#131 - When Performance Becomes Personal: Mental Health, Identity, and the Injured Athlete with Dr. Karolina Shander, Part 1

Welcome to The Factor Podcast, where we talk about the stuff they didn't teach you in school, how to grow your practice, refine your clinical skills, and get better results for your patients. We're here to help you navigate the real-world challenges of being a healthcare provider, from delivering top-notch patient care to running a business that doesn't run you into the ground. Whether you're fresh out of school or scaling your practice, we're diving into effective cutting-edge treatments to get patients better faster. We'll also talk about business strategies and tactics to help you work smarter and not harder, and the mindset shifts required to thrive as a top performer in your field so you can build a career you love without burning out. If you're ready to learn what works and what doesn't from leading experts, industry innovators, and respected clinicians across a wide range of specialties, you're in the right place, my friend. Let's dive in.

Welcome back to The Factor Podcast, where we bridge the gap between rehabilitation, performance, and real-world clinical practice. I'm your host, Jessica Riddle, and today we're kicking off a new conversation with Dr. Carolina Schander, a licensed psychologist and certified mental performance consultant who specializes in sports and performance psychology. In this episode, we're diving into an area that is becoming increasingly important for clinicians, Coaches, athletes, and really anyone working with high performers. That is the connection between physical health, mental health, identity, recovery, and performance. Dr. Shander's work focuses on supporting athletes and other high-achieving individuals to help them understand not only how to perform at a high level, but how to stay well while doing it. Through her work with athletes, coaches, teams, and organizations, including her connection with USA Gymnastics, she brings a valuable perspective on what it means to care for the whole human, not just the performer. In part 1 of this 2-part conversation, we talk about how sport psychology fits into the larger healthcare and performance team, why trust is such a critical part of working with athletes, And how coaches, health providers, and mental health professionals can better collaborate to support performance and wellbeing. We'll also explore the pressure many athletes and high achievers feel to constantly push harder, do more, and ignore the signals that something may be off. And Dr. Shander will offer some helpful insights into what providers can look for when an athlete's pain, injury, or performance challenges may also be connected to their identity, worth, stress, or emotional health. Whether you work with athletes, active individuals, performers, or simply have patients who are trying to return to the activities that matter most to them, this conversation is a reminder that the body and the mind are not separate systems. They are deeply connected and both matter in the recovery and performance process. Let's get into part one of my conversation with Dr. Carolina Shander.

We like to have a bit of a master series conversation ever so often with different healthcare providers that have meaningful insights to share that I think are definitely relevant and. things that could be helpful to our community. So we're excited to have you with us today. If you could start out by telling Jimmy just a little bit about what it is that you do and specifically how you and Dr. Riddle got connected through USA Gymnastics.

Absolutely. Thank you for having me. I'm really excited to have this conversation and be able to connect on this topic and, and discuss the idea of sports psychology. So a little bit about me. I'm a counseling psychologist. With a specialization in sport and performance. And so what that meant is I got generalist training in all types of clinical mental health difficulties and challenges, and then was able to find a program that also allowed me to pursue sport and performance. So any kind of high-achieving individuals, athletics, IO psychology, and be able to learn like, what does it look like to be a performer and maintaining your wellbeing? And so I've been really fortunate to have that background and I met Dr. Riddle by being connected with USA Gymnastics, primarily trampoline and tumbling. Started working with them with my coworker here, Dr. Zane Dodd, and we were invited to just be a mental health support person at some of the trainings and competitions. And then I was able to foster some relationships with the clinical health providers and physicians and was invited to be a part of the team to deliver some training to parents athletes as well as coaches regarding mental health and mental performance and to help foster this idea of the whole human needing to be well to be excellent. And so I, I met Dr. Riddle when we were in Alabama, I think, for a training camp and was able to have a lot of conversations about what it looks like to, I don't know, combine the idea of physical and mental health.

Absolutely. Now, I think you have kind of a, a fascinating choice that you took when it comes to the specialization within your profession. Obviously, under the umbrella of mental health, there's so many different ways that someone can specialize, especially in that clinical setting where they're doing counseling. What made you select kind of this niche within IO and with high performers and performance psychology in particular?

Yeah, that's a great question. Part of it was me search, which is I was a collegiate swimmer and a big part of my challenge was competing. And so at meets, I would really struggle to be able to reach my potential. And so I noticed that within myself, if there was something that was holding me back. And also when I was pursuing my degree, I had some wonderful mentors that work actually in a couple different departments that have a master's in sport and performance. And they shared with me that like the way that you function and see relationships and see humans and see how they work within a system, Mm-hmm. You're going to probably do really well in the University of North Texas department, working in, in a place where you get experiences working within a collegiate athletic department, you're working within a system, and then you have that background simultaneously of being able to learn about how to support people just from like a clinical view. And so the program here at University of North Texas has a 5-year program specifically in counseling psychology, focusing on diagnosing, assessment, and then an additional couple of years regarding the sport and performance. And what I loved about the program here was that you get embedded within a team immediately, kind of once you step foot on campus, and you learn to understand the system as a whole of how they work within the athletic department, how each team has a different culture, how coaches work, what kind of approaches they have, as well as the individual athletes themselves, and how they work within also the health system of how their physicians work, their athletic trainers. And, and where you might fit. And I was, I had the opportunity to work with a couple different teams within UNT, and each one was so different. And it, and it challenged me to figure out how I can kind of best serve based on just the information that I've learned throughout my, my schooling.

That's huge. So when you say they kind of allowed you to integrate into a team, do you mean specifically a sports team? And maybe this is an answer that says both, but a sports team or within the sports medicine team where you're co-managing managing these athletes along with other providers?

So it's a little bit of both. The setup is you get kind of paired with a kind of like a senior consultant. So somebody who's further along in the program who is doing counseling psychology and the sport and performance specialization. And you as like a first year get to learn from them and see what they do. You, you help plan like mental skills sessions, conversations with coaches, as well as then start relationships with the physicians, the other parts of the sports And then you're kind of— you negotiate and figure out like how often you're at practice, how often you are at competitions, and be able to determine kind of what your role is in the health of the athletes. Certain physicians or certain practitioners would want us around more and would want to like run things by us a little bit more than others. And then some we had to negotiate of like, okay, maybe return to play doesn't involve me as much just because of kind of some of the protectiveness around the sport. But that's also just a difference based on just the culture of everything.

Absolutely. Have you, in your experience, found that many people within the coaching staff, the training staff, sports med staff have a good understanding of how mental health professionals can play into that? Have you experienced a good bit of maybe resistance at times where people don't really understand how you guys fit into that team?

You ask a wonderful question and I'm smiling because It's been both. I think a lot of it has been dependent on trust as well as understanding of how we fit. And there have been opportunities or experiences where I've been like placed with a group or placed with the team and they don't know how to utilize me. And there's a lot of fear around having, A, an outsider, and B, having somebody that is mental health or clinical come into a space because they don't want it to be disrupted and they don't trust me. Right. And so a big part of those relationships has been Creating a strong bond and creating trust by me sharing what I could offer while also being able to observe and allow people to kind of invite me in at the same time. Because I think that's a huge barrier for, for us as providers in the mental health or mental performance spaces. Sometimes we're not necessarily invited, even though we might be wanted and needed at times. But we have to work with that relationship first and the trust before we can even be able to help. At least that's my belief.

In the times where you've had the most success in terms of being able to effectively help your athletes, but then also being able to work well co-managing care, have you found that it was typically more practitioner-led, meaning that the other healthcare providers or the coaches really kind of bring you in and drive that relationship? telling the athletes we have this resource, or have you found that sometimes it's more patient-led, whereas if your athletes request mental health or if your athletes are the ones to kind of, I guess, initiate that relationship, it works better?

A little bit of both. I think from my experience, actually top-down, it's probably the most effective when the individuals at the top, whether that's athletic departments or just leaders of a system find us to be useful and helpful and interested in creating just space for us, then it's probably the most helpful. There've been instances where the athletes or the patients involved have pushed because of the how much they request. And I think that's how currently in, in private practice, I see a lot of my work grow is I work with a couple individuals, I work then with, with a group, and then the interest and kind of effects of that are shown that leaders, coaches, et cetera, kind of notice the difference and then But for me, it's been most successful when the kind of individuals in power are bought in, because then they're also kind of using the same language. They also want to learn. We're able to intervene across the system, whether that's management, whether that's coaches, other practitioners. And so we see the most positive effects that way.

I can see that, especially when, when it is a top-down approach, when you have that athletic staff, when you have that sports med staff saying, This is a part of our culture. Like, this is what it means to be a member of this team. I think that's huge because I would imagine that much like our musculoskeletal providers see with athletes, athletes are always wanting to be strong. They're always wanting to show no weakness. And I'm sure there's a lot of misconceptions or maybe even like just bad stereotypes in their mind about if I ask for help, That means I'm weak, or if I admit that I'm struggling, then I could be cut from the team. I could have— be benched or whatnot. How have you— or, or I guess, how have you helped some of these athletes that are a bit more hesitant or have that mindset kind of work around that to realize that mental health is just as important as their, their physical health?

I think There's a couple different ways, but the, the primary way that I do it is by being a human. I traditionally start with, hi, I'm like Carol or Carolina, depending on how people know me. And I share with them kind of like my background and what got me here. And then I, I traditionally just start with a relationship of like, hey, I'm, I'm noticing these things. What, what's happening for you? And getting to understand them as a human before I start kind of thinking or sharing what I think might be helpful, but more so trying to understand what somebody's coming in with. And so. There's a huge stigma still, despite it being a lot more prevalent in pro sports. I'm like, baseball has a huge push around mental health, football, but there's still this stigma of like, wow, like somebody's gonna like know my inner thoughts and my inner demons. And quite honestly, I, I try to get across that it's like a freaking privilege to be a part of that journey with somebody. And so being able to get them comfortable with me as a provider first is kind of the way that I lean. And then being able to share with them like, hey, this is what people utilize this For, and also that I don't have to be the one that they pick, that there are so many different kinds of providers that can be a better fit for them that might have a different style, might have a different way of thinking, might have a different way of how they implement their kind of skills and knowledge, and to give them just the option and feeling of agency. Because honestly, when it comes to really anything in our space, the ability to feel like you have any agency and choice is what leads to better outcomes as well as leads somebody to actually want to be in my office and, and be able to practice what I share with them.

The best clinicians aren't the ones who know the most techniques. They're the ones who can execute the right system consistently. The FACTOR Rehab System teaches—

Made with Wondercraft.

Start creating today at wondercraft.ai.

To guide patients beyond pain relief and into performance optimization. Attending a live hands-on FACTOR training allows you to walk away with a system you can run Monday morning.

Made with Wondercraft.

Start creating today at wondercraft.ai.

Houston and Buffalo. Each is limited to only 20 seats and they're selling fast. Visit factreducation.com to learn more and sign up. That's factreducation.com. Now—

Made with Wondercraft.

Absolutely. And I would imagine, and I have to say, I can't speak from experience. I was never an athlete. My husband jokingly calls me a mathlete, even though I stink at math. So I was more of the art and the drama kid and whatnot.

Which is performance too.

Yes, exactly. And obviously being a CEO, having spent most of my career as an executive, like I totally understand that, that inner drive and that ability to have the determination to push through hard things really is something that can be incredibly effective, not only in your sports career, but in all aspects of life.

Yeah.

But when it comes to sports, what I've noticed, at least just kind of getting a look behind the scenes through my own children, and then obviously the athletes that I've had the privilege of working with over the years and various different things or been friends with, is there's sometimes a stigma or maybe even a misconception that so many athletes have that is, I have to constantly go, go, go, go, go. And I have to push harder and push harder and push harder. And that inner drive, I think, is inherent to being a great athlete and being a high performer, obviously.

Yes.

But at the same time, I know many of our healthcare providers are also trying to emphasize to their patients from a physical standpoint, you have to have rest. Like you have to balance things out.

Mm-hmm.

Do you feel like when it comes to many of the high achievers, the high performers that you've worked with, whether it's from an IO standpoint and in the corporate world, or even those that are high-performing athletes, do you feel like sometimes that's one of the hardest challenges is just kind of Educating them about, hey, like, this is how your mental, emotional, spiritual health fits into you as a person and as an athlete. There's so much more that goes into your performance on the field than just what you're doing in, in your physical body.

Yeah, 100%. I think the biggest piece of, like, initial work with somebody is to grow their kind of awareness of What all goes into being someone's best self. Then, I mean, you mentioned a couple of those components, right? Like spiritual health, mental health, and, and rest and sleep and even relationships, right? Like they all impact us. Everything kind of impacts us, not just the work we do in the gym or on the field. That just pushing harder or doing more isn't actually sometimes the, the marker of success. And so it is hard to convince somebody of that. I think that's sometimes one of my biggest challenges, and I try to take the the approach of like, let's just try and understand you as a human in the ways that when you've achieved your best, what's been going the like well, what's been most effective, and then be able to start to help them see, oh wait, like I was really, I don't know, feeling supported by my people, or I was actually like really involved in my church while also competing in my sport, or wow, like I was making sure I was sleeping this much or taking my vitamins. It's like, okay, hey, like there are multiple components here that actually make you be your best. It's not just this one thing of pushing yourself on the field. And, and that's another— I think one of my challenges with the misconceptions in athletics is that you just got to do more and be harder and just like be tougher, just do more better. And, and that's just not actually what's going to create the best outcome as well as like long-term effectiveness, because we see a lot of really high-performing individuals burn out pretty quickly. Just because their resources have been depleted over the years. And you can work hard, but eventually that resource runs out.

Absolutely. When you are working with an athlete and you have a coach that very much has that mindset of— and obviously I'm not calling out the coaches out there, but I, I, as I've seen firsthand, sometimes it is those coaches that have that Conditioning and weight room and practice and practice. Like when you have a coach and a culture and a team that has that mentality of nonstop, we're going to go 100 miles an hour, nothing's going to stop us. How do you kind of convince that coaching staff or convince that from the top-down approach that it's good to implement some of these other aspects. It's good to kind of give priority to rest because I know that has to be a challenge, especially if there's a culture where that's been something that they did and their coaches really instilled that in them and their coaches instilled that in them. Like, how do you break through that?

Yeah, I— very different ways, I think. But it's a good question and something I and a lot of my fellow colleagues also struggle with. But it depends on the system that you're in. If I'm in an athletic department and I'm, I have a really great relationship with a coach and we kind of have an understanding that they want like my input, then I'm probably a lot more likely to just be honest and share of like, hey, like I'm noticing this. I'm noticing that there's no emphasis on the other parts of the human, not just rest, but like maybe some of these pieces of, of your athletes that aren't getting emphasized. And I'm, and I'm worrying that it's kind of leading to some detrimental outcomes. And maybe if If there are outcomes that I'm already seeing in my office and I have permission to share that of like, hey, like there's about 3 or 4 of your humans who are really, I don't know, they're feeling really burned out or have low motivation or are really struggling or are scared to talk to you. I might offer that, or I might really rely on research to showcase that athletes who are able to access different parts of their identities are going to actually perform better. Athletes who are seeing rest as just as important as their physical preparation are going to have longer careers as well as more satisfaction within their careers. And I also might offer a question to the coaches of like, I know this is how you did it. I know that you just pushed harder and you grinded. Like, that's true. But what if this isn't the most opportune environment for your people? Like your kids, your athletes on the field. What if they don't learn that way? What if they don't achieve their best result that way? And to offer kind of different ways of thinking without pushing my agenda on them, because that's also not what I want to do. It's hard to also get somebody to buy in if they're not interested. So I try and understand the coaches too, of like, what, what's going to allow them to hear me, or at least be open to a different idea.

I love that. And I love the way that you worded that. I think that's one of the most impactful things that All of us can learn from mental health professionals is sometimes how to approach conversations and that your word choice is incredibly important. A lot of the providers in our network and many people that are listening see athletes when they are in pain. They'll see athletes or even just the regular everyday driven individual when they're at a place where they are Either dealing with an injury, maybe they're struggling with chronic pain or a chronic injury, and they're trying to figure out the best path forward. If I'm a healthcare provider working with someone, and you know maybe we're going through our care plan in terms of their physical body, but there's something that just kind of seems a little bit like there's something extra there, there's something more that's kind of beneath the surface, and I'm not. Sometimes people just have an intuition when it comes to these things. Sometimes people don't. What are some things that healthcare providers should look for, whether they're working with an athlete or anyone really, that kind of makes them think it might be time to have a conversation to see if they're open to going to see a mental health professional?

I think that was, that was one I've always thought about, like when I'm sitting in a doctor's office or if I'm like sitting with a Another person and in, in the health setting of when is it time for escalated care, some different kind of support. Big pieces I think would be to pay attention to how somebody's responding to any kinds of challenges from the physical standpoint. Are they saying things like, I'm never going to be the same, I can't do this, very kind of more closed Kind of defining statements. I start to worry a little bit more when somebody is— and then a big kind of picture, seeing them maybe describe big changes in their life, right? So like, oh, I'm not sleeping, I'm not eating, I may be pulling away from people. I'd be paying attention to kind of different changes in their life outside of just their sport. But a big thing to, to pay attention to is— and listen to is how are they viewing themselves? Has the injury and the chronic pain potentially changed how they view themselves in a way that they don't maybe have different aspects to how they see themselves? So for example, right, like if I'm, I'm, I'm postpartum, I've had 2 kids and I have some kind of like back pain and I'm sitting on your table and I'm saying like, I, I don't have anything else. I am just an athlete. And you know different parts about me and you're like, wait, wait, wait, like you're a mom, you're a partner, you, Okay, that that just taking account of those things or hearing somebody like myself say I if I don't do this like I've got nothing else like I don't I don't prove I can't prove my worth to anybody else if I don't do this thing if I don't compete and so if those things tied to identity or worth are really coming up that's a really I think really impactful way place to be able to say hey like it sounds like you might. Really want to have somebody else on this journey to help support you and, and show you that there are other really valuable parts to you, or that like your life can still be really fulfilling and important even if it is including managing this pain or this injury. But those are the big things when, when worth and identity are collapsing. That is a really great time to be able to incorporate somebody in the mental health space.

That's huge. And I know that in recent years in the musculoskeletal space, there's been a lot more, at least awareness of the biopsychosocial aspects of pain and more and more providers, I think, especially post-2020 when COVID hit and people are dealing with, or practitioners are seeing a lot more COVID cases or even that year. We're really seeing more and more patients that had so much stress, so much anxiety, so much going on mentally that it weighed heavily on their physical bodies as well. At least there's more of a conversation and an awareness now. But if I'm a new graduate, I'm starting my practice for the first time. Obviously, I've learned a lot of ways in that initial new patient visit to ask a lot of questions about their physical body. Do you have any recommendations about maybe just like one or two simple questions that someone should ask in that initial new patient visit, just to kind of get an idea to gauge where that person is from a mental healthcare standpoint so that it can better inform their care plan moving forward?

Yeah, I think other than the big questions of if you're hearing somebody struggling with injury or pain and the like, Have you thought about ending your life or hurting yourself? Other than those, what, what I would recommend asking is like, what does this pain mean to you?

Mm-hmm.

How does this pain disrupt your daily life? What does this pain also mean to your relationships? What is getting this work done right in the musculoskeletal space? Like, how much relief does it give you? And, and how do you know that it's giving you relief? Not just physical, but How does this work here impact you? Because you may start to hear, maybe this is the one moment where I don't have to be responsible for my pain, or this is the one moment I'm being taken care of. It's like, okay, that gives you a little bit more information of the different kinds of struggles someone on your table might be having. And the meaning of pain too.

Mm-hmm.

If somebody sees pain as just like a threat that they can't handle and manage, that's another kind of indicator of like, shoot, okay, they might need some other resources and some more support in this kind of way. To help equip them to be able to recover better, faster, or manage this. And then who else kind of holds their pain? Who else helps them and holds kind of the challenges that they are bringing in? I like to ask it in that way because sometimes people giggle and they're like, what do you mean? And then I'll clarify, like, who else holds some of your stress or challenges? And then finally, I, you guys, I mean, I've seen my fair share of PTs and chiros in the last couple of years, not during my athletic career, but y'all get to hear all the lot of interesting things and paying attention to also maybe how they experience their sensations. Like a big part of what I do in my office is also helping somebody grow in the awareness of where they hold things in their body. And so if you can hear that, like, oh yeah, after games, like I'm really, and it's not just like from a physical use standpoint, but like, oh, I noticed like my neck's really tight or my, my back tenses up after this kind of experience. If somebody's paying attention to that and has more awareness of that, they're probably going to be a little bit better off. But if they have no awareness of their pain— so if you notice you're working on something and, and they're like, wait, wow, like that hurts, it's like, oh, interesting, okay, how much do you notice this? Or do you ever pay attention to that? Or what does this feel like? If somebody is unable to maybe grasp that, like, oh wait, I do feel that, or pay attention to those sensations, that might be another indicator of like they benefit from working with somebody like us to be able to understand and be able to manage some of that.

That wraps up part 1 of our conversation with Dr. Carolina Shander. In this episode, Dr. Shander helped us better understand the role of sport and performance psychology. Not only for elite athletes, but for anyone navigating pressure, identity, injury, recovery, and high expectations. One of the biggest takeaways from this first part of the conversation is that performance is never just physical. Sleep, stress, relationships, identity, support systems, mental health, emotional regulation, and the meaning someone attaches to pain or injury can greatly influence how they recover and how they perform. For healthcare providers, this is such an important reminder. We might be treating the body, but we are always treating a whole person. And sometimes the clues that someone may need additional support show up in the way they talk about their injury, their worth, their identity, or their fear of not being able to return to who they were before. Dr. Shander also reminds us that integrating mental health support into performance and sports medicine settings starts first with trust. It is not about forcing another provider into the room. It is about building relationships, creating safety, and helping athletes understand that support is not a sign of weakness. It's part of helping them become more durable, more self-aware, and better equipped for the demands of performance. In part 2, we'll continue the conversation and go deeper into the provider's role in recognizing these patterns by asking better questions and helping patients access the right type of support when they need it. As always, thank you for listening to the Factor Podcast. If this episode resonates with you, share it with a colleague, coach, or another healthcare provider who works with athletes or high-performing individuals. Until next time, keep learning, keep refining your systems, and keep raising the standard of care.

We'll see you then. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings, as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.