The Experience of Burnout, Compassion Fatigue and Vicarious Trauma among Psychotherapists in Ireland

The Experience of Burnout, Compassion Fatigue and Vicarious Trauma among Psychotherapists in Ireland

One can give nothing whatever without giving oneself -- that is to say, risking oneself. If one cannot risk oneself, then one is simply incapable of giving”

(James Baldwin)

“Whoever battles with monsters had better see that it does not turn him into a monster. And if you gaze long into an abyss, the abyss will gaze back into you."

(Friedrich Nietzsche)




 This work is mainly related to those of us who work in the field of counselling and Psychotherapy. The work may also give some insight into the experiences of the caring professions to the general public, those contemplating attending a counsellor/therapist and those thinking about becoming a professional in the field. Anybody can experience the symptoms of Burnout. For example, those out in the workforce, homemakers and students. Sometimes it can be difficult to recognize when you're slipping from a state of chronic stress to Burnout. Simply put, if you feel exhausted, start to hate your job, and begin to feel less capable at work, you are showing signs of Burnout. The stress that contributes to Burnout can come mainly from your job, but stress from your overall lifestyle can add to this stress. Freudenberger (1974) originally defined burnout as, “the extinction of motivation or incentive, especially where one's devotion to a cause or relationship fails to produce the desired results.”

 There are several professions where the prevalence of Burnout, Vicarious Trauma (VT) and Compassion Fatigue (CF) commonly exists. The following list is a sample of those in the helping professions who are secondary witnesses to trauma on a regular basis: addiction counsellors, mental health workers, psychologists, social workers, marriage and family therapists, psychiatric/general nurses, medical doctors, paramedics/ambulance, firemen/women, police officers. All of these professions are distinct, with specialized areas of knowledge and techniques. However, they are united by engaging in the intense giving of themselves to enhance the lives of others. “There is no greater pleasure than knowing that you made a real, lasting difference in the life of another human being – a common experience for the effective psychotherapist, one that never loses its special meaning” (Norcross, Guy, 2007, p.21).

 Time and again, we therapists neglect our personal relationships as our work takes over our life. At the end of our workday, having given so much of ourselves, we feel drained of need for more relationship (Yalom, 2002). Since Freudenberger (1974) first used the term Burnout, many authors have discussed the difficulty of professional vitality in the helping and related fields (Bria, M., Baban, A. & Dumitrascu, D 2012; Figley, C. R, 2002; Jackson, S., Schwab, R. 1986; Susman, M.B. 2007; Burke, R. J., Shearer, J., & Deszca, G. 1984; Maslach, C. 1982). Can we afford to ignore the consequences of Burnout? If we do not care now, who will and when? At what cost? As witnesses and healers, we cannot help taking on the emotional pain of those we are privileged to know and care for. Over time, we accumulate fragments of their trauma by exposure to their lives. To be successful in the helping professions, we must continually maintain professional vitality and avoid depleted caring. For counsellors, psychotherapists and others mentioned earlier, this can be a very difficult task. “One of the most distinguished characteristics of our profession is our intense focusing on highly skilled perspective taking: a combination of empathy, perceptual flexibility, tolerance for ambiguity and affective sensitivity. When successful, all of this translates into a profound ability to understand the world as other people understand it. This well-honed ability, one of our occupational strengths, is not possessed by many people in other occupations” (Skovholt, 1988, p.283).



 Psychotherapists focus on everyone else’s problems. By nature, psychotherapists are caring and compassionate people. For example, in several research studies, excessive empathy was found to be one of the many contributors of Burnout among therapists due to the counsellor’s desire to feel and experience the pain and trauma of his or her client (Koeske and Kelly 1995). However, they very often fail to attend to their own needs and desires. The old proverb, “the cobbler always wears the worst shoes” comes to mind. If we as psychotherapists neglect to look after our own self-care, how then can we attend to the needs of our clients?

 It may be argued that this neglect can lead to high rates of alcoholism, depression, fear and suicide among psychotherapists. For example, large surveys have indicated that psychologists are at risk for mental health problems such as depression, anxiety, substance abuse, and suicidality. In a sample of 800 psychologists, Pope and Tabachnick (1994) found that 61% reported that they had suffered at least one episode of clinical depression. Over one in four (29%) disclosed that they had felt suicidal, and nearly 4% reported having made a suicide attempt. Additionally, in a sample of over 1000 randomly sampled counselling psychologists, (Gilroy, Carroll, and Murra 2002) found that 62% of respondents self-identified as depressed. Of those with depressive symptoms, 42% reported experiencing some form of suicidal ideation or behaviour. It may also be interesting to note that Arvay and Uhlemann (1995) found that younger inexperienced counsellors appeared to be more prone to Burnout/CF/VT according to their higher scores on the Maslach Burnout Inventory (MBI) scale (Maslach, 1982). Norcross (2000) believes that due to experience and more time, seasoned clinicians are more likely to have developed strategies to cope with stressors than their younger colleagues.

 For the psychotherapist who works with acutely burdened clients, immense stress may lead to conditions known as Compassion Fatigue (CF), Burnout and Vicarious Trauma (VT), all of which pose a risk to both the therapist and his or her clients. Those who work in the mental health field frequently witness the recollection of client’s traumatic experiences and the repeated exposure to reported traumatic events can lead to a stress reaction in the therapist (Coetzee & Klopper, 2010). Extensive work with trauma survivors, which involves listening to a litany of detailed descriptions of atrocities and constantly empathizing with clients, can also take a high toll on clinicians. Many experts believe that the most effective therapists ironically are also the most vulnerable to this hazard, as those who have the greatest capacity for empathy are at greatest risk for Compassion Fatigue (Miller, 1998). If too much stress is produced, it can threaten professional integrity. It is widely believed that Burnout/CF/VT only occurs in seasoned practitioners. This is not the case. Research has shown that Burnout/CF/VT frequently manifests itself in trainee and novice psychotherapists (Maslach, 1982).


 Compassion Fatigue is a broad term comprising of two components, Burnout and secondary traumatic stress. In 1992, Joinson first used the term in print, in discussing Burnout among nurses who deal with hospital emergencies, counsellor, emergency workers and other professionals who experience Compassion Fatigue (Joinson, 2002). Most of the literature available today relates to the exploration of Burnout/CF/VT in the United States and the United Kingdom. On randomly choosing thirty-six published texts made up from medical/psychology journal articles and books the author observed that ninety four percent of the research data dealt with Burnout/CF/VT among care workers in the United States and three percent each related to Burnout/CF/VT in the UK and New Zealand.

 It would appear that research on Burnout/CF/VT among therapists in Ireland is virtually non-existent. As a consequence, it would seem that research is needed to examine how Psychotherapists and Counsellors in Ireland are faring in the Burnout/CF/VT spectrum. The study of traumatic events and their subsequent impact on human beings has grown considerably over the past two decades. Figley, (2002) posits the view that people can be traumatized simply by learning about the traumatic event rather than having first-hand experience. According to a review of various traumatology literatures, the focus was almost entirely on the direct victims of the trauma. Those affected indirectly or secondarily; the therapists and other caregivers received very little attention in relation to distress, suffering or upset. (Craig & Sprang, 2010; Figley, 2002). As practicing professional therapists, we are continually analysing the mental progress and wellbeing of our clients. So, the question is; “what is our experience of Burnout, Compassion Fatigue and Vicarious Trauma” and do we continually monitor ourselves for the good of our own mental wellbeing?

What does the Data Reveal?

 What are the conditions known as Burnout, Compassion Fatigue (CF) and Vicarious Trauma (VT), where do they come from, how do they work? There are many diverse opinions on the subject including the view that there is no such thing. In any case, whatever Burnout/CF is or is not, it is a much discussed issue these days and psychotherapists may want to examine as many viewpoints as possible. Burnout can be very difficult to define, even though it is so prevalent and we all think we know what we mean by it. Psychotherapy and Counselling can be observed as a profession that is strongly “client” orientated. There are many definitions of Burnout/CF/VT. Possibly, the best known definition of Burnout is that suggested by Maslach and Jackson (1981). They define Burnout as “a pattern or disorder of emotional exhaustion and cynicism that occurs frequently among individuals who do “people-work” of some kind and experience detachment from the job” (Maslach & Jackson as cited in Soderfeldt et al., 1995, p.639). Maslach and Jackson’s definition was developed from the ground up as the result of extensive research involving various employee groups. For example, day care workers, mental health staff, police officers, physicians, nurses and so on (McCormack, Cotter, 2013). The symptoms and conditions of Burnout/CF/VT often intertwine. However, they do have their own individual subtleties. Burnout, Compassion Fatigue and Vicarious Trauma will be characterised separately in an endeavour to outline these nuances.


            It is believed that the term “Burnout” was first mentioned by Harold B Bradley (1969) in an article about probation officers who ran a community based treatment programme for juvenile delinquents (Schaufeli, Buunk, 2003). According to Yvonne Gold (1985) the concept of Burnout began in the early 1970s and had many different definitions as it was researched. However, the psychiatrist Herbert Freudenberger is generally considered to be the founding father of the “Burnout” concept. His influential paper on “Staff Burnout” (1974) set the stage for the introduction of the concept syndrome (Schabracq, Winnubst, Cooper, 2003; Casserly, Megginson, 2009). Freudenberger was employed in a New York Free Clinic for drug addicts. It   was mainly staffed by young, idealistically motivated volunteers. Freudenberger observed that many of them experienced a gradual energy depletion and loss of motivation and commitment, which was accompanied by a wide array of mental and physical symptoms. To label this particular state of exhaustion that usually occurred about one year after the volunteers started working in the clinic, Freudenberger chose a word that was being used casually to refer to the effects of chronic drug abuse; “Burnout”. The effects include a condition of being exhausted, wearing out, or failing in response to an overload of demands (Bradley, H.B, 1969).

 At about the same time, Christina Maslach (1976), a social psychological researcher, became interested in the way people in the human services cope with emotional arousal on the job. She noticed that the term “Burnout” was nonchalantly used by Californian poverty lawyers to describe the process of gradual exhaustion, cynicism and loss of commitment in their colleagues. Maslach decided to adopt the term “Burnout” as it was easily recognized by the interviewees in her own study of human services professionals. In recent times, an expanding number of studies are examining the phenomena of Burnout and Compassion Fatigue in the helping and caring professions. However, there is, it seems, a notable scantiness of research on Compassion Fatigue and Burnout among psychotherapists, particularly in Ireland. This gap seemingly exists despite the fact that almost eighty years ago, Freud (1937) wrote of the "dangers of analysis" for analysts.

 Early studies of work related stresses were first conducted in business and industry, and subsequently in the human service professions. In recent years, increasing attention has been paid to the phenomenon of Burnout, particularly in human services professions. Burnout appears to be a response to interpersonal stressors on the job, in which an overload of contact with people results in changes in attitudes and behaviours towards them. We must also keep in mind that our job may give us “the blues” rather than an overload of interpersonal contact. Burnout is far more than feeling blue or having a bad day. According to Leiter & Maslach (2005, p.2) “when Burnout hits you, then you’ve got trouble with a capital T. It is a chronic state of being out of sync with your job, and that can be a significant crisis in your life”. The conditions known as Burnout, Compassion Fatigue and Vicarious Trauma could be likened to the three legged stool. Three legs keep everything in balance. If the stool is steadily overladen, things begin to become unstable. At some point the stools strength becomes overwhelmed and consequently, it collapses.

 Burnout has also been referred to as an “endpoint” of unsuccessful coping, feelings of overextension, inactive problem solving, supervisory appraisal and other pro-active coping skills that may help mediate occupational stress prior to Burnout (Jennett, Harris & Meswibov, 2003). Burnout doesn’t happen to us overnight but it is the end result of a long and often slow process. As this process develops, we can feel that we are getting close to the brink. Every minute we have is used up with doing everything except taking a little timeout for ourselves. Basically, we are just about holding everything together by a thread. We continue to function, but in our heart of hearts we are exhausted and there is no enjoyment or relish left in what we do. This progression has been labelled with the title “Brownout”. Brownout is the stage before Burnout, when we have felt overstressed and pressurized for some time, and it is beginning to take its toll on us physically and emotionally (Proctor & Proctor, 2013). The consequences of burnout are potentially very serious for staff, the clients, and the larger institutions in which they interact.

 Kottler (2012) posits the view that when therapists neglect to look after themselves to the point where they not only lose joy in what they’re doing, they also lose themselves in the process and Burnout may result. Anna Freud once made the telling observation that “becoming a psychotherapist was one of the most sophisticated defence mechanisms granting us an aura of control and superiority and avoiding personal evaluation of ourselves”(Norcross, 2007, p.1).This situation may be a perilous and progressive condition. “In fact, the term “rust out” might be more appropriate, because a professional doesn’t usually flame out all at once, in a single moment, but rather slowly loses interest in work and begins to exhibit the same or similar symptoms as those of his or her clients” (Kottler, 2012, p.143).

 The Oxford Dictionary (2006) defines “Burnout” as “physical or mental collapse caused by overwork or stress”. It also includes frustration, fatigue or apathy resulting from prolonged or intense activity. Its definition of Compassion is a "feeling of deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its cause". Some would argue it is mistaken for a practitioner to have deep feelings of sympathy and sorrow for a client's suffering. Indeed, practitioners must understand their limitations in helping to alleviate the pain suffered by their clients.

 Burnout has been associated with spending extensive amounts of time in direct care of clients (Lewiston, Conley and Blessing-Moore, 1981), sizeable and demanding client caseload (Maslach and Jackson, 1984b), and an insufficient degree of peer and professional support (Jackson, Schwab and Schuler, 1986; Maslach, 1982). Burnout is a response to the prolonged exposure to occupational stress which negatively affects the individuals (psychotherapists), the organisations, and the healthcare service recipients (clients) (Maslach & Leiter, 2008). In some cases, interactions with co-workers have been cited as the most important sources of job stress and Burnout (Gaines and Jermier, 1983). These findings suggest that contact with people, whether they are clients or co-workers can be a major source of distress, frustration, or conflict in human services professions, and that such a negative experience can be an important element in an employee’s satisfaction with the job and commitment to continue working in it (Burke, Shearer and Deszca, 1984; Maslach and Jackson, 1984b). Burnout is very frequent in those professions that require close and involved contact with another person. The results of different studies show that psychotherapists are particularly vulnerable to Burnout (Patsiopoulos & Buchanan, 2011; Lee, Yang, & Lee, 2011). The causes of Burnout syndrome among psychotherapists include the long lasting process of psychotherapy, often without measurable therapeutic success (Farber & Heifetz, 1982), transferring patients’ problems to one’s own private life (Rosenberg & Pace, 2006) and the burden of interaction with some categories of clients (Perseius, Kaver, Ekdahl 2007).

 Burnout has also been described as a psychological syndrome resulting from chronic work related stress that is characterised by high levels of emotional exhaustion, or chronic feelings of emotional and physical strain. As Maslach and Jackson describe it, Burnout is a syndrome of emotional exhaustion that occurs frequently among individuals who do “people-work” of some kind. As their emotional resources are depleted, workers feel they are no longer able to give of themselves at a psychological level (Maslach and Jackson, 1981). Low personal accomplishment and/or poor feelings of efficacy may also be included in the effects of Burnout and Compassion Fatigue. (Maslach, Schaufeli, Leiter, 2001). Recent studies point out that healthcare professionals share the highest Burnout rates. (Shanafelt et al., 2012, as cited in Bria, Baban, Dumitrascu, 2012). Extensive data has highlighted that healthcare professionals’ work is relentlessly overloaded, emotionally overwhelming, intensifying their private life, and thus favouring Burnout development (De Jonge, et al., 2007). For example, therapists working one-on-one with children with autism experience high levels of job related stress and occupational “Burnout,” as well as lower levels of job satisfaction which results in higher than average job turnover (Hurt, 2011).

 In 2005 it was estimated that Burnout/CF cost the U.S. economy $300 billion in sick time, long-term disability, and excessive job turnover. Furthermore, disengaged and unhappy employees cost the British economy almost £46 billion a year in low productivity and lost working days. Long term disability claims based on stress, Burnout, and depression are the fastest growing category of claims in North America and Europe (Leiter & Maslach, 2005).


Therapeutic Approaches and Gender Difference

 It appears there is a shortage of studies investigating the level of Burnout among psychotherapists representing different therapeutic approaches. Some authors highlight the fact that the type of therapeutic relationship, which varies in the intensity of contact between the client and the therapist, is important (Gelso, Carter, 1985). For example, in Gestalt psychotherapy, the therapeutic relationship is one of the most important healing factors, which implies the therapist’s readiness to be wholly committed to contact with the client during the session, “the here and now” (MacKewn, 2006; Yontef, 2005). By contrast, in cognitive behavioural therapy (CBT), where therapeutic relationship is an important but insufficient condition of effecting a change in the client, the therapist strives for a relationship not because a relationship based on mutual trust and respect has a healing value in itself but because the client’s trust allows the therapist to apply various techniques considered to be essential in the therapeutic process (Butler, Chapman, Forman, & Beck, 2005). This means the “intensity” of the client therapist relationship is much less in the CBT model and consequently, may be seen as less prone to Burnout. Another avenue for further exploration is gender differences in the level of professional Burnout among psychotherapists. Some authors point out that male psychotherapists are more prone to symptoms of lack of professional involvement, whereas female psychotherapists experience the symptoms of emotional Burnout more intensely (Rupert, & Kent, 2007).


Measuring Instrument

 The most frequently used instrument to assess burnout is the Maslach Burnout Inventory (MBI) (Schaufeli, Enzmann, 1998).The Maslach Burnout Inventory captures three dimensions of Burnout: emotional exhaustion, depersonalization and personal accomplishment. Emotional exhaustion refers to feelings of being emotionally overextended and drained by one's contact with other people. Depersonalization refers to an unfeeling and callous response toward these people, who are usually the recipients of one's service or care. Reduced personal accomplishment refers to a decline in one’s feelings of competence and successful achievement in one’s work with people. These three aspects of the Burnout syndrome have been the focus of numerous research studies investigating the causes and outcomes of Burnout (Maslach and Jackson, 1986). Given that the BMI was developed in the United States, how does this measuring tool operate in countries where the working culture and environments contrast with that of the developed world?


Compassion Fatigue

 Arguably, the concept of Compassion Fatigue has been around only since Carla Joinson (1992) used the term in a nursing magazine. It fit the description of nurses who were worn down by the daily hospital emergencies. Compassion Fatigue, in contrast to Burnout, is associated with a sense of helplessness and confusion and there is a greater sense of isolation from supporters. “Compassion Fatigue” being a relatively new term, is appearing only in the latest dictionaries, resulting in the fact that definitions of the concept were few and very repetitive in nature (Coetzee and Klopper, 2010). They characterise and illustrate Compassion Fatigue in the following way: “Compassion Fatigue is the final result of a progressive and cumulative process that is caused by prolonged, continuous, and intense contact with clients, the use of self, and exposure to stress. It evolves from a state of compassion discomfort, which if not removed through adequate rest, leads to compassion stress that exceeds therapists’ endurance levels and ultimately results in Compassion Fatigue”. (Coetzee, Klopper, 2010, p.237). Risk factors and causes are the precursors of Compassion Fatigue. “Risk” can be defined as a “hazard, danger, chance of loss or injury” (Hawkins, 1990, p. 334), while “cause” is defined as “that which produces an effect; that by or through which anything happens” (Hawkins, 1990, p.62). Essentially, “risk” poses a chance or probability of developing Compassion Fatigue, while “cause” produces or brings about Compassion Fatigue.

 Figley (2002)  posits the view that Compassion Fatigue is a form of secondary traumatic stress and refers to a “state of tension and preoccupation with the traumatized clients by re-experiencing the traumatic events, avoidance/numbing toward reminders, persistent arousal and anxiety associated with the client” (Figley, 2002, p.1435). Compassion Fatigue is the ultimate result of caring repeatedly for someone going through a traumatic event. Anyone in the healthcare field is at risk for developing CF. Burnout may require changing jobs or careers. However, Compassion Fatigue is highly treatable once workers recognize it and act accordingly (Perry, Toffner, Merrick, & Dalton, 2011). Figley (1995) developed the concept of Compassion Fatigue when he began to focus on the unique work environment of trauma workers and mental health professionals and how they appeared to vicariously experience the effects of trauma. It is suggested that both secondary trauma and job Burnout are likely central and critical clinical features of Compassion Fatigue. In their review of the literature on CF, Sabin-Farrell and Turpin (2003) suggested several possible psychological and psychoanalytic mechanisms at play. For example, countertransference and emotional contagion, by which working with clients may result in Compassion Fatigue. Studies that have examined the indirect effects of trauma on the helping individual often use the terms Compassion Fatigue and vicarious traumatization, (Craig & Sprang, 2010).

Vicarious Trauma

 “Milton Erickson used to say to his patients, “My voice will go with you”. His voice did. What he did not say was that our clients' voices can also go with us. Their stories become part of us. Not all stories are negative; the point is that they change us” (Mahoney, 2003, p.197). Sigmund Freud, arguably the father of modern psychology recognised the possible consequences of entering the traumatic world of a client when he said “No one who, like me, conjures up the most evil of those half-tamed demons that inhabit the human breast, and seeks to wrestle with them, can expect to come through the struggle unscathed” (Freud, as cited in Sussman, 2007, p.60).

 Vicarious traumatization refers to a transformation in the therapist's inner experience resulting from empathic engagement with clients' trauma narrative. These effects are cumulative and permanent, and evident in both a therapist's professional and personal life (Pearlman & Saakvitne, 1995). Figley, (1983) initially identified secondary trauma in sexual assault survivors’ and combat veterans’ significant others. The concept was recently expanded to apply to professionals (police officers, nurses, and trauma therapists) who provide direct services to sexual assault along with other trauma survivors.

 Working with trauma survivors as a mental health professional is often challenging and frequently places the professional at risk for difficult countertransference reactions, Vicarious Trauma, and over time, symptoms of Burnout (Wilson, Lindy, 1994; Pearlman, Saakvitne 1995). According to Hatfield, Cacioppo & Rapson (1994) Vicarious Trauma is not the same as Burnout, although Burnout may be exacerbated by Vicarious Trauma. Burnout is related to chronic tedium in the workplace rather than exposure to specific kinds of client problems such as trauma. Secondary trauma and Vicarious Trauma have not been linked to workplace conditions (Schauben & Frazier, 1995). Hatfield et al., (1994) describe Vicarious Trauma as a type of emotional contagion that may lead psychotherapists to the “catching of emotions" of their clients.

 It may be important to note that Meichenbaum (n.d.) states that while the concept of VT has received widespread attention, he believes that some cautionary observations should be kept in mind. These include the following: methods of measuring the VT concept are indeterminate. Symptoms of PTSD, Burnout and general psychological distress have been found by some studies, although most correlates are weak and the evidence for VT in trauma workers is inconsistent and ambiguous. In an endeavour to outline the difference or separation between Compassion Fatigue and Vicarious Trauma, Figley (1995a) described three areas of symptoms: the re-experiencing of the client’s traumatic event, the avoidance of reminders and/or numbing in response to reminders and persistent arousal. Figley also asserts that one severe exposure to only one other person’s traumatic material can lead to VT symptoms, but for McCann and Pearlman (1990a), VT results from cumulative exposure to traumatized clients over time.

 Vicarious Trauma is not a sign of weakness or sickness, or an indication that we’ve chosen the wrong profession. It is a natural and normal process whereby the helper’s emotional experience and relationships are disrupted or transformed by exposure to and empathic engagement with the painful trauma experiences of our clients. When we open ourselves to a client’s story of torture, loss, devastation, or betrayal, we are challenged and we are changed (Arnold, Calhoun, Tedeschi, Cann, 2005). Many therapists may face a sense of frustration or failure when they hope for success and change in their clients who are emotionally most challenging. In cases like this, empathic pain together with disappointingly slow or no progress can translate into Vicarious Trauma. For us therapists, could our greatest strength; “the compassionate connection” be also our greatest vulnerability?

 Although psychotherapy is clearly a relational, interactive process that affects clinicians and clients alike, it is hardly surprising that research on the therapeutic process has focused almost exclusively on its impact on clients. The success of psychotherapy is measured, after all, by its effect on the client’s life. According to Arnold, et al., (2005) in recent years a growing number of researchers have begun to investigate the impact of psychotherapy on therapists themselves, with particular attention directed toward understanding the effects of working with a specific subgroup of clients, that is those who are struggling to cope with traumatic events. The specific ways in which clinicians are affected by their work with survivors vary somewhat according to the nature of the trauma. Psychotherapists dealing with trauma survivors have distinct risks that fall into two major categories. Firstly, the therapist’s conscious or unconscious responses to a given client during a particular therapy session, otherwise known as countertransference and secondly, more acute, enduring changes in the therapist that result from repeated engagement with clients’ trauma material (Lindy & Wilson, 1994; Pearlman & Saakvitne, 1995).

 Apparently, the existing data is dominated by unreliable reports and theoretical discussions about the ways in which therapists are negatively affected by their work. Wilson and Lindy (1994) maintain that these negative reactions lead to “empathic strain,” which makes it difficult for therapists to provide empathy while maintaining appropriate therapeutic boundaries and objectivity. These difficulties give rise to conditions or symptoms such as withdrawal or repression of empathy. For example, over identifying with the client. This happens when it sounds like the client is telling “your story”. This may mean that the therapist has failed to take care of his or her own struggles or indeed trauma. These kinds of responses may be accompanied by feelings of self-doubt, anxiety, and insecurity about one’s ability to be helpful to trauma survivors (Wilson & Lindy, 1994).

 Finally, it is suggested that a lifestyle embracing multiple strategies for self-care include self-awareness, self-monitoring, support from peers, spouses, friends, mentors, therapists and supervisors. Further aspects include the personal values that help the practitioner to observe ethical standards of practice and a balanced life that incorporates holidays and stress-reducers along with continuing education to ensure that the practitioner diversifies their work and keeps abreast of changes and new ideas (Coster & Schwebel 1997; Norcross 2000; Jennings & Skovholt 1999).

Author: Aidan Cahill. Á



Arnold, D., Calhoun, L., Tedeschi, R., & Cann, A. (2005). Vicarious Postraumatic Growth in Psychotherapy. Journal of Humanistic Psychology, 45(2), 239-263.


Arvay, M. J., & Uhlemann, M. R. (1996). Counsellor Stress in the Field of Trauma. Canadian Journal of Counselling and Psychotherapy, 30, 191-210.


Baldwin, J. (1963). The Fire Next Time. New York, USA: Random House Inc.


Barr, A. (2006). An investigation into the extent to which psychological wounds inspire Counsellors and Psychotherapists to become Wounded Healers, the significance of these wounds on their career choice, the cause of these wounds and the overall significance of demograph. University of Strathclyde, Glasgow, Scotland.


Bradley, H. (1969). Community based treatment for young adult offenders. Crime and Delinquency, 15(3), 359-370.


Bria, M., Baban, A., & Dumitrascu, D. (2012). Systematic review of Burnout risk factors among European healthcare professionals. Cognition, Brain, Behaviour. An Interdisciplinary Journal., 16, 423-452.


Burke, R. J., Shearer, J., & Deszca, G. (1984). Burnout among men and woman in police work: An examination of the Cherniss model. journal of health in human Recources of Administrators, 7, 162-188.


Butler, A., Chapman, J., Forman, E., & Beck, A. (2005). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol RevClinical Psychology review, 26(1), 17-31.


Casserley, T., & Megginson, D. (2009). Learning From Burnout. Oxford. UK: Elsevier/Butterworth-Heinemann.


Coetzee, S., & Klopper, H. (2010). Compassion fatigue within nursing practice: A concept analysis. Nursing and Health Sciences, 12, 235-243.


Craig, C., & Sprang, G. (2010). Compassion Satisfaction, compassion fatigue and burnout in a national sample of trauma treatment therapists. An International Journal, 23(3), 319-339.


De Jonge, J., Le Blanc, P. M., Peeters, M. C., & & Noordam, H. (2008). Emotional job demands and the role of matching job resources. International Journal of Nursing Studies, 45(10), 1460-1469.


Farber, B. A., & Heifetz, L. (1982). The process and dimensions of burnout in psychotherapists. Professional Psychology, 13, 293-301.


Figley, C. R. (1983). Catastrophes: An Overview of Family Reactions. (C. M. Figley, Ed.) Stress and the Family, 2, 3-20.


Figley, C. R. (Ed.). (1995a). Compassion Fatigue as a Secondary Traumatic Stress Disorder: An Overview. New York: Routledge.


Figley, C. R. (2002). Compassion Fatigue: Psychotherapists' Chronic Lack of Self Care. Journal of Clinical Psychology, 58(11), 1433 - 1441.

Freud, S. (1937). Analysis Terminable and Interminable. International Journal of Psycho-Analysis, 18, 373-405.


Freudenberger, H. (1974). Staff Burnout. Journal of Social Issues, 30(1), 159-165.


Gaines, J., & Jermier, J. M. (1983). Emotional Exhaustion in a High Stress Organization. Tha Academy of Management Journal, 26(4), 567-586.


Gelso, C., & Carter, J. (1985). The real relationship in counselling and psychotherapy: Components, onsequences and theoretical antecedents. The Counselling Psychologist, 13, 155-243.


Gilroy, P., Carrol, l. L., & Murra, J. (2002). A preliminary survey of counseling Psychologists' personal experiences with depression and treatment. Professional Psychology: Research and Practice, 33, 402–407.


Gold, Y. (1985). Burnout: Causes and Solutions. The Clearing House: A Journal of Educational Strategies, Issues and Ideas, 58(5), 210-212.


Hatfield, E., Cacioppo, J., & Rapson, R. (1994). Emotional Contagion. Current Directions in Psychological Sciences, 2, 96-99.


Hawkins, J. M. (1990). The New Oxford Dictionary. Oxford: Oxford University Press.


Hurt, A. A. (2011). Personality Factors and their Influence on Autism Spectrum Therapist Burnout and job satisfaction. Department of Psychology.Western Carolina University.


Jackson, S., Schwab, R., & Schuler, R. (1986). Toward an Understanding of the Burnout Phenomenon. Journal of Applied Psychology, 71(4), 630-640.


Jennett, H., Harris, S., & Mesibov, G. B. (2003 ). Commitment to Philosophy, Teacher Efficacy, and Burnout Among Teachers of Children with Autism. Journal of Autism and Developmental Disorders, 33(6), 583-593.


Jennings, L., & Skovholt, T. (1999). The cognitive, emotional, and relational characteristics of master therapists. Journal of Counseling Psychology, 46, 3-11.


Joinson, C. (1992 ). Coping with Compassion Fatigue. Nursing, 22(4), 116-122.


Jung, C. G. (1954). The Practice of Psychotherapy. New York: Pantheon Books, Inc.

Keoske, G. F., & Kelly, T. (1995). The impact of over involvement on burnout and job satisfaction. American Journal of Orthopsychiatry, 65(2), 282-292.


Kottler, J. A. (2012). The Therapist's Workbook: Self-Assessment, Self-Care and Self-Improvement Exercises for Mental Health Professionals (2 ed.). Hoboken, New Jersey.: John Wiley & Sons, Inc.


Lee, J., Lim, N., Yang, E., & Lee, S. (2011). Antecedents and consequences of three dimensions of burnout in psychotherapists: A meta-analysis. Professional Psychology: Research and Practice, 42(3), 252-258.


Leiter, M. P., & Maslach, C. (2005). Banishing Burnout (1st ed.). San Francisco. CA.: John Wiley & Sons, Inc.


Lewiston, N., Conley, J., & Blessing-Moore, J. (1981). Measurement of hypothetical burnout in cystic fibrosis caregivers. Acta Paediatrica, 70(6), 935-939.


MacKewn, J. (2006). Developing Gestalt Counselling. London: Sage Publications Ltd.


Mahoney, M. J. (2003). Constructive Psychotherapy. New York: The Guilford Press.


Maslach, C. (1976). Burned out. Human Behaviour, 5(9), 16-22.


Maslach, C. (1982). Burnout: The Cost of Caring. New York: Prentice Hall.


Maslach, C., & Jackson, S. (1981,). The Measurement of Experienced Burnout. Journal of Occupational Behaviour, Volume. 2, pp 99-113.


Maslach, C., & Jackson, S. (1984b). Patterns of burnout among a national sample of public contact workers. Journal of Health and Human Resources Administration, 7, 189-212.


Maslach, C., & Jackson, S. E. (1986). MBI: The Maslach Burnout Inventory Manual (2nd ed.). Palo Alto. CA, USA: Consulting Psychologists Press.


Maslach, C., & Leiter, M. (2008). Early Predictors of Job Burnout and Engagement. Journal of Applied Psychology, 93(3), 498-512.


Maslach, C., Schaufeli, W. B., & & Leiter M, P. (2001). Job Burnout. Annual Review of Psychology, 52, 397–422.


McCann, I., & Pearlman, L. (1990). Vicarious Traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131-149.


McCormack, N., & Cotter, C. (2013). Managing Burnout in the Workplace. Oxford. UK: Chandos Publishing/Woodhead Publishing Limited.


Meichenbaum, D. (n.d.). Self-Care for trauma Psychotherapists and Caregivers: Individual, social and Organizational Interventions, training materials.


Miller, L. (1998). Our own medicine: Traumatized psychotherapists and the stresses of doing therapy. Psychotherapy, 35, 137-149.


Norcross, J. C. (2000). Psychotherapist Self-Care: Practitioner-Tested, Research-Informed Strategies. Professional Psychology Research and Practice, 31(6), 710-713.


Norcross, J. C., & Guy, J. D. (2007). Leaving It at the Office. New York/London: The Guilford Press.


Patsiopoulos, A. T., & Buchanan, M. J. (2011). The Practice of Self-Compassion in Counseling: A Narrative Inquiry. Professional Psychology: Research and Practice, 42(4), 301-307.


Pearlman, L. A., & Saakvitne, K. (1995). Trauma and the Therapist:Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. New york: WW Norton & Company.


Perry, B., Toffner, G., Merrick, T., & Dalton, P. (2011). An exploration of the experience of compassion fatigue in clinical oncology nurses. Canadian Oncology Nursing Journal, 21(2), 91-105.


Perseius, K., Kaver, A., & Ekdahl, S. (2007). Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms. Journal of Psychiatric and Mental Health Nursing, 14(7), 634-643.


Pope, K., & Tabachnick, B. (1994). Therapists as patients: A national survey of psychologists' experiences, problems, and beliefs. Professional Psychology: Research and Practice, 25, 247-258.


Proctor, E., & Proctor, A. (2013). Burnout: Overcomming Excess Stress. Oxford. UK: Lion Books.

Rosenberg, T., & Pace, M. (2006). BURNOUT AMONG MENTAL HEALTH PROFESSIONALS. Journal of Marital and Family Therapy, 32(1), 87-99.


Rupert, P. A., & Kent, J. (2007). Gender and work setting differences in career-sustaining behaviors and burnout among professional psychologists. Professional Psychology: Research and Practice, 38(1), 89-96.


Sabin-Farrell, R., & Turpin, G. (2003). Vicarious traumatization: implications for the mental health of health workers? Clinical Psychology Review, 23(3), 449-480.


Schabracq, M., Winnubst, & J. Cooper, C. (2003). The Handbook of Work and Health Psychology. Chichester.UK: John Wiley & Sons Ltd.


Schauben, L. J., & Frazier, P. (1995). Vicarious Trauma:The effects on female counsellors of working with sexual violence survivors. Psychology of Women Quarterly, 19, 49-64.


Schaufeli, W., & Enzmann, D. (1998). The Burnout Companion to Study and Practice: A Critical Analysis. London: Taylor & Francis Ltd.


Schwebel, M., & Janet, C. (1998). Well-Functioning in Professional Psychologists:As Program Heads See It. Professional Psychology: Research and Practice, 29(3), 284-292.


Sexton, L. (1999). Vicarious Traumaisation of counsellors and effects on their workplace. British journal of guidance and counselling, 27(3), 393-403.


Skovholt, T. M. (1988). Searching for Reality. Counselling Psychologist, 16(2), 282-287.


Soderfeldt, M., Soderfeldt, B., & Warg, L. (1995). Burnout in social work. Social Work, 40, 638-646.


Stamm, B. (1995). Secondary traumatic stress: Self-care issues for Clinicians, Researchers, and Educators ( 2 edition ed.). Lutherville. MD. USA: Sidran Press.


Sussman, M. B. (2007). A Currious Calling. New York: Jason Aronson.


Wilson, J. P., & Lindy, J. (1994). Countertransference in the Treatment of PTSD. (J. L. Wilson, Ed.) New York: Guilford Press.


Yalom, I. D. (2002). The Gift of Therapy. Harper Collins Publishers.