This paper was first published in Grief Matters: The Australian Journal of Grief and Bereavement Volume 6, No 1, 2005. Reproduced with the kind permission of the Centre for Grief Education, Clayton, Victoria.

Managing Pressure and Stress

Neil Thompson

Abstract

It is often assumed that it takes a very special sort of person to work in the fields of loss and grief, someone who is very strong and resilient and able to withstand the inherent pressures of working in such an emotionally charged area of practice. However, this view can be problematic and can lead to issues of stress and workplace well-being not being adequately addressed. This paper examines the relationship between stress and the demands of working with loss and grief and, in so doing, warns of the dangers of failing to take stress seriously.

Occupational stress is a phenomenon that has received a great deal of attention in recent years. However, despite that increased level of attention, it continues to be a widely misunderstood concept and one that is not taken sufficiently seriously – although there are signs that this is beginning to change.

This paper seeks to clarify the nature of stress as a workplace phenomenon, especially workplaces in which loss and grief are part of the main professional task (hospices, for example) and to examine the relationship between helping people deal with loss and grief and experiences of stress.

I shall begin by defining the key terms of pressure and stress before exploring a concept that links loss and grief with stress – namely emotional management. From this I will move to a consideration of the risks of experiencing stress and consider personal, educational and managerial strategies for meeting the challenge stress presents.

Pressure and stress

The terms, ‘pressure’ and ‘stress’ are often used interchangeably. However, this can lead to a great deal of confusion and can contribute to the problem of failing to take stress seriously (for example, the dangerous argument that ‘stress is good for you’). The Health and Safety Executive (2005) in the UK have helped to remove some of this confusion by defining stress as “the adverse reaction people have to excessive pressure or other types of demand placed on them”. The important words here are adverse and excessive. While pressure can be positive (motivating, stimulating and rewarding) or negative undermining, overwhelming and distressing), depending on the circumstances, stress is always negative, by definition, as it refers to situations where pressure is excessive and thus doing harm (to health, well-being, relationships, job performance and so on). Stress is therefore not good for you, although pressure can be if not taken to extremes.

A further confusion surrounding the notion of stress is the tradition of conceiving it in narrow, individualistic terms and thus failing to take account of the wider social and organisational factors that can have a major bearing on stress. As Delargy and Thompson (2004) put it:

Stress is traditionally presented as primarily, if not exclusively, a psychological /biological phenomenon. In reality, it also has a major sociological dimension, relating to organisational dynamics and culture and wider social forces, processes and institutions. The tendency to have a narrow, psychological perspective, focusing on the individual, means that organisational and social issues are often not addressed. (p. 10)

An adequate understanding of stress must therefore: (i) distinguish it from the related concept of pressure; and (ii) adopt a more holistic perspective by recognising that there are sociological considerations as well as psychological ones which need to feature.

Emotional management

Cooper, Dewe and Driscoll (2001) make the point that:

In their review of the role of emotions in work and achievement, Pekrun and Frese (1992) concluded that, at least in the organizational psychology literature, ‘there is little research that speaks directly to the issues of work and emotions’ and that ‘industrial and organizational psychology ought to take the issues of emotion at work more seriously. Given that models of stress are essentially theories about emotional reactions (Lazarus, 1993) and that ‘stress constitutes an emotional subset referring to emotions that are distress related’ (Lazarus, 1995, p. 183), the lack of explicit attention to emotions in job stress research is disconcerting. (p. 70)

Since 1992 the situation has improved in terms of literature relating to stress and emotion – for example, Fineman (1995) and Cooper and Cartwright (2001). There is also now a growing literature on the sociology of emotion (for example, Bendelow & Williams, 1998; Barbalet, 2002). However, it remains the case that the links between stress and emotion have yet to be given adequate attention in terms of research and theory
development.

While this is a significant gap in general, it is particularly significant in relation to emotionally charged occupations that involve dealing with loss and grief. As Renzenbrink (2004) comments, “Dealing daily with intense emotion can be extremely challenging and may even be dangerous to health and well-being” (p. 848).

A key concept in relation to emotion in the workplace is Hochschild’s (1983) notion of ‘emotional labour’, which Fineman (2000) describes as follows:

Hochschild has shown that much work, especially face-to-face service (such as flight attendants, debt collectors, waitresses, secretaries, fast food operators) involves having to present the ‘right’ (that is, managerially prescribed) emotional appearance to the customer or client, and that involves real labour on the employee’s part. Sometimes the employee contract involves having to ‘feel good’ about the customer too. Organizations can ensure that employees more or less comply by refining their personnel selection methods, inculcating required scripts and regularly monitoring performance. (p. 4)

While this is clearly one form of emotional labour, we could also extend the concept to refer to jobs in which the worker’s ability to respond to other people’s emotions is a key tool in his or her repertoire. Working with loss and grief clearly involves this wider sense of emotional labour in which our ability to work with feelings (our own and those of other people) is a central part of the role.

An important factor in this regard is that of resilience, which Kahn (2004) describes in the following terms:

Resilience is ‘the capacity to rebound from adversity more strengthened and more resourceful. It is an active process of endurance, self-righting, and growth in response to crisis and challenge’ (Walsh 1998: 4). Individuals are tested in some form or another, they endure suffering and they emerge stronger from the experience. They are not invulnerable or impervious to adversity. Rather, they ‘struggle well,’ ... (p. 36)

Indeed, this is often what is encountered – people who work in very emotionally demanding circumstances who not only manage to survive, but who actually flourish in this type of work. While this is certainly something to be grateful for, we should also be wary of the dangers of operating in such emotionally
demanding situations, not least the harm that can be caused by stress.

Stress dangers

The idea that stress is a sign of weakness in an individual is one of ten myths identified by Thompson, Murphy and Stradling (1996). Indeed, there is a danger of a vicious circle in which an individual feels more stressed because of the additional burden of risking being labelled as ‘inadequate’ or ‘not up to the job’ (Thompson, Murphy & Stradling, 1994). Miller (2000) captures the point well when he argues that:

Most health systems convey a double jeopardy for the staff member who is brave enough to acknowledge their own work stress: to do so means admitting a psychological vulnerability and need, which can then be interpreted as due to a lapse in professional detachment and standards, and even an advertisement of future unemployability. (pp. 9-10)

I would add that it is not only health systems that can do this – a ‘blame the victim’ mentality can also be readily recognised in many social welfare organisations and indeed across the public services more broadly. It is important to recognise that stress is not simply an individual-level, psychological phenomenon. It also has significant sociological dimensions – that is, it is shaped and constrained by social and organisational, as well as individual, factors. If we wish to understand stress (so that we are better able to guard against it), then we need to go beyond narrow, individualistic explanations. We need to take on wider factors, such as:

Organisational culture Do the ‘unwritten rules’ of the organisation help or hinder when it comes to dealing with difficult, sensitive issues? Cultures can range from being, at one extreme, very supportive and thus a very positive aid to managing pressure and promoting resilience to, at the other, very unsupportive or ‘macho’, based on the idea that, ‘if you can’t stand the heat, stay out of the kitchen’.
Management style Do managers have an understanding of the pressures staff face or do they simply ‘stoke up the fire’ by placing more and more pressure on team members’ shoulders? Is there complacency based on the assumption that staff who are used to dealing with intense emotions will be ‘tough’ enough not to need support?
Adequacy of resources Of course, there are never enough resources, but is the expectation that staff achieve very high standards with very sparse resources putting them in an untenable position?
Abuse of power Bullying and harassment are significant sources of stress. Organisations that deal with loss and grief issues are not immune from such problems (Thompson, 2000).
The interactional nature of stress Stress is often presented as if it were an illness, with talk of ‘symptoms’ and ‘cures’. However, the reality of stress is far more complex than this. Stress is a multidimensional phenomenon and so it will involve a certain amount of interaction between different elements or dimensions. For example, someone who normally copes extremely well with workplace pressures may struggle to do so at a time when he or she is experiencing problems at home that bring additional pressures (a bereavement, for example) or undermine coping abilities (an event of some description that undermines confidence, for example). That is, work-life balance issues are important (Clutterbuck, 2003).

This is not an exhaustive list but it should be sufficient to demonstrate that stress is not simply a matter of individual psychology, even though it is commonly conceived as such.

Strategies for dealing with stress

While pressure is clearly an inevitable part of working life, stress is not. Stress depends on a complex interaction between various elements – personal, organisational and social. While individuals can explore means of managing pressure and promoting resilience, it is important to go beyond personal responsibility and recognise that the problems of stress are also an organisational matter (a challenge of leadership) and a social problem (a social policy concern). The common tendency to medicalise and individualise stress issues not only distracts attention from these wider matters, but also serves to add further pressures to individuals who are already experiencing excessive levels of pressure. This means that stress presents a major challenge. In order to meet that challenge we need to develop a range of strategies. Space does not permit a comprehensive analysis and exposition of possible strategies, but I am able to present at least a selection of possible strategies to act as a basis for future debate, deliberation and development. I shall divide them into three separate (but interrelated) areas: personal, educational and managerial.

Personal

Manage expectations Stress can arise from unrealistic expectations. Are you being realistic about what you can achieve? Are you able to be assertive with people who expect too much from you? Stress can also arise from unclear expectations. Are you clear about what is expected of you? Are you able to negotiate with others where such clarity of expectation is missing (or where there are conflicts of expectation)?
Develop your coping resources Do you have a well-developed repertoire of coping methods? Can you develop this further? In particular, are you able to make sure it includes positive, proactive coping methods (problem-solving skills), rather than relying on reactive methods geared towards accommodating pressures (rather than removing or reducing them)?
Use support Stress is not a sign of a weak individual and is therefore not something to be ashamed of. Using support systems (formal and informal) can be very important and can also help to make sure that stress problems are not camouflaged or swept under the carpet.

Educational

Challenge myths and misunderstandings Training and development opportunities in relation to stress should not reinforce a narrow individualistic model (for example, by concentrating solely or predominantly on individual coping methods). Similarly, it is important to make sure that proactive, problem-solving skills are promoted and not just reactive accommodations methods (relaxation, massage and so on).
Promoting stress management training for all It is unfortunately the case that many organisations regard stress management training as ‘remedial’ – that is, as something to fill a skills gap, rather than a broader positive educational process about managing pressures and promoting resilience.
Promoting staff care training The focus on learning about stress should not be a narrow one focused on own’s own pressures. There is also a duty (especially for managers) to promote an ethos of staff care – a shared responsibility to develop a supportive working environment and culture.

Managerial

Managing workload pressures A high workload can be stimulating, motivating and rewarding. However, the moment a high workload becomes an unreasonable workload, it can become demotivating, distressing and a threat to health and well-being. If a group of staff face unmanageable levels of pressure, this is a challenge of leadership for the manager to find a way forward, rather than simply heap more and more work on staff members.
Developing a supportive culture Organisational cultures tend to have a life of their own, but they can be influenced by managers in certain regards at least. It is therefore important that all reasonable steps are taken to promote an ethos of staff care.
Work together ‘Stress can have the effect of making people feel isolated – and even of making people isolate themselves – and so the importance of working together becomes even more of an imperative’ (Thompson, 1999, p. 96). Managers therefore have a responsibility to cultivate a collective approach to tackling stress and thus not allowing an individualistic model to, in effect, ‘divide and conquer’.

There are no easy solutions to the problem of stress, but it is to be hoped that the ideas presented here can make at least a small contribution to making progress in rising to the challenge that stress raises for all health and human services workers, but especially for those where loss and grief issues and their emotional demands are very much to the fore. It is important to move beyond the traditional, individualistic model and take account of the wider sociological issues. Stress is a psychosocial phenomenon, not simply a psychological one. If we fail to recognise this, we run the risk of adding fuel to the fire by making individuals feel responsible for matters that have their roots in the wider organisational and social context.

References

Barbalet, J. (Ed.). (2002). Emotions and sociology. Oxford: Blackwell.
Bendelow, G. & Williams, S. J. (1998). Emotions in social life: Critical themes and contemporary issues. London: Routledge.
Cooper, C. L. & Cartwright, S. (2001). Organizational management of stress and destructive emotions. In R. L. Payne & C. L. Cooper, (Eds.), Emotions at work: Theory, research and applications for management. Chichester: Wiley.
Cooper, C., Dewe, P. J. & O’Driscoll, M. P. (2001). Organizational stress: A review and critique of theory, research and applications. London: Sage.
Clutterbuck, D. (2003). Managing work-life balance. London: Chartered Institute of Personnel and Development.
Delargy, K. & Thompson, N. (2004). Stress and strategy: The STEPER approach. Internal Communication. October.
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Hochschild, A. R. (1983). The managed heart: Commercialization of human feeling. Berkeley: University of California Press.
Kahn, W. A. (2004). Holding fast: The struggle to create resilient caregiving organizations. Hove: Brunner-Routledge.
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Miller, D. (2000). Dying to care: Work, stress and burnout in HIV/AIDS. London: Routledge.
Pekrun, R. & Fraser, M. (1992). Emotions in work and achievement. International Review of Industrial and Organizational Psychology 7, 153–200.
Renzenbrink, I. (2004). Relentless self-care. In J. Berzoff, & P. R. Silverman, (Eds.), Living with dying: A handbook for end-of-life healthcare practitioners. New York: University of Columbia Press.
Thompson, N., Murphy, M. & Stradling, S. (1994). Dealing with stress. London: Macmillan – now Palgrave Macmillan.
Thompson, N. Murphy, M. & Stradling, S. (1996). Meeting the stress challenge. Lyme Regis: Russell House Publishing.
Thompson, N. (1999). Stress matters. Birmingham: Pepar.
Thompson, N. (2000). Tackling bullying and harassment in the workplace. Birmingham: Pepar.
Walsh, F. (1998). Strengthening family resilience. New York: The Guilford Press.

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