CE Corner

About CE

"CE Corner" is a continuing education article offered by the APA Office of CE in Psychology.

To earn CE credit, after you read this article, purchase the online exam at www.apa.org/ed/ce/resources/ce-corner.aspx.

Upon successful completion of the test — a score of 75 percent or higher — you can immediately print your CE certificate.

The test fee is $25 for members and $35 for nonmembers. The APA Office of CE in Psychology retains responsibility for the program. For more information, call (800) 374-2721.

Overview

CE credits: 1

Learning objectives: After reading this article, CE candidates will be able to:

  1. Describe the components of burnout. 
  2. Discuss ways to determine whether psychology practitioners are experiencing burnout. 
  3. List ways to prevent or treat burnout.

Polarized politics. Natural disasters in California, Puerto Rico and Houston. Emboldened white supremacy. Health insurance at risk. Escalating tensions with North Korea: All this is taking a toll. Almost two-thirds of American adults across party lines say the nation's future is a significant source of stress, according to APA's 2017 Stress in America report. More than half say this is the lowest point in U.S. history they can remember.

Burn outAnd when the public experiences heightened distress, so can practicing psychologists, who not only spend their days listening to their clients' worries but may themselves be experiencing the same stressors. The result? A heightened risk of burnout.

Burnout is more than just feeling worn out. According to psychologist Christina Maslach, PhD—a pioneering burnout researcher who developed what has become the gold standard for measuring burnout—the condition has three components: overwhelming exhaustion, cynicism and detachment, and a sense of ineffectiveness and lack of accomplishment (Maslach Burnout Inventory Manual, fourth edition, 2016).

"People kind of switch to doing the bare minimum instead of doing their very best," says Maslach, a professor emeritus of psychology at the University of California, Berkeley, and co-editor-in-chief of the journal Burnout Research.

For practicing psychologists, burnout can result in clients who don't get better or who are actively harmed, warns W. Brad Johnson, PhD, a psychology professor in the department of leadership, ethics and law at the U.S. Naval Academy. That's because burnout can lead to compassion fatigue, a condition Johnson equates with a compromised capacity for empathy.

"In my experience, the more empathic a caregiver is and the more he or she works with emotionally needy or traumatized clients, the more exhausting this can become," says Johnson. "That can lead to a muting of empathy, where the psychologist begins to process what's going on with the client in a purely cognitive way." As a result, he or she is less capable of processing and mirroring for the client, he says.

That makes addressing burnout an ethical obligation, says Johnson. The section of APA's Ethical Principles of Psychologists and Code of Conduct focused on competence requires practitioners to take appropriate steps or even stop working temporarily when they become aware of personal problems that may be interfering with their work, he points out.

Are you burned out?

Stacey Prince, PhD, is one psychologist who recognizes that she is at risk of burnout. Her four-person Seattle practice focuses on clients experiencing overlapping oppressions, such as racism, sexism, homophobia or transphobia.

"Folks who are in marginalized communities are having a very hard time," says Prince. Even clients who aren't in "targeted groups" are more distressed than ever, she says. And that makes Prince's job harder than usual. As a lesbian and social justice activist, Prince shares many of her clients' fears herself, and spending her work life listening to clients express the same concerns is exhausting. In the past, she explains, she may have been experiencing the same kind of trauma—whether a breakup or the death of a parent—as one or two of her clients. "It was contained," she says. "Now it's hour after hour, and I have to work much harder on my own self-care."

Unfortunately, says Johnson, the kind of self-awareness that Prince exhibits may be unusual among mental health practitioners. In fact, he is convinced that the very psychologists who are the most burned out may be the ones least likely to be aware they have a problem.

There's plenty of research to show that practitioners aren't very accurate when it comes to assessing themselves, he says. Often, the tendency is to chalk up a client's failure to improve as the fault of the client or to attribute a sloppy mistake to just having a bad day—something circumstantial. "We have a lot of defenses, just like the clients we treat," Johnson says.

One way to overcome these overly optimistic self-assessments is to assemble a group of trusted colleagues who can help monitor each other for burnout or other signs of waning competence, says Johnson, who calls for a communitarian approach to competence (Training and Education in Professional Psychology, Vol. 8, No. 4, 2014).

"We have to have each other's back," Johnson says. This small group could check in regularly and—in a collegial, supportive way—engage those who seem to be developing problems. "They might say, ‘I'm concerned about you because things don't seem to be going well,'" he says. The person might be seeing too many patients with trauma, for instance, and may need to decrease his or her patient load temporarily or even seek therapy.

Signs to look for in yourself or other mental health practitioners include negative feelings about clients, reduced quality of care, a tired appearance, reduced eye contact, irritability or agitation and poor communication, says Maslach (World Psychiatry, Vol. 15, No. 2, 2016).

Evidence-based self-care

What's the best way to prevent burnout or treat yourself if you're already feeling burned out? That depends on you, says Julie Radico, PsyD, an assistant professor of family and community medicine at Penn State's Milton S. Hershey Medical Center. She co-chaired a session on work/life integration for early career psychologists at APA's Annual Convention last summer. "What works for you may not work for me," says Radico.

Self-care doesn't have to be expensive or time-consuming, either. It shouldn't feel like another item on an overly long to-do list, adds Rebecca Schwartz-Mette, PhD, who chairs APA's Advisory Committee on Colleague Assistance (ACCA). "Repeated small doses of self-care are more effective than a once-a-week event," she says, citing the restorative power of a quick walk outside or even a cold glass of water.

Here Radico, Schwartz-Mette and other psychologists share tips that go beyond the usual exhortations to eat right and get enough sleep:

  • Assess your self-care resources. The self-care scale developed by clinical psychology graduate student Katherine E. Dorociak of Loyola University Chicago and colleagues can help you determine how well you're caring for yourself (Journal of Counseling Psychology, Vol. 64, No. 3, 2017). While the 21-item Professional Self-Care Scale was designed for use by researchers studying burnout and related issues, psychologists and other mental health professionals can also use it to ensure they're tapping resilience-building strategies in five domains: professional support, professional development, life balance, cognitive strategies and daily balance. That might mean sharing work-related stressors with colleagues, being aware of stress-inducing triggers or simply staying up to date on the research in your area. In a study of 422 licensed psychologists, Dorociak and her colleagues found that high scores in each of the domains were significantly correlated with less emotional exhaustion, less depersonalization of clients, less stress and a greater sense of personal accomplishment and satisfaction with life.
  • Try mindfulness. An emerging body of evidence suggests that mindfulness may protect mental health professionals at risk for compassion fatigue, according to a review of the literature by British psychologists David Turgoose, PhD, and Lucy Maddox, PhD (Traumatology, Vol. 23, No. 2, 2017). You don't have to have a full-scale meditation practice, says ACCA co-chair Judith Holder, PhD, who directs the Professional and Personal Development Program at Duke University. Instead, she suggests, try "micro" breaks. "When you're going from patient to patient, take five or 10 minutes to hit the pause button, think about something enjoyable and breathe in and out," says Holder. "If we do that after each client, we build reserve energy so we aren't feeling so drained at the end of the day."
  • Change the way you think about your work. Much of the burnout research focuses on job demands, such as long hours. It's also important to explore the personal resources that can help prevent burnout, says Patricia A. Rupert, PhD, an associate professor of psychology at Loyola University Chicago. In a review of the literature, Rupert and co-authors note such useful cognitive strategies as reflecting on satisfying work experiences, keeping your job in perspective, being aware of your strengths and weaknesses and monitoring your own reactions on an ongoing basis (Professional Psychology: Research and Practice, Vol. 46, No. 3, 2015).
  • Get moving. In a small study, Australian psychologist Einar Thorsteinsson, PhD, and medical student Rachel Bretland found that both cardiovascular exercise and resistance training seem to be effective burnout interventions (PeerJ, 2015). Psychologist Tyson Bailey, PsyD, a partner in Spectrum Psychological Associates in Lynnwood, Washington, takes such findings seriously. "Usually the first thing to go out the window when stress gets higher is going to the gym," says Bailey, who practices and teaches martial arts. "Instead of saying, ‘I'll go to the gym next week,' we should be saying, ‘Oh, my stress load is really high; I need to go to the gym right now.'"
  • Seek social support. Bailey checks in with his mentor monthly. "She might say, ‘The last four times I've seen you, you've reported being really tired. Have you noticed that pattern?'" he says. Bailey and the other members of his practice also look out for each other. Because the risk of burnout is especially high in the kind of trauma work the practice specializes in, he says, Bailey urges his colleagues to check in with him frequently. Support from friends helps, too. ACCA can also help connect psychologists with resources that can help them prevent or treat burnout, says Schwartz-Mette, an assistant professor of psychology at the University of Maine in Orono.
  • Get political. Many of Radico's patients are terrified that the Affordable Care Act will be repealed. To help them and prevent her own burnout, Radico responds to and shares every APA Federal Action Network alert, contacts her state and federal representatives and is active with the Pennsylvania Psychological Association. "When I'm feeling burned out after seeing several patients in a day and need to switch gears, I advocate for change," she says. So does Oakland, California-based psychologist Bedford Palmer II, PhD, who believes the best fix for burnout in this political climate is to transform anger into action. To fulfill that goal in his own life, Palmer and psychologist LaMisha Hill, PhD, launched a podcast called "Naming It" to explore the intersections of psychology, social justice and blackness. A form of self-care for themselves and other social justice advocates, the podcast helps both psychologists and targeted populations move beyond outrage to constructive action. That's why, says Palmer, every episode features not just discussions of current events but takeaways that offer suggestions for moving forward. "Sitting in inaction is a very quick way to get burned out as a social justice advocate," says Palmer, who is also an assistant professor of counseling at Saint Mary's College of California.
  • Unplug, both technologically and mentally. Being unable to switch off work after hours is associated with burnout, says Sabine Sonnentag, PhD, a professor of work and organizational psychology at the University of Mannheim in Germany. In a review of the literature, Sonnentag and co-author Charlotte Fritz, PhD, an associate professor of industrial/organizational psychology at Portland State University, found that refraining from work-related thoughts and activities during non-work hours can be restorative (Journal of Organizational Behavior, Vol. 36, No. S1, 2015). "People ought to take leisure time more seriously," says Sonnentag.

Resources

APA's Advisory Committee on Colleague Assistance
www.apa.org/practice/leadership/colleague-assistance.aspx

Burnout Research
www.journals.elsevier.com/burnout-research

The Resilient Practitioner: Burnout and Compassion Fatigue
Prevention and Self-Care Strategies for the Helping Professions, 3rd Edition

Skovholt, T.M., & Trotter-Mathison, M., 2016