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Article 46

Burnout Prevention for Professionals in Psychology

Karen Much, Amy L. Swanson, and Richard L. Jazazewski

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The prevention of burnout is a topic that is especially relevant to those of us who work in the field of psychology. The nature of the work in this field places us in near-constant and often intense interpersonal interactions with our clients. Frequently, we find ourselves working within systems that test our abilities to focus fully on our clients and that place numerous other demands on our individual resources. Because of these challenges, the likelihood that we could face emotional and mental depletion during our careers is quite high. At its extreme, the depletion that comes with full-blown burnout can lead to serious personal and professional impairment. Certainly, the costs to our own lives are of concern. However, because there is the distinct possibility that our depletion could be damaging to our clients, the prevention of burnout must be considered not just a concern but an ethical imperative for psychological professionals.

To better understand burnout, we must first recognize the particular ways in which it manifests itself. We then must identify the factors that can place us at risk for developing the syndrome. Lastly, we can utilize the specific strategies that will allow us to keep burnout at bay.

Maslach (1993) has identified a comprehensive, multidimensional model of burnout. This model conceptualizes burnout as a prolonged response to chronic emotional and interpersonal stressors on the job. It can be considered a distinct psychological syndrome, encompassing emotional exhaustion, depersonalization, and reduced personal accomplishment. According to Maslach, individuals experiencing burnout will display decreased energy and/ or exhaustion, feel depleted of emotional resources, find they have a negative or callous attitude, are detached from others, and feel they are nonproductive and incompetent.

Burnout has several general characteristics. An individual may suffer from acute or chronic burnout, and it may range from mild to severe (Hamann & Gordon, 2000). Symptoms do tend to be progressive and worsen over time if not attended to, and may manifest in physical, emotional, cognitive, and interpersonal ways (Maslach & Goldberg, 1998).

Physical symptoms may include fatigue, tension, insomnia, physical illness, and low energy. Emotional and psychological symptoms may manifest themselves as boredom, feeling out of control or overwhelmed, resentment, guilt, moodiness, frustration, anger, helplessness, hopelessness, emotional drain, cynicism, anxiety, low self-confidence, tearfulness, dread of work, and powerlessness. Several cognitive and mental symptoms may be present as well. These include a negative attitude about work, self-doubts, decreased concentration, memory difficulties, and overfocusing on the negative. Interpersonal symptoms such as withdrawal from relationships and general social isolation are common. Another characteristic of burnout is disengagement, which can include an inability to care about one’s job, detachment from loved ones, missing work, daydreaming, desiring to quit work or escape, and/or the use of alcohol or drugs. Individuals may also experience a decline in the quality of work, increased procrastination, decreased enthusiasm, lack of interest, decreased motivation, ineffectiveness, and impairment via incompetence or unethical behaviors (Maslach & Goldberg, 1998; Skovholt, 2001). These many symptoms exemplify how burnout manifests itself and can be useful for recognizing when it is becoming a concern. Risk factors, however, can be used as a tool to identify the potential for developing burnout before it occurs.

There are several risk factors for developing burnout, ranging from systemic issues inherent in the work environment, to cultural factors, to individual variables. Concerns inherent in one’s work environment or job conditions include, but are not limited to, excessive workload, lack of administrative support, lack of appreciation or recognition, budgetary and other resource limitations, long hours, insufficient rewards, unrealistic or unclear expectations, breakdown of community, significant value conflicts, lack of control, unfairness and organizational politics, rules, restrictions, and policies (Byrne, 1998; Hafen, Karren, Frandsen, & Smith, 1996; Maslach & Leiter, 1997).

There are several cultural factors that may create a higher risk for burnout. These include social, political, and economic factors that shape the work environment, a decrease in the quality of workplace health, and high value being placed on overachievement and overfunctioning. Work cultures that normalize and reward overextending oneself beyond developmental, physical, or emotional capacities lend themselves to a much higher risk of burnout. This risk may be due to confusing overfunctioning with ambitiousness, which can blur the boundary between professional and personal lives (Skovholt, 2001).

There are also several individual variables that may serve as risk factors for burnout. Individuals who have unmet personal needs or who have conflicting needs are likely to find it quite difficult to be satisfied with their professional lives, adding additional stress and tension to their work. The ability to tolerate and deal with stress effectively varies significantly from person to person, and is based on several psychological, physiological, and developmental factors. Clearly, someone who is able to manage stress effectively will fare better than someone who is prone to more quickly and intensely feel the negative effects of stress.

Personal variables, such as caretaking tendencies, ability to set limits and boundaries, and personal life stress may also factor into burnout. Professionals who are typically self-sacrificing at work and at home and who take care of others at the expense of themselves are at much higher risk for burnout than individuals who more appropriately balance these competing needs. Also, being unable to set appropriate boundaries and limits with colleagues can significantly contribute to burnout. Personal life stress, crises, and an inability to compartmentalize problems or feelings can also significantly contribute to burnout, as the individual is typically unable to effectively and in a healthy manner manage the demands of his or her personal life on top of his or her professional life.

Other factors which may contribute to burnout include having an identity exclusively based on work, and believing that it is selfish or self-indulgent to give time and attention to self. A professional who develops an identity defined almost entirely through work will find that he or she must keep working (and often, must keep working more) to feel competent and important. Such an individual may be actively ignoring personal problems or creating a limited sense of identity in cases where self-awareness is lacking. Creating an identity solely based on one’s occupation certainly contributes not only to burnout but also is a major risk factor for becoming a workaholic or compulsive worker – the professional becomes further driven to be more productive at work, and either has no personal life, or finds it to be in shambles. Believing that giving time and attention to oneself is unnecessary, selfish, and/or self-indulgent may also play a role in developing burnout. Appropriately giving to oneself and engaging in healthy self-care can allow professionals to be more effective in their work. However, not all professionals, especially in more competitive academic climates, understand that it is self-respecting and responsible to indulge in self-care and to set appropriate limits and boundaries.

Prevention strategies that can be employed to decrease these risks, and thus decrease burnout, fall under two categories: system-centered and person- centered approaches. The system-centered approaches attempt to directly target the job-specific factors that affect our vulnerability to burnout. Options that fall under this category may include decreasing worksite stressors, enhancing autonomy, recognizing employee achievement, providing competitive compensation, and offering wellness-related services to employees. Though burnout, operationally defined, is a byproduct of various workplace stressors, for a variety of reasons the system-centered approaches are typically the least likely to be implemented within our workplaces (Maslach & Leiter, 1997).

Most likely, we will need to apply the person- centered approaches, which target our individual susceptibilities to developing burnout. These approaches include those strategies that we can utilize on the job and outside of work. Both types of strategies are necessary for maintaining a balance between our professional and personal lives.

At work, we can consider a variety of strategies to reduce our stress level. We may change our work patterns by avoiding overtime and reprioritizing our tasks by setting daily goals. We can take moments of time for ourselves, through short breaks and self-reward. Additionally, we can make sure that we avoid isolation at work by seeking out supportive professional relationships through supervision, peer consultation groups, mentoring relationships, and/or informal support from our colleagues (Skovholt, 2001). When the stress from work originates from boredom and routine, we can focus our efforts on keeping our work stimulating by looking for the professional development experiences that allow us to develop new skills and interests that are in line with our professional values and goals. Additionally, in our daily routines, we can seek out novelty by recognizing the uniqueness in each repeat experience and involving ourselves in different tasks and roles that bring a manageable yet interesting variety to our days (Skovholt, 2001).

Outside of work, through adequate self-care, we can reduce our overall level of stress and refuel ourselves so that we have the energy that both our jobs and our broader lives require. For some of us, our self- care will include developing or enhancing our coping skills so that we can, for instance, better manage our time and stress, set appropriate limits, and resolve conflicts. For others, we may concentrate on our physical health as a crucial part of maintaining our overall well-being. In part, we can meet our physical needs by maintaining a balanced diet, exercising regularly, getting adequate rest, limiting our use of alcohol as well as caffeine and tobacco, and accessing our preventive medical care checkups (Baker, 2003; Butler & Hope, 1995; Lehrer & Woolfolk, 1993; Skovholt, 2001). Social support can be another key strategy for staying emotionally and physically healthy, providing everything from direct assistance with our problems to emotional comfort to a basis of comparison for our reactions (Hafen et al., 1996; Maslach & Leiter, 1997; Skovholt, 2001). Our spiritual, religious, and philosophical resources can also be enlisted by reading spiritual or inspirational materials, meditating, spending time in nature, seeking out spiritual counseling or advising, and reflecting about the meaning we derive from our work and life (Baker, 2003; Firestone, Firestone, & Catlett, 2003). Likewise, the use of play cannot be undervalued. As work dominates a massive part of our time, creativity, and mental and emotional energies, it is of great value to balance the seriousness of our work demands with a sense of lightness, spontaneity, and adventure. Whether this includes working on hobbies, traveling, listening to music, or any number of other leisure and recreational activities, we can purposefully seek out positive life experiences that can counteract the effects of our work stresses, allowing us to recharge our internal batteries and face the challenges in our lives (Baker, 2003; Skovholt, 2001).

It is obvious that the work we do as professionals in psychology demands that we care for both our professional and our personal needs. The difficulty in doing so is in making the commitment to ourselves and taking the steps to incorporate the burnout prevention strategies into our daily lives. We may enhance our motivation to take those steps by thinking of our self-care as a professional and an ethical imperative. Our job requires us to continually strive for a delicate balance between caring for others and caring for ourselves. At one end, our clients’ trust in us will be enhanced as they see us modeling the positive self- care that we encourage them to do. At the other end, if we find ourselves unbalanced and emotionally depleted, we are less able to competently treat our clients, and thus, our lack of self-care puts our clients at risk for harm by us. That risk is not one that we can afford to take.