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Objectives The general aim of this systematic review is to synthesize, analyze, and critically review existing studies concerning the relationship between sociodemographic, intrapersonal, and work-related factors and burnout, as well as psychological wellbeing among psychotherapists. Methodology We performed a structured literature search utilizing the PRISMA framework in the following databases: Web of Science, Scopus, MedLine, PsyARTICLES, ProQuest, and Google Scholar. The most relevant inclusion criteria were quantitative and peer-reviewed articles published in English. Results After the selection process, we accepted 52 articles for further systematic review. Thirty-eight studies examined burnout among psychotherapists, while the other 14 studies focused on psychological wellbeing in this sample. Conclusions Burnout and wellbeing among psychotherapists are related to numerous sociodemographic (e.g., age, gender), intrapersonal (e.g., coping, personality), and work-related characteristics, including work settings and professional support in this profession (e.g., supervision or personal therapy). However, the high heterogeneity observed between studies in terms of burnout and wellbeing operationalization and measurement warrants more consistent and advanced methodological models of these theoretical constructs in the future in this specific sample.
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SYSTEMATIC REVIEW
published: 15 August 2022
doi: 10.3389/fpsyg.2022.928191
Frontiers in Psychology | www.frontiersin.org 1August 2022 | Volume 13 | Article 928191
Edited by:
Abanoub Riad,
Masaryk University, Czechia
Reviewed by:
Yi Huang,
Masaryk University, Czechia
Salmi Razali,
Universiti Teknologi MARA, Malaysia
Naeem Hayat,
University Malaysia Kelantan, Malaysia
*Correspondence:
Angelika Van Hoy
angelikahoun@psych.uw.edu.pl
Specialty section:
This article was submitted to
Psychology for Clinical Settings,
a section of the journal
Frontiers in Psychology
Received: 25 April 2022
Accepted: 23 June 2022
Published: 15 August 2022
Citation:
Van Hoy A and Rzeszutek M (2022)
Burnout and Psychological Wellbeing
Among Psychotherapists:
A Systematic Review.
Front. Psychol. 13:928191.
doi: 10.3389/fpsyg.2022.928191
Burnout and Psychological Wellbeing
Among Psychotherapists:
A Systematic Review
Angelika Van Hoy*and Marcin Rzeszutek
Faculty of Psychology, University of Warsaw, Warsaw, Poland
Objectives: The general aim of this systematic review is to synthesize, analyze, and
critically review existing studies concerning the relationship between sociodemographic,
intrapersonal, and work-related factors and burnout, as well as psychological wellbeing
among psychotherapists.
Methodology: We performed a structured literature search utilizing the PRISMA
framework in the following databases: Web of Science, Scopus, MedLine,
PsyARTICLES, ProQuest, and Google Scholar. The most relevant inclusion criteria
were quantitative and peer-reviewed articles published in English.
Results: After the selection process, we accepted 52 articles for further systematic
review. Thirty-eight studies examined burnout among psychotherapists, while the other
14 studies focused on psychological wellbeing in this sample.
Conclusions: Burnout and wellbeing among psychotherapists are related to numerous
sociodemographic (e.g., age, gender), intrapersonal (e.g., coping, personality), and
work-related characteristics, including work settings and professional support in this
profession (e.g., supervision or personal therapy). However, the high heterogeneity
observed between studies in terms of burnout and wellbeing operationalization and
measurement warrants more consistent and advanced methodological models of these
theoretical constructs in the future in this specific sample.
Keywords: burnout, wellbeing, distress, psychotherapy, systematic review
INTRODUCTION
Although Freud (1937, 1964) highlighted several negative phenomena in therapeutic settings
constituting the danger of analysis for the analysts themselves, studies on the psychological health of
psychotherapists are lacking in psychotherapy, which has traditionally concentrated solely on the
clients of psychotherapy rather than on the psychotherapists (see systematic reviews: Simionato
and Simpson, 2018; Lee et al., 2020). Nevertheless, the psychotherapeutic occupation is associated
with multidimensional psychological distress, primarily including a high degree of emotional
strain and constant demands for empathy, which all pose a significant risk of burnout among
psychotherapists (Simionato and Simpson, 2018). Maslach et al. (2001) created one of the most
prevalent in the literature model of burnout, which defines this syndrome in terms of emotional
exhaustion, depersonalization, and reduced feelings of work-related personal accomplishment.
According to Maslach et al. (2001), burnout is particularly common in helping professions.
However, it is worth underlining the fact that in contrast to other helping occupations in the
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
health care field (e.g., physicians or nurses; Schaufeli et al., 2009;
Woo et al., 2020), burnout research among psychotherapists
is much less prevalent (Lee et al., 2020). However, existing
studies have demonstrated that psychotherapists who experience
burnout, are no longer able to manage therapeutic processes,
which may even endanger their clients (e.g., Farber and
Heifetz, 1982; Ackerley et al., 1988; Rupert and Morgan, 2005;
Berjot et al., 2013). They also suffer from several somatic
and psychological disorders, including back pain, headaches,
gastroenteritis, depression, and substance abuse (Raquepaw and
Miller, 1989; Rupert and Kent, 2007), and they frequently
express job turnover intentions (Rosenberg and Pace, 2006;
Garcia et al., 2014). Previous systematic reviews on burnout
among psychotherapists (Simionato and Simpson, 2018; Lee
et al., 2020) have concentrated almost entirely on homogeneous
groups of predictors (work-related or sociodemographic factors,
e.g., caseload, years of experience, age, or gender) and the
burnout measures used (mostly Maslach Burnout Inventory and
its scales: emotional exhaustion, depersonalization, and reduced
personal accomplishment; Maslach et al., 2001). Nevertheless,
it is not entirely clear why there are so many discrepancies
in burnout prevalence among psychotherapists from various
countries, ranging from 6% to as high as 54% (Farber, 1990;
Hannigan et al., 2004; Berjot et al., 2017). On the one hand, this
may be related to overlooking other burnout measures in this
occupational group and alternative theoretical burnout models
(e.g., Demerouti et al., 2001). On the other hand, an insufficient
focus on psychotherapists’ intrapersonal variables (personality,
social support, and self-compassion) as burnout risk factors may
also be a reason for the aforementioned inconclusive findings
on burnout prevalence in this professional group (Rzeszutek and
Schier, 2014; Yip et al., 2017).
Compared to burnout studies, much less research has
investigated the issue of psychological wellbeing among
psychotherapists (Laverdière et al., 2018, 2019; Brugnera
et al., 2020). In other words, while there is a relative
consensus regarding why and how the psychotherapeutic
profession may be damaging to psychotherapists’ mental
health, very little is known about personal, social, and work-
related characteristics that can foster higher wellbeing and
quality of life among psychotherapists. To the best of our
knowledge, the existing literature does not contain a systematic
review on that topic. This latter issue is of fundamental
significance, as several classic reviews have noted that clients
choose to work with psychotherapists who they perceive
as psychologically healthy and satisfied with their own life
(Wogan and Norcross, 1985; Lambert and Barley, 2001). In
addition, some authors have observed that the poor quality
of life and associated mental difficulties of a psychotherapist
may significantly hamper their ability to forge a therapeutic
alliance (Enochs and Etzbach, 2004; Holmqvist and Jeanneau,
2006). Overall, the aforementioned results support a need
for further studies on psychotherapists’ mental health, both
from a negative (burnout), as well as a positive perspective
(wellbeing) as a crucial issue related to the overall process and
outcomes of psychotherapy.
OBJECTIVE
The general aim of this systematic review is to synthesize, analyze,
and critically review existing studies concerning the relationship
between intrapersonal and work-related factors and burnout and
psychological wellbeing among psychotherapists. We focused on
various theoretical models and associated measures of burnout
in the literature (see Methodology). Regarding the concept of
wellbeing, we concentrated on its vast operationalizations and
assessments, as suggested in the respective literature (Laverdière
et al., 2018, 2019; Brugnera et al., 2020), to better capture the
uniqueness of that phenomenon in that specific occupation.
More specifically, we included both positive (e.g., quality
of life, satisfaction with life, and satisfaction with job) and
negative dimensions of wellbeing among psychotherapists (e.g.,
depression, traumatic stress, and secondary traumatic stress).
Importantly, we wanted to clearly distinguish these latter factors
in particular, namely negative wellbeing indicators for burnout,
based on numerous authors indicating that they are two robust
and separate constructs (see e.g., Bakker et al., 2000; Maslach
et al., 2001; Schaufeli et al., 2009; Koutsimani et al., 2019).
METHODOLOGY
Systematic Review Protocol
The two authors of this review have performed the literature
search and review, which adhered to the standards of the
Preferred Reporting Items for Systematic Reviews and Meta-
analyses (PRISMA) statement (Moher et al., 2009; see Figure 1).
We then searched the following databases on 06 November 2021:
Web of Science, MedLine, Scopus, ProQuest, and PsyARTICLE.
We also focused on Google Scholar as an additional source of gray
literature (Bellefontaine and Lee, 2014). In Boolean algebra, the
query consisted of the following terms for burnout: (“burnout”
OR “fatigue OR “job strain” OR “job stress OR “exhaustion”
OR “occupational stress OR “pressure OR “cop OR “manag”)
AND (“psychologist OR “psychotherap OR “mental health
professional OR “mental health work OR “social worker OR
“counsel”). The respective search terms for wellbeing were as
follows: (“wellbeing” OR (“well” AND “being”) OR (“life AND
“satisf”) OR “life-satisf OR “wellness OR (“life AND “quality”)
OR “life-quality” OR “depress OR “anxi OR (“post-traumatic
AND “stress”) OR (“posttraumatic AND “stress”) OR “ptsd”)
AND (“psychologist OR “psychotherap OR “mental health
professional OR “mental health work OR “social worker OR
“counsel”). In this review, we used the Covidence software to
screen references and undertake data extraction.
Study Selection Criteria
Despite the English-language criterion, eligible studies must also
meet the requirements enumerated below to be included in the
systematic review:
(1) Type of study: We included only peer-reviewed,
quantitative, empirical articles that assessed the relationship
between work-related, personal, and social factors and burnout,
as well as psychological wellbeing among psychotherapists. We
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Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
FIGURE 1 | Flow diagram. Based on: Moher et al. (2009).
eliminated other systematic reviews and meta-analyses, as well as
editorials, letters, and qualitative studies.
(2) Participants: We included studies with samples of
psychotherapists, with no restrictions related to gender, age,
ethnicity, work experience, or therapeutic modality. We also
accepted studies with mixed representations of, broadly speaking,
mental health workers, which consisted of psychotherapists, as
well as psychologists, psychiatrists, coaches, etc. We excluded
studies that dealt with burnout or wellbeing among health care
workers outside of the mental health arena.
(3) Methodology: We only accepted studies with
psychometrically sound measurements of burnout and wellbeing
outcomes. We excluded studies with no psychometric burnout
or wellbeing measures.
(4) Quality of study: We based this on the Quality Assessment
Tool for Observational Cohort and Cross-Sectional Studies
(Shuang et al., 2015), which consisted of 14 criteria. Two
independent evaluators investigated the studies (see Results and
Figure 1). The evaluators were particularly interested in whether
the study utilized validated measures using psychometric data
and presented a clear operationalization of burnout and
wellbeing and their predictors. Moreover, if we encountered
articles by the same authors, we determined whether they used an
identical sample of participants more than once. If this happened,
only one of them was included in the final analysis.
RESULTS
Screening and Eligibility
Initially, we identified 1,632 titles and abstracts via the search of
the electronic databases, including 479 hits on Web of Science,
262 hits on MedLine, 506 hits on SCOPUS, 352 hits on Proquest,
20 hits on PsyARTICLES, and 13 hits on Google Scholar. After
removing duplicates, we pared them down to 656 potentially
eligible articles for further screening. After a comparison of two
independent coders, including the consistency of abstract and
full-text screening, as well as the quality assessment, 175 full
articles remained for the assessment. Using the exclusion criteria,
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Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
we eliminated 123 papers. Ultimately, we accepted 52 articles for
systematic review, 38 for studies on burnout, and 14 for studies
on psychological wellbeing among psychotherapists.
We managed to find articles dating from 1986 through 2021.
The total sample size was n =15,229, including 3,972 men, 11,005
women, 18 participants, who declared the “other” option, and 234
participants in a study that did not specify gender. Finally, 49/52
(94%) of the analyzed studies were cross-sectional.
Burnout and Wellbeing Measures
The most common measure of burnout was the Maslach
Burnout Inventory (MBI, Maslach and Jackson, 1986), which
measures three dimensions of burnout (emotional exhaustion,
depersonalization, and lack of personal accomplishment). Some
authors using this scale created the global burnout score
(see Table 1). Less utilized burnout measures were as follows:
the Copenhagen Burnout Inventory (Kristensen et al., 2005),
Oldenburg Burnout Inventory (Demerouti et al., 2001), and
Professional Quality of Life Scale (ProQOL; Stamm, 2010). These
all followed the global burnout scores. The most frequently
used wellbeing measures were Satisfaction with Life (Satisfaction
with Life Scale; Diener et al., 1985), Professional Quality of Life
Scale (Stamm, 2010), Job Satisfaction Survey (Spector, 1985), and
Psychological Wellbeing Scales (Ryff, 1989).
It is worth mentioning several remarks concerning burnout
and wellbeing assessment and operationalization. First, the vast
majority of studies adopted the Maslach et al. (2001) burnout
model. Second, in the eligible studies, the authors typically
performed statistical analysis using the global burnout/wellbeing
score. As the majority of studies used such a global burnout
and/or wellbeing score, the final conclusions were also drawn
from such global indicators. If more than one dimension of
burnout or wellbeing was mentioned in the study, the result with
the highest strength of associations with appropriate predictors
was selected, which was recommended by other authors as well
(Simionato and Simpson, 2018).
Tables 1,2summarize all the details related to the systematic
review of our 52 final studies related to burnout (n=38) and
psychological wellbeing (n=14) among psychotherapists.
SUMMARY OF FINDINGS AND MAIN
CONCLUSIONS
The primary goal of this systematic review was to synthesize,
analyze, and critically review already-existing research regarding
the relationship between intrapersonal and work-related factors,
burnout, and psychological wellbeing among psychotherapists.
In terms of burnout, the main focus was on various theoretical
models and measures that were associated with the construct,
although the Maslach et al. (2001) model was the most
prevalent (see further). Within that model, we observed that
the most common burnout dimension among psychotherapists
was emotional exhaustion, which was consistent with previous
reviews on that subject (Lee et al., 2020). The concept of wellbeing
was examined in relation to its numerous operationalizations and
assessments, specifically in the psychotherapeutic occupation.
Both positive and negative dimensions of wellbeing were
included. However, as was already underlined, we aimed to
clearly distinguish these latter negative wellbeing indicators from
burnout based on numerous authors indicating that they are
two robust and separate constructs (see e.g., Bakker et al., 2000;
Maslach et al., 2001; Schaufeli et al., 2009; Koutsimani et al.,
2019). Finally, after a careful selection process, we included 52
articles in the review, 38 for burnout and 14 for wellbeing,
published between 1986 and 2021. Selected papers satisfied the
selection criteria regarding the content and quality of the studies
(see Methods).
Sociodemographic, Intrapersonal, and
Work-Related Factors Related to Burnout
Among Psychotherapists
When it comes to sociodemographic correlates of burnout
among psychotherapists, it appears that, in particular, age and
gender play a significant role. Firstly, a total of nine relevant
studies (i.e., those which provided data on the age-burnout
association) revealed that younger psychotherapists tend to
report increased levels of burnout symptoms in comparison
to older and more experienced colleagues in that profession
(Ackerley et al., 1988; Huberty and Huebner, 1988; van der Ploeg
et al., 1990; Rupert and Kent, 2007; Rasmussen et al., 2016;
Berjot et al., 2017; Allwood et al., 2020; Tsai et al., 2020; Kotera
et al., 2021). This finding is consistent with the previous meta-
analysis concerning the aforementioned relationship in various
employment settings (Brewer and Shapard, 2004). In our specific
context, this is explained by the fact that young psychotherapists
often have excessively high and unrealistic expectations about
their role in this job, and the subsequent reality crash may
be a significant burnout catalyst for them (Rupert and Kent,
2007; Rasmussen et al., 2016; Berjot et al., 2017). Secondly, in
terms of gender, studies have yielded mixed findings. On the
one hand, higher burnout levels have been recorded among
women in comparison to men (Emery et al., 2009; Allwood
et al., 2020). This is consistent with gender role theory (Eagly,
1987), which suggests that women are more likely to express
negative feelings (e.g., emotional and physical fatigue) compared
to men, who typically conceal these emotions from others, which
does not mean that they do not experience them. Thus, this
could indicate an artificial overrepresentation of burnout among
females, which would correspond with Rupert and Kent (2007),
who reported contrasting evidence, with men experiencing more
burnout than women in their sample of psychotherapists. A
relevant meta-analysis on that topic demonstrated that men and
women can experience burnout in different ways. For instance,
women score higher on emotional exhaustion, whereas men
score higher on depersonalization (Purvanova and Muros, 2010).
In addition, it appears that the psychotherapeutic profession may
be especially conducive to burnout among men due to gender
differences in self-efficacy, which is usually higher among females
in helping professions (e.g., Roohani and Iravani, 2020). Gender
also moderates the effects of work stress and the association
between self-efficacy and health in various professions (Shoji
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Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 1 | Summary of data on burnout among psychotherapists.
References Year &
country
Study
design
Burnout
measure
Burnout predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relationship
(% of
sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
1. Kahill
(1986)
1986, USA Cross-
sectional
“Tedium”
burnout
measure
Social Support,
Professional
Expectations
M 127
F 128
Total 255
36,2 71 % 33,2 / 11,1 100% N/A CBT 100% Social support and professional
expectations about the job were
negatively related to burnout
among psychotherapists.
Burnout was not associated with
professional experience or to
other demographic factors in this
sample of psychotherapists.
2. Ackerley
et al. (1988)
1988, USA Cross-
sectional
Maslach
Burnout
Inventory
Age, Overinvolvement,
Lack of control of
therapy setting,
Medical issues, Sexual
Abuse,
Sexual Dysfunction
M 410
F 152
Total 562
44,15 79% 39,22 / 13,8 39% Yes / yes PD 20 %
CBT 9%
Hum 6%
Int - 56%
Syst 9%
Significant burnout predictors in
this sample were: younger age,
lack of control in the therapeutic
setting, feeling overcommitted to
clients, problems with physical
health, history of sexual abuse
and sexual dysfunctions. It was
also found that lack of personal
psychotherapy and lack of
supervision correlated positively
with burnout intensity.
3. Huberty
and Huebner
(1988)
1988, USA Cross-
sectional
Maslach
Burnout
Inventory
Job & Role definitions
Time pressures (heavy
workload)
External pressures
(superior pressure)
Internal pressures
(personality conflicts)
Age
M N/A
F N/A
Total - 234
38,72 N/A N/A / 7,54 N/A N/A CBT 100% Role definitions, time pressure
(heavy workload), external and
internal pressures were all related
to burnout among
psychotherapists. Younger
psychotherapists declared higher
burnout level.
4. Raquepaw
and Miller
(1989)
1989, USA Cross-
sectional
Maslach
Burnout
Inventory
Work load
Work setting (public)
M 26
F 42
Total - 68
N/A N/A N/A N/A N/A Syst 100% Working for a public agency and
perceived caseload were the
strongest predictors of burnout
among psychotherapists.
Symptoms of urnout were
related to intention to leave this
job for other professions.
5. van der
Ploeg et al.
(1990)
1990
Denmark
Cross-
sectional
Maslach
Burnout
Inventory
Age
Work experience
M69
F 29
Total 98
36,2 N/A 32,1/11,1 100% N/A CBT 100% Younger age, less experience in
psychotherapy and working in a
public sector (compared to
private practice) were the
strongest predictors of burnout
among psychotherapists.
(Continued)
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Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 1 | Continued
References Year &
country
Study
design
Burnout
measure
Burnout predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relationship
(% of
sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
6. Mills and
Huebner
(1998)
1998, USA Longitudinal Maslach
Burnout
Inventory
Work experience,
Perceived job stress,
Neuroticism,
Extraversion,
Agreeableness,
Conscientiousness
M 60
F 165
Total 225
40,3 N/A N/A / 10,4 100% N/A Int 100% Less experience in
psychotherapy, high level of
perceived stress in job as well as
personality traits (neuroticism
positively, extraversion,
agreeableness and
conscientiousness negatively)
were the most significant
burnout predictors among
psychotherapists.
7. Wilkerson
and Bellini
(2006)
2006, USA Cross-
sectional
Maslach
Burnout
Inventory
Emotion-Oriented
Coping
M 22
F 56
Total 78
43,19 64,1% N/A / 11 90% N/A Int 100% Emotion-oriented coping style
was the strongest burnout
predictor among
psychotherapists.
8. Wiseman
and Egozi
(2006)
2007, Israel Cross-
sectional
Burnout
Questionnaire
Personal Therapy M 16
F 83
O 4
Total 103
41,2 N/A N/A / 10,6 100% Yes / yes CBT 50%
Int 50%
Personal therapy occurred to be
the strongest buffer against
burnout symptoms among
psychotherapists.
9. Ben-zur
and Michael
(2007)
2007, Israel Cross-
sectional
Maslach
Burnout
Inventory
Social Support,
Problem-oriented
coping
M 0
F 249
Total 249
41,66 73% 37,62 / N/A 100% N/A CBT 100% Appropriate social support at
work as well as problem-focused
coping with stress were the most
important buffers against
burnout among
psychotherapists.
10. Deighton
et al. (2007)
2007,
Germany,
Austria,
Switzerland
Cross-
sectional
Maslach
Burnout
Inventory
Supervision in working
with trauma clients
Prevalence of
psychotherapists own
trauma history
M 34
F 65
O 1
Total 100
N/A N/A 24,7 / 7,7 100% N/A PD 17%
CBT 14%
Hum 8%
Int 31%
Syst 12%
Supervision and a low
prevalence of psychotherapists
own trauma history were related
to lower burnout level among
trauma psychotherapists.
11. Rupert
and Kent
(2007)
2007; USA Cross-
sectional
Maslach
Burnout
Inventory
Age
Work load
Administrative
paperwork
Negative client
behaviors
Overinvolvement
Sense of control over
work
M 248
F 347
Total 595
51,98 75% 39,19/17,19 42% Yes, yes PD 23 %
CBT 32%
Hum 0%
Int - 20%
Syst 25%
The main important burnout risk
factors among psychotherapists
were: younger age, too much
workload, negative client
behaviors and work settings
(higher burnout in public sector,
with less subjective control over
the therapeutic work). In addition
it was found that females
declared less burnout symptoms
than males.
(Continued)
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Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 1 | Continued
References Year &
country
Study
design
Burnout
measure
Burnout predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relationship
(% of
sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
12. Rupert
et al. (2009)
2009, USA Cross-
sectional
Maslach
Burnout
Inventory
Work-Family conflict,
family-work conflict,
workload, Sense of
control over work,
Family support
M 205
F 292
Total 497
54,1 96% 35,2 / 19,6 39% Yes / yes CBT 30%
Int 30%
Syst 40%
The strongest predictors of
burnout among psychotherapist
were perceived conflicts on the
dimensions work-family or
family-work, as well as high
workload. Buffers against
burnout were family support and
perceived sense of control over
the job.
13. Kim and
Lee (2009)
2009,
South
Korea
Cross-
sectional
Maslach
Burnout
Inventory
Perceived job stress,
Supervision
M 110
F 101
Total 211
42,2 N/A N/A 100% Yes / N/A Syst 100% Perceived job stress was
positively related with burnout
level among psychotherapists,
while support received from
supervision buffered against this
syndrome in this sample of
psychotherapists.
14. Emery
et al. (2009)
2009,
Australia
Cross-
sectional
Maslach
Burnout
Inventory
Gender, Work setting,
Personal resources,
Sense of control over
work
M 54
F 136
Total 190
34,5 75,3% N/A / 7,1 45% N/A CBT 100% Significant burnout risk factors
included: gender (females, but
only when they work in public
sector), public work sector, lack
of personal resources and lack of
feeling of control over the work.
15. D’Souza
et al. (2011)
2011,
Australia
Cross-
sectional
Copenhagen
Burnout
Inventory
Perceived job stress
Perfectionism
M 12
F 75
Total 87
45,6 N/A N/A, 3,5 95% N/A CBT 100% There was a significant positive
relationship between burnout
level and the intensity of
perfectionism and perceived
stress at work.
16. Kim et al.
(2011)
2011, USA Longitudinal Maslach
Burnout
Inventory
Physical health M 62
F 223
Total 285
46,1 N/A N/A / 18,1 100% N/A CBT 100% Burnout symptoms predicted
deterioration in psychotherapists’
physical health (see headaches,
gastrointestinal problems,
respiratory infections) over three
years period of observation.
17. Acker
(2012)
2011, USA Cross-
sectional
Maslach
Burnout
Inventory
Perceived job stress M 123
F 337
Total 460
41 57% N/A / 11 100% N/A Int 100% Perceived job stress occurred to
be the strongest burnout
predictor among
psychotherapists.
(Continued)
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Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 1 | Continued
References Year &
country
Study
design
Burnout
measure
Burnout predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relationship
(% of
sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
18.
Malinowski
(2013)
2013, USA Cross-
sectional
Maslach
Burnout
Inventory
Humor oriented coping M 42
F 91
Total 133
53,5 N/A 26,1 / 19,5 54% N/A CBT 100% Self-enhancing humor, as coping
style, was positively related with
the level of perceived personal
accomplishment among
psychotherapists.
19. di
Benedetto
and Swadling
(2014)
2014,
Australia
Cross-
sectional
Copenhagen
Burnout
Inventory
Mindfulness
Work experience
Career-sustaining
behaviors
M 22
F 145
Total 167
42,47 77,8 N/A 80% N/A N/A Practicing mindfulness and more
years of experience seemed to
protect from burnout among
Australian psychotherapists.
20. Rzeszutek
and Schier
(2014)
2014,
Poland
Cross-
sectional
Oldenburg
Burnout
Inventory
Social Support,
Briskness,
Perseveration
M 89
F 111
Total 200
35,94 N/A 26,1 / 19,5 60% Yes / yes CBT 50%
Hum 50%
The level of burnout symptoms
among psychotherapists was
positively related to
perseveration and negatively
linked to briskness and
perceived social support.
21. Steel
et al. (2015)
2015, UK Cross-
sectional
Maslach
Burnout
Inventory
Work demands
Sense of control over
work
Perceived job stress
M - 20
F 74
Total 94
36,9 N/A N/A,1,9 100% N/A CBT 88%
Int 12%
Significant predictors of burnout
among psychotherapists were
high work demands, perceived
job stress and lack of control
over the organization of work.
22.
Rasmussen
et al. (2016)
2016,
Australia
Cross-
sectional
Maslach
Burnout
Inventory
Age, Work demands,
Work reward,
Overinvolvement,
Meaningfulness of work
M 66
F 351
Total 417
49,5 N/A 34,9 / 5,5 82% Yes/ N/A CBT 52%
Int 17%
Syst 31%
Significant predictors of burnout
among psychotherapists were
younger age, perceived high
work demands, perceived low
work efforts, over- involvement in
therapeutic process and lack of
sense of meaning in work.
23. Kim
(2017)
2017,
South
Korea
Cross-
sectional
Maslach
Burnout
Inventory
Work experience,
Personal resources,
Secondary Traumatic
Stress,
Workload
M 59
F 120
Total 179
32,4 N/A 16,2 / 1,75 100% N/A Int 18%
Syst 82%
Significant predictors of burnout
among psychotherapists were
little work experience, high work
load, few personal resources,
perceived high work demands,
and high symptoms of
secondary traumatic stress.
24. Berjot
et al. (2017)
2017,
France
Cross-
sectional
Maslach
Burnout
Inventory
Work setting
Type of work contract
Age
Seniority in workplace
M 66
F 598
Total 664
35,44 N/A N/A 54% N/A N/A Working in a company, having
multiple work contracts, younger
age and seniority in the
workplace all showed to be
significant predictors of burnout
among psychotherapists.
(Continued)
Frontiers in Psychology | www.frontiersin.org 8August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 1 | Continued
References Year &
country
Study
design
Burnout
measure
Burnout predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relationship
(% of
sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
25. Garcia
et al. (2018)
2018, USA Cross-
sectional
Maslach
Burnout
Inventory
Rule overload in work
Vulnerability to
oversight
Politics influence on
treatment methods
Supervision
M 143
F 338
Total 481
41,2 N/A N/A 100% N/A CBT 69%
Int 16%
Syst 15%
Burnout was particularly
associated with reports of
“political influence” on treatment,
feelings of vulnerability of
complaints to leadership or
government, and rule overload in
a sample of trauma
psychotherapists. Clinical
supervision buffered the burnout
symptoms in this sample.
26. Simpson
et al. (2019)
2019,
Australia
Cross-
sectional
Maslach
Burnout
Inventory
Work demands,
Abandonment,
Mistrust/Abuse,
Emotional Inhibition,
Detached Protector
M 87
F 356
Total 443
42,93 52,8% N/A 54% N/A PD 7%
CBT 68%
Int 17%
Syst 8%
Job demands, early maladaptive
schemas and maladaptive
coping modes significantly
predicted burnout among
psychotherapists.
27. Lee et al.
(2019)
2019,
South
Korea
Cross-
sectional
Maslach
Burnout
Inventory
Perceived job stress,
Resilience
M 56
F 214
Total 270
35,5 52% N/A 100% N/A N/A It was found that the level of
perceived stress at work
positively, and resilience
negatively were associated with
burnout among
psychotherapists.
28. von
Hippel et al.
(2019)
2019,
Australia
Cross-
sectional
Copenhagen
Burnout
Inventory
Work satisfaction,
Commitment to
organization,
Commitment to
profession,
Work engagement,
Workplace wellbeing,
Intentions to leave
organization, Intentions
to leave profession
M 80
F 265
O 4
Total 349
35 N/A N/A / 5,65 100% N/A N/A Burnout was significantly related
to lower job satisfaction and
lower job engagement,
decreased workplace well-being,
and increased turnover rates
among psychotherapists.
29.
George-Levi
et al. (2020)
2020 Israel Cross-
sectional
Maslach
Burnout
Inventory
Sense of coherence M 26
F 78
Total 104
37,4 N/A N/A6,5 100% N/A CBT 100% Sense of coherence buffered the
burnout symptoms among
psychotherapists and the
perceived loneliness moderated
this association.
30. Tsai et al.
(2020)
2020, USA Cross-
sectional
Maslach
Burnout
Inventory
Age, Ethnicity
(Caucasian)
M 16
F 26
Total 42
39,6 36% 42,9 / 4,7 100% Yes / N/A CBT 100% Significant predictors of burnout
among psychotherapists were
younger age and being white.
(Continued)
Frontiers in Psychology | www.frontiersin.org 9August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 1 | Continued
References Year &
country
Study
design
Burnout
measure
Burnout predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relationship
(% of
sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
31. Hricová
(2020)
2020,
Slovakia
Cross-
sectional
Maslach
Burnout
Inventory
Perceived job stress,
Self-care
M 80
F 618
Total - 698
43,9 N/A 20,34 / 13,12 100% Yes / N/A CBT 32%
Int 41%
Syst 27%
There was a significant
association between perceived
job stress and burnout and this
relationship was also mediated
by health self-care among
psychotherapists.
32. Allwood
et al. (2020)
2020,
Sweden
Cross-
sectional
Shirom-
Melamed
Burnout
Questionnaire
Age,
Ruminations: general,
Ruminations: work,
Family-work conflict,
Work demands
M 182
F 646
Total 828
42,1 N/A 38 / N/A 100% N/A CBT 100% Burnout was significantly
associated with younger age,
tendency to ruminations (at work
and in general) perceived work
conflicts as well as high job
demands among
psychotherapists. Moreover,
results showed that women
experienced higher burnout
levels than men.
33. Kotera
et al. (2021)
2021, UK Cross-
sectional
Maslach
Burnout
Inventory
Age
Workload
Work-life balance
M 23
F 83
Total 106
47,42 N/A 31,3/9,3 100% N/A Int 50%
Syst 50%
Younger age, high workload and
problems with work-life balance
were found to significantly
predict burnout among
psychotherapists.
34. Zarzycka
et al. (2021)
2021,
Poland
Cross-
sectional
Link Burnout
Questionnaire
Therapeutic
relationship: relational
depth
Therapeutic
relationship: relational
quality
Psychological wellbeing
M 75
F 26
Total 101
44,34 56% N/A / 10 19% Yes / yes Hum 100% Aspects of therapeutic
relationship (relational depth and
relational quality) were the
strongest buffers against burnout
among psychotherapists.
Burnout symptoms significantly
hampered wellbeing of
psychotherapists.
35. Chang
and Shin
(2021)
2021,
South
Korea
Cross-
sectional
Professional
Quality of Life
Scale
Compassion
satisfaction,
Compassion fatigue,
Adaptive emotion
regulation, Maladaptive
emption regulation,
Perceived job stress,
Negative client
behaviors
M 45
F 80
Total 125
N/A N/A N/A 100% N/A N/A Burnout was positively related
with compassion fatigue level,
maladaptive emotion regulation,
and experience of aggression by
clients among psychotherapists.
Conversely, compassion
satisfaction and adaptive
emotion regulation strategies
buffered from symptoms of
burnout in this sample.
(Continued)
Frontiers in Psychology | www.frontiersin.org 10 August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 1 | Continued
References Year &
country
Study
design
Burnout
measure
Burnout predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relationship
(% of
sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
36. Smout
et al. (2021)
2021,
Australia
Cross-
sectional
Maslach
Burnout
Inventory
Resilience
Work demands
Coping style: detached
protector
M 82
F 343
Total 425
42,79 53% N/A 54% N/A CBT 89%
Int 11%
Maladaptive coping (detached
protector coping mode), high
work demand seemed to be
significantly associated with
burnout among
psychotherapists. Resilience
acted as a buffer against burnout
symptoms in this sample.
37. McCade
et al. (2021)
2021,
Australia
Cross-
sectional
Copenhagen
Burnout
Inventory
Depression,
Self-Compassion
M 44
F 203
O 1
Total 248
41,04 75% N/A / 12,2 82% N/A CBT 50%
Int 25%
Syst 25%
Self-compassion may be treated
as protective facto against
burnout and depression among
psychotherapists.
38. Litam
et al. (2021)
2021, USA Cross-
sectional
Professional
Quality of Life
Scale
COVID-19 related
distress
Resilience
Compassion fatigue
M 24
F135
O 2
Total 161
39,1 N/A N/A 68% 1, N/A CBT 50%
Int 50%
COVID-19 related distress and
high level of compassion fatigue
were the strongest predictors of
burnout among
psychotherapists. Resilience
acted as a buffer against burnout
symptoms in this sample.
Gender: M, Male; F, Female; O, Other; Therapeutic Modality: PD, Psychodynamic; CBT, Cognitive Behavioral Therapy; Hum, Humanistic; Int, Integrative; Syst, Systemic; N/A, Not Available.
Frontiers in Psychology | www.frontiersin.org 11 August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 2 | Summary of data on wellbeing among psychotherapists.
Authors Year and
country
Study
design
Wellbeing
outcome and
measure
Wellbeing predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relation (%
of sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
1. Schlarb
et al. (2012)
2012,
Germany
Cross-
sectional
Satisfaction
with life
(Satisfaction
with Life Scale)
Workload, Job
demands, Insomnia
level
M 193
F 581
Total - 774
46,1 N/A 39,7/17,5 22% N/A PD 40%
CBT 40%
Int 10%
Syst 10%
Almost 45% of the studied
psycho therapists suffered from
insomnia symptoms. Workload,
specific job demands and
insomnia level were the strongest
negative predictors of life
satisfaction among
psychotherapists.
2. Puig et al.
(2012)
2012, USA Cross-
sectional
Wellness (The
Five Factor
Wellness
Inventory)
Devaluing client,
Deterioration in
Personal life,
Incompetence,
Exhaustion
M 23
F 106
Total 129
40,67 N/A N/A 89% N/A Int 53%
Syst 47%
Significant predictors of wellness
among psychotherapists were
specific behaviors of clients
(devaluing client), problems in
personal life, subjective feeling of
incompetence and exhaustion by
the work.
3. Hardiman
and
Simmonds
(2013)
2013,
Australia
Cross-
sectional
Existential
wellbeing
(Spiritual
Wellbeing
Scale)
Severity of client
trauma, Emotional
exhaustion
M 18
F 71
Total 89
49,69 N/A 20,48/16,4 21% N/A PD 17%
CBT 25%
Hum 4%
Int 48%
Syst 6%
Psychotherapists declared high
level of existential wellbeing
coped better with highly
traumatized clients and avoided
emotional exhaustion at work.
4. Rzeszutek
et al. (2015)
2015,
Poland
Cross-
sectional
Secondary
traumatic
stress (PTSD
Questionnaire:
Factorial
Version)
Temperament:
Emotional reactivity,
Temperament: Sensory
Sensitivity, Social
Support
M 21
F 59
Total 80
39,48 N/A 10,44/9,45 66% Yes / N/A PD 11%
CBT 44%
Hum 36%
Int 4%
Syst 5%
The level of secondary traumatic
stress symptoms among trauma
psychotherapists was positively
related to emotional reactivity
and negatively linked to sensory
sensitivity and perceived social
support.
5. Roncalli
and Byrne
(2016)
2016,
Ireland
Cross-
sectional
Job satisfaction
(Minnesota
Satisfaction
Questionnaire)
Workload, Work
experience,
Supervision,
Team work with
co-workers
Satisfaction with work
with co-workers
M 18
F 59
Total - 77
37,8 N/A 11,3/6,7 100% Yes/ N/A CBT 100% Supervision and satisfaction with
teamwork with colleagues
occurred to be the strongest
predictors of psychotherapists’
job satisfaction.
(Continued)
Frontiers in Psychology | www.frontiersin.org 12 August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 2 | Continued
Authors Year and
country
Study
design
Wellbeing
outcome and
measure
Wellbeing predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relation (%
of sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
6. Yip et al.
(2017)
2017, China Cross-
sectional
Compassion
fatigue (The
Professional
Quality of Life
Scale)
Mindfulness,
Self-Compassion:
self-warmth,
Self-Compassion:
Self-coldness
M 9
F 68
Total 77
35,2 N/A N/A /4,5 95% N/A CBT 100% The relationship between
mindfulness and compassion
fatigue was mediated by
self-coldness (negative qualities
in self-compassion). Thus,
mindfulness may buffer the
compassion fatigue among
psychotherapists, but
self-compassion of therapists
matters.
7. Fleury et al.
(2017)
2017,
Canada
Cross-
sectional
Job satisfaction
(Job
Satisfaction
Survey)
Team work with
co-workers
Interdisciplinary
collabaration
M 15
F 53
Total 68
40 N/A 22,45/6,1 72% Yes / N/A Int 100% Team work, especially mutual
supervision and the frequency of
interdisciplinary collaboration
with colleagues representing
other psychotherapy
organizations occurred to be the
strongest predictors of
psychotherapists’ job
satisfaction.
8. Hitge and
van
Schalkwyk
(2018)
2017,
South Africa
Cross-
sectional
Psychological
wellbeing
(Mental Health
Continuum
Short Form)
Meaningfulness,
Resilience
M 72
F 182
Total 254
43,2 N/A 7,5/13,4 53% Yes / N/A N/A Searching for meaning and
resilience as a personality trait
were the strongest predictors of
psychotherapist’s wellbeing.
9. Laverdière
et al. (2018)
2018,
Canada
Cross-
sectional
Satisfaction
with Life
(Satisfaction
with Life Scale)
Perceived stress, Work
experience, Workload
M 53
F 187
Total 240
42,25 N/A 23,5/13,5 60% Yes / N/A PD31%
CBT 31%
Hum 15%
Int 22%
Syst 1%
Perceived stress, high workload
and less years of experience
were predictors of poor life
satisfaction among
psychotherapists.
10. Rupert
and Dorociak
(2019)
2019, USA Cross-
sectional
Satisfaction
with Life
(Satisfaction
with Life Scale)
Self-Care, Perceived
job stress
M 127
F 295
Total 422
50,48 76% 44,13/16,71 66% Yes/ N/A N/A Self-care enhanced
psychotherapists’ wellbeing and
the main mechanism in that
process was reducing the level
of perceived stress at work.
11. Yela et al.
(2020)
2019 Spain Longitudina; Psychological
wellbeing
(Psychological
Wellbeing
Scales)
Mindfullness
Self-compassion
M 7
F 54
Total 61
25,6 N/A 11,3/1,1 100% N/A N/A Training in mindfulness and
self-compassion showed
significant improvement in
psychotherapist’ wellbeing over
time.
(Continued)
Frontiers in Psychology | www.frontiersin.org 13 August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
TABLE 2 | Continued
Authors Year and
country
Study
design
Wellbeing
outcome and
measure
Wellbeing predictors Sample
(gender)
Sample
(mean age
in years)
Stable
relation (%
of sample)
Workload
hours week
/ experience
years
Work setting
(% of public
sector)
Supervision/
personal
therapy
Therapeutic
modality
Main conclusions
12. Müller
et al. (2020)
2019,
Germany
Cross-
sectional
Satisfaction
with Life (Life
Satisfaction
Questionnaire)
Work-related strain,
Supervision
M 54
F 56
Total 110
51,4 N/A 41,6/ 13,7 25% Yes / N/A Int 100% Supervision significantly
improved psychotherapists’ job
satisfaction when they
experienced a high amount of
work-related strain.
13. Brugnera
et al. (2020)
2021, Italy Cross-
sectional
Psychological
wellbeing
(Psychosocial
General
Wellbeing
Index)
Attachment anxiety,
Attachment avoidance,
Reflective Functioning,
Gender, Age
M 84
F 332
Total 416
43,94 76% N/A / 10,1 N/A Yes / N/A PD 13%
CBT 11%
Int 66%
Syst 1%
Attachment anxiety and
attachment avoidance were
negatively related, while reflective
functioning was positively
associated with wellbeing among
psychotherapists. Older
psychotherapists declared higher
wellbeing.
14. Summers
et al. (2021)
2021, UK Cross-
sectional
Psychological
Wellbeing
Depressive symptoms
Harassment or bullying
Work experience
Age
M 320
F 1334
Total 1654
46,2 N/A N/A / 4,3 96% Yes/ N/A CBT 9%
Int 52%
Syst 39%
The strongest, negative
predictors of psychotherapists’
wellbeing were: being harassed,
feeling depressed, older age and
higher work experience.
Gender: M, Male; F, Female; O, Other; Therapeutic Modality: PD, Psychodynamic; CBT, Cognitive Behavioral Therapy; Hum, Humanistic; Int, Integrative; Syst, Systemic; N/A, Not Available.
Frontiers in Psychology | www.frontiersin.org 14 August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
et al., 2016). Future research should also consider the “close-
to-zero” gender differences observed in this context, which may
explain discrepancies in this area of research, particularly when
using the Maslach model (Purvanova and Muros, 2010).
Secondly, eight studies have highlighted the significant
role of intrapersonal variables as burnout predictors among
psychotherapists, including predominantly personality traits
(Mills and Huebner, 1998; Rzeszutek and Schier, 2014; Lee et al.,
2019; George-Levi et al., 2020; Smout et al., 2021) and various
stress coping styles (Wilkerson and Bellini, 2006; Ben-zur and
Michael, 2007; Malinowski, 2013). Generally, traits related to
negative emotionality (e.g., neuroticism, emotional reactivity)
were burnout predictors, while those associated with emotional
stability and high levels of subjectively perceived resources (e.g.,
resilience) were buffers against this syndrome in this occupation.
Similarly, emotion-oriented coping was positively correlated,
while problem-focused coping or the use of humor to deal
with work-related stress were negatively linked to burnout
symptoms in this occupation. Although there are numerous
studies on the personality-burnout (Alarcon et al., 2009) and
coping-burnout association (Lee et al., 2016), this problem is still
highly understudied in this specific occupation and calls for more
research, ideally in the prospective methodological framework.
Alternatively speaking, one should remember that aside from
work-related characteristics, there are substantial intrapersonal
factors related to burnout in that occupation, which until now
were not sufficiently underlined in the contemporary reviews on
that topic (Simionato and Simpson, 2018; Lee et al., 2019).
Finally, concerning work-related covariates, workload, and/or
work experience, work settings and supervision/personal therapy
exerted relatively homogenous effects on burnout. Six studies
have revealed significant associations between high workload
and increased levels of burnout (Huberty and Huebner, 1988;
Raquepaw and Miller, 1989; Rupert and Kent, 2007; Rupert
et al., 2009; Kim, 2017; Kotera et al., 2021). Similarly, four
studies have suggested that less experienced psychotherapists
were particularly vulnerable to burnout compared to their more
experienced colleagues (van der Ploeg et al., 1990; Mills and
Huebner, 1998; di Benedetto and Swadling, 2014; Kim, 2017).
Specifically, these latter results generally corresponded with the
previously mentioned role of the younger age of therapists as a
significant burnout predictor in that job. Additionally, working in
the public sector seemed to be positively associated with burnout
levels, as highlighted by five studies (Raquepaw and Miller, 1989;
van der Ploeg et al., 1990; Rupert and Kent, 2007; Emery et al.,
2009; Berjot et al., 2017). This finding was usually explained
by a lack of control over their own work environment among
psychotherapists and an increased level of bureaucracy in such
workplaces compared to private psychotherapists’ offices, where
they may feel that they have more control over when, where,
and how they will be working with their clients. Lastly, personal
therapy and/or supervision act as a buffer against burnout, as
mentioned by five authors (Ackerley et al., 1988; Wiseman and
Egozi, 2006; Deighton et al., 2007; Kim and Lee, 2009; Garcia
et al., 2018), which is a highly important argument in the ongoing
discussion related to self-care behaviors among psychotherapists
(Norcross et al., 2008).
Sociodemographic, Intrapersonal, and
Work-Related Factors Behind
Psychological Wellbeing Among
Psychotherapists
First of all, it is worth mentioning that to the best of our
knowledge, no systematic review has investigated the problem
of wellbeing and quality of life among psychotherapists in the
literature thus far. This latter issue is of fundamental significance,
as psychotherapists’ poor quality of life and associated mental
difficulties among psychotherapists may significantly hamper the
entire psychotherapeutic process (Enochs and Etzbach, 2004;
Holmqvist and Jeanneau, 2006). However, as may be visible
when we compare the number of studies concerning burnout vs.
wellbeing among psychotherapists (see Tables 1,2), studies on
the latter issue are particularly scarce, as attention has still focused
mainly on negative aspects of psychotherapists’ functioning.
Thus, although we intended to fill this existing research gap, the
empirical evidence on that subject is minimal compared to that
concerning burnout among psychotherapists.
In the context of wellbeing among psychotherapists, the
only significant relationships with sociodemographic variables
were with age, but two studies presented contrasting results
(Brugnera et al., 2020; Summers et al., 2021). On the one hand,
older psychotherapists appeared to experience higher levels of
wellbeing. This is consistent with findings concerning the role
of age in the general population, which indicate that older adults
tend to be more satisfied with their lives and experience enhanced
psychosocial and economic conditions (Ulloa et al., 2013; Steptoe
et al., 2015). On the other hand, older age was also a negative
predictor of wellbeing; these results may be “time-specific, as this
was one of the few studies conducted during the COVID-19 era
among this specific population. Perhaps older psychotherapists
experience greater difficulties organizing their work, mainly due
to the obligations inherent to online settings compared to their
younger counterparts, who are typically much more fluent in
new technologies.
Studies on intrapersonal variables related to psychotherapists’
wellbeing have confirmed the role of personality as well as
self-care behaviors, including self-compassion and mindfulness
practices, in maintaining a high quality of life in that profession
(Rzeszutek et al., 2015; Yip et al., 2017; Hitge and van
Schalkwyk, 2018; Rupert and Dorociak, 2019; Yela et al., 2020).
It appears that greater care for the personal emotional balance of
psychotherapists is a crucial, but highly understudied issue, both
in the empirical field, as well as in relation to psychotherapists’
training procedures involving various therapeutic modalities
(Laverdière et al., 2018).
Concerning work-related characteristics, only workload, work
experience, and professional support were significant. Workload
and amount of experience in the profession appeared to be
important in terms of psychological wellbeing (Schlarb et al.,
2012; Laverdière et al., 2018; Summers et al., 2021). Higher
workload was revealed to be a negative predictor of wellbeing,
while less experience seemed to be related to lower life
satisfaction, especially if both elements were present. This latter
finding is consistent with the previously mentioned data and
Frontiers in Psychology | www.frontiersin.org 15 August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
socio-demographic and work-related factors behind burnout in
this profession. Moreover, three studies consistently proved that
supervision and general support from team coworkers played a
positive role in terms of wellbeing (Roncalli and Byrne, 2016;
Fleury et al., 2017; Müller et al., 2020). This is another argument
in favor of the significance of professional support in that
occupation (Norcross et al., 2008).
Strengths, Limitations and Future
Directions
So far, the focus of existing research has focused on the positive
(wellbeing) and negative (burnout) aspects of therapists’
functioning. This review adds to the literature concerning
these issues. Additionally, this brings awareness to the need
for implementing education about self-care practices in
psychotherapy training programs. These suggestions also extend
to current psychotherapists that have already completed their
initial training in the profession. Psychotherapists can benefit
from maintaining their wellbeing and taking action to decrease
risk for burnout. This can also positively affect their clients.
This systematic review is not free of limitations, which
should be delineated along with recommendations for potential
future research regarding burnout and wellbeing among
psychotherapists. First, we excluded studies that were conducted
in languages other than English and/or qualitative research,
which could be a valuable source of information related to
psychotherapists’ mental functioning. In the future, it would
be interesting to review qualitative studies on psychological
functioning among psychotherapists. Burnout is a global
phenomenon, thus, future research should include non-English
papers, as well.
Second, while preparing this review, we faced several
problems related to the operationalization and measurement of
burnout and wellbeing. More specifically, the burnout measures
were inconsistent across the included studies; some employed
the three scales of burnout (see MBI), while other studies
only included statistics based on the global burnout score.
The Maslach model and the MBI tool dominated most of the
reviewed studies, although this model has been the subject of
widespread criticism (Demerouti et al., 2001). In the context
of this review, one should underline that the use of MBI
cutoff values to screen “cases” of burnout is very problematic,
as it may be an insufficient way to diagnose the prevalence
of burnout in various samples. Another important criticism
concerns the fact that the MBI subscales all contain only one-
directional items, which may lead to the artificial clustering of
factors (Halbesleben and Demerouti, 2005). Analog problems
arose related to measures of psychological wellbeing; we found
a large variety of measurements and models of this theoretical
construct. Furthermore, there was also a high diversity in
burnout and wellbeing predictors. The aforementioned two
factors make it highly difficult to summarize these findings in
the form of a meta-analysis. Future studies should employ a
more unitary operationalization and measurement of burnout
and/or wellbeing in this specific sample. Regarding burnout,
different models from the Maslach model should be more widely
accounted for to avoid the criticism of a lack of theoretically
driven research in the burnout field (Demerouti et al., 2001).
New insights into the Job Demands–Resources theory may point
researchers in a promising direction regarding combating these
shortcomings (Bakker and de Vries, 2021).
Third, about 95% of the reviewed studies utilized a cross-
sectional design. Thus, no cause-and-effect conclusions can be
drawn. Further research should also include more longitudinal
studies to examine long-term relationships between burnout and
wellbeing and their predictors among psychotherapists. This
issue is especially crucial in this profession and its outcomes, with
it usually being a long-term process (Norcross et al., 2008).
Fourth, the reviewed studies consisted of heterogeneous
groups of psychotherapists, representing not only different
therapeutic modalities, but sometimes also those outside of the
pure psychotherapeutic occupation. This is related to the fact
that the psychotherapeutic occupation may be represented by
several occupational groups, as different regulations for the
psychotherapeutic profession exist in various countries. In the
future, it would be wise to focus on more homogeneous samples
of psychotherapists; for example, researchers could compare
whether and how different psychotherapy modalities differ
concerning psychological functioning (Rzeszutek and Schier,
2014).
Finally, more research should be conducted regarding
psychotherapists’ wellbeing, as we have noticed that there were
almost three times more studies concerning the negative aspects
of psychotherapists’ functioning compared to research focusing
on how to maintain high wellbeing and quality of life in this
professional group (Laverdière et al., 2018). Studies have shown
that clients often choose to attend therapy with psychotherapists
who are perceived as psychologically stable and seem satisfied
with their personal lives (Wogan and Norcross, 1985; Lambert
and Barley, 2001). Low quality of life among psychotherapists
can potentially deteriorate therapeutic alliances with clients as
well as the entire therapeutic process (Enochs and Etzbach, 2004;
Holmqvist and Jeanneau, 2006).
CONCLUSIONS
Our systematic review suggests that burnout and
wellbeing among psychotherapists may largely depend on
sociodemographic (e.g., age, gender), intrapersonal (e.g.
coping, personality), and work-related characteristics, including
work settings and professional support in this profession
(e.g., supervision or personal therapy). However, future
research is required, particularly studies that adopt more
advanced methodological models and burnout/wellbeing
operationalizations and assessments (Lee et al., 2019). Numerous
studies use various definitions of burnout and wellbeing. It
would be beneficial to find universal definitions of the terms
in order to address the vast discrepancies in existing research
(Simionato and Simpson, 2018).
From a clinical perspective, the overall problem of
psychological health among mental health workers remains
largely understudied. This topic is not only important for
psychotherapists, but also for the clients who receive their help,
as well as for the entire psychotherapeutic process. Thus, it
is recommended that training programs for psychotherapists,
Frontiers in Psychology | www.frontiersin.org 16 August 2022 | Volume 13 | Article 928191
Van Hoy and Rzeszutek Burnout and Psychological Wellbeing
within various therapeutic modalities, should include a greater
focus on self-care behaviors among psychotherapists, to
teach them to better manage their work-related distress and
enhance their professional quality of life (McCormack et al.,
2018). Further, current psychotherapists should continue
to seek support within the profession as well as outside, in
order to maintain their wellbeing and decrease the risk of
experiencing burnout.
DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included
in the article/supplementary material, further inquiries can be
directed to the corresponding author.
AUTHOR CONTRIBUTIONS
AV and MR contributed to conception and design of the study,
performed the statistical analysis, and wrote sections of the
manuscript. AV organized the database and wrote the first draft
of the manuscript. Both authors contributed to manuscript
revision, read, and approved the submitted version.
FUNDING
This project has received funding from the New Ideas
of POB V project implemented within the scope of the
Excellence Initiative - Research University Program (Number
PSP: 501-D125-20-5004310).
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Frontiers in Psychology | www.frontiersin.org 19 August 2022 | Volume 13 | Article 928191
... Some studies have reported prolonged and chronic workplace stress and high levels of burnout among mental health workers compared to other healthcare professionals (Franzoi et al., 2021), and burnout is particularly common in helping professions (Maslach et al., 2001). However, unlike other healthcare occupations (e.g., doctors or nurses), research on burnout among psychotherapists is significantly less prevalent (Schaufeli et al., 2009;Woo et al., 2020;Van Hoy and Rzeszutek, 2022). ...
... Although there are numerous studies on the personality-burnout association, this issue remains understudied in the specific occupation of psychotherapists (Van Hoy and Rzeszutek, 2022). Several studies have revealed significant associations between high workload in the public sector and increased burnout levels (Ibrahim et al., 2022;Rupert and Dorociak, 2019;Rupert et al., 2009). ...
... These results highlight the complex relationship between individual personality and occupational wellbeing. Differences in the degree of psychotherapist burnout could be related to the complex and distinctive set of characteristics and psychological processes that define the personality (Van Hoy and Rzeszutek, 2022). High environmental sensitivity has emerged as a significant factor associated with psychotherapist burnout, functioning as both a potential risk factor and a possible protective factor. ...
Article
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Introduction The COVID-19 pandemic has worsened global mental health, thereby burdening mental health services and raising burnout risk among professionals. Online therapy may be an optimal solution to reduce burnout risk, ensuring flexibility for psychotherapists and the continuity of care for patients. This study investigates the link between burnout and online therapy, focusing on environmental sensitivity and exploring tailored solutions to reduce burnout while maintaining healthcare performance. Method Participants were 95 French psychotherapists (89% females), aged from 24 to 59 years (M = 37.13, SD = 7.75). Participants were administered the Maslach Burnout Inventory, the Highly Sensitive Person Scale, and a questionnaire assessing their professional activity. Results Digital psychotherapists reported lower levels of burnout compared to traditional psychotherapists who did not use online therapy. Specifically, they had lower depersonalization scores (mean difference of 0.37 points, p = 0.038) and tent to have lower scores in emotional exhaustion (mean difference of 0.44 points, p = 0.07). This association was more pronounced for those with high environmental sensitivity. Discussion Online therapy ensures greater workplace flexibility, serving as a protective factor in reducing psychotherapists’ burnout. Integrating digital health into public mental health services can enhance care delivery and support the wellbeing of professionals, especially those with high environmental sensitivity. Essential guidelines for online therapy use are needed to maximize benefits and ensure its effective implementation.
... Occupational factors like burnout may vary as a function of therapist characteristics such as the language in which they provide services. In addition to interpersonal factors such as stress coping styles, available resources, and perceived work-loads (Van Hoy & Rzeszutek, 2022), burnout has also been associated with therapist characteristics (e.g., age, minority status, level of education, years of experience) (Shell et al., 2021;Yang & Hayes, 2020). Therapist burnout can also be related to secondary traumatic stress. ...
... Specifically, in an exploratory study, Teran and colleagues (2017) found lower rates of burnout among Spanishspeaking therapists compared to English-speaking therapists (Teran et al., 2017). As Spanish-speaking therapists have increased burden in finding their own Spanish-language training and consultation resources as well as in developing competences in multiple languages (Castaño et al., 2007;Delgado-Romero et al., 2018;Diaz-LePage et al., 2023;Valencia-Garcia & Montoya, 2018), previous studies on burnout would suggest that this high workload would cause these therapists to have increased levels of burnout (Pines & Maslach, 1978;Van Hoy & Rzeszutek, 2022). However, more work is needed to replicate this burnout finding and to understand how English and Spanish speakers differ across various training and other professional outcomes. ...
Article
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In response to a growing demand, therapists in the United States (U.S.) are increasingly providing mental health services in Spanish. However, little is known about therapists who provide Spanish-language services in the U.S. context, particularly in relation to training in cognitive behavioral therapy (CBT). Thus, this study describes and explores differences between community therapists who provide services primarily in English or Spanish in regard to their demographic characteristics, evidence-based practice attitudes, burnout, secondary traumatic stress, compassion satisfaction, and CBT competence. We also longitudinally compared changes in therapist CBT competence across three time points. We analyzed data from 1497 therapists within a public mental health system, of whom 61 (4%) reported working with Spanish-speaking populations. Therapists were part of a 7-month CBT training and implementation program offered in both English and Spanish. We found that Spanish-speaking therapists were significantly older, had higher educational attainment, and had more years in their current role. Spanish-speaking therapists also had significantly lower pre-training secondary traumatic stress and CBT competence. There were no significant cross-sectional differences in EBP attitudes, burnout, and compassion satisfaction. Longitudinally, Spanish-speaking therapists showed greater gains in CBT competence from pre-training to 3 months and from pre-training to certification. By the end of training, therapists in both groups demonstrated strong CBT competence, regardless of their primary language. Current findings provide initial evidence that constructs underlying CBT can serve as a bridge to providing services to Spanish-speaking groups, for whom CBT was not originally developed.
... Being a psychotherapist is already known to be stressful and challenging per se, without being in a pandemic situation [22]. In particular, owing to the nature of their work, psychotherapists face an increased risk for emotional exhaustion and fatigue [20,23]. Their daily work exposes them to emotionally intense experiences, including the cumulative effects of witnessing suffering, trauma, and loss [24]. ...
... Longitudinally, as the interaction effect of sufficient recovery during spare time on depression was negative, it might be suggested that changes in recovery patterns over time might be associated with later changes in depressive symptoms among psychotherapists. Previous studies have found that psychotherapists are at an increased risk of emotional exhaustion and fatigue [20,23]. The above-mentioned and previously known overestimation of their competence and well-being, and the tendency to continue working despite burnout or compassion fatigue [31], might play an important role here. ...
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Background The COVID-19 pandemic has posed challenges to healthcare systems worldwide. For healthcare workers (HCW), an increased prevalence of mental distress and the impact of various resources have been identified. Psychotherapists specialise in helping people cope with stressful life events. At the same time, they are susceptible to mental distress, resulting from their work. Data on symptoms of depression and the role of resources during the COVID-19 pandemic are scarce for psychotherapists. Therefore, the present study aimed to evaluate the course of self-reported depression of psychotherapists throughout the COVID-19 pandemic. Additionally, the impact of resources on depression was evaluated. Methods We investigated symptoms of depression using the Patient Health Questionnaire-2 (PHQ-2) at four time points (T1-T4) during the COVID-19 pandemic in Germany. The PHQ-2 scores and resources such as sense of coherence (SOC), general optimism and social support (ESSI-D) of the psychotherapists (N = 1733) were compared with those of a comparison sample of HCW (N = 8470). The impact of resources on PHQ-2 scores was examined using cross-sectional linear modelling and longitudinal linear mixed modelling with interactions and lagged predictors. Results At T1-T4, psychotherapists showed lower mean PHQ-2 scores than the comparison sample (p < 0.001). Among psychotherapists, the PHQ-2 scores increased (T1-T2, and T1-T4, p < 0.050). Cross-sectionally, higher SOC was associated with lower PHQ-2 scores (p < 0.001), with the protective influence weakening over time (p = 0.033). Longitudinal analyses confirmed a protective effect of sense of coherence (stable over time) and general optimism (declining over time) on PHQ-2 scores. An exploratory lagged-predictor analysis suggested that higher social support was associated with lower PHQ-2 scores, whereas higher general optimism was linked to increasing PHQ-2 scores. Conclusions This study revealed lower levels of depression among psychotherapists compared with the comparison sample throughout the pandemic. Concurrently, the resource levels were mostly comparable and stable, with a protective impact of the sense of coherence (stable) and optimism (decreasing) and an association of high social support with low depression throughout the pandemic. Strengthening the sense of coherence and social support should be the focus of professional and policy attention to improve the ability of psychotherapists to cope with future crises.
... En cuanto a la primera pregunta, entiéndose que el estrés consiste en un mecanismo básico de autoconservación y fundamental para el mantenimiento de la especie humana (Benzoni, 2023(Benzoni, , 2019Slavich, 2020;Pereira;Cavalcante;Albuquerque, 2018), no hay discusión acerca de esto, porque donde hay personas, hay estrés. Sobre todo, el grupo ocupacional para el que se está adaptando el instrumento, los psicoterapeutas, está constituido por un grupo que tiende a presentar niveles considerables de estrés, como se destaca en la literatura científica (Owen et al., 2021;Van Hoy;Rzeszutek, 2022). Respecto de la segunda pregunta, se realizó un conjunto de actividades para verificar la comprensión del instrumento en el contexto chileno, especialmente entre los psicoterapeutas. ...
... En cuanto a la primera pregunta, entiéndose que el estrés consiste en un mecanismo básico de autoconservación y fundamental para el mantenimiento de la especie humana (Benzoni, 2023(Benzoni, , 2019Slavich, 2020;Pereira;Cavalcante;Albuquerque, 2018), no hay discusión acerca de esto, porque donde hay personas, hay estrés. Sobre todo, el grupo ocupacional para el que se está adaptando el instrumento, los psicoterapeutas, está constituido por un grupo que tiende a presentar niveles considerables de estrés, como se destaca en la literatura científica (Owen et al., 2021;Van Hoy;Rzeszutek, 2022). Respecto de la segunda pregunta, se realizó un conjunto de actividades para verificar la comprensión del instrumento en el contexto chileno, especialmente entre los psicoterapeutas. ...
Article
Full-text available
El estrés es una preocupación global para los organismos internacionales de salud, dada su relación con diversas enfermedades físicas y psicológicas. Este estudio buscó adaptar y validar de contenido un instrumento para medir la percepción del estrés y de los estresores en adultos, para ser utilizado con psicoterapeutas chilenos. El instrumento denominado Inventario de Percepción de Estrés y Factores Estresantes de Benzoni – IPEEB, fue desarrollado originalmente en portugués, en Brasil y aborda 8 áreas potencialmente estresantes de la vida. El instrumento traducido al español de Chile fue entregado a 5 jueces, académicos y/o profesionales del área de Ciencias Sociales y salud mental, para que brindaran apoyo con la revisión del instrumento en su adaptación y validación. Para que los jueces pudieran realizar la evaluación, se envió un conjunto de cinco preguntas sobre 1) la redacción original del ítem, 2) si el ítem mide adecuadamente la variable propuesta, 3) si la redacción del ítem era apropiada para el público objetivo del instrumento traducido, 4) si el número de ítems era excesivo, apropiado o insuficiente, y 5) si consideraron que podría haber algún aspecto que no estuviera abordado en el instrumento. Para la puntuación de los jueces se utilizó el criterio del 50% + 1. Los ítems fueron considerados, en su mayoría, representativos de las variables presentadas, lo que indica que la validez de contenido cumple su objetivo, pero algunos ítems requirieron modificaciones en su expresión para evitar ambigüedades y malas interpretaciones. Se sugiere realizar la validación estadística del instrumento.
... Therefore, it seems reasonable to suggest that this new information will build on that research. Furthermore, the study illuminates the understanding of therapy from the perspective of therapists themselves, as well as the factors that may render them susceptible to, or resilient against, the psychological strain associated with therapy work (Van Hoy & Rzeszutek, 2022). ...
Article
Full-text available
How therapists’ interoceptive accuracy or awareness affects the therapy process, and especially the therapeutic alliance, has not been previously studied. In this paper, data on objectively defined interoceptive accuracy and subjectively assessed interoceptive awareness were collected from forty Finnish psychotherapists. Interoceptive accuracy was measured with a heartbeat discrimination task and interoceptive awareness using the Multidimensional Assessment of Interoceptive Awareness, version 2, questionnaire. The therapists and their clients evaluated their experience of the alliance and provided written descriptions of each session in the study period. Using mixed methods, we then examined the associations between interoception and the therapeutic alliance and client wellbeing, as well as how psychotherapists used their internal bodily sensations as a source of information. The key result of this study showed that the therapists’ interoceptive accuracy and awareness were positively correlated with their experience of the alliance. Through thematic analysis, we identified five sub-themes that illustrate how bodily sensations serve as a source of information for the psychotherapist. However, the therapists’ interoceptive accuracy or awareness were not associated with the clients’ experiences of alliance or their wellbeing. In conclusion, a psychotherapist’s increased interoceptive accuracy and high level of interoceptive awareness enhance the therapist’s own experience of therapeutic alliance with the client. In addition, their increased awareness of internal bodily sensations also brings more elaborated information to the therapeutic process.
... While the preponderance of literature emphasizing hazardous outcomes is justified given the prevalence rates of these phenomena and concern for retaining providers (Yang & Hayes, 2020), research is needed to examine factors that promote well-being. Studies often conflate low levels or the absence of negative outcomes with well-being (Van Hoy & Rzeszutek, 2022), and a dual-factor perspective views these as conceptually distinct. Furthermore, the literature on MHC functioning primarily relies on variable-centered analyses that estimate relationships between constructs. ...
Article
Full-text available
Mental health clinicians (MHCs) are at known risk for adverse outcomes such as compromised well-being, mental health challenges, burnout, and secondary traumatic stress. Prior research has identified demographic and work-related risk factors, but fewer studies have examined personal capacities that might reduce risk and simultaneously promote MHC well-being. Research is also needed on the interplay between these factors and wider contextual influences. This mixed methods study explored MHC functioning and factors contributing to their experiences coming out of the COVID-19 pandemic. We used a concurrent triangulation design and collected cross-sectional survey data between 2022 and 2023 from a U.S. sample of MHCs (N = 116). Latent profile analysis identified four distinct profiles on indicators for self-compassion, differentiation of self, burnout, well-being, and work-related secondary traumatic stress. Concurrently, we used reflexive thematic analysis to analyze MHCs’ responses to open-ended questions about their experiences, including (a) work-related situations that contributed to overwhelm, fear, and/or helplessness, (b) what they found challenging about their work, (c) what fueled or sustained them to continue in their work, even under stressful conditions, and (d) and what they needed to thrive. Finally, we integrated latent profile analysis and qualitative findings. Our findings signal the potential benefits of holistic MHC development for mitigating risk and supporting well-being, as well as highlighting how systemic ingenuity will be necessary to address the organizational and contextual factors compounding risks when working with distressed and traumatized populations. Implications and directions for future research are discussed.
... Encouraging peer support groups where counselors collectively brainstorm solutions to common challenges (like disengaged students or high caseload stress) can reinforce an organizational culture of proactive problemsolving and shared coping, reducing feelings of isolation. These efforts echo recommendations in the social work field that self-care and support be incorporated into professional practice to maintain well-being [5]. In essence, creating formal and informal structures for counselors to support each other -through mentorship, debriefings, or peer workshops -can bolster both coping skills and morale, acting as a buffer against burnout. ...
Article
This study examines whether counselors’ social problem-solving ability can mitigate the impact of high job stress on burnout in demanding educational settings. Drawing on the Effort-Reward Imbalance (ERI) model and the Job Demand-Control-Support (JDCS) model as frameworks for occupational stress, and integrating Social Cognitive Career Theory (SCCT) constructs as personal resources, we test a model in which social problem-solving skills act as a mediator, buffering counselors from burnout. A cross-sectional survey of 401 university counselors was conducted. Participants completed measures of job stressors (ERI and JDCS), career-related personal resources (self-efficacy, outcome expectations, and goals from SCCT), social problem-solving ability (Social Problem-Solving Inventory–Revised, SPSI-R), and burnout (Maslach Burnout Inventory–Educators Survey, MBI-ES). Structural equation modeling (SEM) was used to assess the direct effects of stressors and SCCT constructs on burnout, and the indirect effects via problem-solving ability. The SEM results supported our hypotheses. High ERI and high job demands/low control (JDCS conditions) were directly associated with increased counselor burnout, whereas strong SCCT-related personal resources were associated with reduced burnout. Importantly, social problem-solving ability was a significant protective mediator: higher problem-solving skills were associated with lower burnout and partly buffered the negative effects of ERI and JDCS on burnout. Indirect effect analyses (bootstrapped) confirmed that problem-solving ability significantly mediated the relationships between each job stressor and burnout (accounting for approximately 11–12% of the total effects). Social problem-solving capacity serves as a valuable personal resource that alleviates the impact of chronic work stress on counselor burnout. Interventions to enhance counselors’ problem-solving skills, alongside organizational efforts to reduce effort–reward imbalance and extreme job demands, may jointly reduce burnout risk in high-stress educational contexts. These findings underscore the importance of developing problem-focused coping resources to maintain well-being among counseling professionals.
Article
The article is devoted to the phenomenon of occupational burnout and the peculiarities of its cognitive-behavioral therapy in specialists working with the category of stress-related disorders, including PTSD. A general review of scientific data on occupational burnout (OB) is made. Modern definitions of burnout, ideas about the boundary between normality and disorder, diagnostic criteria and diagnostic methods, risk factors for development, and different ideas about the stages of development of occupational burnout are considered. Modern ideas about the prevention of burnout are analyzed. The most widespread is the model of influence on six factors (workload, control, reward, community, justice, and values). There is low-quality evidence of the effectiveness of CBT, mindfulness, relaxation methods (physical and mental), changes in work schedule, and creating a sense of professional security from the studies on the prevention of OB. The general conclusion is that the level of research on the prevention of OB is insufficient and that it is impossible to identify an unambiguously effective approach to prevention. The theoretical models of the VP, the main of which are the stress model and the depressive model, as well as the criticism of the OB as a diagnostic category, are considered. At the moment, there are more factors favoring the depressive model of OB than the stress model. Studies of OB among psychologists identify the following OB factors: younger age and less work experience, female gender, low emotional stability and low level of subjectively perceived resources, emotionally oriented coping, and imbalance between personal life and professional activities. Personal therapy and/or supervision act as a significant buffer against OB. Studies of OB in professionals working with mental trauma show that client load, occupational burnout, and secondary traumatization are in a complex, ambiguous, and mediated by other parameters relationship. Organizational factors (support and security, or vice versa, pressure and insecurity) and factors of training, supervision, and personal psychotherapy have the greatest impact. A very important factor is job satisfaction and a sense of meaning, which can be a powerful buffer against occupational burnout, but most likely not against secondary traumatization. The article provides recommendations for the work of crisis psychologists in modern Ukrainian realities, the main of which are acceptable loads; physical activity, relaxation and mindfulness; work with depressive personal factors (including disappointment in work); supervision; support for meaning and professional satisfaction; and a full personal life outside of work. Recommendations for psychotherapy in case of occupational burnout are also provided.
Chapter
The concluding chapter of this edited volume reflects on the interconnectedness of personal history, cultural identity, and professional development in shaping the journey of counsellors. It emphasises the vital role of holistic self-care, resilience, and reflective practices in sustaining counsellor well-being and professional efficacy across their lifespan. Personal narratives highlight the balance between empathy, professional boundaries, and the need for continuous self-awareness through supervision, personal therapy, self-care practices, and mindfulness. The chapter also discusses the increasing importance of cultural competence and multidisciplinary collaboration in addressing the complexities of the counselling profession. This autoethnographic approach offers practical insights into self-care practices, the importance of professional support systems, and the integration of personal and professional experiences to enhance therapeutic practice. Ultimately, the chapter calls for a reimagined, integrated approach to counsellor well-being, aiming to inspire resilience and professional growth in current and future practitioners.
Article
Background Interpersonal empathy is a well‐researched concept in the counselling and psychotherapy literature, although less is known about how it is experienced at an intrapersonal level. What is known is that self‐empathy involves a change in perspective and a re‐evaluation of events, in kinder and less judgemental ways. Aim The aim of this study was to understand and appreciate the meaning of self‐empathy to trainee creative psychotherapists. The research was in the context of the students' own self‐care and intrapersonal relating. Methodology and Methods An interpretative poetic inquiry design was utilised. Interviews were conducted with 4 trainee creative psychotherapists at a university in the Northwest of England, UK. Results Self‐empathy was experienced as a process, often involving several aspects of the self, to understand and accept feelings and events in the context of self‐care. Development of self‐empathy involved internal dialoguing through activities such as journaling, poetry writing, meditation, and being outdoors. The use of interpretative poetic inquiry enabled the emotional aspects of the data to be distilled and combined reflexively with the experiences of the researchers. Conclusions This research provides contemporary insights into the experiences of self‐empathy from the perspective of a small number of trainee creative psychotherapists. It has implications for students in terms of self‐understanding and self‐care, and for educators, to inform future psychotherapist preparation and curriculum development. Finally, there are implications for future research using interpretative poetic inquiry as a reflexive approach, which embraces the presence of the researcher in the research.
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The purpose of this research is to identify a path model to explain burnout in community mental health professionals based on the compassion satisfaction–compassion fatigue (CS-CF) model. A total of 125 mental health professionals, including nurses, social professionals, and psychologists working in mental health welfare centers in various regions across South Korea were surveyed using a structured questionnaire. A path analysis was conducted using SPSS 24.0 and AMOS 24.0. The results showed that compassion satisfaction and compassion fatigue are significant predictors of burnout (β = −0.20, p = 0.011; β = 0.40, p < 0.001, respectively). The indirect pathways associated with burnout included occupational stress (β = 0.21, p = 0.021) and experience with aggressive behavior in the workplace (β = 0.33, p = 0.004) through maladaptive cognitive emotion regulation and compassion satisfaction. The total effect of the variables on burnout via compassion fatigue and compassion satisfaction explained 62.5% of burnout among mental health professionals. These findings indicate that providing nursing interventions might reduce compassion fatigue and increase compassion satisfaction to reduce burnout. Furthermore, intervention programs that help to reduce the use of maladaptive cognitive emotion regulation strategies are necessary to effectively reduce burnout in mental health professionals.
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Although it is well established that emotion‐focused coping is associated with burnout, the schema therapy model may improve the prediction of who is most vulnerable to using emotion‐focused coping and what kinds of emotion‐focused coping carry the greatest risk of burnout. It is also unknown the extent to which resilience might buffer against maladaptive coping in protecting against burnout. The present study investigated whether maladaptive coping modes would incrementally predict emotional exhaustion (EE) adjusting for resilience and whether resilience might moderate the effect of maladaptive coping on EE. The possible role of maladaptive coping as a mediator of job demands on EE was also explored. Four hundred and forty‐three clinical and counselling psychologists completed online measures of job demands, EE, resilience, and maladaptive coping modes. The Detached Protector mode was associated with greater EE after adjusting for resilience. Bully and Attack mode was associated with greater EE when considered separately from other coping modes but associated with decreased EE when considered together. Resilience did not moderate the effect of job demands on EE, or the effect of coping modes on EE, except for Compliant Surrenderer. Coping modes only partially mediated the effect of job demands on EE accounting for 20% or less of its effect. Maladaptive coping modes appear to make independent contributions to the risk of EE and efforts to reduce burnout in psychologists should focus dually on increasing resilience‐building practices and decreasing maladaptive coping.
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Previous studies on the therapists' burnout have focused on individual and environmental risk factors. This study aimed to analyse whether variables reflecting therapeutic relationship—the therapist experience of relational depth and quality of the therapeutic relationship—can be related to psychotherapist burnout. Four alternative path models were examined. A total of 101 humanistic–experiential psychotherapists, aged between 29 and 86 years, participated in the research. The Relational Depth Frequency Scale, the Scale to Assess the Therapeutic Relationship, the Psychological Well‐Being Scale and the Link Burnout Questionnaire were applied to the research. The results showed that relational depth and therapeutic quality correlated negatively with psychotherapist burnout. Relational depth is the main predictor of psychological well‐being and psychotherapist burnout through its effect on therapeutic quality. The experiences of relational depth, primarily of person‐centred therapists, have positive psychological potential in predicting lower professional burnout.
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Though negative impacts of COVID-19 on occupational mental health have been re-ported, the mental health of psychotherapists has not been evaluated in depth. As this occupational group treats ever-increasing mental health problems, it is essential to ap-praise key factors for their mental health. Accordingly this study aimed to explore burnout of professional psychotherapists. 110 completed self-report measures regarding burnout, self-compassion, work-life balance and telepressure. Correlation, regression and moderation analyses were conducted. Both of the burnout components—emotional ex-haustion and depersonalisation—were positively associated with weekly working hours and telepressure, and negatively associated with age, self-compassion and work-life balance. Weekly working hours and work-life balance were significant predictors of emotional exhaustion and depersonalisation. Lastly, self-compassion partially mediated the relationship between work-life balance and emotional exhaustion but did not mediate the relationship between work-life balance and depersonalisation. Findings suggest that maintaining high work-life balance is particularly important for the mental health of psychotherapists, protecting them from burnout. Moreover, self-compassion needs to be cultivated to mitigate emotional exhaustion. Mental health care for this occupational group needs to be implemented to achieve sustainable mental health care for workers and the public.
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Objective: The primary aim of this research was to explore the relationship between burnout and depression among Australian psychologists, and to investigate the role of self-compassion in this relationship. Method: A sample of 248 psychologists (average 41 years old; 81.1% female) currently working in Australia completed an on-line survey including measures of burnout (Copenhagen Burnout Inventory), depression (Depression Anxiety Stress Scale), and self-compassion (Self-Compassion Scale – Short Form). Results: In total 69 psychologists (27.8%) met criteria for burnout, while 42 (16.9%) reported at least mild depressive symptoms. Burnout and depression were significantly associated with each other (r = .44), while negative medium associations were found between self-compassion and burnout and depression (r = .48), respectively. A hierarchical regression analysis revealed self-compassion moderated the relationship between burnout and depression; psychologists with high levels of burnout and low to moderate levels of self-compassion reported significantly higher levels of depressive symptoms. Conclusions: The current results indicate that self-compassion may act as a protective factor against the effects of depression and burnout. Given elevated burnout and depressive symptoms reported by Australian psychologists, the development and promotion of self-compassion focused self-care practices for psychologists may be beneficial and warrants further research. KEY POINTS What is already known about this topic: • Burnout and depression are highly prevalent among psychologists. • Self-compassion is associated with enhanced psychological health and well-being. • Self-compassion can buffer against negative states. What this topic adds: • Psychologists who are more self-compassionate experience lower levels of burnout and depressive symptoms. • For psychologists with high levels of burnout, the practice of self-compassion can significantly lower the severity of depressive symptoms experienced. Self-compassion may be a useful self-care tool to reduce psychological distress.
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The well‐being of the psychological workforce is an area of concern. However, it has been sparsely studied in a holistic manner encompassing workplace well‐being as well as burnout. This study reports a survey of 1,678 psychological practitioners accessed through professional networks. The short Warwick Edinburgh Mental Well‐being Scale (SWEMWBS) and the Psychological Practitioner Workplace Well‐being Measure (PPWWM) were administered with a demographic questionnaire. The mean for the SWEMWBS was below that of a national population survey. The intercorrelation of these tests was .61. Subgroup analyses showed significant differences: assistant psychologists, counsellors and psychological well‐being practitioners demonstrated better than average workplace well‐being. But for general well‐being (SWEMWBS), trainee clinical psychologists and assistant psychologists showed lower than average well‐being, whereas psychological well‐being practitioners were higher than average. Other factors associated with well‐being were contract type—both measures (higher workplace well‐being in those with temporary contracts and the self‐employed); employment sector—for PPWWM only (private organisation/independent workers and third sector/charitable organisation workers scored above the PPWWM mean); ethnicity—for both measures (Asian groups except Chinese had higher well‐being than average for the PPWWM and SWEMWBS) and disability was strongly associated with lower well‐being on both measures. Harassment, feeling depressed or a failure and wanting to leave the National Health Service (NHS) were associated with lower well‐being. Greater age, pay and years of service were negatively correlated with well‐being. A five‐factor structure was obtained with this sample. The results confirmed psychological practitioners as an at‐risk group and identified a number of factors associated with workplace well‐being.
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Background: High job demands and low job resources may cause job strain and eventually result in burnout. However, previous research has generally ignored the roles of time and self-regulation. Objectives: This theoretical article synthesizes the literature to propose a multilevel model that delineates how acute job strain translates into enduring and severe job burnout. Methods: We integrate self-regulation perspectives in job demands-resources (JD-R) theory to propose that short-term job strain and eventually enduring burnout is the result of consistently high job demands and low job resources – combined with failed self-regulation. Results: The model shows that when employees are confronted with increased job strain, they are more likely to use maladaptive self-regulation strategies, such as coping inflexibility and self-undermining. In addition, when job strain increases, employees are less likely to use adaptive self-regulation strategies, such as job stress recovery and job crafting. It follows that when the job becomes more stressful, stable resources become more important. Organizational resources such as human resource practices and healthy leadership may help employees to regulate their short-term fatigue and avoid enduring burnout. Furthermore, key personal resources like emotional intelligence and proactive personality may help employees to recognize and regulate their fatigue in an effective way. Conclusion: The proposed model of burnout expands JD-R theory and offers important practical implications for the prevention and reduction of burnout.
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This study investigated the effects of gender, personality (prosocialness, relational-interdependent self-construal, and brooding), job demands, affective work rumination, and personal-to-work conflict on burnout (exhaustion and disengagement), among clinical public-health psychologists in Sweden. The participants answered a self-report questionnaire (n = 828). Hierarchical multiple regression analyses showed that affective work-rumination, brooding and personal-to-work conflict were most strongly associated with exhaustion, whereas affective work-rumination, brooding, role conflict, and prosocialness most strongly predicted disengagement. Furthermore, in the full models, quantitative job demands and relational-interdependent self-construal related to exhaustion, whereas emotional demands related to disengagement. Interestingly, role conflict had a positive relation and emotional demands a negative relation to disengagement. Women reported higher exhaustion, but not higher disengagement, than men. Women also reported higher levels on most of the independent variables. In sum, the results show that a broad range of factors influence burnout among clinical psychologists.
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Objective: Subjective well-being is a crucial variable for mental health practitioners. This study examines the influence of therapists’ attachment dimensions and self-reported reflective functioning on their perceived well-being. Further, it examines if reflective functioning mediates the association between attachment insecurity and well-being. Method: A total of 416 experienced psychotherapists were enrolled in this cross-sectional study, and completed self-report measures of attachment insecurity, reflective functioning, and well-being. We tested the hypothesized mediation model with path analysis that examined indirect effects. Results: Both attachment anxiety and avoidance dimensions had a significant negative association with perceived well-being with small to medium effects. “Certainty” in reflective functioning had a small positive effect on therapist well-being. Reflective functioning mediated the association between insecure attachment dimensions and well-being, suggesting that therapist's lower ability to mentalize may partially account for the effects of higher attachment insecurity on lower well-being. Conclusion: The well-being of psychotherapists with greater insecure attachment may deserve special attention, and therapists’ mentalizing capacities may be targeted by researchers and trainers as a core ability to be cultivated in order to preserve therapists’ professional and personal resources.