being exceedingly cruel to her mother based on their curt encounters with her and their seeming lack of sympathy toward what her mother has had to deal with—she was Grand-dad’s caregiver for the past three years. The young woman’s outburst at her uncle in the hallway, claiming that he was trying to go over his mother’s head and have the doctors take her grandfather off life support is in line with her being in the grip of her least favorite mental function. Whereas ISTPs and INTPs would strive to analyze her grandfather’s situation and her uncle’s actions objectively, regardless of her relationship to anyone, including her mother, Introverted Thinking, as a least favorite mental process, employs a less structured and...

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Type at the Family Conference Table: Introverted Thinking

May 13, 2016 in MBTI Talk | 0 comments

Written by Mathew David Pauley, JD, MA, MDR Dispassionate objectivity can seem out of place in environments such as hospitals, where passions can run high. And thus we come to Introverted Thinking types: ISTPs and INTPs. For them the goal is to understand, and they will be quick to let you know that true understanding can be clouded by “erratic” emotions mucking things up. Reportedly, Introverted Thinking types confront catastrophe with the same air of detachment with which they confront their normal work and can seem nearly unflappable—that is, until the catastrophe affects them personally and evokes their least favorite mental process, Extraverted Feeling. ISTPs and INTPs have feelings, of course, but expressing them and using them to communicate are not their areas of strength. And since emoting to others isn’t generally comfortable for them, they tend to find being forced into personal emotional experiences very distressing. The normally quiet, thoughtful person at the family conference table currently erupting with unchecked emotion may indeed be an individual whose favorite mental process is Introverted Thinking. In contrast, Extraverted Feeling types prioritize the feelings and welfare of others, often sharing their emotions in the process. The need to be “as objective as possible” does not rank as high for them. For example, an INTP’s significant other had completed an advance directive instructing healthcare providers to discontinue life-sustaining interventions if a terminal diagnosis has been made and meaningful recovery is unlikely. Objectively, the logic is very clear: If condition A (terminal diagnosis) is present, along with condition B (unlikely meaningful recovery), life support should be discontinued. Making such a decision might even be easy (or as easy as such a decision can ever be) for the INTP partner, but coping with or expressing the very illogical emotions that follow from it can lead to an emotional outburst. CPP studies, for example, report that ISTPs and INTPs have the fewest coping resources of all 16 types (MBTI® Manual, pp. 84 and 86). Illness, death, and loss can seem senseless and illogical, and trying to make sense of them can be a fool’s errand. It can be helpful to give the Introverted Thinking types time to figure this out for themselves. Until they do, recognizing that questions such as “How do you feel?” may actually be a trigger for them. Want to read more? Check out my previous blogs in this series: Type at the Family...

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Type at the Family Conference Table: Extraverted Intuition

May 10, 2016 in MBTI Talk | 0 comments

Written by Mathew David Pauley, JD, MA, MDR People with preferences for ENTP and ENFP are comfortable directing their focus and energy toward the future and what is possible. They generally see potential options, but when they cannot, they often are willing to create them. They can generate a sense of optimism in others due to their natural abilities to see connections and brainstorm different, creative approaches to problem solving. This is exactly what ENTPs’ and ENFPs’ favorite mental function, Extraverted Intuition, is all about—focusing on the future, and in many ways, hope. For all of us, maintaining hope can be difficult when a loved one is critically ill, especially as viable options come off the table. Moreover, the devil is in the details—not just for the clinical aspects that a supporting friend or relative of the patient needs to become familiar with, but also the minutiae of the healthcare system in general. Lots of little things can add up to something quite overwhelming. Take, for example, a mother with preferences for ENFP. Normally she is one of the more flexible, adaptable people you will ever meet, and she doesn’t let herself get bogged down in the nitty-gritty. But right now she is in the ER with her teenage daughter, who has just been admitted to the hospital following a car accident. Her daughter is now within the hospital’s extensive system of diagnostics, assessments, and best practices created to improve her chances for a good outcome. The clinicians will diligently strive to collect all relevant data on which to base their future decisions. For an ENFP like the mother, this can seem very bureaucratic and she may struggle with the health care team’s constant focus on the “right now.”  Moreover, while “in the grip” of her least favorite and least used mental function, Introverted Sensing, she may tend to focus on small, singular facts to the exclusion of others. She is scared, as any parent would be, and she is frustrated. It is very easy to shake the confidence of a person’s least favorite and least used function; where an ISTJ or ISFJ can embrace dealing with and organizing all the little details, doing so can unnerve an ENFP. We can all flex, but are less able to do so when we are in the grip of our least preferred function.  Giving this person room for hope and possibility...

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Type at the Family Conference Table: Introverted Sensing

May 5, 2016 in MBTI Talk | 0 comments

Written by Mathew David Pauley, JD, MA, MDR As care providers, we are often balancing experience with hope. When our patients are critically ill, we weigh our desire to help them return to normal life against our experience with all the cases we have dealt with in the past—those that had a good outcome and those that did not—and we try to make the best recommendations we can. From a type perspective, there is an intriguing analogy between analyzing data and maintaining hope and our preferences for Sensing or Intuition. And just as every person uses both Sensing and Intuition to take in information about the world, every person needs good data as much as they need hope for the future. The struggle for many care providers in finding that balance is determining where to begin. Patients and their families also perform the same balancing act. We often hear things like, “My mother spent months on a ventilator and had an awful death—and I want to avoid that,” as much as, “Mom got over cancer three times before, so she can surely overcome this,” and “Y’know, they told me I had only six months or so left to live, and here I am alive five years later.” People with preferences for ISTJ or ISFJ use their experiences to help them understand what is happening currently and make confident decisions. Medical recommendations that fail to link facts and experience to the goals (or worse, fly in the face of them) are not endearing to Introverted Sensing types. It is uniquely difficult for a nurse to have a loved one facing surgery because she knows—she knows the good and the bad, the risks and the benefits. Saying, “The surgery will go fine,” may do less to reassure her than it would run afoul of her years of experience caring for patients for whom surgery did not go fine. Baseless assurances without an empirical foundation, coupled with the inherent high level of stress in treating a loved one, can definitely trigger this nurse’s least favorite mental process, Extraverted Intuition. And whereas individuals with preferences for ENFP or ENTP like to look toward the future and possibilities, they are also savvy at discerning what is more or less likely while remaining optimistic. On the other hand, those who have preferences for ISTJ or ISFJ tend to catastrophize, which typically does not lead to making...

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Type at the Family Conference Table: Introverted Feeling

May 3, 2016 in MBTI Talk | 0 comments

Written by Mathew David Pauley, JD, MA, MDR In my previous post, we encountered Extraverted Thinking types (ESTJs and ENTJs) who were stressed, upset, and were facing some very hard decisions. Though they are accustomed to and comfortable in the role as decision maker, emotionally charged situations can sometimes inflame their least preferred and least used mental process, Introverted Feeling, creating emotional turmoil. Introverted Feeling types, such as ISFPs and INFPs, are at their best when processing their emotions, reflecting on what is the right thing to do, and knowing what is important given the circumstances. The practice of medicine, however, can be ruthless in its demand for decisions to be made, and to be made on its schedule. Its if-this-then-that causal approach may seem unsympathetic to individuals who focus mostly on values. For instance, a normally calm and composed woman with INFP preferences who generally finds solace in reflective mindfulness exercises and meditation can find herself out of sorts from the constant time-is-of-the-essence demands that follow a recent cancer diagnosis. This might be especially true if she finds herself unable to take time to consider values that are important to her or, even worse, is forced to make choices inconsistent with her sense of self-identity. Her oncologist may not encounter the normally thoughtful, contemplative woman she’s been treating, but rather this other person relying on her least favorite mental process, Extraverted Thinking—making rash, shortsighted decisions and overly critical of the oncologist’s competence and challenging his medical advice. Physicians are under increasing time constraints and are pressured to be more time-efficient. Accordingly, it is understandable that many of their conversations are strictly to the point: “Here is your diagnosis, here are your options, what do you think?” But patients who are Introverted Feeling types will desire, if not need, more time to process, and reflect what and who matters to them. Speaking with these patients sincerely about values that are important to them should be the first step in helping them restore some inner balance, which in turn may support their decision making concerning their care. Want to read more? Check out my previous blogs in this series: Type at the Family Conference Table: Extraverted Thinking Type at the Family Conference...

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Type at the Family Conference Table: Extraverted Thinking

Apr 28, 2016 in MBTI Talk | 2 comments

Written by Mathew David Pauley, JD, MA, MDR In my previous post I discussed how I’ve found type to be a useful tool for working with individuals who need to make difficult decisions or who are in conflict. When discussing matters such as whether to continue aggressive interventions or consider more palliative approaches, or when disclosing bad news (e.g., a new life-limiting diagnosis, an unsuccessful surgery, a medical error or medication mistake, or an unanticipated injury or death), the patients, family members, and care providers in the room may not be demonstrating their best self. More likely, they are exaggerating their type preferences or are fully in the grip of their least preferred mental process. What might this look like? Beginning with individuals with preferences for ESTJ or ENTJ—who at their best are decision makers, naturally driving toward doing what needs to be done in a clear and decisive manner—we would keep in mind that Extraverted Thinking is their favorite mental process—the process they use and rely on most. Whether as patient, family member, or care provider, they tend to feel comfortable in, and often seek, a leadership role—and are comfortable with being expected to make decisions. Imagine, though, a husband with preferences for ESTJ whose spouse has been in the ICU for a month without much improvement, while the doctors frequently want to keep talking about “what to do?” The man’s prospect of losing his spouse is daunting: His children and other close family members are often expressing emotions of sadness and distress, and he constantly feels the pressure to decide from both family and from physicians. He also likely is faced with a very common moral dilemma: his duty as husband to fight for and defend his spouse, and to prevent his spouse from suffering. For this natural leader, so much of what happens is beyond his ability to control. These are all triggers for an ESTJ’s least used Introverted Feeling. Whereas ISFPs and INFPs are at home when reflecting internally about what is important and how to feel about things, ESTJs and ENTJs will likely experience more inner turmoil.  And because it is inner (or introverted), their distress may not be noticed readily. Emotions come forth unbidden, and their decisiveness is diminished. Thus, those employing type in healthcare environments would do well to get to know their patients’ family members as well as the patients. On first glance,...

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Type at the Family Conference Table

Apr 26, 2016 in MBTI Talk | 0 comments

Written by Mathew David Pauley, JD, MA, MDR Strewn throughout hospitals are conference rooms primarily devoted to provider-patient discussions.  No, that is not entirely accurate—providers meet their patients bedside.  So, it is more precise to say that these meeting spaces are used by providers meeting with family members.  They are meeting with family members probably because their patients are too sick to participate in the decisions about their health, and the people who love the patient are there to help make those important decisions on the patients’ behalf. Physicians and nurses are the providers we most often think about, but there are other individuals who may be present, such as social workers, case managers, and chaplains. It’s within these conference rooms, primarily within intensive care units, where families are frequently presented with some of the most difficult news of their lives, and where they are confronted with the hell of choosing the best of several heart-breaking options.  And it is within this context where I began to see type dynamics playout.  As a practicing clinical ethicist, one of my primary roles is to facilitate discussions among providers, patients and family members around morally difficult issues—and I see conflict and uncertainty emerging in a myriad of unique ways. I began seeing Type dynamics play out in care conferences in tandem with my introduction to personality preferences.  At the time, I was a new fellow in the California Health Care Foundation’s Leadership Program. The fellowship began with, and continued to have, sessions on type. For me, and likely many of my colleagues, personality type provided a cohesive structure to understand one’s preferences and needs with regards to taking in information and making decisions. Once I returned from my first seminar, I started to apply what I learned. How do we talk about disability and death? Not in an abstract way, like one may have in a classroom or on a long car trip after hearing a podcast on the subject, but when disability and death are immediately before you.  Where does one wish to focus and what information matters?  Our patients’ values and wishes are by their nature future focused and theoretical, but achieving them will be near impossible without a thorough and honest look at panoply of medical data they present to the providers. And with that in mind, let me re-word a well-known preference-driven question: Who would you prefer...

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How to Decide on Management Styles for Your Company

Apr 21, 2016 in MBTI Talk | 0 comments

This article was written by Chuck Cohn. It was originally published in Forbes Magazine on April 6, 2016. To read the article on the original site, click here.  A leader’s management style is sometimes thought of as inherent, but in truth, it is partially dictated by circumstance. There is no one approach that works for all people and all tasks in all situations. The most successful managers are flexible and use a wide range of styles appropriately. But what does “appropriately” mean? Different people will respond uniquely to different management styles The level of relevant experience and personality type of a given staff member can affect the management style you use with him or her. For instance, if your team has little or no experience, and if you do not yet know your staff members’ strengths, weaknesses, and how they prefer to operate, you may need to provide close coaching to facilitate learning. Alternatively, at one extreme, you may need to utilize an autocratic approach where you are the sole decision maker. Margaret Thatcher, former Prime Minister of the United Kingdom, is a prime example of an autocratic leader. While some individuals in government disliked her, she often worked efficiently because she did not seek others’ opinions when making decisions. She was thus able to make swift change during a difficult time in the United Kingdom’s history. As you become familiar with your team, you can delegate managerial responsibilities to others. If your team has ample experience, you can opt for a democratic style, soliciting each person’s opinion and making decisions as a group. The visionary approach—where you outline a vision and allow your team to work toward it with minimal oversight, intervening only to remove any obstacles that present themselves—is a third option. A personality test, such as the Myers-Briggs Type Indicator, can help you understand how each personality on your team (including your own) is perceived by others. As industrial psychology has suggested, personality can affect how you interact with and motivate your staff—if you are an ENTJ (one of several extroverted personality types) and your team member is an INTJ (an introverted personality type), he or she may not be as vocal as you are when brainstorming or sharing opinions, but this does not mean that he or she is not engaged and participating. Different situations will require different management styles Trust is also a factor...

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