By Sandra "Sam" Foster, Ph.D.

“I hope you have a new career planned,” an economist colleague cautioned in 1989, as he observed the signs of Silicon Valley’s coming recession—layoffs at Lockheed Missiles and Space and other major corporations and upheaval in the health care industry. “You psychologists are going to find your reimbursement rates cut in the next few years,” he opined. “It’s also likely that you will all be competing for market share with others who do therapy.”

These prophetic words were uttered ten years ago and just three weeks before my oral exam for licensure. This colleague proved to be an excellent forecaster of economic trends. His well-timed prediction allowed me to respond to changing economic conditions that would dramatically alter the way psychologists functioned as sole practitioners in California and elsewhere. By December of 1993, I had resigned all the managed care panels to which I belonged. A move out of state set the stage for me to realign my practice.

An Alternate Approach to Practice Specialization

Many psychologists have responded to changing conditions, some by developing a practice that offers services helpful to a targeted population with specific problems. Another approach, which I chose, is shaping a niche specialization that serves several distinct populations who have similar goals. Both approaches to practice specialization promise opportunities outside of managed care.

An interest in performance anxiety research guided my practice specialization as it had my dissertation. Graduate training in sport science and performance enhancement strategies for athletics complimented my experience in working with business people in Silicon Valley. My early years of training in dance, flute and voice aided me in understanding the challenges faced by members of the performing arts community. My marketing activities and materials eventually declared the designation of my specialty—performance enhancement psychology.

Performance Enhancement as a Way of Assisting Clients

Although I have established this performance enhancement emphasis, my initial interactions with a new client appear no different from those of any psychologist in clinical practice. I conduct a thorough intake interview and formulate the diagnostic criteria as I learn about the client’s current life and relationships, family of origin, educational background and medical history. At this point, treatment for an Axis I disorder like unipolar depression or substance abuse may be the first course of action. Later, issues at work or on the stage or playing field become the focus. I may refer the client to another colleague for care or address those clinical issues myself. Other referrals may be relevant such as a medication evaluation or testing for learning deficits or some suspected organicity.

However, in a number of cases, the impediments to a satisfying work life or performing well at sport or in the arts may not be found in the DSM-IV nomenclature. Instead, these barriers may be the client’s mismatch with his or her position in the workplace or with the career choice itself. For some clients, their perceived past failures provoke distress and result in performance impairment or avoidance of the performance situation.

A specialist in performance enhancement assists a client in identifying the overall criteria for acceptable, then optimal functioning within a specific work or performing arts environment. The benchmarks or measures for this functioning are operationally defined. A discussion follows of the client’s own assessment of how well he or she is meeting these criteria, using self-report or external feedback such as performance reviews or the outcomes of job interviewing or auditioning. The client is then asked to imagine key performance situations. With the performance specialist facilitating, the client identifies the beliefs, physical sensations, and past events that inhibit or completely block the desired performance.

The psychologist’s role in performance enhancement is that of supportive advocate for performance improvement and as an educator who teaches high performance skills that are useful in the particular environment and generalizable to other settings. Further, the psychologist must think in terms of systems in which the client finds himself or herself, and consider the impact of the client’s change toward higher functioning. Questions such as the following are posed: How will the client’s loved ones react to greater success that may result in longer hours at work? Even if the client’s coworkers are relieved by gains in his or her productivity or proficiency in communication, what other reactions might they have?

Further, the psychologist’s role is also one of examining the barriers to optimal performance. Fears of success, manifesting as doubts about sustaining achievement or worries about “outdoing” a sibling, parent or partner are explored. Fears of experiencing failure, shame and disappointment must likewise be worked through, so that the client can deploy the actions that meet the criteria for success.

The question of quality of life is crucial at this point, in my experience. A client who reports career dissatisfaction may be so overworked or trying so hard that burnout is an appropriate diagnosis. The benchmarks for “success” may be so excessively or inhumanly set that the client cannot meet them or, in a healthy sense, should not aspire to because of the costs involved. When burnout is the problem, performance enhancement intervention becomes the philosophical exploration of a life out of balance—and finding solutions other than “working harder.”

Case Formulation and Interventions for Performance Enhancement Work

The client’s beliefs about success and failure can, of course, be formulated from a number of theoretical perspectives. My orientation is cognitive therapy. Therefore, I assist the client in framing his or her experience in terms of early life experiences that gave rise to beliefs that are life and relationship enhancing and those that are not. Jeffrey Young’s Schema Questionnaire (Young, 1993) and related interventions to are useful in diagnosing and treating not only Axis II disorders but also milder forms of blocking beliefs that cluster around particular self-percepts. For example, a belief that one does not deserve to enjoy success at work or in an avocation can “harden” into a schema that inhibits personal development, the learning of new skills, or taking pleasure in accomplishments.

Other techniques of cognitive therapy are useful for clients who wish to improve their performance such as observing, then questioning the self-statements that are triggered by situations in which masterful deeds are expected. Disputation is an important strategy that aids clients in grappling with the beliefs that activate physical distress and hesitation when action is what is needed.

Eye Movement Desensitization and Reprocessing (EMDR) is another tool that I have utilized since 1990. After attending Francine Shapiro’s first training, I pioneered the application of EMDR to performance enhancement along with my colleague, Jennifer Lendl. Together, we found that this treatment for trauma could be applied to upsets at work and to helping clients more rapidly break through emotional barriers that impede their athletic and artistic performance (Foster & Lendl, 1996).

The Skill Set for Optimal Performance

What constitutes the high performance skill set that could benefit almost any client? While I cannot point to any one reference that describes these attitudes and actions, there is a knowledge base is found in the sport psychology literature. Two recommendations are the work of Canadian sport psychologist Terry Orlick (1986, 1990) and the seminal volume by Robert Nideffer (1985).

Here is the skill set that I teach my clients:

1. Sense of purpose (personal mission, the vision for one’s work or avocation). This is the statement of “why I do what I do.” Clarity of purpose can be motivating, can give rise to persistent action, and may provide the foundation from which decisions can be made. A client with a well-defined sense of purpose has both a path and a map. The is the reference point to which he or she can refer to when challenges arise: “This is why I do this work. I believe in this.”
2. The Capacity to Focus on the performance task is often easier after the client has described and embraced his purpose. Focusing is attending to what is important at the right time may require less effort because he or she knows the why of doing the task or creating the performance. Focusing and the capacity to sustain attention (to concentrate) comprise one of the cardinal performance skills (Nideffer, 1985), and I impart techniques for centering, refocusing and maintaining attention under difficult conditions.
3. Managing Distractions, so focusing is easier. Distractions may be thought of as internal (self-defeating thoughts, distressing physical sensations and emotions such as anxiety), or external (noise, interruptions, overload of information). Clients acquire techniques for managing time and information flow and communication skills for negotiating with others about performance tasks. We psychologists have numerous strategies for helping clients manage internal distractions such as relaxation training.
4. Managing Energy Levels so the client can adjust the level of arousal with relative ease, either by “pumping up” when necessary or being able to calm down the sympathetic nervous system response when feeling “overamped.” Certainly there are many factors that influence a client’s perceived and actual state of arousal: diet, exercise, amount of sleep, hormonal levels, ingestion of street or prescription drugs, steroids or alcohol, and exertion, health status, and state anxiety. Performance enhancement interventions include assessment of the client’s choice of foods and hydration routines, sleep patterns, and other lifestyle and health maintenance behaviors. Recommendations are made to improve the client’s overall health status which is likely to enhance his or her performance.
5. Initiating and sustaining activities that nurture the spirit as well as the body and the mind. A client’s spiritual well being is my concern, along with physical, mental and emotional health. Where I practice in San Francisco, there is marvelous diversity evident in my clients’ religious and spiritual beliefs and practices. I encourage greater comfort with an examined life and mindfulness at work and in relationships with others. When a client is open to it, we look at how contemplative time may become part of each day. For executives and leaders of teams, there may incentives for this time to be set aside for visioning. For athletes and performing artists, this time may begin as cognitive rehearsal of desired performance and then be expanded into reflection about life more generally.

Suggestions for Developing a Theme-based Specialization

My colleague, Kate Hays, now in Toronto, has produced a device that practitioners may utilize as they think through their interests, talents and training in order to fashion a practice specialty. I recommend it to you, from my experience in having collaborated with Kate in two presentations on practice diversification. She calls it the “Exercise and Sport Psychology Development Matrix,” and it is one part of her Exercise and Sport Psychology Development Plan found in her forthcoming book (Hays, in press). You may also wish to read about Kate’s practice specialization (Hays, 1995), and her early call for integrating the techniques of performance enhancement into a more traditional practice.

Additional resources might be a course in sport psychology that focuses on performance enhancement techniques or consultation with a local practitioner who provides performance enhancement work in settings you find intriguing. Please keep in mind that I am discussing the application of techniques of performance enhancement in working creatively with clients and their performance-related issues in the workplace or with performing artists. I am not suggesting that one course in sport psychology is sufficient for a psychologist to then work ethically and effectively with athletes. There are significant issues related to scope of practice when intervening with athletes. Training in clinical psychology alone does not provide the background in the sociology of sport nor the sport science information necessary for a practice specialization in sport psychology. You might want to consider hiring a reputable executive coach for yourself for two or more hours to experience first-hand how performance improvement work is conducted. You could also look for continuing education opportunities to explore practice diversification from the point of view of other psychologists.

My theme-based practice specialization has invigorated my career and increased my satisfaction with my work. I hope that you find these ideas appealing and perhaps even inspiring.

References

Foster, S., & Lendl, J. (1996). Eye movement desensitization and reprocessing: Four case studies of a new tool for executive coaching and restoring employee performance after setbacks, Consulting Psychology Journal: Research and Practice, 48(3), 155-161.

Hays, K. (1995). Putting sport psychology into (your) practice, Professional Psychology: Research and Practice, 26, 33-40.

Hays, K. (in press). Working it out: Using exercise in psychotherapy. Washington, DC: American Psychological Association.

Nideffer, R.M. (1985). Athletes’ guide to mental training. Champaign, IL.: Human Kinetics Publishers, Inc.

Orlick, T. (1986). Psyching for sport. Champaign, IL.: Leisure Press.

Orlick, T. (1990). In pursuit of excellence. Champaign, IL.: Leisure Press.

Sandra Foster, Ph.D., is a performance enhancement psychologist and executive coach based in San Francisco. She is a Consulting Associate Professor at Stanford University where she received her doctorate. Dr. Foster is certified by the Association for the Advancement of Applied Sport Psychology (AAASP) as a sport psychology consultant, and is a member of the US Olympic Committee Sport Psychology Registry. Her address is: Success at Work, 220 Montgomery St., Suite 315, San Francisco, CA 94104, samrolf@aol.com.