I recently gave a presentation to psychologists in Melbourne, Australia reflecting on my 20 years experience treating targets of workplace bullying. This gave me the opportunity to review my learning and growth as a therapist in this field. I thank my clients and my international colleagues in the Therapist Special Interest Group of International Association on Workplace Bullying and Harassment (IAWBH), and my mentor, Evelyn Field for the insights I have gained. My goal in this article is to share my learning on the depth of the wounding for those who have experienced Workplace Bullying, the diagnostic issues confronting treatment professionals, and my insights to the most effective treatment strategies. I hope these insights will provide therapists, targets, and organizational representatives insight to the need for prompt and effective treatment for targets of workplace bullying and to developing a deeper understanding the nature of the wound created from experiencing workplace bullying.
First, let me describe the clients I see. The clients that I see are typically those who were competent employees and functional people. They have a good if not exceptional work history and are very conscientious (sometimes to the point of frustration to others). They are what I call politically naive – they consciously ignore office dynamics because they just want to go to work and do their job. They also tend to have a strong belief in a just world e.g., people get what they deserve and that justice should prevail. When an organization does not recognize a problem or deal with an allegation effectively, this sets this type of person up to develop a secondary wound – the sense of betrayal from people they believed would provide support and justice. As a therapist, I have seen this lead to as much or greater wounding as the experience of Workplace Bullying itself.
After 20 years of treating targets of Workplace Bullying, I am still in wonder at the depth of damage and wounding that I see. I never would have imagined how deeply these experiences injure the soul and psyche of people and the severe functional impairment that results. Even during this time when Workplace Bullying is much discussed and written about, I believe that the impact of exposure to workplace bullying is still poorly understood by many including therapists, the target themselves, their treating physicians, and their organizations.
Some of the most profoundly disturbing symptoms I see are the loss of the self, the inability to make sense of what happened, the self-blame, and the sense of injustice and betrayal that sets this experience off from other trauma and stress-related psychological injuries. Many people simply dissociate from life and never work again, others carry an impaired ability to trust forward in their lives, and others experience an embitterment toward work and life that impairs their ability to establish positive relationships with people.
In understanding these particularly impairing symptoms, it is important to understand the experiences that injures: the hazard that we must be aware of and mitigate in the workplace. Many think of Workplace Bullying as only verbal abuse: yelling at and verbally putting down a person. While verbal abuse does constitute Workplace Bullying,there is a wider range of behaviors that injure as well. These include ostracizing, rejecting, and excluding someone from their work processes, performance and colleagues. When employees are: mocked, cut out of communication or social events, gossiped about or have false rumors circulated, not protected from harm, not given performance feedback, not given the resources they need to perform, exposed to delays in actions about important matters, lied to, exposed to embarrassing notes or jokes, publicly reprimanded or put down in front of others, ignored when they are having a hard time, these behaviors signal our psyche that we are not worthy of inclusion in a valued group and this creates anxiety. Exposure to these experiences also violates four basic human needs: 1) the need for safe attachment to a group, 2) the need for self esteem, 3) the need for personal control, and 4) distress avoidance.
With the exception of verbal abuse (which is often done in private anyway) bullying experiences are often difficult to observe and often go unnoticed or denied by Human Resources, management, colleagues etc., as well as by a target themselves until the exposure has continued for a long period of time (e.g., three to six months), and damage is severe. In response, a target often initially tries to fit in through conformity, complying as best they can, working harder and mimicking behavior of the actor – sometimes making their own behavior offensive. The work of Kip Williams and colleagues shows that after experiencing ostracism, a target is also more likely to act aggressively, derogate someone else and cheat on a test. In the world of work, this looks like and can become a performance problem that leads to even more mistreatment. Ostracism (and likely other forms of Workplace Bullying) leaves a target feeling that life is meaningless, interferes with complex problem solving, sharpens the focus on picking up subtle social cues, activates pain regions in the brain, and increases stress hormones.
At some point, the target loses power to defend themselves against mistreatment; they cannot withdraw and cannot confront. The target becomes depressed, alienated, resigned and helpless leading to even greater reduced performance at work and impaired functioning in life. Often, the actor has set the stage behind the scenes that the target is a poor performer. When the target seeks help, their story of mistreatment is not validated and further wounding occurs resulting in further attempts to find justice. The end result of all of this can be termination or disability leave. In summary, Workplace Bullying can result in a complex relational trauma that typically results in a pattern of symptoms that reflect social, physical, psychological, and moral and spiritual damage.
Following on the experience of mistreatment if a target seeks psychological treatment, other issues emerge. A significant issue at present is the diagnosis of the injury sustained through exposure to Workplace Bullying needed for disability coverage or Workers Compensation Board coverage. Treating professionals have limited options in making a diagnosis and often find it hard to use a diagnostic category that truly reflects the symptoms they see.
In my my opinion that the best clinical description of the injury is Complex Cumulative Trauma, which is at present not a formal diagnostic category. This class of trauma includes domestic and community violence; combat trauma e.g., prisoner or war; political trauma e.g., the refugee crisis we are seeing; political persecution; human trafficking; prostitution; and sexual harassment for examples. Framing the injury in this class of trauma distinguishes the injury from other workplace stressors (which can also lead to severe stress injuries such as depression and anxiety) such as overload, dissatisfaction, and conflict and places the injury where it belongs in severe and disabling conditions that require a specialized treatment.
Those who treat targets of Workplace Bullying report high levels of dissociation, embitterment and rumination; numerous physical problems such as musculo-skeletal, endocrine, and digestive issues; and functional impairment in occupational and social functioning. When needing to make a formal diagnosis, Major Depressive Disorder or Anxiety Disorder are most commonly used. Some use the diagnosis of Adjustment Disorder however many therapists view this as an inappropriate diagnosis or one that should be made for less severe presentations. Many wish to use or do use the diagnosis of Post Traumatic Stress Disorder (PTSD) however, Workplace Bullying does not technically meet Criterion A – the experience of a physical traumatic experience. On this point, however, recent research supports that the most common symptoms reported by targets of Workplace Bullying are those that reflect PTSD.
Further, the identification of treatment strategies has been lacking in the research. However, the work of the Therapist Special Interest Group of the IAWBH has highlighted important foundations of treatment. Many in this group believe that treating those targeted by Workplace Bullying requires a relational approach and requires a knowledge of the damage created by Workplace Bullying. In my experience, the initial therapeutic goal is the development of attachment security and calming the nervous system. Mid and long range goals include the development and restoration of a sense of self and self-esteem, improvement of trust in others, and increasing normal emotional regulation. It is critical that the therapist creates safety, provides empathy and education, and models a safe relationship before providing other forms of psychological treatment.
The initial stages of treatment therefore generally involve narration of events, support and empathy, and teaching emotional regulation and anxiety management. Later stages of treatment can involve expressive therapies such as art, music, dance, and drama, as well as spiritual, energy, hypnotherapy, meditation and somatosensory approaches. Traditional therapies such as third wave Cognitive Behavioral therapies e.g., Acceptance and Commitment Therapy and Rumination Focused Cognitive Behavioral Therapy can be effective as well in these stages.
The therapeutic journey can take longer than other psychological issues because of the need to establish safety and trust, validate and educate on the injury and therefore needs commitment by all, including the organization to provide the time required to heal. If a client comes to therapy long after their experiences, therapy may need a long term approach.
In summary, after 20 years of treating targets of workplace bullying and working with organizations to develop skill in identification, prevention and remediation of workplace bullying, I am still struck by the depth of injury targets experience, the difficulty in treating the injury if not addressed in the early stages, and the continued lack of understanding of the injury by all those involved, including the target themselves. I have seen targets debilitated for life. Nevertheless, the good news is that I have seen targets recover quickly and with personal growth when two factors are present: 1) a gentle, supportive therapist trained in the treating workplace bullying, and 2) an organization that will provide resources and some support and understanding.
Together, we can do this … we can identify early on when exposure has resulted in an injury, provide the best treatment, and return targets to a workplace that has dealt with the hazard. To this end, I encourage the adoption of Occupational Health and Safety legislation around Workplace Bullying in jurisdictions, and I encourage certification of counselling professionals in the treatment of Workplace Bullying.