A recent workshop with allied health professionals has the Stress Doc reflecting on provocative workplace power struggles. He also illustrates a variety of systemic and interpersonal intervention strategies and skills that transcend the medical setting. And, for a little lagniappe...enjoy a "Shrink Rap."

Disarming Aggression and Organizational Power-Struggles
From the Heart of Team Focus to the Art of "Tongue Fooey"

A recent workshop with nurses and social workers highlighted a familiar medical institution conflict: the dysfunctional power-struggles between the mostly male doctors and the mostly female health professionals. And in the context of cost-cutting managed scare and utilization review, doctors, not surprisingly, feel their professional decision-making and procedural turf is continuously being eroded. Alas, some physicians will openly or passive- aggressively act out their anger, fear and loss of control. Some even play patients against the allied health staff, much like a Parent A in a dysfunctional family (in this analogy, "the doctor") who creates an unhealthy alliance with a child ("the patient") against Parent B ("the nurses-social workers"). This alliance: a) distorts the child's view of Parent B (they become "The Uncaring Wicked Witch"), b) gets the child to side with "nice guy" Doctor-Parent A and c) the Child-Patient becomes a mouthpiece for Parent A and overtly or covertly attacks Parent B. The classic family triangle maneuver. Actually, it's an extended family operation…We must not overlook "Critical, Judgmental and Frugal or Tight-Fisted Uncle Insurance Company."

The workshop generated a variety of intervention strategies - systemic leadership, peer support and verbal and non-verbal, one-on-one disarmament skills, i.e., "The Art and Practice of Tongue Fooey!" Lets start with the big picture:

1. Enlisting Top Management Leadership. Sometimes there is a role for a Godfather or Matriarch when a "family" is behaving criminally or cannibalistically with each other. My recommendation: the President of the Hospital needs to meet with supervisors and/or representatives from these two warring health camps - the doctors and the joint intake-utilization review team. Then both sides need to agree to participate in a field-tested, combat strategies at the burnout battlefront workshop - "Practicing Safe Stress: Disarming Anger and Building Team Morale through Humor." And guess who's rested and ready…and it's not Dan Quayle! (Gee, he could certainly benefit from a communication and conflict resolution skills program.)

Seriously, a dynamic session that allows these warring professionals to better appreciate and to laugh at the stressors and tensions from the other's perspective is a key step towards fostering empathy for "the enemy." Engaging in real yet safe interactive team exercises helps shift the isolated competition--interdependent cooperation balance. (Email stressdoc@aol.com for my article, "On Becoming a Psychohumorist," for philosophy, techniques and strategies on using humor and interactive exercises.)

2. Creating Peer Support. Let's not just pick on those patriarchal males. The women nurses and social workers were also being beaten down by the Director of Utilization Review ("UR Us"). This woman was heavy-handed and harsh-mouthed. The allied health professionals spoke of the weekly verbal bashings in "the hot seat." This Tyrannosaurus Administratus was pushing the nurses-social workers to cut the length of patients' stays and reject "unnecessary" medical procedures. The participants' bent heads upon speaking, weighed down by hurt and humiliation, eyes diverted from mine, told me these folks were in a classic abusive, battered-spouse/battered child-like situation. (Her throwing threats of dismissal darts was a favorite intimidation tactic.)

First, we had to help a supervisor in the room not minimize the severity of this administrator's behavior. Yes, she's under considerable performance pressure herself. Nonetheless, don't enable or explain away the depth and breadth of such destructive and demoralizing leadership style. This supervisor is somewhat trusted by Herr Adminstrator. Once we got this supervisor on board, the group agreed to select one nurse, one social worker along with the aforementioned supervisor to meet with the Tyrant Queen. The goal: to make the UR staff meetings more productive for all concerned and to have the group help this leader meet her mission. (Sometimes you just have to use tactful language and to soothe and support a troubled ego.) Hopefully, this planning meeting will set the stage for a full group gathering and the establishment of a bottom-line objective: making constructive and participatory communication (not just a top down mode) a vital group norm. And, of course, built into this process, is calling a "time out" when conflict and tensions are escalating precipitously.

Tuning In. Finally, as I suspected, this dozen-member UR team had weekly staff meetings that are totally task- and time-driven. I shared my concept of "the wavelength section" of team meetings. For example, in an hour meeting, the last fifteen minutes should be set aside for discussing how the group is working as a team; how people are feeling and relating; are folks bumping into and/or supporting each other. Create time and space for acknowledging and appreciating individual and group practices and partnerships that are stress relieving and morale building. And this wavelength segment can rotate leadership; all members get a chance to facilitate. (And why can't there be family wavelength meetings as well?)

3. Utilizing Verbal and Non-Verbal Disarmament Skills. One of the nurses set the tone for the imaginative use of humor in disarming an aggressor. The battleground was the telephone; the adversary was her husband. When hubby calls, being overly loud and demanding, displacing frustration with his work onto her, a disarmingly ingenious ritual is triggered. Our heroine starts scratching the phone receiver and delivers a subtly powerful line of her own: "With all that yelling there's an awful lot of static on the line." She claimed this procedure acts like a whack on the head. Her husband quickly regains some awareness and emotional equilibrium. (Ah, I can hear the hallelujah chorus sighing, "If only more men were so easily trainable.")

Verbal Martial Arts. I also shared an existential encounter at a previous conflict management workshop for beleaguered nurse supervisors and their administrator. Voicing the frustration for the collective, the administrator, with barely disguised anger, exasperatedly asks, "What happens if you're just tired of accommodating these (mostly male) doctors, being the one who always has to bend? Then what?" As the expert, I definitely felt on the hot seat. Fortunately, only time froze, my brain was cooking. (Hey, I guess when you're on the "hot seat" it's not so bad having brains where you sit…;-) I suddenly replied, "Try telling the doctor, 'I may not be my normal cheerful self today.' When he asks, 'Why not?' say, 'I hurt my back.' Then, when he inquires in a somewhat haughty manner, 'Now how did that happen?' reply humbly, 'I'm not sure but, lately, I think I've been bending over backwards for too many people.'" Both groups of nurses roared their approval.

Diplomatic Aggression. When issues such as managing conflicts and defusing power struggles cry out or muscle their way onto the workshop agenda, I invariably respond with a story and an exercise (the latter to be shared in a future newsletter). The story dates from my computer virgin, pre-cybermania phase. I was bringing word processing work to a woman who owned an office services business. Like myself she was a classic, Type A ex-New Yorker. (Both of us from Queens.) Anyway, I handed Miss A two stacks of paper, white and gray, along with a typed draft to be word-processed. Upon picking up the work, I discovered the work had been copied on just one of the stacks. Having barely finished declaring that I need the work on both sheets of paper, our business tiger sprung into her "being offensive is the best defense" mode: "Well how am I supposed to know what to do if you don't know how to give clear instructions!"

Suddenly, it feels like I've been speared in the gut. After recoiling momentarily, I purposefully raise myself up, lean forward, deepen my voice and moderately but noticeably increase the decibels. Remaining in control, I put up my hand, the open palm facing her, held at shoulder level, about eighteen inches from my body, two feet away from touching her, and firmly announce, "I'm not so sure!"

Now Ms. Aggressor, stopped in her warpath, lowers her volume and tone a bit and says, "Well if there was a problem in communication, it takes two." (I told you…she's a New Yorker. Ground is given grudgingly.)

Reflecting ever so briefly, I respond with conviction: "That I can live with." The confrontation is over. What happened here? How did I disarm my attacker? (Does anyone feel I wimped out?)

Several judgment calls and interventions are operating - some simultaneously, some sequentially:

1) "I'm not so sure." On a verbal level, I'm taking a diplomatic approach to her blaming "acc-you-sation" regarding my alleged inability to give instructions. I'm implying (and this is certainly possible, especially in my "New York Minute Mode") that perhaps I did not give clear instructions. However, am I taking all the blame for the problem? Definitely not. I'm using a mutual face-saving strategy - sharing the responsibility.

2) Non-verbal language. While my words are tactful, my nonverbal communication such as tone of voice, serious facial expression, body language - being upright, moving forward, giving a hand signal, etc., is unambiguously clear. My essence declares, "Stop! I won't accept or allow such verbal hostility to continue." And my purposeful and passionate retort deflates some of her self-righteous steam. However, this is not a trivial ego.

3) The existential moment. My antagonist now delivers her ego-saving encounter: "Well, if there's a problem in communication, it takes two." Does this woman have an attitude, or what? I mean, if you are not left speechless, dumfounded, or just walk away muttering to yourself, what do you really want to do in this situation? You want to shake this person silly. Fortunately, the self-protective parry, "I'm not so sure," was like a quick acting antitoxin procedure for a snake bite, removing the verbal poison from my system. This maneuver also reduces the likelihood of my succumbing to a state of blind or smoldering rage.

Now I'm in a position to evaluate and play out this tenacious tango more objectively. Too often we get entangled in the power struggle web. When a challenging attitude is in our face, the instinct is not just to set up a boundary, but often to put someone down: it's win-lose, right-wrong. And we miss the essential issue.

Once Miss A dropped her overtly hostile blaming, then I could take the high road. Hey, if I stopped negotiating or problem solving with all folks with a bothersome attitude in Washington, DC…I might as well join a monastery. Abuse I won't accept; attitude I can live with. The greater goal is clear: I want us to get back on the same page and get the project accomplished. (Miss A does very good and efficient work. Granted, sometimes, you pay an unexpected price.)

So don't get sidetracked by ego- or pride-driven issues of being right and vaingloriously victorious. It may be enough to hold on to the self-satisfying words of French author, Andre Gide, from his book, The Immoralist: "One must allow others to be right…It consoles them for not being anything else!" (Sometimes a touch of self-righteousness just can't be helped. For example, see my lyrical ode below: "The Self-Righteous Rap.")

In conclusion, returning to the workshop, three powerful interventions emerged for dealing with organizational, hierarchical and dysfunctional power struggles: 1) firmly encouraging top management to play a constructive mediator role between warring parties, 2) enlisting peer support -- a tactical display of strength in numbers -- to counter abusive authority, and 3) employing a variety of nonverbal and verbal communication skills and strategies for disarming those ever-present stress carriers. With consistent usage, these tools will become a natural part of your organizational survival kit and, most important, you'll be…Practicing Safe Stress!

The Self-Righteous Rap

You didn't know life is all right or wrong Your victor or victim…or just don't belong There is no question; life's but bleak or white Forget ambiguity when hooked on Freud-lite.

What happened to subtlety and shades of gray? The world's drinking and shrinking its brain cells away The rage that's stirred by mental oppression Compels this shrink rap regression confession.

When others demand you follow their lead (For they, of course, realize just what you need.) Don't get upset over autonomy Just ask where they go for a lobotomy.

Or, are you a martyr in self-imposed prison? Denying your needs becomes heaven's vision. When you've been hurt you just quietly pray But wish you could scream, "Go ahead, make my day!" (Pow, Pow)

There's a real craft to fine confrontation But first let go of those "acc-you-sations" Like "It's all your fault" or "you drive me crazy" All this reveals is a mind that is lazy.

Be thoughtfully outraged and learn to reframe Make the strange familiar, the familiar strange. We really are at a critical juncture So little time…so many egos to puncture. (Pop, Pop)

To disarm those who intimidate you Some self-defense lessons in the art of "tongue fooey." With an all-knowing boss who wants to be feared, hey One more grad of the Institute for the Compassion-Impaired. The Institute for the Compassion-Impaired.

Or, if you've had enough of that self-righteous scam: "I am as important as I think I am." You don't have to listen to this bovine fodder Just say you're allergic; it makes your ears water.

And for those who demean with, "Grow up, act your age" Here's some advice that's worthy of a sage While only young once, it's true, however, You intend to be immature forever.

So if life's a soap opera: "As the Head Swells" No need to be walking on those ego shells. When the righteous start ranting they're all of a kind The bigger the ego, the smaller the mind!

© Mark Gorkin 1992 Shrink Rap Productions

Mark Gorkin, LICSW, the Stress Doc, a psychotherapist and nationally recognized speaker, trainer, consultant and author, is also known as AOL's and the internet's "Online Psychohumorist" ™. Check out his USA Today Online "Hot Site" website - www.stressdoc.com  and his page on AOL/Online Psych, Keyword: Stress Doc

** Join the Doc's "Shrink Rap and Group Chat" on AOL/Digital City, Tuesdays, 9-10:30pm EDT (AOL Members Only) -- Dig City Promo - Stress Doc.

** The Stress Doc's Work Stress Q&A  -- Ask the Stress Doc  is now featured on five Portals to the Web, including

1. Netscape Netcenter  
2. Compuserve
3. Digital City
4. MCI
5. AOL.COM Washington, DC - Home

All five portal links can be shared with and are operational for both users of AOL and the Internet.