Challenges to Therapist Self-Care with In-Home Work

Module Sections:

Therapist Stress & Burnout

Organizational

Occupational stress results from an imbalance between occupational demands and available coping resources (Maslach et al., 1996). Therapist caseloads, administrative responsibilities, and supervisory resources each contribute to added stress. When a therapist experiences these as usurping one's own sense of control, he/she may feel helpless and disempowered from making any changes.

Interpersonal

Compassion fatigue, vicarious traumatization, secondary traumatization, secondary traumatic stress, secondary victimization (Figley, 2002) result from repeated exposure to clients' traumatic stories. This exposure can alter a person's perception of basic psychological needs, such as those for safety, trust in self and others, esteem for self and others, intimacy, and control (Trippany et al., 2004). Gilroy, Carroll, & Murra (2002) note, "The increasing attention in the professional literature to issues of secondary trauma (Cerney, 1995) and vicarious traumatization (McCann & Pearlman, 1990; Pearlman & MacIan, 1995) has, for example, served to heighten our consciousness about the potential negative impact that [practicing] psychotherapy can have on clinicians" (p. 406).

Burnout is related to a clinician's degree of self-efficacy and satisfaction association with therapy roles and responsibilities. Burnout can result from a clinician's efforts to address issues and challenges that arise in the course of accomplishing the work. Through a gradual onset, clinicians experience burnout after repeated inadequate attempts to address stress that has accumulated, or piled up, over time. The culmination of the stress leads to the following constellation of factors:

  • Emotional exhaustion - The concept of burnout integrates exhaustion with staff members' involvement in their work, especially the people with whom they work, and their sense of efficacy or accomplishment (Cushway et al., 1996)
  • Depersonalization – Refers to an impersonal and dehumanized perception of recipients, characterized by a callous, negative, and detached attitude (Salanova et al. 2005)
  • Reduced/Lack of personal accomplishment – The tendency to evaluate one's work with recipients negatively (Salanova et al. 2005)
  • Negative self-concept - Feelings of decreased sense of self-worth and diminished self-esteem, which may lead to self-defeating behavior
  • Cynicism and negative job attitudes-Resulting from seeing one's job in a negative light and wondering if the career was a bad fit, where one used to enjoy their work

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