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Burnout and Psychological Wellbeing Among Psychotherapists: A Systematic Review

Frontiers in Psychology

August 2022
13

DOI:10.3389/fpsyg.2022.928191

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Authors:

Angelika Van Hoy

University of Warsaw

Marcin Rzeszutek

University of Warsaw

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

Frontiers in Psychology | www.frontiersin.org 2August 2022 | Volume 13 | Article 928191

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

M−69

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)

Frontiers in Psychology | www.frontiersin.org 7August 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

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

F−135

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 PD−31%

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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Conﬂict of Interest: The authors declare that the research was conducted in the

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The effectiveness of online therapy in promoting wellbeing and reducing burnout among psychotherapists

Article

Full-text available

Mar 2025

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.

Cognitive Behavioral Therapy Training and Implementation: Comparisons Between Spanish-Speaking and English Monolingual Therapists

Article

Full-text available

Jun 2025

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.

Course of mental distress among psychotherapists throughout two years of the COVID- 19 pandemic: individual and inter-relational resources make a difference—cross-sectional and longitudinal results of the VOICE study

Article

Full-text available

May 2025
BMC PSYCHIATRY

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.

Adaptación y validación de contenido de instrumento para evaluar percepción de estrés

Article

Full-text available

Mar 2025

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.

The Role of the Psychotherapist’s Interoception in the Therapeutic Alliance

Article

Full-text available

Jun 2025
J Contemp Psychother

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.

Therapists’ Functioning and Secondary Traumatic Stress Emerging From the COVID-19 Pandemic: A Mixed Methods Study

Article

Full-text available

Jun 2025
Traumatology

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.

Social problem-solving ability as a protective mediator: Reducing burnout among counselors in high-stress educational contexts

Article

Apr 2025

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.

Cognitive-Behavioral Therapy for Burnout among Crisis Psychologists

Article

Apr 2025

Denys Starkov

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.

Sustaining the Helping Profession: Key Reflections on Self-Care and Counsellor Well-Being

Chapter

Apr 2025

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.

Student Psychotherapists' Experiences of Self‐Empathy: An Interpretative Poetic Inquiry

Article

Feb 2025
Counsell Psychother Res J

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.

A Path Model for Burnout in Community Mental Health Professionals

Article

Full-text available

Sep 2021
Int J Environ Res Publ Health

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.

The influence of maladaptive coping modes, resilience, and job demands on emotional exhaustion in psychologists

Article

Full-text available

Jun 2021
CLIN PSYCHOL PSYCHOT

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.

Therapeutic relationship and professional burnout in psychotherapists: A structural equation model approach

Article

Full-text available

Jun 2021
CLIN PSYCHOL PSYCHOT

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.

Burnout in Professional Psychotherapists: Relationships with Self-Compassion, Work-Life Balance, and Telepressure

Article

Full-text available

May 2021
Int J Environ Res Publ Health

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.

Burnout and depression in Australian psychologists: The moderating role of self-compassion

Article

Full-text available

Mar 2021

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.

A survey of psychological practitioner workplace well‐being

Article

Full-text available

Oct 2020
CLIN PSYCHOL PSYCHOT

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.

Job Demands–Resources theory and self-regulation: new explanations and remedies for job burnout

Article

Full-text available

Aug 2020

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.

The relationship between personality, work, and personal factors to burnout among clinical psychologists: exploring gender differences in Sweden

Article

Full-text available

May 2020

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.

Stress and Resilience Among Professional Counselors During the COVID-19 Pandemic

Article

Sep 2021
J COUNS DEV

The present study used a national sample of professional counselors (N = 161) providing services during the COVID-19 pandemic to examine the extent to which perceived stress, coping response, resilience, and post-traumatic stress predict burnout, secondary traumatic stress, and compassion satisfaction. The results of a multiple regression analysis indicated resilience had a strong positive relationship with compassion fatigue and a strong negative relationship to burnout. Perceived stress was also strongly positively related to burnout. Implications and strategies for counselors to mitigate the effects of perceived stress during the COVID-19 pandemic by engaging in self-care practices and cultivating resilience are provided.

Self-reported reflective functioning mediates the association between attachment insecurity and well-being among psychotherapists

Article

May 2020

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.

Burnout and Psychological Wellbeing Among Psychotherapists: A Systematic Review

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