Burnout among mental health professionals is a problem that is well-documented and may affect staffing shortages and patient outcomes. Burnout is characterized by emotional exhaustion, depersonalization or cynicism about the work, and a lack of competency or self-efficacy. Burnout can likely affect the quality of care that professionals provide. This may be particularly evident in psychotherapy where clinician empathy and engagement are key to therapeutic success. Although there are several surveys of psychotherapist burnout, surprisingly there is little research on patient outcomes associated with burnout of mental health professionals. In this prospective study, Sayer and colleagues examined treatment outcomes associated with burnout among psychotherapists providing trauma-focused therapies for post-traumatic stress disorder (PTSD) among military personnel in the US. The Veterans Health Administration (VHA) in the US has widely adopted cognitive processing therapy (CPT) and prolonged exposure (PE) for the treatment of PTSD. These treatments were manualized protocols of relatively brief therapies that lasted between 8 to 15 sessions. Therapists were experienced psychologists or social workers. Of the 165 therapists in the study, 35.2% reported burnout. Of the 1258 patients treated by all therapists in the study, 34% achieved clinically meaningful improvement. That is, about two-thirds of patients did not benefit from either CPT or PE and 46.3% of the patients dropped out of the therapies. On average, therapists were very adherent to the treatment manual, but adherence was not associated with clinically meaningful improvement in their patients (OR, 1.09; 95%CI, 0.95-1.25; P = .22). Therapist burnout was not associated with patient dropout (OR, 0.98; 95%CI, 0.78-1.24; P = .88) or adherence to the manual (OR, 0.95; 95%CI, 0.68-1.34; P = .76). However, compared to those who did not report burnout, therapists who reported burnout had fewer patients who experienced clinically meaningful improvement (OR, 0.63; 95%CI, 0.48-0.85; P = .002). That is, 36.8% of patients improved if they saw a therapist who did not report burnout, whereas 28.3% of patients improved if they saw a therapist who did report burnout.
Practice Implications
Therapists who are emotionally worn out may have a reduced capacity to demonstrate empathy, form a therapeutic alliance, or be present and engaged with patients who are suffering. Therapists and the agencies they work for may need to manage their caseloads carefully so that therapists have a case mix that is not overloaded with emotionally challenging content. Therapists also tend to do better when they have control and flexibility over their work and experience a sense of support and collegiality in the workplace. Beyond that, therapists should take enough time to care for themselves outside of the work environment and seek social support, and personal therapy if the content of their work triggers difficult emotional responses.
Sayer, N.A., Kaplan, A., Nelson, D.B., Stirman, S.W., & Rosen, C.S. (2024). Clinician burnout and effectiveness of guideline-recommended psychotherapies. JAMA Network Open, 7(4):e246858. doi:10.1001/jamanetworkopen.2024.6858
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