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Burnout among psychotherapists: Effects of work environment, stressful life events, coping, and social support

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Burnout among psychotherapists: Effects of work environment, stressful life events, coping, and social support

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Content BURNOUT AMONG PSYCHOTHERAPISTS:
EFFECTS OF WORK ENVIRONMENT, STRESSFUL LIFE EVENTS,
COPING, AND SOCIAL SUPPORT
by
Shirley Anne Flournoy
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Education-Counseling Psychology)
August 1990
Copyright 1990 Shirley Anne Flournoy
UMI Number: DP25331
All rights reserved
INFORMATION TO ALL USERS
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and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.
Dissertation Publishing
UMI DP25331
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
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This dissertation, w ritten by
SHIRLEY. .ANNE. .FM V M Q X .............................................
under the direction of h s?. Dissertation
Committee, and approved by all its members,
has been presented to and accepted b y The
Graduate School, in partial fulfillm ent of re
quirem ents for the degree of
D O C TO R OF PHILOSOPH Y
Dean of Graduate Studies
D a te .........
DISSERTATION COMMITTEE
Chairperson
0 .
ACKNOWLEDGMENTS
I would like to express my appreciation and gratitude to my dissertation
committee, Drs. Michael Newcomb, Frank Fox, and Essie Tramel-Seck, for their
excellent guidance and suggestions throughout this project. A special thanks is
extended to my outside member, Dr. Essie Tramel-Seck, for her tireless
availability, emotional support, and guidance throughout all stages of this project
which was invaluable.
My heartfelt thanks to my family, Cecil Jr., Cecil III, and Bryon, who made
many sacrifices and provided enormous support during my studies. To my father,
Cleon Collins, who encouraged me at an early age to strive for excellence.
I am indebted to many close friends who worked diligently with me
throughout my studies and provided invaluable help and assistance. I would
especially like to thank my closest friend, Beverly Jackson, my mentor and friend,
Rose Monteiro, and my dear friends, Margarette Crockett, Irmgard Johnson and
Deitra Simon.
I would also like to thank Dr. Sally McCollum, my intern supervisor at
Occidental College, for her guidance and assistance in the formative stages of the
project. My appreciation is also extended to Dr. Kumea Gooden-Shorter for her
encouragement and support.
Finally, I would like to extend my appreciation to those college counseling
center directors and psychotherapists who so willingly and honestly participated
in this study.
ii
TABLE OF CONTENTS
ACKNOWLEDGMENTS........................................................................ ii
LIST OF TABLES AND FIGURE.......................................................... v
CHAPTER
I. THE PROBLEM............................................................................. 1
Background Of The Problem........................................................... 3
Statement Of The Problem............................................................. 4
Purpose Of The Study...................................................................... 6
Theoretical Framework................................................................... 6
Research Hypotheses....................................................................... 8
Delimitations................. 9
Definition Of Terms......................................................................... 10
Overview Of The Study.................................................................... 12
II. REVIEW OF THE LITERATURE.................................. 13
The Evolution of Burnout Theory................................................... 13
Dynamics Of Burnout...................................................................... 18
The Burnout Syndrome.................................................................... 23
Effects On Psychotherapists............................................................ 25
Predicting Factors In Burnout......................................................... 29
Mediating Factors In Burnout......................................................... 32
Prevention And Intervention........................................................... 37
Summary Of The Literature ............................................... 39
III. METHODOLOGY.......................................................................... 42
Research Design.............................................................................. 42
Selection Of The Sample................................................................. 43
Instrumentation................................................................................ 46
Procedures......................................................................................... 50
Data Analysis.................................................................................... 55
Methodological Assumptions........................................................... 56
Limitations........................................................................................ 57
IV. THE RESULTS............................................................................... 58
General Levels Of Burnout............................................................. 58
Multivariate Tests............................................................................ 64
Summary............................................................................................ 84
iii
CHAPTER
V. SUMMARY, DISCUSSION, AND RECOMMENDATIONS 85
Summary........................................................................ 85
Discussion.......................................................................................... 88
Results of Tests of Hypotheses........................................................ 93
Implications Of The Findings................................................ 103
Conclusions and Recommendations for Future Research............ 105
REFERENCES.......................................................................................... 108
APPENDIX
A. Questionnaire.................................................................................. 115
B. Pre-Contact Letters......................................................................... 131
C. Telephone Appointment Conversation......................................... 134
LIST OF TABLES AND FIGURE
TABLE
3.1 Description of the Sample............................................................... 44
3.2 Descriptive Statistics of 25 Burnout Items...................................... 51
3.3 t Tests between Collection Methods and Burnout Items.............. 53
4.1 Maslach Burnout Inventory Means and Standard Deviations....... 59
4.2 Correlations of Demographic Data and the MBI........................... 60
4.3 Correlations of Age and Experience with Significant
Independent Variables..................................................................... 61
4.4 Significant t Tests for Gender Differences on
Independent Variables..................................................................... 62
4.5 Results of t Tests for Females and Males on the
Maslach Burnout Inventory............................................................. 63
4.6 Prediction of Emotioned Exhaustion from Burnout
Measures by First Hierarchical Multiple
Regression Analysis.......................................................................... 65
4.7 Incremental R^ for Domains First Hierarchical Analysis............. 67
4.8 Prediction of Emotional Exhaustion from Burnout
Measures by Second Hierarchical Multiple
Regression Analysis.......................................................................... 68
4.9 Incremental R^ for Domains Second Hierarchical Analysis......... 69
4.10 Prediction of Depersonalization from Burnout Measures
by Hierarchical Multiple Regression Analysis............................... 74
4.11 Prediction of Depersonalization from Burnout Measures
by Second Hierarchical Multiple Regression Analysis.................. 75
4.12 Prediction of Personal Accomplishment from Burnout
Measures by First Hierarchical Multiple Regression Analysis..... 80
4.13 Prediction of Personal Acomplishment from Burnout
Measures by Second Hierarchical Multiple
Regression Analysis.......................................................................... 83
FIGURE
l.Diagram of Variables.............................................................................. 7
CHAPTER I
THE PROBLEM
In today’s society, burnout is an increasing problem due to increased job
\ tensions and job pressures to get more work done in a shorter period of time.
i
j Burnout is a human cost and specific form of occupational stress that results
j from increased job pressures. Worker burnout has serious consequences for both
> the worker and his or her employer. Job-related stress claims have skyrocketed
and the job-related pressures facing workers are expected to continue to increase
in the coming years (Peterson, 1990).
, A broad spectrum of the work force— from blue-collar workers to corporate
; chairpersons, hospital nurses, social workers to psychologists-struggle with work
that is faster, more tension-packed, and overall, more exhausting than it used to
be. Peterson (1990) believed that many of the cost cutting efforts that occurred
during the 1980s have resulted in more being expected of employees. Workers
frequently feel that they have too much to do and too little time to do it.
Burnout tends to affect individuals who work in the helping professions in
greater numbers than individuals who work in other professions (Cherniss, 1982;
Edelwich & Brodsky, 1980; Freudenberger, 1974, 1977; Freudenberger &
Richelson, 1980; Maslach, 1976,1978a, 1982).
However, the process of burnout is not limited to the helping professions.
Burnout can and does affect people from a variety of occupations. One would
1
i expect job stress and burnout to be particularly pronounced among psycho-
j therapists, who work all day with other people’s problems and must also contend
j with their own problems.
Psychotherapists employed in college counseling centers are expected to
| provide quality services to increasing numbers of clients as demands for their
services increase. There are always more clients seeking services than there are
psychotherapists to provide the services,
j The process of burnout has serious psychological, social, and physical health
consequences for the helping professional as well as the recipient of his or her
| care. Maslach (1976) found that burned out professionals, "lose all concern, all
emotional feelings for the persons they work with and come to treat them in
^ detached or even de-humanized ways" (p. 16). The psychological consequences
i
; of burnout can include depression, negative self-concept, and cynicism. The
j social consequences can include withdrawal from others, loss of concern and
caring for others, and a negative attitude towards others. The physical conse
quences can include various kinds of stress-related health problems such as
chronic colds, ulcers, hypertension, headaches, backaches, and chest pains
(Golembiewski, Munzenrider, & Stevenson, 1986; Maslach, 1976; Selye, 1976).
Burnout also has serious implications for employers in terms of job
dissatisfaction leading to job turnover, absenteeism, and loss of productivity.
Even more unfortunate for employers is that the process of burnout tends to
affect the workers who are the most committed and who are high achieving
(Freudenberger & Richelson, 1980; Pines & Aronson, 1988). These are the very
employees who we can least afford to lose.
2
Background Of The Problem
Until recently, there have been few studies of burnout among psycho
therapists (Cherniss, 1982; Deutsch, 1984; Farber & Heifetz, 1982; Raquepaw &
Miller, 1989; Udovch, 1983). Causality between stress and burnout has mainly
been speculated from the correlational data which relates one variable (e.g.,
stress) to another variable (e.g., degree of burnout). Therefore, many questions
about the process of psychotherapists’ burnout remain unanswered. Most of the
previous studies have been correlational that focused on within-session sources of
stress. Few efforts have been made that focused on the stresses inherent in the
work environment and personality.
Results from these correlational studies indicate that there is a strong
relationship between stress and burnout (Cherniss, 1982; Farber & Heifetz, 1982;
f
| Udovch, 1983). The direction of that relationship, whether stress leads to
1 burnout or burnout increases stress, has not been established. Bundy (1981)
i
posited that "the main cause of burnout is stress" (p. 11). Muldary (1983)
believed that job stress is a necessary precursor of burnout. Yet, there remains
I
the need to identify what situational and personality factors are the best
i
I
I predictors of burnout.
Most studies of psychotherapists’ burnout have generally focused on
heterogeneous populations in various work settings. The populations studied in
the psychological literature have been predominantly psychiatrists, although
: more recently studies on psychologists have begun to emerge. In the sociological
literature, there have been extensive studies on social workers. The work settings
studied have included predominantly private practice and institutional/agency.
1 There is consistently a higher occurrence of burnout found in the institutional
settings than in the private practice settings (Farber & Heifetz, 1982; Raquepaw
& Miller, 1989; Udovch, 1983). Although some college counseling center psycho
therapists have been included in the institutional setting samples, no study has
focused exclusively on college counseling center psychotherapists,
j For purposes of this study, burnout was defined as a state of total emotional
and physical exhaustion that is characterized by a loss of a sense of personal
j accomplishment and feelings of depersonalization that affect one’s attitude
toward clients (Maslach, 1976). Stress was defined as minor stressful life events
I that are experienced in daily living that have been labeled "hassles" by Lazarus
and Folkman (1984). This differs from other studies that have focused on major
I life events as sources of stress (i.e., Holmes & Rahe, 1967) such as divorce, death,
| marriage, or serious illness.
! An individual copes with stressful life events, as conceptualized by Lazarus
| and Folkman (1984), via eight coping strategies that can be defined as emotion-
focused or problem-focused. Coping processes are considered mediating effects
I that help account for the association between stress and burnout for different
i
individuals in the same work setting.
; One type of coping resource is perceived social support in times of need.
! Perceived social support has been shown to have a buffering effect on the process
of burnout.
Statement Of The Problem
There has been very little research on the process of burnout among
i psychotherapists. No previous studies on burnout have focused solely on burnout
i
| on psychotherapists employed in college counseling centers.
| The professional duties of psychotherapists may invite burnout due to the
i
high level of stress that is inherent in their work in which they are constantly
confronted with other people’s problems (Maslach, 1978a). Research has shown
that the longer one works in the mental health field (Pines & Maslach, 1978) and
the more excessive one’s caseload is (Heilman, Morrison, & Abramowitz, 19867),
the more likely burnout becomes.
The nature of stresses within the therapy sessions have been examined and
identified. However, the stresses of the work environment and stressful life
] events that add tensions and pressures above and beyond the work with the client
1 have received far less attention, especially in the college counseling center set-
i
j tings. The psychotherapists in this setting carry the responsibility of assisting in
the development of the future leaders of our society.
It is a commonly held belief that stress leads to burnout. However, this
l __
| causal relationship has not been established empirically. The primary data that
f
j now exist on the relationship between stress and burnout are correlational,
j There remains a need to establish empirically the relationship between stressful
life events, work environment stresses, and burnout.
Burnout has been predictive of psychotherapists’ reported intentions to
| leave the profession of psychotherapy for other professions (Raquepaw & Miller,
i
| 1989). Raquepaw and Miller found that psychotherapists wh6 leave the pro-
| fession, in general, tended to be the most committed and the most effective in
i
j working with their clients. There is a need to identify the stresses that lead to
| burnout and result in psychotherapists leaving institutional settings for other
i kinds of employment. There is also a need to identify factors that may mediate
or buffer the process of burnout in psychotherapists.
Purpose Of The Study
The purpose of this study was to test the hypothesis that chronic stress that
consists of daily hassles and stressful work environment tends to exhaust one’s
physical, psychological, and social resources leading to burnout. The occurrence
of burnout was believed to be mediated by perceived social support resources
and coping processes (See Figure 1).
The primary purpose of this study was to establish empirically that stress
leads to burnout. It was anticipated that this would be accomplished by testing
two basic hypotheses:
1. that the process of stress leading to burnout is mediated by social
support resources and coping processes;
2. that burnout will result from chronic exposure to high levels of stressors
regardless of the level of social support and coping processes.
The findings of this study would have important implications in terms of
delineating empirically the process of stress which ultimately leads to burnout in
psychotherapists employed in college counseling centers. Once this process has
been clearly identified, then appropriate intervention strategies could be devel
oped and implemented to reduce the incidence of job burnout. The process of
burnout robs our institutions of the most dedicated and effective individuals
(Raquepaw & Miller, 1989)~a loss that we can ill afford.
Theoretical Framework
This study postulated that chronic stress, consisting of daily hassles and
stressful work environment, tends to exhaust one’s physical, psychological, and
6
Stressful Life Events
A.Number Daily Hassles
Bintensity Daily Hassles
Coping Processes
A.Emotion-focused
B.Problem-focused
Work Environment
A.Relationships
B.Personal Growth
C.System Maintenance
— >
and Change
D.Caseload
E.Experience
i
-a Figure 1. Diagram of Variables
Social Support
Burnout
A.Existence
A.Emotional Exhaustion
B.Perceived Adequacy
B .Depersonalization
social resources leading to burnout. The process of burnout is mediated by one’s
social support resources and psychological coping processes. 1
This theory attempts to integrate the theoretical frameworks of the bio
logical stress syndrome (Selye, 1974), the burnout syndrome (Maslach, 1976, !
i
1978a, 1981b; Freudenberger, 1974, 1977), Lazarus’ cognitive-phenomenological :
analysis of psychological stress and coping (Larazus & Folkman, 1984), and
perceived social support (Sarason, Levine, Basham, & Sarason, 1983) to explain
j the burnout processes in psychotherapists.
i
j Research Hypotheses
j It was hypothesized that:
1. Male and female psychotherapists employed in college counseling
j centers will differ on the levels of burnout as measured by the Maslach Burnout
Inventory.
2. Work environment climate would predict burnout as measured by
j emotional exhaustion in psychotherapists employed in college counseling centers.
i
, 3. Stressful life events would predict burnout as measured by emotional
exhaustion in psychotherapists employed in college counseling centers.
1 4. Coping processes would predict burnout as measured by emotional
i
exhaustion in psychotherapists employed in college counseling centers.
i
i 5. Perceived social support would predict burnout as m easured by
| emotional exhaustion in psychotherapists employed in college counseling centers.
! 6. Work environment climate would predict burnout as measured by
i
! depersonalization in psychotherapists employed in college counseling centers.
8
7. Stressful life events would predict burnout as measured by depersonal
ization in psychotherapists employed in college counseling centers.
8. Coping processes would predict burnout as measured by depersonal-
i
j ization in psychotherapists employed in college counseling centers.
i
I 9. Perceived social support would predict burnout as measured by deper
sonalization in psychotherapists employed in college counseling centers.
10. Work environment climate would predict burnout as measured by
j reduced personal accomplishment in psychotherapists employed in college
| counseling centers.
11. Stressful life events would predict burnout as measured by reduced
I personal accomplishment in psychotherapists employed in college counseling
' centers.
12. Coping processes would predict burnout as measured by reduced
personal accomplishment in psychotherapists employed in college counseling
; centers.
!
13. Perceived social support would predict burnout as measured by reduced
personal accomplishment in psychotherapists employed in college counseling
centers.
i Delimitations
(
| The present study was subject to the following delimitations which serve to
' narrow its focus and generalizability. The study was limited to a sample of
practicing psychotherapists employed in college and university counseling centers
in the urban Southern California area. Therefore, the findings cannot be
j appropriately generalized to the total populations of psychotherapists. However,
j this geographic area is a major therapeutic center in terms of the number of
j psychotherapists and variety of modalities utilized, and has been used in previous
i studies (London, 1977; Udovch, 1983).
j Definition Of Terms
For the purpose of the study, the following terms were defined:
Burnout. A syndrome of emotional exhaustion, depersonalization, and
reduced personal accomplishment that can occur among individuals who do
"people work" of some kind. The main characteristics are: (a) emotional
exhaustion; (b) depersonalization that entails negative, cynical attitudes and
feelings about one's clients; and (c) lack of feelings of personal accomplishment
i
resulting from negative self-evaluation, particularly with regard to work with
clients (Maslach & Jackson, 1981b, 1986).
! Emotional exhaustion. Feelings of being emotionally over-extended and
exhausted by one’s work (Maslach & Jackson, 1981b, 1986). As emotional
i resources are depleted, workers feel they are no longer able to give of
themselves.
Depersonalization. An unfeeling and impersonal response towards
' recipients of one’s service, care, treatment or instruction (Maslach & Jackson,
1981b, 1986). This aspect of burnout involves negative, cynical attitudes and
feelings about one’s clients.
1 Personal accom plishm ent. Feelings of com petence and successful
: achievement in one’s work with people is the third aspect of the burnout
i syndrome. Involves feeling unhappy about oneself and dissatisfied with the
!
accomplishments on the job (Maslach & Jackson, 1981b, 1986).
10
Stress. Psychological stress is viewed as a relationship between the person
and the environment that is appraised by the person as taxing or exceeding his or
her resources and endangering his or her well-being (Lazarus & Folkman, 1984).
There is also a physiological component that is experienced as a "nonspecific
response of the body to any demand made upon it" (Selye, 1974, p. 14).
Minor stressful life events. The repeated or chronic stresses and strains of
daily living that are experienced subjectively as "hassles" by the individual
(Delongis, Coyne, Dakof, Folkman, & Lazarus, 1982). This is in contrast to
major life events which assess major life changes and traumas such as death of
spouse, divorce, marriage, or major illness. The major life events are assessed
objectively rather than subjectively like the minor life events. According to
Lazarus and Folkman (1984, 1989), hassles are irritants that can range from
minor annoyances to fairly major pressures, problems, or difficulties. Hassles
arise from a person’s transaction with the environment that are considered by the
person to be stressful events.
Coping process. Lazarus and Folkman (1984) described the process of
coping with a stressful situation as involving two functions. One function is that
of helping to regulate distressing emotions (emotion-focused coping). The other
function involves doing something to improve the situation causing the distress
(problem-focused coping).
Social support. Two dimensions of social support are utilized in this study.
The amount of support is defined as the perceived available others to help in
times of need in a variety of situations. The quality of support is defined as the
respondent’s perceived satisfaction with the help available from others in times of
need (Sarason, et al., 1983).
11
P sychotherapist. Includes C alifornia licensed and non-licensed i
I
practitioners trained in the disciplines of psychiatry, clinical/counseling !
psychology, clinical social work, and marriage and family therapy having doctoral !
or master’s level degree.
i
i
i
Overview Of The Study !
i
The study examined the causal relationship between stress and burnout by
looking at the work environment and minor life events stressors and their
relationship to burnout when mediated by social support resources, and coping
strategies. This conceptualization was tested using a hierarchical multiple
| regression model in which the direct and indirect effects of stressful life events
! and work environment on burnout were examined.
I
Chapter Two reviews the literature on burnout and stress theory and
j research, in general, and on psychotherapists in specific. Three major research
studies on psychotherapist burnout are also reviewed. Coping processes and
social support as mediator processes are reviewed as they relate to burnout and
I
stress. Chapter Three presents the research design, selection of sample, instru
mentation, procedures, data analysis, methodological assumptions, and limit-
! ations. Chapter Four contains the findings of the study for each hypothesis.
C hapter Five presents the summary, discussion, conclusions, and
recommendations of the study.
12
CHAPTER II
REVIEW OF THE LITERATURE
This chapter contains a review of the literature related to the evolution of
burnout theory, the dynamics of burnout, the burnout syndrome, and the effects
of burnout on psychotherapists. Stressful life events and work environment are
examined as predictors of burnout in psychotherapists who work primarily in
college and university counseling centers. Coping processes and perceived social
support are discussed as mediating factors in burnout. Burnout prevention and
intervention are also discussed. The chapter concludes with a summary of the
literature.
The Evolution of Burnout Theory
The theory of burnout is firmly embedded in stress theory. In fact, burnout
is conceptualized as a specific type of stress reaction.
Stress has been a popular phenomenon of extensive study for the past 40
years. On the other hand, the identification and study of burnout as a specific
syndrome are relatively new, having occurred within the last 15 years (Maslach,
1976). Burnout is often conceptualized as a specific type of stress reaction that
frequently affects people working in the helping professions. Therefore, a brief
overview of stress theory provides the foundation for some of burnout theory.
13
Stress Theory
Research into stress has been inhibited by the lack of a clear, generally
accepted definition of stress. However, there is some agreement that stress
involves a combination of an environmental stressor, an individual’s psychological
or physical response to the stressors, or the interaction between these two
(Ivancevich & Matteson, 1980). The existing research on stress has focused on
the physiological, psychological, or behavioral outcomes resulting from exposure
to stressors that are appraised as unpleasant (Ivancevich, Matteson, Freedman, &
Phillips, 1990).
Hans Selye (1974) pioneered biological studies into stress that have laid the
groundwork for much of what is known today about stress. Selye (1974) defined
stress as, "the nonspecific response of the body to any demand made upon it" (p.
14). Selye believed that stress was a necessary and functional part of life and that
complete freedom from stress only existed in death. Selye further refined his
definition by stating that stress is not merely nervous tension, not always the non
specific result of damage, and not necessarily something to be avoided. Selye
believed that stress was a necessary part of life and that "complete freedom from
stress is death" (p. 20). Today the word stress is used to refer to pressures and
emotional responses to traumatic events. Selye (1974) distinguished between
healthy stress that is a part of daily living and unhealthy stress called "distress"
that is physically damaging and unpleasant.
There are many approaches to research and the conceptualization of stress.
Some theories focus on the characteristics of the environment, other theories
i
focus on individual differences in personality, and still others on the individual’s
response to stress (Cherniss, 1982; Girdano & Everly, 1979; Selye, 1974).
14
| Selye (1974) developed a theory of stress that focused on the individual’s
| response to stressors. Selye noted that patients suffering from diverse diseases
had many signs and symptoms in common. All patients tended to lose their
i appetite, their muscular strength, their ambition to accomplish anything, and
i
| usually to lose weight. Selye called this the "syndrome of just being sick" (1974, p.
j 25). This process characterized a nonspecific adaptive physical reaction to
I change in the person’s environment.
Selye (1974) hypothesized that the human being, when faced with pro
longed and unaccustomed hardship or stressors, will respond in a predictable
!
pattern. At first, the experience is difficult, then one gets used to it, and, finally,
one cannot stand it any longer. This is a triphasic response that regulates the
I
j behavior of all living beings faced with exacting demands made upon the body.
| This conceptualization of stress eventually evolved into what Selye (1974)
i
I called the G eneral Adaptation Syndrome (GAS) used to describe a set of
j organized changes caused by cold, heat, infection, trauma, hemorrhage, nervous
I
1 _
! irritation, and many other stressful stimuli. This syndrome was produced by
i various stressors and consisted of three stages. The first stage was called the
j alarm reaction. The second stage was called the stage of resistance. The third
and final stage was called the stage of exhaustion.
During the alarm reaction, the body responds by preparing for fight or
i
| flight. There is an increase in blood pressure, muscle tension, and heart rate.
| These are the signs characteristic of the first exposure to a stressor. At the same
time, the body’s resistance is diminished. After the initial alarm reaction, the
body becomes adapted and begins to resist. This is the stage of resistance. The
| length of the resistance period depends on the body’s innate adaptability and the
i
i
15
intensity of the stressor. The body’s resistance can not go on forever because the
I
body’s adaptability or adaptive energy is finite. In time, the human body
becomes the victim of chronic wear and tear, and exhaustion ensues. The stage
! of exhaustion occurs following long-continued exposure to the same stressor, to
l
which the body had become adjusted. During this stage, the adaptation energy is
exhausted and the signs of the alarm reaction reappear, but now they are
i
I irreversible. Death ensues following the irreversible loss of adaptability,
i Lazarus and his colleagues (Kanner, Coyne, Schaefer, & Lazarus, 1981;
! Lazarus, 1966, 1981; Lazarus & Folkman, 1984) developed a model of stress that
| is cognitive-phenomenological. In this model, stress is viewed as a relationship
! between the person and the environment that is appraised by the person as taxing
| or exceeding his or her resources and as endangering his or her well-being. This
! perspective is phenomenological because cognitive appraisal refers to a person’s
| subjective interpretation of a transaction (Lazarus & Folkman, 1984).
Stress was seen as a result of three major variants of psychological reactions
[ to the environment. In response to and interaction with given environmental
situations, the person generates cognitive appraisals of harm/loss, threat, or
challenge that can cause stress. Appraisals of harm/loss are concerned with
; damage the individual has already sustained; threat refers to harms or losses that
i
- are anticipated; and challenge refers to encounters that hold the possibility for
t
gam or mastery.
| Burnout Theory
i
! Research into burnout has also been inhibited by the lack of a clear and
generally accepted definition.
16
Freudenberger (1974) was the first to coin the term "burnout" about 15
years ago. Freudenberger originally used the term to mean cynicism and loss of
energy, motivation, idealism, and hope. Freudenberger (1974) formally defined
"burnout" by using the dictionary definition of the verb, "to fail, wear out, or to
become exhausted by making excessive demand on energy, strength or resources,"
(p. 13) to describe the physical signs and behavioral indicators of this phe-
| nomenon. Freudenberger and Richelson (1980) later refined the term burnout to
i
I mean a "state of fatigue or frustration brought about by a devotion to a cause,
i
; way of life, or relationship that failed to produce the expected reward" (p. 13).
1 Pines, Aronson, and Kafry (1981) defined burnout as a condition char
acterized by feelings of helplessness and hopelessness, by emotional and physical
drain, and by the development of negative self-concept and negative attitudes
\ toward work life and other people.
Although defined in various ways, there is a general consensus in the
j literature that burnout is a syndrome that includes problems with one’s attitudes,
i emotions, and physical conditions (Farber, 1983). Furthermore, burnout is also a
i
i phenomenon that is related to job stress (Maslach, 1982), and is a process that
I
occurs when workers perceive a discrepancy between the rewards they expect to
receive for their work efforts and the rewards they actually receive (Farber, 1983;
i
| Freudenberger, 1980, 1982; Maslach, 1982; Raquepaw & Miller, 1989).
Maslach was one of the original investigators in the field who conducted
pioneering research on burnout in the helping professions and utilized a defin-
; ition of burnout appropriate for this population (Maslach 1976). She defined
burnout as a syndrome of emotional exhaustion, depersonalization, and reduced
; personal accomplishment that can occur among individuals who do "people-work"
I
! of some kind (Maslach, 1982; Maslach & Jackson, 1981b).
Both Freudenberger and Maslach defined burnout in terms of the impact
I
on the individual. A job which calls upon an individual to help others by working
with them intimately over a long period of time involves special talents and a
j great deal of stress. This stress is a major factor in absenteeism, low morale, and
! high job turnover, which ultimately affects the quality of services delivered to
! clients (Maslach, 1976; Maslach & Pines, 1977).
i
Burnout has been identified by Maslach (1981, 1982) as one type of job
; stress. It has some of the same harmful effects as other stress responses. How
ever, burnout is unique from the other stress responses in that the stress of
I burnout arises from the situational sources of job-related, interpersonal stress.
i
I
i
j Dynamics Of Burnout
The literature reveals that not only has there been difficulty with the
definitions of burnout, there has also been difficulty in conceptualizing the
i
process. Many different theories exist about what produces burnout. However,
there are three currently accepted approaches to the study of burnout. Berkowitz
(1987) identified these approaches as the study of: (a) focussing on external or
situational factors, that is similar to the work done in attribution theory;
(b) internal factors, such as personality, age, coping skills; and (c) most recently,
attempts at dealing with the interaction of the external and internal factors.
In general, burnout is conceived of as a process that is gradual. Daley
(1979) saw the process as, "so gradual that the worker may not be aware of what
is happening and will refuse to believe that anything is wrong" (p. 443). Maslach
18
and Jackson (1981) conceptualized burnout as a continuous variable, ranging !
i
from low to high degrees of experience. i
Edelwich and Brodsky (1980) have attempted to clarify the dynamics of
burnout by explaining it as an ongoing process that varies both in severity and
frequency of repetition for many individuals as they go through a series of ;
predictable developmental stages in the work environment. These stages are
| enthusiasm, stagnation, frustration, and apathy. Frustration is the stage of
i
I development that can either lead back to enthusiasm by triggering some change
| in the situation or else can proceed into the fourth stage, apathy. Burnout is
i often used to refer to this cyclic process, but it has also been used to refer to the
!
I
| end product of the cycle. These authors make a crucial distinction by stating that,
j
I "frustration is not burnout. Burnout means apathy" (p. 135).
I Many researchers have noted both the physical and emotional components
i
i
i of burnout. Pines and Kafry (1978) posited that burnout is "characterized by
| physical depletion, feelings of helplessness and hopelessness, emotional drain,
[ and by the development of a negative self-concept and negative attitudes toward
work life and other people" (p. 15).
However, the most congruence on the process and dynamics of burnout (
exists in the identification of the physical symptoms found in burnout.
The physical signs of burnout include a feeling of exhaustion and fatigue,
i
| inability to shake a lingering cold, frequent headaches and gastrointestinal
I disturbances, sleeplessness, and shortness of breath. Behavioral indicators of
i
I
burnout include quickness to anger; rapid irritation and frustration; suspicion and
paranoia; rigid, inflexible thinking; and verbalized negative attitudes.
!
19
Physical exhaustion is characterized by low energy, chronic fatigue, weak-
j ness, and weariness. The burned-out person reports more accident proneness,
greater susceptibility to illness, headaches, muscle tension, back pains, ulcers, and
j changes in eating habits and weight, as well as more serious illnesses. Emotional
exhaustion involves feelings of depression, hopelessness, and entrapment, which
in extreme cases may lead to mental illness and thoughts of suicide. Mental
j exhaustion is characterized by the development of negative attitudes towards
i
| one’s self, work, and life (Maslach, 1982).
In general, burnout is viewed as the individual’s response to the chronic
; emotional strain of dealing extensively with other human beings, particularly
when they are troubled or having problems (Freudenberger, 1982; Maslach,
1978b; 1982a).
|
* Conflict exists in the literature as to whether burnout is a result of person
ality, the situation, or an interaction of both personality and the situation. There
! is general agreement among the majority of researchers that burnout can occur at
an individual level (Daley, 1979; Farber, 1983; Freudenberger & Richelson, 1980;
!
Maslach, 1982) and on an organizational level (Golembieski, Munzenrider, &
Stevenson, 1986). There is also agreem ent that burnout is an internal
psychological experience involving feelings, attitudes, motives, and expectations.
There is general agreement that burnout is a negative experience for the
individual that involves problems, distress, discomfort, dysfunction, and other
negative consequences (Paine, 1982).
20
Situational Factors
Most discussions of burnout emphasize contact with people and the factors
that make that contact emotionally stressful as one major source of burnout in
individuals. In addition to examining the dynamics of interpersonal relation
ships, causal analyses have focused on job stress and the characteristics of the
organizational setting in which work takes place (Golembiewski et al., 1986;
Paine, 1982).
Pines and Kafry (1978) identified two general sources of stress leading to
burnout: internal stress and external stress. Internal stress includes intrinsic
properties of the work conditions such as variety, challenge, interest, feedback,
and a sense of success. External sources of stress revolve around work relations,
which include relationships with one’s boss, subordinates, colleagues, and clients.
Pines and Kafry found that external characteristics were correlated more strongly
with burnout than were the internal characteristics.
Burnout remains a specifically job-related phenomenon in the literature. It
is not mentioned in medical dictionaries nor is it seen as a possible affective
disorder by the American Psychiatric Association in the Diagnostic and Statist
ical Manual for Mental Illnesses (DSM III-R. 19871. The DSM III-R does
describe symptoms of depressive episodes in terms remarkably similar to those
used for burnout symptoms. These include loss of interest or pleasure, appetite
and sleep disturbances, a decrease in energy level with sustained fatigue, a sense
of worthlessness, guilt, difficulty in concentrating, feelings of anxiety, irritability,
fear, brooding, excessive concern with physical health, and phobias. Burnout
appears closely linked to depression in the medical profession in terms of
diagnosis and treatment of the disorder.
21
j Personality Factors
! Early research into burnout first looked for the causes of burnout within the
i
1 person; that is, the intrapsychic dynamics that made a person vulnerable to
j burnout. Maslach (1982) identified what she called the burnout-prone individual
to refer to personality factors within the individual that made him or her vul-
| nerable to burnout. These factors can best be described as the insecurities that
| the person may harbor within. Maslach (1982) described the burnout-prone
individual as someone who is weak and unassertive in dealing with people. Such
a person is submissive, anxious, and fearful of involvement and has difficulty in
setting limits within the helping relationship. It is easy for this person to become
overburdened emotionally and so the risk of emotional exhaustion is high.
The burnout-prone individual is also someone who is impatient and
intolerant. Such a person will get easily angered and frustrated by any obstacles
j in his or her path and may have difficulty controlling hostile impulses. This
i individual is likely to project these feelings onto their clients and treat them in
■ more depersonalized and derogatory ways.
Finally, according to Maslach (1982), the burnout-prone individual is
someone who lacks self-confidence, has little ambition, and is more reserved and
conventional. Such a person has neither a clearly defined set of goals nor the
| determination and self-assurance needed to achieve them. Faced with self-
j doubts, this person tries to establish a sense of self-worth by winning the
i
j approval and acceptance of other people. In so doing, the person may be so
accommodating that he or she becomes overextended too often.
I Maslach (1982) cautioned that the people who match this personality
I
! profile are not the only ones at risk. Everyone is at risk to some extent if the
emotional stress of their work becomes excessive. To be assertive in dealing with
people, one needs confidence in himself or herself. The burnout-prone persons,
instead of shaping and controlling the surrounding environment, are at the mercy
of it.
Freudenberger provided a somewhat different profile of the person most
likely to burn out. According to Freudenberger and Richelson (1980), the person
; most likely to burn out was the person who was the most committed, idealistic,
I and overachieving. Freudenberger believed that people who fall prey to burnout
i
I are, for the most part, decent individuals who have striven hard to reach a goal.
j
| Their schedules are busy and they can be counted on to do more than their share.
They usually are the leaders among us who have never been able to admit to
limitations. They started out with great expectations and refused to compromise
along the way. These contradictions exist within the individual and are part of
| the problems which ultimately leads to burnout.
i
|
( The Burnout Syndrome
Maslach’s conceptualization of the burnout syndrome is used as the primary
; theoretical underpinning of this study. Maslach (1982) posited that a pattern of
j emotional overload and subsequent emotional exhaustion is at the heart of the
! burnout syndrome. Maslach (1982) stated that a person who becomes overly
i
1 involved emotionally, gets overextended, and feels overwhelmed by the emo-
I tional demands imposed by other people is emotionally exhausted. The response
' to this situation is one aspect of the burnout syndrome called em otional
I exhaustion. The individual feels drained and used up, lacks enough energy to
I
!
i
23
face another day, emotional resources are depleted, and there is no source of
replenishment.
After emotional exhaustion occurs, people feel that they are unable to give
' of themselves to others. Maslach (1982) further stated that one way people
i
attempted to relieve their emotional burden was by cutting back their involve
ment with others. They try to reduce their contact with others to the bare
minimum to get the job done. This is one of the many ways people detach
I
1 themselves psychologically from any meaningful involvement with others. This
detachment puts emotional distance between the individual and the people
i
j whose needs and demands are overwhelming.
; This detachment can be any effective tool for handling the emotional strain
I characterized by people work when this emotional buffer is combined with a
! genuine caring for others (Maslach, 1982). This would be the professional ideal
I
j of "detached concern" that blends closeness and distance (Lief & Fox, 1963).
However, rather than achieving a balance, many people feel pulled towards one
of the extremes of closeness or distance. In burnout, the retreat into the
detached stance away from others is an attempt at emotional self-protection
where patients get treatment without any personal caring (Maslach, 1982).
j With the increasing detachment comes an attitude of cold indifference to
| others’ needs and a callous disregard for their feelings. The development of this
i
| detached, callous, and sometimes dehumanized response signals a second aspect
| of the burnout svndrome-depersonalization. Maslach (1982) described this
: aspect of burnout as the individual developing a poor opinion of other people,
expecting the worst from them, and even actively disliking them. This negative
reaction to people manifests itself in various ways. The provider of care may
subtly put other people down, refuse to be courteous to them, ignore their pleas
and demands, or fail to provide the appropriate help, care, or service.
Feeling negatively about others can progress until it encompasses being
i
| down on oneself. Caregivers often feel distress or guilt about the way they have
i
thought about or mistreated others. They sense they are turning into the very
type of person-cold and uncaring— that nobody likes very much. At this point, a
!
| third aspect of burnout appears-a feeling of reduced personal accomplishment.
Providers develop a gnawing sense of inadequacy about their ability to relate to
i clients and this may result in feelings of failure. This feeling of inadequacy can
lead to the crumbling of self-esteem with depression setting in. This usually
triggers the onset of full blown burnout. Some people may seek counseling or
i therapy for what they believe are personal problems. Others may change their
l
- jobs, often to abandon any kind of work that brings them into stressful contact
with people.
Effects On Psychotherapists
More recently, the literature on burnout has begun to focus on psycho
therapist burnout. Three major studies have made significant contributions to
the growing body of knowledge that exists on burnout. However, these studies
continue to be correlational in nature, and, therefore, do not establish causality.
Raquepaw and Miller (1989) conducted a study of burnout on practicing
psychotherapists in Texas. Their sample included psychologists and social
workers holding doctoral or master’s degrees. A random sample of 68 psycho
therapists were surveyed, using the Maslach Burnout Inventory (MBI) (Maslach
& Jackson, 1981b). Demographic questions and questions designed to assess the
25
respondents’ intent to leave the profession, treatment orientation, and perceived
ideal caseload also were obtained. Their return rate was modest at 45%.
Raquepaw and Miller’s sample was derived from three work settings. Some were
employed full-time in agencies, some part-time in agencies and part-time in
private practice, and some full-time in private practice. They found more
symptoms of burnout in psychotherapists who worked for agencies than in those
who worked solely in private practice. They also found that size of caseload was
not associated with burnout, but that satisfaction with caseload was. Burnout was
associated with psychotherapists’ intentions to leave psychotherapy for other
professions.
Another study by Snibbe, Radcliffe, Weisberger, Richards, and Kelly (1989)
focused on burnout in an institutional setting. They examined burnout among
primary care physicians and mental health professionals. The mental health staff
was composed of 51 psychiatrists, psychologists, and social workers who were
employed at a Kaiser Permanente facility. The Maslach Burnout Inventory was
administered to them. Snibbe et al. (1989) found that the psychiatric staff scored
higher on burnout than the primary care physicians staff at a Health Maintenance
Organization in Southern California. This study found high levels of emotional
exhaustion, depersonalization, and reduced personal achievement in the psychi
atric staff. Psychiatrists and social workers had significantly higher scores on
depersonalization than psychologists. Other interprofessional differences were
that social workers scored significantly higher on emotional exhaustion than
psychiatrists or psychologists; social workers and psychiatrists had significantly
higher scores on depersonalization than the psychologists. There were no
differences among these groups on reduced personal achievement.
26
The higher occurrence of burnout in this institutional setting was attributed i
by the authors to the large numbers of patients and the carefully managed
resources typical of H ealth M aintenance O rganizations. It was further
speculated that the short-term treatm ent demands of this setting may have
conflicted with the psychotherapists’ training that may have emphasized long
term treatment resulting in increased frustrations. i
Johnson and Stone (1986) explored the different types of job stressors in a 1
i sample of 46 social workers using the MBI, Work Environment Scale (WES),
i
j Jenkins Activity Survey, and the Hassles Scales. Johnson and Stone utilized a
j mailed survey to obtain their data, which were analyzed using correlational
I methods. This was a descriptive study that attempted to examine psychological
processes through the use of measures reflecting a more phenomenological
' approach to stress (Johnson & Stone, 1986) and revealed that, "overall, the
i
i
j findings indicated that the respondents were experiencing moderate levels of job
! stress as measured by the MBI" (p. 73). This study confusingly used burnout and
job stress interchangeably. The authors found that burnout was related to hassles
of daily living and that these hassles accounted for 25% of the variance in burn-
; out, which contrasted with the WES which only accounted for 3% of the variance
; found in burnout.
Cherniss (1980) sees burnout as due to sociological causes: chiefly
decreased attention to human service needs, fewer jobs, and fewer options for
i those who were dissatisfied with their present work situations.
. There are three currently accepted approaches to the study of burnout.
Berkowitz (1987) identified these approaches as the study of: (a) external or situ
ational factors similar to the work done in the field of attribution theory;
27
(b) internal factors such as personality, age, coping skills, etc., and (c) most
recently, attempts at dealing with the interaction of the external and internal
factors.
Farber and Heiftz (1982) found that the primary source of stress for most
psychotherapists was a lack of therapeutic success, that is, the inability to pro
mote positive change in their patients. According to the psychotherapists they
studied, the primary factor underlying their burnout was the nonreciprocated
attentiveness and giving that are inherent within the therapeutic relationship.
| Berkowitz (1987) believed that constant giving without the compensation of
! success apparently produces burnout in psychotherapists.
Farber (1983) further found therapeutic work to be most stressful for
inexperienced therapists and for therapists who worked in institutional settings.
Psychotherapists employed in academic settings found themselves as pro
fessionals psychologically distanced from faculty members because they did not
! teach, from administrators because they had no administrative responsibilities or
influence, and from the population they served because of their role as "pro
fessional helper." The discrepancy between the ideal situation espoused during
their education and their experiences in the real world of their jobs led to
i
disillusionment and loss of the idealism which led many of them to counseling.
, Another area of difficulty for psychotherapists in institutional settings was
| the client’s passive-dependency in relationship with the therapist, which placed a
I tremendous burden of responsibility on the staff person. This frequently led to
the psychotherapist feeling overwhelmed by the client’s problems and the client’s
dependence on him/her to solve them.
Predicting Factors In Burnout
! Stressful life events and work environment stressors have been the focus of
extensive study. Many studies that have attempted to establish a link between
stress and health outcomes have focused on the various stressors that exist in
either life in general, and/or the work environment specifically.
Stressful Life Events
Controversy exists in the literature regarding whether acute major life
j events or chronic minor life events (e.g., hassles) are more accurate predictors of
| adaptational outcomes, such as, psychological symptoms and somatic illnesses.
| Most studies of acute stressful life events have focused on major life events,
I
! such as death of a loved one, birth of first child, divorce, or loss of job, especially
| when they accumulate over a brief period in the lives of individuals. Abundant
i
j evidence exists that these types of stressors are related to a variety of mental and
!
physical illnesses (Dohrenwend, Dohrenwend, Dodson, & Shrout, 1984). Life
events are typically defined as experiences that cause the individual to sub
stantially readjust his or her behavior patterns (Dohrenwend & Dohrenwend,
1974; Holmes & Rahe, 1967).
The focus on the assessment of major life events evolved from the work of
i Holmes and Rahe (1967). They developed a measure of major life events called
<
the Schedule of Recent Events.
i
Attention is now on small life events that occur more frequently than do
' major life events. These smaller occurrences are more chronic stresses and
| strains. Kanner and his associates (1981) have labeled these irritating, ongoing
i
29
| sources of stress as "hassles," the frustrating, distressing demands and troubled
i
; relationships that plague us day in and day out.
i
■ Work Environment
Maslach (1982; 1982a) observed that when burnout begins to occur, there is
a tendency to see people as causing it. The blame is placed on either the pro-
j vider or the recipient of care. We assume that some personal flaw must be
j causing the burnout rather than looking at the work environment or the insti-
i
| tutional structures and policies. Maslach believes that it is easier for us to look
j for and attribute cause to defective people rather than the situation in which
j people find themselves on the job. The focus on situational factors allows for the
i
; possibility that it may be the nature of the job that precipitates burnout and not
i
just the nature of the person performing that job. Maslach (1982a) found that,
although personality does play some part in burnout, the bulk of the evidence is
! consistent with the view that burnout is best understood in terms of situational
i
sources of job-related, interpersonal stress. "Bad people" as a cause of burnout is
difficult to substantiate because the people affected by burnout are so numerous,
i
and their personalities and backgrounds are so varied (Maslach, 1982). Instead
of looking for "bad people," Maslach believed our focus should be on trying to
identify and analyze the critical components of "bad" situations in which many
i
! good people function.
| Freudenberger and Richelson (1980) also believed that good people, those
, who are idealistic and ambitious, are at greater risk to become victims of burnout
as a result of the work environment. Unfortunately, the helping professionals see
i
! a lot of failure, pain, and suffering. Psychologists in institutional settings, in
30
particular, battle against the overwhelming odds of poverty and hopelessness
i
i
which take their toll on the individual. Since it hurts too much to care, they tend
* to anesthetize themselves from their feelings and go about their daily routine in a
i
more mechanical and cut-off way to survive.
When the focus is on the work environment, a major theme emerges. Many
i
! difficult job settings that are burnout-prone have one thing in common—
\ OVERLOAD. Whether it is emotional or physical, the burden that exceeds the
I individual’s ability to handle it is the epitome of what we mean by stress. For
i
i
many psychotherapists, overload translates into too many people to serve and too
little time to serve their needs adequately. This type of situation is ripe for
j burnout (Maslach, 1982).
| Pine, Aronson, and Kafry (1981) found that three major antecedents of
| burnout existed in most institutional settings: (a) overload; (b) lack of autonomy;
j and (c) lack of reward.
Many psychotherapists work in institutional settings and are faced with
I
1 many of the factors that contribute to burnout that were identified above. There
can be an excessive overload from the number of clients who need to be seen
| and the pressure to provide short-term treatment even when longer term treat
ment may be indicated. There is also pressure to meet the demands of the
! institutional setting in which one is employed. Excessive pressure can occur when
I
| the demands of the institution conflict with the psychotherapist’s personal needs.
I
j One of the first studies on burnout conducted by Maslach and Pines (1977)
examined the cause of burnout in day care centers. Eighty-three staff members
from 12 child care centers were involved in the study. They found that a large
child-to-staff staff ratio resulted in overload for the staff members. They also
31
found that the longer the staff worked with children, the more stress and negative
j attitudes emerged. The programs with the least amount of structure were found
| to be more taxing for staff members than programs with more structure. Finally,
i
! the centers with the lowest incidence of burnout were those with frequent staff
meetings which provided interaction, support, advice, and clarification of goals
for its members.
j
| Mediating Factors In Burnout
! The relationship between life events and various adaptational outcomes
j
1 have tended to be small (Rabkin & Struening, 1976). This fact has led
(
J
| researchers to focus on a variety of other environmental aspects of life stress and
■ on personal dispositions that may influence the impact of the events. Most
j prominent among the possible mediating factors have been coping processes
t
! (Billings & Moos, 1981; Lazarus & Folkman, 1984) and social supports (Cobb,
1976; House, 1981; Cohen & Wills, 1985).
i
Coping Process
i Researchers looking for variables that might moderate the stress-illness
| relationship have identified coping as a major candidate (Billings & Moos, 1981).
It is believed that if individuals can cope effectively with the problems that they
face, they may be able to reduce harmful consequences of stress.
Coping refers to cognitive and behavioral efforts to master, reduce, or
tolerate the internal and/or external demands that are created by the stressful
i
transaction (Folkman & Lazarus, 1980; Lazarus & Launier, 1978). Folkman
i (1984) defined coping independently of its outcome; that is, coping refers to
I
i
! 32
efforts to manage demands, regardless of the success of those efforts. This is
different from the popular conceptualizations of coping, which implies managing
or succeeding, and not coping which implies failure.
1 There has also been controversy over whether coping responses are
determined by the situation, person, or some interaction of these. However,
current research focuses on situational determinants of behavior, rather than
intrapsychic processes that had previously dominated the field.
i
| The functions of coping, according to Folkman and Lazarus (1980; 1984),
|
are conceptualized as: (a) the regulation of emotions or distress (emotion-
; focused coping), and (b) the management of the problem that is causing the
j distress (problem-focused coping). Emotion-focused coping is used to control
i
i distressing emotions, sometimes by altering the meaning of an outcome, whereas
j problem-focused coping is used to control the troubled person-environment
| relationship through problem solving, decision making and/or direct action.
i
^ Problem-focused coping can be directed at the environment as well as oneself,
i Folkman and Lazarus (1980) have shown that both forms of coping are
i
| used in most stressful encounters. They conducted a study with 100 men and
women ages 45 through 64. Subjects responded to the "Ways of Coping" checklist
j \
regarding how they coped with a wide variety of real life events over the course of
i
| 7 months. The checklist contained eight domains of confrontive coping, dis-
I tancing, self-controlling, seeking social support, accepting responsibility, escape-
avoidance, planful problem solving, and positive reappraisal. These domains can
! be categorized as problem-focused and/or emotion-focused strategies. Examples
of problem-focused strategies included "got person responsible to change his/her
i
j mind," "made a plan of action and followed it," and "stood your ground and fought
i
j
33
for what you wanted." Emotion-focused strategies included items like "looked
for the silver lining, tried to look on the bright side of things," "accepted sympathy
and understanding from someone," and "tried to forget the whole thing." The
events reported by the subjects ranged from minor problems, such as car trouble,
to major problems, such as job loss or life threatening illness. More than 1,200
stressful episodes were analyzed and findings showed that both problem-focused
and emotion-focused coping were used in over 98% of the episodes. Moreover,
problem-focused forms of coping increased in situations that were appraised as
changeable and emotion-focused forms of coping increased in situations
appraised as not amenable to change. Folkman and Lazarus (1980) reasoned
that problem-focused and emotion-focused coping occurred together because it is
necessary to control emotions to have effective problem-solving efforts occur in
stressful encounters.
Lazarus and Launier (1978) maintained that the determining feature of a
response to a stressor is the individual’s appraisal of the situation. They further
stated that a situation can be construed as a loss (or harm), a threat, or a
challenge, and that it is the individual’s interpretation of the event that prompts a
particular set of coping reactions. A loss is defined as damage that has already
occurred (death, accidental injury). A threat also refers to damage, but damage
that is anticipated and may or may not be inevitable. Lazarus and Launier point
out that most stress research emphasizes loss and threat and that challenge is
neglected. Challenges differ from threats in their generally positive tone,
although, like stressors, they require exceptional efforts from the individual.
Another difference is that both challenges and threats are likely to be chronic,
whereas losses tend to be acute stressors. Lazarus and Launier (1978) perceived
34
loss, threat, and challenge as characteristics of the relationship between the
individual and the environment.
McCrae (1984) also saw most coping efforts as responses to external
stressors, such as illness, divorce, bereavement, rather than responses to
unconscious conflicts. Because responses are considered conscious strategies,
McCrae believed that researchers can identify stressors and the individual can be
asked directly what he or she does to cope with them as an effective way of
assessing coping.
McCrae (1984) examined specific coping responses to assess the influence
of losses, threats, and challenges situations on the choice of coping mechanisms
in two separate studies. In the first, a longitudinal study was conducted with 255
men and women (1980). Subjects were assigned to loss, threat, or challenge
groups based on the type of experienced stressors occurring within the past 18
months. In the second study, 151 subjects selected instances of loss, threat, and
challenge they had recently experienced. In both studies, type of stressor had a
consistent and significant effect on the choice of coping mechanisms. McCrae
found that the most popular coping strategies used were rational action directed
toward solving problems and positive thinking. He also found that rational
coping action was used more often with threat (illness) situations than with loss
(death) situations. These strategies were categorized as effective methods of
coping. McCrae found that the least often used coping strategies were self
blame, denial, and passivity.
Most recently, coping has been conceptualized as an on-going process that
changes over time. Folkman and Lazarus (1985) investigated emotion and
coping during three stages of a college examination. The anticipation stage was
35
before the exam. The waiting stage was after the exam and before the grades \
were announced. The after stage was after grades were posted. Coping was [
i
assessed with the Ways of Coping Checklist (Folkman & Lazarus, 1985). This is
a modified version of the 68-item list reported by Folkman and Lazarus (1980).
Folkman and Lazarus (1985) found that at least 94% of the subjects used both 1
problem-focused and emotion-focused forms of coping at each of the three stages j
i
of the exam. This confirmed their earlier finding that both functions of coping
are represented in most stressful encounters (Folkman & Lazarus, 1980).
I
i
j Social Support
J
i
| Social support is another variable that has been studied extensively for its
I
; ability to "moderate" or "buffer" the impact of psychosocial stress on physical and
| mental health (Cobb, 1976; House, 1981; House & French, 1980; Kobasa &
j Puccetti, 1983; LaRocco, Newcomb, 1990; Newcomb & Chou, 1989; Sarason,
Levine, Basham, & Sarason, 1983; Sarason, Shinn, Pierce & Sarason, 1987;
i
‘ Thoits, 1982). Social support is also considered one specific form of coping
(Folkman & Lazarus, 1984).
I A common element in much of the literature is the positive effect of social
i support resources on reducing burnout (Freudenberger, 1980; Maslach, 1982a;
Pines & Aronson, 1988). Pines and Kafry (1981) found that the use of social
i support systems provided an effective preventive mechanism against burnout.
; They examined the effectiveness of social support systems as buffers against
burnout and tedium and for the direct effects on burnout and tedium. The
! results indicated that the more social support exists, the less the burnout and
tedium experienced.
36
Many previous studies provide substantial evidence that social support in
I fact reduces job stress, job-related strain, and improved health. However, the
issue of buffering studies have been split.
LaRocco, House, and French (1980) found support for the buffering
hypothesis regarding mental and physical health variables (anxiety, depression,
irritation, and somatic symptoms), but failed to support the buffering hypothesis
regarding job-related strains (job satisfaction, boredom, and dissatisfaction with
| workload).
! Discussions of coping tend to be limited to the individual level, where its
j effectiveness in dealing with burnout is questionable because of the effect of
, external factors from the environment that also contributes to burnout. The
i
: effects of social support and organization level coping are often ignored even
though they have shown positive results on reducing burnout.
1
i
Prevention And Intervention
Many theorists have suggested various coping strategies for reducing the
stress of burnout. Pine et al. (1981) posited four strategies for dealing with
I burnout. The first strategy involved being aware of the problem. Fully aware
means being aware of the locus or the cause of the problem. The second strategy
involved taking responsibility for doing something about it. Many people are
willing to take responsibility for something that is "their fault," but are reluctant
to do something about situational or institutional problems. Once the individual
takes responsibility for affecting change in a difficult situation, this in and of itself
is therapeutic simply because it reduces the debilitating effects of the feelings of
helplessness. Individuals must assume power and control over their lives by
37
gaining control over their environment. The third strategy involved achieving
some degree of cognitive clarity. This is the ability to discriminate the things that
can be changed from the things that cannot be changed. Burnout occurs in
people who tend to assume everything destructive and dehumanizing can be
changed and end up banging their heads against the brick wall of a nonresponsive
bureaucracy. Trying and failing repeatedly leads to feelings of hopelessness and
helplessness and the individual comes to believe that nothing can be changed.
Individuals must learn to make clear discriminations between the concrete
demands of the job and the demands they place on themselves that they some
times erroneously attribute to their supervisor or the organization. Finally, the
fourth strategy that is posited by Pine et al. (1981) involves developing new tools
for coping, and improving the range and the quality of the old tools. This
involves some diagnostic and discrimination skill and the ability to look for and
find alternatives to problems and difficulties. The individual needs to practice
looking inward to be able to articulate clearly what his or her own needs are in a
given situation.
This model and many others that exist in the field of burnout address
coping on an individual level. Freudenberger and Richelson (1980) stressed the
importance of awareness and of individuals achieving balance in their lives.
Freudenberger and Richelson believed that the underlying cause of burnout is
the dichotomy between the expectations and the actuality of the individual.
Maslach (1982) proposed coping techniques that are more comprehensive
in that the focus is on the individual level, the organizational level, and the social
i
level. At the individual level are the actions that can presumably be taken. At
the organizational or institutional level are the policies and administrative actions
38
that can help the staff deal with emotional stress. At the social level are those j
i
techniques that require the joint efforts of several people, such as co-workers.
Maslach cautions that all coping techniques may not work for all people and that
the individual must choose the technique that works best for them.
i
I
Summary Of The Literature
| Maslach’s initial approach to research was exploratory. She asked a lot of
| open-ended questions, made on-site observations, and in general went where the
I
i data led. Maslach utilized few participants but studied them in depth. Next, she
1
conducted a series of survey studies with Pines (1977, 1978a). They targeted
specific variables for investigation and comprehensive questionnaires were devel-
i oped. Large samples were used that were more broadly representative, although
studied in less depth. They used self-report measures and ratings collected from
i
I colleagues and spouses of subjects (Maslach, 1982).
i
| Research has now focused on more integrative studies in which both
i
| personality and situational factors in burnout are being assessed (Maslach, 1982;
Raquepaw & Miller, 1989; Shinn, Rosario, Morch, & Chestnut, 1984; Udovch,
| 1983). Research is also being conducted on the identification of the important
!
I
correlates of burnout such as the connection to job turnover, its ties to the
impairment of family relationships, and its apparent link to various types of
health problems such as high blood pressure and ulcers.
However, significant problems in the conceptualization and definitions of
| burnout remain. These problems continue to plague research in terms of diffi-
' culty in comparing outcomes when different definitions or conceptualizations are
l tested. Despite these difficulties, significant gains continue to made in the field.
In summary, to evaluate information on burnout, one needs to know what is |
i
being discussed. Burnout has many definitions and has been variously measured. ;
Stressors are better defined, but tend to be interdependent, so that it is difficult .
to untangle their effects. Discussions of coping tend to be limited to the indi- !
i
vidual level, where its effectiveness in dealing with burnout is questionable |
because of the effect of external factors from the environment that also con- j
tribute to burnout. The effects of social support have often been ignored even
though they have shown positive results.
I
This study attempted to address some of these problems by positing and
testing a theoretical model of burnout. The model attempted to establish a
relationship among sets of variables from the work environment, stressful life
events, coping process, social support, and the components of burnout as
identified by the Maslach Burnout Inventory. The following hypotheses related
to this theory of burnout were tested:
1. Male and female psychotherapists employed in college counseling
centers will differ on the levels of burnout as measured by the Maslach Burnout
Inventory.
2. Work environment climate would predict burnout as m easured by
emotional exhaustion in psychotherapists employed in college counseling centers.
3. Stressful life events would predict burnout as measured by emotional
exhaustion in psychotherapists employed in college counseling centers.
4. Coping processes would predict burnout as measured by emotional
exhaustion in psychotherapists employed in college counseling centers.
5. Perceived social support would predict burnout as m easured by
emotional exhaustion in psychotherapists employed in college counseling centers.
40
6. Work environment climate would predict burnout as measured by
depersonalization in psychotherapists employed in college counseling centers.
7. Stressful life events would predict burnout as measured by depersonal
ization in psychotherapists employed in college counseling centers.
8. Coping processes would predict burnout as measured by depersonal- !
ization in psychotherapists employed in college counseling centers.
9. Perceived social support would predict burnout as m easured by
depersonalization in psychotherapists employed in college counseling centers. ■
10. Work environment climate would predict burnout as measured by
reduced personal accomplishment in psychotherapists employed in college
counseling centers.
11. Stressful life events would predict burnout as measured by reduced
I
j personal accomplishment in psychotherapists employed in college counseling
| centers.
: 12. Coping processes would predict burnout as measured by reduced
i
■ accomplishment in psychotherapists employed in college counseling centers.
13. Perceived social support would predict burnout as measured by reduced
| personal accomplishment in psychotherapists employed in college counseling
! centers.
41
CHAPTER III
METHODOLOGY
In this chapter, information concerning the design and procedures of the
investigation are presented. A description of the research design, methodology,
selection and description of subjects, instrumentation, procedures, data col
lection, statistical analysis, methodological assumptions, and limitations of the
study are included.
Research Design
This study was designed as a nonexperimental cross-sectional survey that is
descriptive and correlational in nature. The overall objective of this research was
to examine a theory of burnout by considering the correlations among variables
related to the work environment, stressful life events, coping processes, perceived
social support and the degree to which these were related to burnout. Data
regarding work environment climate, hassles, coping, amount and perceived
adequacy of social supports, and three scales of burnout were collected to
develop a model of the components which contribute to burnout in a sample of
psychotherapists employed in college counseling centers.
42
Selection Of The Sample
The sample consisted of 82 psychotherapists employed in college counseling
centers in the Southern California area. A total of 16 college counseling centers
, were selected from the roster of the 1989 Organization of Counseling Center
Directors in Higher Education. This organization consists of 53 member schools
from the University of California system, the California State system, and the
Independent Colleges and University system in the State of California. Of the 16
i
i schools contacted, 11 agreed to participate in the study. The college counseling
I centers were located in the urban area of Los Angeles County with an equal
I number of independent and public schools being contacted.
; Of the 145 questionnaires distributed, 94 were returned for a response rate
1
of 64.8%. Of the 94 surveys returned, 12 were unusable resulting in a final rate
j of 56.6%. The sample was limited to practicing psychotherapists who provided
l
| direct treatment to students (psychologists, marriage and family therapists, social
^ workers, psychiatrists, and doctoral interns). About 80% held doctoral degrees,
; an additional 12% had m aster’s degrees, and the remaining 8% were pre-
; dominantly predoctoral interns. Respondents had worked an average of 7 years
in their current jobs. The average age was 42, and ranged from 24 to 80 years.
There were somewhat more women (54%) than men (46%) in the sample,
j Presented in Table 3.1 is a description of the sample of psychotherapists in
, this study. This sample proved fairly representative of other psychotherapists’
j samples used in the study of burnout. The characteristics (age range, median
i age, and median years in current job) for this sample of psychotherapists
! compared similarly to other samples (Shinn, Rosario, Morch, & Chestnut, 1984).
i
43
TABLE 3.1
Description of the Sample
Characteristics N %
Gender
Male 38 46.3
Female 44 53.7
Age
Mean 42.39 (59.7% 30-49 yrs.)
Range 24-80 yrs.
Ethnicity
Black 8 9.8
Hispanic 2 2.4
White 64 78.0
Asian 7 8.5
Marital Status
Married 42 51.2
Single 14 17.1
Divorced 13 15.9
Cohabitation 9 11.0
Widowed 3 3.7
Years Married
Mean 13.58 yrs.
Range 1-52 yrs.
Total # of Children r
None 44 53.7
One 13 15.9
Two 15 18.3
Three or more 10 12.1
Children living with me 25 30.5
Religion
Protestant 29 35.4
Jewish 16 19.5
Catholic 7 8.5
None 19 23.2
Other 9 11.0
44
| Table 3.1, continued
Characteristics N %
Training
Psychiatrists 4 4.9
Psychologist (Doctoral) 63 76.5
Clinical 42 66.7
Counseling 21 33.3
MFCC (Master) 6 7.3
Social Work 4 4.9
Other 5 6.1
License
Medical 4 4.9
Psychologist 27 32.9
MFCC 14 17.1
LCSW 3 3.7
Experience
Mean 12.06 yrs.
Range 1-43 yrs.
Position
Supervisors 13 15.9%
Staff 53 64.6
Interns 15 18.3
Caseload
Mean 18.56
10 or less 15 18.3
11-20 43 52.4
20 or more 24 29.1
Private Practice
On the side 35 42.7
Mean hours worked 9.26 hrs
Range hours worked 1-40 hrs.
Therapeutic Orientation
Eclectic 41 50.0
Psychodynamic 27 32.9
Cognitive Behavioral 9 11.0
Humanistic 3 3.7
Psychoanalytic 1 1.2
45
! Instrumentation
j Respondents completed a 318-item, anonymous, survey questionnaire (see
I Appendix). This consisted of four standard self-report measures on work
environment, hassles, coping, and burnout, a new instrument on social support,
and demographic questions. A cover letter from the researcher introduced the
questionnaire as a study on job-related attitudes of psychotherapists. The
following instruments were included in the questionnaire packet.
i
j
i
Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1986)
j
Burnout was operationalized by using scores on the three subscales of the
j MBI, which measures the domains of responses to stresses. The three subscales
i
of the MBI assess different aspects of experienced burnout. The MBI consists of
22 statements about the respondent’s attitudes, feelings, and perceptions of
| themselves and their clientele.
The MBI was developed by using factor analysis techniques with a pop-
: ulation of adult human services professionals. The internal consistency reliability
: estimates of the MBI’s subscales range from .77 to .81 (Maslach & Jackson,
1981). The three subscales are reported to be relatively free of social desirability
i
bias.
! The Emotional Exhaustion subscale concerns feelings of being emotionally
| drained, the Depersonalization subscale concerns the development of negative
1
! and cynical attitudes toward people with whom one works, and the Personal
Accomplishment subscale concerns feelings of competence and success in
j working with people. Higher scores on the Emotional Exhaustion and
46
Depersonalization subscales and lower scores on the Personal Accomplishment
subscale reflect higher degrees of burnout.
Scores for each subscale are considered separately and are not combined
into a total score. The subscales of Emotional Exhaustion and Depersonalization
are moderately intercorrelated at .52. Em otional Exhaustion and Personal
Accomplishment are weakly intercorrelated at .22 and Depersonalization and
i
Personal Accomplishment are weakly intercorrelated at .26.
i
I
i
: Work Environment Scale (Moos, 1986)
| The work environment stressors were operationalized by the work environ-
| ment scale. This is a 90-item self-report measure of the social environment of the
■ work setting. Each item is answered true or false. The scale assesses three
: dimensions including relationships, personal growth, and system maintenance
| and change by way of 10 subscales.
i
| The Relationship dimensions are measured by Involvement, Peer Cohesion,
i
and Supervisor Support subscales. These scales assess the extent to which
, employees are concerned about and committed to their jobs and the extent of
| peer and management support. The Personal Growth or goal orientation dimen-
i
sions are measured by Autonomy, Task Orientation, and Work Pressure sub-
- scales. These subscales assess the extent to which employees are encouraged to
be self-sufficient, degree of emphasis on good planning, and how much the press
of work and time urgency dominates the job milieu. System Maintenance and
! System Control are measured by the Clarity, Control, Innovation, and Physical
! Comfort subscales. These subscales assess the extent to which employees know
what to expect on the job, the extent management attempts to exert control over
employees, the emphasis on change, and the nature of the physical surroundings.
The internal consistencies (Cronbach’s Alpha) for each of the ten subscales
are all in the acceptable range. They vary from .69 for Peer Cohesion to .86 for
Innovation. The test-retest reliabilities are all in the acceptable range, varying
from a low of .69 for Clarity to a high of .83 for Involvement over a 1-month
period.
Hassles Scale (Kanner, et al., 1981)
Stressful life events were operationalized by the Hassles Scale. This is a
117-item questionnaire that reflects the content areas of work, family, social
activities, the environment, practical considerations, finances, and health.
Respondents are instructed to indicate the occurrence of any items which have
"hassled" them in the past month. Each hassle is rated on a 3-point scale as
having been "somewhat," "moderately," or "extremely" severe. This instrument
yields two scores: A frequency score, which is a simple count of the number of
items checked, and an intensity score, which was the mean severity reported by
the participant for all items checked. The scale has a test-retest reliability
average correlation of .79 for frequency and .48 for intensity for a nine-month
period.
Wavs of Coping Questionnaire (Folkman & Lazarus, 1988)
Coping strategies were operationalized by the Ways of Coping Question
naire. This is a checklist of 68 items describing a broad range of behavioral and
cognitive coping processes that an individual might use in a specific stressful
48
episode. This instrument is based on Lazarus’s cognitive-phenomenological
analysis of psychological stress as the theoretical framework. The items reflect
domains of confrontive coping, distancing, self-controlling, seeking social support,
accepting responsibility, escape-avoidance, planful problem solving, and positive
reappraisal. The checklist has a yes or no response format and is always
answered with a specific stressful event in mind. The internal consistencies
ranged from .90 to .97.
Perceived Social Support
This is a brief measure of perceived social support that consists of two parts.
The first part simply asks participants to identify the amount of perceived social
support available in times of need. The second part asks subjects to indicate
their degree of satisfaction with the level of perceived social support available to
them. This is a new instrument used to assess the amount of and satisfaction with
total perceived social support available to an individual. The perceived social
support measure is different from measures of received social support. Perceived
social support is a subjective assessment of what the individual believes to have
available. Social support is viewed as an evolving developmental and interactive
process between an individual and his or her social environment (Newcomb,
1990).
Demographic Data
Participants were asked to provide their age, gender, m arital status,
education level, profession, number of hours worked per week, size of caseload,
49
[ involvement in personal therapy, and a variety of other information. A copy of
I
these questions is included in the Appendix.
Table 3.2 contains a description of all the subsets of the four constructs that
were regressed in hierarchical fashion on the three components of burnout:
emotional exhaustion, depersonalization, personal accomplishment.
Procedures
j The Directors of 16 College Counseling Centers in Los Angeles County
i
were first contacted by mail asking for their participation in a study that focused
i on psychotherapists employed in counseling centers. Two letters were mailed
simultaneously. One letter was from the D irector of a College Counseling
Center and President of the Organization of Counseling Centers Directors in
' H igher E ducation endorsing the study. The second letter was from the
researcher providing more specific information about the study. The study was
identified as a survey of job-related attitudes, rather than as a study of burnout to
avoid biasing the responses. The letter also indicated that a telephone call would
follow to answer personally any questions and to confirm their participation in
, the study. Each school that consented was scheduled a time to have the question-
j
- naire administered to the staff. Eleven of the 16 schools agreed to participate in
j the study.
| The questionnaire was designed to be adm inistered by the researcher
I
j during staff meeting time. However, all schools were not able to allow staff time
| for the administration of the survey. Therefore, the administration procedure had
I
! to be modified.
j TABLE 3.2
Descriptive Statistics of 25 Burnout Items
Variables Mean Variance Skewness Kurtosis
Burnout
Emotional Exhaustion 16.88 63.99 .68 .11
Depersonalization 4.55 13.09 .96 .90
Personal Accomplishment* 41.99 15.79 -.73 .13
Work Environment
Involvement Work 7.54 4.87 -1.51 1.26
Peer Cohesion Work 6.42 5.97 -.90 -.35
Supervisor Support 6.38 3.65 -1.01 .96
Autonomy 6.88 3.27 -1.11 1.52
Task Orientation 6.62 3.47 -.97 .60
Work Pressure 4.18 7.14 .06 -1.03
Clarity Work 5.95 3.48 -.76 -.30
Control Work 3.39 4.88 .57 -.40
Innovation Work 4.21 6.12 -.18 -.82
Physical Comfort 4.68 5.60 -.03 -.99
Stressful Life Events
Hassles Frequency 21.74 255.58 3.02 14.59
Hassles Severity 1.44 .14 .85 .09
Coping Processes
Confrontive Coping 5.56 12.92 .77 .30
Distancing 3.04 6.16 1.01 1.12
Self-Controlling 4.01 7.94 .71 .31
Seeking Social Support 9.27 18.47 -.02 -.92
Accepting Responsiblity 2.63 6.33 .92 -.03
Escape-Avoidance
Planful Problem Solving
4.50 14.45 .97 .63
8.99 16.04 -.30 -.22
Positive Reappraisal 5.81 18.18 .45 -.71
Social Support
Amount of Perceived
Social Support 8.35 16.63 1.00 .97
Level of Satisfaction
with Social Support 5.17 1.45 -2.20 4.80
51
Two collection methods were utilized. Staff meeting time was used to
administer the questionnaire by the researcher when available. If there was no
available staff meeting time for the researcher to administer the questionnaires,
then the questionnaires were left with the counseling center directors for
individual self-administration. Each director was given a package containing
envelopes for dispersement to psychotherapists on their staff. A collection time
was scheduled for 10 to 14 days following delivery of the surveys. Each question
naire was dispersed in individual envelopes with a cover letter from the
researcher. The cover letter contained specific instructions to the psycho
therapists (See Appendix B). Each respondent was assured anonymity. All
respondents were directed to return their individually sealed envelopes to their
directors or to the researcher at the designated pick-up time. Respondents were
also given the option of mailing their replies directly to the researcher if they so
desired. O therwise, the questionnaires were personally collected by the
research er. D ata w ere collected in this m anner as opposed to m ailed
questionnaires because a higher response rate was expected.
Data obtained by the two different collection methods were examined by
t tests to determine if there were significant differences between the two groups.
There were no differences on the burnout measures. However, there were
significant differences for the two groups on confrontive coping, seeking social
support, planful problem solving, positive reappraisal, peer cohesion work and
supervisor support work (see Table 3.3). The staff meetings group one (con
sisting of three colleges) scored higher than the individual self-administered
group two (consisting of eight colleges). The sample is not large enough for
52
TABLE 3.3
t Tests between Collection Methods and Burnout Items
VARIABLE N MEAN SD t VALUE
Emotional Exhaustion
Group 1 20
Group 2 62
Depersonalization
Group 1 20
Group 2 62
Personal Accomplishment
Group 1 20
Group 2 62
Involvement Work
Group 1 20
Group 2 62
Peer Cohesion
Group 1 20
Group 2 62
Supervisor Support
Group 1 20
Group 2 62
Autonomy Work
Group 1 20
Group 2 62
Task Orientation
Group 1 20
Group 2 62
Work Pressures
Group 1 20
Group 2 62
Clarity Work
Group 1 20
Group 2 62
17.40
16.71
5.05
4.39
40.85
42.35
8.25
7.31
7.35
6.11
7.10
6.15
7.15
6.79
6.40
6.69
3.30
4.47
5.90
5.97
8.83
7.78
4.32
3.38
3.91
3.96
1.48
2.36
2.08
2.49
1.59
1.96
1.35
1.93
1.47
1.98
2.77
2.60
1.52
1.98
.33
.71
-1.48
1.68
2.00*
1.98s
.77
-.61
-1.72
-.14
53
Table 3.3, Continued
VARIABLE N MEAN SD t VALUE
Control Work
Group 1
Group 2
Innovation Work
Group 1
Group 2
Physical Comfort
Group 1
Group 2
Hassles Frequency
Group 1
Group 2
Hassles Severity
Group 1
Group 2
Confrontive Coping
Group 1
Group 2
Distancing
Group 1
Group 2
Self-Controlling
Group 1
Group 2
Seeking Social Support
Group 1
Group 2
Accepting Responsibility
Group 1
Group 2
Escape-Avoidance
Group 1
Group 2
20 2.90 1.86
62 3.55 2.30
20 3.80 2.46
62 4.34 2.48
20 5.05 2.37
62 4.56 2.37
20 23.05 13.92
62 21.32 16.68
20 1.53 .36
62 1.42 .37
20 4.60 2.85
62 5.05 3.39
20 3.60 2.26
62 2.85 2.54
20 4.60 2.85
62 3.82 2.80
20 11.55 3.99
62 8.53 4.16
20 3.20 2.82
62 2.45 2.41
20 5.65 3.45
62 4.13 3.86
-1.14
-.85
.80
.42
1.18
2.34*
1.17
1.07
2.85**
1.16
1.57
54
Table 3.3, Continued
VARIABLE N MEAN SD t VALUE
Planful Problem Solving
Group 1 20 10.50
Group 2 62 8.50
Positive Reappraisal
Group 1 20 7.40
Group 2 62 5.29
Amount of Perceived Social Support
Group 1 20 9.70
Group 2 62 7.92
Level of Satisfaction with Support
Group 1 20 5.20
Group 2 62 5.16
2.89
4.21
3.39
4.41
4.80
3.76
1.06
1.26
1.98*
1.96*
1.72
.12
* *
< .05
l p < .01
separate analysis. Therefore, the groups were combined. Interpretation of
results was done with caution because of the observed differences.
Data Analysis
This section includes the hypotheses tested in the present study as well as
the statistical techniques used to test each hypothesis.
t tests were conducted on level of burnout between males and females to
I
determine if there were significant differences in the responses of the two groups, j
|
Also t tests were completed on the two primary types of collection to determine if j
there were significant differences in the responses for group administration
during staff m eetings and individual self-adm inistration at their leisure.
55
The investigator wished to identify all possible relationships between burn-out
and the other variables in order for future researchers to develop a model of
causality with prospective data that could be tested in a path analysis. Therefore,
a complete correlational matrix was obtained. Demographic data were also
included in the correlational matrix. Hierarchical multiple regression analyses
were performed to sort out the unique influences of the relatively large number
of independent variables. This allowed for the effects of individual variables to
be considered only if the set of which they are a part contributes a significant
proportion of the variance. For each of the dependent variables, sets of inde
pendent variables were entered into the regression equation hierarchically: the
set of ten work variables was entered first, followed by the two hassles variables,
the set of eight coping variables, and finally the two social support variables. The
three MBI subscales were used as dependent variables: Emotional Exhaustion,
Depersonalization, and Personal Accomplishment. The investigator selected the
independent variables which correlated most highly with burnout and a supple
mental hierarchical multiple regression analysis was similarly performed with
MBI subscales as the dependent variables and a smaller number of variables in
each set.
Methodological Assumptions
The methodological assumptions in this study included the following:
1. The instrum ents used were sufficiently reliable and valid for the
purposes of this investigation.
2. The tests were administered appropriately and scored correctly by the
investigator.
j
56
3. The data were accurately recorded and analyzed.
4. The subjects em ployed in the investigation w ere sufficiently
representative of the population studied to permit limited generalization of the
findings.
Limitations
! The limitations in this study included the following:
1. The internal and external validity of the investigation are limited to the
j degree that any of the assumptions set forth were not met.
| 2. The sample size was limited to 82 subjects.
3. The range of predictors were limited.
I __
| 4. The geographical location was limited to urban Los Angeles area.
5. The sample focused only on psychotherapists employed in college and
| university counseling centers that operated full-time.
57
CHAPTER IV
i
i
THE RESULTS
i
The present study investigated whether the work environment, stressful life
! events, coping processes, and social support have a significant effects on pre-
*
1 dieting burnout in psychotherapists employed in college counseling centers. This
! chapter contains the results of the data analyses.
j
General Levels Of Burnout
! The burnout scores for the present sample were similar to that of the MBI
i
j normative sample of mental health professionals for the emotional exhaustion
| subscale. However, the present sample of psychotherapists scored marginally
’ (p < .15) lower on depersonalization than the normative sample, indicating
1 slightly less depersonalization. However, both group scores were in the low
range. The mental health sample scored significantly higher on feelings of per-
j sonal accomplishment from their job (m oderate level of burnout) than the
i
present sample of psychotherapists (low level of burnout), indicating reduced
j feelings of competence and successful achievement in their work with people.
! The means, standard deviations, and t tests between the present sample and the
m ental health normative sample are included in Table 4.1. The normative
| sample included psychologists, psychotherapists, counselors, medical hospital
staff, and psychiatrists (Maslach & Jackson, 1981).
TABLE 4.1
Maslach Burnout Inventory (MBI) Means and Standard Deviations
Present Sample MBI Normative
Psychotherapists Mental Health Sample
M SD M SD t tests
(n = 82) (n = 730)
Emotional Exhaustion 16.88 7.99 16.89 8.90 -.01
Depersonalization 4.55 3.62 5.72 6.42 -1.02
Personal Accomplishment 41.99 3.97 30.87 6.37 15.47***
interpreted in the opposite direction
* * * /? < .001
Demographic Variables
Pearson product-m om ent correlations were used to investigate the
relationship between selected demographic variables and the components of
burnout in psychotherapists. These correlations are reported in Table 4.2. Age
had a significant negative relationship with em otional exhaustion. Neither
experience nor caseload was significantly related to emotional exhaustion. Age,
experience, and caseload were also not significantly related to depersonalization
or to personal accomplishment.
Age was negatively correlated with supervisor support and seeking social
support. Age was marginally non-significantly correlated with planful problem
solving and positive reappraisal.
59
TABLE 4.2
Correlations of Demographic Data and the MBI
Demographic
Data
Emotional
Exhaustion
r
Depersonalization
r
Personal
Accomplishment
r
Age
*
ri
r
-.03 -.02
Experience -.03 .12 .14
Caseload .03 .04 .14
*p < .05
Experience was significantly correlated with seeking social support, escape-
avoidance, planful problem solving and positive reappraisal. Experience was
m arginally non-significantly related negatively with hassles severity and
supervisor support work.
Caseload was significantly correlated with the autonomy (r = -.22, p < .05)
and was marginally non-significantly related positively with control (r = .20,
p < .07) and positively with hassles frequency (r = -.18,/? < .09).
60
Table 4.3
Correlations of Age and Experience with Significant Independent variables
Age Experience
r r
Supervisor Support -.24* -.21
Seeking Social Support -.25* -.31**
Planful Problem Solving
•
-.20 -.23*
Positive Reappraisal -.20 -.30**
Escape-Avoidance -.31**
Hassles Severity -.20
■ **p < .01
j *p < .05
! Gender Differences
t tests on all independent variables revealed some significant differences
i
| between males and females, particularly for perceived social support and coping
i
| behaviors (Table 4.4). Females perceived significantly more social support
j resources than males. Females were also significantly more satisfied with their
| levels of perceived social support. In terms of coping behaviors, females utilized
significantly more escape-avoidance behaviors than males, and more seeking
social support behaviors than males. Males, however, utilized more distancing
| behaviors than females to cope with stressful life events. No other sex differences
! were found for the independent variables.
i 6 i
TABLE 4.4
Significant t tests for Gender Differences on Independent Variables
Variable N M SD t
Amount of Perceived
Social Support
Males 38 6.95 3.74 -3.05***
Females 44 9.57 4.00
Level Satisfaction
with Social Support
Males 38 4.92 1.30 -1.77*
Females 44 5.37 1.08
Escape-Avoidance
Males 38 3.66 3.63 1.89*
Females 44 5.23 3.83
Distancing
Males 38 3.58 2.67 1.87*
Females 44 2.58 2.24
Seeking Social Support
Males 38 8.45 4.39 -1.62*
Females 44 9.98 4.14
***p < .001
*p < .05
Hypothesis 1
| Male and female psychotherapists employed in college counseling centers
j will differ on levels of burnout as measured by the Maslach Burnout Inventory.
Gender comparison results are presented in Table 4.5. The two groups
! were similar on levels of burnout. Both females and males experienced mod
erate levels of em otional exhaustion and low levels of reduced personal
accom plishm ent from th eir jobs. The low level of reduced p erso n al
accomplishment is indicative of high feelings of personal accomplishment
| (reverse scored). Both groups were also low on level of depersonalization with
i
i men scoring slightly higher than women on this scale. This difference was
; marginally nonsignificant. This is consistent with the literature which found that
men, in general, were higher than women on depersonalization. The women
were higher than men on emotional exhaustion, but not significantly.
1 TABLE 4.5
Results of t Tests for Females and Males on the Maslach Burnout Inventory
Females Males
M SD M SD t tests
(n = 44) (n = 38)
Emotional Exhaustion 16.95 9.00 16.79 6.77 -.09
Depersonalization 3.95 3.51 5.24 3.67 1.62*
Personal Accomplishment 41.72 4.03 42.29 3.95 .64
| interpreted in opposite direction
: *p < .10
63
! Multivariate Tests
i
i In order to examine the influence of sets of variables relating to the work
environment, stressful life events, coping, and social support on predicting the
j three components of burnout, hierarchical multiple regression analyses were
!
I
| used. The following section presents these findings as they relate to each
i
hypotheses.
! Two separate hierarchical multiple regression analyses were computed in
an attempt to identify which subset of variables was more effective in predicting
! the components of burnout and are reported for each hypotheses. The variables
i used in this analyses were selected on the basis of theoretical implications and
correlations with the dependent measures. The burnout measure contains three
separate components scales which were used as dependent variables. For each
' dependent variable, subsets of independent variables were entered into the
, regression equation hierarchically. Each of the hypotheses has been broken
( down into the three components of burnout for testing and reporting.
Hypothesis 2
j W ork environm ent clim ate would predict burnout m easured as by
1 emotional exhaustion in psychotherapists employed in college counseling centers.
Pearson product-moment correlations were used to investigate the relation-
i
i ship between all independent variables, including work environment and emo-
: tional exhaustion in psychotherapists (Table 4.6). The only work variable found
i
I
! to have a significant relationship with emotional exhaustion was work pressure.
i 64
j TABLE 4.6
j Prediction of Emotional Exhaustion from Burnout Measures by First
| Hierarchical Multiple Regression Analysis
i
\
\
Predictors Correlation Beta F SigF
Work Environment
Physical Comfort .16 .41 8.04 .01**
Work Pressure .45** .62 19.58 .00***
Innovation -.02 -.14 .94 .34
Control .05 .05 .11 .75
Clarity -.09 -.05 .09 .76
Supervisor Support -.00 .25 2.22 .14
Task Orientation .05 -.35 3.41 .07
Autonomy -.12 -.11 .42 .52
Peer Cohesion -.03 .04 .03 .86
Involvement .02 .09 .15 .70
Stressful Life Events
Hassles Frequency .17 .13 1.29 .26
Hassles Severity .15 .05 .15 .71
Coping Processes
Planful Problem Solving .02 -.08 .37 .54
Escape-Avoidance .08 .12 .92 .34
Accepting Responsibility -.09 -.07 .26 .61
Confrontive Coping -.02 -.12 .61 .44
Distancing .10 .01 .01 .93
Positive Reappraisal -.19* -.11 .62 .43
Self-Controlling .00 .20 2.09 .15
Seeking Social Support -.13 -.01 .01 .94
Perceived Social Support
Level of Satisfaction -.13 -.15 1.82 .18
Amount of Support -.07 -.05 .16 .69
i Multiple Regression Summary Table
Multiple R .67
R2 .44
F 2.14**
I *Significant atp < .05
: ** Significant at p < .01
I ***Significant a tp < .001
65
Ten work environment variables were entered into the first step of the ;
hierarchical multiple regression analysis. All work variables were regressed on |
emotional exhaustion simultaneously and accounted for 35% of the variance. !
The F-ratio was significant for the total equation at the p < .001 level. Two of
the work variables, work pressure and physical comfort of the work environment, {
j
significantly predicted emotional exhaustion. I
A second hierarchical analysis conducted with seven selected variables from !
! the work scales revealed three significant work variables (work pressure, physical ,
; i
comfort, and work clarity), while three additional demographic variables
i
i
(experience, number of hours worked, and caseload) yielded no significant con
tributions. The variables used in this analysis were selected on the basis of theory
i
, and correlations with the dependent measures. In this regression, the total work
i
i variables accounted for 30% of the variance in emotional exhaustion and the F-
■ ratio for the equation was significant (p < .001). Tables 4.7 and 4.8 summarize
the effects of all the variables in predicting em otional exhaustion. Both
equations are significant (p < .01).
In the second hierarchical multiple regression analysis analyzing the
increm ental variance of each subset, the first steps entered were significant
! predictors of emotional exhaustion and depersonalization (Table 4.9). However,
j none of the steps was a significant predictor of personal accomplishment.
66
TABLE 4.7
Incremental R for Domains First Hierarchical Analysis
Emotional Personal
Exhaustion Depersonalization Accomplishment
j Step R 2 F R 2 F R 2 F
1. Work Environment .35 3.78*** .21 1.84- .10 .79
2. Stressful Life Events .02 .91 .05 2.55 .02 .75
3. Coping Processes .06 .75 .07 .81 .12 1.23
4. Perceived Social Support .02 1.22 .02 .98 .03 1.07
*p < .05
| **/? < .01
i
| ***/? < .001
-marginally significant/? < .07
67
TABLE 4.8
Prediction of Emotional Exhaustion from Burnout Measures by Second
Hierarchical Multiple Regression Analysis
Predictors Correlation Beta F SigF
Work Environment
Physical Comfort .14 .34 7.36 .01**
Work Pressure .50“ .45 14.41 .00***
Clarity -.08 -.27 4.26 .04*
Supervisor Support -.00 .10 .75 .39
Experience -.03 -.11 .81 .37
Caseload .01 .09 .60 .44
Hours Worked .13 -.01 .01 .93
Stressful Life Events
Hassles Frequency .00 .15 1.86 .17
Coping Processes
Planful Problem Solving .00 -.08 .43 .51
Escape-Avoidance
Confrontive Coping
.09 .15 1.57 .21
-.04 -.03 .04 .83
Positive Reappraisal -.22* -.12 .82 .37
Seeking Social Support -.14 -.08 .33 .57
Perceived Social Support
Amount of Support -.07 -.03 .10 .75
1 Multiple Regression Summary Table
Multiple K .60
R2 .36
F 2.65
‘Significant atp < .0,
** Significant at p < .01
‘ “ Significant atp < .001
68
I TABLE 4.9
i
i Incremental R2 for Domains Second Hierarchical Analysis
Emotional
Exhaustion Depersonalization
Personal
Accomplishment
Step R2 F R2 F R2 F
1. Work Environment .30 4 37* * * .23 3.02** .10 1.15
2. Stressful Life Events .02 1.73 .06 5.91* .002 .17
3. Coping Processes .05 .98 .02 .44 .10 1.63
4. Perceived Social
Support .001 .10 .002 .20 .02 1.71
*p < .05
**p < .01
***/?< .001
Hypothesis 3
Stressful life events would predict burnout as m easured by emotional
exhaustion in psychotherapists employed in college counseling centers.
Pearson product-moment correlations were used to examine the relation
ship between stressful life events and emotional exhaustion in psychotherapists
(Table 4.6). Hassles frequency (p < .10) was the only stress variable that had
even a marginally nonsignificant relationship with emotional exhaustion.
The two hassles scales were entered during the second step of the
hierarchical multiple regression analysis. These two variables accounted for an
additional 1.7% of the variance in em otional exhaustion. When this set of
69
variables were added to the equation, 36% of the variance ofvemotional exhaus
tion was accounted for by the work environment scales and the hassles scales, i
9 i
The F ratio was significant for the total equation but the increment of R was not ;
significant. In this equation, only the two work variables, work pressure and
physical comfort of the work environment, were significant predictors. Task ,
orientation almost reached significance (p < .08). I
The second hierarchical analysis used only the Hassles Frequency scale for ;
the variable set and added only 1.7% of additional variance to the total equation. :
In this regression, the work environment and hassles scales accounted for 31% of
j the variance in emotional exhaustion. The F ratio for the equation was signif-
i icant {p < .001) and work pressure, physical comfort, and clarity of work were
I
1 significant predictors of emotional exhaustion.
| Hypothesis 4
! Coping processes would predict burnout as m easured by em otional
; exhaustion in psychotherapists employed in college counseling centers.
i
Pearson product-moment correlations were used to test the relationship
between coping behaviors and emotional exhaustion in psychotherapists (Table
| 4.6). Only one coping variable was significantly correlated with em otional
exhaustion: positive reappraisal.
j The eight coping scales were entered as the third step of the hierarchical
I
I multiple regression analysis. These variables added another 5.7% of variance to
i
j the equation and, with work environment and hassles, accounted for 42% of the
j variance in emotional exhaustion. The only individual variables that made a
!
I
I
70
significant contribution to the regression equation were work pressure and
physical comfort. Task orientation almost achieved significance.
In the second hierarchical multiple regression analysis, five coping variables
I
. were entered into the equation (planful problem solving, confrontive coping,
j escape-avoidance, positive appraisal, and seeking social support). These vari
ables were chosen on the basis of theory and levels of correlations with predicted
; variables. They added another 4.7% of variance to the regression equation. The
i
1 total variance accounted for after the regression of the coping variables was 36%.
j The F ratio for the equation was significant. With all the variables entered, work
pressure, physical comfort, and clarity of work were significant.
I Hypothesis 5
Perceived social support would predict burnout as measured by emotional
, exhaustion in psychotherapists employed in college counseling centers.
[ Pearson product-moment correlations were used to examine the relation-
!
ship between perceived social support and emotional exhaustion in psycho
therapists (Table 4.6). Neither of the social support variables significantly
! correlated with emotional exhaustion.
i
i The two social support measures were entered during the fourth step of the
hierarchical multiple regression analysis. Social support measures consisted of
! amount of support and satisfaction with support. The addition of these variables
: to the equation in combination with work environment, hassles, and coping
I accounted for 44% of the variance in emotional exhaustion. The social support
j
! variables added another 2.3% of variance to the equation. The total equation
i
i was still significant but the increment in R was not significant. The individual
variables that were significant predictors of emotional exhaustion were work
pressure and physical com fort. Task orientation again alm ost reached
| significance (p = .07).
i
! In the second hierarchical multiple regression analysis, amount of social
support was entered into the equation for the variable set perceived social sup
port. This variable added another .1% of variance to the regression equation.
i
i The total variance accounted for after the social support variable was added to
i
j the equation was 36%. The F ratio for the equation was not significant. With all
the variables entered, work pressure, physical comfort, and clarity of work were
still significant predictors of emotional exhaustion.
i
i
i
; Hypothesis 6
| W ork environm ent clim ate would predict burnout as m easured by
; depersonalization in psychotherapists employed in college counseling centers.
Pearson product-moment correlations were used to test the relationship
| between work environment and depersonalization in psychotherapists (Table
4.6). Only two work environment variables were significantly correlated with
i depersonalization: work pressure and clarity of work.
i
j Ten work environment variables were entered into the first step of the
t
i hierarchical multiple regression analysis. All work variables were regressed on
1 depersonalization simultaneously and accounted for 21% of the variance. The F
ratio was not significant for the total equation. However, three of the work
; variables, physical comfort, clarity of work, and work pressure, significantly
predicted depersonalization.
i
j The second hierarchical analysis using seven selected variables from the
i work scales revealed three significant work scales (work pressure, physical
i
j comfort and work clarity), while three added demographic variables (experience,
j number of hours worked, and caseload) yielded no significant contributions. In
this regression, the total work variables accounted for 23% of the variance in
depersonalization and the F ratio for the equation was significant (p < .01).
Tables 4.10 and 4.11 summarize the effects of all the variables in predicting
i depersonalization. Only the second equation was significant (Table 4.11).
i
I
i
1 Hypothesis 7
| Stressful life events would p red ict b u rn o u t as m easured by
depersonalization in psychotherapists employed in college counseling centers.
Pearson product-moment correlations were used to examine the relation-
i ship between stressful life events and depersonalization in psychotherapists
i
(Table 4.10). The only stressful life events variable found to have a significant
relationship with depersonalization was hassles frequency.
The two hassles scales were entered during the second step of the hier
archical multiple regression analysis. These two variables accounted for an
additional 5.5% of the variance in depersonalization. The addition of hassles was
I not significant but the equation combining hassles and work reached significance.
i
The hassles and work variables accounted for 26% of the variance in depersonal
ization. The F ratio was significant for the total equation. In this equation, only
| two of the work variables, clarity work and physical comfort of the work environ
ment, significantly predicted depersonalization. Also, hassles frequency was
I
p
| significant (p < .05) in predicting depersonalization.
73
TABLE 4.10
Prediction of Depersonalization from Burnout Measures by Hierarchical
Multiple Regression Analysis
Predictors Correlation Beta F SigF
Work Environment
Physical Comfort .09 .52 11.40 .001***
Work Pressure .22* .27 3.28 .08
Innovation -.14 -.07 .18 .67
Control .03 .04 .06 .82
Clarity -.27* -.38 4.95 .03*
Supervisor Support -.14 -.04 .04 .84
Task Orientation -.06 -.17 .64 .43
Autonomy -.16 -.04 .05 .83
Peer Cohesion -.16 .05 .02 .88
Involvement -.14 .09 .13 .72
Stressful Life Events
Hassles Frequency .22* .25 4.18 .045*
Hassles Severity .14 .02 .02 .88
Coping Processes
Planful Problem Solving .04 -.16 1.28 .26
Escape-Avoidance .04 -.05 .15 .70
Accepting Responsibility .18* .25 3.14 .08
Confrontive Coping .14 -.00 .00 .98
Distancing .16 -.10 .45 .51
Positive Reappraisal -.03 -.03 .05 .83
Self-Controlling .13 .15 1.06 .31
Seeking Social Support -.03 .08 .25 .62
Perceived Social Support
Level of Satisfaction -.21* -.17 1.96 .17
Amount of Support -.05 -.05 .17 .69
i
t Multiple Regression Summary Table
Multiple R* .59
R2 .35
; F 1.46
I
| ^Significant atp < .05
| **Significant dip < .01
! ***Significant atp < .001
74
TABLE 4.11
Prediction of Depersonalization from Burnout Measures by Second Hierarchical
Multiple Regression Analysis
Predictors Correlation Beta F SigF
Work Environment
Physical Comfort .06 .40 9.47
oo* * *
Work Pressure .22* .18 2.09 !l5
Clarity -.29* -.49 12.49
oo* * *
Supervisor Support -.16 .00 .00 .98
Experience .12 .08 .40 .53
Caseload .02 .14 1.14 .29
Hours Worked -.07 -.12 .67 .42
Stressful Life Events
Hassles Frequency .24* .28 5.75 .02*
Coping Processes
Planful Problem Solving .01 -.13 .95 .33
Escape-Avoidance
Confrontive Coping
.05 .01 .01 .92
.12 .12 .66 .42
Positive Reappraisal -.06 -.08 .32 .58
Seeking Social Support -.05 .05 .12 .73
Perceived Social Support
Amount of Support -.06 -.05 .20 .66
Multiple Regression Summary Table
Multiple R~ .56
R2 .31
F 2.10*
: * Significant at p < .05
| ** Significant at p < .01
I * * * Significant at p < .001
75
The second hierarchical analysis using only the Hassles Frequency scale for i
the variable set added 5.9% of additional variance accounted for to the total
i
equation. In this regression, the work environment and hassles scale accounted 1
for 29% of the variance in depersonalization. The F ratio for the equation was
significant (p < .01) and only physical comfort, clarity of work, and hassles
I
frequency were significant predictors of depersonalization. !
i
i
Hypothesis 8
f
Coping processes would predict burnout as measured by depersonalization
in psychotherapists employed in college counseling centers.
Pearson product-moment correlations were used to test the relationship
between coping behaviors and depersonalization in psychotherapists (Table
4.10). Only one coping behavior variable was significantly correlated with
depersonalization: accepting responsibility.
The eight coping scales were entered as the third step of the hierarchical
multiple regression analysis. These variables added another 7.1% of variance to
the equation and with work environment and hassles accounted for 33% of the
variance in depersonalization. The total equation was not significant. Work
pressure, physical com fort, and clarity of work were the only significant
predictors.
In the second hierarchical multiple regression analysis, five coping variables
were entered into the equation on the basis of theoretical implication and cor
relations with the dependent variables (planful problem solving, confrontive
coping, escape-avoidance, positive appraisal, and seeking social support). These
variables added another 2.3% of variance to the regression equation. The total
76
variance accounted for after the regression of the coping variables was 31%. The
F ratio for the equation was significant. With all the variables entered, physical
comfort, clarity of work, and hassles frequency were significant.
Hypothesis 9
Perceived social support would predict burnout as measured by depersonal
ization in psychotherapists employed in college counseling centers.
Pearson product-moment correlations were used to examine the relation
ship between perceived social support and depersonalization in psychotherapists
1 (Table 4.10). Only one social support variable was significantly correlated with
1 depersonalization: level of satisfaction with perceived social supports.
j
The two social support measures were entered during the fourth step of the
hierarchical multiple regression analysis. Social support measures consisted of
; amount of support and satisfaction with support. The addition of these variables
! to the equation in combination with work environment, hassles, and coping
I accounted for 35% of the variance in depersonalization. The social support
\ variables added another 2.2% of variance to the equation. The total equation
! was not significant. The individual variables that were significant predictors of
j
I depersonalization were physical comfort, clarity of work, and hassles frequency.
In the second hierarchical multiple regression analysis, amount of social
support was entered into the equation for the variable set perceived social sup
port. This variable added another .2% of variance to the regression equation for
i
; depersonalization. The total variance accounted for after the social support
i
1 variable was added to the equation was 31%. The F ratio for the equation was
I
j
I 77
significant. With all the variables entered, physical comfort, clarity of work, and '
hassles frequency were significant predictors of depersonalization. 1
i
Hypothesis 10
Work environment climate would predict burnout as measured by reduced ■
personal accomplishment in psychotherapists employed in college counseling
centers.
|
| Pearson product-moment correlations were used to examine the relation
ship between all independent variables, including work environment and per-
i
| sonal accomplishment in psychotherapists (Table 4.12). The only work environ-
i m ent v ariab le found to have a significant rela tio n sh ip w ith personal
accomplishment was work pressure.
Ten work environment variables were entered into the first step of the
hierarchical multiple regression analysis. All work variables were regressed on
I personal accomplishment simultaneously and accounted for 10% of the variance.
i
; The F ratio was not significant for the total equation. The only individual
variable that was significant in predicting personal accomplishment was work
- pressure.
i
| A second hierarchical analysis using seven selected variables from the work
i scales revealed three significant work scales (work pressure, physical comfort,
and work clarity), while three added demographic variables (years employed as
psychotherapist, number of hours worked, and caseload) yielded no significant
j contribution. These variables were selected on the basis of theory and cor-
: relations with the dependent variables. In this regression, the total work
environm ent v ariab les accounted for 10% of the v ariance in p ersonal
78
accomplishment and the F ratio for the equation was not significant. No other
variables were significant in this regression. Work pressure almost reached
significance (p < .06).
Hypothesis 11
Stressful life events would predict burnout as m easured by reduced
personal accomplishment in psychotherapists employed in college counseling
centers.
Pearson product-moment correlations were used to examine the relation
ship between stressful life events and personal accomplishment in psycho
therapists (Table 4.12). Only hassles severity emerged as marginally non-
significantly related negatively with personal accomplishment (p < .10).
The two hassles scales were entered during the second step of the
hierarchical multiple regression analysis. These two variables accounted for an
additional 1.9% of the variance in personal accomplishment. When this set of
variables w ere added to the equation, 12% of the variance of personal
accomplishment was accounted for by the work environment scales and the
hassles scales. The F ratio was not significant for the total equation.
A second hierarchical analysis used the Hassles Frequency scale for the
variable set and added only .2% of additional variance to the total equation. In
this regression, the work environment and hassles scales accounted for 10% of
the variance in personal accomplishment. The F ratio for the equation was not
significant and none of the individual variables was significant. However, work
pressure was marginally nonsignificant (p = .08).
79
TABLE 4.12
i
Prediction of Personal Accomplishment from Burnout Measures by First
Hierarchical Multiple Regression Analysis
Predictors Correlation Beta F SigF
Work Environment
Physical Comfort .00 -.07 .17 .68
Work Pressure -.19* -.02 .02 .89
Innovation .07 .24 2.19 .14
Control -.08 .08 .21 .65
Clarity .09 .17 .88 .35
Supervisor Support .09 .07 .14 .71
Task Orientation -.07 -.14 .39 .54
Autonomy .16 .16 .70 .41
Peer Cohesion .03 -.24 .97 .33
Involvement -.05 -.15 .30 .59
Stressful Life Events
Hassles Frequency -.12 -.05 .18 .67
Hassles Severity -.17 -.17 1.26 .27
Coping Processes
Planful Problem Solving .18* .15 .97 .33
Escape-Avoidance -.10 -.17 1.35 .25
Accepting Responsibility -.05 -.05 .09 .76
Confrontive Coping .01 -.19 1.13 .29
Distancing -.03 -.05 .10 .76
Positive Reappraisal .21* .23 2.16 .15
Self-Controlling .09 .12 .57 .46
Seeking Social Support .16 .19 1.43 .24
Perceived Social Support
Level of Satisfaction .10 .01 .00 .96
Amount of Support .15 .19 1.95 .17
Multiple Regression Summaiy Table
Multiple R* .52
R2 .27
F .98
* Significant at p < .05
** Significant at p < .01
: * * * Significant at p < .001
i
Hypothesis 12
j Coping processes would predict burnout as measured by reduced personal
accomplishment in psychotherapists employed in college counseling centers.
Pearson product-moment correlations were used to test the relationship
between coping behaviors and personal accomplishment in psychotherapists
(Table 4.12). Positive reappraisal and planful problem solving were positively
significant predictors of personal accomplishment.
r
j The eight coping scales were the third step of the hierarchical multiple
i
j regression analysis. The coping scales consisted of eight variables. These vari-
' ables added another 12% of variance to the equation and, with work environ-
- m ent and hassles, accounted for 24% of the variance in personal accom-
j
, plishment. The total equation was not significant. None of the individual
i
| variables was significant predictors of personal accomplishment.
; In the second hierarchical multiple regression analysis, five coping variables
; were entered into the equation (planful problem solving, confrontive coping,
!
■ escape-avoidance, positive appraisal, and seeking social support) on the basis of
I
theory and correlations with the dependent variables. These variables added
, another 9.9% of variance to the regression equation. The total variance
I accounted for after the regression of the coping variables was 20%. The F ratio
for the equation was not significant. With all the variables entered, years
i employed as psychotherapist emerged as a significant predictor of personal
i
j accomplishment. Years employed was positively correlated with personal
| accomplishment.
81
Hypothesis 13
Perceived social support would predict burnout as measured by reduced
I
j personal accomplishment in psychotherapists employed in college counseling
i
i centers.
Pearson product-moment correlation was used to examine the relationship
between perceived social support and personal accomplishment in psycho
therapists (Table 4.12). Neither of the social support variables were significantly
correlated with personal accomplishment.
| The two social support measures were entered during the fourth step of the
! hierarchical multiple regression analysis. Social support measures consisted of
1 amount of support and satisfaction with support. The addition of these variables
| to the equation in combination with work environment, hassles, and coping
I accounted for 27% of the variance in personal accomplishment. The social
| support variables added another 2.6% of variance to the equation. The total
I
equation was not significant. With all the variables entered, neither of the
, variables were significant predictors of personal accomplishment.
In the second hierarchical multiple regression analysis, amount of social
, support entered into the equation for the variable set perceived social support.
' This variable added another 2.1% of variance to the regression equation for
i personal accomplishment (Table 4.13). The total variance accounted for after
the social support variable was added to the equation was 22%. The F ratio for
the equation was not significant. With all the variables entered, years employed
! as a psychotherapists was again, the only significant predictor of reduced personal
i
! accomplishment.
i
82
TABLE 4.13
Prediction of Personal Accomplishment from Burnout Measures by Second
Hierarchical Multiple Regression Analysis
Predictors Correlation Beta F SigF
Work Environment
Physical Comfort -.03 -.12 .78 .38
Work Pressure -.20* -.16 1.41 .24
Clarity .10 .11 .55 .46
Supervisor Support .08 .04 .10 .75
Experience .14 .25 3.89 .05*
Caseload .12 .04 .11 .75
Hours Worked .02 .09 .32 .57
Stressful Life Events
Hassles Frequency -.11 -.08 .42 .52
Coping Processes
Planful Problem Solving .15 .16 1.31 .26
Escape-Avoidance
Confrontive Coping
-.09 -.09 .48 .49
-.02 -.18 1.35 .25
Positive Reappraisal .18* .23 2.36 .13
Seeking Social Support .15 .18 1.29 .26
Perceived Social Support
Amount of Support .13 .16 1.71 .20
Multiple Regression Summary Table
Multiple R_ .47
R2 .22
F 1.33
* Significant at p < .05
* ‘Significant atp < .01
***Significant a ip < .001
83
Summary
All the steps entered in the first hierarchical multiple regression analysis
were significant predictors for emotional exhaustion. The work environment
subset was the most significant predictor of burnout and accounted for the largest
amount of variance that was added in step one. Adding steps after step one did
not significantly increase the variance in the equations (Tables 4.7 and 4.9). For
depersonalization, the work environment subset was not significant. The addition
of the hassles subset also was not significant. However, the overall equation
com bining hassles and w ork steps becam e significant. F or p erso n al
accomplishment, none of the steps was a significant predictor.
84
CHAPTER V
SUMMARY, DISCUSSION, AND RECOMMENDATIONS
Summary
This chapter contains a presentation of a summary of the study, discussion
of the statistical results along with their implications, and recommendations for
further research concerning burnout.
This was a nonexperimental, cross-sectional survey, descriptive and
correlational in nature. The overall objective of this research was to examine a
theory of burnout by considering the correlations among variables related to the
work environment, stressful life events, coping processes, perceived social sup
port, and the degree to which these were related to burnout. D ata regarding
work environment climate, hassles, coping, amount and perceived adequacy of
social supports, and three scales of burnout were collected to develop a model of
the components which contribute to burnout in a sample of psychotherapists
employed in college counseling centers.
Problem
In today’s society, burnout is recognized as an increasing problem thought
to be due to increased job tensions and job pressures to get more work done in a
shorter period of time. Nowhere is this problem more evident than in the helping
professions. Burnout tends to affect individuals who work in the helping
professions in greater numbers than individuals who work in other professions
(Cherniss, 1982; Edelwich & Brodsky, 1980; Freudenberger, 1974, 1977;
Freudenberger & Richelson, 1980; Maslach, 1976, 1978a, 1982).
The burnout syndrome is characterized by feelings of emotional exhaustion,
depersonalization, and reduced personal accomplishment derived from one’s
work with other people (Maslach & Jackson, 1981, 1986). Burnout can lead to
poor quality of care for clients and impaired physical functioning on the part of
the psychotherapists (Golembiewski, Munzenrider, & Stevenson, 1986; Maslach
& Jackson, 1981).
A review of the literature revealed that many factors may contribute to
burnout. In general, these factors can be identified as resulting from the
personality, situation, or an interaction between personality and situation. The
work environment has been identified as a primary situational source of stress
that leads to burnout. Personality factors, such as coping and social support, have
been associated with mediating or buffering effects between stress and burnout.
The process of burnout has serious psychological, social, and physical health
consequences for the helping professional as well as the recipient of his or her
care. The psychological consequences of burnout can include depression,
negative self-concept, and cynicism. The social consequences can include
withdrawal from others, loss of concern and caring for others, and a negative
attitude towards others. The physical consequences can include various kinds of
stress-related health problems such as headaches, backaches, lingering colds,
ulcers, hypertension, and chest pains (Cherniss, 1980; Golembiewski et al., 1986;
Maslach & Jackson, 1981).
86
j Burnout also has serious implications for employers in terms of job dis-
j satisfaction leading to job turnover, absenteeism, and loss of productivity. Even
| more unfortunate for employers is that the process of burnout tends to affect the
; workers who are the most committed and who are high achieving (Freudenberger
& Richelson, 1980; Pines & Aronson, 1988).
There is a need to identify the stressors that lead to burnout and result in
| psychotherapists leaving institutional settings for other kinds of employment.
There is also a need to identify factors that may mediate or buffer the process of
' burnout in psychotherapists.
i
I
!
Methods
! The present study hypothesized that the work environment and stressful life
i events would be significant predictors of burnout in psychotherapists employed in
! college counseling centers. It was further hypothesized that coping processes and
social support would have a mediating effect on the process of burnout and also
would be predictive of burnout.
The population investigated consisted of 82 psychotherapists in Los Angeles
; County. This sample consisted of 11% psychologists, 5% psychiatrists, 7%
I
I marriage and family therapists, and 5% licensed clinical social workers.
A 318-item survey questionnaire was administered to the participants of the
[ study. The questionnaire consisted of four standard self-report measures on work
environment, hassles, coping, burnout, a new instrument on social support, and
! demographic questions. The Maslach Burnout Inventory (MBI) measures three
^ dimensions of burnout: emotional exhaustion, depersonalization, and reduced
i
! personal accom plishm ent. The W ork Environm ent Scale m easures ten
: 87
dimensions of the work climate: involvement, peer cohesion, supervisor support,
autonomy, task orientation, work pressure, clarity, control, innovation, and
physical comfort. Stressful life events was measured by the Hassles Scale which
I assesses the frequency and severity of hassles experienced. Coping processes
were m easured by the Ways of Coping Questionnaire which assesses eight
domains of coping behaviors: confrontive coping, distancing, self-controlling,
seeking social support, accepting responsibility, escape-avoidance, planful
problem solving, and positive reappraisal. Perceived social support was assessed
by a new instrument which assessed the amount of perceived social supports
available and the level of satisfaction with the perceived social supports available.
Measures from work environment, stressful life events, coping processes,
i
and perceived social supports were analyzed to determine their ability to predict
| burnout in psychotherapists employed in college counseling centers. The data
| derived from the demographic questions provided information relative to age,
sex, marital status, experience, and caseload. Some of these data were used to
predict burnout and some were simply correlated with the MBI scales.
Discussion
i
Demographic Variables
I
Pearson product-moment correlations were used to investigate the relation-
: ship between selected demographic variables and the three components of
! burnout in psychotherapists.
j Analyses of the results indicated a significant negative relationship existed
I between emotional exhaustion and age. Age was not significantly correlated with
«
any other burnout scales. The younger psychotherapists were more emotionally
exhausted than the older psychotherapists. The younger psychotherapists were
experiencing more job overload from having too many clients and too little time
to serve adequately their needs. This results in more feelings of psychological
withdrawal and a greater tendency to get less involved with their clients. This
greater degree of emotional exhaustion associated with age may be attributed to
the idealism that young psychotherapists often bring to the workplace. Many
younger psychotherapists tend to be more idealistic and have unrealistic
expectations of what they can accomplish. Their expectations of what can
actually be accomplished have not yet been jaded by experience and reality. This
idealism can lead to feelings of frustration when their idealistic expectations
conflict with the reality of the real world. Cherniss (1980) observed similar
findings based on experience. Cherniss noted that a "professional mystique"
contributes to burnout by creating unrealistic expectations among new workers.
Older psychotherapists, on the other hand, tend to have more realistic
expectations and tend to have better insight into their personal limitations. They
tend to experience less frustrations and stresses because they are better able to
identify what can be changed and what level of energy needs to be invested to
accomplish the desired change. Older therapists may also make more conscious
decisions in terms of choosing their battles rather than fighting every battle that
comes their way as is more common with younger people. Choosing your battles
leads to more successful outcomes and less frustration. Older therapists may also
make more effective and efficient use of their time, energy, and efforts. In
general, older therapists tend to have more realistic expectations of people and
89
things than younger therapists, which may minimize the stresses and frustrations
that they experience which ultimately can lead to symptoms of burnout.
Experience and caseload were found not to be significantly related to
emotional exhaustion. Age, experience, and caseload also were not significantly
related to depersonalization or to reduced personal accomplishment (Table 4.2).
This lack of significant findings of age, experience, and caseload to depersonal
ization and reduced personal accomplishment may be related to the low levels of
these measures of burnout that were found in this sample. Perhaps higher levels
i
(greater variation) would have been more discriminating yielding more signif
icant findings. The psychotherapists in this sample had medium to small caseload
sizes. Higher levels of burnout have been associated with extremely high case
loads that were perceived as unmanageable. For example, in some settings, the
caseloads of social workers may be three times the normal size that can be
effectively managed. However, the nature of psychotherapeutic practice provides
|
external control on the size of the caseload which are regulated to a large degree
by the 50-minute hour.
The findings regarding the relationship of age, experience, and caseload to
burnout reveal mixed results. Beck (1987) found age to be significantly cor
related with burnout in her study of counselor burnout in family service agencies.
Age was negatively correlated with burnout. Beck further found that the case
load size was not associated with burnout, but that satisfaction with caseload was
i
associated with burnout. Therapists whose ideal caseload was smaller than their
! current caseload were found to be more burned out. Therefore, the perception
‘ of having too many clients was associated with burnout, rather than the actual
| size of the caseload. Heilman, M orrison, and Abramowitz (1986) obtained
i
! 90
similar results in their investigation of caselaod and burnout. They found that the
more excessive one’s caseload, the more likely burnout became in a sample of
licensed psychologists. Contradictory findings were obtained by Raquepaw and
Miller (1989) when they studied a sample of 69 psychotherapists. They found
that demographic variables were not accurate predictors of burnout. Age and
years of experience were found to be not significantly related to burnout in their
study.
Pearson product-moment correlations were also used to investigate the
relationships between age, experience, and caseload, and other independent
variables. These findings indicated that age had a significant negative correlation
with the work environment variable, supervisor support, and the coping variable,
seeking social support. Older psychotherapists used less supervisor support than
the younger psychotherapists who tended to seek more guidance, direction, and
support from their supervisors.
Experience was also significantly correlated with the coping variables that
included seeking social support, escape-avoidance, planful problem solving, and
positive reappraisal. The longer one was employed as a psychotherapist, the
more emphasis was placed on efforts to obtain informational, tangible, and emo
tional support. Also, more experience was associated with more wishful thinking
and behavioral efforts to avoid problems. The more experienced psycho
therapists also used greater effort to alter situations by deliberate problem-
focused and analytical approaches to solving problems. Lastly, the more
experienced psychotherapists used more efforts to create positive meaning by
focusing on personal growth.
91
Caseload was significantly correlated with the work environment variable
autonomy. The larger the caseload, the more the psychotherapists were
encouraged to be self-sufficient and make their own decisions. With larger
caseloads, there is also less time to interact with supervisors and coworkers. As
i
the size of the caseload increased, control and hassles also increased. There were
I more pressure from management to keep employees under control and more
, experiences of daily irritants reported by the psychotherapists as their caseload
size increased.
! Other Gender Differences
| t tests on all independent variables revealed some significant differences for
males and females on perceived social support and coping behaviors (Table 4.4).
; Females reported significantly larger amounts of perceived social support
resources than males. Females were also significantly more satisfied with their
i
: levels of perceived social support. This finding is consistent with the literature,
which indicated that women have more supportive others to turn to in times of
need and are more satisfied with the level of support available to them (Cohen &
Wills, 1985; Shinn et al., 1984; Snibbe et al., 1989). These differences in social
support have been attributed to differences in socialization between males and
females. It is believed that females are socialized to seek and accept more
\
, readily support from others. Males may have been socialized to be more
j
1 independent and to equate seeking support with signs of weakness. This makes it
more difficult for males to seek help when needed because it is more threatening
to them to be needy.
i
i
i
92
A difference was also found in the coping behaviors of females and males to I
deal with stresses. Females utilized significantly more escape-avoidance -
i
| behaviors and more seeking social support behaviors than males. Males, how- i
\ »
ever, utilized more distancing behaviors than females to cope with stressful life
events. This is consistent with males scoring higher on depersonalization than
women. Apparently, men tended to cope with stresses by withdrawing to deal in |
solitude while women tended to seek out others for support and to avoid dealing 1
! with the stresses.
i
i
Results of Tests of Hypotheses
i Thirteen research hypotheses were tested relevant to the prediction of
! burnout in psychotherapists employed in college counseling centers. Some of the
i
| hypotheses have been combined for discussion in this section. The three
i
j dependent subscales of burnout are grouped and discussed under the rubric
burnout. However, each subscale is addressed separately within each grouping.
|
Hypothesis 1
Male and female psychotherapists employed in college counseling centers
| will differ on the levels of burnout as m easured by the Maslach Burnout
i
I Inventory.
i Analyses of the data indicated that male and female psychotherapists
! experienced similar levels of burnout. Females and males in the sample
; experienced a m oderate degree of burnout as m easured by the em otional
exhaustion subscale. This indicated moderate feelings of being overextended and
' exhausted by their work. Apparently, the emotional drain of working intensely
93
with clients was a primary source of burnout for psychotherapists in this study.
They were experiencing a low degree of burnout as measured by the reduced
personal accom plishm ent subscale. This indicated that good feelings of
competence and successful achievement were experienced in work with clients.
As a group, the psychotherapists felt good about their jobs and about themselves.
Females and males reported a low degree of burnout as m easured by the
depersonalization subscale. This indicated low experience of impersonal
responses towards their clients such as negative, cynical attitudes, and feelings.
There were no significant differences in the findings on burnout for males and
females except on the depersonalization subscale. Both groups scored within the
low range of depersonalization. However, the males experienced significantly
more depersonalization than the females. This finding has been obtained in
other studies on burnout. Raquepaw and Miller (1989) found that men in their
sample experienced more depersonalization than women. This higher level of
depersonalization found in men may be due to the intense emotional encounters
involved in therapeutic work— encounters that may be less taxing for women since
they are socialized from childhood to assume a more empathic and relational
role.
Hypotheses 2. 6. and 10
Work environment would predict burnout as measured by the Maslach
Burnout Inventory in psychotherapists employed in college counseling centers.
The work environment of psychotherapists employed in college counseling
centers significantly predicted burnout as measured by emotional exhaustion and
depersonalization. The specific aspects of the work environment that accounted
94
! for a significant amount of the variance included work pressure, physical comfort,
i
j and work clarity.
i
| Work pressure was positively correlated with all dimensions of burnout.
The more work demands and pressures dominated the work environment, the
more experienced burnout as measured by emotional exhaustion and depersonal
ization. Physical comfort, measured by the extent to which the physical sur-
| roundings contribute to a pleasant work environment, was positively associated
' with emotional exhaustion and depersonalization. The work environment of this
i
sample was characterized as being above average in terms of physical attractive-
i
j ness and convenience. However, the pleasant surroundings were correlated with
I burnout. Perhaps this correlation between physical comfort and burnout is a
i
! result of the added stresses that new state-of-the-art facilities may experience.
1 Newer facilities will have added stresses to justify the money allocated for their
l
, services. Adm inistrators are likely to experience more pressures to serve
i
. increased numbers of students resulting in greater stresses for psychotherapists.
Clarity of work was negatively correlated with burnout as measured by deper-
' sonalization. That is, the more emphasis in the work environment on clarity of
agency policies and rules, the less b u rn o u t was experienced by the
psychotherapists.
; The work environment subset did not predict a significant amount of
; variance in personal accomplishment. However, the variable work pressure did
^ predict a significant amount of variance and was negatively correlated with
. personal accomplishment. The more work pressure experienced, the more the
i
: feelings of satisfaction and sense of achievement experienced from the job were
reduced.
95
These findings are consistent with other studies on work environment and '
burnout. Beck (1987) found significant correlations between burnout and work
pressure in counselors working in family agencies. Beck found a high correlation
between productivity pressures and burnout in their sample. Beck also noted a
high correlation between problems with agency policies and rules, and burnout,
which is similar to our findings on job clarity and burnout. Golembiewski,
M unzenrider, and Stevenson (1986) also found that burnout was positively :
related to job tensions. Farber and H eifetz (1982) found that burnout was ’
related to feelings of being overworked (emotionally exhausted) and that those
who burn out have perceptions that their efforts are inconsequential; that is, a
low sense of personal accomplishment.
Other researchers have also found work environment to be a significant
predictor of burnout. Udovch (1983) found that work environment was a signif
icant predictor of burnout in psychologists employed in a variety of work settings.
Udovch studied various types of work environments to determine the effect on
burnout. Psychologists who were employed in institutional settings reported
significantly more burnout than psychologists who were employed in private
practice settings as measured by reduced personal accomplishment. This finding
was not confirmed by our sample. The psychotherapists in our sample, who were
mostly psychologists, reported low burnout as measured by reduced personal
accomplishment. This difference in findings could be due to the nature of work
with college students. This population tends to be more intellectually stimulating
for therapists, m ore responsive to interventions, and m ore expressive of
appreciation than the population of a mental health facility.
96
Snibbe et al. (1989) found high bumout in their study of 51 psychiatric staff
at an HMO organization. The researchers found high levels of burnout as
| measured by emotional exhaustion, depersonalization, and reduced personal
■ accomplishment in their sample that consisted of psychiatrists, psychologists, and
i social workers. Interestingly, psychologists in their sample reported lower levels
j of burnout on all scales than either psychiatrists or social workers. Perhaps
psychologists have more control over their workload, are better able to identify
when they are in trouble, and have the control and authority to im plem ent
j effective changes to reduce their stressors. Therefore, earlier intervention may
be more possible and may account for the lower level of burnout symptoms
j experienced.
Hypotheses 3. 7. and 11
I
j Stressful life events would predict burnout as measured by the Maslach
^ Burnout Inventory in psychotherapists employed in college counseling centers.
Stressful life events, m easured by the Hassles Scale, were significantly
; predictive of burnout as measured by depersonalization only. The number of
hassles occurring daily in the life of psychotherapists were significantly predictive
of impersonal responses and lack of feelings towards one’s clients. The more
hassles that were reported were correlated with increased feelings of detached
i
| and callous responses to clients. Depersonalization is also characterized by a
i
I shift in one’s attitude toward others. The new attitude is characterized by the
developm ent of negative and poor opinions of others, negative reaction to
people, and the tendency to expect the worst from others. These negative cynical
: feelings about people that are engendered by burnout are not limited to those
individuals on the job. They become more pervasive and are the bases of a more
permanently negative view of people,
i Similar results were obtained by Farber and Heifetz (1982) who found that
j therapists felt more prone to transient feelings of burnout when stresses at home
lowered their threshold for coping with daily therapeutic frustrations. The study
by Farber and Heifetz focused on the within-session sources of stress for
psychotherapists. Their study confirmed that stresses in other areas of life could
! combine with work stresses to correlate with burnout. They identified three main
i
j sources of work stressors as pressures inherent in the therapeutic relationship,
I
| difficult working conditions, and sense of personal depletion from the job (1981,
i 1982).
t
None of the previous studies has investigated the relationship between
i
j minor life events and burnout in psychotherapists. However, studies do exist that
i
| have investigated the relationship of hassles to other adaptational outcomes.
Weinberger, Hiner, and Tierney (1987) focused on the impact of hassles upon
i
! health status. They found that hassles were significant negative predictors of
health status. More hassles correlated negatively with health status in the
I sample. This finding is also supported by the findings of Delongis, Coyne, Dakof,
Folkman and Lazarus. Delongis et al. (1982) examined the relationships between
; hassles and somatic health. They found that the numbers of hassles and the
| severity of hassles were positively correlated with the degree of somatic illness,
! such as chest pains, back trouble, headaches, and stomach pains. These findings
j are similar to the findings of our study in which the num ber of hassles were
significantly correlated with the experience of burnout as measured by
98
depersonalization. The process of burnout includes many somatic symptoms
| which probably accounts for the similar findings.
i
j The nature of the hassles endorsed by these two samples were very dif-
, ferent. The two most frequently endorsed hassles in the Delongis et al. sample
j were: (a) concerns about health, and (b) health of family member. In our
■ sample, the most frequently endorsed hassles were: (a) too many responsibilities,
i
and (b) too many things to do. The present sample appears to be suffering from
the pressures and tensions to accomplish many things with less time to do so.
i The nature of the hassles experienced by our sample appear to confirm the level
; of emotional exhaustion experienced from being overextended.
Hypotheses 4. 8. and 12
Coping processes would predict less burnout as measured by the Maslach
I Burnout Inventory in psychotherapists employed in college counseling centers.
I
| Coping processes were not significant predictors of burnout as measured by
emotional exhaustion, depersonalization, or personal accomplishment. However,
some types of coping were significantly correlated with burnout. Positive
t
i reappraisal was significantly correlated with more emotional exhaustion and
accepting responsibility was significantly correlated with less depersonalization,
i Planful problem solving and positive reappraisal were significantly correlated
j with more personal accomplishment.
! Prior studies of coping and burnout have examined a broad range of coping
strategies that make it difficult to generalize and compare their results. There is
also little empirical research on the effects of coping in work settings. Shinn et al.
I (1984) studied coping with job stress and burnout. Coping strategies were
99
assessed with open-ended questions and group coping was conceptualized as
social support. They found that group coping was associated with low levels of
job strain and that individual coping had little effect on job strain or burnout.
Pines and Aronson (1988) studied coping and burnout in a sample of
human services professionals. They found that active strategies (confronting or
attempting to change the source of stress or oneself) were used most often to
cope with burnout. The more frequently active strategies were used, the less
burnout. Ignoring the source of stress was also effective in reducing burnout.
This coping strategy included making a conscious decision not to deal with a
i
| problem right now.
* Studies by Richard Lazarus and Susan Folkman have provided vital and
| meaningful information on stress and the process of coping in general. They did
I not evaluate the effects of coping on burnout or on job strain. Folkman and
Lazarus (1980) found that the types of coping strategies used most often tended
! to be situation specific. Problem-focused forms of coping, such as problem
solving, confrontive coping, and seeking social support were used more frequently
in situations that were appraised as changeable (i.e., the work environment).
, Emotion-focused forms of coping, such as distancing, accepting responsibility,
and positive reappraisal were used more frequently in situations judged as not
i
! amenable to change (i.e., illnesses).
In another study, Folkman and Lazarus (1985) examined coping responses
during a stressful situation, at three stages of a midterm examination among
college students. The anticipatory stage was before the examination, the waiting
stage was after the exam and before grades were announced, and the final stage
was after grades were posted. They found significant changes in emotions and
i
I
p
100
coping across the three stages. On average, the students used combinations of
problem-focused and emotion-focused forms of coping. Planful problem solving,
positive reappraisal, and seeking social support were used more during the
anticipatory stage. Distancing was used more often during the waiting stage.
T heir studies confirm ed that coping is a process that changes over tim e,
situations, and demands.
These findings of Folkman and Lazarus and others provide essential
information into the process of coping. Because coping is a process that changes
I over time, it is very likely that coping cannot be accurately captured in cross-
i sectional studies. This is a possible explanation for the lack of predictive findings
|
I in this study.
|
i
I
; Hypotheses 5.9. and 13
Perceived social support would predict less burnout as measured by the
i
i
Maslach Burnout Inventory in psychotherapists employed in college counseling
i
h centers.
Perceived social support did not significantly relate to burnout as measured
1 by emotional exhaustion, depersonalization, and personal accomplishment.
j
| Amount of perceived social support approached significant correlation with less
i
j depersonalization ip . 06 level); the more others were believed available, the less
depersonalization reported. This association finding is not reliable and should be
viewed with caution, because the correlation did not quite reach significance.
This model’s association between social support and burnout sheds light on
; results from a study by Pines and Aronson (1988) regarding social systems as
buffers against burnout. They found that the availability of social support was
1 101
| negatively and significantly correlated with burnout. The better the social
supports, the lower the level of burnout.
Sarason, Shearin, Pearce and Sarason (1987) found that the perception of
support, rath er than the receipt of support, was m ost related to positive
adjustment. They also found that details of how social support is provided, such ;
as by family versus friends or the frequency and amount of support was not highly I
important. The perception or feeling that there are individuals on whom one can
rely was what they found to be most important.
There is a lack of significant findings for social as a buffer against burnout
which is not surprising in view of the preceding review and results of a study by
j Sarason et al. (1983). They found that perceived social support was more
| strongly related to positive rather than negative life changes. This study focused
| on negative life changes rather than positive life changes. The findings did not
support that perceived social support ws strongly related to negative life changes.
| In summary, these psychotherapists employed in college counseling centers
! were experiencing moderate and mixed levels of burnout. They reported high
levels of personal accomplishment from their jobs indicative of low burnout in
this area. They experienced a moderate degree of emotional exhaustion and a
j
! low degree of depersonalization. The work environment was a significant pre
dictor of burnout. Females experienced significant less depersonalization than
i males. Age was a significant predictor of em otional exhaustion, with older
i
psychotherapists experiencing less em otional exhaustion than younger
i psychotherapists.
j
i
i
102
Implications Of The Findings
In this study, reliable and valid measures were utilized, a good methological
design was used, and a relevant sample was obtained. However, there was a
i
fairly clear lack of significant associations with burnout in this population. The
j limited findings for burnout as measured by depersonalization and personal
! accom plishm ent may be due to the fact that this population is really not
j experiencing chronically high levels of stress that is associated with burnout in
their jobs in college counseling centers. The moderate findings related to the
; emotional exhaustion subscale of burnout may indicate being overextended by
( the emotional demands of therapeutic work and role demands of caretaker. The
i
psychotherapists reported feelings of being overburdened by having many things
to do with very little time to do them.
! This lack of more significant findings might also be due to the fact that
: college counseling centers psychotherapists, who are mostly doctoral level
i
i
psychotherapists, are better able to manage and effectively cope with the chronic
i
levels of stress. This population, in general, has experienced extensive training in
intrapersonal and interpersonal processes, and may have greater awareness of
their own dynamics. This may allow them to more accurately identify stressors
i
that could lead to burnout early on and implement the necessary interventions
before the stress progresses to chronic levels characterized by the burnout
syndrome. In many studies that have been conducted on psychotherapists,
i
i
| psychologists tend to report lower levels of burnout than psychiatrists and social
| workers. Also, most of the previous investigations of psychotherapists in
j institutional settings have focused on mental health facilities. Psychotherapists
i
i
! 103
practicing in college counseling centers may experience less stress and burnout |
i
i
i than their colleagues in other institutional settings.
However, burnout does occur in college counseling centers. The amount of
burnout reported in this study is less severe than that experienced in other human ,
services settings except for private practice. Private practice settings tend to have
lower burnout rates than all institutional settings. J
Another explanation for the lack of more significant findings is that the :
factors we attempted to measure may reflect complex dynamic and interactive 1
processes. Determining the structure and priority of the many variables studied
is difficult and equivocal in cross-sectional studies (Thoits, 1982). Newcomb
(1990) examined perceived social support as a reciprocal, interacting process
between the individual and his or her social environment. He found that per
sonal traits (i.e., personality, psychopathology, personal competence) generated
i
I changes in social supports and vice versa. Perhaps the lack of direct effects of
j
! coping and social support on burnout are due to the interactive effects of these
! processes with burnout. As the symptoms of burnout emerge, there is likely to be
a deterioration in coping skills and social support network. How this process may
i
j reciprocally affect the process of burnout is not known at this time.
!
i A nother plausible explanation is that the psychotherapists may have
I answered the survey questions to reflect them selves in a favorable light.
! However, the word burnout was not used specifically to avoid biasing the results.
j There also could be a selection bias in that the less burned out college counseling
centers and therapists may have been more accessible and willing to participate
than the more burned out college counseling centers and counselors.
i
I 104
The survey contained very personal questions that some psychotherapists
may have been hesitant to answer and return to their directors; especially
information that could reflect upon them negatively. Although the forms were
completed anonymously, and sealed by each participant, the fear may have still
been there. In general, the responses appeared to have been completed thought- j
fully and forthrightly. However, if higher levels of stress and burnout truly exist 1
in college counseling centers, we need to identify what factors in particular work
environments or within certain individuals result in lower levels of experienced
! burnout being reported. This information has significant implications for our
j professional settings and training programs.
i
i
i
! Conclusions and Recommendations for Future Research
j The present study was limited to psychotherapists in the Los Angeles urban
I area. It is not known, and seems unlikely, that this sample of psychotherapists is
i
are representative of psychotherapists in general. Further research on burnout .
1 should focus on psychotherapists in other areas or regions that include more
diversity and representativeness, such as a statewide or national survey.
Two survey collection procedures were utilized in this study. The originally
designed method of group administration of the surveys in staff meetings yielded
i
1 a few differences and may be more meaningful and valid for a survey of this
length. A longer collection period is necessary to gather data in this manner to
accommodate the diverse schedules of various colleges.
| This sample tested low to moderate on levels of burnout. The scores were
i
; similar to Maslach’s normative sample, except for depersonalization, which was
| significantly low er in this sam ple. This may be due to several factors.
Psychotherapists in college counseling centers have higher status than those in
mental health centers. They have frequent vacation periods that coincide with
school breaks which allow the psychotherapists to replenish themselves more
frequently than their counterparts in mental health settings. Psychotherapists in
college counseling centers tend to have specific predictable peak and lull periods
in the academic year that provide some degree of regulation of chronic stress.
Testing at one of the peak stressful periods may yield different findings. This
study attem pted to test subjects at the end of the academic year. However,
colleges with the higher levels of stress may not have participated in the study.
One such school, with a waiting list of 30 students, was unable to schedule a time
for test administration.
Longitudinal studies are desperately needed to empirically establish causal
directions between stress and burnout, if they in fact exist. Causal models should
be theory-driven and may be confirmed through structural equation modeling
(Newcomb, 1990). Additionally, research is needed into the area of bidirec
tional interactive processes that may exist between stress and burnout; is, how
stress may lead to burnout, and how burnout may increase the chronic stresses
experienced. More research is also needed to investigate more carefully the
relationship between minor stressful life events and burnout. Many studies of
minor life events have found a relationship with somatic illness. Because many of
the somatic symptoms identified in the health studies are related to burnout
symptoms, further study could confirm this link. Other future research into
burnout should examine the possible linear relationship that may exist between
the components of burnout; that is, how emotional exhaustion leads to
106
depersonalization and how depersonalization may then lead to reduced personal
accomplishment.
I Burnout in the 1990s is becoming a more serious and devastating problem
j that is afflicting organizational and institutional settings at alarming levels,
j especially settings that are characterized by intensive people contact. Effective
I
intervention methods need to be created, implemented, and tested to help bring
| our institutions to optimal levels of effectiveness and productive functioning,
j Burnout is decreasing our pool of the most dedicated and high achieving workers.
i
I
i
i
I
i
I
i
i
!
i
i
i
i
i
i
i
107
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APPENDIX A
QUESTIONNAIRE
SCHOOL OF EDUCATION
DEPARTMENT OF COUNSELING - WPH 503
(213) 743-2380
(213) 743-8707
SU T
Dear Psychotherapist,
Thank you for agreeing to complete this questionnaire.
Because there is little information on psychotherapists and none
on psychotherapists in counseling centers only, your experiences
are invaluable in helping us learn about the job-related
attitudes of psychotherapists.
The attached questionnaire will take only about 30 minutes
of your time. I ask that you do not consult anyone on the answers
as your personal attitudes and feelings are important. Please
answer all items.
I can assure you that your answers will be held in the
strictest of confidence. Your answers and related information
will be used only by persons conducting this study. In order to
protect your identity, your name is not required.
I will be glad to answer any questions regarding the study
or to assist you in filling out the questionnaire. I can be
contacted at (213) 259-2543. If you should feel any emotional
discomfort after answering these questions and would like to talk
to someone, please do not hesitate to call me for a referral.
Your completing and returning the questionnaire signifies
your voluntary participation. If you would like a personal
summary of the findings, please indicate below your name and
address. The overall results are being made available to
participating centers.
Thank you so much for your assistance.
Sincerely,
Michael Newcomb, Ph.D
Associate Professor
OPTIONAL: FOR PERSONAL MAILING ONLY
Name___
Address
City___ Zip
UNIVERSITY OF SOUTHERN CALIFORNIA UNIVERSITY PARK. LOS ANGELES,CALIFORNIA 90089-0031
szcrxoH z
The purpose of this survey is to discover how various persons in the
human services or helping professions view their jobs and the people
with whom they work closely.
On the following page there are 22 statements of job-related feelings.
Please read each statement carefully and decide if you ever feel this
way about your job. If you have never had this feeling, write a
"0" (zero) before the statement. If you have had this feeling, indicate
how often you feel it by writing the number (frou l to 6) that best
describes how frequently you feel that way.
HOW OfTZHi 0 1
Never A few
times a
year or
less
2
Once a
month
or less
3
A few
times a
month
4
Once
a
week
5
A few
times
a week
6
Every
day.
HOW OFTEM
0 - 6 Statements:
1 ._______ I feel emotionally drained from my work.
2. I feel used up at the end of the work day.
3 ._______ I feel fatigued when I get up in the morning and have to
face another day on the job.
4 ._______ I can easily understand how my clients feel about things.
5 ._______ I feel I treat some clients as if they were impersonal
obj ects.
6 ._______ Working with people all day is really a strain for me.
7 ._______ I deal very effectively with the problems of my clients.
8 ._______ I feel burned out from my work.
9 ._______ I feel I'm positively influencing other people's lives
through my work.
10 .______ I've become more callous toward people since I took this job.
11 .______ I worry that this job is hardening me emotionally.
12 .______ I feel very energetic.
13 .______ I feel frustrated by my job.
14 .______ I feel I'm working too hard on my job.
15 ._______ I don't really care what happens to some clients.
16 ._______ Working with people directly puts too much stress on me.
17 .______ I can easily create a relaxed atmosphere with my clients.
18 .______ I feel exhilarated after working closely with my clients.
19 .______ I have accomplished many worthwhile things in this job.
20 ._______ I feel like I'm at the end of my rope.
21 ._______ In my work, I deal with emotional problems very calmly.
22 ._______ I feel clients blame me for some of their problems.
(Adm. use only)
EE:
cat.
DP:
cat.:
PA:
cat.
SECTIO N ZZ
Directions: Hasslas are irritants that can range from minor annoyances
to fairly major pressures, problems, of difficulties. They can occur few
or many times.
Listed in the center of the following pages are a number of ways in which
a person can feel hassled. First, circle the hassles that have happened
to you ia the past month. Than look at the numbers on the right of
the items you circled. Indicate by circling a 1, 2, or 3 how SEVERE
each of the oiroled hassles has been for you in the past month. If a
hassle did not occur in the last month do HOT circle it.
1.
2.
3.
4.
5.
6.
7.
8.
9.
1 0 .
11.
1 2 .
13 .
14.
15.
16.
17.
18 .
19.
2 0 .
2 1 .
2 2 .
23 .
24.
25.
26.
27.
28.
29.
HASSLES
Misplacing or losing things........
Troublesome neighbors..............
Social obligations.................
Inconsiderate smokers..............
Troubling thoughts about your future.
Thoughts about death...............
Health of a family member..........
Not enough money for clothing.......
Not enough money for housing.......
Concerns about owing money.........
Concerns about getting credit......
Concerns about money for emergencies.
Someone owes you money.............
SEVERITY
Somewhat severe
Moderately severe
Extremely severe
2 3
Financial responsibility for someone
who doesn't live with you..........
Cutting down on electricity, water, etc...
Smoking too much........................
Use of alcohol..........................
Personal use of drugs...................
Too many responsibilities...............
Decisions about having children..........
Non-family members living in your house....
Care for pet.............................
Planning meals...........................
Concerned about the meaning of life.......
Trouble relaxing.........................
Trouble making decisions.................
Problems getting along with fellow workers.
Customers or clients give you a hard time..
Home maintenance (inside)................
118
30. Concerns about job security.................... 1 2 3
31. Concerns about retirement...................... 1 2 3
32. Laid-off or out of work........................ 1 2 3
33. Don't like current work duties 1 2 3
34. Don't like fellow workers 1 2 3
35. Not enough money for basic necessities 1 2 3
36. Not enough money for food 1 2 3
37. Too many interruptions 1 2 3
38. Unexpected company........................... .. 1 2 3
39. Too much time on hands 1 2 3
40. Having to wait 1 2 3
41. Concerns about accidents 1 2 3
42. Being lonely 1 2 3
43. Not enough money for health care 1 2 3
44. Fear of confrontation 1 2 3
45. Financial security 1 2 3
46. Silly practical mistakes 1 2 3
47. Inability to express yourself 1 2 3
43. Physical illness 1 2 3
49. Side effects of medication 1 2 3
50. Concerns about medical treatment 12 3
51. Physical appearance 1 2 3
52. Fear of rejection 1 2 3
53. Difficulties with getting pregnant 1 2 3
54. Sexual problems that result from
physical problems.............................. 1 2 3
55. Sexual problems other than those
resulting from physical problems................ 1 2 3
56. Concerns about health in general 1 2 3
57. Not seeing enough people 1 2 3
58. Friends or relatives too far away 1 2 3
59. Preparing meals................................ 1 2 3
60. Wasting time................................... 1 2 3
61. Auto maintenance............................... 1 2 3
62. Filling out forms 1 2 3
63 Neighborhood deterioration 1 2 3
64. Financing children's education................. 1 2 3
65. Problems with employees...................... 1 2 3
66. Problems on job due to being a woman or man....... 1 2 3
67. Declining physical abilities................... 1 2 3
68. Being exploited................................ 1 2 3
69. Concerns about bodily functions................ 1 2 3
119
70. Rising prices of common goods................... 1
71. Mot getting enough rest........................ 1 2 3
72. Mot getting enough sleep 1 2 3
73. Problems with aging parents 1 2 3
74. Problems with your children 1 2 3
75. Problems with persons younger than yourself 1 2 3
76. Problems with your lover 1 2 3
77. Difficulties seeing or hearing 1 2 3
78. Overloaded with family responsibilities......... 1 2 3
79. Too many things to do........................... 1 2 3
80. Unchallenging work............................. 1 2 3
81. Concerns about meeting high standards 1 2 3
82. Financial dealings with friends or
acquaintances 1 2 3
83. Job dissatisfactions 1 2 3
84. Worries about decisions to change jobs 1 2 3
85. Trouble with reading, writing, or
spelling abilities............................. 1 2 3
86. Too many meetings.............................. 1 2 3
87. Problems with divorce or separation 1 2 3
88. Trouble with arithmetic skills 1 2 3
89. SOSSip 1 2 3
90. Legal problems................................. 1 2 3
91. Concerns about weight 1 2 3
92. Mot enough time to do the things
you need to do................................. 1 2 3
93. Television 1 2 3
94. Not enough personal energy 1 2 3
95. Concerns about inner conflicts 1 2 3
96. Feel conflicted over what to do.............. l 2 3
97. Regrets over past decisions 1 2 3
98. Menstrual (period) problems 1 2 3
99. The weather 1 2 3
100. Mightmares 1 2 3
101. Concerns about getting ahead.................... 1 2 3
102. Hassles from boss or supervisor 1 2 3
103. Difficulties with friends 1 2 3
104. Mot enough time for family 1 2 3
105. Transportation problems 1 2 3
106. Not enough money for transportation 1 2 3
120
107. Hot enough money for entertainment
and recreation..................
2
103. Shopping 1 2
| 109. Prejudice and discrimination from others..... 1.. 1 2
< 110. Property, investments or taxes.................. 1 2
I
1 111. Hot enough time for entertainment
, and recreation................................ 1 2
112. Yardvork or outside home maintenance.... 1 2
113. Concerns about news events............. 1 2
114. Noise........................................ 1 2
j 115. Crime......................................... 1 2
! 116. Traffic....................................... 1 2
; 117. Pollution...................................... 1 2
HAVE WB MISSED ANY OP YOUR HASSLES? XT SO,
WRITE THEM XH BELOV:
113.
______________________________________________ 1 2 3
2 3
ONE MORE THING: HAS THERE BBEH A CHANGE XH
YOUR LITE THAT APPECTED HOW YOU ANSWERED THIS
SCALE? IP SO, TELL US WHAT XT WAS:
t
[
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121
32CTI0H III
Please describe a specific stressful encounter you have had in the past
three months in any area of your life. (THE HOST ST&ESS7XTL EVENT)
Please read each item below and indicate, by circling the appropriate
category, to what extent you used it ia the situation you have just
described. f
Used Used Used
Not •
used
some
what
quite
a bit
a grea
deal
1. Just concentrated on what I
had to do next—-the next step.
0 1 2 3
2. I tried to analyze the problem in
order to understand it better.
0 1 2 3
3 . Turned to work or substitute
activity to take my mind off
things.
0 1 2 3
4. I felt that time would make a
difference— the only thing to
do was to wait.
0 1 2 3
5. Bargained or compromised to
get something positive from
the situation.
0 1 2 3
6. I did something which I didn't
think would work, but at least
I was doing something.
0 1 2 3
7. Tried to get the person reponsible
to change his or her mind.
0 1 2 3
8. Talked to someone to find
out more about the situation.
0 1 2 3
9. Criticized or lectured myself. 0 1 2 3
10. Tried not to bum my bridges,
but leave things open somewhat.
0 1 2 3
11. Hoped a miracle would happen. 0 1 2 3
12. Went along with fate; sometimes
I just have bad luck.
0 1 2 3
13 . Went on as if nothing had happened. 0 1 2 3
14. I tried to keep ay feelings to myself 0 1 2 3
15. Looked for the silver lining,
so to speak; tried to look on
the bright side of things.
0 1 2 3
16. Slept more than usual. 0 1 2
17. I expressed anger to the person(s)
who caused the problem.
0 1 2 3
18. Accepted sympathy and understanding
from someone.
0 1 2 3
19. I told myself things that 0 1 2 3
helped me to feel better.
122
2 0 .
2 1 .
2 2 .
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39 .
40.
41.
42 .
43.
44.
45.
46.
47 .
48..
I vas inspired Ho do something
creative.
Tried to forget the whole thing.
I got professional help.
Changed or grew* as a person
in a good way.
I waited to see what would
happen before doing anything.
I apologized or did something
to make up.
I made a plan of action and
followed it.
I accepted the next best thing
to what I wanted.
I let my feelings out somehow.
Realized I brought the problem
on myself.
I came out of the experience
better than when I went in.
Talked to someone who could do 0
something concrete about the problem.
Sot away from it for a while, 0
tried to rest or take a vacation.
Tried to make myself feel better 0
by eating, drinking, smoking,
using drugs or medication, etc.
Took a big chance or did 0
something very risky.
I tried not to act too hastily 0
or follow my first hunch.
Found new faith. 0
Maintained my pride and kept o
a stiff upper lip.
Rediscovered what is important 0
in life.
Changed something so things 0
would turn out all right.
Avoided being with people in general. 0
Didn't let it get to me; refused 0
to think too much about it.
I asked a relative or friend I 0
respected for advice.
Kept others from knowing how bad o
things were.
Made light of the situation; refused 0
to get too serious about it.
Talked to someone about how I o
was feeling.
Stood my ground and fought for 0
what I wanted.
Took it out on other people. 0
Drew on my past experiences; I 0
was in a similar situation before.
123
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
63.
64.
65.
66.
67.
I knew what had to be done, so I 0
doubled my efforts to make things
work.
Refused to believe that it had 0
happened.
I oiade a promise to aiyself that 0
things would be different next tine.
Came up with a couple of different 0
solutions to the problem.
Accepted it, since nothing could 0
be done.
I tried to keep my feeling from 0
wished that Z could change what 0
happened or how Z felt.
Z changed something about myself. o
Z daydreamed or imagined a better 0
time or place than the one Z was in.
wished that the situation would 0
go away or somehow be over with.
Had fantasies or wishes about 0
how things might turn out.
Z prayed. o
Z prepared myself for the worst. 0
Z thought about how a person Z 0
admire would handle this situation
and used that as model.
I tried to see things from the o
other person's point of view.
Z reminded myself how much 0
worse things could be.
Z jogged or exercised. o
I tried something entirely o
different from any of the above.
(Please describe).
124
Please complete the statements on this sheet. They are statements about
the place in which you work. The statements are intended to apply to all
work environments. However, some words may not be quite suitable Cor
your environment. For example, the term supervisor is meant to refer to
the boss, director, department head or the person or persons to whom an
employee reports.
circle T for TRUE if you think the statement is TRUE or mostly TRUE and
F Cor FALSE if you think the statement is FALSE or mostly FALSE of your
work environment.
Please be sure to answer every statement.
T F 1. The work is really challenging.
T F 2 People go out of their way to help a new employee feel comfortable.
T F 3. Supervisors tend to talk down to employees.
T F 4. Few employees have any important responsibilities.
T F 5. People pay a lot of attention to getting work done.
T F 6. There is constant pressure to keep working.
T F 7. Things are sometimes pretty disorganized.
T F 3. There's a strict emphasis on following policies regulations.
T F 3. Doing things in a different way is valued.
T F 10. It sometimes gets too hot.
T F 11. There's not much group spirit.
T F 12. The atmosphere is somewhat impersonal.
T F 13. Supervisors usually compliment an employee who does something well.
T F 14. Employees have a great deal of freedom to do as they like.
T F 15. There's a lot of time wasted because of in efficiencies.
T F IS. There always seems to be an urgency about everything.
T F 17. Activities are well-planned.
T F 13. People can wear wild looking clothing while on the job if they want
T F 19. New and different ideas are always being tried out.
T F 20. The lighting is extremely good.
T F 21. A lot of people seem to be just putting in time.
T F 22. People take a personal interest in each other.
T F 23. Supervisors tend to discourage criticisms from employees.
T F 24. Employees are encouraged to make their own decisions.
T F 25. Things rarely get "put of till tomorrow.*
T F 26. People cannot afford to relax.
T F 27. Rules and regulations are somewhat vague and ambiguous.
T F 23. People are expected to follow set rules in doing their work.
T F 29. This place would be one of the first to try out a new idea.
T F 30. Work space is awfully crowded.
T F 31. People seem to take pride in the organization.
T F 32. Employees rarely do things together after work.
125
T F 33 . Supervisors usually give full credit to ideas contributed by employe
T F 34. People can use their own initiative to do things.
T F 35. This is a highly efficient, work-oriented place.
T F 36. Nobody works too hard.
T F 37. The responsibilities of supervisors are clearly defined.
T F 38. Supervisors keep a rather close watch on employees.
T F 39. Variety and change are not particularly important.
T F 40. This place has a stylish and modem appearance.
T F 41. People put quite a lot of effort into what they do.
T F 42. People are generally frank about how they feel.
T F 43 . Supervisors often criticize employees over minor things.
T F 44. Supervisors encourage employees to rely on themselves when a
arises.
problem
T F 45. Setting a lot of work done is important to people.
T F 46. There is no time pressure.
T F 47. The details of assigned jobs are generally explained to employees.
T F 48. Rules and regulations are pretty well enforced.
T F 49. The same methods have been used for quite a long time.
T F 50 The place could stand some new interior decorations.
T F 51. Few people ever volunteer.
T F 52. Employees often eat lunch together.
T F 53. Employees generally feel free to ask for a raise.
T F 54. Employees generally do not try to be unique and different
T F 55. There's an emphasis on "work before play."
T F 56. It is very hard to keep up with your work load.
T F 57. Employees are often confused about exactly what they are
do.
supposed to
T F 58. Supervisors are always checking on employees and supervise then very
closely.
T F 59. New approaches to things are rarely tried.
T F 60. The colors f i decorations make the place warm and cheerful to work in.
T F 61. It is quite a lively place.
T F 62. Employees who differ greatly from the others in the organization
don't get on well.
T F 63. Supervisors expect far too much from employees.
T F 64. Employees are encouraged to learn things even if they are
directly related to the job.
not
T F 65. Employees work very hard.
T F 66. you can take it easy and still get your work done.
T F 67. Fringe benefits are fully explained to employees.
T F 68. Supervisors do not often give in to employee pressure.
T F 69. Things tend to stay just about the same.
T F 70. It is rather drafty at times.
126
T F 71. It's hard to get people to do any extra work.
T F 72. Employees often talk to each other about their personal problems.
T F 73. Employees discuss their personal problems with supervisors.
T F 74. Employees function fairly independently of supervisors.
T F 75. People seem to be quite inefficient.
There are always deadline to be met.
Rules and policies are constantly changing.
Employees are expected to conform rather strictly to the rules and
customs.
There is a fresh, novel atmosphere about the place.
The furniture is usually well-arranged.
The work is usually very interesting.
Often people make trouble by talking behind others' backs.
Supervisors really stand up for their people.
Supervisors meet with employees regularly to discuss their future
work goals.
There's a tendency for people to come to work late.
People often have to work overtime to get their work done.
Supervisors encourage employees to be neat and orderly.
If an employee comes in late, he can make it up by staying late.
Things always seem to be changing.
The rooms are well ventilated.
T F 76
T F 77
T F 78
T F 79
T F 80
T F 81
T F 82
T F 83
T F 84
T F 85
T F 86
T F 87
T F 88.
T F 89.
T F 90.
127
SECTION V
During difficult or pressured times m life, people often turn to
others for help or support with their current situation. For
example, these are people you can count on to listen to you when
you need to talk or to help you
though they would have to go out
Please place a check mark by
support to you in times of need:
Spouse or lover
Father
Brother(s) How many____?
Coworkers
Supervisor
Children How many ?
Therapist
out m a crises situation, even
of their way to do so, etc.
the people that provide social
Friend(s) How many____?
Mother
Sister(s) How many____?
Religious/Spiritual Leader
Grandparent(s) How many____
Other Person not listed
(please specify)
Overall, how satisfied have you been with the total support you
received from those people you have checked above?
(Please circle the number which best describes your level of
satisfaction)
very moderately slightly slightly moderately very
dissatisfied dissatisfied dissatisfied satisfied satisfied satisfied
128
DEMOGRAPHIC DATA SHEET
This information is for data collection only,
used for subject identification.
1. Your gender: Male
Female
It will not be
2. Your age: _______ Years
3. Your ethnicity (check only one group)
White, Caucasian
Asian, Asian American
Native American,
American Indian
4. Marital Status:
Single
Married
Divorced
5. If married,
spouse?____
Black, African American
Latino, Hispanic, Mexican
American
other ___________________
(please specify)
Widowed
Living with Lover
Other
(please specify)
for how long have you been married to your current
years
6. If you have children, how many of them are living with you?
Ages____________________ _Children live with me
_Total number of children
I have no children
7. What is your Religion?
8. Training:
Psychiatrist:
Protestant
Roman Catholic
Jewish
Other (please specify_
None, No religion
MD (a) Board Certified_
(b) Other __________
Psychologist: Ph.D._
Ed.D._
Clinical Social Worker
MSW/MS in Social Work
(a) Clinical Psychology_
(b) Counseling Psychology^
Ph.D./ D.S.W. in Social Work
Marriage, Family and Child Counselor:
MA/MS in marriage and family_
Other (please specify________
1
129
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20 .
2 1 .
22 .
If you have a license, what kind is it?__________________________
Please indicate the number of years you have been employed as a
psychotherapist._________years
How long have you been at your present job? ________ Years
What is the level of your primary position?
Staff member_______________
Supervisor/Director_______ _
Intern (type)______________
Consultant (type)__________
Please indicate the number of hours per week you spend seeing
pat ients:_________
Please indicate the number of hours per week you presently
work:______ _
Do you have a private practice? Hours per week worked______
Please indicate how much time you spend each week dealing with
crisis situations?
______Less than 25% less than 50%_______less than 75%
Please note the diagnostic category of patients with which you
work with the most:
(a) neurotic____________________________
(b) psychotic___________________________
(c) Character Disorder__________________
(d) Other_______________________________
Please note your general therapeutic orientation:
(a) Cognitive Behavioral_________________
(b) Psychodynamic________________________
(c) Humanistic & Existential____________
(d) Psychoanalytic_______________________
(e) Eclectic_____________________________
(f) Family S y s t e m s ____________________
(g) Other_________________________________
Please note the number of years of personal or training therapy:
Years of Individual______
Years of Group___________
Are you presently in Therapy? Yes______ No______
Are you presently or have you ever been diagnosed as having
hypertension? Yes______ No _
ulcers? Yes______ No _
neck/backaches? Yes___ No _
THANK YOU VERY MUCH FOR YOUR PARTICIPATION!!!!
2
130
APPENDIX B
PRE-CONTACT LETTERS
mm
OCCIDENTAL COLLEGE d i r e c t o r o f c o u n s e l i n g
12131 259-2543
LOS ANGELES
CALIFORNIA 90041-3392
March 26, 1990
Occidental College
Sally McCollum, Director
Counseling Center
1600 Campus Road
Los Angeles, CA 90041-3392
Dear Dr. McCollum:
Shirley Flournoy, a member of my staff this year at Occidental, is
conducting a comprehensive study of factors affecting the job
satisfaction of Psychologists working in college counseling
centers. She tells me that very little research has been done on
our profession and I am excited to see her results.
In order to guarantee a high response rate, Shirley is
concentrating her data collection on Southern California where she
can personally deliver her instruments and answer people's
questions. She's going to ask you to consider asking each of your
staff members, as well as yourself, to fill out her packet of
questionnaires. I know this is a significant imposition on your
staff time, but I personally feel that this is a singular
opportunity to obtain valuable data about our work.
I am consulting with Shirley on the progress of her study although
it is "officially" part of her doctoral work at USC. I can assure
you, however, that Shirley's work is highly competent and
professional, and that her results will be of value.
If you can accommodate Shirley's request, I urge you to do so. If
this is simply not a good time (e.g. there was an earthquake on
your campus last night) , Shirley can, of course, still make the
results available to you. (I'm hoping she can perhaps present them
at OCCDHE next Fall.)
Looking forward to seeing you at La Casa de Maria in May.
Sally McCollum, Ph.D.
Director
SCHOOL OF EDUCATION
DEPARTMENT OF COUNSELING - WPH 503
(213) 743-2380
(213) 743-8707
March 21, 1 9 9 0
University of California, LA
Harold Pruitt, Director
Student Psychological Services
405 Hilgard Avenue; Math Science Bldg.
Los Angeles, CA 90024-1556
Dear Mr. Pruitt:
I am conducting a study which will survey job-related attitudes of
psychotherapists working in College Counseling Centers.
This research project will consider administrators who provide
direct services to students in addition to supervising others as
subjects as well. This is the first research project that has
focused solely on counseling center psychotherapists. I am
studying college counseling centers located in Southern California.
Therefore, I am asking you and your staff to participate in this
research.
This study is the basis for my doctoral dissertation in the
Department of Counseling at the University of Southern California.
It is also part of my work as an intern at the Occidental College
Counseling Center. My work experiences includes six years of
experience working in college counseling centers and 14 years of
experience working in educational settings.
I will gather data relative to stresses, coping processes and work
environment by means of a questionnaire which will be administered
in one sitting. In order to set up an appointment and to answer
any initial questions you have about the study, I will attempt to
contact you by telephone during the fourth week of March.
Your time and assistance in support of this research will be
greatly appreciated. I anticipate that my results will answer
questions about the nature of psychotherapeutic work in college
counseling centers and may suggest ways we might improve the
delivery of mental health care services in educational settings.
The findings of this study will be made available to all
participating centers.
Sincerely,
Shirley Flournoy, ABD, MFCC
Doctoral Candidate
Michael Newcomb, Ph.D.
Associate Professor
UNIVERSITY OF SOUTHERN CALIFORNIA. UNIVERSITY PARK. LOS ANGELES,CALIFORNIA 90089-0031
133
APPENDIX C
TELEPHONE APPOINTMENT CONVERSATION
TELEPHONE APPOINTMENT CONVERSATION
School__________________________________________ Date.
Director __________________________________
Telephone__________ ________________________________
Hello, Dr./ M r . / M s . ______________________
This is Shirley Flournoy calling from Occidental College. A
letter was sent to you a few days ago, from Dr. Sally McCollum
and myself informing you that I would be calling you regarding
your willingness to participate in a study on College Counseling
Center psychotherapists. I would also like to answer any
questions that you might have about the study.
(Pause, wait for Questions)
This study is being tailored specifically for college counseling
center psychotherapists. The purpose of this study is to
determine, in general, the job related attitudes of
psychotherapists who work in college counseling centers. To my
knowledge, no research exists that has focused solely on this
population. By obtaining information on psychotherapists, it is
our hope that the results will answer questions about the nature
of psychotherapeutic work in college counseling centers.
To accomplish this, you will be asked to alot time for you and
your staff to complete a questionnaire survey that will take only
about 30 minutes. Ideally, this would be a staff meeting time but
could be anytime all the staff is available.
Participation, of course, is voluntary. Privacy and
confidentiality is assured by the collection of the responses
anonymously.
When would be a good day for you and your staff to meet with me
and what time is most convenient for you?
Date____________________________________
Time _____
Comments:

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Asset Metadata

Creator Flournoy, Shirley Anne (author)

Core Title Burnout among psychotherapists: Effects of work environment, stressful life events, coping, and social support

Contributor Digitized by ProQuest (provenance)

Degree Doctor of Philosophy

Degree Program Education-Counseling Psychology

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Psychology, clinical

Language English

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c26-534238

Unique identifier UC11246996

Identifier usctheses-c26-534238 (legacy record id)

Legacy Identifier DP25331.pdf

Dmrecord 534238

Document Type Dissertation

Rights Flournoy, Shirley Anne

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA