Applying Psychological First Aid to workplace bullying and mobbing

Is Psychological First Aid a useful tool for coaches, union representatives, employee assistance program specialists, lawyers and legal workers, peer group facilitators, and others who are providing support to those who have experienced workplace bullying and mobbing?

I recently completed an online, continuing education course in Psychological First Aid (PFA) (link here), offered by Johns Hopkins University via Coursera, one of the most popular providers of open enrollment, university-level online courses . The Johns Hopkins course is taught by psychiatry and behavioral sciences professor George Everly, a leading authority on PFA and co-author, with Jeffrey Lating, of The Johns Hopkins Guide to Psychological First Aid (2017). The course itself takes about 8-10 hours to complete, ideally over a span of a few weeks. The course itself is free of charge, with an added fee for a certificate of completion.

Dr. Everly developed his PFA model to provide first responders who are not trained as counselors with knowledge and training to assist those who have experienced traumatic events, such as displacement due to wars, severe weather events, and other man-made and natural disasters. His model is called “RAPID PFA.” Here are the sequential steps covered in the course:

  • R — “Establishing Rapport and Reflective Listening”
  • A — “Assessment/Listening to the Story
  • P — “Psychological Triage/Prioritization
  • I — “Intervention Tactics to Stabilize and Mitigate Acute Distress”
  • D — “Disposition and Facilitating Access to Continued Care”

The final piece of the course relates to the importance of self-care for those providing PFA.

At no time does PFA call upon someone to render a clinical diagnosis. (That would be wrong on so many levels!) Rather, PFA is designed to help non-clinical individuals facilitate emotional and practical support for those who have experienced traumatic events. This may include, when necessary, referrals to professional mental health and medical care, as well as other tangible forms of assistance.

PFA for workplace bullying and mobbing?

I’ve given a lot of thought as to how Dr. Everly’s RAPID PFA model can be deployed to help those who have experienced severe work abuse. I think it’s a very helpful model for non-clinical folks who are providing support to targets of workplace bullying and mobbing. RAPID PFA not only offers a useful, simple framework for providing support and guidance, but also sets markers for when referrals to professional mental health care may be needed.

Research examining the RAPID PFA model has validated its effectiveness as an early intervention tool, especially when rendered soon after a precipitating event. Herein lies a challenge toward applying PFA to workplace abuse situations: All too often, the mistreatment builds over time, especially in the more covert or indirect forms. In such cases, there may be no single, major traumatic event that prompts someone to seek help. Accordingly, targets frequently wait to seek assistance, as work abuse can take an inordinately long time to process and comprehend. In such instances, a lot of emotional damage may have taken place before someone seeks help.

Finally, the RAPID PFA model is designed to help care providers make fairly quick assessments under scenarios where large numbers of people may suddenly need help. By contrast, we know that many targets of work abuse feel the need to share their stories in significant detail. It is a natural and understandable dynamic, but it can make the process of identifying next steps anything but, well, rapid.

Nevertheless, the RAPID PFA model holds a lot of promise as an early intervention protocol for helping people deal with workplace bullying and mobbing situations. For those who want to provide initial support and guidance to targeted individuals, it provides a straightforward, evidence-based approach for doing so, while helping us to understand appropriate boundaries between lay assistance and professional mental health care.

Published: “On anger, shock, fear, and trauma: therapeutic jurisprudence as a response to dignity denials in public policy”

The International Journal of Law and Psychiatry, has just published my article, “On anger, shock, fear, and trauma: therapeutic jurisprudence as a response to dignity denials in public policy.” Through May 18, you may click here to obtain free access to the article.

This piece is not about employment law and policy, but it embraces a relevant theme, namely, how the making and content of public policy can either advance or deny our dignity. Here’s the article abstract:

This article asserts that when policymaking processes, outcomes, and implementations stoke fear, anxiety, and trauma, they often lead to denials of human dignity. It cites as prime examples the recent actions of America’s current federal government concerning immigration and health care. As a response, I urge that therapeutic jurisprudence should inform both the processes of policymaking and the design of public policy, trained on whether human dignity, psychological health, and well-being are advanced or diminished. I also discuss three methodologies that will help to guide those who want to engage legislation in a TJ-informed manner. Although achieving this fundamental shift will not be easy, we have the raw analytical and intellectual tools to move wisely in this direction.

Although it’s a scholarly journal piece, it’s relatively short (10 pp.) and accessible to non-legal folks.

The article appears as part of a special issue honoring Prof. David Wexler (U. Puerto Rico/U. Arizona), a co-founder of the therapeutic jurisprudence movement. It was co-edited by Profs. Amy Campbell (U. Memphis) and Kathy Cerminara (Nova Southeastern U.). The journal is hosted by the International Academy of Law and Mental Health.

Shawn Ginwright: From “trauma informed care” to “healing centered engagement”

Today I’m happy to share the work of Dr. Shawn Ginwright, a San Francisco State University professor who devotes himself to challenges facing young people in urban areas. Dr. Ginwright asserts that rather than focusing on “trauma informed care,” we should embrace a framework of “healing centered engagement.” Although he is a practitioner of trauma informed care, he sees some limitations in the concept. Here’s a snippet of what he wrote last year in Medium (link here):

More recently, practitioners and policy stakeholders have recognized the impact of trauma on learning, and healthy development. In efforts to support young people who experience trauma, the term “trauma informed care” has gained traction among schools, juvenile justice departments, mental health programs and youth development agencies around the country.

…While trauma informed care offers an important lens to support young people who have been harmed and emotionally injured, it also has its limitations. I first became aware of the limitations of the term “trauma informed care” during a healing circle I was leading with a group of African American young men. All of them had experienced some form of trauma ranging from sexual abuse, violence, homelessness, abandonment or all of the above. During one of our sessions, I explained the impact of stress and trauma on brain development and how trauma can influence emotional health. As I was explaining, one of the young men in the group named Marcus abruptly stopped me and said, “I am more than what happened to me, I’m not just my trauma”. I was puzzled at first, but it didn’t take me long to really contemplate what he was saying.

The term “trauma informed care” didn’t encompass the totality of his experience and focused only on his harm, injury and trauma.

Toward healing centered engagement

Ginwright goes on to suggest that we should look at healing from trauma in a more holistic way:

What is needed is an approach that allows practitioners to approach trauma with a fresh lens which promotes a holistic view of healing from traumatic experiences and environments. One approach is called healing centered, as opposed to trauma informed. A healing centered approach is holistic involving culture, spirituality, civic action and collective healing. A healing centered approach views trauma not simply as an individual isolated experience, but rather highlights the ways in which trauma and healing are experienced collectively. The term healing centered engagement expands how we think about responses to trauma and offers more holistic approach to fostering well-being.

A healing centered approach to addressing trauma requires a different question that moves beyond “what happened to you” to “what’s right with you” and views those exposed to trauma as agents in the creation of their own well-being rather than victims of traumatic events.

Although I have written about the importance of understanding psychological trauma, I agree with Ginwright’s preferred framework. Being trauma informed is very important, but it’s just part of the process of healing centered engagement. Furthermore, we might also consider that healing centered engagement naturally incorporates the idea of post-traumatic growth, another important concept that I wrote about last year (go here for link).

Ginwright’s focus also reinforces what I’ve tried to communicate many times here, namely, that social problems must be scrutinized at both the individual and systematic levels. This includes examining the political, social, and economic cultures that create and enable abusive mistreatment of others. 

Applied to workplace bullying and mobbing

This is very relevant to workplace bullying, mobbing, and other forms of worker mistreatment. Severe work abuse can wreak havoc on an individual’s mental and physical health. It can significantly undermine one’s ability to pursue a livelihood and a career. These behaviors rarely occur in a vacuum. Rather, they are typically enabled by the organization and its leadership.

In other words, the actors in work abuse situations and their impacts are often multifaceted — or, to add a twist, negatively holistic. In response, then, we should look at preventing and responding to bullying and mobbing in a more positive holistic, systemic way.

Finally, healing centered engagement helps to focus us away from trauma or victimization as a defining status, without ignoring the underlying mistreatment, its effects, and frequent lack of accountability that come with it. As the young man in Dr. Ginwright’s youth group told him, “I am more than what happened to me, I’m not just my trauma.” 

Applied to law and public policy

Healing centered engagement carries a lot of significance for practitioners of therapeutic jurisprudence (TJ), a school of legal thought that supports psychologically healthy outcomes in legal proceedings and the creation of laws that advance individual and societal well being.

Among other things, how can lawyers, judges, and other practitioners support laws and policies that support healing centered engagement? How can our systems of justice and dispute resolution do the same? Healing from trauma is relevant to many, many aspects of the design and application of our laws and legal systems.

***

As I’ve written here before, I sometimes use this blog to share “pondering in progress.” I’m doing that here. I’ve got more thinking to do about this concept of healing centered engagement, but it resonates with me on many levels. I hope it prompts some useful thinking for you, too.

***

Additional notes

  • Dr. Ginwright later revised his Medium piece and added references for an Occasional Paper published by an Australian social services agency, Kinship Carers Victoria. You may freely access it here. For a YouTube video including Ginwright’s 2018 conference presentation, go here.
  • I serve on the boards of two organizations relevant to the commentary above, and I invite readers to learn more about them. First is Human Dignity and Humiliation Studies, a global network of scholars, writers, practitioners, artists, activists, and students who are committed to advancing human dignity and reducing the experience of humiliation. Go here for the HumanDHS website. Second is the International Society for Therapeutic Jurisprudence, a new non-profit organization dedicated to the mainstreaming of therapeutic jurisprudence perspectives in our laws and legal systems. Go here for the ISTJ website

***

If you’re on Facebook, please “like” my new Page for this blog and the New Workplace Institute, where I’m adding content that doesn’t appear in blog posts. Go here to sign up.

Boston Globe: Two important features on workplace bullying

Over the weekend, the Boston Globe published two lengthy features on workplace bullying. Both are detailed and compelling and worthy of our close attention.

Bullied in the state prison system

The Globe‘s Jenna Russell goes in depth on the story of former corrections officer Marycatherin DeFazio, who suffered years of savage bullying and sexual harassment while working for the Massachusetts state prison system. It is a terrible account of repeated verbal battering, sexual vulgarities, defamatory rumor-mongering, physical assault, and abandonment by co-workers that left her at severe risk of harm. DeFazio’s reports of the abuse to prison officials made no difference.

Like so many stories of severe, ongoing bullying and abuse at work, this one cannot be easily summarized. Russell does a superb job of explaining the personal and organizational dynamics, sharing plenty of nuances that are part of many bullying situations. She also makes brief mention of efforts to enact the anti-bullying Healthy Workplace Bill here in Massachusetts. You can read the entire story here; registration may be necessary.

Bullied in the process of becoming a doctor

Dr. Amitha Kalaichandran, a Canadian resident physician and medical journalist, provides an in-depth look at bullying and mobbing behaviors at the residency stage of medical training:

THERE’S NO QUESTION that bullying is endemic in medical education. One study revealed that about half of residents and fellows in the U.S. reported being bullied, most often by their attending physicians. Canadian researchers found that 78 percent of residents surveyed reported being bullied and harassed in their training, often by attendings or program directors. 

The mistreatment can be so severe that suicides of residents have been associated with it. And if the abuse alone isn’t bad enough, consider that it also negatively affects patient care.

This piece, too, is hard to capture in a few snippets and thus merits a full read. You can read it in full here; again, registration may be necessary.

Some background

In December 2017, the Globe became probably the first major newspaper in the U.S. to put a feature about workplace bullying on its front page, when it ran Beth Teitell’s excellent overview of workplace bullying and its impact on workers and workplaces.

This weekend’s coverage took the focus into a deeper level of understanding. I have to say that I hopefully anticipated both features. I provided background information to both Russell and  Kalaichandran as they were preparing their articles, and I could tell that they “got it” in terms of grasping the complexities of bullying, mobbing, and related behaviors at work. This was borne out by the quality of their published pieces.

We need more media coverage of this caliber in order to expand public education of the human carnage wrought by bullying, mobbing, and abuse in the workplace. Hat’s off to the Globe for providing two excellent examples this weekend.

***

If you’re on Facebook, please consider “liking” my new Page for this blog and the New Workplace Institute. Go here to sign up.

 

Forthcoming article: “On Anger, Shock, Fear, and Trauma: Therapeutic Jurisprudence as a Response to Dignity Denials in Public Policy”

Dear readers, later this year the International Journal of Law and Psychiatry, the peer-reviewed journal of the International Academy of Law and Mental Health, will publish my article, “On Anger, Shock, Fear, and Trauma: Therapeutic Jurisprudence as a Response to Dignity Denials in Public Policy.” Here’s the abstract:

This article asserts that when policymaking processes, outcomes, and implementations stoke fear, anxiety, and trauma, they often lead to denials of human dignity. It cites as prime examples the recent actions of America’s current federal government concerning immigration and health care. As a response, I urge that therapeutic jurisprudence should inform both the processes of policymaking and the design of public policy, trained on whether human dignity, psychological health, and well-being are advanced or diminished. I also discuss three methodologies that will help to guide those who want to engage legislation in a TJ-informed manner. Although achieving this fundamental shift will not be easy, we have the raw analytical and intellectual tools to move wisely in this direction.

If you’d like to read my author’s draft of the piece in a pdf, you may download it without charge from my Social Science Research Network page, here.

Genetic testing for workplace wellness program participants: Coming soon to a company near you?

Ten jumping jacks and a blood sample, please

It sounds like something out of a dystopian sci-fi novel, but Republicans in the U.S. House of Representatives are advancing a bill that would allow employers to require employees to undergo genetic testing in order to participate in voluntary workplace wellness programs. Workers who refuse may face significantly higher health care premiums as a penalty. Lena Sun reports for the Washington Post about the proposed Preserving Employee Wellness Programs Act:

Employers could impose hefty penalties on employees who decline to participate in genetic testing as part of workplace wellness programs if a bill approved by a U.S. House committee this week becomes law.

…Under the Affordable Care Act [a/k/a Obamacare], employers are allowed to discount health insurance premiums by up to 30 percent — and in some cases 50 percent — for employees who voluntarily participate in a wellness program where they’re required to meet certain health targets.

…But the House legislation would allow employers to impose penalties of up to 30 percent of the total cost of the employee’s health insurance on those [wellness program participants] who choose to keep such information private.

Currently the Genetic Information Nondiscrimination Act (GINA) prohibits employers and ensurers from using genetic information for discriminatory purposes. In addition, the Americans with Disabilities Act (ADA) prohibits discrimination on the basis of a recognized disability, which could be identified through genetic testing.

As Sun reports, the dozens of organizations that oppose this bill — which include “the American Academy of Pediatrics, AARP, March of Dimes and the National Women’s Law Center” — argue that the proposed legislation would substantially undermine the basic privacy protections provided by GINA and the ADA.

The bill has passed through the House Committee on Education and the Workforce, with all Republicans voting yes and all Democrats voting no.

If enacted into law, this means that if you want to participate in a workplace-sponsored program to stop smoking, lose weight, or learn mindfulness practices, then you can be required to give your genetic information to your employer as a condition for doing so. If you don’t want to provide a genetic sample but still want to join the wellness program, then your employer can boost your health insurance premiums by up to 30 percent.

The bill itself is alarming enough, but the door it opens is positively frightening. Even if it doesn’t become law, the fact that it has been quickly ushered through a House committee by a pure party line vote sends a disturbing signal about the kind of policy proposals that are holding sway in Washington D.C. today. These are not normal times, and we should all be paying close attention.

NPR report: Future doctors depict mentors as monsters

photo-284-2

Earlier this month, health journalist Julie Rovner reported for NPR on a class of medical students who were invited to draw comics depicting their training, workplaces, and relationships with mentors/supervisors. It’s not a pretty picture:

How stressful is medical training? So bad that in a class that encouraged medical students to express their feelings by drawing comics, nearly half of them depicted their supervisors as monsters, researchers say.

Students imagined the workplace as dank dungeons, represented supervising physicians as fiendish, foul-mouthed monsters, and themselves as sleep-deprived zombies walking through barren post-apocalyptic landscapes, the study authors, Daniel R. George and Dr. Michael Green, wrote Tuesday in JAMA, the journal of the American Medical Association.

In one particularly harrowing image, a student “depicted his supervising physician screaming at the medical team, causing one intern to urinate herself moments before having her head bitten off for possessing too little information about a patient,” the authors wrote.

Click to the full piece if you’d like to see some of the artwork.

This is yet more evidence that the health care workplace is a troubled one. In fact, last week I shared the story of a nurse who attempted suicide after enduring a prolonged course of bullying and harassment.

Because psychological abuse at work tends to roll downhill, it’s also likely that some of these doctors-in-training will take cues from what they’ve experienced and treat their colleagues and co-workers in a similar manner. In an August 2012 piece, I suggested that professional schools can be incubators for workplace bullying:

It has long been my belief that the seeds of workplace bullying are planted in professional schools that prepare people to enter occupations such as law and medicine.

You start with ambitious young people who (1) are used to being heralded as academic stars; (2) do not have a lot of life experience; and (3) tend to be driven, Type A achievers. You then put them in high-pressured educational environments that emphasize technical knowledge and skills and a lot of “left-brain” logical thinking. These degree programs don’t place a lot of emphasis on interpersonal skills and the development of emotional intelligence.

You then unleash them unto the world of work. Uh oh.

That post includes a summary of a New York Times piece about a resident doctor who terrified the medical students with his explosive behavior.

%d bloggers like this: