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Organizational model of individuation and employee retention

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Organizational model of individuation and employee retention

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Organizational Model of Individuation and Employee Retention

Lauren A. Van Vlack

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

May 2023

© Copyright by Lauren A. Van Vlack 2023
All Rights Reserved

The Committee for Lauren A. Van Vlack certifies the approval of this Dissertation

Esther Kim
Monique Datta
Alan Green, Committee Chair

Rossier School of Education
University of Southern California
2023

iv

Abstract
The qualitative applied action research addresses the impact organizational cultures of autonomy,
and transformational leadership have on employee turnover in United States behavioral health
organizations. Additionally, the research explores the organizationally lived experiences of
licensed professional counselors (LPCs) to inform future efforts to mitigate the turnover problem
in the United States behavioral health field. The study proposes an organizational model of
individuation for future research and organizational application for retaining behavioral health
workers. The recommended actions informed by the current research highlight need-supportive
environments as a solution to the problem of practice.

v
Dedication
To all the beautiful souls I love, whose loss has pained me and irreparably marked my life, thank
you. Life, much like death, has wounded me and, in doing so, has shown me the door to life’s
grief, where I have found courage in the heart of humanity. To those experiencing mental illness,
struggling with substance use, or lost upon life’s winding journey, know that I am with you. To
those suffering, whether you suffer loudly or silently, know that I hear you. To the most sensitive
among us, who have felt broken by the wheels of time, to which life often seems far crueler than
death, know that you are not alone. To those this beautifully wretched world has so often
forgotten, I will remember you always: my heart lies, especially with you (Van Vlack, 2017).

To my husband, Jason. Thank you for your endless patience, understanding, encouragement, and
love. My world is so much brighter with you in it, and I am forever grateful for your presence in
my life. Cheers to the rest of our lives with school far behind me. I love you.

vi
Acknowledgments
I want to acknowledge my many friends and colleagues who have given me input on my
dissertation, informed my research, and allowed me the time and space to explore my thoughts
and future direction. I would also like to thank my committee, Dr. Monique Datta, Dr. Esther
Kim, and Dr. Alan Green for their patience, feedback, and the time they spent reading my work.

vii
Table of Contents
Abstract .................................................................................................................................... iv
Dedication .................................................................................................................................. v
Acknowledgments ..................................................................................................................... vi
List of Tables ............................................................................................................................. x
List of Figures ........................................................................................................................... xi
Chapter One: Overview of the Study .......................................................................................... 1
Background of the Problem ............................................................................................ 1
Statement of the Problem ................................................................................................ 5
Purpose of the Study ....................................................................................................... 6
Significance of the Study ................................................................................................ 6
Theoretical Framework and Methodology....................................................................... 9
Stakeholders ..................................................................................................................11
Definition of Terms .......................................................................................................12
Organization of the Study ..............................................................................................15
Chapter Two: Review of the Literature......................................................................................16
History of Behavioral Healthcare in the United States....................................................16
Defining Behavioral Health ...........................................................................................18
Historical Context ..........................................................................................................19
Stigma ...........................................................................................................................21
COVID-19 .....................................................................................................................23
Person-Centered Approach ............................................................................................25
Employee Turnover .......................................................................................................28
Transformational Organizational Factors .......................................................................41
Individual Factors ..........................................................................................................44
viii
Conceptual Framework ..................................................................................................46
Summary .......................................................................................................................48
Chapter Three: Methodology .....................................................................................................50
Research Questions .......................................................................................................50
Overview of Design .......................................................................................................50
Sample and Population ..................................................................................................53
Participants ....................................................................................................................55
Instrumentation..............................................................................................................55
Data Collection ..............................................................................................................57
Data Analysis ................................................................................................................57
Trustworthiness and Credibility .....................................................................................58
Ethics ............................................................................................................................59
The Researcher ..............................................................................................................59
Rationale for Institutional Review Board .......................................................................61
Summary .......................................................................................................................61
Chapter Four: Results or Findings .............................................................................................62
Participants ....................................................................................................................62
Participant Summary .....................................................................................................74
Results for Research Question 1 ....................................................................................75
Results for Research Question 2 ....................................................................................95
Summary ..................................................................................................................... 116
Chapter Five: Discussion ......................................................................................................... 119
Limitations and Delimitations ...................................................................................... 119
Findings ...................................................................................................................... 120
Recommendations for Practice..................................................................................... 135
ix
Future Research ........................................................................................................... 147
Conclusions ................................................................................................................. 147
References .............................................................................................................................. 149
Appendix A: Screening Survey ............................................................................................... 182
Appendix B: Interview Protocol .............................................................................................. 184
Interview Introduction ................................................................................................. 184
Interview Part 1 Instructions ........................................................................................ 185
Interview Questions ..................................................................................................... 185
Interview Part 2 Instructions ........................................................................................ 186
Interview Part 3 Instructions ........................................................................................ 186
Concluding Interview Statement .................................................................................. 187
Appendix C: Question Alignment ........................................................................................... 188
Appendix D: Cost/Benefit Worksheet ..................................................................................... 190
Cost/Benefit Analysis .................................................................................................. 190

x
List of Tables
Table 1: Data Sources ................................................................................................................ 52
Table 2: Transformational Leadership Program Cost ............................................................... 138
Table 3: Employee Satisfaction Committee Cost ..................................................................... 140
Table 4: Employee Coaching Program for Personal Development ........................................... 142
Table C1: Part 1: Interview Question Alignment ...................................................................... 188
Table C2: Part 2 and 3: Interview Question Alignment ............................................................ 142
Table D1: Cost/Benefit Ratios for Recommendations for Practice ........................................... 142
Table D2: Transformational Leadership Program Cost/Benefit Analysis .................................. 142
Table D3: Transformational Leadership Program Benefit to Cost Ratio ................................... 142
Table D4: Employee Satisfaction Committee Cost/Benefit Analysis ........................................ 142
Table D5: Employee Satisfaction Committee Benefit to Cost Ratio ......................................... 142
Table D6: Employee Coaching Program for Personal Development Cost/Benefit Analysis ...... 142
Table D7: Employee Coaching Program for Personal Development Benefit to Cost Ratio ....... 142

xi
List of Figures
Figure 1: United States Behavioral Health Labor Projections for 2025 ........................................3
Figure 2: Percentages Reporting Suicidal Ideation 2015–2020 ....................................................5
Figure 3: United States. Mental Health Market Spending ............................................................9
Figure 4: Organizational Model of Individuation ....................................................................... 48

1

Chapter One: Overview of the Study
The current field study focuses on the high incidence of licensed professional counselor
(LPC) turnover experienced by behavioral health organizations in the United States and aims to
identify how organizations can better support employee retention. The study highlights the lived
experiences of LPCs, a profession with annual turnover rates of 30–0%, and examines how
organizational culture and leadership practices influence LPCs’ decisions to leave their
organizations of employment (Adams et al., 2019; Beidas et al., 2016). Presently, United States
mental health organizations struggle to maintain a consistent workforce capable of meeting the
current demands (Beck, Manderscheid, & Buerhaus, 2018; Bukach et al., 2017; Covino, 2019;
Fukui et al., 2019). With the additional challenges of the COVID-19 pandemic, the mental health
crisis in the United States further exacerbates the need for mental health services while
decreasing the supply of labor (Kaslow et al., 2020; Mochari-Greenberger & Pande, 2021;
Pfefferbaum & North, 2020). Additionally, with upwards of 40% of adults struggling with
mental health or substance use since the pandemic, finding a way to increase the organizational
sustainability of United States behavioral health organizations has become a public priority
(Czeisler et al., 2020; Jenkins, 2019; Søvold et al., 2021).
Background of the Problem
Understanding behavioral health’s historical background and the current context is
essential in addressing LPC turnover within United States behavioral health organizations. The
lasting implications of the COVID-19 pandemic and the recent observable phenomena of a
swiftly changins sociocultural climade have further complicated behavioral health’s long and
complex history within the United States, adding to the timeliness of the current research
2

(Czeisler et al., 2020; Kaslow et al., 2020; Mochari-Greenberger & Pande, 2021; Pfefferbaum &
North, 2020).
Behavioral health’s consistent labor strains frequently result in workforce shortages,
decreasing organizational sustainability within the field (Beck, Singer, et al., 2018). Figure 1
shows the Health Resources and Services Administration’s (2016) supply and demand
projections for the behavioral health workforce in 2025, where substance use and mental health
counselor demand distinctly surpasses supply. However, due to the COVID-19 pandemic, the
projections from Figure 1 are likely an underrepresentation of the labor shortage currently facing
behavioral health organizations (Centers for Disease Control and Prevention, 2021a; Czeisler et
al., 2020; Health Resources and Services Administration, 2016; Susan, 2021; Virginia, 2021).

3

Figure 1
United States Behavioral Health Labor Projections for 2025

Note. For contrast and clarity, demand is shown in orange and supply is shown in blue. Adapted
from “The National Projections of Supply and Demand for Selected Behavioral Health
Practitioners: 2013-2025” by Health Resources and Services Administration, 2016, United States
Department of Health and Human Services: Bureau of Health Workforce and National Center for
Health Workforce Analysis.

In addition, 2020 had the highest incidence of suicidal ideation ever recorded, represented
in Figure 2, signaling the negative impact COVID-19 has had on mental health in the United
States. (Mental Health America, 2020; Nguyen et al., 2018; Pfefferbaum & North, 2020; Susan,
2021). On average, suicide attempts and completion cost the United States $70 billion annually
due to the medical and work-loss costs associated with each life taken (Centers for Disease
Control and Prevention, 2021b). Suicidal ideation is one factor of behavioral health that has
-
50,000
100,000
150,000
200,000
250,000
300,000
350,000
2025
Supply Demand
4

contributed to the increase in demand for services, which has further strained behavioral health
workers, increasing feelings of burnout among employees (Grassi et al., 2022; Lam et al., 2022;
Mental Health America, 2020). Burnout experiences lead to negative organizational
implications, such as decreased job satisfaction and inflamed turnover intentions, both extremely
costly to the field of behavioral health in the United States, further signaling the need for an
organizational model capable of improving employee turnover within the field (Lam et al., 2022;
Mental Health America, 2020; Søvold et al., 2021; Virginia, 2021).

5

Figure 2
Percentages Reporting Suicidal Ideation 2015–2020

Note. The years spanning 2015 to 2020 appear in different colors to emphasize gaps and overlap
within the suicidal ideation data. In September 2020, 37% (N = 47,968) of people who screened
for depression indicated that they experienced suicidal ideation more than half or nearly every
day of the previous 2 weeks. Twenty-two percent (N = 28,356) indicated that they experienced
thoughts of suicide or self-harm nearly every day. Since the COVID-19 pandemic began to
spread rapidly in March 2020, over 178,000 people have reported frequent suicidal ideation on
the PHQ-9. Reprinted from “COVID-19 and Mental Health: A Growing Crisis” by Mental
Health America, 2020. In the public domain.

Statement of the Problem
The current research addresses the problem of high turnover in United States behavioral
health organizations and identifies ways to increase retention within the field through
6

organizational culture and leadership practices. Additionally, through the exploration of LPC’s
organizationally lived experiences, the research aims to glean a better understanding of employee
experiences related to turnover intentions. Lastly, the research proposes an organizational model
of individuation for improved employee retention in United States behavioral health
organizations.
Purpose of the Study
The current field study aims to address the high incidence of LPC turnover experienced
by behavioral health organizations in the United States and identify how organizations can better
support employee retention within the field to increase organizational sustainability. The
research uses Burke-Litwin’s (1992) model of change to address how organizational culture and
leadership impact LPCs’ organizationally lived experiences and decisions to leave their
organizations of employment.
Two research questions guided this study:
1. What impact do leadership and organizational culture have on employee retention
within United States behavioral health?
2. What organizationally lived experiences affect employees’ decisions to leave United
States behavioral health organizations?
Significance of the Study
While turnover is costly for any business, turnover poses a significant threat to the
sustainability of behavioral health organizations, where turnover rates range from 30–60%,
exceeding the national healthcare average by 10–40% (Beidas et al., 2016; Mercer, 2020;
National Solutions, 2021). If trends continue, the United States will be unable to meet the needs
of the 56% of United States residents who are seeking mental health services (Cohen Veterans
7

Network & National Council for Mental Wellbeing, 2018; National Council for Mental
Wellbeing, 2018; Nguyen et al., 2018). Moreover, already marginalized populations, such as
people of color, low-income families, and veterans, are the most negatively affected by the
current behavioral health workforce shortage (American Psychiatric Association, 2016; Cohen
Veterans Network & National Council for Mental Wellbeing, 2018; National Council for Mental
Wellbeing, 2018). Additionally, lack of access to behavioral health services increases
incarceration rates by 15–34% and providing more behavioral health support for people with
mental illness saves an average of $27,000 per person compared to the average cost of
incarceration, meaning prevention can serve as a significant cost-saving mechanism for the
United States (North Carolina State University, 2013; Van Dorn et al., 2013; Wolff, 2017).
Therefore, finding an organizational model capable of providing comprehensive organizational
support to mental health workers serving communities throughout the United States stands to
decrease incarceration costs and increase the supply of labor to meet current demands (Brooks et
al., 2018; Eliacin et al., 2018; Hem et al., 2015; Johnson et al., 2018).
Recently, perceptions on the importance of mental health have positively shifted, with
76% of Americans viewing mental health as equally important to physical health (Cohen
Veterans Network & National Council for Mental Wellbeing, 2018; National Council for Mental
Wellbeing, 2018). However, the use of emergency services for psychiatric care increased by 42%
due to the increasing behavioral health labor shortages and more than 40% of the United States
population experiencing mental illness within the last year (Center for Behavioral Health
Statistics and Quality, 2016; Centers for Disease Control and Prevention, 2021a; Czeisler et al.,
2020; Kessler et al., 2007; National Alliance on Mental Illness, 2021; Weiner, 2018). Prior to the
COVID-19 pandemic, emergency department visits for behavioral health cost upwards of $5.6
8

billion, accounting for more than 7% of the total annual costs of all emergency department visits
(Karaca & Moore, 2020). Considering the increase in the use of emergency services for
psychiatric care, these numbers are likely to underrepresent the current public costs associated
with behavioral health’s inability to meet the demand for services.
The ongoing pandemic and increases in social and health instability increase the
importance of behavioral health services for the well-being of those living in the United States
(Boston University & The Rockefeller Foundation, 2021). Figure 3 shows the nation’s value of
behavioral health, with increased yearly spending, which is likely an underrepresentation for
2020, given the data prior to the pandemic (Open Minds, 2020). If behavioral healthcare trends
continue, the United States finds itself on what could be the brink of collapse for mental health
services; such a collapse would be detrimental to public health, economics, and social justice
within the United States (Beidas et al., 2016; Johnson-Kwochka et al., 2020; Liu et al., 2017).
Therefore, identifying how organizations can better support employee retention within
behavioral health is necessary to positively alter the mental health landscape in the United States.

9

Figure 3
United States. Mental Health Market Spending

Note. Projections indicate a significant increase in spending for 2020 due to the increases in need
experienced after the COVID-19 pandemic began. Reprinted from “The United States Mental
Health Market: $225.1 Billion in Spending in 2019: An Open Minds Market Intelligence Report”
by Open Minds, 2020. In the public domain.

Theoretical Framework and Methodology
The high turnover experienced by United States behavioral health organizations calls for
the need to identify how organizational factors within an organization’s control can influence
employee retention. The current study uses the Burke-Litwin (2018) model of change as the
guiding framework in addressing the research questions, emphasizing LPC voices and their
organizationally lived experiences to identify how culture, leadership, and individual needs
impact LPCs decisions to leave their organizations of employment (Tuck & Yang, 2013).
10

Theoretical Framework
Burke-Litwin’s (1992) model includes twelve organizational aspects, grouped into five
levels, that influence organizational change and performance. The model views organizations as
a complete system comprised of complex and evolving parts, with variables ranging from the
individual to the external environment, leaving a lasting impact on all others (Burke, 2018).
When guiding organizational change, the comprehensive model evaluates structure, systems,
internal climate, performance, motivation, strategy, culture, and leadership (Burke, 2018;
Rangachari & Woods, 2020). The theory differentiates organizational variables into
transformational and transactional categories and highlights their inherent interdependence
(Burke, 2018). The model’s holistic and multidimensional nature is relevant in addressing the
complex ways culture and leadership influence employee turnover and retention within the
behavioral health field and allows for the investigation of how compounding organizational
aspects influence job satisfaction, organizational performance, and marketplace sustainability for
behavioral health organizations (Al-Suraihi et al., 2021; Arslan Yürümezoğlu & Kocaman, 2019;
Burke, 2018; Willard-Grace et al., 2019).
Burke-Litwin’s (1992) model emphasizes the impact of leadership and culture on
individual employee decisions (Bugental & Bracke, 1992; Deci & Ryan, 1985; Jung, 1939).
Framing how behavioral health agencies receive organizationally influenced individual
behaviors, to stay or leave employment, as retention and turnover data (Beidas et al., 2016;
Bukach et al., 2017). Burke-Litwin’s (2018) use supports a comprehensive understanding of how
organizational aspects, such as leadership and culture, influence employee retention and impact
outcomes, like organizational sustainability, within United States behavioral health (Brabson et
al., 2020; Bugental & Bracke, 1992; Burke & Litwin, 1992; Deci & Ryan, 1985).
11

Theory of Change and Methodology
The current research’s theory of change believes in the correction of errors in
organizational culture through conscious alterations in modes of being, respect for individual
human needs, and the mechanization of intentional leadership (Frolova & Mahmood, 2019;
Meng & Berger, 2019; Tuck & Yang, 2013; Van Vlack, 2021a; Vesso & Alas, 2016). I believe
organizational cultures are dynamic and change as their relationships evolve (Schein & Schein,
2016; Tuck & Yang, 2013). The current research aims to provide insight into the perceptions and
reciprocal relationships between employees and leaders within the context of their organization’s
culture and investigate the influence on employee retention within behavioral health (Burke,
2018; Schein & Schein, 2016; Tuck & Yang, 2013; Van Vlack, 2021a).
The current applied action research uses a qualitative approach to align with the
qualitative nature of the research questions, categorized as qualitative descriptive and qualitative
process (Creswell & Creswell, 2017; Merriam & Tisdell, 2016). Semi-structured interviews
examine the influence of leadership and organizational culture on retention and highlight the
organizationally lived experiences of LPCs within United States behavioral health (Burke, 2018;
Creswell & Creswell, 2017; Labrague et al., 2020; Lan et al., 2021; Schein & Schein, 2016).
Stakeholders
There are many stakeholders involved in the behavioral health retention challenge,
including the following: employees and their loved ones, team members, clients, organizational
leaders, organizations, the field of behavioral health, and society. While changes to employee
retention in United States behavioral health impacts each stakeholder, the current research
highlights the business case for organizations (Gravett & Caldwell, 2016; Jones & Gates, 2007;
Kumar & Kavitha, 2016). Understanding how increases to employee retention impact the supply
12

of labor, the health of the United States’ population, the general workforce, and the ability of
behavioral health organizations to meet the current demand for services are necessary to fully
understand the contribution and implication of the current research on the United States economy
through its complex web of connecting impact.
The business case highlights the organizational and socio-economic benefits of solving
the retention challenge in behavioral health (Bhagwandeen, 2021; Crisp, 2021; Kumar &
Kavitha, 2016). The argument addresses the high costs of turnover within healthcare and, due to
most individuals spending most of their waking hours at work, posits the workplace as an
opportune environment for improving social benefit through increased employee retention
(Bhagwandeen, 2021; Crisp, 2021; Kumar & Kavitha, 2016). When employees experience more job
satisfaction, organizations benefit via increases to productivity, retention, and organizational
sustainability (Barriball et al., 2015; Kumar, 2022; Kumar & Kavitha, 2016; Salunkhe, 2018).
Definition of Terms
The subsequent definitions serve as tools for the adequate comprehension of the current
research and assist the reader in understanding the links between key concepts.
The following terms are essential to the interpretation of the current research: autonomy;
behavioral health; behavioral health workers; individuation; individuated organizational model;
job satisfaction; retention; self-actualizing tendency; transformational leadership; turnover;
organizational culture; organizational retention business case; organizational sustainability; and
personal development.
Autonomy refers to individuals need to feel they have influence over their lives and have
the free will to embrace choice, take responsibility, and make self-endorsed decisions (Ryan &
Deci, 2019).
13

Behavioral health is the connection between the enacted behaviors of body, mind, and
spirit and the corresponding level of well-being one experiences resulting from their complex
interactions (InSync Healthcare Solutions, 2018).
Behavioral health workers refer to those working in the behavioral health profession as
psychiatrists, psychologists, licensed clinical social workers, licensed professional counselors
(LPCs), counselors, marriage and family therapists, psychiatric technologists, and advanced
practice nurses specializing in behavioral health; for the current field study, LPCs are the
participants of focus (Nguyen et al., 2018).
Individuation is the process by which an individual personality develops, self-actualizes,
and integrates their paradoxical complexity of light and dark, recognizing it within their own
identity and the individual and collective identities of others (Jung, 1939, 1954).
Individuated organizational model refers to an organizational model using
transformational leadership, a culture of autonomy, and the prioritization of employee personal
needs to increase organizational learning and emotional intelligence (Burke, 2018; Deci & Ryan,
1985; Jung, 1939, 1954).
Job satisfaction is the degree to which an employee is contended or discontented with
their work and organization (Ohunakin et al., 2019).
Retention works in opposition to turnover and represents an organization's overall
strategy or ability to retain valued employees (Singh, 2019).
Self-actualizing tendency represents life’s ability to reach for life, even in the most challenging
of circumstances; the innate mechanism to survive; resilient action (Joseph, 2020; Meng, 2016;
Rogers, 1942, 1978).
14

Transformational leadership is a leadership style characterized by genuine care for
employees’ personal and professional development and the following: idealized influence;
inspirational motivation; intellectual stimulation; individualized consideration (Burke, 2018;
Northouse, 2018; Ohunakin et al., 2019; Schein & Schein, 2016).
Turnover is the loss of talent within an organization or field over time, generally one
year, includes voluntary resignations, involuntary terminations, and retirement (Qualtrics, 2022).
Turnover costs are the organizational or societal costs associated with losing talent within
an organization or field over time, including the following: talent acquisition costs, revenue lost
due to the time it takes to backfill the role, and training costs (Beidas et al., 2016; Bhagwandeen,
2021; Crisp, 2021; Qualtrics, 2022).
Organizational culture determines how employees engage in their work and encompass
the complex and multidimensional intermingling of diverging values, beliefs, knowledge, skills,
expectations, systems, and practices whose nuances define the context within which employees
interact (Burke, 2018; Burke & Litwin, 1992; Kumar, 2022; Schein & Schein, 2016; Van Vlack,
2021a).
Organizational retention business case refers to the argument that identifies
organizational benefits through increased profitability, competitive advantage, and organizational
sustainability from employee retention (Gravett & Caldwell, 2016; Jones & Gates, 2007; Kumar
& Kavitha, 2016).
Organizational sustainability is the ability of an organization to successfully compete
within the marketplace across time (Burke, 2018; Burke & Litwin, 1992; Labrague et al., 2020;
Mehta & Maheshwari, 2014).
15

Personal development is an individual’s desire to grow and develop, to improve and
reach for something more in alignment with the self-actualizing tendency of humanity (Carducci,
2020; Meng, 2016; Rogers, 1942; Willmott et al., 2018).
Organization of the Study
Five chapters organize the current research. The first chapter lays the foundation of the
current study by providing the reader with the purpose, importance, and proposed contribution to
the study of retention in United States behavioral health. Additionally, the first chapter identifies
the guiding research questions, provides an overview of the theoretical framework and
methodology, and offers relevant definitions essential to the thorough understanding of the study.
Chapter Two provides a review of the current literature on employee retention and turnover
within the field of United States behavioral health and, relating each area of focus to the purpose
of the research, expands on the following topics: history of behavioral healthcare; employee
turnover; employee retention; transformational organizational factors; and individual factors.
Chapter Three covers the methodology of the current study, which encompasses participant
selection, data collection methods, and a description of the data analysis process. The fourth
chapter provides the data and results of the research and integrates the analysis into research
findings. Chapter Five collectively synthesizes the information from the previous four chapters
into data-based recommendations, addresses gaps and practical applications of the research, and
makes suggestions for future research within the field.

16

Chapter Two: Review of the Literature
For the current research, the literature review addresses the problem of high turnover in
United States behavioral health organizations and identifies ways to increase retention within the
field. Additionally, the literature review discusses the historical background and context of
behavioral health within the United States, mapping how a dark and complicated legacy has
evolved into the current state of crisis. There is a discourse on the multidimensionality of
employee retention within the behavioral health field and an investigation into how
organizational understandings of individuals’ needs influences employees’ decisions to leave
organizations. Finally, there is an appraisal of transformational organizational factors concerning
their impact on organizational retention and sustainability within behavioral health.
History of Behavioral Healthcare in the United States
Behavioral healthcare organizations serve a vital function in the United States healthcare
system. Within the United States, behavioral health affects a large proportion of the population
and is a leading indicator of morbidity and mortality, decreasing the life expectancy of those
diagnosed with a severe mental disorder by 10–20 years compared to the general population
(Fagan et al., 2019; Liu et al., 2017). The field of behavioral health encompasses a variety of
mental, psychological, neurological, and social supports, including the following services:
mental health, marriage and family counseling, substance use, social work, psychiatric care, and
neurological services and focuses on prevention, intervention, treatment, and rehabilitation
(Alvernia University, 2022; American Psychiatric Association, 2018; Centers for Disease
Control and Prevention, 2021a; Nguyen & Davis, 2017). Behavioral health organizations serve
clients across the nation in hospitals, clinics, homes, communities, schools, and the justice
system (Fagan et al., 2019; National Alliance on Mental Illness, 2021; U.S. Department of
17

Health and Human Services, 2022). Mental health has a long history within the United States and
affects all individuals, directly or indirectly, regardless of age, sex, race, gender, national origin,
income level, or any other aspect of one’s identity, making it not only necessary for society’s
proper functioning, but uniquely impacted by field-related challenges, such as turnover (Adams
et al., 2019; Bukach et al., 2017; Mannarini & Rossi, 2019; McGinty et al., 2018; National
Alliance on Mental Illness, 2021).
The turnover issue within behavioral health is complex and requires an understanding of
the contextual history led the United States to arrive at the current mental health crisis. Recent
increases in demand for behavioral health further exacerbate challenges already faced by
practitioners (Beck, Manderscheid, et al., 2018; Bukach et al., 2017; Covino, 2019; Fukui et al.,
2019). Additionally, behavioral health continues to grow as a field due to increasing awareness
of its critical role in overall health (Cohen Veterans Network & National Council for Mental
Wellbeing, 2018; National Council for Mental Wellbeing, 2018). Behavioral health focuses on
the healing of wounds that are indirectly seen through individuals’ enaction of life-disrupting
behaviors (Alvernia University, 2022; American Psychiatric Association, 2018; Centers for
Disease Control and Prevention, 2021a; InSync Healthcare Solutions, 2018; Nguyen & Davis,
2017).
Therefore, to understand the research fully, there is a need to be aware of the indirect
connections and nuances which define the field of behavioral health within the United States
(Alvernia University, 2022; American Psychiatric Association, 2018; Centers for Disease
Control and Prevention, 2021a; InSync Healthcare Solutions, 2018; Nguyen & Davis, 2017).
Behavioral health impacts everyone, either directly or indirectly, and serves as an underpinning
structure by which humanity can understand and represent itself within society (Mannarini &
18

Rossi, 2019; McGinty et al., 2018; National Alliance on Mental Illness, 2021; Schnyder et al.,
2018). To fully understand the complex multidimensionality of the field and the aims of the
current study, knowledge of the field’s history, challenges, and composing structures are
essential (Mannarini & Rossi, 2019; McGinty et al., 2018; National Alliance on Mental Illness,
2021; Schnyder et al., 2018)
Defining Behavioral Health
Since the early 1940s, the United States saw mental health as a foundational aspect of
overall health and well-being, although recognizing it as a vital component of primary healthcare
did not occur until the 1970s (Jenkins, 2019; Sharp, 1947; World Health Organization, 1978).
More recently, behavioral health has continued to expand and the field has been highlighted as a
significant public priority for the United States, especially since the start of the COVID-19
pandemic (Søvold et al., 2021). Behavioral health connects the enacted behaviors of body, mind,
and spirit and the corresponding level of well-being one experiences due to these complex
interactions (InSync Healthcare Solutions, 2018). Although mental illness and mental health are
aspects of behavioral health, the terms have different meanings (American Psychiatric
Association, 2018; Centers for Disease Control and Prevention, 2021a).
Mental illness collectively refers to one’s experience of diagnosable mental disorders,
and mental health is the varying levels of psychological, social, and emotional well-being one
experiences as a facet of overall health (American Psychiatric Association, 2018; Centers for
Disease Control and Prevention, 2021a). Although the term “behavioral health workers”
encompass individuals in the following professions: psychiatrists, psychologists, licensed
professional counselors (LPCs), licensed clinical social workers, counselors, marriage and family
therapists, psychiatric technologists, and advanced practice nurses specializing in the field of
19

behavioral health, the current research focuses on the lived experiences of LPCs (Nguyen et al.,
2018). Behavioral health is a field that encompasses a variety of mental, psychological,
neurological, and social supports that underwrite social connections and aim for the betterment
of society (Alvernia University, 2022; American Psychiatric Association, 2018; Nguyen &
Davis, 2017). Behavioral health is a complicated, ambiguous, and nuanced field; therefore,
understanding its historical context within the United States is necessary for comprehending how
the turnover challenges within the field have significant impacts on the landscape of behavioral
health within the United States.
Historical Context
To fully appreciate the significance of the current research, an understanding of the
indirect linkages characterizing the field’s history and context is necessary (Alvernia University,
2022; American Psychiatric Association, 2018; Centers for Disease Control and Prevention,
2021a; InSync Healthcare Solutions, 2018; Nguyen & Davis, 2017). For clarity, the following
sections discuss how the United States has arrived at the current turnover problem within the
field of behavioral health and address how the demand for services has risen sharply in recent
years, putting behavioral health organizations at greater risk for marketplace failure (Czeisler et
al., 2020; Kumar & Kavitha, 2016; Søvold et al., 2021).
Behavioral health has had a long and complicated history stemming back to the early
1900s (Bertolote, 2008; Esterwood & Saeed, 2020). In 1946, behavioral health became a
definable field when the International Health Conference established the World Health
Organization and Mental Health Association (Bertolote, 2008; Jenkins, 2019). That is not to say
that mental illness did not exist before government organizations defined the field through
speech and the written word (Bertolote, 2008; Esterwood & Saeed, 2020). However, it was not
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until the 1950s that various behavioral health organizations formed in response to the worsening
conditions of mental institutions, which housed over half a million Americans (Grob, 2005; Hall
et al., 2021; Hudson, 2020; Scull, 2021; Sharfstein, 2019; Van Vlack, 2021a).
Although the creation of mental institutions stemmed from the best intentions, their
characterized abuse, deplorable living conditions, isolation, overcrowding, and long-term use led
to experiences of social breakdown and a comprehensive investigation into the nation’s handling
of behavioral health (Grob, 2005; Hudson, 2020; Nelson, 2021; Scull, 2021; Sharfstein, 2019;
Van Vlack, 2021a). Following the investigation, the approval of federal funds for the
deinstitutionalization of mental health across the United States led to significant shifts in
behavioral health (Grob, 2005; Joint Commission on Mental Illness and Health, 1961; Scull,
2021; Sharfstein, 2019; Van Vlack, 2021a). While mental deinstitutionalization led to the closure
of many psychiatric hospitals and several changes in psychiatric practice, the United States failed
to preemptively address the social supports needed to effectively accommodate the vast number
of mentally ill Americans (Douglas, 2021).
Lack of appropriate funding for mental health, alongside inadequate federal policy,
replaced the practice of institutionalization with nontreatment and incarceration (Douglas, 2021).
Currently, anywhere from 25–40% of mentally ill Americans are incarcerated at some point in
their lives, compared to the 6.6% incarceration rate of the general population (Wolff, 2017).
Moreover, lack of access to behavioral health services has increased incarceration rates by 18–
34% (Wolff, 2017). In addition to the comorbidities, decreased life expectancy, and increased
chance of incarceration experienced by those impacted by mental illness, those in need of mental
health services frequently do not seek help due to societal stigma (da Silva et al., 2020; Fagan et
al., 2019; Liu et al., 2017; Mannarini & Rossi, 2019; Wolff, 2017).
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Stigma
Stigma is a multilayered and complex social process that transpires through the
interconnection of cognitive, emotional, and behavioral aspects and involves collective labeling,
devaluation, discrimination, and othering of individuals (Knaak et al., 2017). The knowledge of
stigma remaining a significant social problem in the field of behavioral health is common, yet
there is lacking empirical research on why stigma exists and the consequences that stigma
presents to behavioral health and those affected by mental illness (da Silva et al., 2020;
Mannarini & Rossi, 2019). Goffman’s (1963) seminal research on stigma identifies levels of
stigma and articulates that experiences of stigma are influenced by behavioral health workers’
expressed attitudes and beliefs towards clients (Clair, 2018; Knaak et al., 2017; Schnyder et al.,
2018). Additionally, Mannarini and Boffo (2015) highlight that the type of mental health
diagnosis impacts social perceptions and levels of enacted stigmatization, with individuals
suffering from substance use being the most highly rejected by society.
If behavioral health workers are not properly set up for their own success, they are more
likely to exhibit negative behaviors, even towards clients, which can negatively impact patient
outcomes and increase feelings of stigmatization (Clair, 2018; Knaak et al., 2017; Schnyder et
al., 2018). Persistent patterns of experienced rejection, discrimination, and isolation can increase
the incidence of mental illness, creating a feedback loop where increased experiences of
depression, suicidal ideation, and substance use further decrease the likelihood that individuals in
suffering will reach out for help (Mannarini & Rossi, 2019). While aspects of communication
and culture show promise in mitigating stigma, persistent organizational gaps, such as the
misalignment between the organizational prioritization of person-centeredness for patients but
not employees, contribute to increasing behavioral health stigma and negatively impact
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employee retention within the field (Barbosa et al., 2015; Dimoff et al., 2016; Johnson et al.,
2018; Milner et al., 2015; Parish & Yellowlees, 2014; Rosenberg, 2019; Viktoria & Christine,
2020).
Moreover, stigma also poses a significant threat to behavioral healthcare employees.
Compared to the general population, mental health workers often experience more significant
stigma surrounding mental illness due to high personal expectations, professional pressure, and a
rigid culture known within the medical profession to increase burnout and depression (Burke,
2018; Gold, 2021; Vaughn, 2020). A recently published Centers for Disease Control and
Prevention survey of more than 5000 participants presented that 22% of essential workers had
considered suicide within the previous 30 days, and 13% had used substances to manage
pandemic-related stress (Czeisler et al., 2020). In addition, the cross-cultural and cross-
diagnostic experience of mental illness as an individual flaw in character rather than a medical
condition invites further complications. When organizations do not make targeted efforts to
support behavioral health employees’ wellness, behavioral health employees are likely to
experience increased workplace burnout, decreased job satisfaction, increased turnover
intentions, and may unintentionally increase the clients’ experiences of stigma (Knaak et al.,
2017; Mannarini & Rossi, 2019; Miller-Fox, 2018; Willard-Grace et al., 2019).
Currently, behavioral health employees are experiencing unprecedented stress and
pressure, increasing their risk of experiencing mental illness; at the same time, stigma decreases
the likelihood of employees reaching out for the support they need (Søvold et al., 2021). The
additional strain on the behavioral health workforce also further complicates the challenge of
behavioral health organizations retaining employees, raising costs, and decreasing organizational
sustainability (Willard-Grace et al., 2019). Addressing the needs of behavioral health workers is
23

necessary if the field is to sustain the vital services behavioral health provides to communities
(Armitage & Nellums, 2020; Wong et al., 2020). Furthermore, the recent complications COVID-
19 presents to practitioners requires additional research into comprehensive organizational tools
to increase support for behavioral health workers to decrease the burnout and turnover of United
States behavioral health employees (Armitage & Nellums, 2020; Czeisler et al., 2020; Wong et
al., 2020).
COVID-19
The COVID-19 pandemic has further exacerbated the already challenging behavioral
health field in the United States. According to a recent survey conducted by the American
Psychological Association (2021), 78% of Americans consider COVID-19 a significant stressor
in their life, and 84% felt distressed the two weeks prior to taking the survey. Due to exponential
increases in mental health needs, the White House (2021) declared addressing behavioral health
amidst the ongoing COVID-19 pandemic as necessary for the nation's recovery (U.S.
Department of Health and Human Services, 2021). While experiences of crisis are not new for
the field of behavioral health, the ongoing pandemic has overburdened an already taxed system
and called for many adaptations, including the following: decreasing admissions to state
hospitals where the mentally ill would usually receive treatment; shifting the use of psychiatric
beds to medical beds, worsening psychiatric capacity constraints; increasing requirements for
categorization of crisis services to reduce COVID-19 exposure and conserve personal protective
equipment; decreasing community-based face-to-face services and increasing telehealth services,
which many clients cannot access; and laying off behavioral health employees to maintain
operations within cost margins due to delays in billing code approval for the increased use of
telehealth services (Fagan et al., 2019; Mochari-Greenberger & Pande, 2021; Pinals et al., 2020).
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These external inputs requiring organizational adaptation have strained employees, leadership,
and culture, requiring transformational organizational adjustments to maintain performance
(Burke, 2018; Burke & Litwin, 1992). What is more, Murphy et al.’s (2021) research identifies
business operations as the most significant COVID-19 risk due to increased financial burdens
and loss of revenue, and expanding expenses within the field, adding to the relevance of the
current research on decreasing turnover costs to support organizational sustainability.
Moreover, fear of exposure, lack of personal protective equipment, and illness from
COVID-19 have further compounded the behavioral health employee shortage and thereby
decreased the nation’s ability to meet current mental health needs (Pfefferbaum & North, 2020;
Pinals et al., 2020). Prior to the pandemic, approximately 54% of Americans diagnosed with a
mental illness went without treatment; currently, more than 56 million Americans live with an
untreated mental illness due to budget cuts and employee shortages within the field (Czeisler et
al., 2020; McIntyre & Fazel, 2021). Furthermore, already marginalized populations, such as
those of color or low socioeconomic status, are 20% more likely to experience mental illness as a
result of the pandemic compared to their white, middle-class counterparts (Cohen Veterans
Network & National Council for Mental Wellbeing, 2018; Fagan et al., 2019; Kassens et al.,
2021; Mannarini & Rossi, 2019; National Council for Mental Wellbeing, 2018). Therefore,
finding a solution to support the stabilization of the behavioral health workforce is no longer an
option; it has become a national necessity (Czeisler et al., 2020). If behavioral health is to
survive, organizations need to prioritize employee needs and find ways to decrease turnover in
support of retention (Czeisler et al., 2020; Herschell et al., 2020; Kumar & Kavitha, 2016;
Pfefferbaum & North, 2020; U.S. Department of Health and Human Services, 2021).
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Person-Centered Approach
Behavioral health experienced notable progress since the field took roots in the early
1900s; most recently, common behavioral health practice has adopted a more person-centered
culture (Barbosa et al., 2015; Miles & Mezzich, 2011; Parish & Yellowlees, 2014; Rogers,
1979). Person-centered is a term used in psychotherapy to characterize a client-therapist
relationship built upon trust, mutual respect, and unconditional positive regard (Joseph, 2020;
Kirschenbaum & Jourdan, 2005; Rogers, 1979). Interestingly, Carl Rogers (1902-1987), a
notable founder of humanistic psychology, developed the person-centered approach in the 1940s,
but it would take healthcare three-quarters of a century to attempt to adopt the philosophy as
common therapeutic practice (Barbosa et al., 2015; Rogers, 1942).
Organizational cultures that prioritize the development of their employees are some of the
most effective when it comes to retention, output, and organizational sustainability (Botnaru et
al., 2021; Lan et al., 2021; Taylor, 2017). Carl Rogers’ (1942) person-centered theory can be
applied to organizations to increase alignment between patients and practitioners, support
employee development, and increase retention. Like self-determination theory, the person-
centered approach addresses three basic human needs, unconditional positive regard, empathy,
and congruence, that support an individual’s tendency to develop (Rogers, 1942). The theory
highlights the ability of person-centered environments to catalyze self-actualization and
positively benefit the environment and the individuals whose evolution is catalyzed (Deci &
Ryan, 2012; Rogers, 1979). Moreover, with the knowledge that emotionally intelligent cultures
support employee retention, a case is made for the adoption of organizational cultures that
embody person-centeredness and prioritize employees’ self-awareness and personal development
(Deci & Ryan, 2012; Dora et al., 2019; Maulding et al., 2012; Rogers, 1979; Taylor, 2017). The
26

person-centered approach is based on the tenet of the transformative nature of need supporting
contexts and serves to identify ways in which organizational cultures can increase job
satisfaction and employee retention in behavioral health organizations (Madsen, 2016; Rogers,
1979).
Rogers (1942) believed that human beings were motivated to self-actualize; however,
Rogers did not believe an individual’s actualizing tendency solely depended on the external
environment (Carducci, 2020; Willmott et al., 2018). Rogers took Maslow’s hierarchy of needs
one step further and stated that there is a tremendous social benefit when individuals find
themselves in environments that cultivate genuineness, acceptance, and empathy, but that even in
the unhealthiest of conditions, life still reaches for life (Joseph, 2020; Rogers, 1978). The self-
actualizing tendency aligns with recent research on human beings’ innate desire to grow and
serves as an essential window into one of the most fundamental human needs, the desire to
discover and become more self-aware (Hamidianpour et al., 2016; Raelin, 2016; Ryan & Deci,
2017; Spano-Szekely et al., 2016).
The case for considering person-centeredness as more than just a therapeutic practice is
most compelling in Rogers’ (1979) own words; he uses memory from his boyhood to facilitate a
gripping potato analogy that describes the actualizing tendency experienced. Rogers (1979)
states that one’s tendency to self-actualize is never destroyed, even within what could be
considered the darkest nights of one’s soul. Rogers describes a bin of winter potatoes that his
family kept in their basement, several feet below a dim window (Rogers, 1979). The potatoes, in
the most desperate of positions, Rogers (1979) details, would sprout long white tendrils, ghostly
in comparison to the bright green sprouts that would emerge had they been planted in the rich
soil of spring:
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They were, in their bizarre, futile growth, a sort of desperate expression of the directional
tendency I have been describing. They would never become a plant, never mature, never
fulfil their real potentiality. But under the most adverse circumstances they were striving
to become. Life would not give up, even if it could not flourish. In dealing with clients
whose lives have been terribly warped, in working with men and women on the back
wards of state hospitals, I often think of those potato sprouts. So unfavourable have been
the conditions in which these people have developed that their lives often seem abnormal,
twisted, scarcely human. Yet the directional tendency in them is to be trusted. The clue to
understanding their behaviour is that they are striving; in the only ways they perceive as
available to them, to move toward growth, toward becoming. To us the results may seem
bizarre and futile, but they are life’s desperate attempt to become itself. (p. 8)
Rogers’ (1979) believed the person-centered approach was capable of transforming more than
the client-therapist relationship. He supported the theory’s use in education and business,
positing that acknowledging the collective experience of the human condition could stand to
change the landscape of society’s most important institutions (Joseph, 2020; Kirschenbaum &
Jourdan, 2005; Rogers, 1979). If behavioral health organizations can catalyze employees’ desire
to self-actualize, they may have a limitless tap from which to build employee retention,
workforce stability, organizational motivation, resilience, and sustainability (Carducci, 2020;
Meng, 2016; Rogers, 1979; Ryan & Deci, 2017; Willmott et al., 2018).
Rogers’ person-centered approach is frequently taught to healthcare providers to increase
positive patient outcomes, making the approach particularly beneficial to behavioral health (Isaac
et al., 2021; Rogers, 1979; Scerri et al., 2021; Stanhope et al., 2021). However, according to my
present knowledge, researchers have not studied the use of the person-centered approach used for
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clients as a potential application to the retention of United States behavioral health employees,
which I identify as a gap in the literature due to the need-supportive characteristics of the person-
centered approach.
Employee Turnover
Human resources departments across fields use turnover rates as a critical indicator of
human capital management. Turnover is defined as the loss of talent within an organization or
field over time, generally one year, and includes voluntary resignations, involuntary
terminations, and retirement (Qualtrics, 2022). High employee turnover rates can be a costly
organizational problem, especially in behavioral health, where turnover rates supersede the
national average by up to 40% (Beidas et al., 2016; Herschell et al., 2020; Mercer, 2020;
National Solutions, 2021). When employees leave organizations, they take many things with
them, such as skill, knowledge, expertise, training, and other organizational resources of human
capital (Johnson-Kwochka et al., 2020). An organization’s ability to retain employees benefits
organizational performance and increases an organization’s competitive advantage in the
marketplace (Cosgrave, 2020).
In behavioral health, where the average employee turnover rate is between 30%–50%,
employee turnover is exceptionally costly (Herschell et al., 2020; Johnson-Kwochka et al.,
2020). The reasons behind turnover intentions are complex, but research shows that a confluence
of multilevel organizational elements, including leadership and organizational culture, influence
an employee’s decision to leave an organization (Willard-Grace et al., 2019). The
multidimensional nuances of the behavioral health field further embroil the associated costs of
turnover; however, it is essential to note that turnover, although costly, can be beneficial to
organizations, but only when within the appropriate range (Johnson-Kwochka et al., 2020;
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Maertz et al., 2022; Willard-Grace et al., 2019). Therefore, weighing the costs and benefits of
turnover within behavioral health is necessary to highlight the importance of retention and enable
a more thorough grasp of the risk high turnover presents to the field (Herschell et al., 2020;
Johnson-Kwochka et al., 2020).
Cost and Benefits
Employee turnover is incredibly costly; however, it enables organizations to replace
current employees with new additions to their workforce (Yee et al., 2022). When experienced
within reason, turnover can serve a healthy organizational function (Herschell et al., 2020).
Functional organizational turnover involves the exiting of less-skilled, low-performing, and
ineffective employees (Maertz et al., 2022). Functional turnover allows organizations to replace
low performers with more effective and competent employees, enabling organizations to backfill
positions with what may turn out to be more skilled, valued, and qualified candidates (Herschell
et al., 2020). When turnover rates are below 7%, they are considered normal and undisruptive to
organizational profitability and may stand to increase an organization’s competitive advantage
(Crisp, 2021; Dwesini, 2019). Thus, functional turnover benefits organizations and works in
opposition to dysfunctional turnover, which is the turnover of highly skilled, valued, and
competent employees (Maertz et al., 2022).
Organizational turnover costs healthcare organizations roughly $7,000 per employee per
year and includes costs associated with talent acquisition, training, lost productivity, disruption
to service, and increased burnout experienced by remaining employees (Han et al., 2019;
Johnson-Kwochka et al., 2020; Willard-Grace et al., 2019). Replacing an employee can cost
organizations between 50–200% of that employee’s annual salary, depending on role, skill, and
level of specialization (Bhagwandeen, 2021; Cloutier et al., 2015; Fisher & Connelly, 2017). The
30

average hospital loses between $3.6 million and $6.5 million per year in registered nurse
turnover alone, increasing by approximately $270,800 per year for each percent change in
turnover (National Solutions, 2021). Furthermore, some organizations will experience 100%
turnover within four years, creating dramatic cost increases while decreasing the likelihood of
continued organizational sustainability (Beidas et al., 2016).
Non-monetary organizational costs, although harder to quantify, are also linked to
turnover, such as the loss of individually acquired knowledge and skill and stifled organizational
growth (Bhagwandeen, 2021; Cloutier et al., 2015; Fisher & Connelly, 2017; Singh, 2019).
Additionally, compounding costs to team morale, heightened turnover intentions, burnout, and
decreased productivity harm organizations, but are primarily unaccounted for when accounting
for the cost of turnover (Bhagwandeen, 2021; Crisp, 2021). Moreover, turnover costs are not
considered in annual operation costs or the traditional line-item budget; they are pervasive,
subversive, and challenging to account for appropriately; thus, most turnover estimations likely
underrepresent actual organizational turnover costs (Bhagwandeen, 2021; Crisp, 2021).
Despite recognized organizational benefits to turnover, behavioral health organizations
continue experiencing labor shortages and high rates of turnover dysfunction, projected to cause
severe disruptions in service (Pietras & Wishon, 2021). Overall, turnover has a negative linear
association with organizational performance, meaning organizations with the highest turnover
are the least likely to experience positive organizational outcomes and the most likely to struggle
with long-term organizational sustainability (Williams & Glisson, 2013). Organizations can
assess whether their levels of turnover are healthy or disruptive with a cost-benefit analysis,
which can identify how beneficial or damaging organizationally experienced turnover is to
overall business function (Trepanier et al., 2012; Zhang, 2016). Although all organizations
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should do their own comprehensive cost-benefit analysis to determine how dysfunctional their
turnover is, with turnover rates up to 50%, behavioral health organizations are generally
struggling to retain half of their workforce and suffering costly consequences as a result (Czeisler
et al., 2020; Herschell et al., 2020; Johnson-Kwochka et al., 2020; Pietras & Wishon, 2021).
Causes
The reasons for turnover across fields are complex, but they are exceedingly complex
within behavioral health (Herschell et al., 2020). Employees leave organizations for several
reasons, ranging from personal motives to organizational shortcomings (Beidas et al., 2016;
Bukach et al., 2017). With personal motives outside of organizational control, human resources
managers seek to understand the organizational causes of turnover and retain employees whose
leaving would be regrettable (Zhang, 2019). Regrettable turnover is the exiting of
organizationally valued talent and serves as a helpful tool in discerning what organizations can
do differently in the future to retain their most prized employees (Speer et al., 2019). Currently,
there is no clear understanding of why employee turnover has continued to remain high within
the United States behavioral health organizations (Herschell et al., 2020). Many organizations
oversimplify the variables involved in employees’ decisions to leave and hyper focus on wage as
the primary reason for turnover intention, which has become a reason for great debate (Beidas et
al., 2016).
Compensation
Organizations frequently highlight compensation as a primary reason for turnover within
behavioral health, especially within the public sector. Beidas et al. (2016) erode the wage
argument by showing that employees exiting non-profit or governmental organizations stay
within the public sector, where salaries are historically known to be lower than in the private
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sector. The notion of a $75,000 threshold upon which pay becomes less critical to employees
partially explains the contradictions in the wage argument (Herschell et al., 2020). Individuals
making less than $75,000 per household, per year, within the United States report increased
stress and lower life satisfaction than those making more than $75,000; therefore, further
research should aim to understand the significance of a pay threshold on employment decisions
and turnover intentions (Herschell et al., 2020).
According to Park et al. (2021), compensation was the least viable reason employees left
their organizations; however, Park et al. researched participants who made enough money to pay
for their basic needs, further signaling the existence of a wage threshold. Steiner et al. (2020)
also found that financial reward explained minimal variance in employees’ decisions to leave an
organization, demonstrating that pay is not a primary driver for organizational commitment,
retention, or turnover. Regardless of the wage argument, turnover research shows consistency in
identifying variables of significant impact on employee retention within the field of behavioral
health; one such consistency is the negative impact of practitioner burnout on organizational
retention (Beidas et al., 2016; Bukach et al., 2017; Daghash, 2022; Herschell et al., 2020).
Burnout
There is extensive research on the mitigation of burnout, and the term has become a
buzzword in the medical field, yet organizations continue to struggle in efforts to solve the
problem (Herschell et al., 2020). Burnout is when one feels emotional exhaustion, detachment,
reduced self-efficacy, and openness to leaving one’s job (Kumar, 2022; Maslach et al., 1986).
Employees experience burnout when one or more of the following are true: workload exceeds
available resources; experiences of autonomy are limited; there are perceptions of low-value
recognition; a decreased sense of belonging or relatedness; experiences of unjust systems and
33

processes; or lack of meaning in the workplace (Dall'ora, 2020). When employees experience
burnout, they are less likely to be engaged in their work and more likely to consider other
employment opportunities, making burnout a valid concern for human resources management
within behavioral health (Janssen et al., 2020; Steiner et al., 2020).
Organizational burnout negatively affects employee retention. Employee burnout
contributes to decreased employee engagement and job satisfaction and an increased likelihood
of organizationally experienced turnover rates (Edwards et al., 2021). However, job satisfaction
and employee engagement have a more significant impact on employees’ decisions to leave
organizations than burnout alone (Fletcher et al., 2018). Additionally, with the added stress of the
COVID-19 pandemic and the mental health toll from isolation, illness, and loss of loved ones,
emotional resiliency, a known mitigator of burnout, has continued to decrease, while experiences
of burnout among behavioral health workers continue to rise (Daghash, 2022; Lam et al., 2022).
Sklar et al.’s (2021) research focuses on the mediation of the added stressors of COVID-19 via
organizational elements. finding that supportive and trusting organizational cultures can
successfully mediate employee burnout, but only when these elements are present prior to the
experience of change (Sklar et al., 2021). Thus, research recommends that organizations find
ways to prioritize employees’ needs and build person-centered cultures (Fletcher et al., 2018;
Marais-Opperman et al., 2021). However, although significant research emphasizes the impactful
role of organizations in influencing employee burnout experiences, many organizations and
researchers focus on individual factors contributing to burnout (Zaninotto et al., 2018).
American culture enables organizations to take an individualistic perspective and engage
in a sort of victim-blaming for corporate-fueled issues, such as burnout; this myopic approach to
the problem fails to acknowledge the complexity of burnout and therefore denies organizations
34

the opportunity to recognize the root of the problem (Viktoria & Christine, 2020). For instance,
in recent literature, the term “resilience” has emerged as a powerful tool to mitigate the adverse
effects of the unintended emotional costs of business; nonetheless, the term focuses attention on
employees’ responsibilities to handle burnout rather than identifying organizational ways to
reduce the occurrence (Garrett, 2016). Additionally, healthcare organizations frequently expect
money to solve the burnout problem; however, during the COVID-19 pandemic, organizations
experienced a limit at which bonus pay was no longer adequate; when given the bonus,
employees expressed appreciation for the increase but reminded leaders that what they “truly
needed was a break” (Virginia, 2021).
Viktoria and Christine (2020) contradict the popular narrative that the organizational
solution to burnout is to encourage individuals to become more resilient on their own time.
Similarly, Garrett (2016) emphasizes the importance of organizations committing to values,
ethical leadership, and sound business practices to empower employees’ resilience rather than
leaving them to their own devices. Viktoria and Christine (2020) highlight the toxicity of
organizational cultures in behavioral health and call attention to how organizations exacerbate
burnout while denying all responsibility for the cause or providing hope of remedy. Research
recommends behavioral health organizations undergo a process of critical assessment and
reflection to understand the ways in which they may contribute to burnout and calls future
research to focus on identifying which cultural elements have the greatest influence on employee
burnout and turnover (Dall'ora, 2020; Garrett, 2016; Viktoria & Christine, 2020).
Although burnout concerns within healthcare are not new, research on burnout in the
field of behavioral health is scarce (Grassi et al., 2022; Zubatsky et al., 2020). Behavioral health
employees face unique challenges that do not exist in other areas of healthcare, mainly due to the
35

complex nature of mental illness exhibited within the populations served (Heyns et al., 2021;
Marques & Berry, 2021). Considering limited research, Edwards et al. (2018) recommend that
future research isolate the field of behavioral health and focus on specific ways to mediate
burnout within the field, adding to the timeliness of the current research.
Strategies to Decrease Turnover
Organizational turnover is multivariable and influenced by a confluence of factors,
including personal values, employee perceptions, leadership practices, and organizational
cultures (Beidas et al., 2016; Bukach et al., 2017; Burke, 2018). Employees are less likely to
leave an organization when they perceive their leaders as empowering, supportive, and ethical
(Suifan et al., 2020). Contrarily, leadership perceived as toxic by employees negatively impacts
job satisfaction and increases turnover (Bakkal et al., 2019). Toxic leadership is when leaders
exhibit self-serving motivation, self-promotion, manipulation, and control (Fizza & Sobia, 2020).
Labrague et al.’s (2020) study of 770 registered nurses across 15 hospitals found toxic leaders to
be a statistically significant predictor of team dysfunction, negative job satisfaction,
psychological distress, absenteeism, and employee turnover intention (Fizza & Sobia, 2020).
Leaders have substantial influence within an organization and have the power to
encourage or destroy team function; therefore, leadership is considered a notable contributor to
employee turnover and organizational sustainability, which is the ability of an organization to
succeed within the marketplace across time (Burke, 2018; Burke & Litwin, 1992; Labrague et
al., 2020; Mehta & Maheshwari, 2014). Although leadership’s influence on turnover is
significant, other organizational aspects, such as culture, have also shown promise in guiding
employees’ turnover intentions within healthcare (Brouwers & Paltu, 2020).
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Healthy organizational cultures are associated with increased organizational success and
decreased regrettable turnover. Organizational culture is multidimensional, determines how
employees engage in their work, and encompasses the complex intermingling of diverging
values, beliefs, knowledge, skills, expectations, systems, and practices whose nuances define the
context within which employees interact (Burke, 2018; Burke & Litwin, 1992; Kumar, 2022;
Schein & Schein, 2016; Van Vlack, 2021a). Organizational cultures depicting trust, employee
support, empowerment, and authenticity are less likely to experience turnover when compared to
organizations with less supportive cultures (Rangachari & Woods, 2020). Additionally,
according to Rangachari and Woods (2020), healthcare employees that feel supported by their
organizations exhibit better individual problem solving and contribute to more remarkable
organizational adaptation and resilience in the marketplace.
When testing the mitigating effect of organizational culture on leadership, Brouwers and
Paltu’s (2020) research showed a partially mediated relationship, suggesting that culture alone is
not enough to overpower the organizational dysfunction caused by toxic leaders. Organizational
cultures are comprised of individuals and thus require some aspect of healthy leadership to
manage levels of toxicity expressed within the culture (Brouwers & Paltu, 2020). In an ideal
scenario, organizational culture is supportive enough to foster systems and practices that enable
healthy leadership and detract from the perpetuation of those that may exhibit toxic tendencies
(Brouwers & Paltu, 2020; Weberg & Fuller, 2019). Although organizational culture does not
fully mitigate leadership toxicity, supportive organizational climates are foundational to healthy
leadership (Brabson et al., 2019; Burke, 2018; Burke & Litwin, 1992).
Organizational culture and leadership practices can have an antagonistic or synergistic
effect depending on their integral alignment. Organizations with positive cultures and toxic
37

leaders are likely to attract good talent but unlikely to retain their highest-valued contributors for
a long time (Brouwers & Paltu, 2020; Weberg & Fuller, 2019). Similarly, negative
organizational cultures may contain leaders with positive leadership styles but are unlikely to
support and earn the respect of those leaders long-term (Brabson et al., 2019; Rangachari &
Woods, 2020). For the most substantial influence on turnover, organizations may benefit from a
comprehensive assessment of their organizational culture and leadership practices to identify
where gaps and opportunities for alignment exist (Al-Suraihi et al., 2021; Brabson et al., 2019;
Burke, 2018; Burke & Litwin, 1992; Cerutti et al., 2020; Cosgrave, 2020; Dora et al., 2019;
Moriarty et al., 2018; Rangachari & Woods, 2020; Sklar et al., 2021). After organization’s
identify gaps, research recommends they build organizational proficiency in person-
centeredness, paying close attention to employee identified needs for the creation of collective
culture supportive of employee retention (Dishop et al., 2019; Herschell et al., 2020; Williams &
Beidas, 2018).
Employee Retention
Like turnover, employee retention is a complex issue that readily impacts the success of
organizations across sectors, fields, and industries. Employee retention works in opposition to
turnover and is an organization's overall strategy or ability to retain valued employees (Singh,
2019). Retention in a world of increasing competition is essential for organizational
sustainability; organizational elements affecting retention are numerous and include total
rewards, organizational culture, work-life balance, employee development, and leadership
(Burke, 2018; Burke & Litwin, 1992; Kossivi et al., 2016; Kumar & Mathimaran, 2017). The
increasing globalization of business has quickly developed the need for an organizational model
that may increase retention across cultures, embrace diversity, and support inclusivity.
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Organizational cultures and leadership styles can be enabled within organizations to
influence expressions of employees’ job satisfaction, engagement, and motivation and increase
organizationally experienced retention (Al-Suraihi et al., 2021; Burke, 2018; Burke & Litwin,
1992; Dishop et al., 2019). Steiner et al.’s (2020) research of over 200,000 employees across a
global organization focused on measures of employee satisfaction to develop effective strategies
for increasing organizational retention; findings showed that the following variables significantly
impacted employee retention: work engagement; organizational commitment; perceived
supervisor support; and communication. This research shows hope for finding a solution to the
complicated and multivariable retention challenge in behavioral health; however, it requires
organizations to develop a more holistic understanding of employees’ needs and identify how to
influence employees’ decisions to leave (Al-Suraihi et al., 2021).
Existing Retention Strategies
Understanding employees’ turnover intentions are necessary for the development of
effective retention strategies; once behavioral health organizations can identify why employees
leave at rates up to 40% higher than in other fields, they can begin to address ways to mitigate
turnover and increase retention (Czeisler et al., 2020; Dishop et al., 2019). One of the most
significant predictors of turnover intentions is job satisfaction; therefore, if organizations are to
increase retention, they must focus on ways to increase the job satisfaction of their employees
(Dishop et al., 2019; Herschell et al., 2020; Sklar et al., 2021).
Herschell et al.’s (2020) mixed-methods research of 169 behavioral health participants
found that employees frequently know they are going to leave organizations well before deciding
to do so; additionally, employees’ decisions to leave are associated with increased experiences of
job dissatisfaction. Therefore, the time between when an employee first thinks of leaving their
39

job, and the time they do leave, is a time of great opportunity for organizations. Herschell et al.
(2020) advise that future studies seek to identify how behavioral health organizations can
influence job satisfaction as a preventative measure against regrettable turnover. Moreover,
research shows congruence in organizational elements, namely organizational culture and
leadership, having strong promise in increasing behavioral health retention when supportive of
employees’ needs (Herschell et al., 2020). Behavioral health organizations perceived by
employees as supportive are the most likely to experience high retention rates. Although
employees rarely consciously view organizations as responsible for meeting their psychological
needs, supporting employees’ emotional needs influences organizational retention by indirectly
impacting employee perceptions (Gorgenyi-Hegyes et al., 2021). Even when faced with
significant increases in stress, such as those posed by the COVID-19 pandemic, employees
remain at organizations where they feel supported by their organization’s culture and leadership
practices (Burke, 2018; Burke & Litwin, 1992; Sklar et al., 2021).
Organizational climates that embrace functional psychology and embody role clarity,
opportunities for growth, and cooperation, are some of the most supportive for employees
(Dishop et al., 2019). Research recommends that behavioral health organizations focus on
supporting employees in specific areas where employees have expressed concern, like schedule
flexibility and bandwidth support (Sklar et al., 2021). Emotional health is becoming an
increasingly important aspect of employee well-being and can set organizations apart from
competitors when it comes to recruiting; therefore, it is recommended that organizations find
ways of supporting employees’ emotional health to reap positive organizational benefits, such as
increased productivity and organizational sustainability (Gorgenyi-Hegyes et al., 2021).
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To retain employees long-term, organizations can create a supportive work environment
that respects employee autonomy, creativity, and proper employee development via training (Al-
Suraihi et al., 2021; Alshehhi et al., 2021). Additionally, when employees feel supported by
organizational culture and leadership, their organizational identification increases (Al-Suraihi et
al., 2021; Burke, 2018; Burke & Litwin, 1992). As organizational identification increases,
employee engagement, job satisfaction, and employee experiences of well-being increase, all of
which further solidify employee retention (Al-Suraihi et al., 2021). Moreover, well-trained
employees remain within organizations with significantly higher confidence than those that have
not received adequate training (Alshehhi et al., 2021). Therefore, behavioral health organizations
are to increase retention and decrease employee turnover, having a thorough understanding of
employee needs, including training needs, is necessary to influence employee engagement,
motivation, and job satisfaction (Al-Suraihi et al., 2021; Dishop et al., 2019).
High retention rates are particularly prevalent in collaborative organizations where
employees feel organizational support for their psychological needs through many variables,
including leadership practices (Burke, 2018; Dishop et al., 2019; Sklar et al., 2021). Leaders
capable of inspiring employees foster teams that exhibit increases in cooperation, innovation, and
organizational dedication, all of which are positive indicators of an employee’s intentions to stay
(Cerutti et al., 2020; Karanges, 2014; Ohunakin et al., 2019; Vargas-Hernández, 2022). Thus,
when considering tools for the retention of employees, it is essential to discuss the power of
organizational factors, like leadership and organizational culture, that influence individuals
decisions to stay or leave their organizations of employment (Cerutti et al., 2020; Northouse,
2018; Oreg & Berson, 2011; Tian et al., 2020).
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Transformational Organizational Factors
Transformational organizational factors encompass aspects of leadership and
organizational culture and the reciprocal relationship these factors have on an organization’s
outcomes. Burke-Litwin’s (1992) framework shows variables at different levels of an
organization’s structure and elucidates the influence each variable has on all others, addressing
the interdependence of all necessary levels of function on organizational performance. The
model’s open system recognizes the environmental inputs that spark change and divides the
organizational factors into two categories: transactional and transformational (Burke, 2018). For
the current research, emphasis will be placed on the transformational organizational factors that
most significantly influence employees (Burke, 2018). The current section will examine the
many elements that influence employee retention in behavioral health and address how firms
may shift perceptions to achieve organizational sustainability (Burke, 2018).
Leadership
According to Burke-Litwin’s (1992) model, one transformational factor that plays a
significant role in organizational outcomes is leadership. Leadership also significantly impacts
employees’ turnover intentions; employees being supervised by leaders they perceive to be
inspiring, authentic, supportive and accountable frequently have no intentions of leaving their
organizations (Ohunakin et al., 2019). Contrarily, leaders unable to authentically communicate or
mentor significantly increase employees’ intentions to leave. Additionally, evidence shows that
treating employees fairly and being perceived as a just leader builds trust and significantly
increases employees’ productivity and intentions to stay (Ohunakin et al., 2019).
Furthermore, leaders with the ability to be genuinely inclusive and respectful of
individual differences, voices, and needs, significantly increase employee commitment and
42

retention, as employees feel supported by leaders they perceive to notice and care about their
workplace contributions and well-being (Ohunakin et al., 2019; Steiner et al., 2020). What is
more, employee perceived supervisor support directly relates to turnover intention; employees
who feel supported by their supervisors are more likely to be engaged in their work, committed
to the organization, and far less likely to leave the organization by which they are employed
(Bhatnagar, 2014; Suan & Nasurdin, 2016).
While organizational commitment alone is not a significant predictor of turnover
intention, combined with other variables, such as employee engagement, organizational
commitment can indicate employees’ intentions to stay (Steiner et al., 2020). Additionally,
employee engagement and organizational commitment mediate the relationship between
turnover intention and pay satisfaction, meaning employees who feel supported by their leaders
are less likely to leave, even when they are not completely satisfied with their pay (Steiner et al.,
2020; Taylor et al., 2017). Leaders who know how to support employee engagement build
organizational trust and positive organizational perceptions and increases organizational
effectiveness through workplace productivity, compounding retention benefits on organizational
sustainability; therefore, research recommends organizations find ways of supporting positive
leadership behaviors to increase employee retention (Burke, 2018; Steiner et al., 2020).
Organizational Culture
Burke-Litwin’s (1992) model identifies organizational culture as a transformational
factor with significant influence over employee behavior and organizational sustainability.
Organizational cultures are the contextual background within which relationships are formed,
and accountability binaries are supported; having a strong organizational culture is necessary to
signal the values foundational to an organization's business operations and human capital
43

practices (Ott et al., 2018; Schein & Schein, 2016). Research signals the primary significance of
organizational culture in building employee retention, especially in high-turnover fields, such as
behavioral health (Cho & Kim, 2020; Griffiths et al., 2019).
How organizations behave through the collective individual behaviors of employees,
policies, procedures, and other enacted practices describes organizational culture. Organizations
can preach values all day, but if the values organizations act out are out of alignment with their
statements, dysfunctional turnover may be a byproduct (Adeoye & Hope, 2020; Dishop et al.,
2019; Shuck et al., 2017; Steiner et al., 2020). Although frequently overlooked, employee
perceptions are central to an organization’s culture; employees will leave if they think the culture
is toxic and unsupportive, regardless of what is preached about the culture by executives.
Therefore, the study of organizational culture begins with understanding employees' needs, their
desires, their perceptions of leaders, and the organizational prioritization of their interests
(Brouwers & Paltu, 2020; Gevrek et al., 2017; Herschell et al., 2020; Vargas-Hernández, 2022).
Moreover, organizational culture serves a vital function in employee job satisfaction and
retention. Specifically, autonomy-supportive organizational cultures reduce unwanted turnover
and increase organizational productivity (Karanges, 2014; Shuck et al., 2017; Weinstein et al.,
2012). Additionally, need-supportive cultures can significantly predict employee turnover; thus,
research recommends that organizations develop a values-based culture to maintain internal
value alignment and increase the likelihood of congruence between organizationally espoused
and enacted culture (Adeoye & Hope, 2020; Schein & Schein, 2016).
Furthermore, due to the significant impact of organizational culture on employee turnover
intentions, recent research recommends practitioners take a holistic view of organizational
culture to support cohesive stakeholder interests, highlighting the often-overlooked primary
44

stakeholder, employees (Burke, 2018; Dasgupta et al., 2021; Nadim & Singh, 2019; Salunkhe,
2018). Thus, the study of organizational culture is salient to any discussion on employee
retention and organizational sustainability and may serve as a valuable tool in solving the
turnover problem in behavioral health, especially when inclusive of perceptions of significance,
such as the perceptions of employees (Bukach et al., 2017; Griffiths et al., 2019; Park et al.,
2019; Zhang & Xu, 2021).
Individual Factors
Burke-Litwin’s model (1992) views organizations as a comprehensive system and
addresses variables of influence over organizational outcomes at varying levels, each of which
interacts with one another and has long-term effects on the rest of the business. One aspect of the
model highlights the importance of individual elements, meaning the variables associated with
employees within the organization’s open system (Burke, 2018). Within an organization, these
individual factors are heavily influenced by other variables within the Burke-Litwin model
(1992), such as an organization's culture, priorities, and leadership practices. Therefore, the
current section will go into greater depth in describing the individual factors that impact
employee retention within the field of behavioral health and identify how organizations may
influence perceptions to increase organizational sustainability.
Job Satisfaction
According to Burke-Litwin’s model (1992), job satisfaction is an individual factor
because it is operationalized within an organization but ultimately depends upon an individual’s
experience of it. Job satisfaction is a positive psychological state and a causal factor of retention
that mediates the relationship between perceived support for employee development and
turnover intentions (Fletcher et al., 2018). While organizational decisions, behaviors, and
45

practices influence job satisfaction, it is based upon an individual’s perceptions; interestingly, job
satisfaction is one of the most significant indicators of whether an employee is thinking about
leaving their job or not (Gevrek et al., 2017; Ohunakin et al., 2019). Therefore, job satisfaction is
foundational to the health of a workforce and an organization and plays a key role in employee
retention (Ohunakin et al., 2019; Smith et al., 2020; Williams & Beidas, 2018).
The high staff turnover experienced by behavioral health organizations becomes a
negative feedback loop where lack of retention decreases job satisfaction, increases burnout, and
further decreases organizationally experienced retention (Bukach et al., 2017). Additionally,
research finds a direct link between job satisfaction and employee-business-value because of the
positive association between job satisfaction and employee performance (Alshehhi et al., 2021;
Salunkhe, 2018). Moreover, job satisfaction may have a stronger direct and mediational
relationship with turnover intentions than burnout (Fletcher et al., 2018). Thus, job satisfaction is
an essential aspect of properly managing human resources capital for organizational
sustainability within the field (Fletcher et al., 2018).
However, job satisfaction is not a simple solve. Further complicating the matter, job
satisfaction is based on continually evolving comparison valuations and is partly determined by
previous experience with employment and valuations of projected future professional capability
(Gevrek et al., 2017). Thus, employees’ current levels of job satisfaction are primarily
determined by compounding perceptions of the past, present, and future (Gevrek et al., 2017).
The evolving perceptibility of job satisfaction complicates studies within the field; one frequent
limitation of job satisfaction research is the quality of hindsight, due to the conducting of
research after the employee has left the organization (Herschell et al., 2020). However,
regardless of these limitations, job satisfaction is a strong signal of intentions to stay within
46

organizations and researchers recommend that organizations discover how to influence employee
perceptions and increase job satisfaction to reap the benefits of a more stabilized workforce (Ada
et al., 2021; Gevrek et al., 2017).
Employee Values and Needs
Like job satisfaction, employees’ needs and values are individual factors within Burke-
Litwin’s (1992) organizational model. Although values and needs may change over time, when
aligned with organizations of employment, employees’ needs and values positively impact
organizational outcomes, including retention (Ryan & Deci, 2017). Organizations that
understand the power of integrating an organizational culture that respects individuals’ values
and needs are at an advantage for increasing employee retention (Haerens et al., 2021; Kwon &
Kim, 2020; Ryan & Deci, 2017). Employee values and human psychological needs are powerful
individual drivers, and organizations able to tap that well of motivation can embolden their
workforce, attract the best and brightest talent and succeed in retaining their most valuable
employees (Al-Suraihi et al., 2021; Arslan Yürümezoğlu & Kocaman, 2019; Cosgrave, 2020;
Dora et al., 2019; Ryan & Deci, 2017). Therefore, organizations aiming to increase retention
should be aware of employee values and needs and find ways to support them through their
organizational practices (Haerens et al., 2021; Kwon & Kim, 2020).
Conceptual Framework
The current research’s conceptual model, seen in Figure 4, is an adaptation of Burke-
Litwin’s (1992) model of change. However, to give proper credit, it is important to note that my
thoughts contain influence from the following researchers’ and their theories: Deci and Ryan’s
(1985) self-determination theory; James Bugental’s (1992) existential-humanistic theory; and
Carl Jung’s (1939) theory of individuation. The current research focuses on four of the twelve
47

listed aspects of the Burke-Litwin (1992) model, emphasizing organizational culture, leadership,
individual needs, and motivation. Within Burke Litwin’s (1992) framework, organizational
culture and leadership fall under transformational organizational aspects, while individual needs
and motivation are categorized as individual factors on an organization. The model’s
multidimensionality, interdependence, and holism support the complexity of studying turnover in
behavioral health (Al-Suraihi et al., 2021; Arslan Yürümezoğlu & Kocaman, 2019; Burke, 2018;
Willard-Grace et al., 2019). Moreover, the model’s application underwrites the current research
in identifying the influence of leadership, culture, and LPCs organizationally lived experiences
on employee retention within the field (Al-Suraihi et al., 2021; Arslan Yürümezoğlu &
Kocaman, 2019; Burke, 2018; Willard-Grace et al., 2019).
Three categorical areas influence the turnover problem within behavioral health
according to Burke-Litwin’s (1992) model: leadership, culture, and individual perceptions.
Values are present within each overlapping layer and can represent congruence or incongruence
between any of the three areas, with emotional intelligence (EQ) at the center of the overlapping
spheres, signaling centrality. Additionally, these transformational and individual organizational
factors comprise the “organizational self,” where the external environment, individuals,
leadership, culture, and organizational outcomes are part of an interwoven and multidimensional
system in which each aspect influences all others. The conceptual framework in Figure 4 will
guide the current research, examining the influence of leadership and cultural practice on
organizational outcomes, namely turnover, retention, and organizational sustainability.

48

Figure 4
Organizational Model of Individuation

Note. Adapted from Burke-Litwin’s model of change, 1992. Coopyright 1992 by Burke-Litwin.

Summary
The current field research uses Burke-Litwin’s (1992) model of change as the theoretical
framework in addressing the high incidence of turnover experienced by United States behavioral
health organizations, examining how organizational leadership and culture influence LPCs’
decisions to leave. The literature review provides the historical context and background of the
behavioral health field, identifying progress, remaining gaps, spheres of opportunity, and
relevant areas of significant cultural and economic impact, such as the COVID-19 pandemic.
The research recognizes the costs and benefits of turnover and examines strategies for retaining
employees in organizational environments prone to burnout, such as behavioral health.
49

The literature highlights emotional intelligence as an area of emanating impact and a
significant signal of need-supportive environments central to individuals, leaders, and
organizational cultures. According to research, organizations are capable of influencing
employee retention by means of job satisfaction, which is a statistically significant predictor of
employee retention across industries and fields. Moreover, the literature identifies areas of
incongruence within behavioral health, where organizations expect employees to adopt a person-
centered approach toward clients without being person-centered towards employees.
Furthermore, the business case for retention highlighted the need to stabilize the behavioral
health workforce to increase organizational sustainability.
Throughout, emphasis is on the problem of practice, which is the high incidence of
turnover in United States behavioral health organizations during a time of unprecedented demand
for services due to national crisis. In summary, the identified conceptual framework further
guides the action research to investigate the influence of leadership and organizational culture on
employee decisions to leave their organizations of employment in the United States behavioral
health system.

50

Chapter Three: Methodology
The current research addresses the high incidence of employee turnover experienced by
United States behavioral health organizations and aims to understand how organizations may use
organizational culture and leadership to influence retention and organizational sustainability. The
current chapter addresses the research methodology and covers the following: research
questions; overview of design; descriptions of the research setting and a description of myself as
the researcher; acknowledgment of positionality and assumptions; validity and reliability; and
ethics.. Together, these research elements form the methodology, guiding the selection of
participants, data collection, the trustworthiness of the study, and supporting the answering of the
stated research questions (Merriam & Tisdell, 2016).
Research Questions
1. What impact do leadership and organizational culture have on employee retention
within United States behavioral health?
2. What organizationally lived experiences affect employees’ decisions to leave United
States behavioral health organizations?
Overview of Design
A qualitative approach will be used in the present applied action research to match the
qualitative descriptive and qualitative process research questions (Creswell & Creswell, 2017;
Merriam & Tisdell, 2016). The current study gathered data through twelve semi-structured
interviews, which included questions to address the research questions, as seen in Table 1, and
assess the impact of leadership and organizational culture on employee. Specifically, the lived
experiences of LPCs were analyzed to determine how an organizational model of individuation
might be applied to promote employee retention and organizational sustainability in United
51

States behavioral healthcare (Burke, 2018; Creswell & Creswell, 2017; Labrague et al., 2020;
Lan et al., 2021; Schein & Schein, 2016).
Initially, I explored options for conducting quantitative research into the relationship
between retention and the following variables: transformational leadership, autonomous cultures,
and personal development. I intended to use job satisfaction as the link between the stated
variables because job satisfaction correlates with employee retention; however, I decided against
quantitative analysis due to sample size concerns. I also considered mixed methods research, but
the time needed to conduct a proper mixed methods study was an obstacle for the current
research. Ultimately, I chose qualitative research for the following reasons, listed in no order:
• To address a gap in the literature where previous United States behavioral health
researchers had not studied LPCs perceptions of transformational leadership,
organizational cultures of autonomy, and the prioritization of employees’ needs,
including the need to grow and develop personally.
• To develop a deeper understanding of how organizations can use transformational
elements to increase employee retention and organizational sustainability within
United States behavioral health.
• To develop greater insight into the organizationally lived experiences of behavioral
health employees, specifically LPCs, and the impact these experiences have on
employees’ decisions to leave United States behavioral health organizations.
• To explore how behavioral health organizations might employ an organizational
model of individuation to increase congruence between patient and employee care
expectations.
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Furthermore, I chose a constructivist inquiry paradigm to align with the ontological
perspective, defined as one’s worldview, and the epistemology, defined as one’s experientially
based assumptions. The constructivist approach is based on the belief that world meanings are
negotiated through the interaction of socially constructed interpretations and individual
narratives (Aliyu et al., 2015; Creswell & Creswell, 2017). Additionally, the study’s axiology,
which integrates ontology and epistemology, investigated the transformational organizational
aspects influencing employee retention within behavioral health (Aliyu et al., 2015; Burke, 2018;
Creswell & Creswell, 2017; Saunders, 2019). The current research blends phenomenological
research and narrative inquiry to adequately address the qualitative research questions, as seen in
Table 1 (Merriam & Tisdell, 2016). Phenomenology is appropriate for the current research
because of the investigation into employees' lived experiences within behavioral health, while
narrative inquiry is relevant in highlighting participants' perspectives and emphasizing their
unique experiences (Creswell & Creswell, 2017; Merriam & Tisdell, 2016).

Table 1
Data Sources
Research questions Interview
1. What impact do leadership and organizational culture have on
employee retention within United States behavioral health?
X
2. What organizationally lived experiences affect employees’
decisions to leave United States behavioral health organizations?
X

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Sample and Population
With the current research being a field study rather than an organizational study, the
interviewees came from various backgrounds and had numerous organizational affiliations.
Logistically, I used a screening survey to purposefully sample participants with experiences
relevant to answering the research questions. Twelve semi-structured interviews were conducted
via Zoom© and guided by an interview protocol that included informed consent in compliance
with IRB (Creswell & Creswell, 2017; Merriam & Tisdell, 2016). Additionally, the research
used convenience sampling, and participants were recruited via posts within social media groups,
such as Facebook©, dedicated to behavioral health practitioners (Merriam & Tisdell, 2016). I
have access to these sites due to affiliations with networks from previous work and connections
with individuals who remain active within the behavioral health network. Previously, I had
success posting for contracted behavioral health work within behavioral health spheres on
Facebook©; thus, I was hopeful to gather participants based on previous success and by using a
familiar means.
Participants recruited via social media posts were required to complete a screening survey
prior to selection, which constituted purposeful criterion sampling (Merriam & Tisdell, 2016).
The screening survey assessed whether participants had relevant professional work experience as
an LPC and had left at least one job within the field of United States behavioral health (Merriam
& Tisdell, 2016). Furthermore, the screening survey aimed to ensure that interviewees had
experience working at, and leaving, behavioral health organizations due to factors that could
have been influenced by the organizations they left and which may have been mitigated by
elements included in the conceptual framework (Burke, 2018; Merriam & Tisdell, 2016). The
screening survey supported the rich gathering of data on the lived experiences that impacted
54

LPCs decisions to leave behavioral health organizations for a richer phenomenological and
narrative contribution to the field (Creswell & Creswell, 2017; Merriam & Tisdell, 2016).
Criterion 1
Participants worked as a LPC in a behavioral health organization within the United
States.
Criterion 2
Participants left a behavioral health organization within the United States due to
organizational factors, such as culture and leadership.
Data Sources
The current applied action research is qualitative to align with the qualitative descriptive
and qualitative process research questions (Creswell & Creswell, 2017; Merriam & Tisdell,
2016). A screening survey, outlined in Appendix A, was used for the purposeful sampling of
participants that had worked as LPCs and had left a behavioral health organization due to
elements that may have been influenced by organizational factors, such as culture and leadership
(Merriam & Tisdell, 2016). Data was collected via semi-structured interviews, which asked
questions aligned with the current study’s research questions and key concepts from the
conceptual framework; the twelve interviews followed the interview protocol outlined in
Appendix B. Twelve participants were purposefully selected after completing a screening survey
meant to identify individuals who had worked as LPCs and left organizations due to
transformational organizational factors, such as leadership and culture (Burke, 2018; Creswell &
Creswell, 2017; Merriam & Tisdell, 2016). Additionally, participants lived experiences were
investigated, and imaginative variation was incorporated to see if an organizational model of
individuation may be used to improve employee retention and organizational sustainability
55

within behavioral health (Burke, 2018; Labrague et al., 2020; Lan et al., 2021; Merriam &
Tisdell, 2016; Schein & Schein, 2016). Triangulation via member checks was undertaken,
meaning analyzed findings were presented to participants in follow-up interviews to see whether
participants were aligned with the findings. Member checks further explored participants’
perceptions and reasoning, improving internal validity, credibility, and the richness of the
collected data (Cooper, 2017; Creswell & Creswell, 2017; Merriam & Tisdell, 2016; Van Vlack,
2021b).
Participants
Participants were recruited using purposeful sampling via social media networks
specialized for mental health practitioners, such as behavioral health Facebook© groups
(Merriam & Tisdell, 2016). I used my affiliation and contacts with behavioral health networks to
recruit participants due to previous success recruiting contractual behavioral health workers
using similar processes. Prior to selection, individuals recruited through social media posts were
required to take a screening survey, which determined whether they came from the appropriate
background and had left at least one employer within the field due to transformational
organizational factors (Burke, 2018; Merriam & Tisdell, 2016). Participants were diverse,
coming from a variety of demographic backgrounds, having various behavioral health
organizational affiliations, having been within the field for a wide range of years, and having
unique experiences and reasons for their turnover intentions (Creswell & Creswell, 2017;
Merriam & Tisdell, 2016).
Instrumentation
The instrumentation for the current research includes the following: alignment with the
research questions, a screening survey for the purposeful criterion sampling of participants, and
56

the interview questions and protocol to facilitate answering the stated research questions. These
instrumentation tools were created to align with information from the literature review as well as
variables from the following theoretical frameworks: Burke-Litwin’s (1992) model of change.
The screening survey used for purposeful criterion sampling of participants contained
five questions to assess experience in the following: working as an LPC and leaving a behavioral
health organization for a reason relevant to the research questions (Merriam & Tisdell, 2016).
Additionally, the screening survey asked participants about their willingness to share their
experiences in an interview with me. Appendix A contains the screening survey used to increase
the richness of data and answer the research questions (Merriam & Tisdell, 2016). Interested
participants who had not worked as an LPC, had not left an organization in behavioral health due
to reasons that the organization could have influenced, or those unwilling to share their
experiences in an interview, were not included in the study.
The interview protocol was created to align with ethical research guidelines on informed
consent and decrease any unintended variables, such as variance in how the study was introduced
to participants (Creswell & Creswell, 2017; Merriam & Tisdell, 2016). Appendix B contains the
interview protocol used for the current research, including an introduction for the interviews,
interview questions tied to the theoretical framework, and concluding researcher statements.
Semi-structured interviews were chosen to align with the qualitative descriptive and qualitative
process research questions and contribute to the gap in the literature on employees’ perceptions
of transformational organizational factors’ influence on turnover intentions within United States
behavioral health (Merriam & Tisdell, 2016). The interview questions were developed based on
my knowledge and professional behavioral health experience, including unpublished employee
engagement survey results from a previous employer, variables from the theoretical framework
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described in the conceptual framework, and the information described in the literature review
(Bugental & Bracke, 1992; Burke & Litwin, 1992; CI, 2021; Deci & Ryan, 1985; Jung, 1954).
The alignment between the semi-structured interview questions, research questions, and key
concepts from the conceptual framework is addressed further in Appendix C.
Data Collection
The 12 semi-structured interviews lasted approximately 30 minutes and depended upon
the depth of participant responses and the number of clarifying or follow-up questions asked by
myself. Interviews were conducted via Zoom©. I recorded transcription of the interviews, took
notes, asked clarifying and follow-up questions, summarized key findings, identified similarities,
themes, and gaps across interviews, and remained professional and transparent, building trust
with participants throughout the study (Merriam & Tisdell, 2016).
Data Analysis
Semi-structured interview data was analyzed using axial coding, identifying similarities
and differences across identified categories (Creswell & Creswell, 2017; Merriam & Tisdell,
2016). The coding and categorizing process was evolutionary, meaning that it evolved as the
study was being conducted (Merriam & Tisdell, 2016). I took notes while conducting interviews,
reviewed interview transcripts, took additional notes in the margins of the interview transcripts,
took observer notes to increase richness, and used the lens of the stated theoretical framework in
the functional analysis of the interview data (Merriam & Tisdell, 2016). Additionally, I remained
reflective and cognizant of similarities and differences in the data compared to the review of the
literature, theoretical framework, and other interviews within the study (Merriam & Tisdell,
2016). Researcher notes were taken but were kept separate from interview responses; however,
an analysis of my notes was included in the study's data analysis to decrease my bias. Data
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categories were named and sorted into the named categories; from there, inferences were made
about the data from the analysis (Creswell & Creswell, 2017; Merriam & Tisdell, 2016). Themes
of organizational leadership, culture, and individual employees’ needs were identified, anchoring
the research in the identified theoretical framework and the variables encompassing an
organizational model of individuation (Creswell & Creswell, 2017; Merriam & Tisdell, 2016).
Trustworthiness and Credibility
Within qualitative research, validity and reliability are collectively referred to as
trustworthiness, which is built upon the ethicality of the research (Merriam & Tisdell, 2016). In
support of trustworthiness, I adhered to all procedures and remained aware of biases;
additionally, semi-structured interviews allowed me to adhere to the procedure while enabling an
openness with participants to encourage a greater depth of sharing (Merriam & Tisdell, 2016).
Building trust throughout the research was vital for participants to feel comfortable sharing their
experiences, which were essential in answering the research questions (Merriam & Tisdell,
2016). The research underwent the process for research involving human subjects and received
approval from the University of Southern California’s IRB before participants were recruited.
Before conducting research, participants were informed of the purpose of the research and
accompanying procedures; additionally, the participants had time to ask me questions to address
any questions they had (Merriam & Tisdell, 2016).
To further increase trustworthiness, the qualitative methodology was aligned with the
research questions and theoretical framework, which was consistent throughout the research as
exemplified by the research’s conceptual guiding framework (Merriam & Tisdell, 2016).
Purposeful sampling was used to increase trustworthiness, and participants with experiences
relevant to addressing the research questions were included in the study (Merriam & Tisdell,
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2016). Participants were treated with the utmost respect throughout the research while
maintaining confidentiality to protect participants and the experiences they shared with me.
Additionally, member checks and triangulation through follow-up interviews were used to
increase the study’s trustworthiness and gain additional insight into participants’ perceptions of
their alignment with findings to increase data richness (Merriam & Tisdell, 2016).
Ethics
As a first step in sustaining ethics during human participants' research, everything from
research design to the interpretation and analysis of findings underwent rigorous metacognition
(Merriam & Tisdell, 2016). Additionally, a commitment to ethicality and morality to not harm
was practiced throughout the study (Merriam & Tisdell, 2016). Unforeseen ethical difficulties
did not arise during the study, and I maintained the moral obligation to respect and protect
participants. All of the study’s participants were provided with accurate information on the study
by which they agreed to participate (Merriam & Tisdell, 2016). I remained cognizant of bias,
disclosed within this study for transparency, and remained neutral, avoiding siding with
participants or organizations and only disclosing findings upon the study's conclusion for official
member checks (Merriam & Tisdell, 2016). Participants were respected and unexploited, and I
went through all proper procedures prior to conducting research, including passing the
University of Southern California’s IRB (Creswell & Creswell, 2017; Merriam & Tisdell, 2016).
The Researcher
I have a background in the study of behavioral health and has worked within the field but
currently has no direct ties to behavioral health organizations. However, I have indirect ties to
behavioral health organizations via connections to an active network of behavioral health
practitioners. Although I do not currently work within the field of study, I have a deep passion
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for behavioral health. Additionally, I have lived experience via the affliction of loved ones with
mental illness, drawing me to the study area. The following sections describe my positionality,
draw attention to my underlying assumptions, and describe the data sources foundational to the
study’s findings (Merriam & Tisdell, 2016).
Intersectionality refers to the collision of the multitudinous components of one’s identity
and how these identities are linked to oppression, dominance, or privilege within society
(Cooper, 2017; Van Vlack, 2021b). Within inclusion literature, a graphic represents the junction
of identities on what appears to be a horizon of dominance (Cooper, 2017; Morgan, 2018; Van
Vlack, 2021b). While this picture is applicable and appropriate, I believe the illustration
overlooks a key identity of power and oppression that affects over 56 million Americans and has
led to the current socially-realized mental health crisis in the United States (Czeisler et al., 2020;
McIntyre & Fazel, 2021; Morgan, 2018; The White House, 2021; Van Vlack, 2021b). I have an
intimate relationship with behavioral health due to personal and familial experiences of
depression, anxiety, substance use, suicidal ideation, attempts, and completions (Van Vlack,
2021b).
The have professional experience working in United States behavioral health
organizations and recognizes preconceived views about how the power dynamics of behavioral
health corporate culture and leadership can aid in maintaining the status quo while preaching
service to the people (Van Vlack, 2021b). I am sensitive to incongruence in these areas and the
hypocrisy that can generate within such fields, which is a noteworthy bias (Van Vlack, 2021b).
Additionally, I believe that increasing retention in behavioral health organizations increases
equity for those affected by mental illness due to increased access to required services (American
Psychological Association, 2021; Cohen Veterans Network & National Council for Mental
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Wellbeing, 2018; Wolff, 2017). For the current study, I intend to remain self-aware of my
preconceptions on behavioral health issues and consistently highlight the voice of the
participants and the findings with intentional objectivity (Creswell & Creswell, 2017; Merriam &
Tisdell, 2016; Van Vlack, 2021b).
Rationale for Institutional Review Board
Prior to performing the study, I received approval from the University of Southern
California’s IRB, adhering to all official policies and procedures for researching human subjects
(Creswell & Creswell, 2017; Merriam & Tisdell, 2016). I did not pressure participants to
participate in the study, nor did I influence participants' statements or research findings (Creswell
& Creswell, 2017; Merriam & Tisdell, 2016). I remained mindful of vulnerable populations,
power differentials, and intersectionality and focused on building trust and respect throughout
interactions (Creswell & Creswell, 2017; Merriam & Tisdell, 2016).
Summary
The aim of the current research is to inform retention in United States behavioral health
organizations. The current research conducts 12 semi-structured interviews of LPCs working for
United States behavioral health organizations to study the impact organizational culture and
leadership have on employees’ decisions to leave their organizations of employment.
Additionally, the organizationally lived experiences of LPCs are examined to identify themes of
employee turnover in United States behavioral health organizations.
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Chapter Four: Results or Findings
The current research addresses two research questions answered within the current chapter.
The research aims to identify ways to improve employee retention in United States behavioral
health organizations. The current research intends to address the behavioral health employee
retention problem by better understanding LPC experiences within United States behavioral health
organizations. For this purpose, the current chapter will briefly describe the participants in the
study, identify themes that emerged after data analysis and clarify the findings.
Participants
I conducted 12 semi-structured interviews with LPCs who had left a behavioral health
organization within the United States due to factors associated with organizational culture and
leadership practices. Participants were of varying ages, ethnicities, races, and sexes and worked
as LPCs within the United States. All participants had left more than one behavioral health
organization within the United States and had previously worked as Qualified Mental Health
Professionals at behavioral health organizations prior to receiving their LPC licenses.
While participants expressed varying levels of power and privilege with their associated
identities, some participants highlighted the importance of socio-economic status when it came
to the privilege of leaving a job. Several participants expressed that they had felt trapped in
previous jobs due to a lack of economic resources, which impacted their perceived ability to
leave their organizations of employment. Additionally, participants expressed interest and
determination to have their voices heard in the interviews, which I observed through their actions
and settings during the interviews. Participants took interviews on their breaks, from their parked
cars, and between seeing clients, and all participants expressed appreciation for my interest in
interviewing them to hear their stories. These experiences, observed by myself, emphasized
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participants' tenacity and dedication to improving the behavioral health field and their
willingness to do so on their own time, without extrinsic reward, as there was no financial or
otherwise extrinsic reward offered for participation in the study.
To provide greater depth to the current qualitative research, I ascribed pseudonyms to the
participants. Pseudonyms were chosen to protect participants’ identities while providing a means
of describing participants individually and retaining the personal narrative of their unique voices.
Prior to going into the results of each research question, the following section identifies the
pseudonym of each participant and provides additional context from each interview to paint a
more comprehensive picture for readers and attempt to breathe the life of the participants into the
current study’s findings.
Patricia
Patricia is a woman in her early 30s and prior to leaving her last organization, she had
worked at the same behavioral health organization for almost five years. Patricia had worked in
several different roles throughout her 5 year tenure, the most recent role was as a LPC. Patricia
was calm and reflective when she spoke. She verbalized that she had a lot of anger towards her
previous company because of the way they had treated her, but her anger was not observable in
the interview. What did come out in the interview was her care, the deep care and responsibility
she felt for her patients, and her wish that things could have been different. Patricia seemed
disappointed throughout the interview, like she had been let down by a company she had given
five years of her life to.
Patricia explained that she had stayed at the company for so long because she kept
thinking that it would change. She had felt “dismissed, undervalued, controlled, used, and
burned” until she had nothing left to give, but Patricia continued to give leaders at all levels
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feedback on how she felt and she held out hope that someone would eventually listen. As
Patricia spoke about her time there, a deep sadness came through when speaking about her
patients, she felt they would always be the ones to lose the most, unless the behavioral health
system began to treat employees differently. Patricia described her time there like a bad
relationship, one you keep holding out hope for until you finaly get to the point where you say “I
just can’t take it anymore.”
Tammi
Tammi is a woman in her late 30s to early 40s and described two behavioral health
organizations during her interview that she expressed she felt anger towards. When interviewing
Tammi, anger did not come across; however disappointment was palpable. Tammi took the
interview from her kitchen table and would have to pause from time to time as she tended to her
two dogs, Roscoe and Benni. Tammi explained that she had been in client meetings all day and
the dogs were in need of some attention. Tammi would apologize for the dogs’ interruptions as
they occurred, taking a few minute pause at one point to feed them. It was clear that Tammi had
a full plate, but she expressed that she wanted to share her experiences in the hopes that someone
else might benefit from it. Tammi hoped for change and said she knew that the best way to keep
things the same is to not say anything at all and the interview was Tammi saying something.
Tammi had been in behavioral health pretty much her whole life. She had worked in the
field since she was a teenager, working in various roles at different times until she completed her
hours and became a LPC. Something that stood out about Tammi was her heavy understanding
of the privilege she felt she had in her roles. In describing the organizations that Tammi had left,
she emphasized that “lots of people feel rightfully trapped in their jobs and have to put up with
the way they are treated due to lack of other options.” Tammi made a point to recognize her
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privilege in this area, addressing the high turnover in behavioral health, she said she felt it would
be a lot higher if people in those positions did not feel so trapped by lack of options. When
speaking of the experience of feeling trapped, Tammi addressed the intense responsibility that
LPCs feel for their patients, especially when working in government programs where there is
high demand and an increasingly limited supply of clinicians. As a LPC, Tammi said she felt she
gave all of herself to her work and her clients, but could no longer feel like she was sacrificing
her own wellbeing by working in organizations that chewed her up and spit her out.
Brooklyn
Brooklyn is a soft spoken woman in her late 20s to early 30s who expressed great
appreciation and gratitude for being able to participate in the study. Brooklyn took the interview
from her car, in a parking lot outside of the clinic she currently worked for. Brooklyn explained
that she was on break, which was the only time she had for the interview. Brooklyn had spent
most of her professional career working for the same behavioral health organization. Like other
participants, Brooklyn said that when she began observing leaders acting in ways she did not
agree with, she provided feedback and hoped things would change.
Brooklyn described feeling trapped and not having a lot of options for work when she
first began as a LPC, which was why she remained at the same organization for over six years.
She also made several mentions of her colleagues and the support her small team had provided
her, which helped her get through her toughest days. Brooklyn had a high tolerance threshold
when it came to her jobs, partly because of her own self-image. Brooklyn felt like she was
looked over consistently as an introvert and feared it had a negative impact on her ability to find
jobs because she felt she did not stand out in interviews. However, one unethical experience with
a supervisor flipped a switch for her, and from that day forward, Brooklyn knew she had to leave
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the particular organization that had been employing her. Brooklyn appeared calmly frustrated
when describing the experience, like it was something she was still grappling with and working
to accept. She was working for a new organization now, one that made her feel respected and
valued, but in reflecting on her experiences at the organization she had left, it became apparent
that there were painful feelings that remained in the aftermath of her time there.
Simon
Simon is an energetic individual in their mid to late 30s who identifies as non-binary.
Like other participants, Simon had worked at a behavioral health organization for several years
before leaving to start their own clinical practice. Simon appeared reflective throughout the
interview and exuded passion at several moments as they descrived the “need for change” within
the field. Simon was specific in identifying what they saw as the culprit for the high turnover in
behavioral health and they thought it was “the top-down” leadership practices and “disrespect for
employees that they had experienced throughout their tenure.” Simon did not say they were
angry, but a subtle anger did come through in their interview.
Like other participants, Simon had worked in several positions throughout their tenure in
behavioral health; however, Simon was unique in that they had worked in clinical and non-
clinical positions and stated they had tried to bring a cross-functional perspective to their roles,
but felt continually “shut down and dismissed” by leaders. Simon has an activists nature, taking
any opportunity to raise the voices of their clients and colleauges while doing the hard work of
counseling within government crisis services. Simon takes pride in taking a stand and felt it was
their responsibility to have their voice heard so that there would be hope for changing the future
of work in behavioral health. Simon highlighted that the voices of LPCs are frequently
overlooked, even within the field of behavioral health itself and they expressed feelings of
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encouragement in having the chance to share their lived experiences to shed light on the
employee experience of LPCs.
Lanea
Lanea is a woman in her late 20s to early 30s. When being interviewed, Lanea brought
attention to the years of school, clinical practice hours, and dedication that it takes to become a
LPC, which she thought should warrant some acceptance of competency and professionalism.
However, in her experience, she felt these characteristics had been missing from the behavioral
health organizations she had left and spoke of feeling “replaceable.” Lanea works with jailed
populations loves the support she is able to provide people that she feels are frequently
overlooked within the field of behavioral health. Lanea also spoke of the personal challenges she
has experienced trying to have a life outside of work, making sure she is maintaining her
continuing education for her license, dealing with work politics, and having an overwhelming
caseload. In spite of these challenges, Lanea clarified that the work she does is worth it all, and
she would not change the population she serves for anything.
Lanea made it through school on her own; she worked full-time throughout her schooling
and did her best to pay her way, but like many others, Lanea took out student loans to pay for her
undergraduate and masters degrees and frequently felt burdened by the debt. Lanea explained
that it is challenging at times to make it by financially and that she would make more money if
she opened her own clinical practice; however, Lanea did not want to leave the jailed populations
she served. Lanea felt like her work mattered, especially serving a population she described as
highly overlooked and while Lanea expressed she would love to be paid more for the work that
she does, serving a population she is passionate about means more to her. Lanea’s one wish for
her contribution to the current study was to bring attention to the importance of treating
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employees with dignity. Good clinicians, according to Lanaea, treat their clients with dignity and
support them by helping them reach for the tools necessary for their continued growth as
individuals in some of the most challenging of circumstances. Lanea believes this same dignity
and support should be provided by organizations to the clinicians who are on the ground doing
some of the most challenging work in behavioral health.
Amanda
Amanda is a woman in her early to mid 30s who left public service in behavioral health
organizations to start her own private practice. Amanda spoke of her frustrations at the
organizations she had left, but like other participant interviews, the disappointment and sadness
was palpable. Amanda had left public service after getting married and shared that the workload
and high stress of working at her previous organization of employment had put strain on her
relationship and her hopes of starting a family. When Amanda had been single, she explained
that she had given more of her life than she had realized to the demands of public service, which
became more apparent to her after marriage. Amanda felt finding balance would be nearly
impossible if she stayed within her role because her job had felt unforgiving when it came to the
flexibility she felt she needed to raise a family.
Amanda was clear during the interview that she had personal and professional goals and
clarified that part of the reason she felt it was necessary to address their intersection was due to
caregiving and personal needs remaining largely unadressed in organizational cultures, even
those that “preach inclusivity.” Amanda was an advocate for diversity, equity, and inclusion
work and found that her time in public service was incongruent when it cames to words and
actions in this area. Amanda described her time working at a behavioral health organization that
prided itself on being “inclusive,” but when she and her partner had decided to start a family,
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Amanda felt unsupported and expressed feeling that the organizational culture was forcing her to
choose between a family and her career. Ultimately, Amanda did not choose one or the other, she
chose an option that worked for her needs, but her presence in the interview showed the weight
of the decion to leave public service to achieve her goals. Amanda explained that “life is about
choices” and choosing her and her family is a decision she made without regret; however,
Amanda wishes she had never been put in a situation where she “had to choose at all” between
her own wellbeing and having the ability to remain in public service.
Ryan
Ryan is a male in his late 20s to early 30s. Ryan took the interview from the car while his
partner drove so they could go hiking. Like many participants, Ryan expressed the desire to be
included in the research and share his experience, but also mentioned that he has very little time,
so the drive to the hike was the only way he could make the interview work. Ryan has worked in
behavioral health for several years and shared many ideas on how to “streamline process” and
build partner relationships to leverage contracted work to decrease LPC caseloads while
increasing clients’ access to services. Ryan was hungry to make the behavioral health system
function more efficiently and he felt the way to do so was to listen to what the people doing the
work had to say, which he shared was his rationale for joining the current study.
Ryan left his previous behavioral health organizations because of his frustration with
feeling like he was not being heard. Like many others, Ryan had voiced his concerns, opinion,
and even proposed solutions to the problems he had observed, but Ryan found the lack of action
on the part of leadership to be disheartening. Ryan is someone that is fascinated by process and
innovation and said he did not feel he could thrive or grow in the environments he had
previously been in because they did not seem interested in progressing forward, they seemed
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more interested in the politics of maintaining the status quo. Ryan expressed hope in sharing his
unique ideas for change in behavioral health by means of the current study to support increased
innovation within the field to encourage greater employee retention.
Ellen
Ellen is a lighthearted woman in her early to mid 30s. Ellen joined the interview on her
personal computer while in a work call on her work computer. Ellen had herself on mute while in
the work call and explained that she had been trying to “do all the multitasking” and that her
“team meeting went a bit over on time” but it was important to her that she did not miss the
interview for the current study. A few minutes later, Ellen’s Amazon Alexa began going off and
she had to ask it to stop. Ellen apologized again for the work call and the disruption of the timer,
but explained that it was the only way she would be able to keep track with all the things she had
going on in her life. Busy was an understatement for Ellen and it was clear that she was using all
the tools and tricks she knew how to hold herself accountable for all her life tasks.
Ellen spoke of the incredible need for the current study and hoped that her lived
experiences could prove helpful because she felt there is “a long way to go in behavioral health
for employees.” Ellen was fun and energetic throughout the interview, making lighthearted jokes
about the overwhelm of her caseload and how amazing it is that she is even able to function at
all. Ellen emphasized the manipulation she experienced at previous behavioral health
organizations by means of leadership and described some of the cultures as “disconnected.”
Ellen expressed her hope of drawing attention to the employee experience because she felt that
LPCs voices were rarely considered in the frequent conversations on turnover and retention
among behavioral health’s leadership.
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Cam
Cam is a woman in her late 50s to early 60s. Cam has worked in healthcare for over 30
years and worked as a LPC for more than 10 years. Cam described the ways in which her
perspective had changed throughout her tenure and the phases of her life. Cam said she used to
be a lot angrier, but she had grown to accept the challenges she saw in behavioral health for her
own sanity. Cam described “fighting the system as too hard” and said she would have become
bitter if she had not learned to work within the parameters of the “broken system” to find ways of
improving it, no matter how slowly the needle moved. Cam spoke of her faith throughout the
interview and highlighted its importance in keeping her grounded and stable while remaining in a
field that can “take everything from you” with very little organizational thanks.
Cam, like many participants, was drawn to behavioral health because of her value for the
work and the populations she was serving. Cam went to nursing school originally and decided to
become a LPC after seeing firsthand the increase in patient comorbities when behavioral health
challenges were present. Cam defined leadership at one of her previous organizations as
“corrupt” and made several mentions of the “political game” she had experienced during her
tenure. Cam’s hope for the future of behavioral health was a refocusing to “see clients as people
instead of numbers” and for organizations to acknowledge that taking care of employees is
essential for providing the highest quality of patient care.
Robert
Robert is soft-spoken man in his late 30s to early 40s. Rober took the interview from his
place of work and apologized at the start for running a few minutes late. Robert explained that he
had been in sessions with clients all day and the last session had gone over on time. Robert had
to move twice during the interview to take his laptop to a more quiet and private location due to
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limited space at his office. Robert came across as reflective and articulated that he had time to
process since he had left his previous organization, which allowed him to be less angry and have
more distance from the experiences that had caused him to leave in the first place.
Robert specifically pointed to “toxic” experiences with one of his previous supervisors as
being the main reason for his departure from the company and was able to clearly articulate his
experience of incongruence between the organizational culture and leadership practices. Overall,
Robert described organizations that he felt had the intention of cultivating a supportive fulture,
but highlighted that they had failed to do so because of lack of process for accountability and
feedback. Robert hoped that his personal experiences in an unhealthy work environment could be
useful for organizations so that “nobody else had to go through” some of the things Robert had
experienced while working for behavioral health organizations in the United States.
Jose
Jose is a man in his late 40s to early 50s. Jose worked in behavioral health organizations
across the United States for 20 years before he left the field entirely. Jose explained that his
passion for behavioral health stemmed from his own experiences of it and that he loved the work
he was able to do as a LPC. Ultimately, Jose left the field to prioritize his own health as he felt
that he could not do so while working for the organization employing him. Jose wanted the
stability of working for an established organization, which is why he never explored starting his
own private practice, and he spoke with sadness as he reflected on how he had been let down by
a field that meant so much to him.
Jose left behavioral health to work in operations for a software company, which he
appreciated because it gave him the time and flexibility to focus on his own wellbeing. Jose
described some of the challenges of the work that LPCs do in their day-to-day, saying “we deal
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with all kinds of people with varying levels of mental illness in all kinds of settings and we have
our own lives and workplace experiences that add onto that.” Jose described feeling unsupported
by his supervisor and feeling as though he had exhausted all avenues of feedback and did not see
anything changing, so he left. Jose elaborated on why he chose to leave the field, saying “with
the number of years I have spent in behavioral health, I had the chance to see different workplace
cultures and ways of managing and honestly, I feel the field itself is lacking in some major areas
when it comes to supporting employees.” Jose hoped that his experiences could be used to
encourage change within the field, saying “I hate to see passionate people like me find new fields
to work in due to things that I think could have been solved.” While Jose does not see himself
going back to the field, he does hold hope that things will improve and get better so long as
executive leaders in the industry begin to “wake up” and use their power and sphere of influence
to create real change.
Bill
Bill is a man in his late 30s to early 40s who is extremely driven towards personal and
professional growth. Bill works as a LPC at a public behavioral health organization and when he
is not with his family, he is attending continuing education courses to build upon his current
counseling practice. Bill has two young children at home and took the interview from the kitchen
table. Bill apologized for a few interruptions as he shared that his youngest, Analisa, was not
feeling well and had been fussy all day. Bill clarified that he fortunately had the flexibility at
work to be able to tell his supervisor that he needed to work from home for the day. Bill’s wife,
Clara, also worked in public service as a schoolteacher and had less flexibility in her job. Bill
said he thought about leaving his current organization frequently, but the one thing stopping him
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was all that was going on in his life and the few times where he was able to work from home
when it was a family need.
Bill has hopes of opening up his own private practice and explained that it is part of the
reason he feels so motivated to continue taking continuing education courses beyond what is
required for his license. Bill has been weighing the pros and cons of leaving his current
organization and he and Clara have decided that it makes more sense for him to stay until they
feel like they are at a place financially where he can open his own practice. Bill does not feel he
has the bandwidth, with he and Clara working full time and the two little ones at home, to start
over at a new organization. Bill has worked for his current organization for the last five years and
his primary reason for staying has been his family. Bill shared that he would like to contribute
his experience to draw attention to an aspect of life that he feels is not discussed enough in the
field of behavioral health, the impact of responsibilities outside of work on employees’ decisions
to leave. Bill feels that more employees would leave their organizations if they felt they were in
positions in life where they felt they could do so and he believes that a big contributing factor is
the responsibility of caregiving.
Participant Summary
The 12 participants for the current research came from a variety of backgrounds and
identities. Participants included men, women, and non-binary individuals, some were single,
married, and each had varying levels of caregiving commitments outside of work, which was
articulated in several interviews. Something that remained consistent across interviews was the
passion that each participant had for the field of behavioral health and the determination to have
their voices heard. An area that stood out was the alignment across participant responses
regarding their interest in joining the study, all participants mentioned an element of hope for
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change within a field that clearly meant a lot to them. Additionally, it became apparent during
the interviews that participants had extremely busy personal and work lives, regularly providing
services to extremely challenging populations; however, without any compensation or externally
motivating reward, each participant made being present in the interview and responding
thoughtfully to the questions a clear priority. This begs the question, if behavioral health
organizations found a way to support the needs of employees to deter even their most passionate
LPCs from wanting to leave, what would the field of behavioral health look like?
Results for Research Question 1
The first research question inquired about the impact leadership, and organizational
cultures have on employee retention within United States behavioral health. In answering the
first research question, the following themes appeared in participant interviews on organizational
culture: autonomy, feedback, employee-centered, and authentic. Regarding leadership practices,
participants identified the following themes: emotional intelligence, accountability, and
transparency.
Autonomous Organizational Culture
With an organization's culture having a significant impact on enacted employee behavior,
the research analyzed 12 LPC responses to semi-structured interviews and identified the
following themes: autonomy-supportive, feedback-focused, learning and development-centered,
employee-centered, and alignment of words and action as positively impacting participants
decisions related to organizational retention.
All participants identified autonomy as necessary for retaining employees in behavioral
health. In autonomous environments, participants expressed increased job satisfaction and
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decreased turnover intention. Participants characterized autonomous environments as
empowering, flexible, transparent, accountable, trusting, and open to feedback.
One of the main themes that stood out from participant interviews as a primary
characteristic of autonomous cultures was employee perceptions of work environments high in
trust and low in control. In these environments, LPCs expressed feeling more satisfaction in their
roles. In addition, environments high in trust and low in control increased LPCs’ perceptions of
feeling valued and respected, which empowered LPCs and heightened their self-efficacy. In
addition to decreasing feelings of competence and trust, high control environments negatively
impacted employees motivation and feelings of wellbeing. As Tammi put it, “I can’t function
well in environments where I’m micromanaged and there isn’t a lot of trust in who I am as a
clinician…I need autonomy to be able to enjoy my work life.” Similarly, Ellen highlighted her
need to feel empowered to make decisions and emphasized the importance of empowerment in
providing good clinical care. Ellen described the lack of autonomy she experienced at one of her
previous organizations as “painful” and clarified the negative impact it had on her wellbeing,
which decreased her ability to provide the best care to her clients.
What is more, communication builds trust and empowers teams, further increasing
feelings of autonomy and intentions to stay. Participants characterized healthy communication as
constructive, collaborative, and supportive of reciprocal feedback. In environments with healthy
communication, participants perceived increased autonomy, support, and self-efficacy. In
addition, participants identified autonomous environments to be receptive to questioning, which
they found to increase their ability to advocate for their clients to increase positive patient
outcomes.
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What is unique about behavioral health when compared to other fields, even in
healthcare, is the complexity within which clinicians regularly operate. In particular, all of the
LPCs interviewed had experience working in crisis services at one point or another during their
career. During interviews, most of the participants described at least one experience where they
felt their lives had been in danger while providing services to a client. One noteworthy
characteristic of these participant descriptions was the lack of care they felt from their
organizational cultures when reaching out for support in the aftermath of these traumatic
experiences.
During Patricia’s interview, she opened up about an experience she had while working in
crisis services where a man was in the middle of a schizophrenic episode. While she had been
trying to deescalate the situation, a police officer called on scene had accidentally agitated the
man, leading the man in crisis to break a mirror nearby and grab a large shard of glass and hold it
at his neck. After several hours, they were able to calm the man down enough for him to release
the glass and be taken into emergency services. However, when Patricia spoke with her team
lead later that day, her manager continually highlighted how Patricia was behind on her daily
quota. When sharing the experience, Patricia still seemed shocked that her manager felt it
appropriate to mention her quota at all during the debrief. Patricia perceived this conversation
with her manager to be unhealthy, damaging their work relationship and negatively impacting
her decision to leave the organization where she had worked for several years. As Patricia
described it, “that creates a scary environment … nobody wants to work in an environment like
that, it just isn’t sustainable.”
Similarly, Simon shared of an experience they had while working with a “trouble-client”
who had already been reported several times for inappropriate behavior. In this particular
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instance, the patient had made several hateful remarks regarding non-binary individuals, a
community within which Simon identified. When Simon reached out to their manager to discuss
how to best move forward with the client, Simon felt blamed rather than supported. As Simon
put it, “it was the complete lack of empathy and compassion … it wasn’t about the work or the
people, it was about the numbers and that became clear to me.” Like, Patricia, Simon felt
abandoned by their manager during a time when they needed support, which decreased their
internal motivation and job satisfaction and increased their desire to leave their organization.
Participants described a lack of autonomy in their work environments as partially
characterized by leaders not trusting employees to do their job; however, these participants also
identified that leaders in these controlling environments frequently lacked the education or
professional work experience to fully understand the work the LPCs were doing. Disconnect
between clinicians and managers evolved as a sub-theme within autonomy throughout the
current research, as leaders’ lack of experience, either in management or clinical practice,
increased participants’ frustration, decreasing their job satisfaction and increasing their intentions
to leave. Further analysis of these findings on participants’ experience of disconnect from leaders
is in the leadership section.
Additionally, participants identified unstructured environments, where managers were too
laissez faire, as unsupportive, disconnected, and expressed increasing strain in their roles when in
such environments. In Ellen’s interview, she described feeling like her ability to do her work was
inhibited by the “hands-off approach” of her organizational culture. Although the organization
emphasized their “flexibility” as a benefit of their culture, Ellen characterized it as disorganized,
unsupportive, and confusing. Ellen described flexibility as knowing when to bend the structure to
support employees and their work but said the organization she left did not have enough
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structure to know what was there to bend in the first place. Ellen described the organization to
lack top-down management, which she and several of her colleagues experienced as a complete
lack of accountability at all levels. As Ellen put it, “people weren’t being held accountable. I
don’t know if it was a lack of training, or experience, or what, but that was really frustrating.”
Nevertheless, even in environments where participants felt accountability was lacking, or
leadership lacked the appropriate experience to properly support employees and make informed
decisions, participants highlighted the importance of openness to feedback as having significant
influence on their experiences of job satisfaction and turnover intentions. In environments
perceived as open to feedback, LPCs experienced greater autonomy, even when supervised by
managers with controlling tendencies. These findings emphasize the importance of feedback for
autonomous cultures and signal the potential mediating impact of openness to feedback on other
factors of autonomous culture.
With most participants identifying feedback-focused culture as being central to
autonomy-supportive environments, feedback emerged as a key variable for participant retention.
Feedback-focused is contained as a theme in the organizational culture section of
transformational factors due to consistent participant statements on the importance of feedback
as a culture for successful employee retention, rather than a practice of individual leaders.
All participants emphasized the importance of having the opportunity to provide feedback and
feel heard as positively impacting employee retention due to increasing LPC perceptions of
autonomy and feelings of value. However, several participants identified their organizations as
supporting a culture of constructive feedback, but only for those holding certain levels of
hierarchical power. Participants identified a disconnect and contradiction between the feedback
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they were provided and the feedback they could reciprocate, expressing feelings of an
unbalanced manger-employee feedback relationship.
Several participants signaled a lack of formal process and policy for “bottom-up
feedback” as a problem and barrier to employee retention. Interestingly, participants explicitly
called for a “formal process” for feedback due to too many personal experiences with leaders
who did not solicit feedback. The interviewed LPCs had been “burned” too many times and no
longer trusted leaders to be responsible for their own feedback process. These findings
corroborate the need for structure within autonomous organizational cultures, which on the
surface may sound somewhat contradicting. However, the current research has highlighted the
potential mediating impact of feedback on autonomy and participants clearly articulated the need
for formal process to ensure consistency. Additionally, in environments with a structured means
of providing feedback, LPCs perceived feedback to be part of the organization’s culture rather
than leaders’ personal preference.
When describing the need for a formal feedback process to support LPC retention,
Robert’s interview stood out. Robert had tried to provide feedback to his manager on several
occasions, always to no avail and frequently accompanied by retaliation against him. Robert
explained that this led him to choose his “battles” carefully. However, on this particular day,
Robert had observed his manager handling a client situation in what he described as an “ill
advised and maybe unethical” manner. In such a situation, Robert felt he was morally obligated
to share his observation and provide feedback, which he felt was met with “passive aggressive”
and “demeaning” behavior. As Robert put it, “I may have been more likely to stay if the
organization had a process for me to escalate issues … then I would have had some form of
accountability to rely on … like something official to back me up.”
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Similar to Robert, Cam also pointed to the need for a formal feedback system and
described a situation in which she had been put in an uncomfortable position by an executive
leader. However, Cam went a step further and identified specifics of what such a system might
encompass. Cam clarified that she had worked for organizations where they did comprehensive
annual reviews on managers and provided employees the opportunity to give feedback, but said
such a process was not enough. Cam highlighted the need for employees to have multiple
avenues of feedback and for the organization to talk consistently and often about the benefits of a
feedback-culture. Cam emphasized that LPCs not only need formal processes for providing
feedback but need to be empowered by the organizational culture to the point they feel justified
in providing the feedback. However, Cam did see formal feedback processes as a first step “to
protect employees so that they have something to fall back on for support.”
The current findings emphasized the importance of an organizational culture of
autonomy for retention in United States behavioral health, specifically, LPCs highlighted
employee feedback as being central to building autonomy. Additionally, all participants
expressed the desire to feel valued by their organizations and identified another level of
disconnect between clinical treatment of patients and organizational culture; the findings of the
current research examine the person-centered disconnect described by participants next.
Employee-Centered Culture
Participants identified employee-centered cultures as positively impacting employee
retention in behavioral health; characterizing these cultures as authentic, inclusive, valuing of
employee needs, and encouraging employees to bring their authentic selves to work.
Additionally, organizations that embody person-centeredness have positive impacts on patient
outcomes, according to participants. However, while participants highlighted their appreciation
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for the person-centered model when it comes to clinical treatment, participants identified a gap
between the person-centered treatment of clients and organizational treatment of employees.
Participants frequently highlighted the feedback disconnect as an example, describing instances
where their organizations of employment regularly elicited feedback from clients on the clinical
practice of LPCs, without providing reciprocal procedures for employees to provide feedback on
leaders. Participants associated this experienced disconnect with organizational culture and
described the negative impact it had on LPC retention in United States behavioral health
organizations.
Participants emphasized the positive impact of reciprocal feedback on employee retention
in two ways, increasing feelings of autonomy as identified in the previous section, and
influencing feelings of congruence in person-centered behavioral health organizations. The
current research notes the significance of feedback coming up with great frequency from
participants; however, due to addressing the impact of reciprocal feedback on employee retention
in the previous section, the current section moves the findings forward by focusing on additional
aspects of organizational culture impacting LPC decisions to leave.
Organizational cultures perceived as business-centered, rather than employee centered,
negatively impacted participants’ motivation and job satisfaction. Participants identified
business-centered environments as transactional, political, lacking empathy, authenticity, and
being primarily concerned with metrics, sometimes to the detriment of employees and clients.
Participants emphasized that many of their organizations of employment identified as client-
centered or person-centered but highlighted that their agency’s client-centered terminology was
used almost synonymously for business-centered practices.
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Several participants used words like “dishonest” and “unethical” when describing their
organization’s culture. Robert called out one of his previous organizations for claiming to be
client-centered while acting in ways that were not beneficial for clients. During the interview,
Robert addressed the disconnect he experienced within his agency’s culture and spoke to the
impact it had on his decision to leave. In this particular situation, the government funded
behavioral health organization employing Robert had a program that was bringing in a lot of
money for the organization. Due to this, management urged clinicians to stop discharging clients
from the program to increase the reported numbers of attendance for higher funding. Robert
described the experience as “unethical and not in the best interest of the client.” Robert went on
to say, “it was a weird authoritarian culture of dishonesty and politics and there wasn’t a way to
talk about that or change that, that’s why I left.”
Like Robert, Lanea also believed one of her previous organizations had a broken moral
compass, albeit for different reasons. During Lanea’s interview, she continued to emphasize the
lack of authentic care she believed her organization of employment to have towards clients.
Lanea believed that any organization that cared about clients would take a 30-60% turnover rate
among LPCs as a signal that something was broken and in need of repair. Lanea described LPCs
as being central to client success within many of her organization’s programs and stated that her
organization failed to pay enough attention to why the employwees were leaving, which Lanea
felt was an oversight. Lanea, similarly to other participants, had voiced her concerns and offered
not only perspective but proposed solutions to mitigate the excessive turnover within her
department. However, despite her best efforts to be heard, Lanea never observed any
organizational action and turnover continued along with the increased strain her and her
colleauges experienced as a result. As Lanea put it, “I know so many people who have left and
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nothing has changed, so I don’t really think they care. If they cared about their clients, they
would care about maintaining their teams and they just don’t seem to care.”
Cam also drew attention to the primary focus on revenue as an issue within her previous
organization’s culture. Not unlike other participants, Cam made several mentions of her
organization caring more about the “numbers” than helping the clients they were there to serve.
Similar to Ellen, Cam referred to her realization of her organization’s lack of care for clients as
“painful to watch” and described feeling “helpless” in her position. Cam acknowledged that her
role as a LPC was to support her clients and advocate for their best interest to the organization
that was employing her. However, Cam said there existed a “huge disconnect” between the way
the organization was viewed by the public and the way it realistically operated, which included
the ways in which the organization treated its employees. Cam had personal reasons for leaving
the organization, but showing up everyday to work and feeling like she was “living a lie”
because of the business-centered priorities of her organization made leaving that much easier.
Additionally, participants frequently characterized their organizational cultures as
“political.” When describing the politics at Amanda’s most recent organization, Amanda went on
to say“it always felt like we would sacrifice doing the right thing for playing the political game”
and that she felt like the organization itself was getting in the way of her doing her job. Amanda
encapsulated the frustration of the overall experience working at the organization as continually
feeling like “losing an endless battle.”
What is more, participant responses highlighted a significant gap between the espoused
and enacted culture within their organizations, which leaders claimed were “person-centered.”
Patricia pointed to this gap while discussing employee engagement surveys conducted by one of
her previous organizations. Specifically, Patricia emphasized the language that was used by the
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human resources department when sending out the surveys. Patricia shared that phrases like
“your voice matters” and “we want your feedback” were used regularly when promoting the
surveys, but regardless of the messaging, Patricia never felt supported in providing honest
feedback. After all, Patricia had first hand experience of being treated passive aggressively and
receiving punitive action after providing honest input on her department. The results of the
survey were anonymous, but on small teams it was not impossible to figure out who might have
said what.
Additionally, although Patricia described it as “inappropriate” managers would frequently
address the comments people left in team meetings blamingly, making it very uncomfortable for
the person that spoke up. Collectively, these experiences made Patricia feel like there was no
point in speaking up, she did not think things would change and she did not want to cause more
of a problem for herself at work. As Patricia said in her own words, “they knew we were upset
and that there was a problem, but it was just like this elephant in the room … I was too scared
anything more I said would be used against me and I needed that job.”
Moreover, participants emphasized the organizational maintenance of historical systems
of power, which they felt were antithetical to person-centered, client-centered, or employee-
considering cultures. Several participants acknowledged the trend within behavioral health to
become more inclusive, which they felt was constructive. However, participant responses
acknowledged the threat that the lack of employee-centered culture poses to inclusive work
environments and the overall field of behavioral health in the United States.
When interviewed, Brookly and Simon both shared experiences where their previous
organizations had publicly announced a focus on diversity, equity, and inclusion initiatives
across departments. Their organizations had supported these announcements in various ways,
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primarily with events and professional development opportunities featuring guest speakers on the
topics. Brooklyn shared that she rarely had the time to attend these events, which was already an
issue with the initiative, as they scheduled them during her working hours and her manager had
told her their department was too short staffed for her to be able to attend. Unlike Brookly,
Simon had at least been able to attend events, but they felt the presentations fell short due to their
lack of applicability to clinical practice. As Simon put it, “all they cared about was the theoretical
… they seemed to be trying to use the same tactics they always used to dig us out of the hole we
were in., it wasn’t going to work, it never worked.”
During Tammi’s interview, she shared about a particular experience that sparked a lot of
anger and resentment towards her previous organization. Tammi had worked at her previous
organization for several years and had seen them grow throughout her tenure. However, as they
grew, problems ensued due to a lack of advocation for resources in departments Tammi now sees
as fundamental to the ethical functioning of business, like human resources. Tammi explained
that she had witnessed the mishandling of a colleague’s time off due to pregnancy and what
Tammi called “discrimination” upon her colleague’s return from parental leave. Tammi admitted
that the presence of an established human resources department does not guarantee the fair and
just treatment of employees, but according to Tammi, “it sure does help.”
Interestingly, Bill had a different story to tell regarding his experience with parental leave
at a much larger behavioral health organization. Bill had previously mentioned in his interview
that income stability and scheduling flexibility had been one of the main reasons he had stayed at
his organization because of having young children at home. However, Bill did say that he felt his
identity as a man made it easier for him. He had seen women take parental leave and return to
work and heard the way they were spoken about, like having a child would inevitably impact
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their ability to do their job well. Although Bill could not be sure, he shared “I doubt they talk
about me like that, even behind closed doors.” Bill emphasized that he was never made to feel
like having a family was a problem for his professional life, but could not say the same for some
of his female colleagues.
Ryan also had experiences to share regarding the equitable treatment of employees that
he characterized as being central to a person-centered culture. Although Ryan had a different
perspective to share than Tammi and Bill. Ryan was not a parent, nor had he directly witnessed
any discrimination against coworkers but he did think a lot about the use of public resources and
the ways they were “inefficiently” used. Ryan felt one of the quickest ways to decrease
productivity was to make people feel uncomfortable at work and he felt a lack of inclusivity
created environments where people did not feel empowered to be themselves. Ryan aligned with
the business case for inclusivity and highlighted how much more efficient and productive he is
within his own role when he feels like he can be himself. Ryan called out a “huge miss” of
diversity, equity, and inclusion work within behavioral health, stating that it has not been made
clear enough that belonging and inclusivity support everyone, regardless of identity.
Alongside employee-centeredness, participants continued to speak to aspects of
authenticity as being central to an organizational culture they would find appealing for employee
retention. Specifically, participants described the lack of authenticity they experienced within
their organizations as a key piece in their decisions to leave. Thus, authentic cultures emerged as
a central theme to an employee-centered culture, which participants described as increasing their
motivation, intentions to stay, and job satisfaction.
Participants identified authentic organizational cultures as an influencer of their job
satisfaction. Specifically, participants expressed their inability to show up as a whole person in
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inauthentic cultures and described the negative impact these experiences had on them,
identifying these cultures as unhealthy and exhausting. In Jose’s interview, he emphasized the
importance of authenticity within organizational culture, highlighting the need fo leaders in
authentic cultures to express genuineness and give employees permission to show up
authentically. Jose shared that he did think things could have turned out differently for him had
he been in an organizational culture that embraced the totality of who he was as a person,
including his own personal experiences of behavioral health. Before leaving the behavioral
health field entirely, Jose had tried to provide feedback on what he had been experiencing within
the organization’s culture, but he felt there was “no place for it” so instead of wasting his energy
trying to improve things, Jose used that energy to find a new job. As Jose put it, “I couldn’t stay
in an environment where I felt like I continually had to betray myself to fit in.”
Participants emphasized authenticity of leadership as playing a role in their decisions to
leave or stay at behavioral health organizations and described authentic cultures as being
characteristic of employee-centered organizations. Participants characterized authenticity as a
genuine caring for employees’ well-being, transparent communication, and honesty. However,
when describing authentic cultures, participants frequently spoke of leaderships’ impact and used
examples of leaders’ practices when pointing to experiences of inauthentic cultures. Therefore,
the current research identifies accountability and transparency of leadership as a key theme for
effectively creating authentic cultures for employee retention; these findings are elaborated on in
the next section on leadership.
Emotionally Intelligent Leadership
Participants identified the following characteristics of leadership as positively influencing
employee retention and job satisfaction in United States behavioral health organizations: genuine
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care for employees’ personal and professional lives and development; power to influence action
through the inspiration of motivation; individualized consideration; and fostering belonging.
Participants perceived leaders exhibiting these characteristics to be just, ethical, encouraging of
creativity, courageous in constructively challenging the status quo, and respectful of individual
employees’ needs, embodying the person-centered model towards employees and seeing them
through a more holistic lens. Moreover, when leaders lacked these qualities, participants
identified leadership as a significant problem in their organizations, highlighting aspects of what
they described to be toxic leadership and the negative impact it had on employee retention.
Participants emphasized a lack of emotional intelligence exhibited by leadership and the
impact that had on their decisions to leave organizations. Participants in environments perceived
to be emotionally intelligent were more inclined to stay, while participants in environments they
perceived as lacking emotional intelligence were more inclined to leave. In Lanea’s interview,
she described a situation with her manager where she felt uninspired and unsupported. Lanea felt
confident genarlizing this one experience as indicative of the overall culture due to the frequency
in which this type of behavior was exhibited by middle management. Lanea spoke of middle
managers within her department as being “checked out.” The large behavioral health
organization she referenced was frequently used by LPCs as a jumping off point for their careers
because they could earn their LPC hours underneath a supervisor without having to pay for the
supervison out of their own pockets. As a result of this, Lanea described managers as
“disconnected” from their work and from the employees they were in charge of supervising,
which Lanea blamed on a lack of organizational “incentive to care.”
Lanea spoke of one incident in particular that she felt encapsulated her entire tenure at the
behavioral health organization, which she found to lack accountability and empathy, both
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characteristics of emotional intelligence. Lanea went on to describe an experience she had where
she went to her supervisor crying about “serious issues” that had caused some of her recent
colleagues to quit. Lanea said her manager either did not care or did not know how to care, but
from Lanea’s perspective, she found the lack of exhibited care to be upsetting, as she put it,
“we’re clinicians, how could you not know how to deal with that on at least a human level? I felt
so unmotivated and dispensable. I moved on shortly after that experience.”
With leaders being significant players for the modeling of enacted culture to employees,
all participants mentioned some level of leadership accountability as being central to LPC
retention. Specifically, participants identified a lack of leader accountability as a determining
factor in their decision to leave their previous organizations of employment. Participants
described accountability as a complement to a trusting environment, stating that accountability
plays a role in building trust and supports the reciprocity of constructive feedback between
employees and managers. Echoing findings in the previous sections, participants highlighted the
importance of accountability structures within organizations to support leaders’ ability to retain
United States behavioral health employees. In Robert’s interview, he spoke of the lack of
accountability experienced in his organization by sharing an example of an attempt to provide
constructive feedback to his supervisor and the impact it had on his decision to leave, saying:
The day I tried to confront something unethical with my boss, I realized the response, or
lack of one really, that was the biggest for me and I decided in that moment that I would
eventually leave. I had a moment of truth that day and there was no going back.Additionally,
participants highlighted that one of the barriers they see creating challenges with accountability
is a lack of experience and training. Lack of managerial training and experience was frequently
mentioned by participants; identified in the previous section on employee-centered cultures, the
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theme continued to emerge throughout the interviews. However, lack of training and experience
does not exist as a stand-alone theme in the current research due to the interdependence it has
with other themes, such as employee-centered culture and accountability. The current research
elaborates on these findings in the discussion section, located within Chapter Five.
Participants highlighted lack of training at all levels of management, including the
executive level; however, due to increased exposure to communication and oversight by middle
managers, LPCs emphasized the lack of training for middle managers in United States behavioral
health organizations specifically.Bill called out lack of supervisor training as a barrier to
accountability within his previous workplace, highlighting a need to train employees who are
promoted to management positions to support the development of new skills required for the
management of people. According to Bill:
There is a lack of supervisory training for managers and supervisors.. it seems like they
[supervisors] don’t know what they’re doing and like they just do their same [previous]
job with a different title and better pay, but still don’t know how to manage.
In addition, Amanda emphasized the lack of care for the employee experience and connected this
to a lack of training on the impact leadership has on culture. Amanda clarified that it can become
easy to assume that clinicians, who are highly skilled in hearing patients and supporting the
articulation of needs, would make great managers due to the nature of the skills required for
clinical work. However, Amanda shared that she saw many colleagues receive promotions with
little to no training, which she felt was a symptom of an irresponsible and unaccountable
organizational culture. As Amanda said:
Managers didn’t put their best foot forward when it came to supporting us and I don’t
really blame whem, I don’t think they knew how. I saw great clinicians that I thought
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would be fantastic managers go into management positions and fail, at least from my
perspective, it’s not like they lost their job or anything, but they weren’t doing a good job
as a supervisor and that was clear to a lot of us.
Amanda was not the only participant to speak of the lack of training that one of her previous
organizations provided to managers. Several participants identified lack of training as being a
significant player in what LPCs perceived to be their leaders’ inability to foster supportive
environments.
In Jose’s interview, he drew attention to a particular characteristic of leadership within
his organization, referring to them as “uninspiring.” Jose tied this lack of inspiration among
leadership to a lack of training for managers on how to be influential within their roles to
increase motivation, accountability, and experiences of employee job satisfaction. Jose clarified
that supervisors within his department were lacking in their ability to encourage people, saying,
“I think it’s really that simple.” As someone who utilized therapy himself, Jose shared that there
are many skills that people think cannot be taught that actually can be learned through consistent
practice and he believed influence to be one of them. Additionally, Jose highlighted the power of
recognizing people as human beings and the influence that genuince connection within a
workplace can have on retention. Speaking from experience, Jose shared that employees “need to
feel like they’re not just another number or cog in the wheel” to feel purpose within their work
and lives. As Jose called out, LPCs have gone into a “helping profession” to help people and
frequently they feel inspired by knowing their work has purpose. Taking that information into
consideration, Jose shared that there is nothing more “depressing” than feeling like you went into
a profession to help and having a manager that does not believe there is hope for change.
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Similarly, Brooklyn opened up about leaders’ lack of experience in the field and the
negative impact this has on employee experience, especially when combined with a lack of
managerial training. Brooklyn emphasized this lack of training and experience among leaders as
a primary contributing factor to the accountability problem she experienced when dealing with
managers in her department. Brooklyn said that it “felt like people were thrown into positions
without any support” and called it an “impossible situation” to deal with as an employee. In
addition, Tammi felt that a lack of training caused harm to employees and clients, sharing:
We experienced a lot of culturally inappropriate comments due to lack of training and
experience in the field on the part of leadership, which put clinicians in ethically
compromising positions, which has potentially detrimental consequences for us as
clinicians, not to mention clients.
In addition to highlighting the challenge that lack of supervisor training caused employees and
clients, Tammie empathized with the negative impact it had on supervisors. However, Tammi,
like other participants, did not find lack of training to be a justifiable excuse for many of the
things they experienced while working at some of their previous organizations.
Moreover, participants emphasized a lack of transparency from leadership as increasing
turnover intentions and decreasing job satisfaction. Participants associated a lack of transparency
with a lack of trust, meaning participants were more likely to perceive their supervisors as
untrustworthy when they felt their supervisors did not practice transparency in the employee-
manager relationship. Thus, the findings identified transparency as a complement to
accountability and a support for organizational cultures of autonomy, compounding their impact
on employee retention in United States behavioral health organizations.
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Participants emphasized the lack of transparency they experienced within their
organizations as being key factors influencing their decisions to leave. In Patricia’s interview,
she highlighted the impact that a lack of effective change management had on her organization
as it grew over the years. Patricia described the cultural as shifting from more of a collaborative
environment to one that was “siloed and isolated.” According to Patricia, the organization did not
have a strong enough culture among its employees to withstand the changes and her organization
lost “a lot of really good, hard-working people” as a result. Patricia felt one way to have
mitigated the negative costs of the change to the organization would have been to include
employees outside of leadership in the conversations, saying that “only people with certain titles
were included in conversations and decisions were often made without … the people doing the
work,” which Patrica saw as a significant shortcoming of the organization’s change management.
Additionally, participants highlighted their value for leaders who guide employees while
being receptive to feedback and empowering direct reports to make decisions, all while
encouraging employees to be unafraid to ask for help when needing support. Participants singled
out trust as a prerequisite to the manager-employee relationship for functional autonomy, as well
as transparency, and an organizational culture that values employee needs. Ellen described the
lack of authenticity expressed by executive leadership in United States behavioral health in her
interview and shared about the impact of executive leadership on organizational culture through
the trickle-down effect, stating:
I think the fish stinks from the head down. If you have a leader of your organization that
doesn’t care about the people that work there, then that organization, everyone in that
organization, will have the same trend and will get burned out and leave. Which is sadly the case
with every behavioral health organization and non-profit I’ve worked for.Findings of the current
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research highlight the influence supervisor transparency has on employee retention for LPCs;
however, participants identified a fine line of transparency, stating that managers need the
training and experience to know how to be transparent, accountable, and foster an authentic
culture in a way that builds trust and retains employees. Findings from the current section
corroborate findings from the previous section on autonomous and employee-centered cultures,
highlighting the interconnectedness of culture and leadership practices. Additionally, participant
interviews emphasized the importance of high trust and low control environments, healthy
organizational communication, employee-centered cultures, and inclusive environments high in
emotional intelligence as being the most suitable organizational environments for employee
retention among LPCs.
Results for Research Question 2
The second research question explored the organizationally lived experiences of LPCs
and the impact these experiences had on their decisions to leave their organizations of
employment. In answering the second research question, findings showed that organizational
variables, like employee perceptions of need-supportive environments significantly impact
employee retention in behavioral health. Need-supportive environments positively impacted
LPCs’ intentions to stay, while environments perceived to be lacking consideration for
employees’ needs increased feelings of wanting to pursue other organizations of employment.
Participants described need-supportive environments as valuing the following employee needs:
the need to have a voice and feel heard; the need for balance and growth; and the need for
dignity and justice, connection, and congruence..
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Having a Voice and Feeling Heard
Participants identified the desire to have a voice and the need to feel heard as a
prerequisite to wanting to remain employed by their organizations. Leaders and environments
perceived as authentic and empathetic positively influenced employees’ retention because in
these environments LPCs expressed feeling heard, valued, trusted, and respected, all of which
are indicative of emotionally intelligent enviornments. Participants expressed organizationally
lived experiences of not feeling heard, valued, or like they had a voice, as significantly affecting
their decisions to leave their organizations of employment.
All participant interviews contained several descriptions of experiences where LPCs
made attempts to provide feedback and felt shutdown, unsupported, or felt their input had been
ignored by their leaders. Participants expressed these instances as being problematic in two
ways: one, they did not feel their managers exhibited the ability to empathize with them and
make them feel heard; and two, participants identified that their organizations lacked multiple
avenues for providing feedback, which stifled any hope of the feedback culture LPCs desired.
Even in situations where managers had little control over the problem, resolution, or outcome,
LPCs expressed the desire to have their voices acknowledged and for there to be follow through
with observable action after speaking up to their leaders. LPCs clarified that following up with
action could take many forms, such as touching back on the situation with an update, offering a
follow-up conversation, asking how the employee was doing, or clarifying the actions that had
been taken and transparently addressing what may or may not happen as a result.
Moreover, each of the LPC interviews pointed to participants’ understanding of the
intricate layers of an organization and the interdependent influence and impact of individual
leadership and organizational culture on their experiences as employees. What is more,
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participants did not expect leaders or organizations to be perfect but they did expect
organizations “claiming” to be person-centered and desirous of employee retention to have
checks and balances to make sure that feedback is heard. Meaning, if leaders are not prepared to
handle feedback or are not receptive to feedback, employees have a means to provide feedback
elsewhere. Several participants singled out feeling like they lacked a voice within their
organizations, not due to lack of trying, but lack of acknowledgment.
When Patricia spoke of her overall experience at one of the organizations she had left,
she spoke of feeling like she no longer had a voice that mattered. As a naturally outspoken
person, Patricia had no issue with bringing up her concerns to leaders or finding various avenues
of providing feedback to the organization. However, when reflecting on how she felt before
leaving, Patricia clarified:
I left because of the intolerance of my perspective and input. When I saw a problem, I
cared and so I voiced my concern, but there wasn’t anything done about it, and
frequently, nobody even wanted to hear about it. I couldn’t continue to work in an
environment like that.
According to Patricia, it was the cumulative smaller instances of feeling “shut down” or
“unheard” that led her to leave her previous organizations. Additionally, the frequent lack of
action left her feeling like there was no hope for change, which she clarified, is why she chose to
move on.
Robert also described feeling like he no longer had a voice at his organization but he
elaborated on his understanding of the difference between organizational culture and individual
leaders’ inclinations, highlighting that organizations and leaders should mutually support
employee voices to increase LPC retention. Right before leaving his organization, Robert had
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hoped to provide feedback on his experiences within his department and with his manager in a
360-degree review, which was standard practice for the organization. However, when the time
came for annual reviews, Robert was “somehow removed from the 360-degree [review
process],” a process which Robert now described as “circumventable.” Additionally, Robert
clarified that he never received an “exit interview” after putting in his notice, which was also
standard practice at his organization and a means for providing feedback that Robert was denied.
Yet, in spite of these obstacles, Robert did not give up:
I actually submitted a letter about my boss as I was exiting in case someone else ever
spoke up, I wanted them [the organization] to know it wasn’t the first time. I never
received a response, but I didn’t expect to. If they had wanted to improve though, it
would have been smart [to respond], but that was part of the problem, nobody seemed to
care.
In addition to feeling like avenues lacked for providing feedback and standard processes could
become “circumventable” when it served leaders. During interviews, participants shared
experiences where they felt their feedback had been dismissed and identified these experiences
as having a significant impact on their decisions to leave. Jose emphasized this point when he
spoke of his previous organization and described their attempts to retain and recruit LPCs in light
of the high turnover and labor shortages they had been experiencing. As Jose put it, he did not
feel his organization valued their employees, nor did he feel they understood the problem, and
because of that, he felt they were trying to solve it in all the wrong ways. Jose addressed his
frustrations, sharing:
Organizations are going to continue to lose hard-working, loyal, good, intelligent
employees if they continue to mistreat them. They need to wake up and listen to the
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feedback that their employees are giving them. It’s so evident [they’re struggling] by how
understaffed they are and all the hiring bonuses and retention bonuses they’re offering to
try and get people in the door and to stay. Maybe if they directed their attention to what
their employees are actually asking for, they’d experience a better outcome.
Simon classified the lack of receptiveness and response to employee feedback as a lack of basic
service to employees. They felt that their organizations actions lacked care for employees and the
clients they served. As Simon put it:
If you aren’t trusting your clinicians, valuing their feedback, or recognizing their work,
the service to clients is always going to be poor. You can’t disrespect, ignore, and
overwork employees and expect them to be in a good place to provide good service, it’s
just service 101. We can’t help others if our glass is empty.
Tammi expressed feeling that the system itself was “broken.” She went on to describe an
experience where she was unable to file a formal complaint regarding the way her manager had
been treating an employee due to lack of process and the presence of a human resources
department. Tammi said it was not infrequent that human resources requested employees try to
solve things with their managers before taking the formal complaint route, but in this instance,
the only place to file a formal complaint was with the manager she needed to file the complaint
about. Tammi also highlighted that the managers were the ones to make decisions regarding pay
increases and promotions, which was a deterrent for employees to feel comfortable addressing
severe complaints of unethical behavior with the supervisor directly.
Additionally, several participants described incidents where they felt like “appearances”
mattered more to their organizations than the needs of their employees. In Ryan’s interview, he
elaborated on one experience in particular where a client had physically attacked several
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employees in crisis services and the organization ignored employees’ requests for support until
someone went to the news. Ryan explained that several employees had quit when they realized
their organization was not going to prioritize their need for safety but no action was taken by the
organization until the situation became a public concern, only then did they “act like they cared.”
Although participants highlighted the need and value of feeling heard by their employers,
they emphasized their need for seeing subsequent action, or in the lack of action, receiving a
communicated response from leadership.. When participants described situations where leaders
listened to them, they highlighted the need for follow through, and identified a lack of action and
communication as affecting their decisions to leave. Participants spoke to the ambiguity of not
receiving a “why” when something had changed within their organization, or when leadership
failed to respond with next steps in response to a requested change. Participants clarified that the
lack of follow through negatively impacted their perceptions of their organizations and also
decreased their ability to do their job as effectively, especially when the information or change
they had requested was to support efficacy within their job function. Additionally, participants
also identified a lack of balance and growth as affecting their decisions to leave their
organizations of employment. Participants expressed experiences of lack of balance and growth
opportunities to compound turnover intentions by increasing feelings of burnout and decreasing
access to resources for support.
Opportunities for Balance and Growth
Several participants identified burnout as a reason for leaving their previous
organizations and highlighted that their organizations could have influenced their turnover
intentions by supporting their needs with learning and development resources and opportunities
for them to find work-life balance. Something significant that became obvious across all
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interviews was the workload that LPCs face within their regular day-to-day. Compounding the
basic stress of the intense workload, all of the LPCs interviewed had experience working in crisis
services where they quite literally support the most severe clients afflicted by behavioral
health.As Cam put it, “workload is always a problem in this field, but lack of work-life balance is
something that leaders and organizations can encourage to support their employees.”
Participants doubled down on the lack of action and discrepancy they experienced during
their time at previous behavioral health organizations when describing the frequency in which
person-centered organizations speak of supporting employees and decreasing burnout without
following through. From the perspective of LPCs, organizations acknowledged employee
burnout but failed to take supportive action apart from “lipservice” and encouraging employees
to practice “self-care.” In addition, Cam explained that the self-care was “something they
expected us to figure out on our own time, as if our work life was completely separate and didn’t
impact us as individuals.” Additionally, participants described experiences where they felt
increasingly “burned out” and went to leadership for support but were frequently told something
was being done without any actionable follow through, or they were told to practice self-care,
which usually took the form of a recommended bath or massage. Participants spoke of how
“defeating” it felt to be offered a bandaid when what they really needed was life support.
Moreover, some participants clarified the reasons provided by organizations to account
for LPC perceptions of environments lacking in learning and development opportunities.
Frequently organizations cited resource constraints as the problem, mainly time and money. In
Ryan’s interview, he spoke of the desire for organizational innovation and the impact that could
have had on one of his previous organization’s sustainability in the field. Ryan expressed a desire
to do more to support his learning of new skills and be more creative in his work; however, Ryan
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also expressed a thwarting of his creativity due to lack of time resources. From Ryan’s
perspective: “there is a lot of redundancy and lack of streamlining in behavioral health that
decreases our efficiency and [accomplishing] our end goals.” Ryan believes that organizationally
supported learning and development opportunities for LPCs would encourage more innovation
and would lead to increased organizational efficiency, which would support behavioral health in
making the most of their limited resources while improving employees’ job satisfaction.
Additionally, participants highlighted the compounding impact of lack of time with lack
of professional development on burnout. Collectively, participants described organizational
cultures where they experienced a lack of organizationally sponsored professional development
and were refused time off to attend professional development opportunities outside of their
organizations of employment. Amanda referred to this conundrum as “insane” and clarified that
it poses a significant challenge for LPCs who are required to receive continuing education credits
to keep their licensure valid. Lanea went on to describe the lack of career progression and
development at her previous organization, saying:
Career development didn’t seem to matter. The organization just accepted that people
were there to get a few years of experience and then move on. It wasn’t a motivating
environment to be in and in a turnover culture like that, there’s no incentive to improve.
In addition to serving as mechanism for retention, Bill highlighted opportunities for
various types of learning as being a positive signal for recruitment and retention. As Bill put it, “I
want to be in an environment that is encouraging of learning. That’s what I look for now.”
Overall, participants emphasized the importance of learning environments for increasing
organizational commitment and described experiences of personal and professional growth as
positively affecting employee retention in behavioral health. Additionally, participants identified
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recognition as being important for retention, defining it as an acknowledgement for their work in
a variety of ways, including conversation, career development opportunities, awards,
compensation, promotion, and career mobility. Participants who did not feel appropriately
recognized for their work contributions were most likely to leave their organization due to
feeling like they were not being valued by their leaders or organizations of employment.
Several participants spoke of specific experiences where they felt disappointed by the
lack of recognition they had been offered. One experience that Lanea described left her feeling
like she was not valued. Lanea pointed to a “lack of opportunity for growth, in both payment and
leadership opportunities, as well as professional development” and referred to that particular
organization as a “dead end.” Lanea was able to describe at least three instances in which her
organization had misled her to fulfill their needs which Lanea found to be manipulative and
“toxic.” Lanea had been promised that she would be able to progress into a new role the
following year, so she stayed in the role she had working diligently to “prove herself.” When the
time came for the career mobility opportunity, Lanea’s leader said the organization no longer had
the financial resources to fund the role. With her manager’s support, Lanea had already expanded
her workload to encompass the other roles job duties as part of her career mobility plan. In the
end, Lanea ended up doing both jobs without any additional recognition, she went on to say:
somehow they [the organization] found the funds to hire within our department for a
completely different role that was paid more than mine. It was like they just used me to
get one person to do two jobs and then used the money to hire for another role they
needed.
Brooklyn also stated her disappointment with a lack of career mobility within her department,
emphasizing that frequently those working directly with clients have the least opportunity.
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Brooklyn shared about an experience she had in grad school where a professor had told the class
that in order to make more money, LPCs needed to get farther away from client services. As
Brooklyn shared, “as a person who loves to do direct care with clients, it feels like I’m pigeon-
holed in making a specific salary because I enjoy working directly with clients.” Brooklyn felt
that the behavioral health system is set up in a way where those doing the actual clinical work are
the least extrinsically rewarded and recognized, which she sees as a major problem for the
retention of LPCs.
Ellen’s interview added to the importance of recognition for LPCs as she emphasized that
small recognitions can go a long way to make employees feel valued. Ellen described an
experience where she had been nominated for “one of those dumb-named awards that really
doesn’t matter for anything. Contrarily, Ellen went on to describe how impactful receiving the
award had been for her. She said, “it might sound small, but it made me feel appreciated and
valued and that made me want to work harder and stay.” Additionally, Ellen mentioned her
current organization’s process for rewarding for performance through small annual raises. As
Ellen put it, “even though they can’t match the [competition of] the market, they seem to be
trying, which matters to me.”
Overall, participants identified the need for professional and personal growth for
retention in behavioral health. Participants emphasized growth in two ways, increased
experiences of learning and recognizing contributions. Additionally, participants identified the
need for balance and addressed the interdependence of work-life-balance and growth
opportunities. Participants with organizationally lived experiences that lacked opportunities for
personal and professional growth also described having increased feelings of burnout and lacking
balance in their work lives; negatively affecting their retention.
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Another theme that consistently came up across participant interviews was the need for
experiences of justice within the work environment. In justice-lacking environments, LPCs
expressed heightened turnover intentions and decreased organizational commitment. Moreover,
LPCs felt decreased motivation when they perceived their leaders or organizational cultures to
lack justice or value ethical meaning.
Dignity and Justice
Participants highlighted valuing justice and ethicality in leadership, stating that being
treated unfairly, seeing colleagues treated unfairly, or witnessing leadership practices that they
perceived to be unethical and damaging to clients’ needs decreased trust, job satisfaction, and
motivation, while increasing their turnover intentions. Participants signaled that leaders who
lacked empathy in their interactions frequently treated employees with disrespect or disregard,
which participants identified as decreasing their organizational commitment and desire to stay.
All participants emphasized the importance of dignity and justice in the treatment of employees
due to the trust that this type of treatment builds within relationships. Additionally, participents
spoke to consistency within leaders’ treatment of LPCs as necessary for the genuine perception
of respectful work environments.
Moreover, participants identified the need for staff to be resepected at all levels and
interviews showed the interconnectedness of dignity and justice with the following themes: trust,
constructive communication, ethical business practice, inclusivity, and emotional intelligence.
The presences of these themes throughout interviews echoed findings across the study and
doubled down on the importance of autonomous and person-centered cultures and the practice of
emotionally intelligent leadership for the retention of LPCs within United States behavioral
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health organizations. Bill specifically shared about the impact of building relationships of trust
on LPC retention, stating: “showing employees they’re valued goes a long way.”
When participants described the organizationally lived experiences that led to their
turnover from their previous organizations of employment, participants frequently spoke of
instances where they felt they and their colleagues had been treated in a way that lacked dignity
and justice. Brooklyn opened up about an experience that, as she put it, “left a rally bad taste in
my mouth.” Brooklyn, like Lanea, described a situation in which she was tasked with the
responsibilities of two workloads. Brooklyn had applied for a different job on her same team,
one that had different responsibilities and slightly higher pay. Brooklyn had interviewed with her
boss, the hiring manager, and was told she would be a good fit for the role. However, Brooklyn
was not hired for the job, she was assigned both workloads and remained in her previous position
at her previous rate of pay. Understandably, Brooklyn expressed feeling used, undervalued, and
disrespected by her supervisor and the organization. Brooklyn had said she would have
understood if they had gone with a better suited candidate, but did not feel it was fair to have her
do both jobs without at least moving her into the higher paying position. What is more, stories
like Lanea and Brooklyn’s were not isolated incidents among participant interviews.
Amanda opened up about an experience she had where she had witnessed her
organization’s mishandling of her colleague’s parental leave. Amanda described her organization
to be lacking a “well-rounded human resources department” and as a result, Amanda’s colleague
was not going to be receiving any paid time off to bond with her baby. In an effort to provide
support, Amanda and her colleagues started a Go-Fund Me to raise the funds needed so that their
colleague could take some time off to be with her baby. However, this was not the end of the
incident, Amanda went on to say: “when she [Amanda’s colleague] came back from taking some
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time off, her pay was cut and she wasn’t given an explanation or justifiable reason for why. It
seemed retaliatory, unfair, unethical, and honestly illegal.” Amanda clarified that this was one of
the final experiences before she left to find employment at a different organization.
Similar to Lanea and Brooklyn’s stories, Tammi shared about an experience she had
while she was in graduate school where she felt the organization employing her had misled her
for their own benefit. Tammi began working at a behavioral health organization while attending
graduate school. During Tammi’s program, she had dropped down to working part-time hours at
the organization employing her. However, her supervisor had agreed to allow Tammi to come
back to work full-time, once she had completed her graduate coursework. When Tammi
completed her program, she was told that things had changed and they no longer had full-time
work for her. Tammi understood and applied for a different full-time position for which she was
qualified. Tammi did not get the job and officially remained working part-time but her manager
assigned her a full-time workload. Tammi discussed this with her supervisor her supervisor told
her that they had experienced severe budget cuts while Tammi was in graduate school so they
needed her to be a team player and cover her workload, but they could not pay her full-time
salary. “I couldn’t believe it,” Tammi exclaimed during the interview, “they were always finding
new budget funds when it served them, but never seemed to be able to get creative to find funds
when it came to keeping current employees, or just doing the right thing.”
Patricia and Simon also had a lot to say on the topic of dignity and justice in the
workplace. Rather, they had a lot to share about the lack of these two qualities in some of their
previous behavioral health organizations. Both Patricia and Simon described experiences where
they had each been on different crisis care teams for two extremely challenging clients. These
clients had made threats against employees and had been verbally and physically abusive to
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some of Patricia and Simon’s colleagues. Patricia had shared that the client she had been serving
had even stalked her for a short while before she had to get the authorities and legal department
involved. Patricia had refused to come into work until executive management found a solution to
make her feel safe while providing care to her client. Simon on the other hand did not feel that
they were in a place with enough leverage to demand their safety. One of the executives came to
Simon and “basically said, you do the job, or you leave.” As Simon put it,
I didn’t have a lot of options within the field because of my level of experience, so I felt
like I had to stay, but once I was told that, I realized that it wasn’t a place I could stay for
longer than absolutely necessary. They didn’t care about our well-being; I was just a
number to them.
Patricia and Simon expressed their disappointment in the agencies that employed them at the
time each of them had these experiences. Interestingly, both participants felt that their own safety
took a backseat to the organizations political prioritization. Neither of the two participants felt
respcted, valued, or even safe working for their previous organizations after their experiences.
However, during the individual interviews it became apparent that Patricia was able to move on
from her organization more quickly than Simon due to how long she had been with the
organization and having already completed her supervised hours. As Simon’s interview would
clarify, Simmon remained at his previous organization due to a lack of options and still needing
to complete some supervised hours for his license. Interestingly, Patricia and Simon’s similar
stories from two different experiences and organizations add weight to what Bill and Tammi had
to say regarding LPCs decisions to leave or stay at their organizations: many times people will
want to leave a work environment perceived as toxic but that does not mean they have the
privilege of being able to do so. Many LPCs stayed in behavioral health organizations far longer
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than they had wanted to because they perceived a lack of options when it came to leaving. Thus,
the high turnover among LPCs in United States behavioral health could be higher if more LPCs
had the privilege of being able to find better work elsewhere.
Moreover, some participants highlighted specific organizational levels to lack the most
dignity and justice. During Jose’s interview, he highlighted a lack of justice, particularly in
executive leadership, as a barrier to LPC retention. Similar to other participants, Jose emphasized
the deep political nature of one of the behavioral health organizations where he had worked. Jose
pointed to the favoritism that was exhibited by executive leadership and the prioritization of
personal preferences over doing the right thing for clients and employees. As Jose put it,
Our leadership wasn’t consistent in how they treated people. It was very dependent upon
what they were trying to give the appearance of, that’s what guided their actions, not
genuine care or respect for employees. There was a lot of corruption, favoritism, and
nepotism. Executives treated people differently based on individual preferences… it
wasn’t fair.
Jose, like many other participants, felt like he was continually mistreated by organizations that he
had given so much of his life to. However, unlike the other participants, Jose left the field of
behavioral health entirely due to the negative toll the work was having on his personal wellbeing.
It is enough to make one wonder how many passionate and talented LPCs have left the field
entirely to pursue options of employment where they feel they are more likely to experience fair
treatment through the practice of dignity and justice.
In addition to feeling heard, having a voice, opportunities for balance and growth, and
experiences of dignity and justice, participants highlighted the need for experiences of
connection and congruence for employee retention. The need for connection became evident
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throughout LPC interviews as participants spoke with consistency in their appreciation for their
teammates and the deep camaraderie they found in some of these relationships. In addition, the
lack of connection experienced between employee and manager was frequently cited as a reason
for turnover among participants. The need for congruence was highlighted by all participants due
to their experiences of the chasm between espoused and enacted culture, especially in person-
centered behavioreal health organizations.
Connection and Congruence
All participants highlighted the importance of feeling connection and camaraderie at
work, frequently within their smaller teams; however, participants positive interactions and
feelings for their teams were not enough to make them want to stay at their organizations, when
they perceived the macro culture as disconnecting or lacking employee-centeredness. When
participants shared about what they appreciated about their previous employers and the things
that made them want to stay, each of them mentioned aspects of positive micro cultures. Each
participant shared of moments where their team members had supported them through challenges
with their manager, and in interviews like Amanda’s, the support of colleagues helpd a new
mother take time off work to bond with her baby. As Robert shared:
The only thing that made me want to stay was the general collegial and supportive team
climate my colleagues and I created. I liked my coworkers, that was the good part.
There’s even a way that a difficult boss can bring people together without needing to try.
Solidarity among the people who reported to them specifically, we weren’t alone in our
suffering, we were in it together, and that was nice.
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As Robert pointed to, even when experiencing the lack of an emotionally intelligent leader,
camaraderie among team members can be enough to help LPCs get through some of the toughest
times. Similar to Robert, Ryan said:
The only thing that made me want to stay was the direct people that I worked with. They
had a lot of hope and wanted to make good changes where possible. I enjoyed the owkr
that I did with clients and also appreciated the genuine and supportive coworkers I had.
However, in organizations where the macro culture is not autonomous, employee-centered, or
led by emotionally intelligent leadership, even positive and supportive micro cultures are not
enough to create a work environment where LPCs will want to stay. As Cam described her
experience of camaraderie among coworkers clarified: “the camaraderie … is what made me
want to stay, but ultimately, even my coworkers and the relationship I had with them wasn’t
enough to keep me.”
During interviews, all participants spoke to some level of disappointment in their
experience of the gap between employees’ positive intentions and passion for their work and the
reality of working within the field of United States behavioral healthcare. Moreover, all
participants valued some level of connection and camaraderie with their colleagues but one LPC
precautioned leaders on the use of “teamwork” as a means of manipulating employees and
dismissing their individual needs and boundaries. In Ellen’s interview, she identified the idea of
being a “team player” as a phrase that was frequently used to get employees to do things outside
of their scope or predetermined boundaries. For instance, Ellen spoke of the notion of teamwork
being used to get LPCs to work off the clock, cover for multiple workloads, or sacrifice their
own wellbeing for their organizations’ quota. Ellen went on to say:
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I’ve worked for several organizations that had this descructive team mentality. Even in my
current role, we’re a team and we help one another, but they use it in a way that in order to be a
team player, you’re supposed to do what you’re told without complaint or a way of providing
feedback. The leaders act like they’re trying to build ‘camaraderie,’ but we all know it’s just their
way of trying to guilt us into being this quote, team player, that serves their every need,
regardless of how it contradicts our own [needs].
Participants also emphasized a lack of congruence as a reason for their leaving their
organizations of employment. This lack of congruence was frequently described as a disconnect
between what was preached by leadership, and what was acted upon. Additionally, participants
frequently identified incongruence within their culture as a chasm between the enacted and
espoused organizational culture. Interestingly, in person-centered behavioral health
organizations, incongruence was more frequently cited by LPCs as a reason for their turnover.
When discussing specific incidents that led Ryan to leave one of his previous
organizations, Ryan shared that he had been working for a person-centered organization,
clarifying that he felt the organization and its leadership lacked genuine care for clients and the
demanding work that clinicians were doing in their day-to-day. Ryan felt that leadership’s words
spoke of clinicians giving their all to clients; however, he felts leaderships actions to “encourage
us to do the bare minimum.” Ryan elaborated, saying:
When you’re working with people in literal crisis situations, and they [leadership] put restrictions
on the time you have to support your clients because they’re prioritizing metrics and checking
boxes, that sets us up for failure.It isn’t sustainable if we actually want to help people in our
services. It’s also incredibly frustrating to be told to slow down or to care less about the people in
our services. Maybe I shouldn’t care less, maybe they [leadership] should care more.
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Like Ryan, all participants spoke of feeling like they had not been set up for success
within their roles. Additionally, LPCs spoke of a resounding disappointment in the disconnect
they experienced within their organizations. Frequently, LPCs shared about feeling unsupported
by their managers due to their managers lacking an understanding for the very work the
clinicians were doing. As Brooklyn put it, “leaders seemed to forget what a normal day looks
like in the field of a clinician, which is insane and not normal, even though it’s common [for
them to forget].” During Brooklyn’s interview, she spoke with frustration as she articulated, “it’s
hard to explain why you need support, especially to someone that should understand, but doesn’t
because they don’t have the faintest idea what we do.”
In addition to the disconnect between clinical work and leadership’s understanding of the
work, participants emphasized the disconnect between supervisors’ expectations and clinical
reality. Participants identified these two compounding disconnects as being interrelated, citing
leadership’s lack of understanding as the likely root cause for their unrealistic expectations of
clinicians. Lanea elaborated on the disconnect she experienced within one of her previous
organizations in her interview, and clarified the impact this had on her decision to leave, saying:
I mean, so many different things impacted my decision to leave but… at the end of the
day … managers expect you to wear so many different hats … I got hired for one job,
which eventually morphed into several and I felt like I was doing too many things
without being provided the time to focus on any of them and do them well. I was getting
burned out and wasn’t even being recognized for my efforts. I couldn’t take it anymore.
Not only did Lanea experience increasing disconnect within her organization, the additional
workload and lack of care for her well-being left her feeling increasingly burned out. Altogether,
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these experiences and their corresponding feelings caused Lanea to leave one of her previous
organizations and never look back.
Moreover, participants expressed varying levels of disconnect, stemming from individual
supervisor’s disconnect to overarching organizational disconnect from the mission of the
business. Participants expressed the desire to focus on less so that they could do more
meaningful work and fel that saying “yes” to too many things led to the demise of many of their
teams. Bill spoke of a particular instance within his interview where a United States behavioral
health center tried to turn into a crisis center during a hurricane. While Bill liked the idea of
being of benefit during a time of crisis, he recognized that the center was not prepared for the
needs of a crisis center and the outcome would likely be causing more harm than good. However,
as Bill said, the organization’s executive director refused to acknowledge employee feedback
and pushed forward anyway, which he articulated as being misaligned and causing increased
turnover at the center.
Although lack of congruence was identified by all participants to various degrees, Tammi
emphasized the disconnect between business-centered focus and person-centered focus in her
interview, compounding findings from the current study’s first research question. Like many
participants, Tammi had a high client quoats that she needed to meet, which frequently felt
impossible. Tammi also shared that her manager asked her to clock out for break while driving to
and from her clinical appointments with clients, which Tammi went to human resources about.
Tammi clarified that both of these examples highlighted her previous organization’s
prioritization of business over being person-centered. Tammi chose to elaborate on a specific
program within her department where she felt leaders encouraged clinicians to behave
unethically and contrary to client needs. As Tammi clarified, clinicians had spoken up to
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leadership about their moral obligation to do what was best for their clients, but leadership did
not listen. Essentially, clinicians were being asked to refrain from discharging clients who were
ready for discharge to boost the numbers of patients in the program Tammi was describing.
Witholding clients from discharge increased opportunities for more funding; however, doing so
ran the risk of keeping patients in programs that were no longer therapeutically serving them.
Tammi went on to say:
We had a program structure based on what funding was available and operated in ways
that didn’t feel like a win for clients. We weren’t taking clients’ needs into account or
making sure we were appropriately funded to support that. Doing the clinically effective
thing was treated as a subversive act. Culturally, it felt business-oriented … we were
doing things based on the money and hitting numbers, not the clients’ need.
Moreover, based on participant interviews, Tammi’s example of organizational prioritization of
the business over clients and employees was not unique. All participants emphasized the lack of
congruence between the espoused person-centered culture and the enacted business-centered
culture of their organizations of employment. Overall, participants stated the negative impact the
experienced disconnect had on their job satisfaction and their decisions to leave.
Participants also cited their increased experiences of disconnect between executives and
other leaders at various levels, including middle management, as a barrier to LPC retention.
Additionally, all participants spoke of a gap between executives and all other employees as being
a significant challenge for the enactment of person-centered cultures. Licensed professional
counselors highlighted the frustration the incongruence caused them both personally and in their
roles. As Cam phrased it, “it was hard because leadership didn’t know what the lower-level
people did, but they had the most say over everything, so that was pretty frustrating.”
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Additionally, Simon pointed to the gap between the espoused and enacted culture of his
organization by saying: “I think there needs to be more done to rectify the discrepancy between
what leaders preach about employee treatment and how they actually treat employees.” On the
topic of incongruence between leaderss words and actions and organizations’ espoused and
enacted culture, participants responses were unified; lack of congruence positively impacts
turnover and decreases LPCs’ intentions to stay.
Overall, participants highlighted that experiences where they felt their organizations and
leaders neglected to prioritize employees’ need for congruence negatively affected their
decisions to stay. Participants also emphasized the importance of connection and camaraderie
among team members, and stated that genuinely supportive relationships with colleagues were
frequently what helped them get through their challenges with incongruent leaders and
organizational cultures. Interestingly, team connections may serve as a partially mitigating factor
for leadership, organizational culture and employee retention. On several occassions, participants
described one instance as being the “last straw” and deciding factor in their decision to leave,
which points to the power of singular negative experiences on employees’ turnover intentions.
Findings from the current research highlight the importance of the proper management of people
and the significance of genuine relationships and alignment of words and action for impacting
employee retention in United States behavioral health organizations.
Summary
In summary, the current research found several factors of organizational culture and
leadership to significantly impact employees’ decisions to leave United States behavioral health
organizations. Specifically, findings identified cultures of autonomy, employee-centeredness,
and authenticity to support employee retention most strongly. Autonomous, authentic, and
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employee-centered environments are characterized by high trust and low control, which
increases employees’ feelings of empowerment and self-efficacy. What is more, all participants
spoke of their need for justice, ethicality, and a prioritization of client and employee needs as
being central to retention-supportive organizational cultures. In these environments, LPCs stated
that everyone wins: employees, organizations, and most importantly, clients.
Regarding leadership’s role in retaining behavioral health employees, LPCs identified
specific characteristics, such as transparency and accountability, to influence employee retention
most strongly. Moreover, LPCs emphasized the importance of trust between employees and
supervisors for the effective building of autonomous, authentic, and employee-centered cultures.
Specifically, LPCs expressed their need for belonging, which they identified as feeling accepted
for who they are and acknowledged the catalyst such an environment can have on their job
performance. Licensed professional counselors drew particular attention to the skills required of
leaders capable of cultivating the environments they described as encouraging retention; namely:
listening with the intent to understand, practicing healthy communication, accepting LPCs for
who they are, practicing transparency, and holding people, including themselves, accountable.
All of the skills described characterize the emotional intelligence of leaders, which current
findings show to significantly impact LPCs jobs satisfaction and turnover intentions.
In addition, findings identified several employee needs key to the retention of the
behavioral health workforce, namely experiences of feeling heard and having a voice, balance
and growth, dignity, justice, connection, and congruence. When employees are in environments
where organizational culture and leadership practices do not recognize or support these needs,
organizations are most likely to experience increased turnover and decreased organizational
sustainability. Thus, the current study may support organizations and leaders in applying the
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proposed organizational model of individuation to support the retention of United States
behavioral health employees.
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Chapter Five: Discussion
The current chapter discusses the limitations and dilemitations as well as the findings of
the current research, highlighting the importance of employee-centered cultures, transformational
leaders, and need-supportive environments for the retention of United States behavioral health
employees. Additionally, the chapter synthesizes current findings with previous research,
identifying congruence and gaps in the literature, answering the stated research questions, and
making recommendations for future research and application to the field. The research’s findings
address the behavioral health employee retention problem through a better understanding of LPC
experiences within United States behavioral health organizations. Lastly, the current chapter
makes recommendations for future research and recommends ways to apply the findings to United
States behavioral health organizations.
Limitations and Delimitations
One limitation of the current research is the sample size. Twelve participants were
interviewed to increase the richness of data, rather than focusing on the generalizability of data
with a larger sample size; these choices align with the nature of the qualitative research
methodology (Merriam & Tisdell, 2016). Another limitation is the truthfulness of respondents;
while every measure will be taken to be transparent, respectful, and build trustworthiness within
the research through ethical interactions with participants, the truthfulness of participants is
ultimately outside of my control (Merriam & Tisdell, 2016). Additionally, due to participants
being purposefully selected after completing the screening survey outlined in Appendix A, the
semi-structured interviews articulated in Appendix B will occurred after employees left
organizations. Therefore, the semi-structured interviews were intended to elicit reflection upon
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decisions made, which offered insights that may not have been available to participants at the
time they chose to leave their organizations of employment.
Moreover, participants may not have had the self-awareness to identify the root cause of
why they left their organizations which may serve as a limitation to the current study.
Delimitations of the current study are the semi-structured interview questions, which leave room
for rich narratives and the sharing of personal experiences related to decisions to leave
behavioral health organizations within the United States (Merriam & Tisdell, 2016).
Additionally, demographic information was not considered within the current study and could be
an extraneous variable that may warrant further research (Merriam & Tisdell, 2016). For
alignment with the research questions, only United States employees working as LPCs were
included in the study (Merriam & Tisdell, 2016).
Findings
The current research analyzes the mutual influence of transformational organizational
variables, including leadership and organizational culture, on an organization’s ability to retain
employees. Burke and Litwin (1992) address the interdependence of all necessary elements of
function on organizational performance by displaying variables at various levels of an
organization’s structure. The current research findings align with the conceptual framework, an
organizational model of individuation, and address the complexity of the problem of practice,
which is increasing retention in United States behavioral health for the betterment of society (Ott
et al., 2018; Schein & Schein, 2016). The proposed organizational model of individuation
addresses significant aspects of the retention problem. Additionally, the model establishes the
interdependence of transformational organizational factors, like leadership and culture, and
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individual factors, such as employee needs, on employee retention in United States behavioral
health organizations.
The conceptual framework accounts for organizational culture being the frequently
unspoken means of communication for the underlying values of an organization’s business.
Often, employees observe organizational culture through individuals’ behavior, which then
further encourages the enactment of that same observed behavior. Notably, the conceptual
framework highlights leaders as the primary actors of espoused and enacted organizational
culture, meaning leaders are the ones being watched by employees and bear the responsibility of
speaking to the espoused culture while modeling the enacted (Northouse, 2018; Schein &
Schein, 2016). Therefore, leaders are in a place of significant influence regarding employee
perceptions, which can be positive when employees experience congruence between the
espoused and enacted culture exhibited by their leaders and negative when employees observe
discrepancies (Northouse, 2018; Schein & Schein, 2016).
The current research also emphasizes employees’ needs as central to the retention
problem in United States behavioral health. As addressed in the conceptual framework, many
factors impact an organization's performance. These factors interact with one another, having
long-term consequences on organizational sustainability. One feature of the model emphasizes
the significance of individual needs, specifically related to employees within the open system of
the business. These elements are greatly influenced inside an organization by other variables
from the model, such as organizational culture and leadership, further signifying the
interdependence and complexity in addressing the problem of practice (Burke, 2018).
With an organization's culture and leadership significantly impacting enacted employee
behavior, the research analyzes LPC's responses to organizational culture and leadership. It
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identifies employee-centered, transformational, and need-supportive organizational environments
that positively impact participants' decisions about organizational retention. Need-supportive
work environments align with an organizational model of individuation and address the
confluence of variables impacting employee retention in United States behavioral health.
Therefore, current findings emphasize the need to understand and address employees’ needs
through a supportive environment. The findings encourage organizations to use leadership
practices and organizational culture to increase employee perceptions of need-supportive
environments.
Employee-Centered Cultures
Although participants identified person-centered practices as being positively significant
for clients, all of the current study’s participants highlighted incongruence within enacted and
espoused organizational culture, describing a chasm between clinical treatment of clients and
their organizations’ treatment of employees (Barbosa et al., 2015; Dimoff et al., 2016; Johnson et
al., 2018; Milner et al., 2015; Parish & Yellowlees, 2014; Rogers, 1965; Rosenberg, 2019;
Schein & Schein, 2016; Viktoria & Christine, 2020). The experienced discrepancy between the
person-centered client-facing model and the lack of person-centeredness toward employees
emerged as a primary theme for LPC turnover intentions and the lack of employee retention
experienced by behavioral health organizations (Adeoye & Hope, 2020; Hamouche, 2020;
Johnson et al., 2018; Ott et al., 2018; Reynolds, 2011; Schein & Schein, 2016; Viktoria &
Christine, 2020). These findings support the need for additional research on applying the person-
centered approach for organizational retention of United States behavioral health employees.
Participant interviews expressed the desire for more need-supportive environments to
improve job satisfaction and positive perceptions of leadership practices and organizational
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culture, pointing to the need to address the gap between person-centered client care and person-
centered practices toward employees. According to findings from the current research, one way
of addressing the gap is for organizations to become more need-supportive for their employees
by increasing experiences of autonomy, openness to feedback, personal and professional
development, authenticity, and transformational leadership. Additionally, the current research
recommends applying an employee-centered approach, as encompassed within the proposed
organizational model of individuation, for future research on retaining behavioral health
employees.
Autonomy
All participants identified autonomy as essential for retaining employees in behavioral
health, which aligns with previous research. Autonomy is one’s perception of free will and the
level of influence one has throughout life to embrace choices and make self-endorsed decisions.
According to the self determination theory of motivation, autonomy-supportive environments
increase internal motivation, an idea that several participants also expressed in the current study
(Cosgrave, 2020; Deci & Ryan, 1985; Dora et al., 2019).
In addition to increasing job satisfaction, autonomy-supportive organizational cultures
practice healthy communication. Positive employee perceptions of organizational
communication are a significant predictor of employee satisfaction and engagement, both
positively linked with experiences of autonomy and employee intentions to stay (Karanges,
2014; Rangachari & Woods, 2020; Steiner et al., 2020; Togna, 2014). Similarly, all participants
described the organizational cultures they left as lacking healthy communication and feedback,
which the research addresses in a subsequent section. Moreover, participants expressed that
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unhealthy communication increased conflict in the manger-employee relationship and impacted
their decisions to leave; the research further elaborates on this point when discussing leadership.
Moreover, while autonomous and empowering cultures increase motivation and
retention, according to the literature, employees’ perceptions of control mechanisms decrease
motivation, retention, and positive organizational outcomes (Botnaru et al., 2021). However,
somewhat contradictorily, according to the current study, environments perceived to be too
autonomous or heavily lacking control mechanisms decreased participant motivation and
increased their desire to leave. Participants identified environments that lack autonomy as
decreasing motivation, job satisfaction, and desire to stay while increasing turnover intentions.
Participants referred to autonomy-lacking environments as controlling and qualified them as
authoritarian, punitive, unresponsive, and limiting. Nevertheless, one participant spoke of a work
environment that lacked all control and the negative impact on their motivation. Initially, this
seemed to contradict the literature. However, upon clarification, it became understandable that
the participant attempted to draw a comprehensible distinction between autonomous and indolent
environments of disconnection.
These findings lend to Banerjee and Halder’s (2021) research on the previously
unexplored shadow side of motivation, which studies behaviors and actions that increase
motivational resistance. The current research identifies the need for a balance where employees
feel supported, not smothered, and empowered without feeling abandoned. One of motivation’s
complexities, like retention, is that individuals cannot control it through practices of demand or
manipulation; motivation requires influence. The current findings align with previous research
by Behzadnia et al. (2022), where increasing need-supportive behaviors, such as thoughtful
listening, seeking to understand, and guiding employees through a trusting relationship, was the
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most effective way of decreasing the pursuit of extrinsic goals while increasing intrinsic.
Meaning, autonomy-supportive organizational cultures influence employees’ intentions to stay in
ways that extend far beyond the capability of offering external incentives, like more money.
Although some participants expressed their desire for higher pay, they clarified that the
culture was the determining factor in their decisions to leave, not the money. Additionally,
participants stated that they frequently communicated pay as their reason for leaving in exit
interviews because the cultures were not receptive to feedback and money began to carry more
weight as their job satisfaction decreased. These findings point to a potential gap in the research
on employee retention, especially for research that analyzes exit interview data to support
findings of pay being a frequent determining factor of behavioral health workers’ turnover
intentions. Therefore, the current research recommends that a more holistic conversation occurs
in behavioral health organizations surrounding employees’ decisions to leave and encourages
exit interviews ask for a list of three reasons for employee’s departure; the goal with requiring
more than one reason is to dig deeper into the complex reasons for employee turnover.
Moreover, the current research highlights a secondary issue with lack of trust in the
manger-employee relationship. According to findings of the current research, LPCs leaving
behavioral health organizations are not always honest about their reasons for leaving when
organizational cultures have not provided the space for the open sharing of feedback. Therefore,
organizational cultures that limit autonomy and inhibit feedback not only increase employees’
decisions to leave, but they also encourage the skewing of the relevant data used to support
solving the problem. Thus, organizational cultures supportive of employees’ need for trust and
desire to share honest feedback support their own retention and organizational sustainability.
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Feedback.
Autonomy-supportive cultures are a significant predictor of employee retention, partially
because cultures perceived as autonomous by participants have feedback-focused cultures;
organizational cultures supportive of autonomy encourage employees to voice their genuine
opinions and share their real experiences, and when employees do, cultures of autonomy make
sure to listen (Nadim & Singh, 2019; Salunkhe, 2018). When employees feel heard by
organizations, organizational commitment increases, and turnover intentions decrease;
additionally, feelings of autonomy increase because employees feel their perceptions are valued
contributions to their organizations (Ada et al., 2021; Al-Suraihi et al., 2021; Stirpe et al., 2021).
All participants expressed one or more aspects of feedback-lacking organizations as a reason for
their turnover. In these environments, participants shared they felt unvalued, disrespected, and
increasingly disconnected from their jobs and the people they worked with. Analysis of
participant interviews highlighted the importance of a feedback-focused culture for retaining
employees in United States behavioral health organizations.
In conjunction with feedback, learning and development emerged as a relevant sub-theme
of autonomous organizational cultures that foster of employee-centeredness. These findings
support the literature on learning organizations’ ability to retain top talent and increase
organizational sustainability through increased marketplace competitiveness (Fletcher et al.,
2018; Gorgenyi-Hegyes et al., 2021; Hamouche, 2020).
Learning and Development.
Autonomous-supportive organizational cultures empower employees’ personal and
professional development, understanding the positive impact personal and professional growth
has on self-efficacy and productivity (Park et al., 2021). Organizations that prioritize effective
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learning and development are likely to experience employee retention due to increases in
autonomy, a finding echoed by participants of the current study. Learning and development-
focused organizations are especially competitive, according to participants, during times of
economic instability and organizational change, such as that experienced by behavioral health
employees during the COVID-19 pandemic; corroborating previous research on the impact of
learning on retention during times of instability (Fletcher et al., 2018; Gorgenyi-Hegyes et al.,
2021; Hamouche, 2020).
Moreover, employee perceptions of learning and development are positively associated
with employee intentions to stay; this relationship is mediated by job satisfaction, employee
engagement, and change-related anxiety, all of which are positively impacted when employees
feel their growth is supported by the organizational cultures of their agencies (Fletcher et al.,
2018). Additionally, job satisfaction and employee engagement, both positively correlated with
employee retention, are more potent mediators of intentions to stay than burnout and change-
related anxiety; meaning, increases in job satisfaction through learning opportunities can
outweigh employee burnout when it comes to employees’ turnover intentions and decisions to
leave their organizations of employment (Fletcher et al., 2018).
Overall, the current study revealed findings congruent with research on the importance of
learning and development, including personal development, for employee retention and
increased self-efficacy. Participants emphasized that organizations encouraging of their personal
and professional development supported their decisions to stay, which supports previous research
on the mediating impact learning can have on burnout and turnover intentions (Dreison et al.,
2018). However, participant interviews clarified that learning and development is not enough to
keep employees when they perceive their environments to lack authenticity. Thus, the current
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findings identified authenticity as central to need-supportive environments encouraging of
autonomy and employee-centeredness.
Authentic.
All participants identified lack of authentic culture as a reason for turnover, burnout, and
increased occupational stress (Herschell et al., 2020). In addition, participants highlighted
authentic organizational cultures to positively impact decisions to stay, which aligns with
previous research. Participants described authentic cultures to practice the open sharing of
information, accountability, alignment of words and action, and employee participation in
discourse for decision-making (Gevrek et al., 2017; Herschell et al., 2020; Men, 2014; Steiner et
al., 2020). Additionally, authentic cultures increased the positive perceptions participants
expressed of their agencies, while increasing their motivation and organizational commitment;
thus, increasing participant intentions to stay and organizational performance. These findings
were highlighted through participants’ sharing of their experiences of increased motivation and
organizational commitment in environments they perceived to be genuine (Brouwers & Paltu,
2020).
Additionally, participants recognized authentic cultures as supportive and highlighted
increased experiences of autonomy, self-efficacy, and intentions to stay when in environments
they perceived to have alignment of words and actions, which LPCs identified as congruence
(Ada et al., 2021; Bukach et al., 2017). Furthermore, participants expressed the desire for
organizations to take a holistic approach in responding to the high turnover of LPCs and consider
the ways in which the COVID-19 pandemic has changed the future of work. Specifically,
participants emphasized aspects of flexibility, understanding, and being able to show up as their
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authentic selves, which resounds expressions of a need for authentic belonging in the workplace
(Burke, 2018; Deci et al., 2017; Lan et al., 2021; Rogers, 1942; Ryan & Deci, 2017).
Moreover, all participants identified need-supportive environments to be holistic in
nature; participants described the holistic employee experience as an organizational culture and
leadership practice that supports the entire employee and sees employees for more than their
organizational output. Aspects identified by LPCs to support perceptions of a holistic employee
experience included the following: connection and congruence. employees as complete
individuals, rather than means to an organizationally productive end. These descriptions align
with previous research on person-centeredness, further supporting the recommendation that
future research focus on the employee-centered approach, as represented in the organizational
model of individuation, as a means of inspiring and fostering a holistic employee experience.
Additionally, with participants expressing that leaders at all levels had a significant
impact on their perceptions of organizational culture, the current research emphasizes the pivotal
role managers play in creating autonomy in the workplace, making leadership a central theme for
retention in the field of behavioral health.
Transformational Leadership
Participants identified supportive leadership practices when discussing their levels of job
satisfaction, a significant predictor of employee turnover intentions across industries and fields
(Deci et al., 2017). One significant element that emerged throughout interviews with LPCs was
the impact leadership has on employees’ lived experiences and their decisions to stay or leave
their organizations (Beidas et al., 2016; Czeisler et al., 2020). When interviewing participants,
characteristics of transformational leadership appeared consistently as a contributing factor to
employee retention; participants descriptions identified a lack of transformational leadership as
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an influencer of decisions to leave. Additionally, the characteristics of leadership described to
have the greatest impact on LPC decisions to stay aligned with descriptions of transformational
leadership, which emerged as a significant influencer of turnover among LPCs. These findings
align with previous research on transformational leadership and describe the characteristics
identified within the literature (Burke, 2018; Northouse, 2018; Schein & Schein, 2016).
According to the literature, transformational leaders can transform employees into individuals
who experience high job satisfaction and engagement, supporting employees in becoming the
most organizationally productive contributors while increasing the likelihood of their retention
(Ohunakin et al., 2019; Ryan & Deci, 2017).
Leadership’s influence on turnover intentions and job satisfaction within healthcare
become more apparent when comparing toxic leadership with transformational leadership.
According to previous research, toxic leadership within healthcare decreases employee job
satisfaction, increases turnover intentions, and negatively affects organizational effectiveness
(Bakkal et al., 2019). The lack of appreciativeness and care, frequently exhibited by toxic
leaders, are statistically significant predictors of turnover intention, negative employee mindset,
and job dissatisfaction, directly correlating to employee turnover (Bakkal et al., 2019). Findings
of the current research support previous findings in the literature on toxic leadership and the
negative impact it has on employee retention. When participants described organization’s they
had left, all participants identified leadership as playing a key role in their decision. Specifically,
all participants touched on an aspect of toxic leadership in their descriptions, stating they felt
their managers to be selfish, politically motivated, disengaged, and lacking genuine care for the
employees they were responsible for supervising. These findings align with research on the
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association of high turnover with poor leadership, perceptions of decreased autonomy, and low
job satisfaction (Herschell et al., 2020).
Moreover, participants identified the emotional nature of the work to have a
compounding effect on turnover when combined with feelings of low autonomy and job
satisfaction (Herschell et al., 2020; Labrague et al., 2020). These findings are significant, as they
signal the uniqueness of the influence of leadership on retention in environments prone to high
levels of occupational stress and emotional exhaustion. Behavioral health is a field with high
susceptibility to burnout compared to other United States employee groups, making the
importance of positive employee perceptions of leadership that much more impactful for
retention (Brabson et al., 2019). While employee perceptions of minimal autonomy, poor
leadership, and low job satisfaction have been associated with higher turnover rates across fields
and organizations, the current research makes a notable contribution to the literature by pointing
to the a potential gap via the undervaluation of the influence transformational leadership can
have on retention, especially in the most emotionally burdensome and high turnover
environments (Brabson et al., 2019).
When describing leaders that encouraged employee retention, participants emphasized
aspects of transparency and accountability within leadership practices. Participants connected the
accountability relationship to transparency, sharing views on the interdependence of these two
factors. More specifically, the current research clarified the foundational aspect of these variables
for supporting employee perceptions of transformational leadership to increase retention in
behavioral health.
Accountability is complex and multivariable and although participants expressed a strong
desire for accountability in their relationships with supervisors, they expressed challenge in
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thoroughly defining it; nevertheless, participants identified accountability as leaders doing what
they said they would (Dubnick, 2011). According to the Burke-Litwin’s (1992) model,
accountability begins with individuals, rippling throughout the organization as individuals
behave accountably (Dubnick, 2011, 2014; Romzek & Dubnick, 2018; Viktoria & Christine,
2020; Vodonick, 2018). Congruently, the current research findings point to the need to increase
the personal accountability of leaders and the importance of leaderships’ modeling of
accountable behavior to employees for the creation of cultures of autonomy, further adding to the
interdependence of transformational and individual factors inherent within the study’s conceptual
framework.
Additionally, participants identified transparency in supervisor-employee relationships to
increase experiences of trust and job satisfaction, indirectly improving employee retention (Gary
et al., 2022; Grimolizzi-Jensen, 2018; Rogers, 1979; Vargas-Hernández, 2022). The current
study aligns with previous research on the positive feedback loop between supervisor
transparency and increased employee engagement, productivity, and retention (Heyns et al.,
2021). Moreover, participants identified supervisor transparency as a significant trust-builder
within their organizations and findings from the current study associated increased transparency
with decreased conflict in the employee-manager relationship. Further supporting previous
research on lack of transparency and increased conflict in the employee-manager relationship as
statistically significant predictors of turnover intention (Haji Mohammad Hoseini et al., 2021).
Furthermore, the current research aligns with previous literature which characterizes
transformational leadership as emotionally intelligent; transformational leaders can identify
employee needs and provide support, encouraging the emotional intelligence of organizational
environments (Alzyoud et al., 2019; Görgens-Ekermans & Roux, 2021; Wang et al., 2018).
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Emotional intelligence is the awareness to understand the emotions of oneself and others and
intentionally control behavior to be appropriately responsive rather than reactive (Dooley et al.,
2019; Lee & Chelladurai, 2018; Navas & Vijayakumar, 2018). Participants described emotional
intelligence as the genuine awareness and care for others, which they characterized as need-
supportive. When leaders exhibit emotional intelligence, participants expressed feeling heard,
supported, and having opportunities for work-life balance and personal and professional
development. These findings further support research on the significance of emotionally
intelligent leadership for employee retention and highlight the importance of building
organizational cultural practices that support the exhibiting of transformational leadership
(Buchness & Scholar, 2018; Maqbool et al., 2017; Rangachari & Woods, 2020; Spano-Szekely
et al., 2016).
Previous research has discussed the organizational benefits of supporting emotional
intelligence within the workplace to foster employee retention and organizational sustainability
(Shuck et al., 2017; Tian et al., 2020). Additionally, employee perceptions of relatedness at work
heavily influence employee performance, organizational commitment, and turnover intentions,
which significantly impact employee retention and organizational sustainability (Stirpe et al.,
2021). This is significant because one of the tenets of emotional intelligence and
transformational leadership practice is the ability to form connecting relationships, increasing
feelings of employee relatedness at work. Moreover, transformational leadership supports three
distinct needs that increase intrinsic employee motivation, as identified by the self-determination
theory of motivation, greatly impacting employees’ decisions to stay (Deci, 1975; Deci & Ryan,
1980).
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Motivation
Understanding the concept of motivation is central to the idea of influencing individuals;
self-determination theory is one that began by looking into intrinsic motivation and the ways in
which human motivation can be encouraged or inhibited (Deci, 1975; Deci & Ryan, 1980). The
theory is comprised of several identifiable sub-theories, adding to the complexity and
applicability to human needs and values, and was revolutionary in shifting psychology from
behaviorism to interaction and perception being the basis for interpretation, experience, and
subsequent action (Ryan & Deci, 2019). Like Maslow’s hierarchy of needs, self-determination
theory rests on the premise that human beings have basic psychological needs that are either
supported or stifled by the environment (Burke, 2018; Ryan & Deci, 2019). Contrary to Maslow,
Ryan and Deci (2019) posit that there are three basic needs, which are as follows: autonomy,
competence, and relatedness.
Participant interviews aligned with findings from self-determination theory and
corroborated need-supportive environments as effective for increasing the propensity for
employees’ ultimate functionality, psychological development, and desire to stay (Ryan & Deci,
2019). Additionally, according to previous research, the theory applies cross-culturally,
increasing individuals’ openness and conscientiousness and decreasing neuroticism across
samples (Ryan & Deci, 2019). The functionality of the theory aligning with the current findings
emphasizes the increasing of individuals’ awareness for the optimal thriving of society, further
adding to the centrality of emotional intelligence as a key tenet of transformational and
individual factors for improving retention in United States behavioral health (Burke, 2018; Burke
& Litwin, 1992; Ryan & Deci, 2019; Viskovich et al., 2021). Moreover, the theory lends an
understanding of individual needs, and ways organizations can respect autonomy, competence,
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and relatedness for the healthy functioning of employees and support the optimization of
organizational sustainability through employee retention, further compounding the current
study’s findings on employee-centered cultures, transformational leadership, and need supportive
environments (Burke, 2018; Burke & Litwin, 1992; Ryan & Deci, 2019; Viskovich et al., 2021).
Therefore, findings from the current study address the need for organizations to increase
employee centeredness, transformational leadership, and need supportive environments to
address the problem of practice, which is the high turnover experienced within United States
behavioral health organizations. Additionally, triangulation and participant member checks
confirmed the findings of the current research, meaning all participants agreed with the findings
of the current study when interviewed upon its completion (Merriam & Tisdell, 2016).The
current research addresses recommendations aligned with these stated findings next.
Recommendations for Practice
The following recommendations are based on the findings of the current research in
conjunction with literature on employee retention in United States behavioral health
organizations: The development of a Transformational Leadership Program, the creation of an
Employee Satisfaction Committee, and the implementation of an Employee Coaching Program
for personal development. The current recommendations use cost calculations representative of a
behavioral health organization in the southern United States with roughly 1,400 employees due
to my having access to cost data for a behavioral organization of this size in this geographic
location. Future researchers can adapt the current basis to fit the needs of behavioral health
organizations of various sizes.
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Recommendation 1: Transformational Leadership Program
Transformational leadership shows great promise for improving retention due to its
positive influence on employee job satisfaction (Kiran & IkramKayani, 2020; Yeap et al., 2020).
Although research identifies transformational leadership as a learnable skill, the idea is not
without controversy; some researchers believe that leaders’ ability to be transformational is more
of a personality characteristic than a learnable skill(Cerutti et al., 2020; Ohunakin et al., 2019).
However, the current research recommends organizations focus on ways to increase the practice
of transformational leadership to improve employee retention due to the skills LPCs highlighted
as being central to their perceptions of need-supportive cultures. Specifically, LPCs focused in
particular on the abilities needed of leaders capable of creating the environments they described
as encouraging retention. These abilities include the following: listening with the intent to
understand, engaging in healthy communication, accepting LPCs for who they are, acting
transparently, and holding others, including themselves, responsible. All of the aforementioned
traits define a leader’s emotional intelligence and are characteristic of popular definitions of what
it means to be a transformational leader. Moreover, the current study’s findings show these skills
to have a substantial impact on LPCs’ inclinations to stay and their organizations of employment
and feel satisfied by their work.
Moreover, these findings align with previous research on the ability of effective training
programs to increase psychological capital among employees and reduce turnover intentions
(Lan et al., 2021). However, the current findings point to an underrepresentation of the
importance of manager training programs for employee retention in behavioral health and
emphasize the need for programs to focus on aspects of transformational leadership and
emotional intelligence to move the needle on employee retention in United States behavioral
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health (Li et al., 2021; Northouse, 2018). Due to participants expressing a lack of
transformational leadership practice in their behavioral health organizations, the current
recommendation focuses on the use of a third party contractor as a first step to fostering
transformational leadership and emotionally intelligent managerial practice in behavioral health
organizations.
Costs
Using estimations of roughly one supervisor per fifteen employees, the average United
States behavioral health organization has an estimated 100 leaders for the remaining 1,400
employees (ERC, 2014). Convergence Coaching has a Transformational Leadership Program™
that extends over a year period and includes four full day seminars and several online webinars.
The cost of the program is $7,000 per leader for the year of coursework and will take
approximately 50.5 hours of time per leader to complete the program, Table 2 contains the cost
breakdown for implementing this program in an organization of 1,400 employees.

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Table 2
Transformational Leadership Program Cost
Description Cost
Average United States behavioral health worker salary $30,667

Average United States behavioral health leader annual salary $92,001

Average United States behavioral health leader hourly wage $44

Cost of program (per leader) $7,000

Average cost of time spent on program (50.5 hours per leader) $2,233

Total cost of program (per leader) $9,233

Total initial cost of program for an estimated 100 leaders $923,362

Most of the costs to implement a transformational leadership program will be incurred in
the first year as the organization seeks to train all leaders. After the first year, only new leaders
will require transformational leadership training as part of new leaders’ training within their
behavioral health organizations of employment. Assuming leadership turnover of 15%, which is
half the average turnover rate at the average behavioral health organization in the United States,
this solution will incur approximately $138,504 per year, after the first year. Considering
Convergence Coaching’s contract will be front-loaded in year one with approximately
$1,164,359 per year in net present value through 2025.
Potential Effectiveness
According to one source, leadership development programs are estimated to have a 20%
effectiveness rate; although this number is likely to be an underrepresentation, it will be used as a
conservative approximation for the projected effectiveness of employing a transformational
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leadership program within behavioral health (Apollo Technical Engineered Talent Solutions,
2021). The average behavioral health organization within the United States stands to save
approximately $17.3 million by solving turnover; therefore, to calculate the potential
effectiveness as a cost, the $17.3 million is multiplied by 20%, amounting to an approximate
$3,460,000 in annual turnover savings for behavioral health organizations.
Recommendation 2: Employee Satisfaction Committee
Job satisfaction is the leading indicator of turnover intention within organizations
(Alshehhi et al., 2021; Salunkhe, 2018). Therefore, finding ways to increase job satisfaction are
essential for any effort to increase employee retention. In my experience, committees have been
a beneficial way to encourage cross-functional collaboration and reach organizational objectives
within behavioral health (Fletcher et al., 2018; Gevrek et al., 2017).
Costs
An employee satisfaction committee will consist of approximately 10 individuals at
various levels and from diverse departments for cross-functional perspectives. Committee
meetings will occur once a month and require a time commitment of approximately four hours
per month. Due to committees being cross-functional and having members from various levels, it
will be estimated that five of the committee members will have an average middle-management
salary of $61,334 while the remaining five members have an average annual salary of $30,667.
Table 3 contains the cost for implementing a cross-functional employee satisfaction committee at
an organization of 1,400 employees.

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Table 3
Employee Satisfaction Committee Cost
Description Cost
Average United States behavioral health worker salary $30,667

Average United States behavioral health worker hourly wage $15

Average United States middle-manager annual salary $61,334

Average United States behavioral health middle-manager hourly wage $29

Average annual cost of time spent on committee (10 members at 4 hours
per month)
$10,560

Additionally, the committee will be given an annual budget of $250,000 for the
implementation of committee programs to improve employee job satisfaction; this will bring the
total annual organizational cost to $260,560. The creation of an employee satisfaction committee
incurs the same costs year-over-year with the same or similar organizational benefits. Adoption
of an employee satisfaction committee will cost approximately $737,023 per year in net present
value through 2025.
Potential Effectiveness
According to one source, committees have an approximated effectiveness rate of 62%
(The Global Fund, 2015). The average behavioral health organization within the United States
stands to save approximately $17.3 million by solving turnover; therefore, to calculate the
potential effectiveness as a cost, the $17.3 million is multiplied by 62%, amounting to an
approximate $10,726,000 in annual turnover savings per behavioral health organization.
Additionally, solving for employee satisfaction stands to increase life satisfaction and create a
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positive feedback loop within behavioral health organizations, that may further compound
positive organizational impact (Gevrek et al., 2017; Ohunakin et al., 2019).
Recommendation 3: Employee Coaching Program for Personal Development
Employees, now more than ever before, are desiring personal and professional
development within their organizations (Ohunakin et al., 2019). If organizations are to increase
employee job satisfaction, they need to pay attention to employee needs, and participants
expressed personal development as a highly valued need in a world after the COVID-19
pandemic (Hamouche, 2020; Søvold et al., 2021). Employees empowered through an
organizational focus on employee personal development experience increased autonomy within
the workplace and are likely to experience greater job satisfaction (Ohunakin et al., 2019).
Therefore, the third and final option for analysis is the implementation of a personal
development program via third party contracted coaching, which has been linked to up to 50%
increases in retention rates for coached employees (Goodman, 2020).
Costs
A professional coaching package requires the annual purchase of a program that consists
of two one-hour coaching sessions per month per employee over a four-month period. Table 4
contains the cost breakdown of implementing an employee coaching program for personal
development via a third party contractor.
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Table 4
Employee Coaching Program for Personal Development
Description Cost
Average United States behavioral health worker salary $30,667

Average United States behavioral health worker hourly wage $15

Average time cost per employee per year $118

Annual of coaching program (per employee) $8,000

Total annual employee cost for coaching program $8,118

Overestimating that approximately 25% of the company will take advantage of the
coaching program, the personal development program will cost a total of $3,044,250 per year (In
Stride, 2021). The costs of establishing a personal development program will be consistent year
after year, with the same or similar organizational advantages. A conservative net present value
cost estimate for an employee personal development and coaching program through 2025 is
approximately $8,611,000.
Potential Effectiveness
According to the International Coaching Federation (2009), coaching has an
approximated effectiveness rate of 68%. Caring with Integrity stands to save approximately
$17.3 million by solving turnover; therefore, to calculate the potential effectiveness as a cost, the
$17.3 million will be multiplied by 68%, amounting to an approximate $11,764,000 in annual
turnover savings for the average behavioral health organization. The creation of an employee
satisfaction committee incurs the same costs year-over-year with the same or similar
organizational benefits.
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Cost Benefit Analysis
The current cost-benefit analysis is an underrepresentation of the actual costs of the
turnover problem within behavioral health due to the many societal costs associated with the lack
of behavioral health services. Additionally, the benefits of solving the problem are
underrepresentations for the same reason; solving the turnover problem in behavioral health
stands to provide an incredible cost benefit to society, which remains unaccounted for in the
current analysis. Moreover, while the solutions are likely only to solve a portion of the turnover
problem, organizational turnover is costly to organizations due to more than the cost of replacing
talent; high turnover increases burnout and organizational costs for supporting employees’
mental health. These costs remain unaccounted for in the current analysis. Therefore, the current
analysis seen in Appendix D, while helpful in making a cost-effective recommendation, severely
undercalculates the potential benefit to behavioral health organizations and society that would
come to fruition through solving the turnover problem in behavioral health.
Recommendations
According to the cost-benefit analysis, the most cost-effective option for recommendation
is the second option, the development of an employee satisfaction committee. However, the
current research recommends that United States behavioral health organizations pursue the first
option and implement a transformational leadership program. The findings of the current
research, combined with the emphasis in previous research on the transformative ability of
transformational leaders, identify a transformational leadership program as the most effective
option for increased employee retention. Unlike other variables, transformational leadership
directly impacts employees’ turnover intentions, according to participant voices (Cerutti et al.,
2020). Organizations that support transformational leadership encourage individuals to remain at
144

their organizations of employment due to the need-supportive environments they foster.
Participants expressed that when they felt their employer satisfied their needs, they were less
likely to look for other avenues or employment opportunities. Transformational leadership is
influential in creating such an environment (Cerutti et al., 2020).
Transformational leaders know how to recognize employees, which research has linked
to employee engagement and participants highlighted as making them feel valued and heard
within their organizations (Steiner et al., 2020). These findings support the hypothesis that
leadership’s way of being significantly influences organizational culture and employees’
perceptions of organizational culture, making it a significant point for moving the need on
employee retention in United States behavioral health. Additionally, organizations capable of
empowering their teams through transformational leadership practices experience less turnover
and more significant problem-solving than their less resilient counterparts (Rangachari &
Woods, 2020).
Moreover, healthcare employees who feel supported by their organization exhibit better
individual problem-solving, which transfers to greater organizational adaptability, making
transformational leaders effective role models for positive organizational behavior (Burke, 2018;
Burke & Litwin, 1992; Rangachari & Woods, 2020). One contribution of the current research to
previous literature on transformational leadership and employee retention is the ability of
transformational leaders to communicate effectively in ways that build emotional intelligence
within the workforce. Increasing an organization's emotional intelligence increases job
satisfaction and employees’ experiences of autonomy, relatedness, and competence, thereby
increasing job satisfaction, intrinsic motivation, and employee retention (Deci, 1975; Deci &
Ryan, 2012; Rangachari & Woods, 2020). Although transformational leadership alone is unlikely
145

to solve the retention challenge in United States behavioral health organizations entirely, it
shows promise in supporting employees’ needs which all participants emphasized as being
central to their turnover decisions.
Participant statements aligned with research, characterizing transformational leadership
by its genuine care and authenticity, which further support emotional intelligence within the
workplace, paving the road for increased empathy and need-support for employees, all of which
foster employee satisfaction and retention (Buchness & Scholar, 2018; Maqbool et al., 2017;
Ohunakin et al., 2019). Emotional intelligence is a helpful tool that leaders can develop for more
effective leadership and positive organizational outcomes within healthcare (Prezerakos, 2018).
Moreover, when employees perceive leaders as emotionally intelligent, they are more likely to
classify their leaders’ styles as transformational (Baba et al., 2021). Implementing a
transformational leadership program increases emotional intelligence competencies for leaders to
facilitate greater organizational creativity, problem-solving, and retention across fields
(Ohunakin et al., 2019; Rahman et al., 2020; Rinfret et al., 2020).
Emotionally intelligent leaders are effective communicators, empowering employees and
supporting positive conflict resolution within teams and organizations (Maqbool et al., 2017;
Rangachari & Woods, 2020; Spano-Szekely et al., 2016). Like transformational leadership, there
is frequent association of emotional intelligence with personality characteristics; however,
research points toward emotional intelligence being a skill that can be learned and has shown
promise in decreasing burnout in stressful professions (Vesely-Maillefer & Saklofske, 2018).
Emotional intelligence is a significant predictor of leader success, especially within service-
based fields, such as healthcare. These findings further signify the importance of a
146

transformational leadership program to decrease employee turnover and improve the retention of
leaders in behavioral health (Cosgrave, 2020; Frias et al., 2021; Spano-Szekely et al., 2016).
Furthermore, the development of emotional intelligence requires the development of the
self due to self-awareness being foundational to the enaction of emotional intelligence; therefore,
self-aware leaders are typically more astute in emotional intelligence (Gopinath, 2020; Oh, 2021;
Perkins & Schmid, 2019). Self-awareness has been linked to positive organizational outcomes,
including employee engagement and productivity (Mason, 2021; Milhem et al., 2019). Research
has shown that emotional intelligence mediates the relationship between transformational
leadership and employee engagement (Mason, 2021; Milhem et al., 2019). These assertions
further support the recommendation for a transformational leadership program capable of
building leaders’ self-awareness to build organizational emotional intelligence and increase
organizational sustainability (Frias et al., 2021; Maulding et al., 2012; Spano-Szekely et al.,
2016; Taylor, 2017).
As previously addressed, the turnover problem in behavioral health is too complex to be
solved by one program; however, organizational prioritizations of self-awareness and emotional
intelligence through the implementation of a Transformational Leadership Program stands to
make a significant dent in the problem (Boraggina-Ballard et al., 2021; Maulding et al., 2012;
Ryan & Deci, 2017; Schein & Schein, 2016; Shuck et al., 2017; Taylor, 2017). One notable
contribution of the current research to the literature on transformational leadership as a means for
influencing employee turnover in United States behavioral health organizations is the importance
of congruence between leaders’ words and action and the enacted and espoused organizational
cultures (Schein & Schein, 2016). Furthermore, the findings from the current research are clear
in asserting that employee-centered cultures are no longer a luxury but have become a necessity
147

in the aftermath of the COVID-19 pandemic. As organizations and leaders continue to evolve
into the person-centered model for clients, they must be aware of the experienced discrepancy
that may result if they do not adopt the person-centered approach and treat employees in ways
that support their needs. Lastly, the proposed Transformational Leadership Program must
consider these factors and teach leaders alignment and congruence in addition to emotional
intelligence and employee need-supportive behaviors to be effective.
Future Research
With the current research being qualitative, future research should focus on the
quantitative significance of transformational leadership for improving retention in United States
behavioral health organizations. Additionally, future research should build upon the current
findings of the organizational model of individuation and measure the levels of impact that
autonomous culture, transformational leadership, and employees’ perceptions of need-supportive
environments have on turnover intentions. Moreover, future research should focus on the
difference in leaders’ perceptions of themselves and the perceptions employees have of them and
explore the impact of the potential gap on employees’ job satisfaction. Lastly, future research
should focus on the incongruence of the person-centered approach in behavioral health when it
comes to employees and explore additional ways of bridging the gap to increase employee job
satisfaction and employee retention.
Conclusions
In conclusion, the current research asserts the need to mirror the person-centered
approach for clients to employees to increase job satisfaction, experiences of congruence, and
employee retention in United States behavioral health. Additionally, behavioral health
organizations should implement transformational leadership programs as a viable option for
148

supporting emotional intelligence, cultures of autonomy, and creating need-supportive
environments for improved employee retention. Moreover, the impact of leadership for fostering
positive employee perceptions of organizational culture cannot be overstated. Leaders play a
pivotal role in influencing employee’s perceptions and feelings about their work. Lastly, the
organizational model of individuation should be further explored for use in behavioral health
organizations throughout the United States to support employee retention in the midst of the
ongoing mental health crisis.

149

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182

Appendix A: Screening Survey
A screening survey was used as part of the purposeful sampling to recruit participants.
The screening survey asked the following questions:
1. Have you ever worked as a licensed professional counselor within a United States
behavioral health organization? (Assessing experience within behavioral health for
relevance to the field of study)
a. Yes
b. No
2. Have you ever left a behavioral health organization due to organizational factors,
such as culture or leadership? (Assessing experience leaving a behavioral health
organization for a reason relevant to the research questions)
a. Yes
b. No
c. Not applicable
3. If you answered yes to question 2, are you comfortable sharing your experience in an
interview with the researcher?
a. Yes
b. No
c. Not applicable
4. Do you have thoughts on what you think the organization could have done differently
to influence your decision to leave? (Assessing participants’ reflective tendency to
purposefully select participants who have thought about why they left)
a. Yes
183

b. No
c. Not applicable
5. If you answered yes to question 4, are you comfortable sharing your thoughts in an
interview with the researcher?
a. Yes
b. No
c. Not applicable
184

Appendix B: Interview Protocol
The following interview protocol will be used to elicit participant responses after
participants have completed the screening survey outlined in Appendix A. The use of the
screening survey is to support the purposeful sampling of participants with experience relevant to
answering the stated research questions (Merriam & Tisdell, 2016). The purpose of the current
interview protocol is to uphold the continued ethicality of the current study and use semi-
structured interview questions to elicit responses from participants to answer the stated research
questions, as stated in Table 1 (Merriam & Tisdell, 2016).
Interview Introduction
Thank you for taking the time to participate in this interview; as you know, my name is
Lauren Van Vlack, and I am an educational doctoral student at the University of Southern
California. My research aims to highlight employee perceptions within United States behavioral
health organizations and explore how organizational factors can influence behavioral health
employee retention. The interview will take approximately 30 minutes. Please know that you
may ask questions at any time, and if you are uncomfortable and would like the interview to
stop, please let me know, and we will do so. For transparency, please know that your responses
to these questions will be used for my dissertation research to answer my stated research
questions. Please note that your personal information will be protected. Although your responses
will be summarized and used within my current research study, your personal information will
not be included in my submission. Please confirm that you are still comfortable participating in
this interview? Again, if you need to stop the interview, please let me know, and I will be happy
to do so. As a reminder, you may ask questions, and I will do my best to answer them
thoroughly. I will be recording this interview to get an accurate transcription for my research;
185

however, all recordings will be deleted upon completion of the study. Are you comfortable with
this interview being recorded for my research? Again, please know that your responses to these
questions will be used for the intended purpose of this research, and your privacy will be upheld.
Thank you for your participation, and if you do not have any questions that I can answer for you
right now, I will get started.
Interview Part 1 Instructions
For the following questions, please hold in mind the context of a behavioral health
organization that you left or have wanted to leave.
Interview Questions
1. How would you describe the organization’s culture and leadership?
2. What about the organization’s culture a leadership affected your decision or desire to
leave?
3. Is there anything the organization could have done to make you want to stay?
4. From your experience, what are the most important aspects of organizational culture
for retaining employees? What about leadership?
5. Can you recall any specific experiences related to organizational culture that made
you want to leave? What about leadership?
a. If so, can you please describe them for me?
b. What about those experiences made you want to leave?
6. Can you recall any specific experiences related to organizational culture that made
you want to stay? What about leadership?
a. If so, can you please describe them for me?
b. What about those experience made you want to stay?
186

Interview Part 2 Instructions
For the following questions, please imagine you are working at an organization where the
following is true: you have the freedom to voice your thoughts, opinions, and concerns with your
leadership team and are heard when you do so. You have flexibility within your work and are
empowered to make decisions because the organization trusts your ability. The organization
supports you, and leadership cares about your needs. The organization has high standards for
customer and client experience. It has a culture that supports leadership in prioritizing your needs
because they believe that will enable you to support your clients' needs.
1. Would you want to work for this organization?
a. If yes, what about this organization is appealing to you?
b. If no, what about this organization is not appealing to you?
2. On a scale from 1–5, how likely are you to want to find other employment? Why?
3. On a scale from 1–5, how likely are you to want to remain employed at the
organization? Why?
Interview Part 3 Instructions
For the following questions, please imagine you are working at an organization where the
following is true: you are not empowered to make decisions without having to run them past
your supervisor. Work is strict and rigid, and leaders question your competence due to high
customer and client experience standards. You can voice your thoughts, opinions, and concerns,
but leadership may change the way they treat you when you do so. Your needs are not prioritized
because you are ultimately there to serve the customers and clients, and they always come first.
1. Would you want to work for this organization?
a. If yes, what about this organization is appealing to you?
187

b. If no, what about this organization is not appealing to you?
2. On a scale from 1–5, how likely are you to want to find other employment? Why?
3. On a scale from 1–5, how likely are you to want to remain employed at the
organization? Why?
Concluding Interview Statement
Thank you for taking the time to participate in this interview. I greatly appreciate your
willingness. As promised, I want to remind you that everything shared within this space will be
used for the intended research. Your personal information will not be included in any of the
responses, and any of your personal identifying information will be protected. Do you have any
questions I can answer for you? Thank you for your participation, and I hope you have a great
day!
188

Appendix C: Question Alignment
Tables C1 and C2 show the alignment between the current study’s interview questions,
research questions, and key concepts.

Table C1
Part 1: Interview Question Alignment

Question Research
question
Key concept(s)
How would you describe the organization’s
culture and leadership?
1

Organizational culture and
leadership

What about the organization’s culture and
leadership affected your decision or
desire to leave?
1 and 2 Organizational culture and
leadership

Is there anything the organization could
have done to make you want to stay?

1 and 2

Organizational culture and
leadership

From your experience, what are the most
important aspects of organizational
culture for retaining employees? What
about leadership?

1 and 2

Organizational culture,
leadership, and retention
Can you recall any specific experiences
related to organizational culture that
made you want to leave? What about
leadership?
1 and 2 Organizational culture,
leadership, and turnover

Can you recall any specific experiences
related to organizational culture that
made you want to stay? What about
leadership?

1 and 2

Organizational culture,
leadership, and retention
189

Table C2
Part 2 and 3: Interview Question Alignment
Question Research
question
Key concept(s)
Would you want to work for this
organization?
1, 2 Organizational culture,
leadership, turnover, and
retention

On a scale from 1-5, how likely are you to
want to find other employment? Why?
1, 2 Organizational culture,
leadership, turnover, and
retention

On a scale from 1-5, how likely are you to
want to remain employed at the
organization? Why?
1, 2 Organizational culture,
leadership, turnover, and
retention

190

Appendix D: Cost/Benefit Worksheet
Problem: Turnover in United States behavioral health organizations.
Cost types: Employee time and contract costs for third party services.
Solution: Three recommended options to increase employee retention in United States
behavioral health organizations: transformational leadership program, creating and implementing
an employee satisfaction committee, and developing and implementing an employee coaching
program for personal development.
Cost/Benefit Analysis

Table D1
Cost/Benefit Ratios for Recommendations for Practice
Option Benefit to cost ratios
1 4.57
2 41.17
3 3.86

191

Option 1: Transformational Leadership Program
Note on timing of costs and benefits: Most of the costs to implement a transformational
leadership program will be incurred in the first year while most behavioral health leaders are
trained. After the first year, only new leaders will require transformational leadership training as
part of new leaders training. Assuming leadership turnover of 15% each year, this solution will
incur costs of approximately $138,504 per year, after the first year.

Table D2
Transformational Leadership Program Cost/Benefit Analysis
Year Costs Benefits Benefits–costs
1 $923,362 – $(923,362)
2 $138,504 $3,460,000 $3,321,496
3 $138,504 $3,460,000 $3,321,496

Total

$1,200,370

$6,920,000

$5,719,630

192

Table D3
Transformational Leadership Program Benefit to Cost Ratio
Discount rate Net present value of
costs
Net present
value of
benefits
Benefits–cost Benefit to
cost ratio
3% $1,153,770 $6,427,771 $5,274,001 4.57

Option 2: Employee Satisfaction Committee
Note on timing of costs and benefits: The creation of an employee satisfaction committee
incurs the same costs year-over-year with the same or similar organizational benefits.

Table D4
Employee Satisfaction Committee Cost/Benefit Analysis
Year Costs Benefits Benefits–costs
1 $260,560 $10,726,000 $10,465,440
2 $260,560 $10,726,000 $10,465,440
3 $260,560 $10,726,000 $10,465,440
Total $781,680 $32,178,000 $31,396,320

193

Table 5
Employee Satisfaction Committee Benefit to Cost Ratio
Discount rate Net present value of
costs
Net present
value of
benefits
Benefits–cost Benefit to
cost ratio
3% $737,023 $30,339,685 $29,602,662 41.17

Option 3: Employee Coaching Program for Personal Development
Note on timing of costs and benefits: The costs of establishing an employee personal
development and coaching program will be consistent year-over-year, with the same or similar
organizational advantages.

Table D6
Employee Coaching Program for Personal Development Cost/Benefit Analysis
Year Costs Benefits Benefits–costs
1 $3,044,250 $11,764,000 $8,719,750
2 $3,044,250 $11,764,000 $8,719,750
3 $3,044,250 $11,764,000 $8,719,750
Total $9,132,750 $35,292,000 $26,159,250

194

Table D7
Employee Coaching Program for Personal Development Benefit to Cost Ratio
Discount rate Net present value of
costs
Net present
value of
benefits
Benefits–cost Benefit to
cost ratio
3% $8,611,000 $33,275,784 $24,664,784 3.86

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Asset Metadata

Creator Van Vlack, Lauren Ashley (author)

Core Title Organizational model of individuation and employee retention

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2023-05

Publication Date 02/03/2023

Defense Date 01/06/2023

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

Tag behavioral health,emotional intelligence,employee retention,individuated organizational model,job satisfaction,leadership,OAI-PMH Harvest,organizational culture,organizational sustainability,transformational leadership,turnover

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Green, Alan (committee chair), Datta, Monique (committee member), Kim, Esther (committee member)

Creator Email laurenvanvlack@gmail.com,lvanvlac@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC112724696

Unique identifier UC112724696

Identifier etd-VanVlackLa-11466.pdf (filename)

Legacy Identifier etd-VanVlackLa-11466

Document Type Dissertation

Format theses (aat)

Rights Van Vlack, Lauren Ashley

Internet Media Type application/pdf

Type texts

Source 20230206-usctheses-batch-1006 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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