The following is a guest post from Paul Conti, MD, a graduate of Stanford University School of Medicine. He completed his psychiatry training at Stanford and at Harvard, where he was appointed chief resident and then served on the medical faculty before moving to Portland and founding a clinic. Dr. Conti specializes in complex assessment and problem-solving as well as both health and performance optimization, serving patients and clients throughout the United States and internationally, including the executive leadership of large corporations.
What follows is an adapted excerpt from his new book What’s Going Right: A Powerful New Method for Optimizing Your Mental Health.
Please enjoy!
“Paul, I’m finally going to commit myself to a hardcore exercise program. If I don’t do something challenging soon, I don’t think I’ll ever go back to the gym. It’s now or never,” my patient Teresa declared.
It surprised me to hear Teresa make such a powerful statement. She’d been struggling with anxiety and low self-esteem for quite a while, and although she wasn’t suicidal, Teresa had long given up on efforts to make her life better. After failing to experience lasting results from past efforts, she simply didn’t see the point. So when she proudly announced this new resolve, I nodded in cautious agreement. This new exercise program was her revelation, and it reverberated strongly through her life.
She lasted just two weeks.
I’m not one to judge failed expectations when it comes to exercise. Some research estimates that up to 88 percent of New Year’s resolutions fail within two weeks. And while Teresa’s resolution wasn’t for New Year’s, she fell squarely into the majority of that statistic. As she and I discussed why the program hadn’t worked for her, a usual suspect appeared: her new exercise regimen was too much for her busy work schedule. Teresa’s strivings had crashed into the obstinate wall of her reality, and as the weight of making time for weightlifting grew heavier each day, she finally succumbed to excuses not to go.
First, she told herself, “Today I’ll go after work instead of before, like I’d planned,” and then it was, “Well, I’ll skip today, but I’ll make up for it with an extra-long session on my day off.” She’d succeeded in articulating her strivings and changing some of her behaviors, but there was a lot going on for Teresa that she wasn’t entirely conscious of—namely, some self-sabotaging defense mechanisms and a host of automatic, ingrained negative thoughts that had plagued her for most of her life.
At her first slip-up, Teresa fell back into negative self-talk spirals, repeatedly telling herself things like, “I’m just too lazy. I don’t have enough discipline. I’m hopeless. I’m incapable of change. This is more proof that I need to give up and stop trying. Who am I fooling?”
I’d known Teresa for some time. She was as compassionate and insightful as they come. She’d never speak to a struggling friend the way she talked to herself, and yet the voice in her head was relentless, unhelpful, and unkind.
Sound familiar?
Teresa was accomplished and driven at her work. Her problem wasn’t laziness or a lack of discipline or some cursed inability to change; Teresa’s problem was that she’d aimed too high, thereby setting herself up for failure.
In our first meeting after she’d quit her program, I gave Teresa what might sound like suspect advice. “In the future,” I told her, “it would be a lot better to choose not to do the exercise program in the first place than to continually allow yourself to talk your way out of it. At least that way you’d be making the choice conscious.” I stressed the last part since many of our excuses aren’t fully extracted from the unconscious mind. The negative voices within us and the despair to which they can drive us are resistant to change. They lurk in our unconscious, ready to toss a discouraging word above the surface. That’s why it’s so important that we learn to pull them all the way to the surface so that we can shine the light of consciousness upon them and make healthier decisions for ourselves.
Eventually, Teresa and I explored some bite-sized options for self-care that were better suited for her busy life. After a few compassionate corrections, she regrouped and kicked off her year in a positive manner. She allowed herself to collect smaller wins over time and gradually learned to meet her shortcomings with kinder self-talk. Through our work together, she also learned practical steps for self-inquiry that empowered her to continue to bring those detrimental messages into her conscious awareness.
Although asking yourself questions is just one aspect of self-inquiry, it’s probably the most available path of self-inquiry in any given moment. Later, I’ll provide a list of questions as a baseline for helpful self-inquiry. But keep in mind that questions are only helpful if they foster your empowerment and agency. It’s also essential that your questions are imbued with compassionate curiosity.
Looking into your unconscious beliefs and behaviors doesn’t help if it just increases your guilt and shame (which typically, in turn, just furthers those unconscious beliefs and behaviors). The point is to be inquisitive, not inquisitorial. Don’t grill, hound, or nag yourself with harsh critiques or demands for justifiable answers. Rather, do your best to ask questions that are friendly, relevant, and productive.
The question “Why did you screw up again?” comes from a particular mindset and will generate a particular (and likely negative) reply. Questions like “How does this repetitive pattern serve me?” and “What am I missing here?” might address the same issue but from a kinder and more generative angle. Whatever you ask yourself, remember that the best form of self-inquiry is compassionate, curious, honest, and open.
To get the most out of these exercises—to truly be purposeful about self-reflection—consider these guidelines first:
Now that you’re ready, try these basic self-inquiry questions:
Additional questions:
Answer these questions (and any others that come up) with curiosity as opposed to criticism. Don’t confuse being harsh with being honest! When imbued with compassionate curiosity, self-inquiry empowers you to take stock of yourself, which in turn allows you to make desired life adjustments.
When it comes to your thoughts (structure of self), become compassionately curious about yourself and ask:
Let’s use Teresa as an illustration: Much of her negative self-talk was unconscious. It’s hard to make much headway in the dark, so part of our work together involved making Teresa more conscious of all the self-sabotaging things she was telling herself after her understandable failure to follow through with her exercise program.
Recall that defense mechanisms are mostly unconscious, too. We can guess that Teresa’s ongoing rationalizations for not going to the gym (for example, “I’ll go after work instead”) were a way to protect her from immediate disappointment and self-criticism, but they didn’t do much to address one of Teresa’s fundamental issues: She’d set a goal she had no chance of following through with.
In some ways, this wasn’t in line with her character structure, as Teresa was quite adept at making and meeting reasonable goals at work. She was dependable, insightful, and compassionate, as well, which made her harsh self-talk (“I’m too lazy; I’ll never be able to change”) all the more notable.
What does it mean when our “outer” behaviors (that is, toward others, our job, our friends, and so on) don’t align with our inner life? Teresa’s I—that is, her sense of self—had been struggling with anxiety and self-esteem for some time. In response, Teresa chose to do something that was bound to fail. Why? In the process of self-inquiry, what useful information about herself might Teresa learn?
Once you’ve completed a thorough scan of your mind and thoughts, it’s time to consider your actions—that is, your function of self:
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No matter how you choose to practice, self-inquiry will regularly provide more information in service of change. Over time, self-inquiry will help you become the best self-driver you can be. The more often you engage in the process while directing compassionate curiosity toward your structure and function of self and your drives, the more you’ll learn and the more natural the practice will become.
The routes to effective self-inquiry vary from person to person. The tools that work for one person won’t work for another. In truth, it’s not so much the tools but how (and how often) you use them. If today’s self-inquiry didn’t provide you with any deep revelations, it doesn’t mean that tomorrow’s won’t. Make self-inquiry a regular part of your life, and you will see change.
From What’s Going Right: A Powerful New Method for Optimizing Your Mental Health by Paul Conti, MD. Hachette Book Group, publisher. ©2025 by Paul Conti. Reprinted with permission.
Photo credit: Patrick Schneider
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