Wohlbefinden,Burn-out und Ressourcen bei Psychotherapeuten

Background

Well-being and its correlates have rarely been investigated in psychotherapists. Results from research on other occupational groups have shown that subjective and work-related well-being are both associated with performance and motivation as well as with mental and physical health. Therefore, personal and job-related resources of practicing psychotherapists were investigated in this study in order to assess their associations with well-being.

Method

A total of 771 psychotherapists filled in an online questionnaire including questions concerning well-being (WHO-Five Well-being Index, WBI-5), burnout (Maslach Burnout Inventory, MBI), and personal (Psychological Capital Questionnaire, PCQ) as well as job-related (Dutch Questionnaire on Work Experience, VBBA) resources.

Outcomes

Of the participants 45?% reported that they were suffering from high emotional exhaustion. Over 30?% reported a reduced subjective well-being, while more extensive professional experience was associated with better well-being. Psychotherapists reported optimism and hope to be the most important personal resources, whereas opportunities for personal and professional development were the most important job-related resources.

Conclusions

The study identified personal and job-related resources which may be relevant for different aspects of well-being in psychotherapists.     

Integrating counselling, psychotherapy and healing: An inquiry into counsellors and psychotherapists whose work includes healing

A qualitative study of 30 counsellors or psychotherapists whose work also includes healing was conducted using semi-structured interviews. Seven of the participants then joined the researcher in a human inquiry group. Participants in the research had been practitioners for a mean of over 10 years. The main themes that emerged were: the transition by the practitioner towards the use of healing; the taboo concerning talking about spiritual and healing experiences reported by the participants; the nature of healing as distinct from therapy; the supervision difficulties that arose when participants engaged in both counselling/psychotherapy and healing with their clients; and the concept of spiritual space. Some very experienced psychotherapists and counsellors are now including healing in their work. This raises a number of important issues, particularly relating to supervision.     

The Unseen Cost: A Discussion of the Secondary Traumatization Experience of the Clergy

The vocation of clergy life can be a hazardous journey. Stress and burnout are issues, which are increasingly reported by clerics. Burnout is defined by a constellation of work related symptoms (Doolittle, Mental Health, Religion & Culture,10(1), 31–38, 2007), with emotional exhaustion recognised as a core component. Despite this recognition the research has not focused on factors which lead to this state of emotional exhaustion in particular secondary traumatization. The purpose of this article is threefold. Firstly, it presents the theoretical framework of secondary trauma. Secondly it reviews the literature aligning clergy and trauma work and thirdly it discuses the emotional and physical toll upon clergy from this aspect of their role.     

Learning from experience: Examining the impact of client work upon two trainee therapists

This qualitative research study, focusing on the learning and change of two trainee therapists over a nine‐month period, was conducted by the trainees themselves. In collecting and analysing their data, the researchers made use of the heuristic methodology, to which some of the principles of the co‐operative inquiry methodology were added. The findings shed light on some of the ways in which trainee counsellors and psychotherapists might learn through their work with clients, the forms and contexts in which this learning may arise, and how the learning might affect the trainees. The findings additionally highlight some of the possible benefits of engaging in research for trainee counsellors and psychotherapists, in terms of their roles as practitioners. These include positive changes in the ways in which they work with clients, and changes in the ways they think about their practice.     

Moving beyond counselling and psychotherapy as it currently is – taking therapy outside

Research was undertaken by the author in order to describe, interpret and explain what happens when counsellors and psychotherapists who have been trained to work indoors with their therapy clients take their therapy practice into outdoor natural spaces. A central research question addressed ‘What happens when counsellors and psychotherapists, who have been trained to work indoors with their therapy clients, take their therapy practice in to outdoor natural spaces?’ Semi-structured interviews were undertaken with therapists who practised outdoors. Three dominant themes emerged critiquing aspects of current counselling and psychotherapy practice. These were related to the unfolding ecological crisis, the context of the work and moving beyond current conceptions of distress and the role of therapy in addressing this.     

Pastoral Burnout and the Impact of Personal Spiritual Renewal,Rest-taking,and Support System Practices

Pastors risk burnout because of inordinate ministerial demands, which may drain their emotional, cognitive, spiritual, and physical energy reserves and impair their overall effectiveness. Burnout advances across three dimensions: emotional exhaustion, depersonalization, and reduced accomplishment. The debilitating effects of pastoral burnout were examined through a survey of 270 pastors. Relationships between burnout and three potentially preventative or mitigating factors, spiritual renewal, rest-taking, and support system practices, were explored. The results identified spiritual dryness as the primary predictor of emotional exhaustion, the stress dimension of burnout. In the published literature, no other work to date has empirically substantiated a link between pastors’ spirituality and burnout. These findings expand the burnout construct and promote leader self-care practices that foster resilience, vitality, and well-being.     

Common principles of psychotherapeutic change: patterns of use

ABSTRACT

Many authors have proposed the existence of common principles of counselling and psychotherapeutic change. However, little is known about how practitioners use these change principles. A sample of 373 Czech psychotherapists and counsellors participated in an online survey and rated their use of 10 psychotherapy change principles in their practice over the previous year. The frequency of the use of the 10 change principles is reported. Furthermore, three principal components of the change principles were identified: exploration, acceptance, and understanding of clients’ experience; attending to clients’ own resources; and furnishing clients with new skills and advice. The use of these components was mainly associated with the practitioner's theoretical orientation. The implications of the component structure for psychotherapist and counsellor training and practice are discussed.     

The Importance of PRI Therapy for the Pastoral Counsellor

It is not always easy for pastoral counsellors to help people change. Often people have become stuck in their ways. Recent developments in the field of brain research help explain why change is difficult. This article discusses Past Reality Integration Therapy (PRI), a psychotherapeutic method that integrates recent findings of brain research and offers an important addition to the work of (pastoral) counsellors and psychotherapists. The use of this approach with Dutch students in their pastoral training is presented. Furthermore the importance of this new method for counsellors themselves, their clients and their work is discussed and some overall conclusions about the method and its practical application are presented.     

Humanizing Psychotherapy

The essence of the humanistic and existential approaches to psychotherapy is a commitment to conceptualizing, and engaging with people in a deeply valuing and respectful way. Hence, within these approaches, there is an emphasis on viewing clients’ behaviors as meaningful and freely chosen; and there is also a belief that clients have the capacity to become aware of the reasons for their thoughts, feelings and behaviors. Phenomenological exploration is thus a central element of many existential and humanistic psychotherapies, and this requires psychotherapists to put to one side their therapeutic techniques and interpretative assumptions and to listen to clients in an in-depth, non-analytical way. From an existential and humanistic standpoint, however, this valuing of human beings also extends to the psychotherapist's own humanity. Hence, within these approaches, there is an emphasis on the psychotherapists themselves being genuine in the psychotherapeutic encounter, and being willing to meet their clients at a level of “relational depth.” Existential and humanistic practices may not be appropriate for all clients and all psychotherapists, but it is concluded that the principles underlying these approaches are of universal relevance to the practice of psychotherapy.

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Self-handicapping and burnout

Self-handicapping is a process containing strategies of externalization in which an individual can excuse failure and internalize success. This study investigated the relationship of self-handicapping with measures of burnout. The Self-handicapping Scale and the Maslach Burnout Inventory were administered to 309 university students. Self-handicapping was positively correlated to emotional exhaustion, lowered personal accomplishment, and depersonalization. A structural equation model fit the data well and accounted for 20% of the variance in emotional exhaustion, 14% in lowered personal accomplishment, and 10% in depersonalization.     

Supervising counsellors and psychotherapists who work with trauma: a Delphi study

In this study the Delphi technique was used to identify the main supervision issues that require attention and consideration when supervising counsellors and psychotherapists working with trauma. A panel of supervisors, who were additionally experienced in working with trauma in adulthood, completed a series of three questionnaires comprising two qualitative and one quantitative round. Themes and key concepts were identified from the data, and the respondents rated the importance of the themes using a visual analogue scale. This iterative process identified areas where there was consensus amongst the respondents and areas where contention was apparent. The results revealed significant issues pertinent to the supervision of trauma therapists, with a particularly strong emphasis around training, experience and organisational issues. Directions for further research emerging from the study are also discussed.     

Körperbeschwerden bei niedergelassenen Psychologischen Psychotherapeuten

From June until August 2004 we asked 488 freely practising psychological psychotherapists in selected German federal states for the frequency of somatic complaints using the short version of the Gießener Beschwerdebogen (GBB-)24. It turned out that the psychotherapists suffered most from exhaustion and pain. Their somatic complaints were remarkably less influenced by sociodemographic characteristics like age, gender and location of practising (East/West). In comparison to the overall population the psychotherapists in total reported quantitatively the same frequencies of somatic complaints. Qualitatively the psychotherapists reported less problems concerning gastric and heart complaints but more problems concerning exhaustion than the overall population. Compared with a sample of saxonian general practitioners, the psychotherapists suffered from slightly less somatic complaints.     

The practices of existential psychotherapists: development and application of an observational grid

Within the major therapeutic paradigms, observational instruments have been developed to assess orientation-specific interventions or processes. However, to date, no such instrument exists to assess existential practices. Recent research indicates the key practices of existential therapists, and forms an empirical basis on which to develop an observatory grid. This paper describes the development of such a grid, and its exploratory testing with eight clients of four Portuguese existential psychotherapists. A total of 32 sessions were observed and both speaking turn and whole-session analysis showed that it was feasible to assess existential therapy using the instrument, although psychometric findings recommend further refinement of the tool. Session-rating data suggest that the chief practices applied by existential therapists were relational, followed by the use of hermeneutic interventions and reformulations. Interventions based on phenomenological and existential assumptions were observable in practice but limited in frequency. Further refinements and developments of the observational grid, together with additional research – using a range of therapists from different schools of existential therapy – are recommended.     

The psychological well-being of employees who handle cash in a bank in inner city Johannesburg

The aim of the study was to compare the psychological well-being of bank employees who handled cash and those who did not. The study assessed employees' levels of work stress, burnout and life satisfaction. The Job Stress Survey Scale was used to measure work stress, Maslach Burnout Inventory was used to measure burnout and the Congruity Life Satisfaction Scale was used to measure life satisfaction. Two independent sample t tests were run on Statistical Analysis Software. The results showed that the two groups differed significantly in terms of work stress, emotional exhaustion, depersonalisation and overall burnout. The findings of this study suggest the need for organisational support, skills development and the provision of wellness programmes for bank employees.     

Counsellors' experiences of working with suicidal clients: An exploratory study

Counselling is increasingly available in a wide variety of contexts, including mental health and psychiatric services. As a consequence, counsellors increasingly work with clients who present with suicidal ideation, expressing either suicidal thought and/or intent in the counselling session. This paper describes an exploratory study that examined the experience of counsellors when working with suicidal clients. The paper considers counsellors' behavioural, cognitive and emotional responses to such suicidal expression, both on a personal and professional level. The research employed semi‐structured interviews. A constant comparative method was used in analysing the transcribed interview text. Results suggest that counsellors experience a range of responses when their clients express suicidal thought, including fear, anxiety, anger and professional impotence. The interviewees also expressed self‐doubts about their professional competence. In addition, they identified the threat of litigation for negligent practice and the lack of confidence in appropriate risk assessment approaches as significant causes for concern. The implications for further research, and practice, are discussed.     

Social Support, Personality, and Burnout in Nurses

This study sought to find evidence for: (a) a relationship between increased levels of work-related social support and decreased burnout, (b) a relationship between personality traits and burnout, and (c) a significant interaction of social support and extraversion in relation to burnout. Seventy-six staff nurses and their supervisors at a private medical hospital participated as subjects. Two subscales of the Work Environment Scale measured social support. Personality was measured using an instrument known as PROSCAN, and Scale H of the 16PF. Burnout was measured by the Maslach Burnout Inventory. A strong negative correlation between work-related social support and burnout was found. Also, nurses whose supervisors received positive-feedback training showed significant reductions in emotional exhaustion, compared to those whose supervisors did not receive this training. Some dimensions of personality explained a significant amount of burnout. The study also provided further evidence of the interactive effect of social support and extraversion in relation to an emotional distress variable. That is, extraverted nurses required more work-related peer support than did introverts to avoid emotional exhaustion. Suggestions for further research are given.     

The role of self-efficacy in performing emotion work

This study used a sample of 154 cabin attendants to examine the role of self-efficacy in the performance of emotion work. On the basis of the literature, we hypothesized that self-efficacy would have a moderating influence on the relationship between emotional job demands (i.e., feeling rules and emotionally charged interactions with passengers) and emotional dissonance, and on the relationship between emotional dissonance and well-being (emotional exhaustion and work engagement). In addition, we predicted that emotional dissonance mediates the relationship between emotional job demands and well-being. The results of a series of hierarchical multiple regression analyses generally supported these hypotheses. Results confirmed that emotionally charged interactions with passengers are related to emotional exhaustion and engagement through their influence on emotional dissonance. Furthermore, self-efficacy buffers the relationship between emotional job demands and emotional dissonance, and the relationship between emotional dissonance and work engagement (but not exhaustion).     

Relationship Between School and Classroom Environment and Teacher Burnout: A LISREL Analysis

Research was conducted on the relationship between school and classroom psychosocial environment and perceptions of burnout in teachers who staff Queensland private schools. A sample of 246 teachers responded to scales that assess seven school environment and seven classroom environment dimensions and the three facets of burnout measured by the Maslach Burnout Inventory: emotional exhaustion, depersonalisation and personal accomplishment. Preliminary multiple regression analyses resulted in an hypothesised model of seven environment dimensions predicting burnout. This model was tested in a LISREL analysis with posthoc modifications improving model fit to data. While staff affiliation and work pressure were significant predictors of emotional exhaustion, staff mission consensus and co-operation in classrooms were significant predictors of depersonalisation. Staff mission consensus, together with classroom interactions, co-operation and task orientation were significantly related to personal accomplishment. Results supported previous research on the structure of teacher burnout in that emotional exhaustion influenced depersonalisation which subsequently impacted on personal accomplishment.     

Containment lost: the challenge to child psychotherapists posed by modern CAMHS

The paper is an examination of some emotional challenges facing child psychotherapists working in modern CAMHS following the introduction of the NHS internal market for commissioning and providing services. Its introduction has brought the loss of organisational containment for all CAMHS clinicians. The meaninglessness in work reported by clinicians is a clue to this loss. This loss is especially difficult for child psychotherapists because of their particular investment in the apprehension of meaning in symptoms and other presentations by patients. The paper proposes that meaninglessness is itself a clue to the ascendancy of what Freud called the death instinct, and that this is inherent within the internal market model. Because service design and delivery is predicated upon it, the internal market model structurally determines that clinicians are bound to senior management in a way that leaves child psychotherapists open to professional life-threatening dynamics associated with the death instinct. The ?K (Bion) world of CAMHS is thus deathly, leaving child psychotherapists vulnerable to self-destruction. We have lost a workplace in which our approach flourished conferring on us the identity of a discipline structurally favoured, because of the help we provided through this approach to patient and clinic work. This loss of identity brings the dangers of containment lost. This situation leaves child psychotherapists emotionally vulnerable and is akin to Satan’s loss in Milton’s Paradise Lost.     

Siblings as Selfobjects in Childhood: An Interview Study of Factors and Consequences

This study explores the factors psychotherapists working with adult clients identify as contributing to their clients' use in childhood of relationships with siblings to meet selfobject needs or the use of clients by their siblings for selfobject purposes in childhood, and the consequences of this to the children's intrapsychic development as evidenced in their adult psychotherapy. Using interviews with six psychotherapists practicing within the framework of self psychology, this research determines that the emotional and physical unavailability of parents was a common factor causing children to use their siblings for selfobject purposes. The research also explores the lasting impact of these selfobject ties on the psychological development of both the child using a sibling for selfobject purposes and the child who serves this function for another, as well as the role of psychotherapy in understanding these relationships. These findings give psychotherapists from a variety of disciplines, including social work, an enhanced conceptual framework from which to consider the role of siblings in psychological development.