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Couns Psychother Res. 2024;00:1–13.
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1wileyonlinelibrary.com/journal/capr
Received: 24 March 2024
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Revised: 25 September 2024
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Accepted: 25 Septe mber 2024
DOI: 10.1002/capr.12837
REVIEW
Self- care in prevention of burnout amongst counselling
professionals: A systematic literature review
Malini Turner | Robynne Rankine
This is an op en access arti cle under the ter ms of the Creative Commons Attribution-NonCommercial-NoDerivs License, whi ch permits use a nd distribution in
any medium, provided the original work is properly cited, the use is no n-commercial and no modi ficat ions or adaptat ions are made.
© 2024 The Aut hor(s). Counselling and Psychotherapy Research published by Jo hn Wiley & Sons Ltd on b ehalf of B ritish A ssociation for Counse lling an d
Psychotherapy.
Faculty of Health and Medicine, University
of New Engla nd Scho ol of Heal th, Sydney,
Australia
Correspondence
Malini Turner
Email: mturne61@une.edu.au
Abstract
Aim: This paper sought to examine current application of self- care to reduction and
prevention of burnout amongst counselling professionals.
Materials and Methods: A systematic approach to the literature across CINAHL,
EBSCO, PsycInfo, PsycArticles, PubMed, Scopus and Google Scholar was conducted,
adhering to PRISMA 2020 guidelines. Population, Intervention, Comparison, Outcome
(PICO) and Sample, Phenomenon of Interest, Design, Evaluation and Research type
(SPIDER) were applied as strategic tools to paper inclusion. After the completion of
selection process, Critical Appraisal Skills Programme (CASP) was used to examine
the included papers and to narrow the study down to a total of 16 journal articles.
Furthermore, thematic analysis revealed two superordinate themes: Factors contrib-
uting to burnout with total of five subthemes and actions contributing to self- care
with total of six subthemes.
Results: The factors contributing to burnout had both personal and organisational
origin, primarily based on lack of knowledge of burnout symptoms and reduced re-
sources for applied self- care. Furthermore, access to clinical supervision was not
readily available, and self- care concepts were not adequately implemented within the
organisational context.
Conclusion: Despite the extensive research regarding the serious occupational re-
percussions of burnout amongst counselling professionals, the role of timely and
appropriately applied self- care has not been clearly established. Many counselling
professionals were not aware of burnout signs and symptoms while self- care was
seen as optional exercise, applied either minimally or not at all. Holistic education on
the effects of cognitive, emotional, physical and spiritual self- care needs amongst the
counselling professionals is necessar y in prevention and reduction of burnout and
should be further examined.
KEYWORDS
applied self- care, burnout prevention, choices to self- care, qualitative methods, systematic
review
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TURNER and R ANKINE
1 | INTRODUC TION
1.1 | Background
Burnout is an intrinsic condition, with root causes that stem from
neglected work- related stress and exhaustion (Heinemann &
Heinemann, 2017), affecting the counselling professional's well-
being, and leading to a state of distress. Burnout plays a signifi-
cant role in the development of job- related depression, anxiety,
emotion dysregulation and other mental health disorders (Bianchi
et al., 2015; Gul et al., 2017). Originally applied to drug abuse,
burnout was described as behaviour that causes someone ‘to fail,
wear out, or become exhausted by making excessive demands
on energy, strength, or resources’ (Freudenberger, 1975, p. 73).
This description served Maslach and Jackson (1981) in developing
burnout's three dimensions: emotional exhaustion, depersonalisa-
tion and low personal efficacy, and expanding into its demand-
ing biopsychosocial impact (Maslach et al., 2001; Maslach &
Leit er, 2016).
The emotional nature of counselling work escalates stress by
carrying negative implications on the quality of service delivered
(Friedman, 2017). Laverdière et al. (2018) considered empathy to be
the mos t important factor in clinical wor k, while Salyers et al. (2019)
viewed compassionate collaboration as a key to the client's best
interests in therapy. As such, both empathy and compassion are
essential to the practitioner's abilit y to be emotionally invested in
their work (Patsiopoulos & Buchanan, 2011). Emotional exhaustion
deprives an individual of both empathy and compassion, resulting in
poorer treatment outcomes (Cook et al., 2021). Such developments
cause distress to counselling professionals and clients alike, with
negative mental health implications for both.
Work- related tensions can complicate burnout expression and
contribute to professional impairments (Butler et al., 2018). As a
result, counsellors could develop ‘care- less’ behaviours towards
their co- workers, both verbally and non- verbally, leading to emo-
tional despondencies, such as withdrawal from work engagements
(Kleszczewska- Albińska, 2020) or inclination to per form tasks in a
robotic manner along with a c ynical attitude (Beitel et al., 2018).
Such developments may result in overall lethargic approches to
important work- related matters and a reduction of applied critical
thinking capacit y (Gul et al., 2017), often leading to depersonalisa-
tion that neglects maintenance of professional boundaries (Posluns
& Gall, 2020). Depersonalisation frequently results in ruptured ther-
apeutic relationships with clients and dysfunctional relationships
with colleagues.
Negative self- evaluations were consistent with self- perceived
low- quality client care delivery (Oser et al., 2013), steering into
expressions of low personal efficacy, leading to overall low self-
esteem (Dose et al., 2019). Such perceptions produce a cycle
of worry and rumination as well as giving rise to negative feel-
ings towards oneself (Friedman, 2017; Gam et al., 2016; Guler
& Ceyhan, 2020) with newly qualified professionals expressing
dissatisfaction with their current occupation while reportedly
questioning their career choice (Cook et al., 2021). Low personal
efficacy contributed to practitioners feeling unfulfilled in their
chosen field of work.
1.2 | Aetiology
Burnout diagnostic criteria remain indistinct and subjective (de
Hert, 2020). It overlaps with a number of other conditions, including
those it is currently differentiated from (Simionato & Simpson, 2018).
Burnout is known to affect working memory and attention levels
(Atroszko et al., 2020), with practitioners finding it dif ficult to leave
clients' problems at work or family problems at home, affecting their
work- life balance (Baker & Gabriel, 2021). Counselling professionals
see themselves as lacking progress with their clients as they prefer
to spend more time with their family, in an effort to combat their
emotional exhaustion (Lin, 2012). These expressions of a disturbed
work- life equilibrium interfere with the focus on quality client care
(Coaston, 2017), resulting in feelings as if captured between the
‘hammer and the anvil’, negatively impacting inner stability and over-
all focus at work.
Perpetual dismissal of such signs triggers an increase in profes-
sional anxiety (Hill & Curran, 2016). Lack of acknowledgement of a
growth in personal discomfort leads to somatic expressions, such
as physical fatigue, sleeping problems, muscle and abdominal pain,
and palpitations (Deneva & Ianakiev, 2021). When dismissed, burn-
out accumulates (Cocker & Joss, 2016), with neurological, respira-
tory, musculoskeletal and cardiovascular disorders as a consequence
(Morse et al., 2012). In the long term, neglec ted signs and symptoms
can produce various job- related, neurastenia- like symptomatology
Implications for practice and policy
• Despite the extensive research regarding the serious
occupational repercussions of burnout amongst coun-
selling professionals, the role of timely and appropriate
application of self- care has not been clearly est ablished.
The factors contributing to burnout are of both personal
and organisational origin and are primarily based on lack
of knowledge of burnout symptoms and reduced re-
sources for applied self- care.
• Furthermore, access to clinical super vision was not
readily available and self- care concepts were not ade-
quately implemented within the organisational context.
Many cou nsellin g profe ssion als were not awa re of bur n-
out signs and symptoms. Self- care was seen as optional
and was either applied partially or not at all.
• Holistic education on the effect s of cognitive, emotional,
physical and spiritual self- care needs amongst counsel-
ling professionals is necessary in the prevention and re-
duction of burnout and should be fur ther examined.
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TURNER and RANKINE
(Maslach & Leiter, 2016). Dismissed burnout complications result in
behaviours such as endeavours for multidimensional perfectionism
(Hill & Curran, 2016), along with neurotic traits (Jiang et al., 2012)
and ultimately result in the development of depressive, anxious and
other personality disorders (Bianchi et al., 2018).
Although work stress can, over time, deplete the professional's
inner resources and affect both physical and mental health, not all
work- related stress leads to burnout (Awa et al., 2010). Some of
the issues currently arising from the literature are that counselling
professionals generally do not know about its signs and symptoms
(Baker & Gabriel, 2021) and when they do, it is almost too late.
Another current problem is that self- care is applied at a basic rate
and inconsistently (Beitel et al., 2018), alongside ignoring the need
to seek help for personal difficulties in discharging work duties
(Kleszczewska- Albińska, 2020).
Some organisations, such as the British Association for Counselling
and Psychotherapy (BACP) and American Counselling Association
(AC A), emp hasis e self- care as a primar y et hical obl igation fo r both th e
client and the professional and provide a number of directions for its
application. However, actual self- care application is not sufficiently
researched. Despite the increased calls for self- care amidst the tur-
moils of such emotionally demanding work, counselling organisational
proto co ls sti pu la te its imp ort ance in na me onl y, as an empirica ll y va lu-
able tool, left to apply as per one's personal choice. Self- care stands
out as a ‘faceless’ part of the professional's responsibility, and it is
used only for self- protection an d self- preser vation in the face of chal-
lenging work (PACFA, 2017 ), while lacking expansion on its explicit
qualities, towards the professional's long- term health and well- being.
Despite the continued conceptual controversy and burnout debates,
this factor alone gives prevalence to the aetiology of prolonged ne-
glect to applied self- care and informs targeted service training to-
wards long- term well- being. This systematic literature review intends
to explore these gaps in the literature by critically examining self- care
across its various domains, as indicated in selected studies.
2 | METHODS
2.1 | Literature search
The review was performed to address the following question: ‘What
self- care strategies do counsellors use to cope with their burnout?’
The search began on 14 January 2021 and continued until 14 July
2021, using the following keywords and Boolean phrasing: (coping
OR cope OR copes OR coping OR approach* OR strategy* OR “self-
care” OR “self care”) AND (“burn out” OR “burn- out” OR “burnout”
OR “compassion fatigue*” OR “psychological fatigue” OR “secondary
trauma*”) AND (therap* OR counsel*). The search included second-
ary traumatic stress and compassion fatigue because the literature
uses these three terms interchangeably.
The following databases were searched: CINAHL, EBSCO,
PsychInfo, PsycAr ticles, PubMed and Scopus, due to the preva-
lence of counselling and mental health topics in their publications.
A grey literature search was conducted via Google Scholar, with
‘.org’ placed af ter the search words. Over the past 10 years, burnout
research has moved from examination across quantitative research
towards expansion in qualitative, individual- focussed studies of its
prevention (Guler & Ceyhan, 2020; Oser et al., 2013).
The search was limited to publications in the English language
due to costs involved with translation from other languages. The
limit of ‘Full Text’ and ‘Journal Articles’ was applied for a complete
coverage of the data. Ar ticles were searched under both an Abstract
(AB) OR Document Title (TI) where relevant.
After the materials were collated, a systematic approach to the
literature, according to the most recent version of PRISMA 2020
guidelines (Page et al., 2020), was performed (see Figure 1). PRISMA
2020 struct ure uses a combination of PICO (Population, Inter vention,
Comparison, Outcome) and SPIDER (Sample, Phenomenon of
Interest, Design, Evaluation and Research t ype) strateg y tools. In the
context of this study, evaluation consisted of subjec tive and poten-
tially unobservable construc ts, such as attitude s and views expr ess ed
by counselling professionals. As the SPIDER structure allows for bet-
ter indexing of th e qualitative articles across the databases by provid-
ing a room for rigorous examination of article reliability and validity
(Methley et al., 2014) , th e rat ion ale for in cl u di ng th is to ol was ju sti fie d.
SPIDER application was fur ther dictated by the necessity of a sub-
jective evaluation variable, because the focus on the individual's per-
sonal views as connec ted to specific behavioural expressions fosters
a deeper insight into the phenomenon of interest.
2.2 | Paper inclusion criteria
Included papers were peer- reviewed studies, published between 2011
and 2021, that discussed burnout and self- care amongst counselling
professionals. Three research papers did not exclusively meet PICO
criter ia but did fit SPIDER requi rements . One of tho se stud ies was per-
formed in Australia (Butler et al., 2018), and its only deviation from the
cr ite r ia was th at it use d th e ter m ‘wo r ke r ’ and not ‘co u nse llo r ’; howe ve r,
it co ve re d al l th e re st of th e Cr itica l App ra isal Sk il ls Pro gr am (CASP) cri-
teria (discussed in Section 2.4), involving burnout, self- care and within
a population predominantly occupied with counselling work. The sec-
ond study originated from Canada (Alani & Stroink, 2015) and used the
term ‘service provider’ and not ‘counsellor’. The reason for its inclusion
was the same as above. The third study (Dose et al., 2019) was per-
for med in France and used the ter m ‘co un se ll or ’, but also th e term ‘psy-
chologist’. The reason for its inclusion was same as that for the Butler
et al. (2018) and Alani and Stroink's (2015) papers.
2.3 | Paper selection
Excluded were studies related to physicians, nurses, medical or nurs-
ing students, counselling or psychology students, social workers and
the general population, as well as mixed sample studies, at a total of
1371 ar ticles. Exclusions were grouped into three reasons: papers
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TURNER and R ANKINE
focusing on burnout amongst the medical, mental health and social
work field (1), papers looking at athletes and business employees (2)
and general papers on burnout across the population (3).
Across the grey literature search, included were articles related
to burnout in counselling professionals, website publications that di-
rectly discuss occupational burnout and organisational publications
that directly discuss the importance self- care in burnout prevention
amongst counselling professionals. Exclusion followed the same rea-
sons as stated in Sec tion 2.1.
2.4 | Data extraction and management
The Critical Appraisal Skills Programme (CASP) systematic approach
to study eva luation in qualitative research and it s scoring system is de-
signed to suppor t article choice via 10 strategically formulated ques-
tions (CASP, 2018). The CASP appraisal tool was chosen due to its
close alignment wit h the meth odology of this study an d the asso ciated
re qu ire ments, suc h as Sect ion C bei ng an in dic ator for a loca l uti li sat io n
of results. The authors of CASP suggest a scoring system consisting
of ‘yes’ at 2 points, ‘no’ at 1 point and ‘can't tell’ at 0 point s. The more
points the examined study collects, the higher its level or credibility.
Table 1 presents the final data with country of origin, number
of times the keywords occurred, method of study, main themes of
the research, results related to self- care, and qualit y appraisal CASP
score. The superordinate and subordinate themes related to burnout
and self- care are presented in Tables 2 and 3.
3 | RESULTS
3.1 | Search results
The five databases returned a total of 1,619 articles, of which 173
duplicates were removed. Of the remaining 248 articles, 39 were
assessed for eligibility. After applying exclusion criteria (see Sections
2.1 and 2.3), 13 articles remained. The grey literature search re-
turned 758 result s, of which 47 were found relevant and assessed
for eligibility. Af ter applying the exclusion criteria, three were cho-
sen, resulting in a total of 16 articles. The search strategy is pre-
sented in the PRISMA diagram (Figure 1).
4 | DISCUSSION
4.1 | Educational approaches
The literature review demonstrated that exploration of the differ-
ent domains of self- c are was spor adic and inconsistent. Educational
approaches to burnout have been suggested across the literature;
howeve r, th es e co ntinue to be ve r y low in number, ult im ately result-
ing in a lack of specific education on burnout symptoms. Currently,
a number of counselling professionals are not aware of what burn-
out is until experiencing it. Furthermore, they commonly share the
concern that counselling training did not adequately prepare them
for the difficulties of the profession, the dangers of burnout and
the mandatory application of self- care. The consequences of the
phenomenon of self- carelessness were experiencing burnout, and
employing nega ti ve cop in g strategies in an ef for t to com bat it s signs
and symptoms while ade quate attention to lon g- term well- being re-
mained lacking.
Some of the identified challenges were that while organisations
acknowledged the need for self- care, including recommendations
of observation for professional impairment, as well as seeking pro-
fessional help during potential burnout or acute stress, engagement
with self- care is pereceived as optional and not explicitly necessary.
Consi st en t wi th thi s, cod es of pr ac tice and acc re di tati on bodie s co n-
tinue to not provide sets of fixed self- care steps across each of its
domains, making it the professional's responsibility to attend to their
own mental or emotional needs, keeping this a voluntar y and not
a compulsory undertaking. This could be the reason research out-
lines self- care in name only and places it as a sub- theme towards
FIGURE 1 PRISMA 2020 flow diagram
for updated systematic reviews, which
included searches of databases, registers
and other sources.
Records identified from:
Databases (n =5)
CINAHL (n=84);
EBSCO (n=383);
PsycInfo (n=185);
PsycArticles (n=16);
Scopus (n=396);
PubMed (n=555).
Records not retrieved
(n = 209)
Reports assessed for
eligibility
(
n =39
)
Reports
sought for
retrieval
(n =48)
Records identified from:
Websites (n = 1)
Organisations (n = 3)
Citation searching:
Google Scholar (n = 742)
Google (n= 12)
Reports
excluded:
Reason 1
(n = 45)
Reports sought for
retrieval
(
n = 248
)
Records screened
(n = 1,619) Reports
not
retrieved
(n = 711)
Reports included in review
(n = 13)
Reports of included studies
(n = 3)
Reports excluded:
Reason 1 (n =3)
Reason 2 (n =9)
Reason 3 (n =14)
Records removed before screening:
Duplicate records removed (n =173)
Records marked as ineligible by
automation tools (n = 0)
Records removed for other reasons
(n = 0)
Reports
assessed for
eligibility
(
n = 48
)
Reports excluded by human
(n =1,371)
Identification of studies via databases and registers Identification of studies via other methods
Identification
Screening
Included
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TURNER and RANKINE
TABLE 1 Quality appraisal table.
Article
Countr y of
origin
CASP level
of evidence Methodology Number of participant s Factors related to burnout Requirements related to self- care
Butler et al. (2018)Australia 20 Qualitative
approach to
lived experience,
in- depth semi-
struc tured
interviews
11 AOD workers Vicarious trauma, isolation and fear for
safety
Lack of connection between teams
Choice of individual strategies for coping and
well- being, valuing family, friends, and partner
support
Regular supervision, improved employment
conditions, open communication about stress
Lin (2012)Taiwan 20 Phenomenology,
in- depth interviews
Six school counsellors
and three counselling
psychologists
Conflic ts between work environment and
family, frequent changes on campus and
across the counselling profession
Frequent self- assessment to finding the right
balance between self, life and work and taking
appropriate action practising self- awareness
Patsiopoulos and
Buchanan (2011)
Canada 20 Narrative enquiry,
in- depth interviews
15 mixed background
counsellors
Lack of focus on well- being at work Being mindful of present experience, practising
self- compassion via stance of acceptance and
not knowing, compassionate attendance to
the inner dialogue making time for self, being
genuine about one's fallibility, par ticipating in a
compassionate and caring work team, speaking
the truth to self and others
Baker and
Gabriel (2021)
United
Kingdom
19 Interpretative
phenomenology,
semi- structured
interviews
Three counsellors Need to cultivate self- c are attitudes and
activities, feeling s of guilt, lack of physical
activity, financial pressure and lack of time,
service demands
Addressing the value of self- care during
therapist training, implementing self- care on a
day- to- day practice, es tablishing it as a routine
process and a main content to supervision
Barton (2020)United
Kingdom
19 Interpretative
phenomenology,
semi- structured
interviews
Five counsellors Multiple challenges to appropriate self-
care, lack of or inadequate preparation for
self- care
Prioritising self- care, attending to the needs
to its broader underst anding, management
to recognition of its value, requirements for
more knowledge about good self- care such as
mindfulness, self- compassion, relational care,
and spiritual care
Alani and
Stroink (2015)
Canada 18 Individual
interviews,
thematic analysis
Seven domestic violence
counselling workers
Other priorities and difficulties engaging
in mindful/intentional self- care, clients
with ver y complex concerns, concerns
about ef fectiveness of therapy, worrying
about clients, client stories overlap with
own experiences of abuse and trauma, lack
of community resources, lack of sense of
fulfilment and purpose
Continuing training and professional
development, taking time during working day
to self- care, appropriate exercise and nutrition,
connection with one's spirituality, social
suppor t, celebration of strengths as in seeing
one's own and one's client's strengths, selfless
self- care, such as community volunteering
(Continues)
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TURNER and R ANKINE
Article
Countr y of
origin
CASP level
of evidence Methodology Number of participant s Factors related to burnout Requirements related to self- care
Beitel et al. (2018)United
States
18 Semi- structured
interviews,
grounded theory
31 drug counsellors Lack of tr aining , appropriate
communication, accessible paid time off and
clinical supervision
Relaxation, such as engaging in leisure
activities, work- life boundaries, such as leaving
work at work, applying clinical skills to one's
own life and venting
Frequent breaks during workday, collegial
relations, exercise
Pleasur able ac tivities such as spending time
with family and friends
Supervision
Guler and
Ceyhan (2020)
Tur key 18 Phenomenology,
semi- structured
interviews
10 school counsellors Conflic t between occupational stressors
and personal factors, lack of skills to conflict
management and to increasing self- efficacy
Finding what own self- care needs are, need
of balance between physical, cognitive and
emotional self- care as well as other domains
of life
Oser et al. (2013)United
States
18 Grounded theory,
focus groups
28 substance abuse
counsellors
Poor client care, lack of supervision with
challenging clients, large caseload and
excessive paperwork
Finding time for activities of personal choice
co- worker support and clinic al supervision
Meany- Walen
et al. (2018)
United
States
18 Qualitative sur vey 185 play therapists Distractibility or clouded thinking, lack of
mindfulness practices
Therapist's p ersonal trauma history and
length of time in the profession, feeling
depressed and alone, worried about inability
to control situation, feeling apathy to the
clients, stressed, overwhelmed and sad,
feeling ill, lack of exercise, poor diet and
exhaustion, loss of joy and fe elings of
gratitude
Educating professionals about the risks of
burnout
Personal therapy, creative personal
engagement, regular use of humour
Development of good nutritional habits, play
recreational sports
Emphasise on social and family support,
seeking connec tion with God, intentionally
using their energy in effort to integrate mind,
body and spirit and towards connecting a
greater universal life force
Seeking qualit y supervision towards creating a
sense of normalcy and connectedness
Limiting the number of trauma cases in one's
caseload
Beckerman and
Wozniak (2018)
United
States
18 Qualitative study,
focus groups
11 domestic violence
counsellors
Development of hypervigilance and fear of
harm, emotional numbness, lack of abilit y to
experience positive emotion and negative
shift in the worldview poor health
Creating healthy barriers, eng agement with
wider community, making effort to counter
the feelings of vulnerability and victimisation
through action introducing meditation and
practising own religion
Clinical training, more super vision, search
or other creative outlets, life- work balance,
‘venting’ with co- workers
TABLE 1 (Continued)
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TURNER and RANKINE
Article
Countr y of
origin
CASP level
of evidence Methodology Number of participant s Factors related to burnout Requirements related to self- care
Cook et al. (2021)United
States
18 Mixed methods
(including
self- reports)
246 novice counsellors Impairment due to psychological distress.
Negative impact on personal relationships,
negative coping strategies, questions
of one's career choice, self- perceived
inefficacy, negative experience, unfulfilled
in counselling work, gener ally unwell,
fatigued and tired, unhealthy work
environment
Lack of desire or personal interes t in
engagement in self- care
Chen et al. (2019)United
States
16 Survey 140 marriage counselling
therapists
Lack of specific guidelines or preventing
burnout, rendering the therapists more
vulnerable to burnout and decreased
self- efficacy
Conflic t between personal values and
organisational policies, large caseloads,
additional paperwork, rigid policies, lack of
organisational flexibility, supervision offers
little number of practical recommendations
Normalising burnout, reframing self- care as
preventive strategy, gaining a sense of control
Dose et al. (2019)France 16 Quantitative
study; online
questionnaire
224 employment
counsellors
Loss of self- resp ect and self- esteem Supervision to self- acceptance or self- esteem
Satisfaction of the need for autonomy,
promoting sense of p ersonal volition and
freedom to well- being
Good work environment with appropriate
leadership
Fostering personal relationships with empathy
and confidence between leaders and members
Plath and
Fickling (2020)
United
States
16 Questionnaire
with qualitative
expansion
Four counsellors Creative activities according to personality type
Super vision , mindfulness practices, holistic self-
care, own proactive actions to well- being
Note: CA SP rating: 20 = maximum, 19 = ver y strong, 18 = strong, 16 = moderate.
TABLE 1 (Continued)
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TURNER and R ANKINE
an immediate or short- term emotional balance, while its importance
in long- term workplace well- being is overlooked. Although studies
consistently mention the need for ‘good self- care’ (Barton, 2020), the
qualitative domain of research acknowledges a lack of exploration of
what that this actually means, creating barriers to informed choices
to engage with self- c are practices. In this light, there is a need for a
detailed approach to each of the self- care different domains in an
effort to communicate the importance of long- term well- being for
counselling professionals.
4.2 | Cognitive self- care
While many studies relate to the general applic ation of creativity to
mental health, considerably less has been explored in relation to what
type of creative activity could assist in improvement of self- efficacy
and self- esteem (Dose et al., 2019 ; Guler & Ceyhan, 2020). Research
ultimately suggest s a solution- focussed approach to what self- care
choice might be best (Bradley et al., 2013), offering various examples
such as taking time for journaling, engagement with poetry, listen-
ing to music, cooking, watching movies, reading books and keep-
ing a diar y. Those methods develop qualities of optimistic thinking,
support natural curiosity and openness to new experiences. These
interventions are conducive to the development of positive charac-
ter constructs in an effort to support self- efficacy via a systema-
ticincrease in tolerance while facing adversities in the profession.
For example, the structured application of task- oriented approaches
has been recommended, based on personal temperament, character
and sense of humour as natural guides that could enhance cognitive
well- being (Plath & Fickling, 2020). Notwithstanding, studies of this
TABLE 2 Factors identified to contribute to burnout.
Burnout superordinate
themes Subthemes
Lack of education Lack of specific knowledge on burnout
Inadequate preparation for self- care
Multiple challenges to appropriate
self- care
Emotional exhaustion Unable to leave work at work
Feeling isolated
Lack of mindfulness application
Use of negative coping strategies
Self- perceived inefficac y and low
self- esteem
Feelings of apathy; feeling s tressed,
guilty, depressed and worried
Loss of joy; absent feelings of gratitude
Suboptimal physical
health
Feeling fatigued and unwell
Lack of exercise or low engagement
with physical activit y
Poor diet choices
Issues with supervision Low levels of qualit y supervision
Lack of pr actical recommendations to
prevent burnout
Lack of focus on well-
being at wor k
Normalising burnout
Other priorities and difficulties
engaging in self- care
Conflic t between organisational and
personal values
TABLE 3 Actions identified to contribute to self- care.
Self- care
superordinate
themes Subthemes
Educational
approaches
Continued training and professional
development
Requirements for more knowledge about
good self- care
Reframing self- care as a preventive strategy
Cognitive self- care Frequent self- assessment to finding the
right balance; creating healthy boundaries
by applying clinical skills to one's own life
Choice of individual strategies for coping
and well- being, implemented in day- to- day
practice
Need to cultivate self- c are attitudes and
activities
Personal therapy, creative personal
engagement, creating opportunitie s to
relaxation
Emotional self- care Practising self- awareness
Practising self- compassion
Valuing family, friends and par tner suppor t
Physical self- care Appropriate exercise and nutrition
Frequent break during workday
Development of good nutritional habits
Spiritual self- care Seeking connection with G od and practice
own religion; engagement with wider
community
Connection with one's spirituality
Intentionally using energy to integrate mind,
body and spirit
Acknowledgement of one's vulnerability
Engagement with wider community
Organisational
well- being
Regular supervision towards improved
self- esteem
Qualit y super vision towards normalcy and
connectedness
Improved organisational environment
towards open communication about stress
Self- care training
Limiting the number of trauma cases in one's
caseload
Regular use of humour
Satisfaction of the need for autonomy and
freedom for well- being
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TURNER and RANKINE
nature are scarce in the field of counselling and are often a stand-
alone choice rather than mandator y and systematically applied. As
research continues to show the need to recognise the value of self-
care (Barton, 2020), as well as establish a balance between the self-
care and other domains of life (Guler & Ceyhan, 2020), the lack of
explicit application of cognitive self- care has become more and more
apparent.
Despite the literature viewing burnout as a predominantly uni-
tary condition (i.e. whether burnout is present or absent in both
personal and organisational contexts), wellness is not something a
person has or does not have. The individual consideration of one's
well- being requires the precedence of already established self- care
attitudes (Meany- Walen et al., 2018). Following the extensive ‘use
of self’ across counselling work (Aponte & Kissil, 2014), the affect
on the professional's internal st ate on all levels requires an attentive
cultivation of self- care attitudes. In this regard, implementation of
purposeful choices towards personal stability is essential on a day-
to- day basis, calling for a frequent assessment of personal self- care
needs. One such assessment is the creation of healthy boundaries by
applying clinical skills to one's own life (Beitel et al., 2018), and this
continues to be an under- researched issue for counsellors (Baker &
Gabriel, 2021). Consequently, many minimise or dismiss how burn-
out has impacted both themselves and others. Counselling pro-
fessionals' avoidance in seeking assistance for the development of
self- care attitudes (Chen et al., 2 019) was largely due to the per-
ceived consideration that their needs were an expression of selfish-
ness (Barton, 2020), with an explicit focus on the client's needs while
neglecting their own (Kleszczewska- Albińska, 2020). Such a range of
‘self- dismissive’ attitudes perpetuate the lack of self- care behaviours
after troublesome experiences in practice.
A minimisation of burnout impact disregards a professional's
vulnerability, allowing experiences of low efficacy to dominate their
professional lives, resulting in loss of self- esteem and self- respect
(Dose et al., 2019) . Despite the imp ort ance of a mea ni ng ful ac kn ow l-
edgement of negative work experiences (Lin, 2012), the literature still
lacks research addressing vulnerabilities such as burnout- induced
low self- confidence. As a consequence, counselling professionals
develop a lack of personal interest in engaging with self- care. Many
did not seek timely assistance after seeing difficult clients and re-
sorted to negative coping strategies, while remaining unfulfilled in
their counselling work (Cook et al., 2021). Self- fulfilment is a concept
related to the search for transpersonal values and the wholeness
of human existence, and it is essential for holistic health (Turner,
2021). Due to the concept of “use of self” in helping professions,
this understanding is correlated with healthy self- esteem at work,
and, as such, both these aspects play a significant par t in improved
well- being (Gam et al., 2016). Counselling professionals notably ex-
perience helplessness due to overwhelming lack of support, and this
may have been a result of a continued dismissal of their own prob-
lems, leading to a compromised capacity to perform better, low self-
esteem and impaired capacity for professional fulfilment. As such,
no self- care would be complete without addressing these personal
vulnerabilities.
4.3 | Emotional self- care
Research ought to seek an improved capacity to attend to emotional
vulner ab ilit ie s, wit h an inte nt io n to preven t fu rth er menta l he al th com-
plications (Beckerman & Wozniak, 2018). Self- care is often used to
address ways in which counsellors show attention and compassion to
themselves; however, caring for others while looking out for oneself
proves to be a difficult equilibrium to maintain. Emotional exhaustion
has been found to frequently overlap with feeling spritually depleted
(Hardiman & Simmonds, 2013), emphasising the necessity for an in-
creased self- awareness, achieved by heeding to own inner dialogues
during challenging times (Patsiopoulos & Buchanan, 2011). Research
emphatically outlines the importance of individual accountability
of being proactive in regular engagement with self- care methods
(Bradley et al., 2013) towards raising self- awareness, on a daily basis.
For example, regular self- reflective practices can assist with develop-
ment of professional identity and contribute to prevention of low self-
esteem. As such, these may prove particularly effective with novice
counselling professionals, who deal with the negative emotional expe-
riences while discharging their duties (Cook et al., 2021). The develop-
ment of reflective practices towards self- awareness can be viewed as
the main protective factor against burnout- caused inadequacies and a
disturbed sense of personal authenticity (Chang, 2014). Such practice
assists in the creation of a space for personal emotional safet y along
with compassionate avoidance of self- judgement, which are integral in
the processes of self- knowledge, a right to being, and a freedom to
choose own authentic experiences.
Self- awareness is a construct that is tightly related to the capac-
ity to maintain professional boundaries. Burnout disrupts boundaries
due to the invasion of unprocessed emotional issues and percep-
tions of countertransference during physical and emotional states
of vulnerability (Beckerman & Wozniak, 2018). In this light, studies
continue to lack an educational approach that can address personal
emotional needs for timely application of self- awareness towards
preventing feelings of isolation (Barton, 2020; Chang, 20 14).
Addressing personal feelings, along with a mindful enquir y into
their adjacent values, such as self- compassion, is often an overlooked
form of self- care amongst counselling professionals (Beaumont
et al., 2016). Exploring self- compassion appeared an important
facet of both emotional and spiritual well- being. Some research has
placed self- compassion within the emotional domain, enhancing
counsellors' capacit y to make wiser choices regarding their well-
being (Bar ton, 2020), yet others have considered self- compassion to
be closely related to cognitive well- being due to its significant role
in preventing rumination and negative view of self (Kleszczewska-
Albińska, 2020). Nevertheless, self- compassion is a necessary com-
ponent of mindfulness (Patsiopoulos & Buchanan, 2 011). This could
be due to its dual role in increasing self- awareness by combining
connectedness and serenity of the internal state of ‘being’ while
modulating associated activities of ‘doing’ in the external state. Such
concepts make the development of self- compassion a necessary
pathway to personal growth and connects emotional with spiritual
self- care.
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TURNER and R ANKINE
4.4 | Spiritual self- care
Research on burnout amongst counselling professionals considers
connecting with one's spirituality a major protective step in preven-
tion of burnout. Hardiman and Simmonds' (2013) study found that
spiritual practices significantly contributed to burnout prevention,
particularly in easing the brunt of emotional exhaustion. Making
time for practising one's own religion is vital in the restoration of
the capacity for empathy and compassion. Connecting with one's
own spirituality involves the development of a set of holistic skills
that fosters connection with personal intuition, providing greater
emotional flexibility. Daily meditative practices for the purpose of
connection with the universe, such as studying nature and astron-
omy, were found additionally helpful (Beckerman & Wozniak, 2018).
However, there is a lack of research on specific spiritual approaches
and practices for burnout prevention. This may be due to the notion
that these approaches are still largely ignored across mainstream
therapy (Rowan, 2015). Spiritual aspec ts amongst counselling work
are considered as part of an individual cultural competence (Turner,
2021) but, paradoxically, not as part of daily spiritual self- care re-
quirements. While the transpersonal approach unites the spiritual
and the existential perspec tives, it is of value to take into considera-
tion the person's spirit as the governing force of one's existence. It
is by the alliance of the spirit that a motivation towards a recogni-
tion of the intrinsic freedom to own well- being choices is availed.
Further examples of transpersonal approaches include a connection
with one's spirituality (Alani & Stroink, 2015) and increased spiritual
self- care (Barton, 2020). Both call for more studies to explore per-
sonal spirituality, such as self- reflective practices associated with
focus on the self within the here- and- now concept (Patsiopoulos &
Buchanan, 2011) as an expression of personal spirituality aware-
ness. More examples include prayer and openness to spontane-
ous experiences in nature, singing and listening to relaxing music
(Coaston, 2017), as well as suggestions to focus personal energy
towards an integration of mind, body and spirit at a higher rate, in
recognition of the spiritual nature of the human being.
4.5 | Physical self- care
The literature reports low levels of exploration in relation to coun-
selling professionals' specific requirements regarding the applica-
tion of physical self- care. While some counselling professionals are
generally interested in physical self- care, many still report irregular
sleep and eating cycles and engagement in negative coping strate-
gies, such as alcohol consumption (Guler & Ceyhan, 2020). Despite
reported sleeping problems amongst counsellors (Cook et al., 2021),
the literature lacks studies on sleep hygiene across counselling pro-
fessionals, increasing the prevelance of somatic symptomatology,
such as fatigue (Deneva & Ianakiev, 2021). Applied behavioural ap-
proaches to physical self- care continue to be scarce despite the lit-
erature highlighting such approaches as necessary in making better
lifestyle choices (Baker & Gabriel, 2021; Lindo et al., 2015).
A solution- focussed approach is applied solely to help the per-
son figure out what is best for them in a positive way, such as what
makes a particular exercise or specific nutritional choices valuable.
Similarly to task- oriented self- care, physical self- care approaches are
highly individual and, as such, may not be suited to generalist ap-
proaches. For example, Alani and Stroink (2015) mentioned the
necessity of nutritional regulation, while others consider the de-
velopment of good nutritional habits (Bradley et al., 2013; Meany-
Walen et al., 2018) suggestive of a qualitative expansion of suitable
nutritional self- care. Similarly, conventional physical exercises, such
as going to the gym (Beitel et al., 2018), may be contrasted to an in-
corporation of complementary and alternative therapies (CAT), such
as yoga, walking and gentle stretching exercises (Coaston, 2017),
massage and engagement with other sports, such as dancing (Guler
& Ceyhan, 2020). Since physical self- care recommendations for
counselling professionals are scarce and sporadic within the existing
literature, continued investigation is necessary to widen the range
of choices.
4.6 | Organisational well- being—training and
supervision
Quality self- care begins with a positive mental state at work. Dose
et al. (2019) emphasise that a positive mental predisposition is an
essential contributor towards ‘what makes a happy counsellor’.
Seeking supervision for management of appropriate self- care dur-
ing prolonged stressful periods enhanced positivity and capacit y to
complete work tasks (Baker & Gabriel, 2021). Research suppor ts the
selection of quality supervision choices to restore counsellors' feel-
ings of ‘normalcy’ as well as to endorse their sense of connected-
ness (Meany- Walen et al., 2018). Regular supervision supports the
profe ss io na l's feelings of competence and their cap ac it y to acknowl-
edge and focus on an intrinsic ally positive emotion under stressful
situations in the workplace. Maintenance of regular and trusting
relationships with supervisors and co- workers, as well validation of
their experiences, is an important organisational requirement for
self- confidence and self- fulfilment at work (Dose et al., 2019).
The requirements for supervision in burnout prevention involve
assisting the counselling professional to establish work- life balance
and restore blurred boundaries (Lin, 2012). Qualit y supervision was
noted as a significant necessity in the choice of protective coping
strategies against burnout. Supervision was also seen as the first
step towards self- care in the workplace (Butler et al., 2018; Posluns
& Gall, 2020). Regular and timely supervision is the final recommen-
dation for strong organisational ethics towards a supportive work
environment. Apart from its valuable contribution to caring and
compassionate team structures, supervision focusses on discovering
the counselling professional's strengths. There is tension between
the fact that supervision is not always readily available and coun-
selling professionals are resorting to a ‘vent out’ with colleagues
about the demanding nature of their job. Such circuitr y could poten-
tially enforce burnout experiences amongst team members, such as
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11
TURNER and RANKINE
placing strain on collegial relationships and endorsing cynicism and
giving rise to other condescending attitudes. In this light, a set of
healthy organisational changes can enable application of self- care
at a consistent rate, to facilitate open discussion about stress issues
linked to heavy caseloads and the need for improved communica-
tion between teams (Beitel et al., 2018). Timely, appropriate use of
humour (Meany- Wallen et al., 2018), notions of being open about
recovery from stress at work (Butler et al., 2018), being truthful to
each other, the acknowledgement of individual counsellor' contribu-
tions, along with allowance for regular breaks during the day (Beitel
et al., 2018) we re put for wa rd as ne cessar y in cre at ing op en commu-
nication about stress between teams.
5 | CONCLUSION
The lack of systematic approaches to self- care amongst counselling
profes si onals cre ates a te ns ion bet wee n the acc ep tan ce of it s nece s-
sity and commitment to its practice. The counselling professional's
attention to long- term well- being should be viewed as an intrinsic
wellness construct, which involves mental, emotional, physical and
spiritual aspects. Systematic and regulated engagement in self- care
practices calls for a match across the individual cognitive, emotional,
spiritual and physical needs in order to make a significant contribu-
tion to well- being and decrease the chances of professional burn-
out. In this light, a ‘good self- care’ kit for counselling professionals is
an educational, therapeutic necessity that integrates a wholesome
view towards long- term cognitive, emotional, spiritual and physical
well- being.
ACKNOWLEDGEMENTS
Open access publishing facilitated by University of New England, as
part of the Wiley - University of New England agreement via the
Council of Australian University Librarians.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest in this work and give their
informed consent for publication of this systematic review.
DATA AVA ILAB ILITY STATE MEN T
The authors confirm that all data generated or analysed during this
study are included in this published article.
ORCID
Malini Turner https://orcid.org/0000-0002-9018-6982
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TURNER and RANKINE
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AUTHOR BIOGRAPHIES
Malini Turner is an Acad em ic Teacher in the nat ur al me di cine an d
health counselling fields. She obtained her undergraduate degree
in Health and Medical Science from Charles Sturt Universit y, and
has worked in private practice. She has held various positions as
a natural medicine consultant in companies and clinical settings,
while pursuing her postgraduate studies in family and relation-
ship counselling, alcohol and other drugs as well as suicide pre-
vention. Malini's completion of a Master of Counselling at the
University of the Sunshine Coast was followed up by a postgrad-
uate qualification in Neuroscience from the University of New
England. Malini's work expands across a range of integration-
based practices; it is strength- based and person- centred, im-
plementing the transpersonal rather than a pathology- based
approaches. Her teaching favours solution- focussed thinking
to promote well- being and includes biopsychosocial theories
towards emotional, cognitive and behavioural choices in the
maintenance of health. She is interested in narrative and phe-
nomenological exploration of lived experience and prioritisation
of various self- care practices in enhancing feelings of health and
happiness in the workplace.
Dr. Robynne Rankine is a Clinical Lecturer with the Master
of Counselling program at the University of New England.
Previously, Robynne held positions of Discipline Lead of
Counselling and Mental Health at the Universit y of New
England and a clinical lecturer in health leadership at the
University of Tasmania, where she facilitated numerous work-
shops in large organisations on what many call the 'soft skills',
such as mental health promotion, resilient leadership, mind-
fulness, emotional intelligence, conflict resolution and team
dynamics. Robynne's research interests are focussed on the
lived experience of older worker health and well- being from a
strength- based socio- ecological approach, while her counsel-
ling theoretical orientation is humanistic and existential—being
human and trusting that clients have within them the capac-
ity to grow and develop. Robynne's ontological orientation is
towards philosophy rather that psycholog y and she prefers to
avoid medicalisation of life problems. Passionate about self-
development and consciousness raising, Robynne's clinical ex-
perience include private practice, EAP, coaching in health and
hospitals, ter tiary education and human services sector.
How to cite this article: Turner, M., & Rankine, R. (2024).
Self- care in prevention of burnout amongst counselling
professionals: A systematic literature review. Counselling and
Psychotherapy Research, 00, 1–13. https://doi.org/10.1002/
ca pr.12 837
17461405, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/capr.12837 by National Health And Medical Research Council, Wiley Online Library on [06/11/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
