Highly successful people, especially entrepreneurs like private practice owners, often take their work life to extremes. They push well beyond a typical work day or work week at the expense of family and relationships. For these people (I might as well say my people), Gary Keller, author of The ONE Thing recommends counterbalancing. In other words - taking the same approach with leisure time that you take with your work life.

If you are going to work extreme hours… you need to spend some extreme time in rest and recuperation mode as well. If you don’t push your life out of balance, you might get away with a typical work week and relaxing on the weekend… taking the 60-70% of your allotted paid time off each year as many Americans do. For those of us that push hard for long periods of time, failing to counterbalance can lead to big health, relationship and even professional problems.

While our personal rhythm of push and counterbalance might work for us, we often expect the people in their lives to accept the same sort of rhythm. The challenge is that most relationships don’t do well with extremes. If you check out emotionally and don’t focus on your family for a month or two while you are pushing on a work goal, you should not expect everything to be great after a little counterbalancing with a family vacation. Relationships – and particularly spouses and children, require counterbalancing with much greater frequency.

A frequently cited metaphor in the literature around work/life balance comes to us from Bryan Dyson, then CEO of Coca-cola in his mid ‘90s commencement speech at Georgia Tech. He says:

Imagine life as a game in which you are juggling some five balls in the air. You name them - work, family, health, friends and spirit - and you’re keeping all of these in the air. You will soon understand that work is a rubber ball. If you drop it, it will bounce back. But the other four balls - family, health, friends and spirit - are made of glass. If you drop one of these, they will be irrevocably scuffed, marked, nicked, damaged or even shattered. They will never be the same. You must understand that and strive for balance in your life.

Similarly, counterbalancing with diet and exercise just plain doesn’t work. Ever tried pigging out and avoiding exercise for a few months and then trying to get back in shape with a few weeks of eating healthy and exercising? Health requires daily attention… going to extremes doesn’t work.

Failing to counterbalance the stress and fatigue from pushing toward our career goals leads us to begin to pull attention away from the daily and weekly rhythm of relationships and the habits that lead to health, energy and longevity.

Keeping the habits and rhythms of diet and exercise, family and relationships, church and spiritual life (the glass balls) provides us with the resilience we need to launch our professional rubber ball as hard and as fast as we can.

Which ‘ball’ do you tend to have trouble keeping track of?

Proposed by a Hungarian positive psychologist named Mihály Csíkszentmihályi, flow is the mental state of operation in which a person performing an activity is ‘fully immersed in a feeling of energized focus, full involvement, and enjoyment in the process of the activity’.

I am almost certain that if I couldn’t get into a state of flow while performing patient care, I wouldn’t be a physical therapist. Its also one of the reasons why I enjoy being engaged in a busy clinical setting, with just enough patients to where I can flow from one to the next with just enough time to get mandatory documentation and such accomplished.

This is so much more enjoyable than a slow day that drags on and on, or a day that is so hectic that I can never catch up. When I get just the right amount of patients scheduled and making great progress on their goals, time seems to disappear. I’m in control and the day feels like a dance put together by a master choreographer. That is flow.

You have to be involved in an activity with a clear set of goals and visible progress. This adds direction and structure to the task.There are three conditions that flow theory postulates have to be met in order to achieve flow:

1. The task must have clear and immediate feedback. This allows you to adjust performance to maintain the flow state.
2. There must be a balance between opportunity and capacity. In other words, there is opportunity inherent in the task and you have the capacity to meet the challenge of the task.

Clinical practice can often meet all of these requirements when we are fully present and engaged. One of the ways I get into flow during a busy clinic day is by avoiding email, facebook and other distractions. I put my electronic medical record system in full screen mode and avoid the temptation to ‘check in’. This by itself doesn’t create flow state, but one thing is certain - you can’t flow while you are distracted.

Patient care lends itself to meeting the requirements for flow. We often see changes and make improvements immediately when working with patients. This gives us not only goals and visible progress, but immediate feedback.

We have the opportunity to make large improvements in patient’s lives, and we definitely have the capacity to make those changes. Few clinicians have the same opportunity to make immediate improvements and gain the reward of instant positive feedback. This is part of what makes physical therapy a highly sought after profession.