The Stress Doc Letter
Cybernotes from the Online Psychohumorist (tm)
NOV 2000, No. 1, Sect. 2
"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 NAwlins
(only in "The Big Easy") I partook in devouring a 24-pound turkey
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 didnt 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 its 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
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
1-1½ hour speaking or workshop program. This exciting program is a blend of
dynamic lecture and thought-provoking and fun-filled exercises. Here is the
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 Ive 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 wasnt 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 audiences attention by illustrating the
propensity for human frustration and foible in a stress-filled, lean-and-MEAN
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 groups 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: "Arent there some days when you dont want to get out from under
the covers for nothing? Conversely, arent 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. Heres another two-way smoke signal: I ask, "Be honest, dont
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, dont 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, lets 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, hes 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
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
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!
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
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
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
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
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: Im 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, "Well 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 Ill 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 its way to late for that. So buckle
up your straight jackets, its The Stress Docs 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 its 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 cant 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
absolutely no appropriate sense of shame." But
theres another motive for the rap besides breaking tension: Im 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
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 email@example.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