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Jan 12, No 1, Sec 1
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Mar 12, No 1, Sec 1
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Sep 12, No 1, Sec 2
Dec 2012, No 1, Sec 1
Dec 2012, No 1, Sec 2

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

JUNE 2012, No. I, Sec. I

Fight when you can
Take flight when you must
Flow like a dream
In the Phoenix we trust!

Table of Contents:

Sec. I

Notes from the Stress Doc ™
Shrink Rap Poetry: “Grief Ghosts: A Viral Metamorphosis” and “An Ode to Letting Go”

Shrink Rap I: The Burn-in Virus: Lingering Loss, Prematurely Buried Grief, and the Rise of Grief Ghosts – Part IV
Readers Submissions: “An angry person,” “Excellent material” (on “Vicarious Trauma & Codependency”)
Testimonials: HR.com Webinar on Stress and Conflict, Navy Federal Credit Union (for Business Health Services)

Sec. II

Main Essay: When Does Vicarious Trauma (VT) Become a Sign of Codependency? – Parts I & II
Phone Coaching-Consultation-Counseling with the Stress Doc ™ and Offerings: Books, CDs, Training/Marketing Kit: Email stressdoc@aol.com or go to www.stressdoc.com for more info.

Notes from the Stress Doc™:

Today’s newsletter is a mix of poetry and pot pourri – my expanded versions of poems written in the 1st quarter of 2012, and essays on “The Burn-in Virus” and “Vicarious Trauma and Codependency.”
In addition, I want to let you know of an evolving service provided by Stress Doc Enterprises. My webmaster, John Straub, and I have been getting periodic requests as the one immediately below:

Hello,

I am interested in placing a text link on your domain: stressdoc.com. The link would point to a page on a website that is relevant to your page and may be useful to your site visitors. We would be happy to compensate you for your time if it is something we are able to work out.
The best way to reach me is through a direct response to this email. This will help me get back to you about the right link request. Please let me know if you are interested, and if not, thanks for your time.

Cheers!
Sophia

-------------------------

Stress Doc Response:

When inquiries for link placement or link excghange come in hewre is our response: “At this moment we are basically offering two options: $100 for a one-year placement and $200 for a permanent placement, i.e., the life of the website; see note below). Feel free to email or go directly to the site -- www.stressdoc.com; upper right hand corner -- for more info or go directly to the ordering page: Click here: Advertising Rates

If interested in placing an ad/link and you have any questions about placement or paying with Pay Pal, please contact my WebMaster, John at jstraub@lfcu.org. His PayPal email address is jstraub@net-site.com.

We have numerous options re: placement of link and copy, e.g., on the homepage or in the body of a relevant article, etc. You can also have a one-page featured (see website homepage, "Featured Essay") for a fee of $100/per article.

Please reply to jstraub@lfcu.org after you have processed the payment, and John will put up your ad on the appropriate page. Also, please include any additional text you would like to add.

As mentioned, the link (including your own brief text) can be placed on both the home page or on any other page. I can help with the transition form my text to your link or text.

Thanks, to good adventures.

Mark Gorkin
Stress Doc and

John Straub
StressDoc Webmaster

[As JS noted, on the Internet nothing is “permanent”; but I plan to be writing and updating the Stress Doc website for a long time to come!]

------------------------

Another gracious Sophia email:

Hello Mark and John,

I really appreciate your patience in coordinating with the link placement and answering my question. Thank you also, John, for assuring me that the link will stay live for as long as the StressDoc site exists. You're right! Nothing really lasts forever. I probably should not be using the word "permanent" when it comes to link placement from now on. :)

Mark, I do hope that you live beyond 98. You have great ideas and your site is so rich in information. If the site stays live for a long time, you'll continue to touch a lot of people and inspire them by your ideas and experiences. Besides, I like your style of writing. You keep it simple, direct to the point and easy to understand.

Mark

Overview:

1. Shrink Rap Poetry: “Grief Ghosts: A Viral Metamorphosis” and “An Ode to Letting Go”

2. Shrink Rap I: The Burn-in Virus: Lingering Loss, Prematurely Buried Grief, and the Rise of Grief Ghosts – Part IV. Part IV defines more carefully the newly conceived “Burn-in” and differentiates burn-in (with its typically more internal, yin energy and “draining” essence) from burnout (with its more external, “straining” yang nature).

3. Main Essay: When Does Vicarious Trauma (VT) Become a Sign of Codependency? –

Parts I & II. During a keynote address on “Burnout, Burn-in and Grief Ghosts,” an issue from an audience member that resonated with many was the potential for “Vicarious Trauma” (VT). The literature has an international flavor, often speaking to the “humanitarian aid” employee involved with some wide scale, “man-made” or war-torn trauma or disaster, e.g., rape, pillage, “ethnic cleansing,” etc. However, vicarious trauma along with its conceptual and operational cousin, “caregiver burnout,” has a wider interpersonal reach and problematic scope. In addition to fleshing out the VT concept, this essay will examine how certain personality traits and tendencies can fuel the vicarious and vicious exhaustive and erosive “trauma-burnout” cycle.

 

Shrink Rap Poetry:

Grief Ghosts: A Viral Metamorphosis

And the Grief Ghosts will rise from the ashes
When one tries to bury the pain.
Feeding a fire that chokes dreams and desire
Oh when will your tears fall like rain?
Too late…look, soul-sucking phantoms
Spiral higher and higher, madly morph and conspire
As Trojan worms raiding while aerating your brain.

There still may be time to reach for the sublime:
Grieve, let go…and grow with the flow!

----------------------------------------

An Ode to “Letting Go”

To start “letting go” you must rise up and growl
Then let out a howl
Lick wounds for a while…stew in your woes.
Just don’t throw in the towel; better…

Do know your limits, don’t limit your “No”s!

Hmm…What do you know?
Those critical voices, once grief ghosts on the prowl
Now flushed from your bowels
As tears flood timeworn echoes:
Peace flows through gut and soul.

Hey, “black or white” VISION…move out of the way
For that dual-brained mind-dance
Of parade-like precision and chaotic chance.
Aha…a yin-yang eruption

Sparking a tango romance maybe just may
Be the dawn of a Phoenix
Defying naysayers and money masters
With but a self-proclaimed mantra:

One must begin to separate,
One must be separate to begin
…breaking away.

So “strive high, embrace failure”
Jump into the fray
Still learning to fight another day.
For when you let go to life’s ebb and flow
You will even know when it’s time to eat crow!

© Mark Gorkin 2012
Shrink Rap ™ Productions

Shrink Rap I:

The Burn-in Virus: Lingering Loss, Prematurely Buried Grief,

and the Rise of Grief Ghosts – Part IV

Part III began with a vignette that revealed how denying past loss and trauma confounds and contaminates one’s present functioning. It also illustrated how one may need to experience burnout in order to acknowledge and ultimately grapple with primal burn-in “Grief Ghosts.” Next there was a classic definition of burnout followed by an outline of five major sources of burnout and a poignant and playful upgrade to the “Four Stages of Burnout.” (Email stressdoc@aol.com for Part III.)

Definition of Burn-in

Now it’s time to define more carefully the newly conceived “Burn-in” and to differentiate burn-in (with its typically more internal, yin energy and “draining” essence) from burnout (with its more external, “straining” yang nature). Akin to burnout, burn-in is also 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. However, in contrast to the external demands, excessive responsibilities, and over (or under) whelming grind of burnout, burn-in involves the silent, chronic drain of harboring unconsciously repressed or consciously resisted lingering and reverberating memories and smoldering emotions connected to: a) recent and past, b) physical, psychological, and spiritual c) personal and interpersonal, d) family and organizational, as well as e) geographical and cultural losses, transitions, and traumas. And, perhaps most disorienting, painful emotions and memories long denied or prematurely buried become the crucible for the birth of “Grief Ghosts.”

Let me simplify this “Four Step Rise of Grief Ghosts”:

1. Lingering Loss. You experience a painful loss – from the personal to the organizational – whether from the distant or recent past. The nature of the loss is denied or, more likely, acknowledged but quickly pushed to the back of your mind, out of everyday emotional consciousness. “It’s time to move on.” Of course, the more powerful the loss the greater is the potential for kindling grief ghosts. (In general, lingering, unrecognized, minimized, or denied loss + the significance of the loss + the absent or limited nature of grief time (the shorter the overt grief time the higher the kindling potential) + the dysfunctional/defensive characteristics of grief avoidance (e.g., substance abuse, keeping a manic- obsessive distracting schedule or pace, subtle or disguised depression, etc.) x time = the formula for ghostly production.)

2. Prematurely Buried Grief. The energy and feelings connected to the loss and the avoided or alienated grief process means painful emotions and memories are smoldering and reverberating inside. The longer and tighter one tries to keep the lid on this psychic crucible the more potent the condition for this combustible mix to become increasingly pressure-packed and incessantly loud, and to swarm furiously. Clear thought and decision-making processes are scrambled; heightened emotions if not numbed can become overwhelming.

3. Precipitating Event. Other life transitions, traumas, and losses experienced along the burn-in path may only compound and intensify this fuming and rumbling process if, once again, personal mourning is basically avoided. In fact, one of these triggering hazardous events will finally be the spark that detonates the proverbial final straw, firing up, launching, and animating the underground ghosts.

4. Burn-in and the Rise of Grief Ghosts. Finally, one will implode or explode; constantly smoldering and smoking pain or shame not only is exhausting, it burns away your emotional defenses as well as your mind-body-heart-spirit insides; alas, it may be hard not to make an ash of yourself! Your combustible “burn-in” psychic mix, like the high temperatures and pressure that forms metamorphic rocks, now morphs into “Grief Ghosts.” Or subterranean, conflicting and clashing past and present voices in your head, like colliding tectonic plates, may spark the rise of metamorphic and metaphoric ghosts. Whatever the genesis, you are suddenly dealing with two battlefronts: a) the immediate real world problem in the present and b) and the unleashed spectral presence of formerly dormant, now painful, confusing, and often critical grief ghosts. And your inner reserve and resolve feels depleted if not devastated. This ‘Burn-in” process has you susceptible to depression, exhaustion or burnout, emotional overreaction, agitation, or regressing to old self-defeating “survival” patterns. These burn-in smoke signals may occur especially during times of crisis, trauma, loss, and high stress or when in the throes of challenging performance, identity-related transition, and/or intimate relating.

Another Immobilizing Metaphor

Let me try a more contemporary metaphor. Painful losses and evolving phantasms that have not been honestly, courageously, and meaningfully mourned can go viral. It’s as if an undetected virus has been slowly yet steadily corrupting your inner hard-drive, your mother board and operating system, along with the random access memory, while eventually releasing a disruptive Trojan-phantom program called “The Rise of Grief Ghosts.” Form becomes deformed, function morphs into dysfunction. Over time, burn-in emotions – from fear, frustration, guilt, anger, and ennui to panic, rage, shame, numbness, despair, along with mania and melancholia – smolder, disrupt, combust and, finally, often erupt. You may be in a battle with the now looming and swirling (as opposed to the once silently erosive) grief ghosts for control over your mind-body-spirit and family-work-life balance ship of state. Grief ghosts – overt or covert – if not emotionally engaged and grieved wear down resiliency and increase susceptibility to heightened post-traumatic effects. And naturally, this spectral eruption not only leads to disorienting, reactive, and self-defeating or self-destructive behavior but also contaminates communications and interactions with others.

Dynamics and Consequences of Prematurely Buried Grief (PBG)

Whatever the motivation, Prematurely Buried Grief (PBG) is a heavy yet quietly stealthy bio-psycho-social weight that, alas, one often “gets used to” carrying over time and, sadly, its debilitating impact is often unnoticed. PBG’s maladaptive effect frequently eludes the bearer’s as well as observers’ notice until it’s too late. (I have likened it to running a race with an invisible 25 lb. weight attached to your ankle. Almost everything becomes a strain.) This PBG individual is germinating grief ghosts and is susceptible to “burn-in” or “burn-in induced burnout.” (See Part III of this series for a case example of the latter. Grief ghosts denied, of course, can also lead to mental health issues including depression and substance abuse, as well as transfigure emotional pain into panic or trauma.)

Sufficiently grieving a significant loss that prevents the incubation of grief ghosts and contributes to understanding and growth is rarely a one-trial learning curve. As was outlined in Part III, there are initial grief stages and various emotional states to be engaged in the months, sometimes years ahead. In addition, fully tapping into this underground resource becomes an ongoing, lifetime process of memory and reflection, identification with and integration of the psycho-spiritual essence and value of the person, place, thing, dream, or illusion mourned. The specific nature of a head, heart, and soul expanding or contracting grief journey is channeled by the bio-psycho-social history, personality, emotional support, as well as the degree of order and challenge, rigidity and flexibility in the individual’s eco-cultural landscape and mindscape.

Burn-in sits heavy on many people’s minds and bodies, hearts and souls. Yet many are leery of entering the dark and deep labyrinth of grief, afraid of discovering a shadowy monster within, or that once unleashed, the streaming tears will turn into an uncontrollable raging river. And combined with the cultural messages such as “don’t look back; just move on,” “stop feeling sorry for yourself,” or “aren’t you overdoing the martyr role,” not surprisingly, this hulking, smoldering ghost and the need to meaningfully and deeply grieve is often barely recognized in a “TNT” – “Time, Numbers, & Technology” – driven and distracted world. Be advised, at this very moment, these ghosts are loitering in your office halls and on your work floors. In fact, some of the grief ghost carriers distract themselves by always getting into other people’s business. Very quickly a “ghost carrier” can become a “stress carrier.”

[Email stressdoc@aol.com for the entire essay.]
 

Key Sources Fueling Burn-in Smolder

So what nature and nurture life experiences and predispositions become kindling for “Burn-in?” Key sources include:

a) lingering life cycle losses – natural and normative, developmental and transitional – insufficiently mourned – whether from natural devastation, e.g., loss of a home and a community in a tornado or hurricane, to man-made decisions and disasters e.g. drug abuse, gang violence, and other health-risk life style choices, to downsizings and divorces, bankruptcies and foreclosures, or fatal vehicular accidents; these types of loss often affect more than the material, impacting one’s identity and belief in the future,

b) traumatic experiences denied, prematurely buried, “not discussed in public,” or pushed aside by false pride or shame, e.g., mental illness issues in a family, rape, political torture or prison/immigration camp experience, or PTSD in the military,

c) the gradual loss or deflation of a dream, e.g., having to change self-defining career paths, drop out of school, sell or step away from a personal business or home, whether, for example, because: 1) it’s no longer profitable, 2) increasing age or infirmity makes it difficult to sustain the practice or upkeep, or 3) it has grown beyond your expertise, maturity, and control,

d) the poignant pain of early childhood deaths, separations, and illnesses, separations, and abandonments on both individuals and members of the family system, e.g., a parent’s “breakdown” and subsequent lingering depression or diminished emotional presence on a relationship with a child; (e.g., research shows that adults with major early loss issues when exposed to hazardous situations are more susceptible to post-traumatic effects),

e) childhood abuse or bullying; of course, bullying is not confined to the schoolyard – childhood and domestic abuse occurs in the bedroom and worksite bullying is found in the boardroom and on the work floor: the issue of workplace bullying is beginning to share the spotlight with sexual harassment; both may leave indelible scars, and

f) genetic-family predisposition for depression or other mind-body disabilities, along with the stigmatizing societal labels attached by self and others, all may fuel a smoldering, if not burning fire that consumes self-esteem.

All six of these environmental, experiential, and emotional sources and mind-body states and traits intensify the challenge of understanding and managing one’s moods and mindsets, developing work performance competency, as well as evolving emotionally intelligent and successful relationship skills. These hazardous conditions and predispositions often set the stage for eventual burn-in-or burnout implosion or explosion.
 

Key Structural and Diagnostic Characteristics of Burn-in

As noted earlier, unlike the external demands, excessive responsibilities, and over (or under) whelming everyday grind of burnout, burn-in involves the silent, chronic drain of harboring unconsciously repressed or consciously resisted lingering and reverberating memories and smoldering emotions connected to recent and past losses, transitions, and traumas. And, perhaps most disorienting, painful memories long denied or prematurely buried become the crucible for the birth of “Grief Ghosts.” In viral fashion, these poignant, prematurely buried losses and subsequent ghosts eat away or contaminate your energy, psychic equilibrium, memory, and concentration, along with your self-esteem, identity, and integrity. At minimum, these silent specters have you frequently questioning and doubting yourself. Grief ghosts – overt or covert – if not emotionally engaged and grieved wear down resiliency and increase susceptibility to negative post-traumatic effects. Painful memories from the past get stirred making resiliency or recovery in the face of trauma that more daunting. And naturally, this spectral eruption not only leads to disorienting, reactive, and self-defeating or self-destructive behavior but also contaminates communications and interactions with others.

Let’s examine “Five Burn-in Structural and Diagnostic Characteristics”:

1. Ecosystem vs. Echo-system. In contrast to burnout’s chronically stressful ecosystem, the foundation of burn-in is a distracting echo-system. That is, in addition to the aforementioned drain of lingering loss and premature or insufficient mourning, there’s the interference of old grief ghost voices. This reverberating static may distract, anxiously overwhelm, or out shout existing thoughts and feelings, beliefs and values that are not grounded in genuine self-awareness and self-confidence.

And sometimes, mere recall of these ghosts is not sufficient to silence the reverberating and endlessly ringing static; to achieve mind-body-spirit harmony you have to psychologically if not physically wrestle with the pain and the loss. There are times we all must enter that “dark and hollow night of the soul” cave, embrace our shame and fight for our survival, integrity, and peace of mind. For the lingering and worsening pain of ongoing grief that is not sufficiently acknowledged, that is ignored, deferred, diminished, dismissed, shunned, or denied provides the crucible for consolidating raw emotional energy, heartache, or agony into looming, lurking, and loitering grief ghosts. (The entire litany of grief ghosts will be provided in a future series segment.)

Consider this poignant and reverberating example. A friend and colleague, a former Artillery Officer in Vietnam, was perplexed as to why he was feeling so unsettled a week after 9/11. He’d seen plenty of mayhem in his tour of duty, and had knowingly talked with me about it. His powerful war-time experience did not seem to be the crux of his dis-ease. I thought a moment, and then asked, “Didn’t your first wife die years before in a fire that broke out in your home?” Now J. somberly added that he had been unsuccessful in his attempts to rescue her. Suddenly, a knowing look came across his face: “I hadn’t thought of that.” The burning towers of 9/11 had amplified an echo that subliminally was pulling at J.’s gut and heart strings. The grief ghost had come alive; however once embraced emotionally, its powers to disorient and disturb were defused in the moment of epiphany. And if these personal losses are periodically recollected and reflected upon, especially at times of vulnerable loss or separation, those early painful memories may become poignant ones. Grief ghosts will likely remain in hibernation, to be awakened at the time and place of your choosing. Or, when you realize that during crisis periods grief ghosts are often spontaneously aroused, there presence will be less damning and disorienting.

2. From Wearing Out to Shame and Doubt. Because burn-in is often a slow burn, the loss of your role or identity is gradual not surgical, the exhaustion may creep up on you, before you realize the extent of your depletion and disorientation. However, there have likely been signposts along the burn-in path: increasing errors or diminished performance, loss of interest in familiar or favorite activities, going into a social shell or, conversely, in the throes of conflict, displaying “out of character” defensive, exaggerated, agitated, insensitive, or hostile reactions. Clearly, there are some parallels with a depressive or agitated-depressive state. And as your energetic, conscious, decision-making self withdraws or feels stuck, fertile psychic ground emerges for the increasing presence of grief ghosts. And with longevity comes even greater distraction.

3. Amplification of a Ghostly Voice. Over an extended time, the ignored loitering ghost’s voice, while perhaps once operating at a subterranean decibel level, now gets louder and louder, gets more emotionally shrill and accusatory. These past judgmental authority voices often generate a critical static that disrupts our psychic wavelength clarity and distorts or exacerbates memory channels. The potential for amplification only increases in the throes of crisis or as you encounter new and challenging work-life-family transitions, performance-role challenges, and potentially intimate relationships. A new father was struck by how his father’s emotional expressions, ones he did not want to replicate, seemed to unconsciously fly out of his mouth. The more I hear a person declare, “The last person I’ll ever be like is my old man,” the surer I am of a haunted psyche.

4. The Alienated and Introjected Personal-Emotional Toll. Disengaged or alienated grief dries up the emotional juice provided by a once living and breathing, inspiring, and/or infuriating important person, place, position, and/or emotional period in one’s life. As noted, disconnection with the emotions surrounding loss turns burn-in energy and pressure into lingering or loitering ghosts. (Please don’t take my experience having inspiring conversations and vexing head and heart battles with a deceased's voice and internalized essence for the "real" thing, that is, an actual belief in the material existence of ghosts.)

Leaving the ghostly argument to others, consider this startling psychological phenomenon. Most of us know, often first hand, that children are shaped by positive and negative messages from significant others. The praise or ridicule of an authority figure usually has a powerful impact. What often escapes understanding is that they/we also internalize (unconsciously take on or “introject”) the negative and positive emotions and self-images (conscious and otherwise) that these vital and meaningful others have about themselves. Surely, this early, unconsciously internalized psycho-family drama, especially when painful and beyond a child’s comprehension (or even awareness if there are family secrets) is fodder for the birth and evolution of grief ghosts.

This introjected transfusion includes silent emotional energy (positive and negative), degree of self-regard, and the eventual overt and covert communication with insufficiently mourned, lingering, lurking, and even lashing out ghosts. For me, this is a mind-blower. That is, for example, a parent’s or grandparent’s shame or confidence (or lack thereof) unwittingly becomes part of our sense of self and degree of self-esteem, our level of confidence and trust in our competence. The nature of this introjection ultimately impacts how we communicate with our own self as well as with our capacity to relate with others. We are an active and receptive player in a family-ghostly drama, often beyond our apprehension, whether we want to be or not. And the longer the internalized emotions-lingering ghost walks alone, isolated, unrecognized, denied, dismissed, or shunned, the louder and more judgmental the covert voice or look, the heavier the emotional toll and loitering fine. (Insert Hamlet’s Ghost here.) Clearly, when not released through grieving, the negative energy, lingering losses, and critical voices from the past are often interred in our bones and brain.

5. The Disruptive Interpersonal Toll. Remember, restless, rejected ghosts make us susceptible to dysfunctional conflict as we displace onto others old hurts and humiliations. Grief ghost static often induces a low threshold for feeling “disrespected” yet also may generate compensatory hubris, i.e., arrogance or false pride. Personality traits or behaviors we find objectionable often escape self-righteous awareness; those same negative or undesirable qualities of others reside in the grief ghosts of our own making. Ignoring the reality of being quietly consumed by past grief-personal ghosts contaminates and compromises an ability to engage and fight objectively, constructively, and, certainly, with compassion those supposedly difficult people in our present family-social-vocational arenas. Trust me; many of those folks forever in other people’s business are distracting themselves from their own grief ghosts. This increasingly wearing and wary shadowy phantom subtly yet chronically drains individuals, groups, and the overall environment of vital energy for work, play, and love.

Closing Summary

This essay has provided a comprehensive definition of “burn-in” while also outlining the dynamics and consequences of “Prematurely Buried Grief” (PBG). In addition, key sources fueling burn-in were enumerated and, finally, “Five Burn-in Structural and Diagnostic Characteristics” were introduced. Next time, “Six Self-Assessment Questions for Successfully Negotiating the Crisis-Grief Transition Passage.” Until then…Practice Safe Stress!

Readers’ Submissions:

5/29/2012

Hi Mark!
I would like to thank you very much for your quick response, yesterday. It truly brought tears to my eyes.

I found your book "The 4 Faces of Anger", in a general search, looking for resources locally in North Carolina.
I must tell you, I like the way you write, and as well, the way you think.

I never knew I was such an angry person, until I got into a "real" relationship. That statement makes me smile, because, I have been divorced two times. However, I spent 11 years alone. I have only known how to run from, and escape my problems, purely, by just not dealing with them…

It amazes me that I can interact quite well with anyone, have held wonderful jobs, but fight this demon…

One has to find humor in the way we are raised, molds us forever. However, I do think that with given tools that can make you look at yourself, understand, and utilize them in your day to day life, is very hopeful.
Allow a smile to come to your face, for knowing, that you have provided that to me.

Keep writing, and I shall keep reading!!

Sincerely,

Kymberly

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Subject: Re: New "Vicarious Trauma and Codependency" Essay/Webinar Feedback

Date: 5/30/2012

Mark, excellent material. Thanks for your insights and well stated take on this relevant topic. I am teaching a CISM [Crisis Intervention/Stress Management] two day class series for hospital personnel and we have discussed some of this in previous classes; however, you provide a new twist/resource I will integrate immediately in the self-care section.

Thank you!

Pam Ruster, LCSW, CEAP
Supportive Systems, LLC
Indianapolis, IN
317-788-4111
www.supportivesystems.com
A Women Business Enterprise

 

Testimonials:

 

HR.com Webinar on Stress and Conflict [over 100 participants]

 

5/16/2012

 

Fantastic - I knew you were going to WOW them! I had my sound turned off as I was on a call during your webcast but was busy following along - you presented information that was easy to follow and implement and pertinent to everyone!

 

thanks for taking the time to educate our members - it has been a pleasure working with you and would love to have you present again for us when you are able.

 

 

Tara Butt

Content Curator - Employee Wellness

Institute for Human Resources

HR.com

 

124 Wellington Street East

Aurora, ON Canada

L4G 1J1

1-877-472-6648

 

tbutt@hr.com

------------------

 

From: jkmtroth@comcast.net

To: StressDoc@aol.com

Sent: 5/16/2012

 

I was on the webinar you had today during the wellness virtual event.

 

Thank you so much for the information!! I am ready to put it to good use. I currently suffer from a chronic pain disease and stress is one of the main things that will increase my pain. A lot of the slides and things you said really hit home!!! I am ready to use your information to try and manage my stress!! I have also ordered several ebooks and the cd to use.

 

Thank you for your time!!!

 

michelle

--------------------------

 

Navy Federal Credit Union (for Business Health Services)

[1.5 hour small group/workshop and facilitation on "The Sandwich Generation"; open enrollment]

 

4/27/2012

 

GREAT feedback from Navy Federal – very positive session! I think we are looking to suggest an eldercare support group at HQ based on participants’ feedback, subject to NFCU approval, of course!

 

Thank you!

 

Kind Regards,

 

Sunithi Kuruppu, MSW | Senior Program Manager

Business Health Services

[P] 443-955-7989 | | [F] 410-889-7397

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Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is an acclaimed keynote and kickoff speaker as well as "Motivational Humorist & Team Communication Catalyst" known for his interactive, inspiring and FUN programs for both government agencies and major corporations. In addition, the "Doc" is a Team Building and Organizational Development Consultant as well as a Critical Incident/Grief Intervention Expert for Business Health Services, a National EAP/OD Company. He is providing "Stress and Communication,” as well as “Managing Change, Leadership and Team Building" programs for a variety of units at Ft. Hood, Texas and for Army Community Services and Family Advocacy Programs at Ft. Meade, MD and Ft. Belvoir, VA as well as Andrews Air Force Base/Behavioral Medicine Services. A former Stress and Violence Prevention Consultant for the US Postal Service, 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 info on the Doc's "Practice Safe Stress" programs or to receive his free e-newsletter, email stressdoc@aol.com or call 301-875-2567.

(c) Mark Gorkin 2012

Shrink Rap™ Productions

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

[If you do not wish to receive my free mailings, email stressdoc@aol.com]

 

The Stress Doc™ Newsletter
NOTES FROM THE ONLINE PSYCHOHUMORIST™


JUN 2012, No. I, Sec. II

Fight when you can
Take flight when you must
Flow like a dream
In the Phoenix we trust!

~~~~~~~~~~~~~~~~~~~~~~~~~~

 

Main Essay:

 

Click here: Stress Doc: Notes from a Motivational Psychohumorist ™: When Does Vicarious Trauma (VT) Become a Sign of Codepende

or

http://www-stressdoc-com.blogspot.com/2012/05/when-does-vicarious-trauma-vt-become.html

 

When Does Vicarious Trauma (VT) Become a Sign of Codependency? – Part I

 

The other day I launched my inaugural workshop on “Combat Strategies at the Burn-in and Burnout Battlefronts” during a “Loss and Grief” program sponsored by the Psychiatric Institute of Washington, DC. The majority of folks in the audience were social workers and other allied health professionals. An issue from an audience member that resonated with many was the potential for “Vicarious Trauma” (VT). The literature has an international flavor, often speaking to the “humanitarian aid” employee involved with some wide scale, “man-made” or war-torn trauma or disaster, e.g., rape, pillage, “ethnic cleansing,” etc. However, vicarious trauma along with its conceptual and operational cousin, “caregiver burnout,” has a wider interpersonal reach and problematic scope. In addition to fleshing out the VT concept, this essay will examine how certain personality traits and tendencies can fuel the vicarious and vicious exhaustive and erosive “trauma-burnout” cycle.

 

Who Can Catch VT?

 

According to the Vicarious Trauma and Headington Institutes, “Vicarious trauma is the process of change that happens because you care about other people who have been hurt, and feel committed or responsible to help them. Vicarious Trauma is what happens to your neurological (or cognitive), physical, psychological, emotional and spiritual health when you listen to traumatic stories day after day or respond to traumatic [or emotionally maddening, discouraging, and disheartening] situations while having to control your reaction. VT is a process that unfolds over time. It is not just your responses to one person, one story, or one situation. It is the cumulative effect of contact with survivors of violence” and disaster. However, I believe Vicarious Trauma is not only the product of horrific drama; VT conditions need to be placed on a spectrum of distress and disruption. Other less sensational yet often no less demanding person-social situation contexts contribute to VT susceptibility, including continuously working with or caring for:

 

1) stateside military personnel and their caretakers – from VA personnel to spouses and parents – grappling with post-traumatic stress injury or traumatic brain injury and its personal and interpersonal effects; men and women who can’t help but compare their pre- and post-“down range” mind-body state: the lingering mental fog, the depression, the nightmares, the angry flashes, the reduced physical mobility, etc.; and, especially with military personnel or even family members, despite the high command’s systematic efforts to destigmatize mental health issues, the many individuals in a “macho culture” who remain ashamed to acknowledge or to discuss their vulnerable and/or compromised “head case” conditions,

 

2) people who are struggling with poverty or economic displacement, many working in and warehoused by the criminal justice system, or grappling with environments (e.g., a tight job market or foreclosed housing market) that foster a sense of “learned helplessness,” hopelessness for the future, or angry resignation,

 

3) the victims of domestic, child abuse, sexual abuse, and bullying or other anti-social and destructive actions; intervening with substance abusers and those engaged in other self-defeating addictions and behaviors, including defiance and denial,

 

4) people whose disastrous, disruptive, demeaning, and/or self-defeating experience may result in a profound sense of loss of personal control and of trust, often contributing to a wariness with perceived “authority figures” and a resistance to accepting counsel; a clash of divergent cultures or conflicting cultural practices between providers and recipients of aid or service may exacerbate interpersonal contentiousness or distance,

 

5) the aged and infirmed, or being responsible for individuals struggling with profound physical, neurological, and cognitive-affective illness, disability, and/or dementia; not understanding the nature and limits of the condition may create unrealistic expectations and frustration for both parties,

 

6) a once strong family member or significant other who has now lost his or her bearings, balance, and/or bladder control; in their new “strong one” role, a caretaker who prematurely buries his or her grief regarding this loss and potential “role reversal” is inviting exhaustion if not drama or trauma,

 

7) teachers who can’t get through to young, irritated students who come to school hungry, or students from dysfunctional families whose hostile and hurtful patterns of interaction in the kitchen are invariably acted out in the classroom; or when a child’s chronic stress contributes to noticeable underachievement, attention deficit, and learning disabilities, if not a sense of shame and depressive tendencies; alas, hurt and hopelessness can morph into withdrawing inside a hardened protective shell,

 

8) a parent trying to reach, reason with, and restrain a forever angry or defiant, bingeing, texting or drinking while driving, living on the edge, thinking he or she is invulnerable teenager or young adult.

 

Clearly the potential for Vicarious Trauma and Caregiver Burnout cuts across a wide swath of essential and everyday roles and relationships. At the same time, depending on your personal sensitivity, ongoing stress levels, and the plight of those with whom you are engaged, “you can [eventually] come to question your deepest beliefs about the way life and the universe work, and the existence and nature of meaning and hope.” Such daunting and draining work may result in “existential angst” – the sense that one is constantly being pushed out of a comfort zone and is forced to question the meaning of events, one’s own and others’ actions and reactions. How could a benevolent “God” allow such atrocities, catastrophes, or unexpected and unfair casualties? Why were this person and these people targeted?

 

Being the witness, recipient, or active participant in distressing, disheartening, disillusioning, and disempowering life scenarios and stories, “day after day, and year after year” can take a profound toll on one’s mind-body-spirit.

 

So the numbing or alienating field of VT may not just be thousands of miles away; it may be as close as your professional office, a classroom, your living room, or the home of a family member.

 

Defining Codependency

 

Clearly, people who place their mind-body-spirit on the line, helping those fighting for post-traumatic survival or struggling to maintain some sense of economic and/or psychological stability, autonomy, self-worth, and competency in a “survival of the fittest” world rate a Purple Heart for passion and compassion. However, this “Vicarious Trauma” and “Caregiver Burnout” helping context is fraught with both subtle as well as the previously noted more obvious risks. If not sufficiently aware of one’s own psychological patterns and needs that can befog clarity and objectivity, purpose and boundary, the situational hazard may not be the sole or primary cause of the VT Syndrome. One must ask two critical questions: does Vicarious Trauma or Caregiver Burnout ever morph into (or, as likely, finally expose) Professional (or Personal) Codependency? That is, do certain cognitive beliefs, personality characteristics, and patterns of coping and caregiving increase the likelihood of getting VT? And do organizations or family-cultural systems themselves ever purposefully enable or unwittingly facilitate such trauma or burnout?

 

According to Wikipedia [and my own editing], Codependency is defined as a psychological condition or a relationship in which a person is:

a) controlled or manipulated by another [or who allows themselves to be controlled or manipulated],

b) is affected by or involved with a partner with a pathological[/medical] condition (as in an addiction to alcohol or heroin) or [caretaking a significant other with a traumatic injury or seriously disabling condition],

c) and in broader terms, it refers to the dependence on, [fear of,] or control of another,

d) it also involves placing a lower priority on one's own needs, while being excessively preoccupied with the needs of [or the well-being, comfort, approval, performance, or success of] others, and

e) not surprisingly, codependent natures often attract individuals with narcissistic issues, that is people who feel entitled to the care, admiration, and service of others; [however, a subtle form of narcissism may also be present in this codependent dyad, that is, the self-sacrificing individual may also believe, albeit on a covert level, that the world owes him or her for such unselfish, accommodating, and altruistic attitude and behavior; such “fairness” and “heaven’s reward’ fallacies would invariably heighten susceptibility to Vicarious Trauma, both regarding unrealistic expectations in general and with wary recipients of aid in particular].

 

Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships. Codependency may also be characterized by denial, low self-esteem, excessive compliance, or control patterns. More specifically, people who are codependent often take on the “martyr role”; they constantly put others' needs before their own and in doing so forget to take care of themselves. [In fact, such individuals often use the role of “rescuer” to distract or lose themselves or deny and project their vulnerable emotions onto others’ problems.] This creates a sense that [there’s a serious issue for which] they are "needed"; they cannot stand the thought of being alone and no one needing them. Codependent people are constantly in search of acceptance. When it comes to arguments, codependent people also tend to set themselves up as the "victim." When they do stand up for themselves, they feel guilty.

 

Codependency does not refer to all caring behavior and feelings or to normal kinds of self-sacrifice or caretaking, but only those that are excessive to [a dysfunctional] degree. For example parenting is a role that requires a certain amount of self-sacrifice and giving a child's needs a high priority, although a parent could nevertheless still be codependent towards their own children if the caretaking or parental sacrifice reached unhealthy or destructive levels. [Such scenarios might include a child compelled to fulfill the unfulfilled fantasies of a parent, or one frequently parenting the parent, or prematurely and subtly yet fairly literally having to be the “man” or confidant in the household; or when a lonely parent needs to be “best” friends with a teenage son or daughter]. Generally a parent who takes care of their own needs (emotional and physical) in a healthy way will be a better caretaker, whereas a codependent parent may be less effective, or may even do harm to a child. Another way to look at it is that the needs of an infant are necessary but temporary whereas the needs of the codependent are constant.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

Part I has examined the realm of Vicarious Trauma and Caregiver Burnout, illustrating its common occurrence among many roles and relations in contemporary society, and how the humanitarian if not heroic efforts of helpers and healers can without sufficient awareness and supervision, become a disguised, draining, and hazardous process of relating. Part II begins to flesh out the bridge between Codependency and Vicarious Trauma.

 

When Does Vicarious Trauma (VT) Become a Sign of Codependency? – Part II

 

Vicarious Trauma as Type “E” Codependency

 

Alas, succumbing to this self-defeating pattern and propensity may be all too “E”asy, especially when so many of these qualities seem positive, thereby making it difficult or uncomfortable to acknowledge their polar nature. Let’s itemize Ten Key, Double-Edged Characteristics of that “Everything for Everyone, Everywhere, Every Time, and Invariably Exhausted” Type “E” Personality:

 

1. Empathy, Experience and Emotional Perspective. Feeling another’s pain (whether of an individual or a social group) and wanting to respond actively and compassionately to aid the struggle is an honorable, valuable, and principled mission. A capacity for empathy, an ability to walk in another’s shoes (and especially to feel their bunions) is perhaps the cardinal virtue of “emotional intelligence.” At the same time, an ability to place the problem or struggle in context, that is, being able to identify and understand the multiple factors contributing to the battle is crucial. One needs to see the positives and negatives, the fears and fantasies on all sides; although these dynamics, along with resources and responsibilities, of course, are not necessarily evenly distributed or weighted.

 

For example, one social worker spoke of leading an emotional support group for public defender attorneys who frequently show signs of vicarious trauma over time when working with rape victims. One attorney nearly reached his breaking point upon becoming a new father to a baby girl. The intensity of his identification with the problem and the victims, along with a more personal vendetta against the perpetrators, skyrocketed. (Of course, if an attorney – male or female – had been sexually assaulted or abused, some therapy focusing on their traumatic history should be a requisite for working with rape victims.)

 

Experience and Emotional Perspective

 

When your experience and emotional perspective generates heightened identification and commitment it is especially important to blend some detached concern along with emotional self-awareness if empathy is to remain a vital and virtuous quality and not fuel a vicarious or vicious cycle.

 

In fact The Headington Institute [http://headington-institute.org/Default.aspx?tabid=2646] poses two critical questions bearing on the role of empathy and VT:

a) With what sort of problems or people do you find it especially easy to empathize? and

b) What are some ways that caring about people who have been hurt affects you?

 

2. Expectations, Egoals, and Early Pain. As the Headington Institute website noted, feeling deeply invested in your work or caretaking with a great sense of professional and/or personal responsibility “can lead to very high (and sometimes unrealistic) expectations of yourself and others….For example, you may take it personally when your work or the work of your organization doesn’t have the impact [or the results] you want. Ironically, your sense of commitment and responsibility can eventually contribute to feeling burdened, overwhelmed, and hopeless in the face of great need and suffering. [You may also] extend yourself beyond what is reasonable for your own well-being or the best long-term interests of beneficiaries, [especially if your self-sacrificing nature believes, albeit unconsciously, people should recognize and respond to your painstaking efforts.]

 

A kindred issue and a potential stressor inherent in caring work is the notion that your worth is dependent on your “success” rate, that is, your competency as a helping professional depends solely on the performance or outcomes of others. Whether “you did your best” or “all you reasonably could do” is never good enough. And especially when engaging others in the complex, often subjective realm of pain and trauma, psychology and motivation there may be many intervention and intervening factors beyond a professional’s control, including operational policy and procedure. (For example, when talking VT, an overwhelming “doing more with less” caseload size, insufficient worker input in relevant practice issues and decision-making, quality of supervisory support, as well as organizational productivity “numbers” for both people services and paperwork obligations all need to be objectively evaluated.)

 

If a caregiver minimizes the uncertainty of this mindscape and landscape, and is quick to perceive a client’s or patient’s limited progress as a personal indictment of provider competence (or of the client’s worthiness), or conversely, believes she should be able to reach and rehabilitate just about everyone on her caseload (or management is quick to use a similar judgmental mindset), then accountability expectations need to be scrutinized.

 

Egoals and Early Pain

 

In fact, such expectations may indicate this individual (or organization) is less goal-focused and more egoal-driven, that is, the person’s motivation on some level is not mainly determined by the client or infirmed family member’s needs. What’s troublesome is that the helper’s thoughts, feelings, and actions are often covertly driven by approval, power, and/or status needs and, even more, propelled by punctured pride and a thirst for vindication against previous intimidators or abusers. Actually the motivational foundation is often subconscious (early childhood) wounded pain, shame, and smoldering rage. And this lurking pain can too easily and disingenuously devolve into the rigidly righteous or “heroic” HE MAN or sacrificing or savior-oriented SHE MAN complexes.

 

Humanitarian work as a profession is often characterized by self-neglect, toughing it out, risk-taking, and denial of personal needs. Regarding the HEMAN and SHE MAN complexes, the H stands for “Humiliation” and the E stands for “Emptiness” while the S stands for “Self-Sacrificing.” Some people are attracted to healing work to fill their own emptiness and diminished ego or self-esteem; others over time succumb to feelings of exhaustion and emptiness. Remember, burnout is less a sign of failure and more that you gave yourself away! “Expectation, Egoals, and Early Pain” explain much about this erosive spiral; all can contribute to more severe vicarious trauma.

 

3. Enthusiasm and Escapism, Exceptionalism and Exorcism. Fire and fervor can be wonderful qualities to spark and fuel any meaningful endeavor, especially one involving service to others. People may be inspired by your warmth and heat, energy and ideals. However, unbounded and unrestrained enthusiasm eventually runs into a brick or burning wall. As was noted in the ‘60s classic The Phantom Tollbooth, “Fantasy and imagination suggest how the world might be. Knowledge and experience limit the possibilities; melding the two yields understanding.”

 

As we’ll see in Part III, escape as in “R & R” – Rest and Recreation – is one of the strategies for preventing or recovering from VT. And momentary escape or controlled flights of fantasy can prime the imagination and originality pump. But if escape becomes constant flight along with “rationalization and running away,” then trauma or drama will likely be your travel companion.

 

When enthusiasm cannot grapple with some limited or restrained possibilities and boundaries, then, according to Headington Institute, “Research on stress and coping suggests that VT will be more problematic for people who tend to avoid problems or difficult feelings, cannot ask for support, blame others for their difficulties, shun self-reflecting mind and soul searching as weakness, or withdraw from others when things get hard.”

 

Exceptionalism and Exorcism

 

Sometimes “headstrong” enthusiasm may morph into rigid idealism, eventually fomenting a fundamentalist doctrine. Such an extremist: a) knows there’s only a single axiomatic truth or “one right way,” b), is motivated to escape one’s past pain and shame, or becomes blind to the multifaceted nature of “reality” and “truth,” c) denies or blows off taking responsibility for one’s own actions or errors, d) labels non-believers as sinners if not infidels and enemies, and e) sees strict and virtuous behavior as a passport to entitlement and exceptionalism or infallible judgment and retribution. Alas, with such a doctrinaire paradigm “heaven on earth” may well transmute into “there’s hell to pay.”

 

Speaking of hell brings us to our final “E” – actually an “E” phrase: “Emotional and Existential Exorcism.” When an individual has a history of personal trauma, especially a trauma that matches or has some parallels with the trauma of the person or people he is assisting (for example, someone who was sexually abused as a child working with rape victims, that is, someone with “intense empathy”) personal therapy and/or careful supervision is essential for balancing emotional involvement and detached concern. Guided awareness is necessary to help manage the emotional identification and countertransference – whereby the helper unknowingly projects his prior painful experience onto the client – thereby confusing the emotional boundaries, needs, and realities of this acutely intimate and mutually vulnerable encounter. (Such identity-boundary confusion and the need for “virtuous and vicarious control” is often a hallmark of codependent relating.) And the Headington Institute adds, “This risk factor may be especially relevant for staff (that) have often survived the same events and suffered similar losses as those they are assisting. In addition, those with a personal trauma history who are (consciously or unconsciously) using humanitarian work primarily to seek their own recovery instead of engaging in personal healing processes, may have a harder time with VT.”

 

My explanation is that the person infusing his or her recovery issues and needs in this so-called healing process is engaging in an “exorcism,” the ceremony that seeks to expel an evil spirit from a person or place (TheFreeDictionary.com). But the real focus of the exorcism is not the person who recently has undergone trauma. The actual target is the “healer” himself, now engaged in an invariably intense and inverted exorcism, attempting to expel his or her own demons in the guise of purging, purifying, and restoring another. In fact, I have come up with “Three Types of Exorcisms”:

a) emotional exorcism or “emoto-cism”: ridding oneself of present pain, loss, angst and/or rage, and disorientation while attempting to subjugate one’s “Intimate FOE: Fear of Exposure,”

b) existential exorcism or “exis-cism”: ridding oneself of identity confusion and uncertainty about one’s future competence, worthiness, and direction while attempting to subjugate one’s “Intimate FOE: Fear of Exposure,” and

c) echo exorcism or “echo-cism”: ridding oneself of ever reverberating, painful, accusatory overt/covert voices and memories, including “grief ghosts” (email stressdoc@aol.com for my series on “Burnout, Burn-in, and Grief Ghosts”) while attempting to subjugate one’s “Intimate FOE: Fear of Exposure.”

 

Hopefully, these “Ten Key, Double-Edged Characteristics of that “Everything for Everyone, Everywhere, Every Time, and Invariably Exhausted Type ‘E’ Personality” illuminate potential links between codependency and the propensity for Vicarious Trauma.

 

Closing Summary

 

Part I of this series has examined the realm of Vicarious Trauma and Caregiver Burnout, illustrating its common occurrence among many roles and relations in contemporary society, and how the humanitarian if not heroic efforts of helpers and healers can without sufficient awareness and supervision, become a disguised and hazardous process of codependency. Part II more specifically examines some common psychological dynamics between Codependency and Vicarious Trauma, especially how “E”asy it can be for an excess of empathy and enthusiasm to transmute into unrealistic expectations, egoals and varieties of inverted exorcism.

 

Part III will focus on the ways family-cultural systems and organizations foster VT amongst its members and how personal helpers and professional healers as well as organizations can prevent the likelihood of Vicarious Trauma and Caregiver Burnout. Until then…Practice Safe Stress!

 

Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is an acclaimed keynote and kickoff speaker as well as "Motivational Humorist & Team Communication Catalyst" known for his interactive, inspiring and FUN programs for both government agencies and major corporations. In addition, the "Doc" is a Team Building and Organizational Development Consultant as well as a Critical Incident/Grief Intervention Expert for Business Health Services, a National EAP/OD Company. He is providing "Stress and Communication, as well as Managing Change, Conflict, and Team Building" programs for the Army Community Services and Family Advocacy Programs at Ft. Meade, MD and Ft. Belvoir, VA as well as Andrews Air Force Base/Behavioral Medicine Services. A former Stress and Violence Prevention Consultant for the US Postal Service, 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 info on the Doc's "Practice Safe Stress" programs or to receive his free e-newsletter, email stressdoc@aol.com or call 301-875-2567.

 

(c) Mark Gorkin 2012

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