**Practice Safe Stress at the Burnout Battlefront:\
*Survival Strategies for Senior Healthcare Professionals and
Organizations****\
Managing Stress and Change and Building Team Morale through Humor*

Caring for patients and family members facing critical \"life and
death\" issues is always a challenge.  One must be prepared to deal with
the most powerful and poignant emotions, from loss and grief to peace
and joy.  At the same time, understandably, anxious patients and family
members can prove demanding.  Add in business (not medical)-oriented and
bureaucratic procedures along with a 24/7 world often cycling between
\"do more with less\" downsizing and ever faster upgrading and the
pressure starts building.  How to rejuvenate energy and sustain morale,
productivity and team coordination in a diverse and demanding
workplace?  Did anyone say ***Stress?***\
\
Have no fear...(well, maybe a little), Mark Gorkin, \"The Stress Doc\" ™
is here with his dynamic and interactive, inspiring and fun-filled
presentation and small group exercises.  Learn to channel stress and
frustration into psychological hardiness, safe sharing,
cooperative/creative action and team and community bonding.**\
\
OBJECTIVES:**\
\
1. Rapidly, purposefully and playfully recognize stress signals and
\"The Four Stages of Burnout\" -- a) "Physical, Mental Emotional
Exhaustion,"

b\) "Shame and Doubt," c) "Cynicism and Callousness" and d) "Failure,
Helplessness & Crisis"\
\
2. Develop Natural SPEED and learn the Six \"F\"s of Dealing with Loss
and Change

3\. Gain time management skills and strategies for achieving
"Emancipation Procrastination"\
\
4.  Learn how to disarm self-defeating or dysfunctional power struggles
through affirming \"I\" messages and through the higher power of
\"letting go\" and building trust\
\
5. Use the Stress Doc\'s signature \"discussion and drawing\" exercise
to:\
a) identify in a safe and supportive manner sources of workplace stress\
b) recognize and empathize with others\' challenging environments; not
feel so alone\
c) and transform stress and frustration into creative problem-solving,
team coordination, seeing the big picture and having FUN!\
\
6. Through exercises, presentation and large group discussion
participants will generate tangible and applicable reorganization, team
building & team hardiness strategies.\
\
Seek the higher power of Stress Doc humor: *May the Farce Be with
You!**\
Don\'t miss your appointment with the Stress Doc.***

**Mark Gorkin, MSW, LICSW, \"The Stress Doc\" ™,** a Licensed Clinical
Social Worker, is an acclaimed keynote and kickoff speaker and
\"Motivational Humorist\" known for his interactive, inspiring and *FUN*
programs.  In addition, the \"Doc\" is a team building and
organizational development consultant, and is America Online\'s \"Online
Psychohumorist\" ™.  Recent speaking clients include Cleveland Clinic,
Sonoma County, CA, Govt. Managers Conference, and the Montana Public
Health Service.  Currently he is leading \"Stress, Team Building and
Humor\" programs for the 1st Cavalry and 4th Infantry Divisions, Ft.
Hood, Texas.  The Stress Doc is the author of *Practice Safe Stress* and
of *The Four Faces of Anger*.  See his award-winning, *USA Today Online*
\"HotSite\" \-- **www.stressdoc.com** \-- called a \"workplace
resource\" by National Public Radio (NPR).  For more, email
**stressdoc@aol.com** or call **301-946-0865**.

**Stress Test**

Rate yourself on how you typically react in each of the situations
listed below. There are no right or wrong answers.

4 -- Almost Always 3 -- Frequently 2 -- Sometimes 1 -- Never

\_\_\_ I do as much as I can in the least amount of time.

\_\_\_ I get impatient with delays or interruptions.

\_\_\_ I have to win at games to feel satisfied or to enjoy myself.

\_\_\_ I accelerate my car through amber lights.

\_\_\_ I am reluctant to admit I need help or to ask for help.

\_\_\_ I am too critical of others' work.

\_\_\_ I feel driven to achieve or acquire more and more.

\_\_\_ I need and seek other people's recognition and admiration.

\_\_\_ I need to look at my watch or clock.

\_\_\_ I overschedule more than I can do realistically.

\_\_\_ I do several things at one time.

\_\_\_ I carry around a lot of irritation or anger.

\_\_\_ I don't have time for hobbies or time for myself.

\_\_\_ I talk rapidly and interrupt conversations

\_\_\_ I see myself as "hard driving."

\_\_\_ Others see me as "hard driving."

\_\_\_ I get involved or caught in multiple projects.

\_\_\_ Deadlines are a part of my work.

\_\_\_ I get somewhat anxious or guilty when relaxing or doing nothing.

\_\_\_ I accept or take on too many responsibilities.

20 -- 30 Chances are you are non-productive or your job lacks
stimulation.

30 -- 50 You have a good balance between stress and controlling it.

50 -- 60 You are marginally too tense; you aren't handling stress well.

60 -- 80 You are a candidate for heart disease.

**Combat Strategies at the Burnout** **Battlefront\
Today's world is 24/7, wired and always on and often cycling between
upgrading and reorganizing\--if not outsourcing and downsizing. And as
company mantras become "do more with less," it's no surprise that more
and more people are struggling with job stress and burnout.**

*By Mark Gorkin, LICSW*

**The Erosive Spiral**

The classic set-up for burnout is a professional or personal situation
that places high ongoing demands and responsibilities upon you while
restricting your sense of control, autonomy and/or authority. Inflexibly
high expectations and elusive goals only add fuel to the fire. Consider
this: If, no matter what you do or how hard you try, results, rewards,
recognition and relief are not forthcoming and you can't say and mean
"no" or won't let go, trouble awaits. The groundwork is laid for apathy,
callousness and despair.

Burnout is a gradual process by which a person detaches from work and
other significant roles and relationships in response to excessive and
prolonged stress and mental, physical and emotional strain. The result
is lowered productivity, cynicism and confusion\--a feeling of being
drained and having nothing more to give.

**The Four Stages of Burnout**

**Physical, mental and emotional exhaustion** is the first stage of
burnout. Do you recognize this sequence? Maybe you are still holding it
together at work, but as soon as you get home you go right for the
fridge, turn on the TV, hit the sofa and are comatose for the rest of
the evening. Normally you pride yourself on doing a thorough job. But
budget cuts have you looking for shortcuts, if not cutting corners, and
this gnaws at your self-esteem. A case of the "brain strain" is
developing, accompanied by an energy shortage and feelings of
exhaustion.

**Shame and doubt** manifest themselves in the second stage of burnout.
For example, if your supervisor asks you to take on a new assignment
your first reaction is to be helpful, but suddenly a voice inside
screams, "Are you kidding?" You're feeling shaky in the present and
losing confidence about managing the future\--you can even start
discounting past accomplishments. Remember, this is not a logical
process but a psychological one.

**Cynicism and callousness** are how people often respond to feeling
vulnerable. They put their guard up and look out for No. 1. In the short
run this strategy may work, but over time this hard exterior can become
a heavy burden. Remember, burnout is less a sign of failure and more a
sign that you gave yourself away. Not surprisingly, you can become
resentful and feel that people are taking advantage of you. Sensitive
individuals begin developing calloused skin for self-protection.

This stage of burnout doesn't just facilitate a hardening of the psyche.
When your stress starts to smolder and turns to frustration and anger it
can lead to a hardening of the arteries. High blood pressure,
hypertension, cardiovascular complications, even heart attacks and
strokes are potential health risks.

**Failure, helplessness and crisis** are symptoms of the fourth stage of
burnout. And while it sounds terrible, consider this: hitting bottom
means there's no more downward spiral. And if you can reach out, there's
nowhere to go but up. Being caught in a career catch-22 often signals
the final stage. Burnout is like trying to run a marathon at full speed.
Without pacing, the body parts wear out, and the mental apparatus breaks
down. In fact, one reason the fourth stage is so disorienting
psychologically is that there are cracks in your defensive armor.

Fourth-stage burnout is the crisis point. Are you ready to reach out for
the help and resources you need? A person recovers and expands his or
her strengths and possibilities by:

-   Getting proper support from a professional trained in crisis
    intervention and loss;

-   Confronting denial, false hopes, cynicism and helplessness;

-   Grieving past and present losses, while turning guilt, anxiety and
    aggression into focused energy; and

-   Acquiring skills and technology for transforming new awareness and
    motivation.

**Rehabilitation and Rejuvenation**

While the erosive spiral of burnout is dangerous, it also provides
opportunity for growth. I know from personal experience.

Back in the 1980s, I was an unrealistic doctoral student. Low
self-esteem and determination to silence critics and doubters had me
trying to turn a mystical-like experience in psychoanalysis into a
doctoral dissertation. For the sake of brevity, let's just say I was
definitely off the ivy-covered wall. And for several months, I was
sidelined by exhaustion, existential emptiness and frightening,
stress-induced dizzy spells. Fortunately, a silver lining emerged from
the academic ashes. I became an expert on stress and burnout eventually
evolving a self-care, recovery and prevention process.

It took several months of grieving and tending to mind-body wounds to
recover. I needed to know that significant others still loved and
respected me despite my feelings of academic failure. You may need a
mentor or a counselor to reconfirm your pre-crisis identity; to help you
see strengths when you are fixated on your weaknesses. And the earlier
one can begin grieving and "letting go," the easier for emotional
catharsis to become a tool for rebuilding healthy purpose and passion.

**Four Rs of Burnout Recovery**

**Running** -- Get moving with 30-40 minutes of exercise, such as
jogging, brisk walking, cycling or swimming, which will get those
disposition-enhancing endorphins pumping. The chemical influx helps slow
a racing mind and helps lift a sluggish mood. There's a beginning and
end point for a tangible sense of control and accomplishment. Your
routine becomes a success ritual fueling burnout recovery.

**Reading** -- Turn to humorous novels or cartoon books to add some
absurdity, if not levity, to your perspective. Hearty laughter also
releases endorphins, giving vital organs a brief but vigorous internal
massage.

**Retreating** -- Take time to reflect on this ego- and
identity-shattering experience and answer some of the big, existential
questions: What are my skills, gifts and talents? What are my emotional,
knowledge and learning gaps? The blank canvas is scary\--but also
exciting. To paraphrase poet Walt Whitman: Follow the open road and
discover or recover your soul.

**Writing** - Research indicates that taking the time to express and
analyze your emotions through writing provides a stress-relieving anchor
in a stormy, troubled sea. Reflective writing can also be a source of
self-discovery\--a tool for your healing, understanding and action.

**Shake Things Up**

Rebuilding may involve shaking up the personal-professional puzzle,
exploring anew or even returning to one's passionate roots. This might
include job or career path changes.

-   Restructure current roles and responsibilities; work in another
    department or division.

-   Take a sabbatical or travel.

-   Consult independently or work for a foundation, an association or an
    institute.

-   Go back to school to pursue a heartfelt interest, or even return to
    the classroom as an educator.

-   Go into business for yourself or, if you're self-employed and
    running on empty, join a company.

-   Recover a previous creative pursuit and turn it into a career path
    or, perhaps, balance a job with a passionate hobby.

-   Pursue a different professional setting or field or a new
    geographical location.

**Burnout Prevention Strategies**

Burnout evokes an experience of loss\--from loss of control or
abandoning a cherished goal to a sense of helplessness and hopelessness.
However, wrestling with loss often yields renewed energy and
transitional possibilities.

To reduce chronic stress and prevent burnout, the Stress Doc prescribes
natural SPEED.

**Sleep** -- While recent research questions the health benefits of
excessive sleep (more than eight hours) a pattern of less than six hours
for most people yields a loss of mental sharpness. Also, sleep research
supports brief napping (10 to 40 minutes) during the day for mind-body
rejuvenation.

**Priorities** -- Focus on the essentials when trying to be productive.
To meet expectations and to achieve goals, it's often vital to establish
limits and set boundaries. Learn to say no and to negotiate. Tactfully
yet assertively discuss what's urgent versus what's important.

**Empathy** -- Listening to or supporting others can be stress
relieving, just make sure the shoulder lending is not a one-way
transaction. At work and/or in your home life, have at least one stress
buddy with whom you can let your hair down.

**Exercise** -- The benefit of regular exercise is both physical and
psychological. Thirty minutes of vigorous activity releases
endorphins\--natural mood enhancers and pain relievers in the brain.

**Diet** -- A diet high in saturated fats (red meat, high-fat dairy) and
simple sugars (sodas, cookies and excessive chocolate) induces
drowsiness and mental torpor, not to mention clogged arteries. And too
much alcohol and caffeine is a roller coaster headache\--moodiness or
depression often follows aggression and agitation. Balancing protein,
fruits and vegetables, complex carbs, grains, nuts and plenty of water
is vital for optimal energy and alertness along with cardiovascular
health.

**Psychological Hardiness**

Psychological hardiness is a concept developed by Dr. Suzanne Kobasa and
her research team while studying the health of AT&T executives during
the stressful breakup of "Ma Bell." Some execs were having a hard time
physically and emotionally, while others were coping effectively with
the transitional storm. The hardiest executives demonstrated what I call
the four C's of psychological hardiness.

**Commitment** -- While not happy about the major restructuring and
resulting turbulence, the hardiest executives did not give up; they were
determined to do quality work. They also had a life outside the office
and received support from family, friends, colleagues and spiritual
activities, as well as from hobbies. Hobbies allow you to take time out
and to stimulate and nurture yourself.

**Control** -- The hardy execs also had a realistic sense of control and
less rigid need to wield it. They understood the necessity of giving up
some turf positions and status posturing. Letting go of your cherished
territory often provides a new vantage point for strategically surveying
the emergent big picture.

**Change** -- The hardy individuals had a realistic attitude toward
change. For them, change was a natural part of life, not something to be
resisted. Even when facing unpleasant or unhappy changes, they quickly
grappled with their emotions. They grieved the loss of their familiar
world, and then prepared themselves for the new or unknown. With this
enlightened perspective, change was more a stepping-stone than a
stumbling block.

**Conditioning** -- Finally, the most hardy of the execs engaged in
regular aerobic exercise or physical conditioning. Why is it so
critical? As we've seen, not only does exercise help you stay fit,
manage your weight and improve your cardiovascular health, but it also
releases mood-lifting endorphins, a good antidote to mild feelings of
agitation and/or depression. Also, when everything's up in the air\--you
can't seem to close any projects or sales or meet elusive
deadlines\--structured exercise provides a self-defined beginning and
endpoint.

When you add natural SPEED to your routine and emulate the hardiest
executives, you will have established a work world and a lifestyle that
is balanced, has boundaries and also is bursting with energy. You have
an awareness and action plan that prevents stress smoke signals from
smoldering and erupting into that burnout fire. You will have truly
learned how to practice safe stress!

MARK GORKIN, LICSW, MCSHRM member, is a keynote speaker and
"Motivational Humorist" as well as a trainer and syndicated writer
specializing in stress, team building, anger management and working with
difficult people. The Stress Doc is the author of *Practice Safe Stress:
Healing and Laughing in the Face of Stress, Burnout & Depression* and
*The Four Faces of Anger: Transforming Anger, Rage and Conflict into
Behavior and Attitude that Inspire.* As America Online's
psycho-humorist, Gorkin runs the weekly Shrink Rap and Group Chat.
Contact him at <stressdoc@aol.com> or subscribe to his free,
award-winning monthly newsletter online at
[www.stressdoc.com](http://www.stressdoc.com/)

# **Stages of Grief**

**1. Shock and Denial or \"It Can't Happen Here!\"** It's no big
surprise when given a days notice that an employee may experience a
state of shock. There's such total confusion and disbelief that a person
often goes numb; the mind-body system has to shut down. Sometimes shock
follows the downplaying or denial of bad news. For example, in the early
'90s, there was talk of significant restructuring in the US Postal
Service. A number of employees took the early attitude: \"We're always
dealing with change here...No big deal.\" Alas, these folks didn't count
on Carvin Marvin Runyon becoming the Postmaster General. Talk about a
shocker\...Within a year 50,000 employees were restructured out of the
service!

**2. Fear, Panic and Shame or \"Oh God, What Do I Do Now?\"** Once the
shock wears off, you are no longer numb, there are some predictable next
steps, such as profound anxiety and vulnerability: how will I survive
this loss of income, identity, my daily routine, my social standing,
etc.? There's a mounting sense of being out of control, which for many
also evokes feelings of shame and inadequacy. And lack of control, not
surprisingly, can stir up childhood memories of the same, being or
feeling tormented, rejected or humiliated by family, peers, teachers,
etc.

I vividly recall the lamentation of a postal supervisor on a management
fast-track, quickly derailed by reorganization: \"I once had a career
path. Then this boulder fell from the sky and crushed it!" Is it only a
career path that's been crushed? How about the human psyche and spirit?
Has it too been burnt up or burned out?

**3. Rage and/or Helplessness or \"How Dare They!\" or \"Oh No, How
Could They!\"** Do you think our once fast-tracked supervisor is feeling
abandoned and betrayed? Most likely. Often people in this phase swing
between rage and profound sadness. Both states can be induced by deep
underlying vulnerability or helplessness. You've been wounded, feel
exposed and just want to lash out. Or you turn the rage inward in
depression and self-condemnation. Now it's crawling under the covers
escapism, or going through the motions of living or, even, straining as
hard as you can to reign victorious over your basic unworthiness; to
battle a fear of failure and lurking dread of being sucked into that
compelling black hole of helplessness.

Consider this: in *The Random House Dictionary: The Unabridged Edition*,
the first six definitions of the word \"failure\" describe it as an act
or an instance. It's not until the seventh and last definition that
\"failure\" takes a personal direction. So losing a job or being
confronted with other losses and separations are often more events or
individual episodes than a judgment upon you.

Also, please consider, that individuals predisposed to a depressive
mindset are likely to over attribute self-responsibility, that is, to
blame themselves for \"negative\" events. These folks minimize the
impact of external factors or environmental stressors. Which is why the
next phase, while often maddening, is also essential for moving through
the grief process.

**4. Guilt and Ambivalence or \"Damned If You Do or If You Don't!\"**
The feelings and old voices of guilt (not living up to an important
other's expectations or standards) and shame (violating or compromising
an internalized core value or essential part of your self-identity,
integrity and esteem) can become louder and more incessant Self-directed
rage keeps taunting you for shortcomings, unworthiness, lost dreams,
etc., and can ultimately drain you. If some energy returns or remains
the battle may continue in other arenas. First, the classic
approach-avoidance conflict: \"Damned if I do, damned if I don't; damned
if I stay, damned if I leave.\" Take the paltry severance or not; leave
the faulty marriage or not. And while the uncertainty is terribly
frustrating, at least there's a struggle.

Some may turn to a spiritual source for relief or rescue: \"Higher
Power, just tell me what to do\" or \"Higher Power, I turn it over to
you.\" And, of course, some in desperation will proclaim newfound or
\"born again\" allegiance if they are only saved. Yet, in the end, with
or without your HP, one must get focused and cut the entangling
emotional cord.

**5. Focused Anger and Letting Go or \"Turning a Lemon into Lemonade\"
and \"Freedom's Just Another Word...\"** This phase truly reveals the
complexity and potential creative energy built into the grief process.
To reach that powerful, purposeful and passionate state of focused anger
one must often blend rage and sadness. Some rage can propel us out of a
shocked, paralyzed or ambivalent state. Yet, you must also face your
sadness and loss and struggle with uncertainty to temper uncontrollable
aggression, to make sadder yet wiser assessments and decisions.
Remember, rage unchecked much more often leads to self-destructive
behavior than it does to \"Going Postal!\"

If you've worked hard to integrate the previous stages then the reward
is \"focused anger\": \"I really don't like what's happened...but how do
I make the best of it?\" You're ready to loosen -- if not untie -- the
knot of hurt and humiliation. And best of all, you're getting ready to
knock on (maybe even knock down) doors again.

**6. Exploration and New Identity or \"Now You're Ready to \'Just Do
It!'\" (even if scared).** Letting go is often unnerving. It's not just
the financial security that's at stake. But losing a job or a vital
relationship also profoundly shakes our personal/professional identity.
We've invested so much time, ego, energy and/or money in this position
or partner...Who am I without the job, without my mate or significant
other?

However, this vulnerable yet fluid state provides unprecedented
opportunities to get to know yourself, to assess your true individuality
-- strengths and warts -- and not only as it relates to financial
dependence, job skills or career paths. Now is the time for a full-scale
person-in-situation life inventory. How healthy or toxic are seemingly
vital relationships and friendships? What about your health? During this
transitional window, do dysfunctional coping patterns \-- habits of
drinking, smoking, drugging, eating, lack of exercise and limited
socializing or spiritual support \-- need to be challenged?

Even with the most dear and painful loss or separation, the words of
Albert Camus, Nobel Prize-winning author and philosopher have the
crystalline ring of essential truth:

*Once we have accepted the fact of loss we understand that the loved one
\[or loved position\] obstructed a whole corner of the possible, pure
now as a sky washed by rain.*

**7. Acceptance or \"The Glass is Half Empty and Half Full.\"** While
submerging yourself in the stages of grief for a time will feel hellish,
there truly is an opportunity for rebirth. Getting out of the black box
is a distinct possibility if you can ride on and ride out this acutely
emotional learning roller coaster. The grief encounter is definitely
more than a learning curve. And there's no absolute or fixed period of
time for your movement through the stages. My blood starts percolating
when I hear \"well-intentioned\" family members, colleagues or friends
say to the grieved, \"Hey, it's been three months (or even six months)
already. Don't you think you're stretching out this grief thing (or
unemployment status) a bit too much.\" The implication, of course, is
that you're indulging in self-pity. Or, sometimes the verbal sting comes
in a seemingly more innocuous message: \"Gee, someone with your skills,
talents, experience...I can't understand why it's taking you so long to
find a job.\"

The most important thing we can do after experiencing a major break --
whether break up or break down, social, physical or psychological -- is
to take time to heal. Now some after a loss of a job or a relationship
feel compelled to jump right back into the fray. And getting back in the
saddle is a cultural icon and wise strategy for a thrown cowboy or
cowgirl. However, for a major loss it's wise to retreat and regroup, at
least temporarily. For example, those folks who are participating in the
Fairfax County Government reeducation and training program are getting
career counseling and job search coaching, taking job training classes
(for many students, leading to computer skills certifications) as well
as the Stress Doc workshops. Perhaps most important, they realize they
are not alone. Also, folks are encouraged to grieve and to gradually
recover and discover: Who am I? What genuinely feels like me? What works
for me and my family? What seems to kindle (or rekindle) my passion?

So remember, there's a real difference between \"feeling sorry for
yourself\" and \"feeling your sorrow.\" When you are feeling sorry for
yourself you are mostly blaming others. When you are feeling your sorrow
you are demonstrating the courage to face your fears and pain. There are
poignant moments in life when we all must take time to embrace our
sorrow.

As I once penned, reflecting on more than one soul shaking grief
process:

*Whether the loss is a key person, a desired position or a powerful
illusion each deserves the respect of a mourning. The pit in the
stomach, the clenched fists and quivering jaw, the anguished sobs prove
catalytic in time. In mystical fashion, like spring upon winter, the
seeds of dissolution bear fruitful renewal.*

And a final encouraging passage:\
\
*Remember, errors of judgment or design rarely consigns one to
incompetence; they more likely reveal inexperience or immaturity,
perhaps even boldness.  Our so-called failures can be channeled as
guiding streams (sometimes raging rivers) of opportunity and experience
that ultimately enrich -- widen and deepen -- the risk-taking passage. 
If we can just immerse ourselves in these unpredictable yet, ultimately,
regenerative waters.\
*\
Surely words to gain a "whole corner of the possible" and also
to...*Practice Safe Stress!*

**Mark Gorkin, LICSW, "The Stress Doc" ™,** a psychotherapist, an
international/Celebrity Cruise Lines speaker, and training/OD consultant
for a myriad of corporations and government agencies. Recently
interviewed by the BBC, the Doc is a syndicated writer and the author of
*Practice Safe Stress: Healing and Laughing in the Face of Stress,
Burnout & Depression*. In 2003, Mark received the inaugural National
Association of Social Workers-Metro-DC Chapter's Social Work
Entrepreneur Award. See his award winning, *USA Today Online* "HotSite"
\-- **www.stressdoc.com** (recently cited as a workplace resource by
National Public Radio (NPR). Email <stressdoc@aol.com> for his monthly
newsletter showcased on List-a-Day.com.

\-\-\-\-\-\-\-\-\-\-\-\-\-\--

The Stress Doc\'s \"Six Strategic \'F\'s for Mastering Loss and
Change\":

1\) [Familiar]{.underline}. Grapple with the anxiety, rage, hopelessness
or sadness in letting go of the familiar or predictable past. Remember,
sometimes your former niche of success now mostly has you stuck in the
ditch of excess. There\'s a critical crossroad ahead,

2\) [Future]{.underline}. Clearly the horizon appears cloudy and
threatening, lacking direction and clarity. Just because your past or
traditional roles and responsibilities may be receding doesn\'t mean you
can\'t transfer your experience and skills into new challenging arenas,

3\) [Face]{.underline}. Some loss of self-esteem and self-worth is all
too common, especially when our life puzzle has been broken up other
than by one\'s own hand. Shame, humiliation, guilt, diminished
confidence are frequent early traveling partners on a profound
transitional journey,

4\) [Focus]{.underline}. If you can honestly grapple and grieve the
first three \"F\"s, then you are engaged in a productive brooding, if
not magical incubation, process. At minimum, you will affirm, \"I may
not like the cards that have been dealt, but how do I make the best of
my reality right now.\" And you\'ll likely start hatching a new
perspective with, if not crystal clear targets, then an intuitive,
crystal ball enlightenment. Suddenly this Stress Doc mantra starts
resonating: \"I don\'t know where I\'m going\...I just think I know how
to get there!,\"

5\) [Feedback]{.underline}. Now you can share new insights or plans with
others. Getting input will help sort out the wheat from the chaff. Or,
some TLC (what I call, \"tender loving criticism\" and \"tough loving
care\") may challenge you to expand or simplify the complexity of the
problem engaged. In times of rapid or daunting change, trustworthy
feedback helps us remember who we are; that our basic, core self remains
intact despite being shaken by unsettling forces.

6\) [Faith]{.underline}. Having the courage to grapple with these \"F\"s
now yields a strength to understand what in your present life rests in
your control and what lies beyond. Some will call on a transcendent
source of faith: a higher power, whether a religious or spiritual force
or the group synergy of a team, family or some communal entity. (For
example, 12-step groups provide both sources \-- turning over one\'s
helplessness to God and, one day at a time, being supported in new
beliefs and behaviors by the higher power of collective consciousness
and group sharing.)

Disarming Power Struggles: Case Example II

Now for the second exercise. As a supervisor, imagine you are caught in
a power struggle with a problematic individual, let's say an employee.
For this mind game the specific issue is not critical. Let's say the
general content involves issues of control, status or who has (or
doesn't have) the right or power to make a decision. Let's call the
employee Person A and the supervisor Person B. In this exercise, the
battle begins with the employee declaring, "You can't make!" and the
supervisor countering, "Oh yes I can!" My workshop instructions
specifically caution antagonists about getting out of their chairs. But
the players can be as aggressive or as whiny as they wish. After a
couple of verbal volleys, the participants are encouraged to say what
they would really like to say to their antagonist.

Not surprisingly, at some point during this exchange, for many folks
there is an eruption of laughter. Perhaps it's the somewhat artificial
and absurd nature of the interaction. (Also, some people cover up
intense emotions, such as raw aggression, through nervous laughter.)
However, for me, the number of people who get hooked by the battle, who
"want to win" seems significant. Why are people so quick to get caught
up in a power struggle? I've come up with "The Five "C"s of Power
Struggles:

1\. Control. Who will be in control? I believe this is connected to
authority issues and, ultimately, the parent-child dynamic.

2\. Competition. This also has family roots -- sibling rivalry issues.
Who is better? Who is the favorite?

3\. Change. During periods of transition, there's much uncertainty. Who
is in charge? Do the rules and operational procedure still apply? Some
people will try to fill the void, appropriately or inappropriately.
Change often stirs uncertainty and anxiety and that may push some to
become overly rigid, manipulating or controlling.

4\. Cultural Diversity. Surely the variety of socio-cultural and
demographic dynamics shape how we give meaning to experience, including
meaning to the motivations, beliefs and behaviors of self and of others.
Personal maturity is often required if difference and disagreement are
not reflexively equated with disapproval and disloyalty.

5\. Communication Skills. Finally, effectively negotiating the
aforementioned "C"s -- Control, Competition and Cultural diversity --
especially in the context of an actual or potential emotionally charged
power struggle requires a communicator who can be both assertive and
empathic; a communicator who can both affirm limits and respect
boundaries.

Key Communication Principles

Now let me provide four communication tips and tools for preventing a
conflict or misunderstanding from turning into a full-fledged struggle
or an ongoing battle:

1\. Drop the Rope. How do you not take the bait when someone is
provocatively fishing for an argument or power struggle? The challenge
becomes not instinctively pulling back when someone offers you a rope
and then "yanks your chain." You don't have to prove you can give (or
be) as big a jerk. In fact, you can just "drop the rope." This is not a
sign of weakness. Your message is, "I don't want to play this
self-defeating or dysfunctional game. Can we come up with a more
productive way to address the grievance or solve the problem?"

2\. Use the "Four 'P' Process of Empathic Engagement." One or both
parties in a power struggle are usually angry or anxious about
something. Your antagonist may be upset about your actions (as a
supervisor) or about a common problematic situation. For example, in an
employee's mind, are you playing favorites in the department? In order
to quickly connect to a belligerent or injured party (after setting
limits on any harassing behavior, of course) attempt to engage the other
person around his "Pain" and "Passion" or her "Purpose" and sense of
"Power" (or feelings of powerlessness or helplessness). These "P"s are
definitely a pathway to empathy and possibly more peaceful coexistence.

3\. Reduce the Status or Power Differential. As a manager (or parent of
a teenager) unless absolutely necessary, don't lead with your authority
trump card. As much as possible, try to level the playing field; strive
for adult-to-adult communication. (Somehow this issue of use of status
and power reminds me of a politically incorrect, somewhat
tongue-in-cheek observation by a bank vice-president regarding his
biggest source of stress: "I can't beat my employees and I can't fire my
children.")

Actually, if used consistently this step will likely free the other
person to be more forthright in their communication. And if you are
fortunate, your antagonist will even provide critical feedback. Why do I
say fortunate? In the long run, I believe nothing builds trust more than
when a person expresses clean and clear anger and finds the recipient
doesn't fall apart, run away or abandon them, doesn't viciously blast
back or seek revenge. You may not agree with the other person's argument
but you have demonstrated acknowledgement and respect.

4\. Avoid Black or White Thinking. An argument that must result in one
person being 'right" the other party "wrong" clearly tightens the
tension in the tug or words if not war. Dividing antagonists into
"winners" and "losers" doesn't foster lasting conciliation and working
partners. Oftentimes, a sign of real strength is the capacity for some
comfort with uncertainty or even being tentative in the heat of battle:
"I'm not sure about that" or "Right now, I don't agree. Still, you make
a good point. Let me think more about this." (We've already discussed
the strategic value of taking a time out.")

Again, allowing for uncertainty or delayed decision-making creates
subjective space for opinions and strategic options. You are inviting
the other to be a genuine problem-solving participant. Setting aside
"black or white" thinking encourages power sharing over power struggle.
Both managers and employees can generate an array of leading and
colorful ideas.

Disarming Words of Wisdom

With the "Four 'C's" (of power struggles) and the above communication
principles in mind, as a manager what might you say to a provocative
employee who declares (or in so many words avers), "You can't make me"?
Consider this response: "I don't know if I can make you or I can't make
you. That's not where I'm coming from. \[Resisting the provocative bait.
Not quickly playing the authority trump card; you are tentative without
giving up your power potential.\] If we have a problem -- if I'm bugging
you or our situation is problematic -- I'd like to hear about it.
\[Inviting criticism often elicits real feedback and can help build
trust.\] I need your contribution to meet our goals. I believe I'm in a
position to support you. For us to succeed we have to be pulling
together not pulling apart. \[Affirming the process -- from dropping the
rope to forging a partnership in power and performing.\]

Closing Summary

Two mind game exercises have been delineated. The first exercise,
interaction with a critical aggressor, highlighted defensive reactions
to a verbal barrage:

1\) feeling rejected, surprised or exposed

2\) feeling attacked and becoming aggressive

3\) feeling fearful or humiliated and withdrawing.

Positive strategic interventions were also outlined:

1\) differentiating reaction and response

2\) metacommunication

3\) using assertive "I" messages

4\) taking a time out.

The disarming power struggle exercise noted the "Four 'C's that spur on
self-defeating or ego-driven battles -- Control, Competition, cultural
diversity and Communication Skills.

Next, four communicational tips and tools for disarming dysfunctional
power games were detailed:

1\) "drop the rope"

2\) use the "Four 'P's" for engagement

3\) reduce the status or power differential

4\) avoid 'black or white' thinking.

And finally, a power sharing to power struggle response in the face of
employee provocation is provided. Surely these are all concepts and
tools to disarm aggressors and power struggles, to forge more productive
working relationships, and to help us all...*Practice Safe Stress!*

**Does Your Organization Practice Safe Stress?**

# Seven Intervention Strategies

## By Mark Gorkin

# "The Stress Doc" ™

Budget cuts, reduction in resources and reimbursements, "24/7" anytime,
anywher work environment, relentless competition for clients, loss of
key personnel\...managed scare tactics. Today, an increasing number of
professionals must \"do more with less.\" Can anyone say
\"frightsizing\" and \"lean-and-MEAN\"? Take heart. Have no fear (well,
maybe a little)\...the Stress Doc is here with his **Seven Highly
Effective Organizational/Professional Strategies for Practicing Safe
Stress**.

**1. Engage in Group Grieving.** I\'m going to assume almost everyone
these days is occasionally flirting with burnout; too many, I fear,
still engage in casual stress. While I\'ll close the article with
individual stress management strategies, let\'s start with a systems
intervention for helping the community of employees grapple with the
above-mentioned stressors and losses. And it\'s not just loss of funds,
friends, philosophies and familiar procedures. Cynicism and despondency
can build when we feel the organization, the profession, the larger
industry and society devalue our services and a once cherished mission.
Workshops that allow departments, if not the entire organization, to
gather and grieve, that enable folks to see the tragedy and comedy in an
absurd world, that encourage the working through of sadness and
vulnerability, while focusing justified anger and helping staff regain a
sense of purpose, play and control\...rebuild the commitment fires and
creative juices.

**2. Insure Your Pros with \"The Triple A.\"** The basic formula for
runaway job stress is simple: a work situation having high demand and/or
high professional responsibility paired with little authority or low
control over work process and outcome. It\'s not just a heavy workload
that\'s the culprit. People can thrive on reasonably high volume if they
have some impact on timing, scheduling and flow. But, for example, when
corporate headquarters or the main offices are making global, top down
decisions that are fairly out of touch with local needs and operational
realities the consequences are often demoralizing.

In these volatile times, here are two philosophical and policy pillars
for supporting employee integrity:

a\) [Encourage and Integrate The Triple \'A\' of
Professional/Organizational Responsibility: Authority, Autonomy and
Accountability]{.underline}. Remember, management must let professionals
exercise reasonable independence and individuality in thought and
practice. Professionals must understand that accountability to clients
and professional management, i.e., effective and ethical management,
supports autonomy and credibility. Also, the accountability process
legitimizes the need for and strengthens the quality of service
delivery.

b\) [Question the notion of customer as king]{.underline}. During my
years as a stress consultant to the US Postal Service, customer service
was top priority. However, the USPS realized that resentment and
depletion build when an operation is customer-driven and employee
negligent. To challenge an organizational ambience where \"client is
king\" and staff are withered and weary peasants, consider my Basic Law
of Safe Stress: \"Do know your limits and don\'t limit your \'no\'s!\"
Clearly, I\'m not saying slam the door shut on your manager or client
population. I do mean practicing \"N & N\" \-- the ability to say \"no\"
and to \"negotiate,\" for example, the number of clients or projects for
which you have responsibility.

Closed door time is also vital for paper work, individual reflection and
collegial bantering and nurturing. And speaking of nurturing, some
private time and space allows for my favorite - brief, restorative power
napping; highly preferable to caffeine overloading.

And if with Type A arrogance, you dismiss that Stress Doc aphorism, "A
time for waste is not a waste of time"...then know what lurks ahead:
MSDS -- the Multiple & Simultaneous Demand Situation. MSDS develops when
you are responsible for: 1) an excessive number of people and projects,
2) when you must keep up with an ever expanding base of data, policies
and procedures and 3) when you feel like a slave to deadlines and tied
up by thieves of time. If you are not careful this M & S Demand
situation can morph into an S & M nightmare -- you become a "Slave" to
too many "Masters!" And you can become entrapped whether on top or on
the bottom, whether dominate or subordinate in a dysfunctional
hierarchy.

**3. Make Task and Process Meet.** \"Not another meeting.\" \"Who has
time for meetings?!\" These can become familiar, plaintive cries in a
downsized, pressure-packed setting. Drastically reducing organizational,
departmental or team meetings is only a formula for isolation and
confusion; making community time meaningful is the key.

Many organizations under a time and resource crunch become increasingly
task-driven. After the proverbial status report, meetings are run
somewhat like the opening to \"Mission Impossible\": hierarchical
assignments are detailed and delegated, though folks usually aren\'t
asked if they choose to accept. Kidding aside, often lacking is some
balance between a task focus and a relationship-group process one. At
some point, the meeting needs to connect with how well people are
working together, how coordinated the communication, how is stress and
conflict being managed, within the team and among various
departments\...Is the atmosphere one of \"esprit de corps\" or esprit de
corpse? Three suggestions:

a\) [Establish a Wavelength Segment]{.underline}**.** In an hour or
ninety-minute meeting, set aside fifteen or twenty minutes for
processing, usually at the end of the session. Individuals and the team
as a whole can check in and tune in with each other.

b\) [Rotate Leadership]{.underline}**.** A common mistake is always
having a supervisor or manager run the show. Rotating the facilitator
can enhance group involvement and commitment, reduce hierarchical
decision-making and strengthen team concept and team morale. Also, this
procedural shift gives supervisors an opportunity to be a real member of
the group, providing an observational vantage point for better grasping
group dynamics. The biggest challenge, as always, involves control and
competition issues: whether the supervisor and the staff can be
comfortable with his or her (i.e., the supervisor) wearing two hats --
being both formal authority in a primary role and peer in the team
meeting?

c\) [Try a Morning Quickie]{.underline}**.** Sometimes an alternative to
a formal meeting can be a ten minute huddle at the beginning of the day.
How about warming up the team by sharing a joke or funny story, with a
prize for the best joke of the month. A quick gathering makes it easy
for giving the troops a heads up and for affirming that all are on the
same day game page.

**4. Envision Mission and Goals.** With the above policies, structures
and procedures in place, hopefully, your organization is no longer a
candidate for becoming the land-based version of the Titanic. Agency and
staff will not be sinking and disappearing. Perhaps proactive leadership
and creative consensus can replace management by crisis. This is
especially critical after a major restructuring or downsizing. Set aside
some team building/staff training time. If you haven\'t already done so,
consider bringing in a \"Team Visioning and Goal Setting\" consultant.
For a mission statement to be viable and for action plans that realize
goals and objectives there needs to both short term and long range
planning and buy in from staff.

Of course, the danger of a big picture retreat is that people and
perspective can get swept away by ideals and rhetoric. Remember,
there\'s often a fine line between vision and hallucination. To preserve
that boundary, integrate past, present and future with my \"Four \'F\'
Model of Loss and Change\": 1) examine honestly and openly the strengths
and vulnerabilities of the [familiar]{.underline} past, 2) collectively
grieve any loss of [face]{.underline} or organizational identity and
pride, 3) recommit to a collaborative method of conflict resolution to
nurture a diverse, participatory team [focus]{.underline}, and 4)
explore new problem-solving options and opportunities for a pregnant and
expansive [future]{.underline}. (Hey, what kind of imagery do you expect
in an article on \"Safe Stress?\")

**5. Manage Stress Carriers.** Now for a delicate matter. Some folks,
even after partaking in these potentially rejuvenating steps, will not
be able to rebuild the fire; there\'s no renewing a genuine sense of
individual and/or organizational purpose and commitment. At least not on
their own. A percentage may respond to individual supervision and
coaching. Others may benefit from Employee Assistance Program (EAP)
counseling or, hopefully, will seek out private psychotherapy. However,
there may be a few individuals just not able to function in the still
demanding day-to-day environment. I can\'t emphasize this enough: when
management does not set appropriate limits and boundaries on such
professional \"stress carriers,\" team morale and productivity are
contaminated and compromised.

Sometimes employees have to intervene with a supervisor or management
before decision-makers realize they are ignoring or covering up for an
impaired colleague (who also may be a personal friend or, even, a high
producer). Clearly, fair, effective (\"do the right thing\') and
efficient (\"do the thing right\") grievance procedures must be in
place. Engaging this troubled individual is essential for his or her
sake as well as for others. Remember, stress carriers (including
managers in denial) may not get ulcers but they certainly can give them!

**6. Fireproof Life with IRAs and PUNCH.** Despite, or because of, the
future shock pace of change, some professionals will have \"been there,
done that\" one too many times. (Organizational crisis often surfaces
chronic individual frustrations.) Maybe it\'s the 300th couple
counseling session or \"not another sexual abuser.\" These folks may be
experiencing what I call \'The Bjorn Bored Syndrome (BBS),\" named for
the late \'70s-early \'80s tennis great, Bjorn Borg. Borg, after a five
year reign, dramatically burned out on the circuit. BBS has a simply
elegant formula: when *[mastery]{.underline}* times
*[monotony]{.underline}* provides an index of ***MISERY!*** The answer:
Fireproof your life with variety. And for management and staff I offer
two stimulating acronyms:

a\) [Organizational IRAs]{.underline}**.** Provide \"Incentives, Rewards
and Advancement Opportunities\" for employees. Merit bonuses, new
training and conference attendance keep the mind, heart and soul supple
and dynamic. I experienced LMR - Lateral Movement Revival - from doing
EAP Orientation training and short-term counseling when the New Orleans
Family Services Society started an EAP venture with a federal government
agency. The move also laid the groundwork for a future
training/consulting career path.

b\) [Entrepreneurial PUNCH]{.underline}**.** More than ever,
organizations must develop new clients and resources. Professionals need
to springboard from the office into the larger real and virtual
community to market products and services. The entrepreneurial spirit is
calling. I\'ve detailed how to embrace it. (See \"Adding Entrepreneurial
PUNCH to Your Career Path: Surviving the Managed Care Scare,\"
*Treatment Today*, Fall 1996 or email for my essay, "On Becoming an
Internet Entrepreneur.") Here\'s a quick outline of skills and
strategies for entrepreneurial evolution and rejuvenation, whether a
professional chooses to stay with the organization or to move on:

**P. Public Presentation.** Public speaking and workshop leading are
both powerful marketing vehicles and challenging, exhilarating and
growth producing opportunities. So too meeting a wide variety of
consumers and colleagues.

**U. User-Friendly.** Avoiding psychobabble and communicating ideas and
concepts with an expanded audience - face-to-face or through writing and
the electronic media - in a lively and tangible, meaningful and
memorable style is critical. For example, are you ready to help folks
\"Practice Safe Stress\" or confront \"The Intimate FOE: Fear of
Exposure?\"

**N. Networking.** Make connections with a variety of consumer/client
groups and professional associations, not just those in your immediate
professional circle. It was hobnobbing with graphic artists that
eventually challenged this computer virgin to integrate hi tech with hi
touch. Recently, in addition to social workers, two dentists and a
marketer attended my public speaking/program marketing seminar. Two
years ago, hobnobbing with self-employed business folks opened the door
to the wonders of space travel.

**C. Cyberspace and (Mass) Communications.** Hopefully, you have already
launched into cyberspace travel and are pioneering new prospects around
the World Wide Web. If not, there are fertile opportunities for
generating unprecedented visibility -- sharing ideas on web sites and in
chat rooms, getting customer feedback, building relationships and
marketing alliances and transacting business. Go web young cyber-ite!

**H. Humor.** You don\'t have to be a standup comic, just appreciate the
absurdity in the world and laugh at and share your own imperfect
humanness. Remember, people are more willing, even eager, to open and
receive a serious message when it\'s gift-wrapped with humor. Every
mental health organization needs at least one in-house
\"psychohumorist\" (tm).

**7. Develop Psychological Hardiness.** While this article has
especially focused on team strategies, a vital group and community
requires healthy and hardy individuals. Here are some final stress
management strategies based on a study with AT&T executives. During the
break up of Ma Bell in the \'80s, researchers discovered four factors
that distinguished execs susceptible to physical and emotional illness
from those who demonstrated \"psychological hardiness.\" To survive and
thrive in a turbulent transition, build in these **\"Four \'C\'s of
Masterful Coping\"**:

**a. Commitment.** While invested in the company\'s reorganization, the
hardy execs didn\'t just have a work life. They had a life\...and were
nurtured by family, friends, religious practice, recreation and hobbies.

**b. Control.** Hardy execs had a realistic and less rigid sense of
control; they avoided self-defeating turf battles. A swollen ego did not
hinder their stepping back and reassessing the changing landscape.

**c. Change.** Quickly dealing with feelings of loss, while not
harboring false hopes and illusions about the future enabled these
individuals to explore new options. Hardy players viewed change as a
stepping stone not a stumbling block.

**d. Conditioning.** Finally, the hardiest execs engaged in regular
physical exercise. Thirty minutes of aerobic exercise - walking,
jogging, swimming, bike riding, etc. - releases the body\'s natural pain
killers and mood enhancers. Equally important, in times of stressful
transition, exercise grounds us when everything else seems up in the
air; there\'s a beginning and end point, providing a tangible sense of
accomplishment and control.

In closing, in these tumultuous times organizations must help rebuild
individual energy. Management and professionals must together cultivate
conflict managing and harmonizing team structures along with healthy
boundaries both within and with the outer environment. Organizations
also need to encourage career and skill evolution and responsibility for
professional productivity and personal integrity. It takes a systems
approach and individual hard work to forge that elusive balance: giving
to your organization, colleagues and clients as well as getting from
others and giving to yourself. But when you create that balance, you
definitely have begun to\...*Practice Safe Stress!*

**Mark Gorkin, LICSW, "The Stress Doc" ™,** a psychotherapist, an
international/Celebrity Cruise Lines speaker, and training/OD consultant
for a myriad of corporations and government agencies. Recently
interviewed by the BBC, the Doc is a syndicated writer and the author of
*Practice Safe Stress: Healing and Laughing in the Face of Stress,
Burnout & Depression*. In 2003, Mark received the inaugural National
Association of Social Workers-Metro-DC Chapter's Social Work
Entrepreneur Award. See his award winning, *USA Today Online* "HotSite"
\-- **www.stressdoc.com** (recently cited as a workplace resource by
National Public Radio (NPR). Email <stressdoc@aol.com> for his monthly
newsletter showcased on List-a-Day.com.