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The dreaded drama triangle.

THE PRACTICE OF MEDICINE IS A HELPING profession. Physicians help and support their patients through their professional knowledge and expertise, and physician leaders help their colleagues through their teaching, mentoring and coaching activities. All helpers--and physicians are no exception--must be aware of falling prey to the dreaded drama triangle.

In the late 1960s psychiatrist Stephen Karman described what he called the drama triangle. The triangle represents a dysfunctional personal relationship and illustrates three roles that an individual can play in that relationship: victim, rescuer and persecutor. The roles are not the people themselves, but parts to be played in the drama that occurs as the relationship unfolds.

A central role in this drama is that of the victim. The victim feels incapable and powerless. A victim believes that other people or events are acting upon him and there is nothing that he can do about it. Victims often feel mistreated, disadvantaged and sorry for themselves. They take no responsibility for their situation. To the extent a person remains in the victim role, it blocks him from analyzing the problem, making decisions and taking action to improve his situation.

In a previous article for Coach's Corner, "Coaching from an Adult Ego State," we presented the idea of ego states--the frames of mind out of which a person may interact with others. Three such ego states were discussed: adult, parent and child. The victim role stems from a negative manifestation of the child ego state, specifically that of a helpless child.

Every victim requires a persecutor--something or someone that can be blamed for the victim's situation. A persecutor isn't necessarily always a person; it may be a condition or circumstance the victim perceives as the cause of his woes.

No doubt that life sometimes isn't fair and that people can become victims of circumstances. However, in the drama triangle we are not talking about a genuine cause-and-effect relationship, such as an adverse event or condition beyond the person's control. Instead, it is the perception that someone or something else is responsible for one's condition such that it prevents them from assuming any responsibility for taking action toward a solution.

The third role is rescuer--the one who intervenes between the persecutor and victim. He is the person who steps in and says, "I can help; just do what I say and everything will be fine." The person who assumes the role of rescuer does so with a sincere intention to help, but in doing so perpetuates the victim's feelings of helplessness, reinforces a "poor me" attitude, and either consciously or unconsciously makes the victim dependent upon him.

Rescuing others can be addictive. It makes one feel needed, important and in charge. Sometimes it fills a psychological need such that one feels guilty if he doesn't rescue. The rescuer role is a manifestation of the nurturing parent ego state.

EVERY VICTIM REQUIRES A PERSECUTOR.

A SHORT EXAMPLE--Jim, a cardiologist, is a junior doctor in a division with four other physicians. He is still trying to prove himself to his colleagues. He approaches his division chief with a concern and takes on the role of victim, views his colleagues as the persecutor while the division chief becomes the rescuer.

JIM: "I'm really struggling. I'm the person everyone turns to when they want to exchange call. I want to be a good citizen, but now it seems that I'm the go to guy for everyone to ask. I don't want to say 'No,' but it's starting to interfere with my personal and professional life. I don't know why they aren't more considerate."

DIVISION CHIEF: "Well, they probably should be more considerate. I don't want anyone in the division being taken advantage of. What can I do to help?"

JIM: "Maybe you could talk to them for me. Or put a policy in place that will help."

DIVISION CHIEF: "Have you tried talking to them?"

JIM: "No, but they won't listen to me anyway. They see me for what I am, the junior member of the team. You're the only one they'll listen to."

DIVISION CHIEF: "Well, it certainly isn't fair if you're carrying more than your share of the load. Don't worry, I'll take care of it."

You can be sure that the division chief believes that he is doing the right thing and that he is truly helping Jim. But what is Jim going to do the next time he has a problem, particularly if he is playing the role of victim? He'll again turn to the chief as rescuer.

If this pattern continues over time, a dynamic will be established in which there is an implicit expectation on Jim's part that when he feels victimized his division chief will rescue him. In fact, sometimes the victim will come to believe that the rescuer should know that he needs help without even having to ask. Being rescued is assumed.

WHERE DOES THE DRAMA COME FROM?--If everyone plays their roles within the framework of the drama triangle things proceed smoothly. The victim can identify the persecutor as the cause of his problems, and the rescuer can reinforce the victim's assignment of blame and helplessness and then step in to save the day. Everybody's happy, except that two things can happen:

1. The rescuer can become tired of the role, feeling like he is doing it all and shouldering all the responsibilities. When this happens the rescuer gets fed up, angry, resentful and says effectively--"Why does everyone have to depend on me? People don't appreciate what I am doing!'--thereby becoming a victim in a new drama in which those who are taking advantage of him become persecutors.

2. A more common occurrence is that once the leader realizes that he has become a rescuer instead of a leader that empowers others, he stops the rescuing. At that point, those who have been victims in the drama triangle feel abandoned, and the leader becomes the new persecutor because he won't "help" in the way that they're accustomed to.

WHAT'S THE SOLUTION?--Don't get trapped in the drama triangle to begin with. However, that is often easier said than done. Here are some guidelines to help avoid the trap:

1. Become aware of when a drama triangle is present. Look for its symptoms as you watch others interact, or as you interact with them. Awareness is 80 percent of the answer. Learn to recognize a rescue while you are doing it. When you can see it, you can avoid it. A note of caution here. Mentoring--giving sage advice based upon your personal or professional experience --can be used as a mechanism for rescuing others. When you mentor for the purposes of feeling needed and in charge you may be rescuing.

2. When you observe someone playing the victim role, treat them as an adult. Adults are responsible for their own lives. Adults can figure out what to do, how to solve their own problems and take action, albeit with some real help from time to time. If someone is playing the role of victim, don't buy it.

3. Empower, don't rescue. As a leader, you are not a savior. Your role is not to solve everyone's problems. However, you are expected to help others solve their own problems by capitalizing on their assets, strengthening their motivation and thinking through problems in a solution-focused way. That is the purpose of coaching.

Given these guidelines, what could the division chief in the example above have done instead of assuming the role of rescuer? If he had recognized the drama triangle at work he could have had a discussion that empowers Jim.

1. First, he would not have reinforced Jim's comments about being treated unfairly.

3. Second, he would have asked Jim how he might be contributing to the situation, albeit unwittingly, such that people are seeing him as the go-to person when they want to exchange call.

4. Finally, he would have helped Jim think about what actions he could take to begin to remedy the situations, perhaps offering support and guidance in the process.

In taking this approach the division chief would have short-circuited the victim-rescuer dynamic and avoided the dreaded drama triangle.

Robert Hicks, PhD, is a clinical professor of organizational behavior and founding director of the executive coaching program at the University of Texas at Dallas School of Management.

robert.hicks@utdalias.edu

* Jim Hicks, PhD, and John McCracken, PhD

John McCracken, PhD, is a clinical professor of health care management and founding director of the University's MS/MBA program for physicians.

jfm@utdallas.edu
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Title Annotation:Coach's Corner
Author:Hicks, Jim; McCracken, John
Publication:Physician Leadership Journal
Date:Sep 1, 2014
Words:1430
Previous Article:Team dynamics in clinical informatics.
Next Article:The impact of an executive leadership development program.
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