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The Stress Doc Letter
Cybernotes from the Online Psychohumorist (tm)

NOV 2000, No. 1, Sect. 2

Main Article

"How to" Manual for Leading a Practice Safe Stress Workshop

Before the traditional holiday repast, I dropped by a potluck Thanksgiving dinner with a decidely non-traditional flair. When asked if I had sampled the vegan turkey, I shyly confessed having passed up this culinary opportunity. Actually, I mentioned that if I was going to be a deviant holiday consumer, my predilection was for the opposite end of the spectrum. Years back, living in N’Awlins (only in "The Big Easy") I partook in devouring a 24-pound turkey…deep-fried in a huge crawfish boil vat. So tender on the inside yet crunchy and optimally greasy on the outside. Yummmmm!! Yes, I know what it means to miss New Orleans.

Before we started eating, a number of folks gave thanks for various blessings and opportunities. As the sentiments were so humanistic and heart-felt, I decided to pass. Alas, with this vegan crowd, being grateful for technological innovations -- the Internet and SSRI inhibitors (i.e., originally Prozac, now Effexor) -- somehow didn’t fit.

Actually, I am grateful that a self-generated aphorism based on a seemingly endless pursuit to grasp an elusive vision indeed contains some self-fulfilling prophecy, if not wisdom: "I don't know where I'm going...I just think I know how to get there!"

Getting There and Giving Back

So as the calendar rapidly spirals toward 2001, it seems as if years of persistence despite self-doubt are being rewarded; perhaps it’s that 20-year overnight success phenomenon. I suppose the most dramatic illustration is the 4-page profile and picture spread in the December 2000 Biography Magazine , wonderfully crafted by Health Editor, Laura Muha. The pics are from the talented eye-lens of Brian Pierce. (You have to check out the totally outrageous photo on page 101. The photos spontaneous and staged, were taken during and after a Practice Safe Stress program with Arts& Entertainment/Biography Magazine staff.)

Which brings me to the giving place: A number of folks have sent "how to" inquiries: how to add humor to a speaking or workshop presentation?; are there interactive stress exercises for fourth to sixth graders? (or for adults?); how does one become a "psychohumorist"? (Email me for the essay, “On Becoming An Organizational Psychohumorist.”)

So one way I can give back to many of you is by generating a, "How to" Manual for Developing and Delivering a Practice Safe Stress Workshop. Toward this end, installments will be presented on the basic sections of my 1-1 hour speaking or workshop program. This exciting program is a blend of dynamic lecture and thought-provoking and fun-filled exercises. Here is the first segment:

A. Introduction to Stress and Burnout 

1. Opening Strategy, Sharing and Stories 
2. Three "B" Stress Barometer Exercise 
3. Four Stages of Burnout 
4. Shrink Rap

1. Opening Strategy, Sharing and Stories. 

At the beginning of a speaking or workshop program, I take a four-pronged approach: a) briefly share background information gleaned through personal interviews or phone conversations along with company literature with the audience; the group knows I’ve done some homework regarding the industry and their specific organizational stress issues, b) provide a broad and brief outline (definitely not detailed in the opening remarks; the handout packet has more specifics) of the basic topical segments to be covered; the ebb and flow between solid information and group interaction is definitely emphasized, c) reveal some personal anecdote with self-effacing humor; for example, I orient myself vocally and geographically: "I was raised in New York City. Then left for New Orleans to work on a doctorate at Tulane University. Alas, during my creative exile I got involved in a wildly creative dissertation topic that was off the academic wall. (I wasn’t going to let those conservative academics stifle this youthful budding talent.) Well despite being hard-headed (maybe because of it) I could only bang my head against the wall for so long. I eventually knocked myself out of the doctoral program. I now look back on those 'Marching to a different drummer' daze and refer to them as, 'When academic flashdancing whirled to a burnout tango.' But there is a big silver lining to my American in Cajun Paris Years experience: I turned an academic lemon into lemonade and became an expert on stress and burnout," and d) relate a professional story that captures your audience’s attention by illustrating the propensity for human frustration and foible in a stress-filled, lean-and-MEAN world:

Let me share a stress survival workshop for VA Hospital Head Nurses. These women were feeling stretched to the limit by demanding doctors, impatient patients and visitors, personnel shortages and staff morale issues, insufficient supplies, difficulty communicating with administration, etc. The tension in the room both crackled and hung heavy like an impending storm or siege. Then each nurse thunderously barked her name and work station: "Johnson, W-14," "Thomas, W-16," "Sanders W-20," etc. I reflexively responded: "It sounds like you're reporting from your battle stations." The nurses' spontaneous and labored sighs told me I was psychologically on target.

While these vets may have been weary, they were not beaten down. This dedicated nursing group knew how to circle their medicine carts against the aforementioned "stress carriers," or, at least, to defuse momentarily their "combat fatigue" with some "M*A*S*H" humor. The nurses' favorite supervisory battle cry: "Do your eight and hit the gate; nine to five and stay alive." Hey, she who laughs last...lasts! (Of course, these battle slogans are tip offs that the burnout may be reaching departmental, if not institutional, levels.)

2. Three "B" Stress Barometer Exercise. 

After this opening, I quickly move into a warm-up exercise that helps the audience focus on the main topic. Initially, people cluster in groups of five-seven. Then I introduce my "Three ‘B’ Stress Barometer Exercise": "How do you know when you are under more STRESS (growling the term) than usual? How does your 'Brain, Body and Behavior' let you know when you are under more stress than normal?" Through 3-4 minute group discussion, each person has the opportunity to share individual signs of stress. A recorder selected by the group pulls together the group’s Three B list.

After this brief discussion, I ask for "a bold group" to share their stress symptoms list with the entire audience. Playful banter triggered by the items shared by the recorder-reporter ensues. Here are three illustrative exchanges: a) Sleeping Problems. When groups mention not getting too much or too little sleep, I acknowledge this as one of the stress symptoms that can go both ways: "Aren’t there some days when you don’t want to get out from under the covers for nothing? Conversely, aren’t their some folks who know all the best buys in the QVC home shopping channel at 3 in the morning?" (Or, maybeyou are placing bids on e-Bay at all hours of the night?) b) Eating Patterns. Here’s another two-way smoke signal: I ask, "Be honest, don’t many of us at times eat those comfort foods to numb stress and anxiety? Yet, are there any folks who lose their appetite and eat less when stressed?" Upon the fluttering of a few hands, I immediately cry out, "And we just hate these folks, don’t we?" (Not surprisingly, most of the audience laughs their approval). c) Bodily/Muscle Tension. Many people relate to tightened neck muscles, lower back pain, a knotted stomach. One response I eagerly pounce upon (or bring up) is jaw tension or TMJ – "Too Many Jerks!"

3. The Four Stages of Burnout. 

To transition from the "Three B" Exercise to the Four Stages, I ask the audience: "Am I the onlyone who periodically flirts with burnout?" Upon seeing a number of nodding heads, if not hearing distinct "Amens," I propose the following: "For those of you are way beyond a flirting relationship, let’s see if we can initiate some burnout divorce proceedings." I direct participants to the relevant page in the workshop handout packet and for ten minutes or so mostly lecture on the burnout phases or "The Erosive Spiral.” (Interspersed is brief, diverting interaction; for example, I guide the audience through a heavy and labored group sigh which breaks up some of "Oh, no, he’s talking about me" tension.)

The Four Stages of Burnout

Years ago, a magicaI moment whirled me in a mystical web. I was consumed by the path of "academic flashdancing." I succumbed to the "burnout tango." Now let me not just walk the talk, but deromance the dance: "Burnout is the gradual process by which a person, in response to prolonged stress and physical, mental and emotional strain detaches from work and other meaningful relationships. The result is lowered productivity, cynicism, confusion...a feeling of being drained, having nothing more to give." Whether at work or school (or even in a marriage), to prevent it you must get it. To provide a framework both for understanding and, hopefully, inoculating against future burnout, let's begin with "The Stress Doc's Vital Lesson of the Four 'R's":

If no matter what you say or what you do, Results,Rewards, Recognition and Relief are not forthcoming, and you can't mean "no" or won't let go...trouble awaits. The groundwork is being laid for apathy, callousness and despair.

Have I captured your attention? Let's examine some of the progressive signs of being caught up in this erosive spiral. Here are "The Four Stages of Burnout":

1) Physical, Mental and Emotional Exhaustion. Maybe you are still holding it together at work (or school). Still, can you relate to this sequence? As soon as you get home, you head for the fridge, get out the Haagen-Dazs or Ben and Jerry's, turn on the tube, collapse on the sofa and you're comatose for the rest of the evening? Doing more with less, having plenty of responsibility but not enough authority, or juggling an unmanageable schedule is taking a toll. (For those grappling with all three stressors...automatically proceed to stage two, if not three.)

Normally, you pride yourself on doing a thorough job, a high quality performance. Now you are looking for shortcuts, if not cutting corners. And this gnaws at your self-esteem. There may even be pangs of guilt. A case of the "brain strain" is developing, accompanied by an energy shortage and feelings of exhaustion. If stress levels continue unabated, you may be ripe for the second stage.

2) Shame and Doubt. Perhaps this scenario is familiar. A supervisor (or professor) asks you to take on a new assignment. You want to...but this voice inside silently screams, "Who are you kidding!" So what's happening? You're not feeling confident about the future; and you're feeling pretty lousy in the present. Not surprisingly, you may even start discounting your past accomplishments. Beware...This is not a logical process; it's a psychological one. Now you wonder if colleagues, friends or family members will detect that something is wrong. While projecting a competent image has been the norm, now this voice inside is relentlessly shouting, "Impostor! "Impostor!"

And then you catch yourself emitting heavy, labored sighs. (When do people often engage in deep, labored breathing or sighing? Other than when calling those 1-900 numbers. Actually, when experiencing a deep sense of loss and change perceived as uncontrollable. Next time you go to a funeral, notice the breathing patterns of the folks most poignantly dealing with the loss.) Is chronically grappling with a profound sense of vulnerability or uncertainty anyone's favorite state? Certainly not mine. No surprise then that some folks will "progress" to the third phase: "Cynicism and Callousness."

Are you starting to feel I've been looking in your window? Or, as a reader recently emailed: "Have you been a fly on the wall in my house?" Let's not be premature. We still have two more stages to go. And next, we'll check out your "tude."

3) Cynicism and Callousness. In response to that prolonged feeling of insecurity or vulnerability, some folks feel there's only one thing left to do: put on the heavy armor. They develop an ATTITUDE: "Look out for # 1." "Cover your derriere." "No one's getting to me." And, in the short run, the strategy often works. You become sufficiently abrasive or obnoxious, people start avoiding you. But this hard exterior can eventually become a burdensome, self-defeating strategy.

Here's an example. Years ago, I was leading a workshop at a construction industry conference. There was a guy, I'll call him Joe, who was head of a large plumber's union. Now Joe was basically a down to earth, nice guy...who found himself becoming increasingly bitter, with that hard attitude. And it was scaring him! Now granted, Joe was in a position that pulled him in all directions - compelling demands, favors, complaints, bribes! Still, what do you think was Joe's biggest stress trap? That's right, this "good Joe" was such a "nice guy." What can't nice guys and nice gals do? They can't say "No!" Nor are they confident in setting limits or establishing their boundaries. They have difficulty with authority -- being one or interacting with one. These nice folks tend to avoid conflict; they don't want to hurt others' feelings. They are not comfortable with anger, or don't know how to express their frustration or displeasure in a focused manner. Their personal mantras are being "fair" and "accommodation" (while feeling deep rejection when other's aren't fair or accommodating).

These accommodators, despite having a full workload plate, when asked to take on new work will just smush their peas and bread into the mashed potatoes and allow others to pile on more stuff. Hey, being a team player doesn't mean you have to sacrifice your integrity or health. There's an option: "Sure I'll help you with this new demand and deadline. But for me to give the assignment the attention it deserves, we'll have to renegotiate my priority list and timelines." (I'm not saying there aren't extra-ordinary and emergency situations. But there is a difference between urgent and important. When everything is urgent, nothing is important!) Setting realistic limits is not a negative reflection on your work ethic or your ability to to go the extra mile. Without boundaries, that mile often morphs into a marathon. If you are going to be able to be productive for the long run, high yet realistic expectations, boundaries and pacing are critical. Remember, someone once said: "Burnout is less a sign of failure and more that you gave yourself away."

Joe was really worried. He thought he was going through a split personality process -- going from Dr. Jekyl into Hiding. I had to reassure him that there wasn't any genetic transformation occurring. Without realizing it, he had been sucked up by the progressive burnout whirlpool.

And there's another reason for paying attention to this process. Burnout doesn't just facilitate a hardening of the psyche. When your stress starts to smolder into frustration and anger; then turns to suspicion and mistrust as you enclose yourself in embattled armor or a crusty shell...This is not just how you harden an attitude, but it's a formula for a hardening of the arteries, as well. Cardiovascular complications, high blood pressure, even premature heart attacks or brain attacks (i.e., strokes) can occur. Which is why, usually, I'd rather people hit the fourth stage of burnout, than linger in the third. Of course, "Failure, Helplessness and Crisis" sounds terrible. But consider this: "Hitting bottom means there's no more downward spiral." And, if you can reach out, there's no where to go but up. Hold on. One more lap to go.

4) Failure, Helplessness and Crisis. Being caught in a familiar "Catch-22" often signals the final phase: "Damned if you do, damned if you don't." "Damned if you stay, damned if you leave." Your coping structure seems to be coming unglued. Next stop...the Stress Doc's couch! (It's a nice couch but, hopefully, not for you.) However, the crisis smoke signals are billowing big time. Why is that? Burnout is like trying to race a marathon - full speed, nonstop. Can anyone race 26 miles fullspeed, nonstop? Of course not. Even Olympic marathon runners must pace themselves. If not, the body parts will break down. And with burnout, overtime, the mental apparatus also wears out.

In fact, one reason the fourth stage is so disorienting is that a person's psychological defenses have worn down. Cracks start appearing in the defensive armor. Painful memories and old hurts normally contained by your emotional defenses are leaking through the cracks. A slight or an emotional bump can set off an overly sensitive and personal reaction. Now a mate's occasional, somewhat annoying behavior really irritates as it reminds you of a mannerism of your father. Or, jealousy towards a colleague reeks of sibling rivalry.


Hey, before throwing up your hands, remember...burnout is not for wimps. A lot of other folks would have jumped ship much earlier. Many of you reach the farther stages of burnout because of your tenacity and dedication. You have a strong sense of responsibility and don't like being deterred from reaching your goals. All noble qualities...unless compelled by rigid perfectionism and "there's only one right way" thinking. Then, pursuing your goals takes a back seat to proving others wrong and overcoming humiliation. You are chasing (maybe, also, being chased by) ego-driven egoals. Especially in times of overload, uncertainty and major change being driven and rigid responsibility can quickly transform a performance benefit into a personal and professional liability.

Also, these folks are usually not just responsible, they often are quite responsive to others. People lean on them for support. Are you a pillar of strength for those around you? If so, will those dependent upon you for their sense of stability be quick to notice when you are feeling shaky? That you may need a shoulder? Often not, as their sense of security is contingent on your always being strong and available. Are you buying into this "superperson" role or hiding behind a heroic mask? Maybe you always had to help mom with (sometimes raise) the other kids. Or you're the emotional sponge in the office, frequently absorbing your colleagues' complaints. Can you hear that screeching, scratching sound? That's the stress knot twisting and turning tighter and tighter about your neck.

On the Edge

No wonder people start jumping out of jobs or school, out of relationships, sometimes just jumping. And for those not into jumping, you may be into swinging by the fourth stage. Mood swinging, that is, between short highs and/or prolonged depressive lows. Okay, the existential question: Is it Miller Time or Prozac Time? From my perspective, it's way too late for the former (though, clearly, many people disagree with me) and a decision on the latter requires expert opinion.

But we do know that prolonged stress will effect the functioning of your hormonal and biochemical systems. The effectiveness of brain neurotransmitters is impaired. Fortunately, the new SSRIs, like Prozac, Zoloft and Effexor (which also targets norepnephrine) help restore the effectiveness of serotonin which plays a key role in mood stability. And for many folks, the side effects are tolerable. But the moral here is clear: Prolonged stress, will affect your biochemistry function predisposing you to mood disability if not a state of depression.

So breaking down our state of ignorance or denial enables us to transform a danger into an opportunity. Fourth stage burnout is the crisis point; it's crunch time. Are you ready to step up to the plate and reach out for the help and resources you need? A person recovers and expands his or her strengths and possibilities through a crisis when:

1) getting proper and sufficient support; someone trained in crisis intervention and loss,

2) confronting denial, false hopes, cynicism or helplessness,

3) grieving past and present losses while turning guilt, hurt, anxiety and aggression into focused energy and

4) acquiring and applying skills and technology for turning new problem-solving options into productive attitudes and actions.

My poetic anthem to burnout and beyond:

For the phoenix to rise from the ashes One must know the pain To transform the fire to burning desire.

Four Stages of Burnout. Four Steps For Recovery and Rejuvenation. Any readers care to share how you turned a burnout situation into a transformational experience? Can you say, "Creative Burnout"?

4. Shrink Rap. Since tension builds again with the close of the fourth stage – "Failure, Helplessness and Crisis" – I apologize for the silent and heavy atmosphere in the room. I propose making amends by revealing a secret identity: I’m pioneering the field of psychologically humorous rap music – "Shrink Rap Productions." And right on cue, a chorus of groans jumps from the audience. I defiantly shoot back, "We’ll see who gets the last groan," as I doff my Blues Brothers hat, black sunglasses and grab a black tambourine. Just before the start, I pause and inform the audience that I’ll be performing a Charlie Chaplin Maneuver (the psychic equivalent of the Heinlich Maneuver). The pioneering film genius declared: "The paradoxical thing about making comedy is that it is precisely the tragic which arouses the funny. We have to laugh due to our helplessness in the face of natural forces and in order not to go crazy." I then assure the audience that, "What you are about to see and hear will give new meaning to the word ‘tragic.’ And as for not going crazy it’s way to late for that. So buckle up your straight jackets, it’s “The Stress Doc’s Stress Rap":

When it comes to feelings do you stuff them inside? Is tough John Wayne your emotional guide? And it's not just men so proud and tight-lipped. For every Rambo there seems to be a Rambette.

So you give up sleep, become wired and spent Escape lonely frustration as a mall-content. It's time to look at your style of stress. You can't just dress or undress for success.

Are you grouchy with colleagues or quietly mean? Hell, you'd rather talk to your computer machine. When the telephone rings, you're under the gun Now you could reach out and really crush someone.

The boss makes demands yet gives little control So you prey on chocolate and wish life were dull, but Office desk's a mess, often skipping meals Inside your car looks like a pocketbook on wheels.

Those deadlines, deadlines...all that aggravation Whew, you only have time for procrastination. Now I made you feel guilty, you want to confess Better you should practice the art of "Safe Stress."

(c) Mark Gorkin 1992 Shrink Rap Productions

Whether it’s the clever lyrics or the absurdity of me dancing, shaking a tambourine and rapping around the room or both, the audience heartily claps their approval. (Maybe they are just feeling sorry for this weirdo; or maybe these folks are envying or admiring someone who can enjoy being so unselfconsciously silly and playful.) I invariably reply to the heart warming audience response, "You can’t fool me; I know when an audience is applauding from relief. Actually, all this proves is after twenty years of all kinds of therapy – from Jungian analysis to primal scream – I have one singular accomplishment…absolutely no appropriate sense of shame." But there’s another motive for the rap besides breaking tension: I’m a role model for being playful and unselfconscious; qualities needed for audience members to fully participate in the looming major exercise of the Practice Safe Stress Program.

Stay tuned…The next newsletter will illustrate this powerful discussion-drawing exercise. Until then, of course…Practice Safe Stress!

Mark Gorkin, LICSW, "The Stress Doc,"™ is the Internet's and America Online's "Online Psychohumorist"™. An experienced psychotherapist, "The Doc" is a nationally recognized speaker, and training and OD consultant specializing in Stress, Anger Management, Reorganizational Change, Team Building and HUMOR! An expert advisor for www.AdviceZone.com and iVillage/allHealth, his writings are syndicated by iSyndicate.com and appear in a wide variety of online and offline forums and publications, including AOL/Online Psych and Business Know How, Mental Health Net, 4Therapy.com, WorkforceOnline, HRHub.com, SelfhelpMagazine.com, Financial Services Journal Online, CONVENE (The Journal of the Professional Convention Management Assn.), OpportunityWorld and Counseling Today. Recently, he has been quoted and/or featured in such publications as Biography Magazine, Cosmopolitan Magazine, Bloomberg Report/News, Forbes Magazine, FoxNews.com, Dallas Morning News and The Washington Flyer. The Doc also leads his national "Shrink Rap and Group Chat" for AOL/Digital City and WebMD.com. Check out his USA Today Online "Hotsite" Website -- www.stressdoc.com . For info on his workshops or for his free newsletter, email stressdoc@aol.com or call 202-232-8662. Fall 2000, look for Practice Safe Stress with the Stress Doc, published by AdviceZone.com.

(c) Mark Gorkin 2000 Shrink Rap™ Productions