By Alex Fradera

Working an emotionally-demanding job can leave you frazzled by alienation, exhaustion, and confusion about whether you are doing any good. Clinical psychologists and psychotherapists live their day-to-day at the interface of their clients’ most difficult emotions and recollections, so it is no surprise that burnout is a leading cause of problems for those in the profession. To better understand the risk factors that contribute to therapist burnout, a new review article in the Journal of Clinical Psychology has examined findings from 30 years of research.

Gabrielle Simionato and Susan Simpson of the University of South Australia gathered 40 articles in English on the topic, involving a total of almost 9,000 psychotherapists. On average, participants expressed a low to moderate degree of occupational stress, with just over half of those canvassed reporting moderate to high burnout. Burnout is often broken into three elements, and of these, the one most prevalent for therapists was emotional exhaustion – feeling physical and emotional fatigue while at work. Also prevalent to a lesser degree were the other two aspects: depersonalisation and a reduced sense of personal accomplishment.

A number of factors correlated with burnout, although as the studies were overwhelmingly cross-sectional we have to take care about assigning causality.

Burnout rates were higher in psychologists who were less experienced, and also in those with less subjective confidence in their professional ability. Several studies showed a lack of social support in or outside the workplace was associated with burnout. However, other studies showed that frequent discussion of work frustration with others was itself associated with higher burnout. This could simply be because therapists on the brink of overload are more likely to vent. Alternatively, there could be a reverse causality – other research has suggested venting can impede recovery from stressful situations.

In some cases, the evidence was contradictory: for example more burnout was identified in women in five studies, but more in men in another three, with no association with gender found in a further six, resulting in no clear message for gender.

The review flagged a number of protective strategies and behaviours, including the value of effective personal boundaries in order to maintain some emotional separation from clients’ problems. Another observation was that therapists experiencing more burnout tended not to use humour, or only in a self-defeating way, although again this could be a consequence of burnout rather than a cause.

Personality traits are reasonably stable so their association with burnout is more likely to be causal. As in previous research, perfectionism was linked to burnout, as was neuroticism, likely due to a heightened sensitivity to negative events. Less agreeable and less extraverted psychotherapists tended to report burnout; the authors suggest this may be because such individuals tend to have weaker social support networks.

Based on their findings, Simionato and Simpson make some specific recommendations for ways of approaching work that may be useful: maintaining boundaries, seeking support, staying in touch with humour. There is also some general evidence that mindfulness may be an effective route to reducing rumination and unrealistic expectations. Supervisors should consider that therapists who muster confidence in their abilities are likely to ward off emotional overload, and therefore ensure that their charges’ successes are recognised and their struggles put in context. The likely influence of personality factors reinforces the need for people to be holistically suited to the particular challenges of a job role. A therapist seeking to work in a highly challenging position, due to the nature of clients or the operating environment, should be both technically qualified and temperamentally suited, or else they may pay the price over time.

—Personal risk factors associated with burnout among psychotherapists: A systematic review of the literature

Alex Fradera (@alexfradera) is Staff Writer at BPS Research Digest