Burnout in therapy

As part of my humanistic integrative counselling diploma, I carried out a systematic review on the topic of burnout in therapists. I will share a summary of my findings with you because these can be helpful to identify causes leading up to burnout as well as interventions and strategies to prevent it not only in therapists but also in other “helping” professions.

What is burnout?

The term “burnout” was introduced by the American psychologist Herbert Freudenberger in the 1970s to describe the consequences of severe stress and high ideals in “helping” professions, such as doctors and nurses. He coined this term when he observed a loss of motivation and commitment in voluntary staff at a mental health clinic.

Burnout is now used to refer to the state of exhaustion and inability to cope in which individuals, regardless of their job, are left due to their stress levels.

In the 1980s American socio-psychologist Christina Maslach developed a burnout theory and the Maslach Burnout Inventory (MBI), which is the most widely used instrument to measure burnout internationally. Maslach’s theory explains that burnout is caused by excessive stress at work. It is characterised by:

• being emotionally drained and lacking emotional resources (Emotional Exhaustion)
• a negative and distant response to other people (Depersonalisation)
• not feeling competent and able to perform at work (reduced Personal Accomplishment)

Maslach’s theory also explains burnout as being caused by a prolonged imbalance in one of these areas:

• excessive workloads
• lack of control on one’s work
• inadequate job-related rewards
• insufficient workplace social support
• inequity between job and pay
• misalignment between employee and company values

Burnout is also understood to present in individuals who have exhausted their resources due to long-term exposure to emotionally demanding circumstances. This could be both at work and in their personal life, thus extending burnout related factors further than the occupational realm.

Burnout in therapists

Counsellors and psychotherapists are understood to be at a great risk of burnout due to the emotional demands typical of their work with clients.

As far as counsellors and other mental health professionals, studies have shown that burnout can lead to:

• high staff turnover
• poor clients’ outcomes
• physical and mental health disorders such as the development of secondary traumatic stress

Research findings

Through my systematic review I analysed a number of studies focusing on identifying burnout predictors (causes of burnout) and protective factors (strategies to prevent burnout) in counsellors and psychotherapists. Outcomes were analysed to understand evidence and common themes in view of applying these to practice.

Socio-demographic factors: burnout seemed more prevalent in younger therapists. This is explained by younger and less experienced counsellors having high and unrealistic expectations of themselves and their role. Conversely, longer work experience and older age seemed to lead to lower levels of burnout.

Therapists’ psychological traits: perfectionism seemed to be linked to higher levels of burnout. One paper noted that female therapists were more likely to present with perfectionistic tendencies. Perfectionism also seemed to lead to maladaptive cognitive emotional regulation strategies (e.g. self-blame, rumination or catastrophising). Conversely, adaptive emotional regulation strategies (e.g. positive refocusing and acceptance) were found to be protective against burnout. Other studies’ findings suggested that self-compassion, resilience affected the perception of stress and were protective of burnout.

The workplace: high workloads, challenging clients, work-life imbalance and lower individual wellbeing (such as tiredness and nervousness) seemed to predict burnout. Training in trauma-focused interventions and evidence-based practices with relevant organisational support and positive experiences of delivering them also seemed protective against burnout although this did not mitigate against the negative effects of high workloads. Peer support and supervision were identified as protective factors.

COVID-19: specifically on the COVID-19 pandemic, this seemed to have increased burnout levels in counsellors. A study also noted that the greater use of technology for client contact caused by pandemic related restrictions may have worsened burnout levels due to its consequent "telepressure" increase (the need to check and reply to messages quickly).

Evaluation and limitations of this study

This systematic review identified a number of  studies which were able to provide an overview of protective factors and predictors of burnout across a wide range of counselling and psychotherapy settings, such as private practice, educational establishments, hospitals/clinics and community services and involving a varied client base including children, adults and families. The diversity in age, gender, ethnicity, experience and training background of the professionals taking part in the studies, including the countries where these were taking place also provided a more comprehensive view of the topic.

As for limitations, not all studies gave information on training provision and organisational/peer/supervisory support available to therapists. Therefore the outcomes can’t be consistently tested against data from all analysed papers. In addition to that, it is also worth noting that supervision is not uniformly required to practice in all countries Also, due to word count and funding restrictions, only one freely accessible database was searched.

Despite this, the study compared well to a previous systematic review on the same topic which analysed fifty-two papers after a search through six databases.

Conclusion and recommendations

This systematic review’s findings have clearly identified a number of burnout predictors and protective factors correlating with previous research. These outcomes are useful to the counselling profession as they highlight the need for work-life balance, self-care, peer support and supervision to mitigate and prevent burnout. This is particularly important if one considers burnout’s negative effects both on counsellors as individuals and on their ability to work effectively and maintain the therapeutic alliance. As the latter is understood to be the most influential factor on therapeutic outcomes, it becomes essential, during and after training, to support the therapist as the most important “tool” of counselling.

If you are interested in working with me as your coach or counsellor, you can schedule an initial free consultation on info.healingmovement@gmail.com

Disclaimer: The author assumes no responsibility for the topicality, correctness, completeness or quality of information provided. This article is not intended as medical advice. Readers should consult their medical professional before making any changes to their lifestyle, including but not limited to diet and physical activity and exercise.

© 2023 Lucia Micheluzzi © 2023 Healing Movement - all rights reserved

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