Osteopathic Journals and Research by Darren Chandler

 

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  1. Introduction

    Emotion not only affects the way people think and act but also determines judgement and information processing (Gong et al 2019). When in a better place the individual is more likely to process positive rather than negative information. Conversely, when in a worse place the individual is more likely to process negative rather than positive information.

    Many people misinterpret their own and other peoples’ emotional reactions, inappropriately express emotional outbursts or act negatively under various pressures. This has harmful consequences to themselves, others and to society as a whole (Drigas & Papoutsi 2018).

    Anyone can become angry-that is easy. But to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way-this is not easy.

    —Aristotle, The Nicomachean Ethics

    Emotional Intelligence (EI) is the ability to positively identify, understand and regulate emotions in oneself and others. It can then inform the individual how to use this information to guide one’s thinking and actions.

    EI attempts to bridge emotion and cognition. Individuals with developed EI have the ability to understand their own feelings and that of others whilst enabling them to use their emotions to positively direct thoughts and behaviour (Drigas & Papoutsi 2018).

    At a fundamental level EI provides the individual with a better inner world to cope with the outside world (Drigas & Papoutsi 2018). 

    Characteristic traits of Emotional Intelligence

    EI consists of four skill dimensions (Gong et al 2019):

    • Perception, assessment and expression of emotions.
    • Facilitation of thought using emotions i.e. the ability to harness emotional information into one’s thinking.
    • Understanding emotions and emotional knowledge and information.
    • Regulation and management of emotions for personal and interpersonal development. 

    Gilar-Corbi et al (2019) found EI is characterised by:

    • Adaptability.
    • Assertiveness.
    • Emotional perception of oneself and others. This will help predict success by managing behaviors and relationships (Drigas & Papoutsi 2018).
    • Emotional expression.
    • Management of oneself and others.
    • Self-regulation is concerned with how you control and manage yourself and your emotions, inner resources, and abilities. People with high levels of EI are more capable of regulating their emotions to reduce stress.
    • Impulsiveness. EI helps to productively manage impulses.
    • Relationships.
    • Self-esteem.
    • Self-motivation.
    • Social awareness.
    • Stress management.
    • Empathy.
    • Happiness.
    • Optimism.

    Psychological capital is the fundamental psychological element of the individual that has a positive impact on performance (Gong et al 2019). It also correlates both to EI and an individual's resistance to change. These traits are:

    • Self-efficacy i.e. an individual's belief in their capacity to execute behaviors necessary to perform.
    • Hope.
    • Optimism.
    • Tenacity.

    Torkoman et al (2020) defined self-esteem as an individuals’ subjective emotional response towards themselves. In order to develop self-esteem, a sense of self-worth is required, by positively embracing challenges.

    Developing EI and psychological capital makes an individual aware of their actions and behaviours. This empowerment facilitates an embracement and completion of personal goals and challenges which develop self-esteem.

    Given the emphasis on developing insights into one's own and others' emotions in EI, Birks and Watt (2007), offered it as a defining feature in standards of excellence in clinical care including:

    • Patient-centred care.
    • Quality and accuracy of history taking and diagnosis.
    • Tailoring treatments and lifestyle advice to the individual patient.

    Emotional Intelligence and burnout

    Gong et al (2019) found employees with higher levels of EI can adjust their perception of their work environment as well as the emotional stimuli from the environment. From a broader perspective EI can be very important for both personal and social functions in life. Individuals with a high level of EI can achieve:

    • Suitable solutions more smoothly at work.
    • Reasonably apply emotional resources.
    • Access social support via communication and interaction with other people. This reduces the possibility of failure and depersonalization which is in itself a symptom of burnout.

    All of these attributes can effectively reduce the chance of burnout. Therefore optimizing EI is a key factor in preventing burnout both in the workplace and with relationships outside of work. Be it in happiness or success emotional intelligence (EQ) matters just as much as intellectual ability (IQ) (Drigas & Papoutsi 2018).

    Employees with high level of EI perform well and have a higher level of satisfaction with their jobs. They are also more likely to build a good social support system. This reduces the chance of depersonalization, where an individual distances from themselves and others, which is one of the characteristic traits of burnout.

    Efstathia et al (2016) found trainees in the Intensive Care Unit with lower EI had higher rates of burnout. These authors found a positive correlation with high levels of EI and high rates of job satisfaction, compassion, and communication skills.

    Developing Emotional Intelligence

    Gilar-Corbi et al (2019) found training interventions improved some dimensions of EI:

    • Ability to positively perceive, understand and accept an individual's own and others emotions.
    • Self-reliance.
    • Achievement of personal goals.
    • Stress mangement.
    • Development of a positive attitude.
    • Control and management of emotions.

    Drigas & Papousi et al (2018) developed the pyramid of Emotional Intelligence. Progressing through each of the seven levels in the pyramid is an attempt to develop EI through personal growth. This is achieved by developing skills in perception, evaluation and management of emotions, both within yourself and others.

    From the bottom of the pyramid up these seven stages, that are to continually reflect and improve upon, rather than 'master' are:

    • Self awareness.
    • Self management.
    • Social awareness; empathy; discrimination of emotions.
    • Social skills.
    • Self actualization.
    • Transcendence.
    • Emotional unity.

    Self awareness

    Self awareness is knowing yourself so you can accurately self-assess your own strengths and weaknesses. It shows you possess a clear perception of your personality, including your strengths, weaknesses, thoughts, beliefs, motives and feelings.

    A lack of self awareness is not knowing yourself. It is characterised by understanding yourself in a way that impedes your ability to self-manage and makes it difficult, if not impossible, to know and respond to other peoples feelings.

    Self awareness has its roots in an individual’s personal values and ego identity. It is the reflection of these qualities that determines the perspective or view point from which an individual perceives and evaluates themselves and their emotions. Therefore developing self awareness involves removing this facade to allow a fundamental shift in perspective.

    As developing self awareness involves developing the ability to change the thoughts and perceptions the individual has of their personality this will lead to a change of emotions which will eventually lead to a change in action. 

    Self management

    Self management involves the individual taking responsibility for their own behaviour and well-being.

    When feelings through self awareness have been recognized and accepted, self management enables you to manage them better.

    This in turn leads to greater flexibility, becoming more extroverted and receptive whilst at the same time being less defensively critical of situations and less reactionary to other people’s attitudes.

    Social awareness; empathy; discrimination of emotions

    Once an awareness has been cultivated of the ability to understand and positively control ones own emotions, the next step in the pyramid is to recognise and understand the emotions of the people around you.

    Social awareness refers to the way people handle relationships and awareness of others feelings, needs, and concerns. Empathy enables the understanding of feelings and thoughts of others from their own perspective.

    Being socially aware means that you understand how you react to different social situations and effectively modify your interactions with other people so that you achieve the best results. This leads to a continual improvement of social skills and personal development.

    Social skills

    Once empathy and social awareness has been achieved so the individual can tune into another person’s feelings and understand how they feel and think about things social skills can be developed.

    Social skills are skills needed to handle and influence other people’s emotions. This effectively helps manage interactions successfully.

    Self actualization

    Self actualization is the realization of personal potential, self-fulfilment, pursuing personal development and fulfilling experiences.

    This is a continual process of ‘becoming’, rather than reaching a state of ‘perfection’.

    Self actualization is a measure of personal commitment to life by contributing to it the individuals most important personal gifts and qualities.

    Transcendence

    People who have reached self-actualization will sometimes experience a state referred to as “transcendence”. In the level of Transcendence, one helps others to self actualize, find self-fulfilment, and realize their potential. Quite a lot of these individuals are middle age who skip the first few steps of the pyramid and spend a lot of time philosophising on Facebook.

    Self-transcendence is the experience of seeing yourself and the world in a way that is not impeded by the limits of an individual’s ego identity. These people have since reluctantly deleted their Facebook account. It involves an increased sense of meaning and relevance to others and to the world.

    Emotional Unity

    Emotional unity is the final level of the pyramid of EI.

    In a symbiotic world, what you do for yourself, you ultimately do for another. All it takes is to see the spark of life, the miracle in everything and to be more optimistic.

    Developing EI using the pyramid of emotional intelligence: metacognition

    Cognitive processes uses existing knowledge and generates new knowledge.

    Metacognition is more self reflective. It is the ability to monitor and reflect upon one’s own performance, learning processes and capabilities.

    Metacognition in Emotional Intelligence means that an individual perceives and self reflects on their own emotional skills. Metacognition includes a variety of elements and skills such as metamemory*, self-awareness, self-regulation, and self-monitoring.

    *metamemory: knowing how good your memory is and in what ways you best remember information.

    References

    Gilar-Corbi R, Pozo-Rico T,  Sánchez B, Castejón J (2019). Can emotional intelligence be improved? A randomized experimental study of a business-oriented EI training program for senior managers 

    Drigas A, and Papoutsi C. (2018). New Layered Model on Emotional Intelligence 

    Birks Y and Watt I. (2007). Emotional intelligence and patient-centred care 

    Efstathia M. Vlachou E, Damigos D, Lyrakos G, Chanopoulos K, Kosmidis G and Karavis M (2016). The Relationship between Burnout Syndrome and Emotional Intelligence in Healthcare Professionals 

    Gong Z, Chen Y, and Wang Y (2019). The Influence of Emotional Intelligence on Job Burnout and Job Performance: Mediating Effect of Psychological Capital 

    Torkaman M, Farokhzadian J, Miri S & Pouraboli B (2020).The effect of transactional analysis on the self-esteem of imprisoned women: a clinical trial.

  2. Contents

    • Introduction
    • Definition.
    • Burnout in physicians.
    • Causes of burnout.
    • Stages of burnout.
    • Treatment of burnout.

    The how to guide ....

    • Therapeutic models used in Transactional Analysis for the treatment of burnout.
    • Developing Emotional Intelligence.

    Introduction

    What makes one person prone to burnout and another not? Management strategies and distribution of workload are undoubtedly key factors but can a personality type render an individual prone to burnout?

    Scott (2018) found two opposite personality types prone to burnout:

    • The ‘pathological driven’ that neurotically works trying to constantly achieve the literally unachievable.
    • The 'apathetic’ that distances themselves from any true meaning of their work seeing all obstacles as oppressive. 

    As well as these personality types new medical graduates experiencing frustration and insecurity are also prone to burnout (Farber 1983, as cited by Scott 2018).

    Swan (2017) addressed the effects of these frustrations and insecurities to his third year medical students:

    mistakes come from bad judgment; good judgment comes from mistakes … You will make mistakes ….. It may be painful, but never let it be the end of the road ….. remember the ancient phrase, Illegitimi non carborundum”.

    This positive mindset engenders qualities associated with resilience (Matheson et al 2016) that places the individual in a better place to develop Emotional Intelligence (EI).

    EI removes the biases that taints the perspective an individual has of their relationship with themselves, their colleagues, their patients and their job (Drigas & Papousi et al 2018). This engenders a progressive view point on success and failure to increase job satisfaction, compassion and communication skills (Efstathia et al 2016).

    Definition

    Burnout is a physical, emotional and mental exhaustion that arises from a mismatch between expectations and reality (Sakaki & Hassan 2017). It is characterized by emotional exhaustion, depersonalization and a sense of reduced accomplishment in day-to-day work.

    Burnout is a syndrome resulting from chronic stress both in and out of the work place generated by external pressure and/or a negative relationship with the indivdual and themselves or others. It is defined by:

    • Feelings of energy depletion or exhaustion (Bendetti et al 2020).
    • Increased mental distancing or feelings of negativism or cynicism. This is characterised by negative or inappropriate attitudes towards patients and oneself, irritability, a loss of idealism and withdrawal (Maslatch & Leiter 2016). This can lead to hostile attitudes and detached feelings towards patients treating them as objects rather than human beings (Patel et al 2018).
    • Reduced professional efficacy. This is defined by reduced productivity or capability, low morale and an inability to cope (Maslatch & Leiter 2016).
    • Reduced personal accomplishment in the form of negative self-appraisal, feelings of incompetence and inefficiency in daily work (Patel et al 2018).

    Burnout in physicians

    Patel et al (2018) reported that 25%–60% of physicians experience exhaustion across various specialties.

    Scott (2018) found burnout negatively affects the patient’s perceptions of the therapist. Physician burnout can result in:

    • Incorrect diagnoses and care.
    • Reduced empathy leading to detachment or dehumanization of the patient.
    • Frustration with the patient’s lack of progress.
    • The practitioner losing confidence in their own skills and feeling disillusioned.

    Causes of burnout

    Relationship issues: relationships to one self and others

    Scott (2018) found two personality types prone to burnout the 'pathological driven' and 'apathetic':

    • Type one: 'pathologically driven'. This individual becomes increasingly frantic and refuses to accept that their initial aims are unachievable. This results in them working extra hard to try and achieve unachievable goals until they reach breaking point. They neglect their personal lives for the hope of professional success.

    Benedetti et al (2020) described these people as being influenced by the experience “I must”. These authors highlighted a potential cause of this personality type as being a neurotic need for acceptance whereby the individual starts experiencing conflicts and problems in the system as faults of their own. This ultimately leads to frustration and a lack of self appreciation.

    • Type two: 'apathetic'. This individual fails to internalize their success or lack thereof as being representative of themselves. This lack of internal self generating reward and motivation from wanting to be better means they view obstacles as oppressive, seem worn out and lack motivation.

    Radostina et al (2010) found minor differences in numbers between men and women experiencing burnout. Women experienced emotional exhaustion more prevalantly than men, whereas men experienced greater depersonalization than women.

    These authors found this to be consistent with gender role theory which predicts that women should be more likely to express feelings of emotional and physical fatigue because they learn to display their emotions. On the other hand men, as they learn to conceal their emotions, are more likely to shut off and withdraw under stress (i.e. experience depersonalization). This study was completed in 2010. It would be interesting to correlate burnout in the sexes along side any cultural advancements in the gender role since then.

    An additional factor for therapists experiencing burnout is their inexperience (Farber 1983, as cited by Scott 2018). Inexperienced therapists are less equipped to deal with patient difficulties and are unfamiliar with the limitations of their therapy rendering them more vulnerable to burnout.

    This can result in therapists becoming frustrated with the variability of success in their work trying to work even harder to achieve their desired response, including thinking about patients outside of work, which can be emotionally draining.

    In contrast to the personality traits leading an individual prone to burnour Matheson et al (2016) investigated the attributes of individuals with greater resilience.

    These authors found greater resilience enabled the individual to be able to positively adapt to adverse situations. The characteristic traits of such individuals were optimism, flexibility and adaptability, initiative, tolerance, organisational skills, being a team worker, keeping within professional boundaries, assertiveness, humour and a sense of self-worth.

    These authors thought it possible to train an individual in resilience, manifested through these traits, through experience, learning from others and formal training.

    External pressures in and out of the workplace

    Maslach & Leiter (2007) identified six critical areas of work life that can contribute to burnout:

    • A mismatch in workload. An excessive workload means there is little opportunity to rest, recover, and restore balance. A sustainable workload, in contrast, provides opportunities to use and refine existing skills as well as becoming effective in new areas of activity (Benedetti et al 2020).
    • Loss of control. There is a clear link between a lack of control and high levels of stress and burnout. However, when employees have the perceived capacity to influence decisions, exercise professional autonomy and gain access to both job and personal resources necessary to work effectively, they are more likely to experience job engagement (Maslach & Leiter 2007).
    • Lack of appropriate reward (financial, institutional, or social): a lack of reward devalues both the work and the worker, and is closely associated with feelings of inefficacy. In contrast encouraging rewards between the person and the job means there are both material rewards and opportunities for intrinsic satisfaction (Maslach & Leiter 2016).
    • Loss of positive connection with others in the workplace and between the person and the job. When relationships are characterized by a lack of support and trust and unresolved conflict the individual experiences a lack of social support and is less likely to experience job engagement (Benedetti et al 2020).
    • Lack of perceived fairness in the workplace. People use the quality of the procedures and their own treatment during the decision-making process as an index of their place in the community. Cynicism, anger, and hostility are likely to arise when people feel they are not being treated with the respect that comes from being treated fairly (Benedetti et al 2020).
    • When there is a conflict between values. Once an individual detaches themselves from the unique value and meaning of the work and orientates themselves towards an external aim or goal or reward they become emotionally disengaged (Benedetti et al 2020). This results in reduced contact with a person’s true values. This gap between the individual and organizational values results in the employees making a trade-off between work they want to do and work they have to do which can lead to greater burnout. 

    Additionally to this Maslach & Leiter (2016) highlighted the influence of personal relationships outside of work as a contributor to burnout.

    Stages of burnout

    Sakai & Hassan (2017) found in high levels of stress information processing is distorted. This results in a decrease in positive emotions and an increase in negative emotions.

    This intern can set the individual on to the path of a twelve step model of burnout development (Benedetti et al 2020):

    • Compulsion to prove oneself e.g. excessive ambition and trying to demonstrate one's own worth obsessively.

    • Working harder e.g. incapacity to switch off from work.

    • Neglecting own needs e.g. sleeping, eating and interacting.
    • Displacement of conflicts and needs e.g. problems are dismissed with psychosomatic disturbs and more mistakes are made.
    • No longer any time for non-work related needs e.g. personal values are shifted giving no space for family, friends and hobbies.
    • Increasing denial of the problem and decreasing flexibility of thought/behaviour resulting in intolerance of others.
    • Withdrawal, lack of direction and cynicism, very little or no social life, person can start abusing alcohol or drugs.
    • Behavioural changes/psychological reactions. 
    • Depersonalization is a distancing and loss of contact. It can be with yourself, your own needs, or that of the patient by neglecting the qualities that make the interaction unique. In such cases burnout ensues when there is a lack of accomplishment born from the individual showing an indifference to themselves and others (Gong et al 2019).
    • Inner emptiness, anxiety and addictive behaviour characterised by activities being exaggerated to overcome negative feelings.
    • Depression in the form of increasing feeling of meaninglessness, exhaustion and a lack of interest.
    • Burnout syndrome i.e. psychophysical exhaustion that can be life threatening with suicidal thoughts.

    Scott (2018) found three main responses to burnout amongst therapists:

    • Feelings of emotional exhaustion.
    • Negative perceptions and feelings of the therapist towards their patients.
    • Emotional turmoil which resulted in a professional crisis and feeling that perhaps the individual is not good at their job.

    Treatment of burnout

    Relationship issues: relationships to one self and others

    Burnout caused by a negative relationship with oneself and others occurs due to an individual’s ability to set non-idealistic expectations and inability to cope with changes in circumstance (Sakaki & Hassan 2017).

    Scott (2018) found two personality types prone to burnout referred to in 'Causes of burnout; Relationship issues: relationships to one self and others'. These personality types are the 'pathological driven' and 'apathetic'.

    To address these causes of burnout treatment should be aimed at intra- and interpersonal issues contributing to, as well as the symptoms of burnout. This empowers the individual to address the relationship they have with themselves, with others and their work.

    Sakaki & Hassan (2017) believes that the disturbance of relationships is not always directly related to the behaviours of the other side or hard failures of life. These authors claim it can be due to the beliefs and opinions that is held in connection with such behaviours and failures.

    Much like Scott (2018) who reviewed causes of burnout with regard to relationships these authors also found it can be a negative mind set which leads to either anger and a turbulent relationship or a positive mind set which leads to patience and resilience.

    Emotional Intelligence and Transactional Analysis in burnout

    Emotional Intelligence (EI) is the ability to positively identify, understand and regulate emotions in oneself and others. It then informs the individual how to use this information to guide one’s thinking and actions.

    At a fundamental level EI provides the individual with a better inner world to cope with the outside world (Drigas & Papoutsi 2018). When taken in context transactional analysis can provide a valuable perspective to develop EI (refer 'Transactional Analysis as a treatment for burnout').

    Gong et al (2019) found employees with higher levels of EI can adjust their perception of their work environment as well as the emotional stimuli from the environment. Individuals with a high level of EI can achieve:

    • Suitable solutions more easily.
    • Apply emotional resources.
    • Access social support via communication and interaction with people. This reduces the possibility of failure and depersonalization.

    Employees with high level of EI perform well and have a higher level of satisfaction with their jobs. They are also more likely to build a good social support system reducing the chance of depersonalization.

    Efstathia et al (2016) found trainees in the Intensive Care Unit with lower levels of EI had higher rates of burnout. Conversley, these authors found a positive correlation with higher levels of EI and higher rates of job satisfaction, compassion and communication skills.

    Using transactional analysis to develop EI, Sakai & Hassan (2017) found psychotherapy based on transactional analysis reduces relationship burnout through:

    • Increasing levels of enthusiasm.
    • Increasing relationship satisfaction by increasing interest and decreasing unrealistic expectations.
    • Reducing stress, emotional exhaustion and apathy.
    • Kindling interest in relationships.
    • Increasing adaptation to realities and life’s fluctuations.
    • Positively changing an individual's style of communication.

    This results in the individual reducing anxiety and frustration and increasing forbearance.

    Forbearance is the level of tolerance before an individual shows a negative reaction.

    Individuals with low forbearance exhibit high pessimism and low-level depression which lowers their resilience making them prone to burnout (Sakai & Hassan 2017).

    Alternatively individuals with high levels of resilience are able to positively adapt to adverse situations. These individuals are characeterised by optimism, flexibility and adaptability, initiative, tolerance, organisational skills, being a team worker, keeping within professional boundaries, assertiveness, humour and a sense of self-worth (Matheson et al 2016).

    These positive qualities defining resilience are similiar to those described by Gong et al (2019) for psychological capital.

    Psychological capital is the fundamental psychological element of the individual that has a positive impact on performance. It is a strong correlator to EI. These traits are:

    • Self-efficacy. This is the individual's belief in their capacity to execute behaviors necessary to perform.
    • Hope.
    • Optimism.
    • Tenacity.

    By developing EI directly (refer to 'developing Emotional Intelligence') and using Transactional Analysis (refer to 'Transactional Analysis as a treatment for burnout') this can develop the personality traits associated with resilience and psychological capital. Not only do these qualities develop self esteem by empowering the individual to set their own goals and embrace new challenges (Torkoman et al 2020) but it is productive from an outcome perspective validating the individuals fundamental sense of worth.

    External pressures in and out of the workplace

    Fawkes (2019) gave practical advice for osteopaths exhibting workplace stressors:

    • Change work patterns e.g. take more breaks, give greater space between patients to avoid feeling constantly rushed, pay attention to natural energy peaks and troughs and reduce working hours if possible.
    • Develop coping skills e.g. use better time management, step back from issues as they arise and try to analyse problems from a neutral standpoint and compartmentalise different types of work to avoid the pressures of multi-tasking.
    • Build social support e.g. maintain contact with family and friends, join a regional society or create a virtual community.
    • Promote good health e.g. pay attention to diet and exercise and use relaxation·techniques.
    • Reflect on your practice and be aware if you feel less engaged with your work.

    Therapeutic models used in Transactional Analysis for the treatment of burnout 

    The role of Transactional Analysis (TA) in the treatment of burnout is to empower the individual to acknowledge and internalise the essential value they see in themselves and others. This helps the person to positively assess and communicate their relationship not only with themselves but with others and their job.

    Drivers

    'Okay-ness' in TA is defined by how someone perceives both their own and anothers essential worth, value and dignity. Someone may perceive themself as an individual that is 'not okay'; in other words they see themselves as fundamentally lacking self worth, value and dignity. In such a case a 'driver' is how this 'I'm not okay' mindset manifests itself and plays out in a real life scenario.

    There are five different 'I'm not okay' drivers. Karpamn (1984) identified how each one of these drivers influence the individuals perceptions of themselves contributing to burnout:

    • 'Be Perfect' driver: "I'm only okay if I do everything right"  (Stewart & Joines 2007 pg 160). A person no longer does a good job out of personal pride. They define their okay-ness by the job being completed to an unachievable perfect standard ... which of course by definition is unachievable.
    • 'Be Strong' driver: "I'm only okay if I hide my feelings and wants from other people. I must not let them see I'm weak" (Stewart & Joines 2007 pg 161). A person 'toughs out' bad work conditions and denies the effect on their body and feelings. Such individuals consider it a weakness to ask for the help and changes necessary to create a healthier workplace. These people may stay too long in a bad job.
    • 'Try Hard' driver: "I'm only okay if I try hard to do things" (Stewart & Joines 2007 pg 161). These people make work unneccessarily hard placing emphasis on the effort but not the completion of the task. These people aim to tire themselves without refuelling by reflecting on and internalizing their achievements.
    • 'Please Me' driver: "I'm only okay if I please other people" (Stewart & Joines 2007 pg 161). This individual is a people pleaser who stakes their okay-ness on approval from others. This crave for external approval is never as satisfying as it is for the person who achieves personal goals to experience a deeper sense of pride and satisfaction. Criticism can be devastating for the 'Please Me' person who, in their Child ego state, will feel the criticism as Parental disapproval.
    • 'Hurry Up' driver: the person gets their okay-ness from looking busy and overworked. They won't give themselves enough time nor ask for enough time to get work done. They are too busy to intelligently reflect on the overall picture. Stewart & Joines (2007) (pg 162) found this driver to only appear as an accompanient to other drivers.

    Drama Triangle

    In TA an initial mindset is formed when young as an early interpretation of positive or negative early life events and experiences. This mindset forms a perception an individual has of not only themselves but others. This constructed identity of oneself and others is not real, it is inauthentic, formed through the eyes of a child interpreting what is happening to them and around them. This constructed childhood identity one forms of themselves and others is called a 'script'.

    Part of being an adult progressing though life is to process emotionally detached logical thought. Through this process the initial script, formed through the eyes of a child, should be challenged and continually re-written. This permits a reinterpretation of yourself and others allowing the individual to continually grow and evolve. This process allows for the popular phrase "I'm flipping the script" to signify the individual undergoing fundamental change.

    When this process doesn't occur a script is left unchallenged. This forms a cracked lens an individual looks through their whole life validating their early childhood perceptions of themselves and others. 

    In certain cases a script may have a negative impact on an individuals interaction with themselves and others. When this interaction is marked by a destructive dramatic relationship in an attempt to create power and conflict a person (or people) are said to be acting in a drama triangle. In a drama triangle the individuals involved can adopt one of three roles:

    • Persecutor: someone who belittles others by putting them down. They view others as not being okay.
    • Rescuer: someone who belittles others by offering help from a one-up position. They view others as not being okay.
    • Victim: someone who belittles and discounts themselves disproportionately beyond the normal scope of their abilities. "I can't cope by myself" without analysing, as an adult, their true potential in a given situation. They view themselves as not being okay. 

    Each one of these roles, when performed in the drama triangle, is inauthentic. When people are in anyone of these roles they are viewing themselves and others in a distorted manner through a cracked lens. 

    In light of the drama triangle Karpman (1984) proposed to identify how deeply an individual feels their frustration leading to burnout by asking the following questions:

    • How many upsetting situations occurred last week?
    • In what way was each frustrating?
    • What were you trying to accomplish but didn't? This helps assess the individual’s role as a Rescuer.
    • What stood in your way? This helps assess the individual’s role as a Persecutor.
    • What did you want to feel, and what did you end up feeling? Which situations are left in limbo? This helps assess the individual’s role as a Victim.

    Benedetti (2020) found burnout is in the script that induces the individual to repeat the game “I am Only Trying to Help You” whereby they repeatedly do unsolicited work for ungrateful people. In this game individuals burnout when the Rescuer, deliberately exhausting themselves to try and "save the day", repeatedly begins to feel like a Victim - frustrated, unappreciated and burnt out.

    Karpman (1984) listed healthy escapes for people to engage in from all three corners of the drama triangle. These escapes can help people tune into their feelings and clarify them in order to understand how they got caught up in the drama triangle. These activities are:

    Rescue corner.

    • Laughing at the absurdity.
    • Privacy or anonymity to get away from people.
    • Shutting off the phone and doing nothing.

    Persecutor corner.

    • Physical exercise and exertion and the expression of anger can release pent up aggression
    • Completing projects, house clean-ups, or other personal goals can help achieve closure in the work situation.

    Victim corner.

    • Cry.
    • Contact friends.

    Some individuals will find their own ways to escape the frustrations and pressures, while others do not. The common thread is that if the work is taken too seriously there will be no room for Free Child play (Karpman 1984).

    Developing Emotional Intelligence

    EI consists of four skill dimensions (Gong et al 2019):

    • Perception, assessment and expression of emotions.
    • Facilitation of thought using emotions i.e. the ability to harness emotional information into one’s thinking.
    • Understanding emotions and emotional knowledge and information.
    • Regulation and management of emotions for personal and interpersonal development. 

    Gilar-Corbi et al (2019) found training interventions improved some dimensions of EI:

    • Ability to positively perceive, understand and accept an individual's own and others emotions.
    • Self-reliance.
    • Achievement of personal goals.
    • Stress mangement.
    • Development of a positive attitude.
    • Control and management of emotions.

    Drigas & Papousi et al (2018) developed the pyramid of Emotional Intelligence. Progressing through each one of the seven levels of the pyramid is an attempt to develop EI through personal growth.

    This personal growth is achieved by developing skills in perception, evaluation and management of emotions in yourself and others. To develop a positive perception and emotional response to one self and others transactional analysis can be a useful tool. 

    From the bottom of the pyramid up these seven stages to continually reflect and improve on rather than 'master' are:

    • Self awareness.
    • Self management.
    • Social awareness; empathy; discrimination of emotions.
    • Social skills.
    • Self actualization.
    • Transcendence.
    • Emotional Unity.

    Self awareness

    Self awareness is knowing yourself so you can accurately self-assess your own strengths and weaknesses. It shows you possess a clear perception of your personality, including your strengths, weaknesses, thoughts, beliefs, motives and feelings.

    A lack of self awareness is not knowing yourself. It is characterised by understanding yourself in a way that impedes your ability to self-manage and makes it difficult, if not impossible, to know and respond to other peoples feelings.

    Self awareness has its roots in an individual’s personal values and ego identity. It is the reflection of these qualities that determines the perspective or view point from which an individual perceives and evaluates themselves and their emotions. Therefore developing self awareness involves removing this facade to allow a fundamental shift in perspective.

    As developing self awareness involves developing the ability to change the thoughts and perceptions the individual has of their personality this will lead to a change of emotions which will eventually lead to a change in action. 

    Self management

    Self management involves the individual taking responsibility for their own behaviour and well-being.

    When feelings through self awareness have been recognized and accepted, self management enables you to manage them better.

    This in turn leads to greater flexibility, becoming more extroverted and receptive whilst at the same time being less defensively critical of situations and less reactionary to other people’s attitudes.

    Social awareness; empathy; discrimination of emotions

    Once an awareness has been cultivated of the ability to understand and positively control ones own emotions, the next step in the pyramid is to recognise and understand the emotions of the people around you.

    Social awareness refers to the way people handle relationships and awareness of others feelings, needs, and concerns. Empathy enables the understanding of feelings and thoughts of others from their own perspective.

    Being socially aware means that you understand how you react to different social situations and effectively modify your interactions with other people so that you achieve the best results. This leads to a continual improvement of social skills and personal development.

    Social skills

    Once empathy and social awareness has been achieved so the individual can tune into another person’s feelings and understand how they feel and think about things social skills can be developed.

    Social skills are skills needed to handle and influence other people’s emotions. This effectively helps manage interactions successfully.

    Self actualization

    Self actualization is the realization of personal potential, self-fulfilment, pursuing personal development and fulfilling experiences.

    This is a continual process of ‘becoming’, rather than reaching a state of ‘perfection’.

    Self actualization is a measure of personal commitment to life by contributing to it the individuals most important personal gifts and qualities.

    Transcendence

    People who have reached self-actualization will sometimes experience a state referred to as “transcendence”. In the level of Transcendence, one helps others to self actualize, find self-fulfilment, and realize their potential. Quite a lot of these individuals are middle age who skip the first few steps of the pyramid and spend a lot of time philosophising on Facebook.

    Self-transcendence is the experience of seeing yourself and the world in a way that is not impeded by the limits of an individual’s ego identity. These people have since reluctantly deleted their Facebook account. It involves an increased sense of meaning and relevance to others and to the world.

    Emotional Unity

    Emotional unity is the final level of the pyramid of EI.

    In a symbiotic world, what you do for yourself, you ultimately do for another. All it takes is to see the spark of life, the miracle in everything and to be more optimistic.

    References

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