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Burnout among mental health professionals: Special

considerations for the marriage and family therapist

Article  in  Journal of Marital and Family Therapy · February 2006

DOI: 10.1111/j.1752-0606.2006.tb01590.x · Source: PubMed

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Journal of Marital and Family Therapy
January 2006, Vol. 32, No. 1, 87–99

BURNOUT AMONG MENTAL HEALTH PROFESSIONALS:

SPECIAL CONSIDERATIONS FOR THE MARRIAGE AND
FAMILY THERAPIST
Tziporah Rosenberg and Matthew Pace
Syracuse University

Burnout is a syndrome consisting of physical and emotional exhaustion resulting from negative
self-concept, negative job attitudes, and loss of concern for clients. This research study explores
potential predictors and prevalence of burnout among marriage and family therapists (MFTs).
It evaluates the Maslach Burnout Inventory (MBI) to establish its applicability to MFTs. Our
sample of 116 Clinical Members of the American Association for Marriage and Family Therapy
responded to a mailed questionnaire including demographic information and the MBI. Overall,
our sample reported low-to-moderate ranges of burnout. Differences were noted in degrees of
burnout across job settings. Predictors of clinician burnout include hours worked per week
and job setting. Factor analysis indicates that the MBI is an appropriate assessment tool for
measuring burnout among MFTs. Implications for clinical practice are discussed.

Although the concept of burnout among mental health professionals is not new, the recent focus on
burnout in scholarly literature has shed some light on a previously under-investigated experience among
clinical practitioners. Fields of study have generally centered around symptoms and risk factors, as well as
prevention and treatment of burnout, but investigations have concentrated almost exclusively on burnout
as experienced by psychologists, social workers, and psychiatrists. Theoretical frameworks, treatment
modalities, and therapist–client relationships particular to marriage and family therapy (MFT) may lead
to different outcomes in studying burnout among therapists. Literature describing research and analysis
concerning burnout and MFT as a separate and distinct profession has been notably lacking. As a result,
this research study examined the burnout syndrome within a sample of MFTs in an attempt to explore
potential predictors and prevalence of burnout among them. We then evaluated a burnout assessment tool
commonly used among other helping professionals to establish its applicability to MFTs. Implications of
these findings for MFT practice will also be discussed.

REVIEW OF LITERATURE

Definition
Burnout is most frequently characterized as a syndrome of physical and emotional exhaustion
resulting from the development of negative self-concept, negative job attitudes, and a loss of concern or
feeling for clients (Maslach, 1976; Piercy & Wetchler, 1987; Pines & Maslach, 1978; Raquepaw & Miller,
1989; Truchot, Keirsebilck, & Meyer, 2000). Physical manifestations of burnout typically include chronic

Tziporah Rosenberg, MA, and Matthew Pace, MA, Department of Marriage and Family Therapy, Syracuse
University.
The authors contributed equally to this project.
A portion of this article was presented as a poster, “Burnout Among MFTs” at the 2001 American Association for
Marriage and Family Therapy annual conference, Nashville, TN.
The authors extend our most sincere thanks and appreciation to Jonathan Sandberg for his love and guidance.
Correspondence concerning this article should be sent to Tziporah Rosenberg, Department of Marriage and Family
Therapy, 008 Slocum Hall, Syracuse University, Syracuse, New York, 13244; E-mail: tzrosenb@syr.edu

January 2006 JOURNAL OF MARITAL AND FAMILY THERAPY 87

fatigue, gastrointestinal problems, insomnia, headaches, and hypertension (Farber, 1990; Pines & Aronson,
1981). Emotional indicators of burnout are most often cited as feelings of hopelessness, futility, and
despair (Kestnbaum, 1984), boredom and cynicism (Friedman, 1985), anxiety, withdrawal, and irritability
(Jayaratne & Chess, 1984), loss of morale, feelings of isolation, and depression and suicidal ideation (Piercy
& Wetchler, 1987). Pines and Aronson (1981) also suggest a third dimension of exhaustion correlated with
burnout characterized by lowered self-concept, increasing inflexibility, distancing from clients, treating
clients as cases rather than as people (Maslach, 1976), disbelief in effectiveness, and increased family and
social conflict (Farber, 1990).
Burnout has generally been described as a process, rather than the experience of isolated symptoms
otherwise correlated with the syndrome. Corey and Corey (1998) offer that considering burnout on a
continuum allows it to be seen as a developmental process with levels of symptoms varying at different
points in the professional lives of practitioners. Kestnbaum (1984) notes that burnout can be approached as
a process typified first by acute, momentary “attacks,” then longer phases of symptoms accompanied by
unresolved conflicts, efforts to recoup, and struggle. Friedman (1985) suggests that burnout occurs only as
the endpoint of a process combining any number of the symptoms listed above.
Symptoms of feeling emotionally drained, depressed, and otherwise fatigued have been associated
with conditions such as compassion fatigue and secondary traumatic stress (Figley, 1982, 1985, 1995,
2002), vicarious traumatization (McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995), and
secondary victimization (Figley, 1982). Although these syndromes have also been characterized as being
associated with “the cost of caring for others in emotional pain,” they are conceptually and operationally
different than burnout.

Risk Factors
Personal characteristics. Recent research into the sources and risk factors of clinician burnout
mentions its multidimensional nature and explores intra-individual, interpersonal, and organizational
aspects (Truchot et al., 2000). Personal characteristics of the therapist may have an especially significant
influence on the likelihood of experiencing burnout. Unrealistic therapeutic goals and expectations and
loosely established guidelines for evaluating progress may interfere with therapeutic efficacy and lead to
lowered morale (Kestnbaum, 1984). Unwillingness to accept occasional “failures” in the therapy room
can encourage therapists to continue to overextend themselves in an effort to prove their professional
competency and to achieve a sense of self-worth (Friedman, 1985). Farber (1990) and Piercy and Wetchler
(1987) note that burnout is likely influenced by a tendency for therapists’ personal issues to get in the way
of treatment. Reluctance to address these issues as they become intrusive may cause therapists to become
overwhelmed and eventually lead to burnout.
There appear to be some discrepancies in the literature concerning the effects of demographic
variables on rates of therapist burnout. Several researchers have reported that factors such as age, gender,
race, and educational attainment do not distinguish those who reported symptoms of burnout from those
who were less exhausted or frustrated (Elman & Dowd, 1997; Raquepaw & Miller, 1989). Conversely,
Maslach and Jackson (1985) found that there do appear to be some differences according to sex or gender
in terms of therapists identifying with symptoms of emotional exhaustion, depersonalization, and lowered
personal accomplishment. Contrary to their earlier hypotheses that women may fare worse than their
male counterparts, their empirical study revealed that women actually do slightly better regarding burnout
symptoms, particularly in the area of depersonalization. Both between and across occupations, women
consistently scored lower in levels of depersonalization than did men, whereas the differences were less
clear in the other two dimensions.
Additional studies support the relationship between demographic variables and symptoms of burnout.
Some empirical evidence reveals a negative correlation between therapist’s age and both emotional
exhaustion (Cicone, 2003; Vredenburgh, Carlozzi, & Stein, 1999) and depersonalization (Lippert, 2000),
suggesting that the development of skills and strategies with age curtails symptoms and onset of the
syndrome. Concerning gender, male therapists have reported higher overall burnout (Dupree & Day,
1995) and higher levels of depersonalization (Vredenburgh et al., 1999). Krogh’s (1996) findings report

88 JOURNAL OF MARITAL AND FAMILY THERAPY January 2006

a significant negative relationship between emotional exhaustion and a masculine gender role, whereas a
feminine role was positively correlated with personal accomplishment. Exploring race, Salyers and Bond
(2001) found that African American clinicians experience significantly less emotional exhaustion and
depersonalization as compared with their Caucasian peers.
Interpersonal influences. Interpersonal influences on clinician burnout include factors specific to
therapist–client relationships and client characteristics in conjunction with those therapist characteristics
described above. Therapists working with chronic clients or clients with particularly severe problems (e.g.,
suicidal ideation, severe depression, child abuse) may be at high risk for experiencing symptoms of burnout
(Azar, 2000; Deutsch, 1984; Farber & Heifetz, 1981; Raquepaw & Miller, 1989). However, some studies
show no relationship between burnout and client prognosis (e.g., clinicians working with sexual assault/
domestic violence cases, Baird & Jenkins, 2003; or suicidal ideation, Fortener, 2000). On the contrary,
findings from Humphries-Wadsworth (2002) even suggest that clinicians working with high numbers of
clients dealing with issues related to trauma experience an increased sense of personal accomplishment.
Clients who are highly resistant, involuntary, or show very little progress or change continually
challenge therapists to expect nothing less than perfection (Horner, 1993), leaving little room for perceived
personal failure. Farber (1990) notes that nonmutuality (in terms of attentiveness, giving, and responsibility)
demanded by the therapeutic relationship can induce therapists’ feelings of dissatisfaction and frustration.
Truchot et al. (2000) also report a decrease in perceived levels of competence, personal accomplishment,
and self-efficacy when therapists sense inequity or a lack of reciprocity with their clients.
Job-related factors. Aspects of the therapist’s job itself, including job setting, affect feelings of overall
burnout (Fortener, 2000) and predict levels of personal accomplishment and depersonalization specifically
(Vredenburgh et al., 1999). Those working in institutional settings may face stressful administrative
issues, such as longer work hours, sizeable caseloads, administrative “red tape,” involvement with third-
party payers, and budgeting concerns that lead to burnout. A study by Trudeau, Russell, de la Mora, and
Schmitz (2001) reveals that MFTs employed in a hospital setting, for example, are likely to experience less
autonomy than those in other work environments. They may be more vulnerable to burnout than those
who work solely in private practice (Farber, 1990). Private practitioners may face problems of being more
isolated without the network of peers and supervisors found in institutional settings (Raquepaw & Miller,
1989).
However, studies show that those self-employed or in private practice report lower overall rates of
burnout (Dupree & Day, 1995; Vredenburgh et al., 1999) and significantly lower emotional exhaustion
and depersonalization (Fortener, 2000; Lippert, 2000). This may be a result of experiencing an increased
sense of autonomy and a greater sense of control over the types of clients they see, length of treatment, and
setting fees (Trudeau et al., 2001).
Additional factors, such as client caseload size, more years of experience, and more client contact
hours per week were found to have a positive correlation with personal accomplishment (Lippert, 2000;
Vredenburgh et al., 1999).

Prevention and Treatment

There have been numerous suggestions for ways in which therapists can implement their own
safeguards against burnout. In his discussion of therapeutic responsibility, Friedman (1985) suggests that
the problem belongs to the family, and they are responsible for positive changes, not the therapist. Kaslow
and Shulman (1987) note that the therapist should serve primarily as a catalyst for this change, adding
that shedding the role of omnipotent expert can be a soothing and beneficial step in preventing burnout.
Openly expressing feelings about their job and obtaining a social support network may lead to a reduction
in or prevention of therapists’ feelings of burnout. Further suggestions include engaging in physical exercise
(Freudenberger, 1974); taking regular vacations (Maslach, 1976); setting limits and separating work and
private lives (Maslach, 1978; Patterson, Williams, Grauf-Grounds, & Chamow, 1998); establishing a proper
diet (Raquepaw & Miller, 1989); and psychotherapy (Fleischer & Wissler, 1985; Kaslow & Shulman, 1987;
Piercy & Wetchler, 1987).
Given that rates of burnout may be particularly high among therapists employed in agencies or

January 2006 JOURNAL OF MARITAL AND FAMILY THERAPY 89

institutionally based settings, interventions at the organizational level may also be especially important.
Martin and Schinke (1998) suggest that orientation programs and in-service training workshops can help
workers to comprehend and to cope with burnout. In addition, they encourage administrators to exchange
constructive feedback and have open discussion of therapists’ feelings to decrease the likelihood of
burnout symptoms. Other suggestions for organizational level prevention and treatment include decreasing
time spent on paperwork and administrative duties (Raquepaw & Miller, 1989), shortening work hours,
allowing workday breaks, and improving work relations between staff members (Pines & Maslach, 1978).
Collaboration, team consultation, and emotional connection within the workplace are also powerful buffers
against feelings of depression and isolation that can lead to burnout (Selvini & Selvini-Palazzoli, 1991).

PURPOSE OF THIS STUDY

Little attention has been given specifically to the experience of MFTs and their likelihood of experi-
encing symptoms of burnout. With the rising number of MFTs joining the mental health field (Northey,
2002), it is becoming increasingly important that discussions of professional issues such as burnout be
tailored to fit the needs of all practitioners. Although there are certainly many commonalities between
MFT and other helping professions (e.g., Simmons & Doherty, 1998), differences in terms of theoretical
frameworks, treatment modalities, and therapist–client relationships (Christensen & Miller, 2001) may
account for some variation in the ways burnout is experienced among those practicing relational therapy as
opposed to individually oriented therapies.
The systemic ideology of MFT and its emphasis on treating families instead of individuals may lead to
therapists experiencing stress with more frequency and intensity. Martin and Schinke (1998) reported that
more than two-thirds of clinicians working with families and/or children reported experiencing moderate
or severe symptoms of burnout as compared with those working only with individuals. These therapists
also reported more dissatisfaction with their jobs and an increased likelihood of leaving their positions
sooner. These findings suggest that there may be factors inherent in the practice of therapy with more than
one client in the room that can intensify feelings of burnout.
Finally, most of the empirical research conducted on burnout among mental health professionals
has utilized the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981), recognized as the most
widely used measure of burnout (Figley, 1995). This inventory assesses the degree to which respondents
experience emotional exhaustion, personal accomplishment, and depersonalization in their work. Based
on existing literature using this measure, the experiences of burnout among MFTs, specifically, have not
been represented or explored. Therefore, independent of other mental health professionals, it is important
to determine whether this inventory is an appropriate fit for measuring burnout among MFTs.
In response to these gaps in existing literature, this research study seeks to answer the following
questions:
1. Is the MBI (Maslach & Jackson, 1981) an appropriate fit for measuring burnout among MFTs?
2. How are demographic variables, such as age, race, gender, and educational attainment, related to
emotional exhaustion, depersonalization, and personal accomplishment?
3. Do MFTs who seek periodic case consultation/supervision, attend work-related seminars, and/or
use personal therapy differ in symptoms of burnout as compared with those who do not?
4. Finally, how do different work settings (e.g., private practice, medical setting, community
agency) and job-related variables (e.g., hours worked per week, type of clientele) relate to
therapists’ symptoms of burnout? Are any of these variables predictors of emotional exhaustion,
depersonalization, and personal accomplishment?

METHOD

Sample
Participants for this study were Clinical Members of the American Association of Marriage and
Family Therapy (AAMFT). The researchers contacted AAMFT and requested a randomized selection

90 JOURNAL OF MARITAL AND FAMILY THERAPY January 2006

of 75 Clinical Members from the lists it maintains for each of five states: California, Georgia, Kansas,
Minnesota, and New York, representing varied geographical locations throughout the contiguous United
States. The request yielded a total of 375 members who, in turn, became the subject pool. Via postal
mail, each participant received a set of questionnaires and a letter inviting them to participate. Of the 375
members invited to participate, 121 responded and 116 of those responses included completed question-
naires, yielding a response rate of 32.3%. This response rate is comparable to that reported by Doherty and
Simmons’ (1996) national survey of Clinical Members of AAMFT. No follow up mailings, postcards, or
phone calls were used after the initial mailing.

Measures
Participants completed a brief demographic questionnaire which asked respondents to describe
themselves (age, gender, racial and ethnic identities, religious or spiritual affiliation, partnership status),
their education (highest degree obtained, type of degree obtained), and their professional practice (years
in practice, primary work settings, average weekly client load, and hours spent weekly with various types
of clients [e.g., individual, couple, family, children, group, etc.]). Questions about participant age, gender,
racial identity, ethnic identity, religious or spiritual affiliation, partnership status, years in practice, weekly
client load and distribution of clinical practice hours by client type were open ended in nature. Respondents
answered questions about education and work setting by selecting their choice from a list provided or by
selecting “other” and providing a choice not listed. Participants were also asked to give the frequency with
which they take part in supervision or case consultation, professional conferences, and their own personal
therapy. These questions were open ended.
In addition to the demographic questionnaire, participants also received the MBI (Maslach &
Jackson, 1981) labeled “Human Services Survey” (HSS) designed to assess the three aspects of the
burnout syndrome (Emotional Exhaustion [EE], Depersonalization [DP], and Personal Accomplishment
[PA]). The MBI-HSS consists of 22 items with Likert-type response sets correlating with the frequency
with which the respondent experiences that feeling. Responses range from 0 (never) to 6 (every day).
Emotional Exhaustion is defined as feelings of being emotionally overextended and exhausted by one’s
work. It is measured through questions such as, “I feel fatigued when I get up in the morning and have to
face another day on the job” and “I feel like I’m at the end of my rope.” Depersonalization is defined as
an unfeeling and impersonal response toward recipients of one’s service, care, treatment, or instruction. It
is assessed through questions such as, “I feel I treat some people in an impersonal manner” and “I don’t
really care what happens to some people I encounter at work.” Personal Accomplishment assesses feelings
of competence and successful achievement in one’s work with people. It is evaluated through questions such
as, “I feel I am making a difference in other people’s lives through my work” and “I have accomplished
many worthwhile things in this job.”
Scores for each of the subscales are calculated by determining the sums of the responses for questions
corresponding with each subscale. Given that burnout has been conceptualized as a continuous variable,
subscales scores can reflect low, moderate, or high degrees of burnout. Higher scores on questions within
the EE and DP dimensions indicate increased levels of burnout. Conversely, lower scores on the PA
dimension correspond with increased levels of burnout.
The first research question was answered by using exploratory factor analyses to determine the
appropriateness of the MBI (Maslach & Jackson, 1981) for MFTs.
Requesting a three factor solution, we conducted principal component analysis using varimax rotation
with Kaiser normalization with the response set for the 22 items (n = 116). Items 4 and 22 were dropped
because of low factor loadings, and the analysis was repeated. Consistent with the findings of other studies
using the MBI (Byrne, 1993; Leiter & Durup, 1994; Schaufeli & Van Dierendonck, 1993), items 12 and 16
had cross-loadings. The remaining 18 items loaded cleanly and exclusively on the appropriate subscale (see
Table 1). Significant moderate correlations between the subscales with low loadings of the items on other
subscales confirm the theoretical explanations that EE, DP, and PA are related, but separate, dimensions
of burnout (see Table 2). As such, Maslach, Jackson, and Leiter (1996) suggest that any statistical analyses
conducted with the subscales consider each separately rather than combining them for a total burnout

January 2006 JOURNAL OF MARITAL AND FAMILY THERAPY 91

 Table 1
Factor Loadings for MBI Subscales

I II III
Emotional exhaustion
1. I feel emotionally drained from my work. .755 .080 –.062
2. I feel used up at the end of the day. .688 .125 .143
3. I feel fatigued when I get up in the morning and have to face .693 .261 .025
another day on the job.
6. Working with people all day is really a strain for me .536 .305 –.102
8. I feel burned out from my work. .611 .232 –.089
13. I feel frustrated by my job. .730 .137 –.038
14. I feel I’m working too hard on my job. .630 .188 –.110
16. Working with people directly puts too much stress on me. .488 .369 –.223
20. I feel like I’m at the end of my rope. .635 .345 –.137

Depersonalization
5. I feel I treat some recipients as if they were impersonal objects. .313 .378 –.168
10. I’ve become more callous toward people since I took this job. .167 .808 –.105
11. I worry that this job is hardening me emotionally. .322 .732 –.173
15. I don’t really care what happens to some recipients. .265 .500 –.071

Personal accomplishment
7. I deal very effectively with the problems of my recipients. –.083 .021 .634
9. I feel I’m positively influencing other people’s lives –.020 –.123 .646
through my work.
12. I feel very energetic. –.293 –.286 .446
17. I can easily create a relaxed atmosphere with my recipients. .031 –.103 .607
18. I feel exhilarated after working closely with my recipients. –.147 –.103 .507
19. I have accomplished many worthwhile things in this job. –.010 –.317 .637
21. In my work, I deal with emotional problems very calmly. –.113 .058 .660

score. These results further confirm that the three-factor structure of the MBI for MFTs has significant
similarities to the structure obtained within other human service professionals.
Tests for internal consistency (Cronbach’s alpha) were also conducted. Reliability coefficients for the
subscales, as established by Cronbach’s alpha test for internal consistency, were as follows: .88 for EE, .77
for DP, and .80 for PA. These results indicate relatively high internal consistency among the items for each
of the three subscales.

Demographic Information
The sample (N = 116) consisted of 70 women (60.3%) and 46 men (39.7%) with a mean age of
54.1 years (range = 30–80, SD = 10.3 years). The vast majority (87.9%) of the sample self-identified as
White/of European descent. The remainder of the sample identified as biracial (3.4%), White, Anglo-
Saxon, Protestant (1.7%), African American (0.9%), Latino/Hispanic (0.9%), Native American (0.9%),
and Jewish (0.9%); four participants entered no response. More than 60% (61.2%) had obtained master’s
degrees (MA, MS, MSW, MDiv), and slightly more than one-third had completed doctoral level training
(35.4%; MD, PhD, EdD, PsyD, DMin, DHealth Sciences). The remaining four participants listed their
highest degree as “Other.” Participants were also asked to identify their primary practice settings. The most
common primary work settings included private practice (46.6%), community agency (15.5%), medical

92 JOURNAL OF MARITAL AND FAMILY THERAPY January 2006

(10.3%), academia (9.5%), and pastoral (6.9%). Others included group practice (3.4%), health maintenance
Table 2 (1.7%), employee assistance program (1.7%), consulting, nonprofit organization, government
organization
Intercorrelations
mental health office, Between
and otherMBI Subscales
(0.9% each). One participant did not respond to the primary work setting
item. The average length of time worked in the field was 20.4 years (SD = 9.2 years) and participants
averaged 36.0 hours working per week Emotional exhaustion
(SD = 16.9). Depersonalization
Within their work week, participants reported working
an average of 16.7 hours with individuals, 9.2 hours with children, 11.4 hours with couples, 10.0 hours with
Depersonalization *
families, and 8.6 hours with groups. More than.553
91% percent of participants reported seeking case consul-
tation, 94% reported attending field-related seminars, and 83.6 % reported having participated in their own
Personal accomplishment –.260 * –.343*Clinical Members are
therapy at some point. These findings regarding the sample population of AAMFT
consistent with those reported by Doherty and Simmons in their 1996 national survey.
* p < .01 (2-tailed).
Mean scores for overall sample by subscale are as follows: EE (M = 16.01; SD = 8.15), DP (M = 2.86;

SDTable 3 PA (M = 37.23; SD = 4.37). (For comparative purposes, see Table 3 for range of experienced
= 3.20),
Range According
burnout.) of Scores Indicating Levelsrange
to the normative of Burnout by Subscale
of experienced burnout among mental health professionals as
reported by Maslach et al. (1996), the sample was distributed across the three subscales as follows: 37%
low, 37% moderate, 26% high on EE (N = 116); 63%Low Moderate
low, 22% moderate, 15% high on DP High
(N = 116); and
94%Emotional
high, 5%exhaustion < 13 where higher14–20
moderate, and 1% low on PA (N = 116), > 21 degree of
scores indicate a lesser
Depersonalization
burnout. <4 5–7 >8
Personal accomplishment > 34 33–29 < 28
ANALYTIC STRATEGY

To explore the research questions presented above, we utilized independent t-tests and one-way
analyses of variance (ANOVA) to test for mean differences, as well as Pearson correlations, and multiple
regression analyses. Exploratory factor analysis was also conducted in order to assess the appropriateness
of the MBI for use among marriage and family therapists.
It is important to note that although most significance levels were set at .05 and reported accordingly,
we also included results that neared the commonly accepted cutoff point for statistical significance but
did not quite attain it (.05 < p < .10). Given the small sample size and the novelty of this research among
MFTs, specifically, we report these results that approach significance to highlight possibly clinically and
professionally relevant results even if the statistical cutoff for “significance” was unmet. That is to say that
some results may become statistically significant in studies with larger samples, and that their statistical
limitations in this study should not preclude the importance of the relationships they portray between the
burnout subscales and various practice variables among MFTs. This stance is consistent with the argument
made by Deal and Anderson (1995), who recommend that meaningfulness should not be replaced by
statistical significance in data interpretation, especially in studies with small samples. We recommend
that our findings be replicated by future researchers to further validate these trends and their clinical and
statistical significance.

RESULTS

Research Question 1
Results confirmed a three-factor solution for the MBI subscales and are consistent with the findings of
the measure’s authors regarding the items loading on to each subscale. Accordingly, the data support that
the factor structure of the MBI for MFTs has significant similarities to the structure obtained when utilized
among other human service professionals.

Research Question 2
How are demographic variables (e.g., age, race, gender, and educational attainment) related to EE,

January 2006 JOURNAL OF MARITAL AND FAMILY THERAPY 93

DP, and PA? Participant age (N = 116) was negatively correlated with EE and DP with values approaching
significance at the .05 level (r = –.18, p = .06, for EE; r = –.16, p = .08 for DP). Age was not significantly
correlated with personal accomplishment. One-way ANOVAs were conducted to detect differences in the
three subscales according to participant race. No significant differences were found between racial/ethnic
groups, with the exception of the PA subscale (F (7, 108) = 6.63, p = .00). Significant differences were
found between male and female respondents in terms of DP, though not with the other subscales (F (2,
113) = 4.81, p = .03). Female participants (n = 70) reported significantly lower levels of DP (M = 2.62)
as compared with male participants (n = 46; M = 3.21). One-way ANOVAs revealed some differences
among participants grouped by educational attainment in terms of PA (F (2, 113) = 3.31, p= .04) with
master’s-level clinicians (n = 71) reporting slightly higher levels than doctoral-level clinicians (n = 41). No
differences were found between groups within the EE and DP subscales.

Research Question 3
Do MFTs who seek periodic case consultation/ supervision, attend work-related seminars, and/or use
personal therapy differ in symptoms of burnout as compared with those who do not? Independent t-tests
showed no differences in EE, DP, and PA among participants who attended work-related seminars, sought
case consultation, or engaged in personal therapy, as compared with those who did not.

Research Question 4
How do different work settings and job-related variables relate to therapists’ symptoms of burnout?
Are any of these variables predictors of EE, DP, and PA? Results of mean comparisons indicated that
participants differed in levels of PA (F (7, 103) = 2.73, p = .01) and EE (F (7, 103) = 2.76, p = .01) according
to their primary work setting. In the PA subscale, those in private practice (n = 54; M = 38.62) reported
significantly higher scores than those in medical settings (n = 12; M = 35.58, p = .01) and in academia (n
= 11; M = 34.18, p = .00). Those employed primarily in community mental health agencies (n = 18; M =
36.87) reported slightly higher scores than those in academia (p = .06). In terms of EE, participants working
primarily in private practice (n = 54; M = 13.18) reported significantly lower scores than respondents in
community agencies (n = 18; M = 19.94, p = .00), pastoral settings (n = 8; M = 20.00, p = .02), and health
maintenance organizations (n = 2; M = 27.50, p = .01). No significant differences were found between
groups in the DP subscale. However, both Tukey’s-b and least significant difference (LSD) post hoc mean
comparisons revealed that respondents working in community agencies (n = 18; M = 4.28) reported signifi-
cantly higher scores than those in private practice (n = 54; M = 2.11, p = .04). These clinicians also reported
slightly higher DP scores than those in academia (n = 11; M = 2.43) although results only neared statistical
significance (p = .07).
Bivariate correlations were conducted to test the relationship between job-related variables and the
three burnout dimensions. Analyses yielded moderately significant correlations between hours worked
per week (M = 35.98) and EE (r = .29, p = .00) and DP (r =. 22, p = .02). No significant correlations
were discovered between any of the three subscales and hours worked with individuals, couples, families,
children, and groups.
Three separate linear regression analyses tested the predictive nature of the work setting and job-
related variables in terms of each burnout subscale. Each model included the following variables: primary
work setting, hours worked per week with individuals, couples, families, children, and groups, and total
hours worked per week. The regression model was found to be significant when PA was entered as the
dependent variable with 26% of the variance explained (F (7, 108) = 5.31, p = .00). Primary work setting
and hours worked with individuals yielded significant betas. With EE entered as the dependent variable,
the regression model was also significant and explained 13% of the variance (F (7, 108) = 2.28, p = .03). In
this model, hours worked per week was a significant predictor (ß =. 17, p = .00). Hours worked per week
was also a significant predictor of depersonalization (ß = .05, p = .01) although the model itself was not
significant and only explained 9% of the variance (F (7, 108) = 1.59, p = .15).
To examine between-group differences according to work setting with specificity, we gave up
statistical power because the sample sizes among select work setting were small compared with others.

94 JOURNAL OF MARITAL AND FAMILY THERAPY January 2006

We present the results in this way to get an initial glimpse of potential trends in burnout experiences across
work settings. Although we may have lost some precision in p, there are clear differences in the mean
scores across groups.

DISCUSSION

Research Question 1: Applicability of MBI to MFTs

How do current findings determine the usefulness of the MBI among MFTs? First, results indicate
that subscales of the MBI reliably measure DP, EE, and PA among this MFT population. Second, results
confirm the factor structure discovered by previous researchers (Byrne, 1993; Leiter, Clark, & Durup,
1994; Schaufeli & Van Dierendonck, 1993) and support the hypothesis that the MBI is a good fit for
measuring burnout among MFTs. Despite differences between MFT and other helping professions in terms
of theoretical frameworks, treatment modalities, and therapist–client relationships, it can be concluded that
the dimensions of burnout are similarly distinguished across human service professions (i.e., social work,
psychology, counseling).
Subsequent research comparing MFTs and other helping professionals can use this measure
confidently to sample across groups to ascertain how their actual experiences of burnout compare with
each other. Given the foundation our exploratory factor analysis has laid, this research should include
confirmatory factor analysis on the MBI and include larger sample sizes to address the limitation of a
relatively small sample in this study. This research will be useful in determining the differential effects of
professional training and practice modalities on experiences of burnout.

Research Question 2: Demographic Variables

With regard to the second research question, which considers demographic variables and the
relationship to each dimension of burnout, our findings yield mixed results when compared with existing
literature. Our results confirmed some earlier findings among other mental health professionals (i.e.,
counseling psychologists, grief counselors, clinical psychologists; Dupree & Day, 1995; Krogh, 1996;
Maslach & Jackson, 1985; Vredenburgh et al., 1999) that there are significant differences between
male and female therapists, and that in some cases, women fare better than men. More specifically, and
consistent with the findings of Maslach and Jackson (1985) and Vredenburgh et al. (1999), these differences
only appear within the DP subscale. We concur with the discussion of Maslach and Jackson (1985), who
suggest that significantly lower levels of depersonalization among female respondents may be a product of
traditional gender-role socialization. It is widely accepted that girls and boys are taught to relate with others
differently. Boys are encouraged to be autonomous and emotionally disconnected, girls are encouraged to
be dependent and emotionally connected (Gilligan, 1982; Walters, Carter, Papp, & Silverstein, 1988). More
specifically in terms of professional therapeutic practice, if women are traditionally encouraged to be more
empathic and sensitive to others, whereas men are traditionally encouraged to be less emotional and more
independent, male therapists may be more prone to deal with people in depersonalized ways (Maslach &
Jackson, 1985). Although this rationale would also suggest that women may be more at risk for emotional
exhaustion and involvement, this study did not reveal significant differences in this dimension.
In terms of age, our findings indicate that as clinicians get older, levels of depersonalization and
emotional exhaustion go down. In agreement with previous studies (Cicone, 2003; Lippert, 2000;
Vredenburgh et al., 1999) it may be that with life experience comes an emotional maturity that serves as a
buffer against symptoms of burnout as therapists age. These therapists may have developed long-standing,
reliable personal and professional support systems and coping strategies over time. Also, with age, a sense
of personal accomplishment may be gained through multiple roles and identities outside of work, meaning
that accomplishment depends less on professional performance and achievement. This derivation of
accomplishment from multiple sources may explain the lack of correlation between age and the personal
accomplishment subscale.
Master’s-level clinicians reported higher levels of personal accomplishment than those having
completed their doctorates. Typically, master’s degrees and doctoral degrees present different professional

January 2006 JOURNAL OF MARITAL AND FAMILY THERAPY 95

trajectories. Each pathway presents a different set of professional expectations or goals for how profes-
sionals will derive a sense of accomplishment and fulfillment. For example, an MFT professor employed
in a training program who has requirements to produce research, teach courses, attend administrative
meetings, and so on, will have a different set of criteria for their own sense of achievement than does a
full-time clinician working in a community agency or in private practice. We assert that master’s-level
clinicians may have more control to define personal accomplishment than do doctoral-level practitioners
who may have more external measures and arbiters of their worth and ability.
Future researchers should consider oversampling from various racial and ethnic groups to determine
the effects of those variables on symptoms of burnout. Although our sample may accurately represent the
racial distribution of clinical members of our professional organization, it remains unclear the extent to
which other, underrepresented segments of the MFT population experience depersonalization, emotional
exhaustion, and personal accomplishment in their work. No significant differences were found between
racial/ethnic groups, with the exception of the PA subscale. A larger, more racially and ethnically diverse
sample may reveal differences. However, our sample population does reflect the composition of the clinical
membership of AAMFT at this point in time. Valid assessments of differences across racial and ethnic
groups would require an oversampling of these underrepresented members.
The range of scores reported from the overall sample was not large, and most respondents’ scores fell
into the low or moderate ranges of EE (74%) and DP (85%) and the high range of PA (94%). However, it
may be that those who have experienced higher levels of burnout have already chosen to leave the field.

Research Question 3: Personal and Professional Development

Although we did not find any significant impact of case consultation, work-related seminars, and/or
personal therapy on symptoms of burnout, these results are not surprising given the set of respondents. By
and large, our sample includes seasoned clinicians who have been in practice for an average of 20 years. It
may be that the most powerful effects of these professional supports are felt much earlier in the clinician’s
development. For example, several respondents indicated that they make use of supervision or personal
therapy “as needed,” implying that the need is not as frequent now as it may once have been. It is possible
that these professional supports do, in fact, buffer against the effects of burnout, but that the effectiveness
of that buffer is greater for less-experienced clinicians or those newer to the field.

Research Question 4: Job-related Variables and Work Setting

Findings from job-related variables and work setting are especially noteworthy. Similar to results
published by Dupree and Day (1995), Fortener (2000), Lippert (2000), and Vredenburgh et al. (1999),
clinicians working in private practice fare the best overall in each of the burnout subscales. They reported
highest levels of personal accomplishment and lowest levels of depersonalization and emotional exhaustion.
Consistent with Trudeau et al.’s (2001) assessment, the ability of a private practitioner to independently
regulate caseload, fees, paperwork, and a general sense of autonomy may buffer the impact of job-related
stress associated with symptoms of burnout. In contrast, and consistent with preexisting literature, those
working in community agencies were more vulnerable to symptoms of burnout as compared with other
settings (Farber, 1990; Raquepaw & Miller, 1989). Community agency clinicians face a considerable
number of constraints resulting from practicing within a hierarchical system. Unless clinicians are located
at the top of the hierarchy, they are subject to the expectations, rules, and policies of those who are.
Examples may include excessive caseloads, limited salaries, and administrative responsibilities. Karger
(1981) and Barr (1984) illustrate this very point, adding that “service providers are caught in a struggle
between promoting the well-being of their clients while, at the same time, struggling with policies and
structures in the human service delivery system that tend to stifle empowerment and well-being.”
Aside from particular work settings, several job-related variables also affect the degree to which
clinicians may experience burnout symptoms. Hours worked per week both correlated highly with and
predicted personal accomplishment, emotional exhaustion, and depersonalization. That is to say, as
hours worked per week increased, personal accomplishment decreased, and emotional exhaustion and
depersonalization increased. This finding lends strength to the assertion that those in private practice are

96 JOURNAL OF MARITAL AND FAMILY THERAPY January 2006

less likely to experience burnout given their greater sense of control over the amount of hours worked per
week. This finding is contrary to studies by Vredenburgh et al. (1999) and Lippert (2000), which report
elevated feelings of personal accomplishment with increased client contact hours per week. The effect of
hours worked per week transcends work setting and holds true for all clinicians, although it is unclear how
the way in which those hours are spent may affect symptoms of burnout. Surprisingly, the proportion of
hours worked per week with multiple clients in the room did not significantly impact clinician reports of
symptoms. We attribute this lack of statistically significant findings to our relatively small sample size. We
encourage future research in this area to continue exploring the connection between relational work and
propensity toward burnout.

CONCLUSION

Fatigue and stress in the form of burnout will continue to be a critical area of inquiry for all helping
professionals, including MFTs. Our research has shown that, although this sample reflects only low-to-
moderate levels of burnout, MFTs are far from immune to its effects. Burgeoning therapists, as well as
seasoned clinicians, should be well-attuned to the impact that job setting, clinical experience, and weekly
work load have on their emotional well-being as well as their capacity to be effective with their clients.
Clinicians new to the field and those at higher risk for experiencing symptoms of burnout should consider
adopting self-care measures and collegial supports to prevent further deleterious effects. These may include
but are not limited to increasing awareness of the signs and symptoms of burnout through education, self-
awareness, and supervision.

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