More Fun & Joy

"Look for the funny side of life. Enjoy what you do. Create an atmosphere of caring, support, and fun in your work. When you are having fun you work more effectively and efficiently"

--Author and therapist Catherine Fenwick, known for conducting humor seminars around the world and running an online laughter therapy center

Secondary Traumatic Stress & Professional Resilience

Gentry, Baranowsky, and Dunning (2002) note that all professional caregivers will at some point in their professional lives be forced to confront secondary traumatic stress and burnout. Working with traumatized clients indisputably has negative effects upon the mental health professional, including social workers (Ting, 2005).

The effects of secondary traumatic stress are believed to impair the ability of clinicians to effectively help those seeking their services (Figley, 1999). Professionals experiencing secondary traumatization are believed to be at higher risk to make poor professional judgements such as misdiagnosis, poor treatment planning, or abuse of clients than those not experiencing secondary traumatization (Rudolph, Stamm, & Stamm, 1997).

Ascher (1992) referred to urban school studies that focused on working conditions as a key to retaining good teachers. Such conditions are associated with better teacher attendance, more effort, higher morale and a greater sense of efficacy in the classroom. These conditions involve:

• Strong, supportive principal leadership
• Good physical working conditions
• High levels of staff collegiality
• High levels of teacher influence on school decisions
• High levels of teacher control over curriculum and instruction (Hammond, 1996)

Questions

What is the relationship between practice wisdom/knowledge and research?

What is and what is possible?

Is there inherent conflict that is insurmountable or is integration possible?

Post-Positivist Epistemology

“Scientists are in the business of providing reasonable justifications for their assertions, but nothing can make assertions absolutely safe from criticisms and potential overthrow" (Phillips, 1990).

How are we worse for the wear? What can be done about it?

"Constructivist self-development theory is interactive in that it view's the therapist's unique responses to client material as shaped by both characteristics of the situation and the therapist's unique psychological needs and cognitive schemas."

"The effects on therapists are pervasive, that is, potentially affecting all realms of the therapist's life; cumulative, in that each client's story can reinforce the therapists gradually changing schemas; and likely permanent, even if worked through completely."

In 1966, Carl Jung "originally conceived that an 'unconscious infection' may result from working with the mentally ill."

In 1976, English described this process: "As the emotional needs and distresses of people in difficulty were presented to me, I not only felt them through the process of empathy, but I also found I tended to absorb them within myself as well."

In 1978, Chessick hypothesized that "conditions of depression and despair in one's clients (which he calls 'soul sadness') can be contagious."

In 1985, Farber cited "evidence that the client can transfer his or her pathology to the therapist."

In 1987, Guy cited "research which supports the notion that doing psychotherapy can be dangerous to the psyche of the therapist."

In 1990, McCann presents her "notion of vicarious traumatization...implies that much of the therapist's cognitive world will be altered by hearing traumatic client material."


In 1999, Figley described secondary traumatic stress and compassion fatigue as "a reaction from indirect exposure to a traumatic event...as a result of the therapist's own empathy towards a traumatized client in addition to the therapist's own secondary experience fo the traumatic material."


In 2007, Hernandez formulates "a new concept: vicarious resilience. It addresses the question of how psychotherapists who work with survivors of political violence or kidnapping are affected by their clients' stories of resilience. It focuses on the psychotherapists' interpretations of their clients' stories and how they make sense of the impact that these stories have had on their lives."

In 2007, Radey and Figley, coin the construct "compassion satisfaction" in the "broader context of positive social work...a paradigm shift towards identifying the factors that lead clinical social workers toward human flourishing in their field...compassions satisfaction or feelings of fulfillment with clients, rooted in positive psychology and expanded to incorporate the social work perspective. The model suggests that affect, work resources, and self-care influence clinicians' positivity-negativity ratio, which in turn can result in compassion satisfaction. To maximize compassion satisfaction, research, education, and training should consider how classroom instruction and workplace policies can promote the most success among clinical social workers."

There is energy exchange between client and therapist. What do we know about this exchange and how can we manage it in the best interest of both parties?

I frequently get massages for health maintenance and self-care. I forego other treats in favor of this one. I have had massages by practitioners up and down the State of California. On a few occassions, I walked in congested and by the end of the hour, walked out breathing easy. On both occassions, I heard my masseuse walking out with those sniffles. I wondered if there had been an exchange of energy and wondered how it had been transfered. After this experience, I asked two different practitioners about what they were taught and how they deal with their clients' release of toxins and energy. They both said that they set their intention at the outset of the massage to release the energy that no longer serves the client, but not take it on.

What are mental health professionals taught about this? We are taught about setting limits and boundaries. Understanding where we begin and end. Empathizing but not becoming responsible for our clients problems. But it appears that empathizing is both a vehicle for the clients' healing and a potential risk hazard for the therapist.

I remember working in South Los Angeles as a beginning social worker and feeling overwhelmed by the sense of hopelessness and despair that is "in the air." I remember thinking that it tapped into my own experience growing up in East Los Angeles and the air of hopelessness that can linger there. I remember wondering if this pre-existing vulnerability made it difficult for me to work in this environment and with this population. That is when the concept of resiliency saved my life. It reminded me of the other side of the story. The truth that despite the risks, most of my classmates were indeed living, loving and working well in adulthood. There is hope, despite the risks.

Early on in my career as a school social worker, I used to get weekly massages for $40. That gifted healer taught me that rather than release the energy accumulated at work throughout the week (my massages were on Friday evening), I could notice the energy coming towards me and shunt or redirect it away from me and not allow it to enter and be processed by my own body. She was like that. She spoke metaphysically and I usually only half-understood. But over time, I practiced this somehow. The visual metaphor helped to give meaning or grounding to the experience - like a guided visualization.

Because of neuroscience research, we now know about mirror neurons and how two people can sync up, right-brainwise, that is. Reevah called this, in the tradition of psychodynamic psychotherapy, knowing a lot about a person by how they make you feel when you are with them for five minutes. In Eastern medicine, this might be called energy or chi/qi. If this is happening between us, it would seem beneficial to explore this further, for all our sakes.

I am fascinated by what we can learn about this transfer of energy, how to manage it and what purpose it serves.

References:
Radey & Figley. (2007). The Social Psychology of Compassion,
Hernandez, Gangsei, & Engstrom. (2007). Vicarious Resilience: A New Concept in Work With Those Who Survive Trauma
McCann & Pearlman. (1990). Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims.

Does the impression a provider has about a patient affect treatment decisions?

Abstract:

The goals of this study were to define the psychological and personality characteristics that physicians attribute to their patients and to determine whether these attributions affect treatment decisions. A Physician Attribution Survey was developed to achieve the first goal, and demonstrated that likeability and competence were salient features of the physician-patient relationship. Videotapes were then created demonstrating patients with three different combinations of likeability and competence: likeable-competent (L-C), unlikeable-competent (U-C) and likeable-incompetent (L-I). After being pre-tested with several samples of health professional students, the tapes were shown to 93 primary care physicians. These physicians then completed both a Physician Attribution Survey and a Patient Management Problem describing their proposed treatment.

There were significant differences in treatment on five of nine treatment dimensions, depending upon the characteristics of the patient.

First, the Likeable-Competent patient would be encouraged significantly more often to telephone and to return more frequently for follow-up than would the Likeable-Incompetent or Unlikeable-Competent patient.

Second, the staff would educate the likeable patients significantly more often than they would the unlikeable patients.

Third, the physician would offer significantly more patient education to incompetent patients than to competent ones.

Fourth, the unlikeable patient would receive significantly more interviewing regarding the psychological aspects of care than would the likeable patients.

Fifth, the Likeable-Competent patient would receive augmented medication more frequently than either the Unlikeable-Competent patient or the Likeable-Incompetent patient.

There were no differences in the use of the physical examination, referral to staff, frequency of return or hospitalization based on the personal characteristics of the patient, although some of these variables were significantly affected by the attributed disease. There were no interactions between patient characteristics and disease as determinants of management.

These findings have implications for medical education, studies of medical decision-making, and assessments of physicians' quality of care of patients. The methods developed provide a basis for more extensive and detailed studies of the explicit and implicit theories physicians have regarding the relationship between the personality characteristics of their patients and treatment decisions.

Reference:
Perceived likeability and competence of simulated patients: Influence on physicians' management plans, Barbara Gerbert, Social Science & Medicine, Volume 18, Issue 12, 1984, Pages 1053-1059.

Double Standards that Suck for Women

Abstract: Social-role theory suggests that women are likely to be penalized for acting assertively (or in other ways that are counter to stereotypical expectations). Using a sample of 76 supervisor–subordinate dyads, this research investigates the reactions of supervisors to the use of intimidation strategies by men and women working in a law enforcement agency. The findings suggest that, among female employees, the use of intimidation tactics of impression management is negatively related to supervisor ratings of likeability. In contrast, among males, the use of intimidation is unrelated to supervisor ratings of likeability. In addition, for females, the use of intimidation is unrelated to performance ratings; among male employees, though, the relationship between intimidation and performance evaluations is positive. The implications of this study for management practice and future research are also discussed.

So do you play the game and conform with expected norms (stereotypical expectations) or do you strive to use your voice, ask for what you need or want, and be authentic at work despite the risks and costs?
I get it that charm goes a long way, I appreciate it as much as the next person. But isn't that how our country got G.W. Bush, when Karl Rove, with considerably less charm and a definite agenda, ran the show? Don't sociopaths and con artists use charm to their advantage (and our disadvantage)? Isn't charm how we get hoodwinked?
I understand that my desire for a more direct/honest form of communication will never take hold, at least half of us or probably more on most days, just don't want to hear it or don't want to risk being the one to say it. But can we expect at least an inching toward relationships, interactions and decision-making with our eyes open?
Reference: Counternormative impression management,likeability, and performance ratings: the use of intimidation in an organizational setting
MARK C. BOLINO AND WILLIAM H. TURNLEY(2003)
Journal of Organizational Behavior, 24, 237–250