|
| |
 |
|
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 19
| Issue : 2 | Page : 117-124 |
|
Exploring burnout in clinical psychologists: Role of personality, empathy, countertransference and compassion fatigue
Bidisha Bhattacharyya1, Ushri Banerjee2
1 Clinical Psychology Centre, University of Calcutta, India
2 Department of Applied Psychology, University of Calcutta, Kolkata, West Bengal, India
| Date of Submission | 09-Jul-2021 |
| Date of Decision | 10-Jan-2022 |
| Date of Acceptance | 24-Jan-2022 |
| Date of Web Publication | 27-Dec-2022 |
Correspondence Address:
Ms. Bidisha Bhattacharyya
Clinical Psychology Centre, University of Calcutta, Rajabazar
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/iopn.iopn_62_21
Objective: Clinical psychologists, as professionals, come across various people and their problems frequently. Regular exposure to information which are distressing, stressful, and sometimes traumatic can create health issues and burnout, which is a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment, in them. A number of psychological variables can contribute to the burnout of clinical psychologists. The ones taken in this study are personality, empathy, countertransference (CT) and compassion fatigue. The study had been conceptualized to find the relation and contribution of the mentioned variables on burnout of clinical psychologists. Methods: Fifty one clinical psychologists participated in the study. Maslach Burnout Inventory, NEO Five-Factor Inventory, Questionnaire of Cognitive and Affective Empathy, Assessment of CT Scale and Compassion fatigue (CF), and satisfaction self-test for helpers were used for assessing the constructs. Relevant statistical analysis were performed. Results: Findings show that there are significant correlations between personality variables, i.e., neuroticism, agreeableness, and conscientiousness with other variables, i.e., compassion fatigue, empathy, and CT. Some of the personality variables are correlated to burnout. Empathy, CT, and CF contribute significantly to burnout. Conclusion: The study shows the probable indicators which can cause burnout in clinical psychologists, and which, if correctly addressed, may help in the maintenance of sound mental health among professionals.
Keywords: Burnout, clinical psychologist, compassion fatigue, countertransference, empathy, personalit
How to cite this article:
Bhattacharyya B, Banerjee U. Exploring burnout in clinical psychologists: Role of personality, empathy, countertransference and compassion fatigue. Indian J Psy Nsg 2022;19:117-24 |
How to cite this URL:
Bhattacharyya B, Banerjee U. Exploring burnout in clinical psychologists: Role of personality, empathy, countertransference and compassion fatigue. Indian J Psy Nsg [serial online] 2022 [cited 2023 May 28];19:117-24. Available from: https://www.ijpn.in/text.asp?2022/19/2/117/365468 |
| Introduction | |  |
Mental health professionals (MHP) are persons who cater to the different needs of wellbeing of mental health of people and assist them in possible ways for betterment. Clinical psychologists are MHPs whose integral part of work is psychotherapy and psychological assessment. Clinical psychologists regularly listen to painful stories and hardship of life from people who visit them for change and respite. Listening to these facts regularly can cause varied types of health issues and burnout in them.
These can include burnout, compassion fatigue, cardiac problems, depression, suicidal thoughts, somatic complaints such as headaches, gastrointestinal difficulties, a weak immune system, and other stress-related problems as well.[1]
Burnout is “a psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can occur among individuals who work with other people in some capacity.”[2] Burnout can have the following determining factors such as age, gender, marital status, genetic endowment, personality, job stressors, unclear job expectations, dysfunctional workplace dynamics, and work overload. There can be a number of psychological variables as well contributing to the burnout of clinical psychologists.
Pope and Tabachnick[3] and Gilroy et al.[4] showed that burnout has been related with depression among psychologists. Teachers, nurses, doctors, psychologists, and counselors are among professionals who experience burnout because they have close interaction and communication with the people by the nature of the work they do.[5] In their study, Wardle and Mayorga found that 85% of counseling professionals are concerned about burnout, or they overtly showed indications of burnout.[6] Clinicians have also reported lower feelings of safety with increased emotional exhaustion.[7] The possible causes or markers of burnout are important to ascertain. Markers relating to or which are an essential part of clinical psychologists' working repertoire are discoursed here.
The personality of clinical psychologists constitutes an important factor of the entire psychotherapeutic process. The psychotherapist's desired personality traits include inner stability and high degree of self-awareness, leading to an understanding and accepting of his or her own self. The other useful personality traits are the therapist's openness for the patient and the unconditional acceptance, empathy, and authenticity which creates an optimal and safe therapeutic setting, enabling the patient to communicate freely and sincerely. All these traits must be expressed simultaneously; otherwise, they could be destructive.[8]
The big five personality traits,[9] i.e., extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience are related to burnout. As personality traits are relatively stable, the way one handles job-related stressors may be influenced by those traits. Emotional exhaustion is significantly correlated with extraversion, agreeableness, and conscientiousness, and on the other hand, depersonalization is also related to agreeableness, and reduced personal accomplishment is related to extraversion.[10]
Blair[11] coined three terms, i.e., cognitive empathy, emotional empathy, and motor empathy under the umbrella term of empathy. Cognitive empathy is the representation of the mental state of another person. Emotional empathy may be categorized in two main forms: a response to emotional stimuli of another person (facial and vocal expressions and body movements) and a response to any other emotional stimuli. The cognitive component of empathy involves the ability to mentally represent the emotional process of others, whereas the emotional components involve the actual emotional reaction.[12]
Research findings and theoretical approaches have suggested that burnout and empathy, which is one of the most important skills in health professionals, are closely linked. However, the exact nature of the relation between burnout and empathy is yet to be determined.[13]
Countertransference (CT) in the context of psychoanalytical theory is determined by the therapist's feelings directed by a patient's particular characteristics, such as the type of transference, personality aspects, attachment pattern, and others. CT is also modulated by therapist personality characteristics. According to recent literature, CT is partly determined by the therapist's pre-existing internal object world and partly influenced by feelings induced by the patient. CT is regarded as an expected part of therapy.[14]
Clinical psychologists are vulnerable to Compassion Fatigue (CF). “The natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person.”[15] MHP often suffer from compassion fatigue, particularly when they treat those who have suffered from high traumatic experiences.[16] A significant relationship was found between empathy and both compassion satisfaction and CF among social work practitioners. Self–other awareness and emotion regulation, which are cognitive components of empathy, appear to be significant contributors to components of CF. In contrast, affective response, which is a physiological component of empathy, was identified as a significant contributor to compassion satisfaction.[17]
Emotion, predisposed features and interpersonal relationship of clinical psychologists affect their work. Burnout, as a psychological syndrome, comprises heightened emotional response, relatedness to others as well as a sense of success. Occupational burnout stems from work-related stress. The research intends to find out in what way personality, empathy, CF, and CT play a role in burnout of clinical psychologist in their working realm.
| Methods | | |
The objective of the present study is to find out whether empathy, CT, personality, and CF contribute toward burnout of clinical psychologists.
Operational definition of the variables:
- Predictor/independent variable – Personality, empathy, CT, compassion fatigue
- Criterion/dependent variable – Burnout.
Personality
Personality has been defined as the set of habitual behaviors, cognitions, and emotional patterns that is relatively permanent for the individual and effects the way he/she deals with the environment.
The following traits have been defined:
- Neuroticism can be defined as the dimension of being sensitive, anxious, depressed mood, and loneliness
- Extraversion can be defined as the dimension of being energetic, assertive, and sociable
- Openness to Experiences can be defined as the dimension of being open to new things and experiences
- Agreeableness can be defined as the dimension of being friendly and compassionate to others (clients)
- Conscientiousness can be defined as the dimension of being efficient and organized.
Empathy
Empathy is defined as the ability of being sensitive both cognitively and affectively to the person one is caring for.
Cognitive empathy is being sensitive to the client's problem/s in a rational way.
Affective empathy is being sensitive to the client's problem/s in an emotional way.
Countertransference
CT is defined as the negative, positive or indifferent feelings of the therapist toward the client.
Closeness is the feeling of nearness to the client.
Distance is the feeling of detachment to the client.
Indifference is not being able to relate to the client.
Compassion fatigue
It is defined as the emotional residue of exposure of working with the suffering, particularly with those suffering from the consequences of traumatic events.
Compassion satisfaction is defined as the gratification one gets by helping the client.
Burnout
It is defined as a state of fatigue or frustration that resulted from professional relationships that failed to produce the expected reward, which causes psychological syndrome involving emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment in the profession as a clinical psychologist.
Emotional exhaustion is defined as being emotionally over extended and exhausted from the job of being a clinical psychologist.
Depersonalization is defined as a feeling of impersonal response toward the clients.
Personal accomplishment is defined as a sense of success and achievement as a clinical psychologist.
Sample
Clinical psychologist.
Inclusion and exclusion criteria
Inclusion criteria
- Should have a degree in M.Phil. in clinical psychology/medical and social psychology from RCI recognized institution
- Practicing as a clinical psychologist
- Minimum 2 years of experience (excluding the experience in M.Phil. course)
- Minimum age – 27 years.
Exclusion criteria
- Currently suffering from any mental illness
- Currently suffering from any major physical illness.
Sample size
According to Elliot and Woodward[18] “if you have 50 respondents in your data set, include no more than 5 independent variables in your regression equation.” Since the maximum of subscale was 5 (in case of NEO Five-Factor Inventory [NEO FFI]), a sample size of more than 50 was chosen.
Sample description
Fifty-one clinical psychologists from across India both male and female aged between 27 and 44 and currently practicing as a clinical psychologist.
Tools used
Information schedule
This was used to get the sociodemographic- and practice-related details of the subject.
Maslach burnout inventory
This test helps in measuring job-related burnout of individuals.
Description
Maslach Burnout Inventory was developed by Christina Maslach, Susan E. Jackson, and Michael P. Leiter in 1996.[19] It is a self-administering questionnaire containing 22 items. It is designed to assess three components of burnout syndrome: emotional exhaustion, depersonalization, and reduced personal accomplishment.
Compassion fatigue and satisfaction self-test for helpers
The test measures compassion satisfaction as well as fatigue of helpers.
Description
This scale was developed by Figley.[15] The scale consists of 66 items. Two subscales of the test, namely CF and compassion satisfaction, have been considered here.
Compassion satisfaction
Compassion satisfaction is about the pleasure one derives from being able to do one's work well. Higher scores on this scale represent a greater satisfaction related to one's ability to be an effective caregiver in the job.
Compassion fatigue/secondary trauma
CF, also called secondary trauma (STS) and related to vicarious Trauma, is about one's work-related, secondary exposure to extremely stressful events.
Questionnaire of cognitive and affective empathy
The questionnaire of cognitive and affective empathy (QCAE) is a tool for assessing cognitive and affective empathy.
Description
The QCAE was constructed to measure cognitive and affective empathy. The items of the QCAE were derived from the EQ,[20] the HES,[21] the empathy subscale of the Impulsiveness-Venturesomeness-Empathy Inventory (IVE),[22] and the IRI.[23]
Cognitive empathy
The ability to construct a working model of the emotional states of others.
Affective empathy
The ability to be sensitive to and vicariously experience the feelings of others.
Assessment of countertransference scale
This scale is used to assess CT feelings of therapists.
ACS was developed by Silveira et al.[24] There were three dimensions: closeness (10 items), distance (10 items), and indifference (3 items). This version was assessed by experienced analysts and psychotherapists with a psychoanalytical background, which considered that the items could assess conscious CT feelings.
NEO five-factor inventory
This scale is used for assessing the personality dimensions of the therapists.
Description – NEO FFI[9] was devised by Costa and McCare. It is a 60-item version of Form S of the Revised NEO Personality Inventory (NEO-PI-R) that provides a brief comprehensive measure of the five major domains of dimensions of personality. It is a self-report inventory. The big five factors or five major dimensions measured by NEO-FFI are:
- Openness to experience (O)
- Conscientiousness.(C)
- Extraversion (E)
- Agreeableness (A)
- Neuroticism (N).
Procedure
Phase 1
The research proposal was first placed in an ethical committee along with all the details such as plan of work, tools to be used, and sample. Once the research proposal was approved by the ethical committee, the data collection process was started.
Phase 2
A list of contacts (e-mail ids) of clinical psychologists of India was obtained from various databases of MHP. All of them were sent an e-mail stating the purpose of the study and the inclusion and exclusion criteria. Those who met the criteria and responded were sent a Google Form for responding along with the consent form. Data were obtained from various parts of India, but the majority of them were from Bengal.
Phase 3
Statistics was done using SPSS for Windows, Version 16.0 Chicago, SPSS Inc. The mean and standard deviation (SD) of all the variables were calculated. Pearson's product-moment correlation was done in between the independent variables. Multiple regression analysis was done to find out the contribution of the predictors on the criterion.
| Results | | |
Among the 51 participants 78% were female, 68% was aged between 27 and 32 and 92% had their highest qualification as M. Phil. Based on their mother tongue, the participants were classified as Bengali (59%), Hindi (21%), Gujarati (4%), Tamil (2%), Telugu (2%), Malayalam (2%), Kannada (2%), Kashmiri (2%), Odia (2%), Urdu (2%), and Bodo (2%). The mean (±SD) years of experience was 4.93 (±3.57) [Table 1].
Cognitive empathy is higher than that of affective empathy. Closeness CT is highest. Compassion satisfaction is higher than CF. Mean of the scores of all the personality dimensions falls in the average category. Mean of personal accomplishment is highest and depersonalization is lowest [Table 2]. | Table 2: The mean and standard deviations of all the variables in the study
Click here to view |
Neuroticism is positively correlated to affective empathy, distance, and CF, respectively. Closeness CT is positively correlated to compassion satisfaction. CF is positively correlated to distance CT. A significant positive correlation between extraversion and compassion satisfaction is seen [Table 3]. | Table 3: Pearson's product-moment correlation coefficient among the independent variables (empathy, countertransference, personality, compassion fatigue, and compassion satisfaction)
Click here to view |
Emotional exhaustion is positively correlated to neuroticism, compassion fatigue, cognitive empathy, and affective empathy. However, it is negatively correlated to conscientiousness. Depersonalization is positively correlated to distance CT, neuroticism, affective empathy, and compassion fatigue, and it is negatively correlated to conscientiousness and compassion satisfaction. Personal accomplishment is positively correlated to cognitive empathy [Table 4]. | Table 4: Pearson's product-moment correlation coefficient between the independent variables and the dependent variable
Click here to view |
Empathy contributes 7.6% of emotional exhaustion. Feeling the same way as that of the client explains being emotionally overextended and exhausted by one's work. For depersonalization, CT is a significant contributor. The coefficient of determinant R2 is 0.161, i.e., 16% of depersonalization is explained by CT. Closeness and indifference as CT contribute negatively to Depersonalization. Depersonalization has been defined as unfeeling or impersonal response to others; in the case of the present study, depersonalization is the impersonal response toward one's clients. Closeness as a feeling contribute negatively toward depersonalization, i.e., if closeness increases, depersonalization decreases and vice versa. Indifference contributes negatively to depersonalization. On the contrary, distance contributes positively to depersonalization, i.e., distance feelings toward client increases depersonalization. Depersonalization is also explained by compassion fatigue. The coefficient of determinant R2 is. 057, i.e., 5.7% of depersonalization is explained by compassion fatigue. CF is the trauma or secondary trauma that results from the caring of traumatized people. Working constantly with traumatized people can give rise to impersonal responses to others. Personal accomplishment is not explained by any of the variables [Table 5]. | Table 5: Regression coefficients that predict the burnout in clinical psychologists
Click here to view |
| Discussion | | |
Mean scores of the three dimensions of burnout, i.e., emotional exhaustion, depersonalization, and personal accomplishment, are within the low-level range. Holistically burnout of clinical psychologists is not alarming. Findings also show that there is significant relation and contribution of the predictors on burnout; empathy contributes to emotional exhaustion, and CF contributes to depersonalization. In addition, the mean scores of neuroticisms, openness to experience, extraversion, agreeableness, and conscientiousness are within the range. The personality variables do not contribute to burnout.
A significant positive correlation between neuroticism and distance CT indicates if the therapist tends to be anxious, depressed, and vulnerable, the chance of feeling distance toward the client increases. The therapist's own emotional instability is directly correlated with feeling distance toward the client, or in other words, if the therapist is unable to handle his or her own anxiety, s/he rejects the client easily. CF is the secondary stress that results from working with traumatized people.[15] Distance CT is the fact of feeling aloof[24] from the client. Hence, having stress induced from the people one is working for may be related to the feeling of distance from him/her, and thus, there is a positive correlation. Brandi[25] found that clinicians who reported having a higher percentage of clients with a personality disorder diagnosis would be a higher risk for CF. A positive correlation is also found in between closeness CT and compassion satisfaction. The pleasure derived from one's work is positively related to feeling close to one's client. The more positively the therapists viewed their time spent in therapy, the lower their risk for CF.[25]
Emotional exhaustion is positively correlated to neuroticism and openness to experience and depersonalization is positively related to neuroticism. High neuroticism indicates high stress and being vulnerable to negative emotions and thus is directly related to emotional exhaustion from work.[26] High neuroticism in clinical psychologists may lead to high emotional exhaustion. On the other hand, depersonalization for a clinical psychologist means impersonal response toward the client. High neuroticism also increases the feeling of un-relatedness toward the client. Furthermore, findings from the current study show that if conscientiousness is high, then emotional exhaustion and depersonalization are less, i.e., an efficient organized person has less feelings of emotionally drained at work and feelings of un-relatedness with the clients.
On the other hand, affective empathy has a positive correlation with emotional exhaustion and depersonalization. Emotional exhaustion is being emotionally tired at work. Depersonalization is emotionally feeling distant from the client. Too much emotional identification with other's problems leads to being emotionally tired and distant from others. However, on the contrary, cognitive empathy is related to personal accomplishment. Hence, cognitively modeling a client's problem is better for a therapeutic alliance than vicariously feeling it. Cognitive empathy gives a sense of personal accomplishment, whereas affective empathy gives a sense of emotional exhaustion and depersonalization. Day and Anderson[27] examined the relationship between burnout and empathy as a personality factor in counselors. They found that burnout was linked with three factors of multidimensional empathy. Empathic concern and perspective-taking were negatively correlated with depersonalization and lack of personal accomplishment. Current findings show that distance, as a CT, is positively related to depersonalization. If the therapist develops negative feelings toward the client, chances of feeling unrelated or impersonal increase.
Empathy contributes to emotional exhaustion. Depersonalization has been explained by distance and compassion fatigue. Bakker et al. showed that emotional exhaustion is uniquely predicted by neuroticism. Depersonalization is predicted by neuroticism, extraversion, and conscientiousness.[28] However, in the current study, none of the personality variables could predict the burnout dimensions.
| Conclusion | | |
The predictors, i.e., personality, compassion fatigue, empathy, and CT are correlated among each other. Personality dimensions are related with the other predictors, i.e., empathy, CT, and CF. The main contributors of burnout are CT, empathy, and CF.
Acknowledgments
The authors are thankful to all the participants who cooperated and those who helped in collecting data.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Schneider J. Stress, Loss, and Grief, Critical Care Medicine. Vol. 12. Baltimore, Williams and Wilkins; 1984. p. 1084.  |
| 2. | Maslach C. Burnout: A multidimensional perspective. In: Schaufeli WB, Maslach C, Marek T, editors. Series in Applied Psychology: Social Issues and Questions. Professional Burnout: Recent Developments in Theory and Research. Washington, DC: Taylor & Francis; 1993. p. 19-32. |
| 3. | Pope KS, Tabachnick BG. Therapists as patients: A national survey of psychologists' experiences, problems, and beliefs. Prof Psychol Res Pract 1994;25:247-58. |
| 4. | Gilroy PJ, Carroll L, Murra J. A preliminary survey of counseling psychologists' personal experiences with depression and treatment. Prof Psychol Res Pract 2002;33:402-7. |
| 5. | Yildirim I. Relationships between burnout, sources of social support and sociodemographic variables. Soc Behav Pers Int J 2008;36:603-16. |
| 6. | Wardle EA, Mayorga MG. Burnout among the counseling profession: A survey of future professional counselors. J Educ Psychol 2016;10:9-15. |
| 7. | Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol 2014;5:1573. |
| 8. | Vymĕtal J. The personality of psychotherapists. Sb Lek 2000;101:165-71. |
| 9. | Costa PT Jr., McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) Professional Manual. Odessa, FL: Psychological Assessment Resources; 1992. |
| 10. | Mills LB, Huebner ES. A prospective study of personality characteristics, occupational stressors, and burnout of school psychology practitioners. J Sch Psychol 1998;36:400-5. |
| 11. | Blair RJ. Responding to the emotions of others: Dissociating forms of empathy through the study of typical and psychiatric populations. Conscious Cogn 2005;14:698-718. |
| 12. | Spinella M. Prefrontal substrates of empathy: Psychometric evidence in a community sample. Biol Psychol 2005;70:175-81. |
| 13. | Picard J, Catu-Pinault A, Boujut E, Botella M, Jaury P, Zenasni F. Burnout, empathy and their relationships: A qualitative study with residents in General Medicine. Psychol Health Med 2016;21:354-61. |
| 14. | Gabbard GO. A contemporary psychoanalytic model of countertransference. J Clin Psychol 2001;57:983-91. |
| 15. | Figley CR. Compassion Fatigue as Secondary Stress Disorder: An Overview. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in those who Treat the Traumatized. New York: Brunner/Mazel; 1995. p. 70. |
| 16. | Culver L, McKinney B, Paradise L. Mental health professionals' experiences of vicarious traumatization in post-hurricane Katrina New Orleans. J Lass Trauma 2011;16:33-42. |
| 17. | Wagaman MA, Geiger JM, Shockley C, Segal EA. The role of empathy in burnout, compassion satisfaction, and secondary traumatic stress among social workers. Soc Work 2015;60:201-9. |
| 18. | Eliot AC, Woodward WA. Statistical Analysis Quick Reference Guidebook. Thousand Oaks, CA: Sage; 2007. [doi: 10.4135/9781412985949]. |
| 19. | Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory. 3 rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996. [doi: 10.4236/ce. 2013.42018]. |
| 20. | Baron-Cohen S, Richler J, Bisarya D, Gurunathan N, Wheelwright S. The systemizing quotient: An investigation of adults with Asperger syndrome or high-functioning autism, and normal sex differences. Philos Trans R Soc Lond B Biol Sci 2003;358:361-74. |
| 21. | Hogan R. Development of an empathy scale. J Consult Clin Psychol 1969;33:307-16. |
| 22. | Eysenck SB, Eysenck HJ. Impulsiveness and venturesomeness: Their position in a dimensional system of personality description. Psychol Rep 1978;43 :1247-55. |
| 23. | Davis MH. Measuring individual differences in empathy: Evidence for a multidimensional approach. J Pers Soc Psychol 1983;44:113-26. |
| 24. | Silveira Júnior Ede M, Polanczyk GV, Eizirik M, Hauck S, Eizirik CL, Ceitlin LH. Trauma and countertransference: Development and validity of the Assessment of Countertransference Scale (ACS). Braz J Psychiatry 2012;34:201-6. |
| 25. | |
| 26. | Schaufeli WB, Enzmann D. The Burnout Companion to Study and Practice: A Critical Analysis. UK: CRC Press; 1998. |
| 27. | Day JR, Anderson RA. Compassion fatigue: An application of the concept to informal caregivers of family members with dementia. Nurs Res Pract 2011;2011:408024. |
| 28. | Bakker AB, Van der Zee KI, Lewig KA, Dollard MF. The relationship between the Big Five personality factors and burnout: A study among volunteer counselors. J Soc Psychol 2006;146:31-50. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
|
Search Pubmed for