The process and dimensions of burnout in psychotherapists.

Abstract

The present study focuses on the phenomenon of therapist burnout—a problem of rapidly increasing public and professional concern. Two-hour semistructured interviews were conducted with a heterogeneous group of psychotherapists (N = 60) in order to investigate their experiences of therapeutic practice. According to therapists, professional satisfaction derives from the ability to promote a helpful therapeutic relationship; dissatisfaction stems primarily from lack of therapeutic success; and burnout is primarily a consequence of the nonreciprocated attentiveness, giving, and responsibility demanded by the therapeutic relationship. The data suggest that although therapists expect their work to be difficult and even stressful, they also expect their efforts to "pay off." Burnout is not only psychologically debilitating to therapists, it also critically impairs the delivery of mental health services. As part of a comprehensive project to investigate the effects of psychotherapy on psychotherapists, the present study was designed to focus on the phenomenon of therapist burnout. Freudenberger (1974) originally coined the term burnout to describe the emotional and physical exhaustion of staff members of alternative health care institutions. In recent years a small but growing number of investigators have studied the burnout phenomenon (Cherniss, 1980; Cherniss, Egnatios, & Wacker, 1976; Edelwich & Brodsky, 1980; Freudenberger, 1974, 1977; Freudenberger & Richelson, 1980; Kahn, 1978; Maslach, 1976, 1978; Maslach & Pines, 1977; Mattingly, 1977; Pines & Aronson, 1980; Pines & Kafry, 1978). Maslach (1976), for example, in studying a broad range of health and social service professionals, found that burned-out professionals "lose all concern, all emotional feelings for the persons they work with and come to treat them in detached or even de-humanized ways" (p. 16). Burned-out professionals may become cynical toward their clients, blaming them for creating their own difficulties or labeling them in derogatory terms. To maintain a safe emotional distance from an unsettling client, professionals may increasingly resort to technical jargon and refer to clients in diagnostic terms. Furthermore, the emotional frustrations attendant to this phenomenon may lead to psychosomatic symptoms (e.g., exhaustion, insomnia, ulcers, headaches) as well as to increased family conflicts. Burnout has become a problem of increasing public and professional concern. Indeed, it may well become a "catch-phrase" of the 1980s (Kennedy, 1979). There is, however, a notable paucity of research on stress and burnout in psychotherapists. This gap exists despite the fact that over 40 years ago Freud (1937/1964) wrote of the "dangers of analysis" for analysts, despite the fact that the inner experience of the therapist has come to be acknowledged as an important variable in the psychotherapeutic process (Burton, 1972), and despite, too, the fact that the manpower shortage in the mental health field (Albee, 1959,1968; Hobbs, 1964) critically increases the need to maximize the job satisfaction and efficiency of available personnel. The literature bearing on the issue of therapist stress and burnout consists primarily of (a) studies that have investigated the general nature of burnout in the human services field (e.g., Cherniss, 1980, Edelwich & Brodsky, 1980; Freudenberger & Richelson, 1980; Pines & Aronson, 1980); (b) clinical accounts of the difficulties of therapeutic