Exploring Mental Health Professionals Described Experiences of Burnout and Coping

Strategy Uses

Submitted by

Heather Briana James

A Dissertation Presented in Partial Fulfillment

of the Requirements for the Degree

Doctorate of Education

Grand Canyon University

Phoenix, Arizona

August 24, 2021

© by Heather Briana James, 2021

All rights reserved.

 GRAND CANYON UNIVERSITY

Exploring Mental Health Professionals Described Experiences of Burnout and Coping

Strategy Uses

I verify that my dissertation represents original research, is not falsified or plagiarized,

and that I accurately reported, cited, and referenced all sources within this manuscript in

strict compliance with APA and Grand Canyon University (GCU) guidelines. I also

verify my dissertation complies with the approval(s) granted for this research

investigation by GCU Institutional Review Board (IRB).

_____________________________________________ ____________
Heather B. James Date
 Abstract

Prior to this study it was not known how mental health professionals s, who treat trauma,

in the U.S., described their experiences of burnout and their use of coping strategies. The

purpose was to explore MHPs described experiences of burnout and their use of coping

strategies. There were two research questions: How do MHPs, who treat trauma, in the

U.S., describe their experience of burnout? And how do MHPs, who treat trauma, in the

U.S., describe their use of coping strategies? The job demands-resource model provided

the theoretical foundation. Purposeful sampling helped select 18 mental health

professionals for participation in the study. Data were gathered through self-report

questionnaires and semi-structured interviews. Thematic analysis was utilized to analyze

data collected in this study. Eight themes arose from the data regarding descriptions of

burnout experiences and uses of coping strategies: (1) conditions as described by MHPs

that resulted in burnout, (2) burnout as described by MHPs that was induced by COVID,

(3) characteristics of burnout as described by MHPs, (4) Staying motivated in the face of

burnout as described by MHPs, (5) strategies and tools utilized for coping as described by

MHPs, (6) beneficial types of support systems utilized for coping as described by MHPs,

(7) utilizing open communication to cope with burnout as described by MHPs, and (8)

utilizing education and preparation for coping with burnout as described by MHPs. Results

indicated that MHPs face the risk of burnout, through strategies such as education,

communication, and self-care plans, this risk could be addressed.

Keywords: Mental Health Professionals, MHPs, burnout, coping strategies,

communication, self-care
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Dedication

I dedicate this dissertation to my baby brother, without whom this long and

arduous journey would not have taken place. He left this earthly plane and stirred a desire

in me to better understand the value of living. Had it not been for him getting sick and

dying, I may never have had the desire to really appreciate life and its wonders. This

study also would not have taken place without him, and so I dedicate this piece of me to

his memory. Thank you, Justin L. Smith, if not for you none of this would have been

possible. Keep shining down on me and know that I did this for you and because of you!

Heaven truly is lucky to have you. I love you little brother, always. I also dedicate this

dissertation to God, without whom I would not be here. You are the reason I am alive

today, and I value life more than you could know. You kept me grounded and were there

in my times of need, showing me the way. Please keep watching over me as I move

forward on my next journey.

 vii

Acknowledgments

Thank you first and foremost to my amazing husband, without his support I would

never have begun, continued, or finished this doctoral journey. He has been and continues

to be my support, my rock, and the love of my life. To my sisters and my parents, you

have been some of my biggest supporters and I thank you. To my children, I did this for

you so that you could see anything is possible you set your mind to, and to never give up

on your dreams. I hope you one day have the opportunity to do something truly

remarkable like each of you are. To my grandson, you my boy, were the reason for all the

late-night work, but I would not have changed that for anything because you helped me to

remember that living is just as important as my work! To my friend Nicole Sumner, I

would not have made it to the finish line without our late-night talks, our shared

meltdowns, and our wonderful friendship we formed through this journey. You are my

sister in every sense of the word, and I love you. To all my fellow students who helped

me and were a great support system when I wanted to give up, you all don’t know how

much I appreciate you. Last, but certainly not least, Dr. Manjounes, you have worked

continually to help me to the finish line, and you have been such an awesome chair. You

believed in me and my study and I thank you for that support. Dr. Goodwin, you may not

be my chair anymore, but we formed a working relationship that I will always value.

Finally, to all of my committee, both new and prior, you helped to make me a better

researcher and for that I thank you from the bottom of my heart.
 viii

Table of Contents

List of Tables ................................................................................................................... xiii

List of Figures .................................................................................................................. xiv

Chapter 1: Introduction to the Study....................................................................................1

Introduction ....................................................................................................................1

Background of the Study ...............................................................................................3

Problem Statement .........................................................................................................5

Purpose of the Study ......................................................................................................6

Research Questions ........................................................................................................7

Advancing Scientific Knowledge and Significance of the Study ..................................8

Rationale for Methodology ..........................................................................................12

Nature of the Research Design for the Study...............................................................13

Definition of Terms......................................................................................................16

Assumptions, Limitations, Delimitations ....................................................................20

Assumptions........................................................................................................21

Limitations and delimitations. ............................................................................21

Summary and Organization of the Remainder of the Study ........................................24

Chapter 2: Literature Review .............................................................................................29

Introduction to the Chapter and Background to the Problem ......................................29

Historical background .........................................................................................31

Identification of the Gap ..............................................................................................35

Theoretical Foundations and/or Conceptual Framework .............................................38

Review of the Literature ..............................................................................................41

Burnout. ..............................................................................................................42
 ix

Coping strategies.................................................................................................53

Methodology and instrumentation/data sources/research materials ...................65

Summary ......................................................................................................................69

Chapter 3: Methodology ....................................................................................................73

Introduction ..................................................................................................................73

Statement of the Problem .............................................................................................74

Research Questions ......................................................................................................75

Research Methodology ................................................................................................78

Research Design...........................................................................................................82

Population and Sample Selection.................................................................................87

Data source one: questionnaire. ..........................................................................92

Data source two: interviews. ...............................................................................93

Data saturation. ...................................................................................................95

Trustworthiness ............................................................................................................96

Credibility. ..........................................................................................................97

Transferability. ....................................................................................................98

Dependability. .....................................................................................................99

Confirmability...................................................................................................100

Data Collection and Management ..............................................................................101

Permissions and informed consent. ..................................................................101

Subject selection. ..............................................................................................103

Data collection. .................................................................................................103

Data protection. .................................................................................................106

Ethical considerations. ......................................................................................107

 x

Data Analysis Procedures ..........................................................................................108

Four step process. .............................................................................................110

Merging of data. ................................................................................................112

Data saturation. .................................................................................................112

Ethical considerations. ......................................................................................112

Limitations and Delimitations....................................................................................114

Summary ....................................................................................................................118

Chapter 4: Data Analysis and Results ..............................................................................122

Introduction ................................................................................................................122

Descriptive Findings ..................................................................................................124

Setting. ..............................................................................................................124

Participant profiles. ...........................................................................................125

Data sources. .....................................................................................................128

Questionnaires ..................................................................................................128

Interviews..........................................................................................................129

Data Analysis Procedures ..........................................................................................131

Preparing the data. ............................................................................................132

Analyzing the data. ...........................................................................................133

Four step process. .............................................................................................135

Data merging.....................................................................................................143

Trustworthiness. ................................................................................................144

Transcript checking...........................................................................................145

Member checking .............................................................................................145

Thick description ..............................................................................................145

Data saturation ..................................................................................................146

 xi

Potential sources of error ..................................................................................147

Results ........................................................................................................................149

Research question 1. .........................................................................................150

Research question 2. .........................................................................................161

Summary ....................................................................................................................172

Chapter 5: Summary, Conclusions, and Recommendations ............................................176

Introduction and Summary of Study ..........................................................................176

Summary of Findings and Conclusion .......................................................................183

Research question 1. .........................................................................................183

Research question 2. .........................................................................................192

Summary. ..........................................................................................................199

Implications................................................................................................................202

Theoretical implications. ..................................................................................203

Practical implications. .......................................................................................205

Future implications ...........................................................................................208

Strengths and weaknesses of the study .............................................................209

Recommendations ......................................................................................................211

Recommendations for future research. .............................................................211

Recommendations for future practice. ..............................................................213

References ........................................................................................................................215

Appendix A. Site Authorization Letter(s) ........................................................................266

Appendix B. IRB Approval Letter ...................................................................................267

Appendix C. Informed Consent .......................................................................................268

Appendix D. Copy of Instruments and Permissions Letters to Use the Instruments .......272

Appendix E. Recruitment Script ......................................................................................274

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Appendix F. Demographic Survey ..................................................................................276

Appendix G. Questionnaire .............................................................................................277

Appendix H. Interview Protocols ....................................................................................280

Appendix I. Expert Panel Review ...................................................................................282

Appendix J. Mental Health Support Resources ...............................................................288

Appendix K. Individual Participant Scales ......................................................................289

Appendix L. List of Codes ...............................................................................................290

Appendix M. Categories and Related Codes ...................................................................298

Appendix N. Emerged Themes ........................................................................................303

Appendix O. Display of Themes .....................................................................................315

Appendix P. License Acronym Definitions .....................................................................319

Appendix Q. Licensing Board Sites.................................................................................320

Appendix R. Sample Transcripts .....................................................................................321

 xiii

List of Tables

Table 1. Research Questions with Related Sources of Data .......................................... 109

Table 2. License Held and Gender of Participants ........................................................ 128

Table 3. Questionnaire Scoring...................................................................................... 129

Table 4. Interviews of Study Participants ...................................................................... 131

Table 5. Step 3: Themes with Related High- Level Categories ..................................... 142

Table 6. Step 4: Research Questions with related themes ............................................. 143

Table 7. Research Questions with Related Themes and High-Level Categories .......... 150

Table 8. Participants Comments on Burnout ................................................................. 159

Table 9. Participants Comments on Coping Strategies .................................................. 170

Table L10. Step 1: List of Codes ................................................................................... 290

Table M11. Step 2: Categories and Related Codes........................................................ 298

Table N12. Generating themes through Analytic Memos ............................................. 303

Table O13. Relating Themes to the Research Questions ............................................... 315

Table P14. License Definitions ...................................................................................... 319

 xiv

List of Figures

Figure 1. A representation of the job demands-resource model (JD-R). .......................... 41

Figure 2. States represented and participants years in practice. ..................................... 127

Figure 3. An example of thematic analysis for identifying themes in qualitative data. . 134

Figure 4. An illustration of the four-step process followed in the thematic data anlysis of
this study. ........................................................................................................ 137
 1

Chapter 1: Introduction to the Study

Introduction

Burnout is a term that describes exhaustion resulting from job demands placed on

individuals within service professions. Burnout is a term that describes the lack of interest

in work, and stress overload from certain work settings (Maslach, & Leiter, 2005).

Burnout is caused by an overload of stress placed on an individual within their specific

work setting. This stress can then lead to exhaustion, emotional shutdown, and even

avoidance of an individual's work (Butler, 2017). Burnout often happens when job

demand is high, and work-life balance is low (Halbesleben, & Buckley, 2004). The

simplest definition of burnout is stress (Maslach, & Leiter, 2005).

Furthermore, burnout has been shown to cause higher incidences of health-related

issues in those who have high demand jobs, specifically those who work within the

helping professions (Bianchi, Truchot, Laurent, Brisson, & Schonfeld, 2014). There are

multiple causes of burnout and even more strategies utilized to cope with burnout,

however, it is unclear how burnout affects those within the mental health setting,

specifically those who treat trauma (Ivicic, & Motta, 2017; Leiter, & Harvie, 1996).

Further research is thus needed to explore the causes of burnout in individual mental

health professionals who treat trauma (Hessels, Rietveld, & Van der Zwan, 2017; Ivicic,

& Motta, 2017).

Burnout keeps individuals from providing the best care to those they serve. The

literature identified various ways individuals can experience burnout, and various causes

of concern which are directly related to the type of jobs that often experience burnout of

employees (Leiter, & Harvie, 1996; O’Connor, Muller Neff, & Pitman, 2018; Piedmont,
 2

1993). Piedmont (1993) stated burnout within the mental health field is of interest as

mental health professionals have jobs high in stress and place a great deal of strain on the

individual mental health professional. Furthermore, Wardle and Mayorga (2016) noted

there are many strategies mental health professionals employ to manage the burnout they

can experience from being in a high-stress job. However, it was not known how mental

health professionals described their experiences of burnout, specifically those who treat

trauma.

This qualitative descriptive study intended to explore how mental health

professionals (hereinafter as referred to as MHPs), who treat trauma, in the U.S.,

described their experiences of burnout and their use of coping strategies. This study

offered significant suggestions for researchers and practitioners within the mental health

field regarding the topic of burnout, as well as coping strategies that can be used to

manage burnout. The results of this study contributed to the existing body of literature by

addressing the gap in the current understanding of how mental health professionals, who

treat trauma, in the United States, described their experiences of burnout and the coping

strategies they used to manage burnout.

Chapter one introduces the study and also provides information about the

background of the study. The chapter also presents the problem statement, the purpose of

the study, and the research questions that guided the study. Chapter one also explains

how the study advanced scientific knowledge related to the topic. The rationale for the

methodology, the research design, and definition of terms are also discussed.

Clarification of assumptions, limitations, and delimitations related to the study rounded

out the rest of chapter one.

 3

Background of the Study

Burnout is something every industry can experience or has experienced.

Individuals employed by almost every service setting have experienced burnout due to

the sheer demand and nature of what is the workforce (Andela, Truchot, & Van der Doef,

2015). Yu, Jiang, and Shen (2016) noted any individual regardless of the industry can

experience burnout, but those who work within the helping profession or work with those

who are suffering are more likely to have experienced burnout. Moreover, burnout poses

not only a serious risk to those who are receiving help, but also those doing the helping

(Dawson, O’Brien, & Beehr, 2015; Jaracz, et al., 2017; Leiter, & Maslach, 1999;

Maslach, & Leiter, 2005).

Additionally, those who work within traumatic settings, often rely upon the

support of others when it comes to coping (Matthieu, & Ivanoff, 2006; Mohamed Saleh

Baqutayan, 2015). Burnout has been a problem within the helping profession for many

years. It dates back as far as 1982 when Farber and Heifetz (1982) discovered those who

experience burnout lose any concern for those they are helping and often suffer from

health-related issues. Furthermore, research has shown burnout causes have changed

through the years as jobs have changed and grown, and job demands have changed as

well (Maslach, & Leiter, 2016).

Mental health professionals have suffered the greatest toll when considering the

role of burnout, as their clientele often suffers due to the burnout of the MHP (Mental

Health Professional). Furthermore, the mental health industry has suffered the turnover of

many MHPs due to burnout and is a short-staffed industry due to this fact (Fye, Gnilka, &

McLaulin, 2018). Finally, burnout has caused individuals to stop their careers in mental
 4

health and seek other employment with fewer demands (Ackerley, Burnell, Holder, &

Kurdek, 1988; Campagne, 2012; Maslach, & Goldberg, 1998; May, & O’Donovan,

2007). Sim, Zanardelli, Loughran, Mannarino, and Hill (2016) found there was a

significant lack of research regarding burnout of MHPs. Moreover, Maguire and Byrne

(2017) found that additional studies were needed that explored the protective factors for

MHPs.

Burnout of those who repeatedly treat trauma, have yet to be fully explored

regarding MHPs. However, various studies have shown the need to explore what MHPs

who treat trauma have experienced (Wilkinson, Whittington, Perry, & Eames, 2017).

Moreover, the mental health profession has changed significantly concerning the

requirements for practice in this field, such as greater educational requirements, stricter

licensing requirements, and lengthy timeframes for training, as such many individuals

who have been and still are in the field, understand the need to explore how those who

treat trauma experience burnout (Wilkinson, et al., 2017).

Hammond, Crowther, and Drummond (2018) suggested further research be done

to examine clinicians’ experiences of burnout. Hammond et al. (2018) also noted there

was a gap in the literature in recognizing and understanding clinicians’ lives when they

experienced burnout. Furthermore, Ivicic and Motta (2017) also suggested that future

research be done to examine therapeutic supports for work-related stress. Additionally,

Ivicic and Motta (2017) noted future research should be done with MHPs to examine the

experience of secondary trauma when hearing about a trauma. This qualitative descriptive

study aimed to explore how MHPs, who treat trauma, in the U.S., described their

experience of burnout and their use of coping strategies.

 5

Problem Statement

It was not known how MHPs, who treat trauma, in the U.S. described their

experience of burnout and their use of coping strategies. MHPs often experience burnout,

as job demands are high and self-care is often low (Coleman, Martensen, Scott, & Arce

Indelicato, 2016). The problem MHPs face is that with a limited number of MHPs

entering into the field, peer support was often a limited tool that could be utilized to cope

with burnout (Beaumont, Durkin, Hollins Martin, & Carson, 2016; Nelson, Hall,

Anderson, Birtles, & Hemming, 2017). The main issue MHPs face is support networks

most often come from their work setting (Shapiro, & Galowitz, 2016). MHPs are often

left to their own means for coping with burnout; stress levels are often higher, and MHPs

often maintain a high client caseload (Schaufeli, Maslach, & Marek, 2017). The specific

problem is, it was not known how MHPs, who treat trauma, in the U.S., described their

experience of burnout and their use of coping strategies.

Creating a self-care plan and choosing several self-care strategies are some of the

ways MHPs can cut down on the experience of burnout (Pratt, & Jachna, 2015; Rupert,

Miller, & Dorociak, 2015; Sansbury, Graves, & Scott, 2015). Self-care is often

considered a great line of defense for reducing burnout (Gil-Monte, Peiro, & Valcárcel,

1998). However, when MHPs treat trauma, self-care plans are the first line of defense for

helping to reduce burnout as peer support does not always have effective results (Neff,

Kirkpatrick, & Rude, 2007; Nelson, et al., 2017). Furthermore, MHPs burnout can be

affected by a variety of different work settings (Hofmann, & Barker, 2017; Nowell,

Norris, White, & Moules, 2017).

 6

This descriptive study explored how MHPs, who treat trauma, in the U.S.,

described their experience of burnout and their use of coping strategies. For this study,

MHPs served as both the unit of analysis and the unit of observation. The strategies for

coping with burnout which are presented within this study could help to reduce the

number of burnout experiences MHPs, who treat trauma, experience. These strategies

could also help MHPs, who treat trauma, to recognize the signs of burnout and develop

self-care plans which could help them to mitigate the effects of burnout.

Purpose of the Study

The purpose of this qualitative descriptive study was to explore how MHPs, who

treat trauma, in the U.S., described their experience of burnout and their use of coping

strategies. The phenomenon under study in this research was burnout. This study

employed a qualitative descriptive design to study MHPs, who treat trauma, in the U. S.,

and their described experience of burnout and their use of coping strategies. The general

population for this research consisted of MHPs from the United States. The target

population consisted of MHPs that treat trauma and were purposefully selected from a

Facebook group for therapists. 18 MHPs, that treat trauma, and were fully licensed in the

U.S., and currently worked as an MHP were selected for participation within this study.

The researcher originally planned for 15-20 participants.

Wardle and Mayorga (2016) noted once burnout is experienced, disruption within

the physical, emotional, and psychological areas of the MHPs life will begin to detour in

a negative direction, thus leading to further separation from the job. Simionato, Simpson,

and Reid (2019) stated job, individual, and organizational factors are often the leading

cause of burnout. In addition, self-care plans and support are needed at both the
 7

individual and organizational levels to ensure burnout is manageable (Simionato, et al.,

2019). Being able to manage the demand placed upon MHPs could help to reduce the

experience of burnout. Kaeding et al. (2017) suggested training students within the

helping professions to recognize signs of burnout and to create plans to manage burnout,

are necessary components of education programs and need to be in place to cut the

amount of burnout MHPs experience. By advancing strategies that can help manage

burnout, this study could help MHPs, and potential MHPs avoid the possibility of

burnout in their professional careers.

Research Questions

The overarching research question that guided this qualitative descriptive study

was intended to help address the problem statement of it was not known how MHPs, who

treat trauma, in the U.S., described their experience of burnout and their use of coping

strategies. An additional research question that supported the overarching research

question was aligned with the understanding that MHPs who treat trauma, experienced

burnout, and that they used coping strategies to manage burnout. Below are the following

research questions for this study where RQ1 is the overarching research question and

RQ2 is the supporting research question.

RQ1: How do MHPs, who treat trauma, in the U.S., describe their experience of

burnout?

RQ2: How do MHPs, who treat trauma, in the U.S., describe their use of coping

strategies?
 8

The research questions were derived from the literature regarding MHPs

described experiences of burnout and their use of coping strategies. The questions

provided the framework to develop the interview protocols for this study (See Appendix

H). The research questions were intended to develop data specific to how MHPs

described their experience of burnout and their use of coping strategies to manage

burnout. Such insights into burnout and the use of coping strategies to manage burnout

allowed this research to identify, explore, examine, and understand how MHPs can

reduce burnout and utilize strategies to cope with burnout.

The choice to become an MHP is one that should not be taken lightly. According

to Sanches et al. (2017) those entering into the health sector experience and observe

many upsetting, and disturbing situations during schooling which could lead to conditions

of burnout, thus students entering into any health field should consider the strain the job

within the health field could cause on their well-being. Furthermore, Cocker and Joss

(2016) noted those who enter areas of health care and deal with trauma, are more likely to

experience burnout, due to the amount of tragedy, strain, and demand placed upon them.

Being an MHP can be a rewarding profession, however, one must have the tools needed

to help them manage the strain of the job to circumvent the experience of burnout

(Carrola, Olivarez, & Karcher, 2016).

Advancing Scientific Knowledge and Significance of the Study

The emergence and understanding of coping mechanisms and strategies for

coping with burnout allow for those in the health sector, specifically MHPs, to utilize

those strategies and mechanisms to help reduce burnout they may experience. Unlike

when burnout was first discovered, there are now many more strategies to help MHPs
 9

cope with the experience of burnout (Coaston, 2017). It has been noted in research, that

those who practice with empathy may be less likely to experience burnout, however, it is

noted that even in practicing with empathy there is no guarantee that burnout will not be

experienced (Miller, & Sprang, 2017). The use of coping strategies minimizes the

experience of burnout and allows for MHPs to continue their work (Wagaman, Geiger,

Shockley, & Segal, 2015). However, the literature suggests that burnout remains a

concern for MHPs, especially those who treat trauma (Bogiatzaki, et al., 2019; Cocker, &

Joss, 2016; Ivicic, & Motta, 2017; Jergensen, 2018; Paiva, Cańario, China, & Gonçalves,

2017).

Burnout has led to a lack of MHPs, as each year more MHPs experience burnout,

and less enter the field (Dreison et al., 2018). Furthermore, Juszkiewicz and Dębska

(2015) suggested MHPs who may not have the necessary skills to help reduce or manage

burnout, often are the first to experience it. However, Rupert et al. (2015) suggested

MHPs who create self-care plans and who are cognizant of the emotional state of their

work are less likely to experience burnout. They also suggest that having a good work-

life balance could help to mitigate the effects of burnout.

This research investigated and explored how MHPs, who treat trauma, in the U.S.,

described their experience of burnout and their use of coping strategies. This research

was necessary to contribute to the knowledge of how burnout of mental health

professionals who treat trauma is described and how their use of coping strategies is

described. Advancing strategies to mitigate or reduce the experience of burnout could

protect both current MHPs and those newly entering the field from experiencing burnout.
 10

Moreover, specific coping strategies addressing burnout uncovered in this study

could significantly reduce the experience of burnout altogether, by giving MHPs the

necessary tools to promote their well-being and eliminate burnout. Given the lack of

empirical research on the experience of burnout in MHPs who treat trauma, this study

provided valuable information into the way MHPs who treat trauma, not only described

the experience of burnout but the coping strategies they used to manage it.

This study utilized the job demands-resources model (JD-R). The JD-R noted that

stress is a disruption of the individual's cognitive-emotional environment caused by

external factors. The external factors which are known as stressors, then cause negative

cognitive-emotional disturbances and thus place strain onto the individual's resources

utilized for coping (Demerouti, Bakker, Nachreiner, & Schaufeli, 2001). Job demands are

the physical, emotional, social, or organizational aspects of a job that require sustaining

both physical and mental effort, and therefore are associated with psychological and

physiological costs to an individual (Demerouti, et al., 2001).

Job resources refer to the psychological, physical, social, or organizational aspects

of a job that can do any of the following a) function in achieving work goals, b) reduce

the job demands associated with both the physical and psychological costs to the

individuals and c) stimulate growth and development in the individual (Demerouti, et al.,

2001). Furthermore, the JD-R models explained “a second assumption in the JD-R

model, is that job stress or burnout develops—irrespective of the type of job or

occupation—when certain job demands are high and when certain job resources are

limited” (Bakker, Demerouti, & Euwema, 2005, p. 170).

 11

This model was appropriate to examine how MHPs, who treat trauma, in the U.S.,

described their experience of burnout and their use of coping strategies, as it directly

allowed for an examination of the job demands placed upon the MHP, and it also allowed

for an examination of how they utilized resources to mitigate the experience of burnout.

This model was appropriate as it gave insight into how individuals within high-demand

jobs experience burnout and how they use resources to negate the effects of that burnout

(Demerouti, et al., 2001).

By being verifiable, the strategies uncovered in this study may have provided the

opportunity to gather empirical evidence of the effectiveness of coping strategies used to

reduce or avoid burnout. The results from this study highlight the effectiveness of coping

strategies used by MHPs who treat trauma. Findings could be utilized to build

educational programs to train and teach other MHPs, (and those in other health sectors),

how to recognize and manage burnout. The results from this study could provide MHPs

(both new and current) the confidence necessary to enjoy their jobs, while not worrying

about the possibility of burnout or how to manage it.

Given burnout is commonplace within the health care field, it is a concern for

how to manage and treat it (Luken, & Sammons, 2016; Malkina-Pykh, 2017; Parola, et

al., 2016). Adoption of self-care plans and well-being strategies may help to mitigate the

effects of burnout. This study contributed to the industry's best practices for mitigating

burnout and the risks of burnout. The results of the descriptive study provide MHPs with

necessary insight into the relevant concerns of how burnout is experienced and how the

use of coping strategies to manage burnout is experienced.

 12

Rationale for Methodology

This study utilized a qualitative methodology to investigate how MHPs, who treat

burnout, in the U.S, described their burnout experience, and their use of coping strategies.

The use of a qualitative methodology was necessary to understand the phenomenon of

burnout, and how it affects MHPs (McCusker, & Gunaydin, 2015; Sherman, & Webb,

2005). Isaacs (2014) noted qualitative research is suitable for a research study within the

health field when it is necessary to understand individual or community experiences with

the phenomenon. Individual accounts of the phenomenon can reveal hidden concerns,

fears, anxieties, anger, or sadness (Dempsey, Dowling, Larkin, & Murphy, 2016).

Furthermore, Kalu and Bwalya (2017) and Grossoehme (2014) suggested qualitative

research is necessary when trying to understand human experiences, or situations, as well

as understanding individuals’ values, beliefs, and cultures; things that cannot be

quantified.

This study was not looking to establish a relationship between variables, compare

variables, or test hypotheses of any form. Given quantitative methods are usually kept to

numerical properties, it was not a suitable method to explore individual described

experiences (Queirós, Faria, & Almeida, 2017). Qualitative approaches allowed for

questions that revealed deep insights into how certain phenomenon were experienced by

individuals (McGrath, Palmgren, & Liljedahl, 2019; McKim, 2017). Moreover, many of

the current studies on burnout were quantitative in nature due to examining relationships

between the causes of burnout, and therefore qualitative research was necessary to

explore the described experiences of burnout (Ghannam, Afana, Ho, Al-Khal, & Bylund,

2020; Houghton, Casey, Shaw, & Murphy, 2013).

 13

Nature of the Research Design for the Study

The design of this qualitative study was descriptive. The unit of analysis was

MHPs. The MHPs served as the unit of observation as well, as they had firsthand

experience with the phenomenon. Descriptive studies aim to explore described

experiences of a phenomenon (Sandelowski, 2000). Atmowardoyo (2018) stated

descriptive designs seek to describe the phenomenon as accurately as possible and the

perspectives of the participants are what is most important. The descriptive design

allowed the researcher to directly answer the research questions about how MHPs

described their experience of burnout and their uses of coping strategies.

A descriptive design offered advantages to the researcher for thoroughly

investigating the described experience of the phenomenon, such as in this study

(Magilvy, & Thomas, 2009). Sandelowski (2000) argued descriptive design's purpose is

to elicit descriptions of experiences. Furthermore, Jiggins Colorafi, and Evans (2016)

mentioned that descriptive designs are often based in naturalistic inquiry and thus are

based in truth and beliefs about how individuals feel about a particular space, Thus,

descriptive design was appropriate to examine the phenomenon of burnout.

Other qualitative designs were examined, they were case study, narrative,

grounded theory, and phenomenology. They were found to be inappropriate for this

study. Case studies examine or develop an understanding of social processes or

organizational processes (Baxter, & Jack, 2008). So, a case study was not used.

Furthermore, this study was not trying to tell a narrative of the participants' burnout

experience (Butina, 2015).

 14

Moreover, this study was not aiming to develop a theory or model of illness, so a

grounded theory was not used (Kolb, 2012). Lastly, this study was not aiming to explore

a shared common lived experience, so a phenomenological design was not chosen

(Picton, Moxham, & Patterson, 2017). This study sought to understand the described

experience of burnout MHPs had and therefore, a descriptive design was chosen.

Descriptive design was appropriate as it aimed to understand how individuals described

the experience of certain events (Kim, Sefcik, & Bradway, 2017; Magilvy, & Thomas,

2009).

Mental health professionals in the United States were the general population for

this study. The target population for this study consisted of MHPs, who treat trauma and

were purposefully selected from a Facebook group for therapists. 18 MHPs, who treat

trauma, in the U.S., that were fully licensed in the U.S., and currently worked as an MHP

were selected for participation within this study. The researcher originally planned for

15-20 MHPs to participate. MHPs were familiar with burnout being in the mental health

field and treating trauma and possessed the knowledge of what burnout is and what

coping strategies were. The sample size for this study was determined by examining

recommendations of other scholars within the field of qualitative research (Marshall,

Cardon, Poddar, & Fontenot, 2013; Moser, & Korstjens, 2018; Onwuegbuzie, & Leech,

2007).

Data sources for the proposed study consisted of a questionnaire and semi-

structured interviews with 18 MHPs. Descriptive designs require two sources of data, the

questionnaire and interviews were the two sources of data (Sandelowski, 2000). The

questionnaire allowed for MHPs to self-report their experience of burnout. The

 15

interviews focused on gaining an understanding of how MHPs, specifically those who

treat trauma, described their experience of burnout, and their use of coping strategies. The

researcher gathered data about the phenomenon of burnout through the questionnaire and

semi-structured interviews with the MHPs through videoconferencing software.

Interviews are a primary source of gathering data within qualitative studies (Tessier,

2012).

Participants were encouraged to add any details they felt were important, but also

probing questions were asked to help gather further data that may not otherwise have

been gathered (Arsel, 2017). Participants had the opportunity to review their responses to

the interview questions, by way of transcript checking. This was to ensure their responses

were correct and elicited the desired data (Chase, 2017). The interviews intended the data

gathered would show a holistic view of MHPs described experiences with the

phenomenon of burnout, and their use of coping strategies.

Data gathered from the interviews was transcribed by the researcher and checked

by participants to ensure all the data gathered was correct and there were no mistakes as

to what was said or meant. Hawkins (2018) noted emails to send participants interview

transcripts are essential for completing steps of the interview process. Once transcripts

were correct, the data from the transcripts were analyzed to gain an understanding of the

overall descriptions from participants. Transcripts were analyzed for codes, and themes

were generated. This helped to ensure all data had been examined and no new

information was present relating to the phenomenon being studied. This provided the

researcher with rich detail and insight into the phenomenon of burnout and the use of

coping strategies.
 16

Definition of Terms

The following section lists the terms which were used throughout the study. The

definitions for the terms are provided to help enhance the understanding of the study.

Burnout. Burnout is a syndrome resulting from prolonged responses to stress but

is also considered the beginning stage of stress (Kovač, Krečič, Čagran, & Mulej, 2016).

Burnout has three major facets to it these are emotional exhaustion, depersonalization,

and a lack of job satisfaction (Maslach, & Leiter, 2016). Each of these facets is defined

below. Burnout additionally has other components connected to it that are discussed

below (Schonfeld, & Bianchi, 2016)

Coping strategies. How individuals react, respond, and interact with problem

situations. Coping strategies are also defined as sets of behaviors utilized to manage

stress. Lastly, coping strategies are defined as a process in which individuals use varying

methods to mitigate the effects of stressful situations (Mohamed Saleh Baqutayan, 2015;

Yih, Uusberg, Taxer, & Gross, 2018). Without appropriate coping strategies burnout can

cause long term effects (Coaton, 2017). Coping strategies additionally protect individuals

from the effects of burnout (Henson, 2016).

Depersonalization. Persistent and often recurrent episodes of estrangement of

one’s self and detachment of one’s self, resulting in altered perceptions, and reduced

emotional and physical states (Fagioli et al., 2015). Burnout often leads individuals to

experience depersonalization in which they distance or detach themselves from the cause

of their stress (Lathrop, 2017). Depersonalization symptoms include altered physical self-

identification, dream like states and lack of empathy (Fagioli, et al., 2015).
 17

Emotional exhaustion. Emotional exhaustion is a state in which emotions are

depleted, and sometimes physical depletion can occur. Emotional exhaustion can also

lead to feelings of being overworked and unable to provide support for others (Van den

Tooren, & Rutte, 2016; Wilkinson, et al., 2017). Emotional exhaustion leads to physical

symptoms of exhaustion, and diminished responses emotionally (Wilkinson, et al., 2017).

Additionally, emotional exhaustion can effect the way individuals view themselves

(Ferri, Guerra, Marcheselli, Cunico, & Di Lorenz).

Emotional overload. It is the act of emotional, and physiological reactions to

negative and continuous exposures of emotional settings of work, this includes certain

work environments (Cieslak, 2016). Emotional overload is characterized by high levels

of stimulation and suffering and often by feelings of not being able to cope (Alberdi,

Aztiria, & Basarab, 2016). Emotional overload happens when individuals are incapable

of processing the emotional aspect of situations they encounter (Fredrickson, 2011).

Emotional work. Conforming to display rules of jobs, or the act of displaying

appropriate emotions for the role (Humphrey, Ashforth, & Diefendorff, 2015).

Bondarenko, Du Preez, and Shepherd (2017) suggested emotional work is the debate

between what is a normal emotional reaction to a situation and behaviors. Emotional

work often entails use of maladaptive emotional regulation techniques (Humphrey,

Ashforth, & Diefendorff, 2015).

Empathy fatigue. What happens when healthy defenses are worn down due to

continuous emotional demands, unpleasant setbacks, or traumatic situations, or difficult

individuals (Wagaman, et al., 2015). Empathy fatigue depletes an individual’s emotional

stores and can lead to things such as exhaustion, nightmares, illness, or even PTSD
 18

(Newmeyer, et al., 2016). Empathy fatigue often is an impairment that not only effects

the individual, but those whom they treat (Stebnicki, 2007).

Family support. Family support systems are described as those which are

informal (Allen, 2001). These support systems can include immediate, extended, and

distant family members. However, this type of support system also can provide

everything from financial support to childcare, to empathy, and emotional support.

Family support systems are one of the top support systems for those who work mental

health (Hilbrecht, 2016). Furthermore, family support allows individuals the ability to

better focus their resources and reduce the demands placed upon them (Hilbrecht, 2016).

Job satisfaction. The evaluation of and judgment about one’s work. An

assessment of job favorability that is measured along a continuum of the work career

(Judge, Weiss, Kammeyer-Mueller, & Hulin, 2017). Person-fit for the job plays a role in

the satisfaction one obtains from their job (Peng, & Mao, 2015). Job satisfaction can be

described as the enjoyment one has for their work (Saari, & Judge, 2004).

Mindfulness. Non-judgmental awareness of experiences that include emotional,

sensation, and cognitive experiences (Gerhart et al., 2016). Mindfulness is being aware of

ones’ surroundings and being focused on the present moment (Gerhart, et al., 2016).

Mindfulness is described as keeping of one’s mind conscience of the present reality

(Hyland, Lee, & Mills, 2015).

Peer support. Peer support is a support system of those who work with an

individual or are friends or acquaintances of the individual (Lane, et al., 2018). Most

often peer support systems are defined as a system of individuals who work within the
 19

same field and experience the same situations (Shapiro, & Gallowitz, 2016). This type of

support system is found most often within organizational settings (Lane et al., 2018).

Resilience. Resilience is when an interaction occurs in an individual’s

environment in which they negotiate and manage resources in response to a stressor

(Frey, Beesley,Abbott, & Kendrick, 2016) . Resilience can further be described as a

positive personality trait that helps individuals manage stressors they may face

(Treglown, Palaiou, Zarola, & Furnham, 2016). Resilience is the ability to persevere even

when faced with adverse stressors (Delany, et al., 2015).

Secondary trauma syndrome. Secondary trauma syndrome is a specific form of

stress and is vicariously experienced when working with individuals who have

experienced traumatic events or situations (Caringi, et al., 2017). The trauma is relived

through both the person who originally experienced it, and the helping individual, by

having listened to the trauma be recounted (McCormack, & Adams, 2016). Secondary

trauma can happen in any environment that negative situations happen (Bercier, &

Maynard, 2015).

Self-care. Self-care is the practice of taking care of one’s basic needs such as

eating healthy, getting enough sleep, seeking support when needed, and practicing self-

kindness. These are techniques for self-care to mitigate the reactions to stress (Coleman,

et al., 2016). The beliefs that individuals hold about self-care can effect the practice of

self-care (Bloomquist, Wood, Friedmeyer-Trainor, & Kim, 2015). Self-care acts as a

preventative for individuals who work in stressful settings (Figley, 2002).

Self-compassion. Self-compassion consists of being gentle with one’s self when

they feel they have failed, or they feel inadequate. It is also described as having facets
 20

oself-kindness, mindfulness, and humanity for one’s self (Coaston, 2017). Self-

compassion helps individuals to feel cared for and helps them be emotionally calm (Neff,

Kirkpatrick, & Rude, 2007). Self-compassion positively impacts emotion regulation in

times of stress (Finlay-Jones, Rees, & Kane, 2015).

Stress. Stress is defined as good, tolerable, or toxic. It is about how the individual

perceives the causes of stress, and how the stress affects, both physical and psychological

aspects of the person, their job, and their self-esteem (McEwen, 2017). Stress negatively

effects development professionalism, skills, and knowledge (Dyrbye, et al., 2010). Stress

often leads to health problems and sometimes economic loss (Alberdi, Aztiria, &

Basarab, 2016).

Stressors of jobs. Often looked at as negative, stressors of jobs cause physical and

psychological reactions to the demands of work throughout one’s career (Smith, Parker,

& Boxall, 2015). It can be a learning experience for some; however, most individuals

relate stress of any kind as negative regarding job demands placed upon them (Fares, Al

Tabosh, Saadeddin, El Mouhayyar, & Aridi, 2016). Stressors of jobs entail the reactions

to demands placed upon the body whether or not the demands are favorable or not (Riaz,

et al., 2016).

Assumptions, Limitations, Delimitations

With any study, there are always assumptions, limitations, and delimitations

present. These assumptions, limitations, and delimitations could affect the results of the

study. Wargo (2015) stated assumptions are statements believed to be true but may not

necessarily be able to be proven. Limitations are what are out of the control of the
 21

researcher and delimitations are what confines the researcher places on the study (Wargo,

2015).

Assumptions. Understanding and awareness of assumptions within a study are

important as assumptions can limit a research study (Van Manen, 1990). In this study,

several assumptions were made regarding burnout in MHPs they included: MHPs who

treat trauma had experienced burnout. MHPs who treat trauma was the best context for

which to conduct this study. MHPs who participated in this study provided an honest

recounting of their experiences with burnout. Lastly, MHPs were honest about recounting

their experiences of using coping strategies. The use of a qualitative methodology and a

descriptive design consistent with works of Sandelowski (2000) and Magilvy, and

Thomas (2009) implied there could be additional assumptions that question the

appropriateness in choosing these methods for the current study.

Limitations and delimitations. Limitations are a part of research no matter the

method chosen and are going to be present in research as every part of the research

cannot be controlled (Wargo, 2015). Limitations are imposed restrictions out of the

control of the researcher (Munthe-Kaas, Glenton, Booth, Noyes, & Lewin, 2019). Wargo

(2015) noted limitations can impact the outcomes of a study.

There was a possibility of design limitations within this study as descriptive

designs are not limited to one type of sampling, data collection, or analysis (Kim, et al.,

2017). Magilvy, and Thomas (2009) noted with the use of descriptive designs there are

limitations to the scope of responses that could be gathered, meaning participants may

answer what they believe the researcher wished to hear. Personal assumptions about the

concept of burnout the researcher may have brought to the study could have made it
 22

difficult to convince readers the conclusions drawn in this study were free from bias. This

was also related to the descriptive design as they are completed within the naturalistic

setting. Readers of the current study may argue a descriptive design and the use of only

18 MHPs was not a large enough sample of the MHP population that treats trauma to

examine the phenomenon of burnout in depth, as it did not provide a large enough group

of individuals to gather data from and thus the diversity of experiences could have been

severely limited.

By doing a descriptive study with only 18 participants, this limited the amount of

data collected for this study and the conclusions that were drawn from the findings. The

deliberate selection of MHPs who treat trauma could have limited the array of

participants' backgrounds and diversity. The utilization of purposive sampling to select

the MHPs for the study could have limited the amount of MHPs that may have

participated, as sampling was not random. Despite this limitation, purposive sampling

helped to find participants who met the criteria and were well-informed of the

phenomenon being studied. The generalizability of the study findings may have been

limited by utilizing such a small sample of the MHP population. Additionally, due to the

small sample size, the findings may not have been transferable to other contexts.

This study had data collection instrument limitations. The questionnaires were

self-report and answers may not have been honest. Interviews were not face-to-face in a

traditional method, as videoconferencing software was used to conduct the interviews.

This may have contributed to a lack of trust between the participants and the researcher

as there were no personal interactions, but impersonal interactions. Time limitations are
 23

always present within research, and interviews for this study were scheduled for a time

that was convenient for both parties.

Delimitations are situations or factors the researcher can control (Turner, &

Crane, 2016). They are deliberate choices the researcher makes to the research study

(Van Manen, 1990). Further, delimitations to this study were necessary to ensure specific

criteria for participation were met (Luciani, Campbell, Tschirhart, Ausili, & Jack, 2019b).

The proposed study was delimited by several points; they were MHPs were fully licensed

within the United States. Interns were not included as they did not have the clinical

experience needed for participation. MHPs treated some form of trauma, this was directly

related to the gap, and as such, this was a requirement. MHPs must have been currently

practicing as an MHP, as retired MHPs experiences of burnout were not current, and thus

held no merit for understanding the phenomenon of burnout in MHPs.

Moreover, MHPs must have been between the ages of 20-65 as this age range

allowed for a deeper understanding of the phenomenon of burnout experiences to be

gathered (Wardle & Mayorga, 2016). Data sources were delimited to questionnaires and

interviews. Although there may have been alternative data sources to gather information

from, such as surveys, or focus groups, questionnaires, and interview data were the data

sources chosen, as it allowed for the most in-depth details of the phenomenon to be

gathered (Arsel, 2017). Although burnout in MHPs remains a concern (Ballenger-

Browning, et al., 2011), this study was delimited to MHPs who treat trauma to examine

their described experiences of burnout.

A descriptive design was best suited for a singular researcher and allowed for the

most flexibility of garnering an understanding of the phenomenon of burnout. Given the

 24

vast amount of mental health issues today, it was most beneficial to gain an

understanding of what those who treat trauma experience in terms of burnout, so MHPs

who treat trauma can learn to avoid burnout. However, by delimiting this study to MHPs

who treat trauma, it allowed for this study to identify strategies for managing and coping

with burnout that could be useful for MHPs who work with trauma or will be entering

into treating trauma.

Summary and Organization of the Remainder of the Study

While not a new concept, burnout has been described by both practitioners and

researchers as the emotional toll or exhaustion which results due to high stress, and high

job demands (Shamoon, Lappan, & Blow, 2016). Self-care is a useful tool for managing

burnout in MHPs. Having coping mechanisms in place is necessary for any individual

who works within the helping profession, as these professionals experience higher levels

of burnout (Cieslak, 2016). Burnout, however, has multiple causes, and there is a vast

array of ways individuals mitigate the effects of burnout (Sansbury, et al., 2015). Avieli,

Ben-David, and Levy (2016) argued not recognizing the signs, and not taking the

necessary steps to prevent burnout, poses severe and ethical risks to both MHPs and those

who they treat. Vlachou et al. (2016) pointed out burnout remains a concern for the

helping professions and learning the signs of burnout helps to prevent it.

The purpose of this qualitative descriptive study was to explore how MHPs, who

treat trauma, in the U.S., described their experience of burnout and their use of coping

strategies. Strategies to avoid or mitigate burnout were intended to help MHPs who treat

trauma avoid the experience of burnout. Furthermore, strategies to cope with burnout
 25

were meant as a tool to teach MHPs newly entering the field, to recognize the signs of

burnout. This study had the possibility to uncover new strategies for coping with burnout.

There were several significant implications for MHPs such as the recognizing of

signs of burnout and the use of coping strategies to manage burnout. As well as the

creating of self-care plans. The results of this study added to the body of knowledge on

burnout, how it is experienced, and what strategies can be implemented to cope with

burnout. The results of this study added to the existing body of literature by addressing

the gap in the current understanding of how MHPs who treat trauma described their

burnout experience and their use of coping strategies.

Below are the research questions in this study, where RQ1 is the overarching

research question, and RQ2 is the supporting question.

RQ1: How do MHPs, who treat trauma, in the U. S., describe their experience of

burnout?

RQ2: How do MHPs who treat trauma, in the U.S., describe their use of coping

strategies?

Due to what was being explored in this study, this study used a qualitative

methodology and a descriptive design. The qualitative methodology was appropriate to

gain an in-depth understanding of the phenomenon of burnout, and as a result was

especially useful for answering the why and how questions related to qualitative studies

(Bradshaw, Atkinson, & Doody, 2017; Twining, Heller, Nussbaum, & Tsai, 2017). The

goal of this research was to explore the described experiences of burnout in MHPs, who

treat trauma, in the U. S., and their use of coping strategies. This study did not intend to

establish any relationships between variables that cause burnout, nor was it trying to test
 26

any hypotheses about burnout, or coping strategies, but rather it was trying to establish an

understanding of how burnout was experienced from the perspectives of MHPs who had

experienced it. Thus, a quantitative methodology was not appropriate (Thalheim, 2018).

Sandelowski (2000) described descriptive designs as a way with which to seek out

and explore the truth of a participants' described experiences of a phenomenon. Wu,

Thompson, Aroian, McQuaid, and Deatrick (2016) stated qualitative methodology is

appropriate for exploring the meaning of people’s lives. Building a theory was not this

study’s focus and therefore a grounded theory was not chosen for this study (Kolb, 2012).

This study’s purpose was not to tell a story of the participant's lives and therefore a

narrative design was not appropriate (Anderson, & Kirkpatrick, 2015). Nor was this study

attempting to examine social, or organizational processes, so a case study was not chosen

(Baxter, & Jack, 2008). This study was not seeking to understand the lived experiences,

so a phenomenological design was not chosen (Matua, & Van Der Wal, 2015).

Data for this study was gathered by way of a questionnaire and semi-structured

interviews. With a descriptive study, there was no need for more than two sources of

data, as the questionnaire and interviews provided detailed information about the

participants' experiences of the phenomenon under study (Magilvy, & Thomas, 2009).

This study used videoconferencing software for interviews, and at a time convenient for

the participants and researcher. Interviews allowed for deep, in-depth, and rich detail to

be garnered regarding the phenomenon under study and lasted between 30-60 minutes to

gather the most detail-rich information about the phenomenon.

The researcher recorded interviews and transcribed the interviews. This allowed

for a thorough examination of the data. Transcripts were provided to the respective
 27

participants to ensure they were correct, they were what the participants meant, and if

corrections were needed, they were made. Member checking helped to add credibility to

the study. Questionnaires and transcripts were coded to identify themes representing the

participants' described experiences of burnout. This provided rich and detailed insight

into the phenomenon of burnout.

An underlying assumption of this research was that MHP ’s who treat trauma had

experienced burnout. MHPs who treat trauma was the best context for which to conduct

this study. That MHPs participating in this study provided an honest recounting of their

experiences with burnout. Lastly, MHPs were honest about recounting their experiences

of using coping strategies. The researcher acknowledged there were limitations to this

study. It did not address MHPs that were practicing in settings other than trauma.

Additionally, only utilizing a small sample of MHPs may not have presented a complete

view of the larger sample of MHPs who treat trauma.

Finally, another limitation was the array of data that could have been garnered

could have been affected by only utilizing 18 MHPs. Delimitations of this study were:

MHPs were fully licensed within the United States. Interns were not included as they did

not have the clinical experience needed for participation. MHPs treated some form of

trauma, this was directly related to the gap, and as such, this was a requirement. MHPs

were currently practicing as an MHP and were between the ages of 20-65. MHPs must

have treated trauma because, as trauma therapists, they have been shown to have higher

rates of burnout (Benuto, Singer, Gonzalez, Newlands, & Hooft, 2019).

The remaining chapters in this study are chapter 2, chapter 3, chapter 4, and

chapter 5. Chapter 2 contains an explanation of the theoretical model which was the basis
 28

for this study. As well as a review of the literature that demonstrated an understanding of

the key points and relevant topics related to the study. Chapter 3 contains discussions,

justifications, and explanations for the research methodology and the design used to

conduct the study. Chapter 4 details the steps that were taken to analyze the data collected

and provides a written and graphic summary of the results. Chapter 5 presents a

discussion of the results and an interpretation of the results which are related to the

existing body of research associated with burnout.

 29

Chapter 2: Literature Review

Introduction to the Chapter and Background to the Problem

As burnout has been introduced to the field of helping professions, there is a

significant amount of research that has taken place regarding the causes of burnout. These

include relationships between factors and relationships between things such as burnout

and jobs. However, as this chapter notes, the literature does not include conclusive

studies on how mental health professionals who treat trauma experience burnout. The

literature review is organized thematically to present the topics of importance within this

study.

The themes are designed and organized to draw from the broad topic of burnout

this study was based upon. The literature review addressed themes as well as subthemes

relevant to the topic of burnout and coping strategies, as they are experienced by MHPs

who treat trauma. This allowed for synthesis, comparison, and contrast of the current

literature over burnout experiences and the literature over the means to circumvent

burnout. This also allowed for the need of the study to be highlighted and allowed for a

complete understanding of the research topic to be developed.

The purpose of this qualitative descriptive study was to explore how MHPs, who

treat trauma, in the U.S., described their experiences of burnout and their use of coping

strategies. The overarching research question “How do MHPs, who treat trauma, in the

U.S., describe their experience of burnout?” was centered on the key themes of (a)

understanding the experience of burnout that mental health professionals who treat

trauma faced, and (b) understanding coping strategies used to address the management of

burnout.
 30

This literature review consists of six sections, each is dedicated to addressing a

major theme of relevance to the study. The first section discusses the history and

background of burnout and how its progression has led to the current problem this

research focuses on. The second section identifies the gap in the literature which

explained the unmet need which was the premise of this research. The third section

explains the study’s theoretical model, the jobs demand resource model (JD-R), and was

the foundation for this study, and provided the lens through which this study was viewed.

The fourth section of this chapter, burnout, discusses several facets or subthemes

of burnout and how those within the helping professions could suffer from any of these

facets of burnout (Razo, 2018). The fifth section of this chapter focuses on coping

strategies and the many subthemes of coping strategies, this section delved into the ways

MHPs utilize strategies to cope, manage, or mitigate the effects of burnout (Myers,

Trepal, Ivers, & Wester, 2016). The sixth and final section of this chapter discusses the

differences and similarities of methodological choices used in other studies. This

discussion helped in explaining and justifying the selection of the qualitative

methodology in this study. The section also discusses how other instruments used in other

studies informed the data collection method for this study.

In examining the literature for this review and study, the researcher

conducted several searches of EBSCOhost, ResearchGate, ProQuest, Google Scholar,

GCU library, Taylor & Francis, and The Directory of Open Access Journals (DOAJ), and

Social Science Research Network (SSRN). Google Scholar had set alerts to notify the

researcher of any new articles, these terms included coping strategies, credibility,

qualitative research, thematic analysis, emotional exhaustion, burnout, stress

 31

management, theories of stress management, counselor burnout, mindfulness, and

resilience. Search terms for databases not set with alerts included burnout, coping

strategies, emotional exhaustion, research methods, research designs, analysis methods,

theoretical frameworks, data sources, mindfulness, resilience, job stress, job satisfaction,

and counselor burnout, mental health, and telehealth.

Historical background. In the early 1970’s Freudenberger, discussed the concept

of burnout as an occupational hazard for those in people-oriented professions (Maslach,

& Goldberg, 1998). Not much has changed in the ways burnout is described as it is still

believed burnout is characterized by emotional exhaustion which is a direct result of

high-stress job demands (Leiter, & Harvie, 1996). As the field of burnout research grew,

its understanding began to change as well. Burnout no longer was believed to be

something that only those in people-oriented professions experienced, but rather as the

field of burnout research grew, it became apparent other sectors of business too

experienced burnout (Bianchi et al., 2014). Bianchi further stated burnout should no

longer be confined to the dimensions of solely work-related, as stress, the very cause of

burnout, could affect every facet of one’s life, and therefore burnout could happen to

anyone at any point in any setting.

In today’s world, the concept of burnout has grown so vast it is considered

something that can be experienced with any job position (Jaracz et al., 2017). Individuals

utilize different strategies personalized to them to help manage, reduce, and mitigate

burnout. While burnout was once described as emotional exhaustion that is a result of

high-stress job demands, the description of burnout has morphed to include all areas of

business, as well as all stress forms, and even conflicts between work and personal life
 32

(Ben-Porat, & Itzhaky, 2014; Bogiatzaki et al., 2019; Carrola, et al., 2016; Cieslak, 2016;

Mäkikangas, & Kinnunen, 2016; Malkina-Pykh, 2017; O’Connor, et al., 2018).

Arguably, burnout is both a personal, and work-environment based experience.

Many factors lead to the experience of burnout (Kaeding et al., 2017). Consequentially,

burnout takes on a different meaning depending upon who it is affecting. For MHPs this

often means burnout is described or defined in terms of work-related, as the mental health

profession is often a demanding job which entails dealing with difficult situations, is very

time consuming, and emotionally demanding (Allsbrook et al., 2016). Furthermore, in the

mental health profession, MHPs may be at higher risk of developing burnout as they are

often in contact with high-stress situations, outcomes of clients are often unknown, and

the effects of emotionally investing in clients are higher (Coleman, et al., 2016).

Additionally, MHPs who treat trauma could be at greater risk of burnout, as they

often rely solely upon peer support or supervision as methods of coping (Hammond, et

al., 2018). Burnout is often described as a crisis of the relationship to an individual’s

work (Schonfeld, & Bianchi, 2016). Burnout affects every facet of one’s career and

personal life if they do not have the correct tools to relegate the issue of burnout

(Schaufeli, et al., 2017). Today more MHPs seek new careers to have control over their

careers. However, in today’s world MHPs who stay in the profession, must have the

necessary tools to combat burnout; as it is fundamentally important to have a plan in

place to circumvent burnout, as it is of great significance to the well-being of those MHPs

are treating (Cieslak, 2016; Mäkikangas, & Kinnunen, 2016; Thompson, Amatea, &

Thompson, 2014).
 33

Burnout has long been considered to be the direct result of job demands placed

upon the individual, however, as the understanding of burnout has grown, it is understood

there are more factors than just one’s job that can be causes of burnout (Maslach, &

Leiter, 2016). Furthermore, it is of importance to note without proper coping strategies to

negate burnout, MHPs not only put themselves at harm, but also those they treat

(Gutierrez, Mullen, & Fox, 2018; Harker, Pidgeon, Klaassen, & King, 2016; Rupert, et

al., 2015). After years of burnout research, burnout has become the model by which

individuals gauge their well-being within the respective jobs they hold (Kaeding et al.,

2017; Shamoon, et al., 2016).

Arguably, features of well-being vary from MHP to MHP. Everyone has their

version of well-being, and their specific plan for self-care (Coaston, 2017). The appeal of

a self-care plan is it can be derived to fit the individual MHPs needs. Self-care plans are

the foundational blocks for alleviating burnout (Nelson, et al., 2017). Self-care plans

provide strategies specific to the MHP and can help them not only to diminish burnout

they may encounter, but it can also help the MHP to find a new path to joy in their work,

as well as the reasoning for entering into the helping profession (Beaumont et al., 2016).

Furthermore, self-care plans are beneficial tools to keep MHPs grounded and present in

the moment when burdensome situations are encountered regularly (Gerhart et al., 2016).

Adoption of self-care plans for MHPs who deal with and treat trauma is of the

greatest importance as they often rely on peer support systems, or supervision, and have

the added stress of repeated exposure to traumatic situations. Some MHPs believe

burnout will not happen to them but given the ways to circumvent burnout are not readily

taught within MHP training, it is unlikely MHPs have the desired repertoire of tools to
 34

manage their burnout, let alone recognize it, and if they do, to minimize the effects of it.

MHPs who treat trauma are less likely to have the tools to recognize burnout with the

added responsibilities placed upon them (Henson, 2016, 2017; Wardle, & Mayorga,

2016).

Simionato et al. (2019) suggested the psychotherapist has a unique role that can

garner great rewards, but also puts them at great risks, especially for burnout. Montero-

Marin, Prado-Abril, Demarzo, García-Toro, and García-Campayo (2016a) suggested

individuals who do not have the necessary coping skills will experience stress and

burnout but will not be able to properly process it. Moreover, Mohamed Saleh Baqutayan

(2015) noted individuals cannot remain in continuous states of emotional strain or

tension, and without coping strategies to negate the experience of stress, one will remain

in the constant state of burnout. Furthermore, O’Connor et al. (2018) stated burnout not

only affects an individual’s mental well-being, but their physical health can also suffer if

they do not have mechanisms in place to cope with burnout.

Additionally, Montero-Marin et al. (2016b) explained burnout is a lack of

harmony between the individual and their work, and passive, or avoidant coping

strategies can lead to more burnout, thus individuals need to utilize positive and active

coping strategies. Lastly, Berg, Harshbarger, Ahlers-Schmidt, and Lippoldt (2016) argued

burnout not only affects the individual experiencing it, but it can also spill over onto

others the individual closely works with. Also, they stated burnout has been known to

cause symptoms of PTSD, if not recognized and combatted properly, having coping

strategies is the first line and most needed defense against burnout.
 35

The literature suggests burnout can affect almost every service sector, but where

burnout is seen most is within the helping professions, as these professions almost always

have a high degree of job demand placed upon the individual (Larsen, Ulleberg, &

Rønnestad, 2017). Furthermore, burnout can significantly cost organizations, as well as

individuals extensive sums of money and success with a loss in employee’s, loss of

revenue, lack of interests in the jobs, and avoidance of stressful situations (Jaracz et al.,

2017; Maslach, & Leiter, 2016; Sansbury, et al., 2015). Therefore, it is necessary to

ensure that MHPs who treat trauma can recognize the signs of burnout and seek specific

coping strategies to mollify the effects of burnout. A qualitative descriptive study based

upon the synthesis of MHPs knowledge helped to advance potential strategies for coping

and understanding of burnout experiences and allowed for addressing the problem. The

continued existence of burnout in MHPs is costly to MHPs and is the phenomenon which

was addressed in this study.

Identification of the Gap

Professionals use the term burnout to describe the effects of everything from

exhaustion to avoidance of work (Wardle, & Mayorga, 2016). Burnout affects

counselors, psychologists, counseling graduates, military counselors, palliative workers,

and more (Bride, & Figley, 2009; Kaeding et al., 2017; Parola et al., 2016; Rausch, 2016;

Sanches et al., 2017). Burnout not only affects many different sectors of service, but it

also costs those sectors time and employees due to turnover, when the employees who

work within them are unable to manage their burnout (Hamidi et al., 2018). Additionally,

MHPs often bring their personal beliefs into their discipline, and thus those beliefs can

also be a line to burnout (Chan, Yeh, & Krumboltz, 2015).

 36

Moreover, MHPs that work within organizational settings may not have to worry

as much about strategies for coping as often, there are strategies in place for employee

care, and this helps to reduce burnout at the agency level (Swensen, & Shanafelt, 2017).

Given burnout can happen to anyone, within any field of work, it is important to find

effective strategies to attenuate the problem of burnout (Rupert, et al., 2015). However,

MHPs who treat trauma are at a higher disadvantage in alleviating the effects of burnout

as more weight is placed upon them repeatedly dealing with traumatic situations

(Hessels, et al., 2017).

Malkina-Pykh (2017) stated burnout is a response to work environments, high-

stress situations, demands placed upon the worker, and lack of personal resources. While

Wardle and Mayorga (2016) noted high caseloads, managed protocols for work and lack

of job control can all lead to burnout. Furthermore, Schonfeld and Bianchi (2016) stated

when one has no control of their environment, the stress will lead to burnout.

Additionally, Vlachou et al. (2016) stated burnout is the direct result of a worker's long-

lasting exposure to stress from their occupation.

Burnout happens when an individual experiences stress in either their job, or

personal life (Simionato, et al., 2019). Burnout happens when an organizational

environment does not allow for an individual to do their job professionally (Parola et al.,

2016). Loss of energy and enthusiasm for one’s work often leads to burnout (Montero-

Marin et al., 2016b). Allsbrook et al. (2016) stated burnout symptoms vary from person

to person but are almost always a direct result of continued exposure to high demands

and stress of the job.

 37

Recent research has shown those in the mental health profession often experience

burnout and those who treat trauma may have different experiences of burnout than those

in other settings (Sim, et al., 2016). Current burnout research has shown there is a higher

prevalence rate of burnout among the MHP professions, however, more research still

needs to be done concerning understanding burnout of health professionals, and the work

environment it is experienced within (Paiva, et al., 2017). Furthermore, Hammond et al.

(2018) stated being well informed about what precursors and risks are of burnout can

help to prevent it. However, they also suggested more research that is qualitative is

needed to understand MHPs experiences of burnout, but also there is a gap in recognizing

and understanding the lives of MHPs who have experienced burnout.

Bogiatzaki et al. (2019) stated the healthcare industry is associated with burnout

due to the nature of the work. They also stated there is a significant need to research what

factors influence and affect the levels of burnout of health professionals. Ivicic and Motta

(2017) noted future research should consider specific types of trauma therapy to

determine other potential factors that could lead to burnout. In an examination of burnout

literature, Dreison et al. (2018) noted burnout seemed to be a pervasive factor in the

health professions and future research on job burnout was critical to benefit both MHPs

and those they are treating. Halevi and Idisis (2018) noted further research needs

conducted to determine the difference between types of trauma and how they lead to

burnout in MHPs. Lastly, Jergensen (2018) suggested burnout, if left untreated, could

have serious consequences for the MHP and they must be aware of strategies to negate

burnout, thus future research should focus on skill use as a mediator of burnout.
 38

This study intended to address the problem of it was not known how MHPs, who

treat trauma, in the U.S., described their experiences of burnout and their use of coping

strategies. Ghannam et al. (2020) stated burnout is a state of mental, physical, and

emotional exhaustion that arises due to constant stress exposures. In addition, they noted

this constant exposure can lead to a lack of motivation, helplessness, and disengagement.

This study was necessary to contribute to the knowledge of how burnout is experienced.

The findings of this study added to the body of knowledge by addressing the gap in

research regarding burnout experiences of MHPs who treat trauma.

Theoretical Foundations and/or Conceptual Framework

This study utilized the job demands-resources model (JD-R). The JD-R noted that

stress is a disruption of the individual's cognitive-emotional environment caused by

external factors. The external factors that are known as stressors can cause negative

cognitive-emotional disturbances and thus place strain on the individual's resources

utilized for coping (Demerouti, et al., 2001). The JD-R model is a model that builds upon

the theoretical models of three other theories, the JD-R model described Maslach’s

multidimensional theory of burnout (1998) to better understand burnout, which is part of

the demands portion of the JD-R.

The JD-R expanded upon the theories of Hockey (1993) Antonovsky (1987) and

Richter and Hacker (1998). The theories that the JD-R are built upon are discussed

below. Job demands are the physical, emotional, social, or organizational aspects of a job

that require sustaining both physical and mental effort, and therefore are associated with

psychological and physiological costs to an individual, or burnout (Demerouti, et al.,

2001; Maslach, 1998). The demands portion of the JD-R is built upon Hockey’s theory,
 39

the control model of demand management (1993) in which individuals utilize

performance-protection strategies when under the influence of environmental factors

such as time constraints, workloads, noise, or heat (Hockey, 1993). The stressors within

the JD-R model are like those of Hockey’s and align with his theory. Within the JD-R

model, performance-protection is gained through the mobilization of sympathetic

activation and increased subjective efforts.

Furthermore, the JD-R model explained how the burnout of individuals is related

to the relationships between demands and exhaustion, and the relationship between

rewards and disengagement which is based upon the multidimensional theory of burnout

by Maslach (1998). The theories of health promotion and management by Antonovsky

(1987) further added to the foundations upon which the JD-R is based, and apply to both

the job demands segment, and the job resources segment of the JD-R. In addition, there is

“a second assumption in the JD-R model, which is that job stress or burnout develops—

irrespective of the type of job or occupation—when certain job demands are high and

when certain job resources are limited” (Bakker, et al., 2005, p. 170). Any occupation and

any individual can experience burnout when the demands of the job are too high and

there are too few resources to cope (Bakker, et al., 2005).

Additionally, Bakker et al. (2005) stated that job resources could act as buffers

against stressors such as burnout. Job resources refer to the psychological, physical,

social, or organizational aspects of a job that can do any of the following a) function in

achieving work goals, b) reduce the job demands associated with both the physical and

psychological costs to the individuals and c) stimulate growth and development in the

individual (Demerouti, et al., 2001). The job resources section of the JD-R is built upon a
 40

theory by Richter and Hacker (1998) in which they stated that there are internal resources

(Action patterns and cognitive factors) and external resources (social and organizational)

that individuals utilize for coping. The JD-R is focused on external factors as they are

known (social and organizational), and internal factors could include anything an

individual feels protects their health and are therefore considered individual specific. The

job resources segment of the JD-R lies within health-protecting factors as set forth by

Richter and Hacker (1998).

This model was appropriate to examine how MHPs, who treat trauma, in the U.S.,

described their experiences of burnout and their use of coping strategies, as it directly

allowed for an examination of the job demands placed upon the MHP. Additionally the

model allowed for an examination of how they utilized resources to mitigate the

experience of burnout. This model gave insight into how individuals within high

demands jobs experienced burnout and how they used resources to negate the effects of

that burnout (Demerouti, et al., 2001). Figure 1 is a representation of the Job Demands-

Resource model and depicts how individuals gauge their work demands as compared to

their available resources.

 41

Physical,
emotional,
social, organizational
strain

Burnout

Coping

Achieve work goals,

reduce demand,
personal growth

Figure 1. A representation of the job demands-resource model (JD-R).

Review of the Literature

Burnout continues to be a troublesome syndrome many MHPs are left dealing

with after the demands of their jobs raise stress levels (Ernst Wood et al., 2017). Burnout

can be described as a threat to mental healthcare as it is a critical issue which not only

affects those who experience it, but the effects of burnout affect the care of those who are

being treated (Eliacin et al., 2018). This section focuses on the evolution of burnout and

includes several subthemes related to the main theme of burnout. The discussion begins

by explaining what burnout is, and how it can affect individuals. The discussion

highlights the subthemes of burnout to develop a deeper understanding of what burnout

is.
 42

Burnout. The term burnout was first introduced around the 1970s by a man

named Freudenberger, he believed burnout was a direct result of stresses placed upon

individuals and emotional exhaustion was the result of that stress (Ackerley, et al., 1988).

The literature describes burnout as the emotionally complex relationship between helpers,

and clients (Farber, & Heifetz, 1982; Piedmont, 1993; Skorupa, & Agresti, 1993).

Moreover, as the years have progressed it has shown through research, burnout not only

affected the emotional well-being of individuals, but it manifested in physical symptoms

as well (Ballenger-Browning et al., 2011; Campagne, 2012; Everall, & Paulson, 2004;

Galek, Flannelly, Greene, & Kudler, 2011; Giuffra, 1981; Maslach, & Leiter, 2005).

Burnout is also the leading cause of job turnover within the healthcare sector, and

it affects both on the individual level and the professional level (Bianchi, et al., 2014;

Dyrbye, et al., 2010; Emery, Wade, & McLean, 2009; Halbesleben, & Buckley, 2004;

Leiter, & Harvie, 1996; Lim, Kim, Kim, Yang, & Lee, 2010; Råbu, Moltu, Binder, &

McLeod, 2016; Rosenberg, & Pace, 2006). Burnout directly impacts the quality of work

of the MHP and thereby negatively affects the care provided to their patients (Joshi, &

Sharma, 2020). Finally, there remains an issue of MHPs experiencing burnout in today’s

society; as it is still relatively uncertain just how many factors play a role in the

experience of burnout, thus there’s a need for more research (Eliacin et al., 2018; Ernst

Wood et al., 2017). This section aimed to establish an understanding of the history of

burnout.

The above-mentioned review of burnout indicated job performance is severely

diminished when individuals are exposed to high demand jobs and do not have the proper

resources to combat burnout. Therefore, the answer to the overarching research question
 43

of “How do MHPs, who treat trauma describe their experience of burnout?” offers

valuable insight into how MHPs described their experiences of burnout and its related

symptoms. The following sections discuss many subthemes related to burnout.

Emotional exhaustion. Emotional exhaustion is one of the key tenets of what

burnout consists of. It is described as the depletion of emotional availability when one

has endured repeatedly high-stress situations (Ito, & Brotheridge, 2003). Ito and

Brotheridge (2003) stated working harder or avoidance type behaviors only serve to

further exacerbate emotional exhaustion. Ito and Brotheridge (2003) conducted a

quantitative study and utilized 600 government employees to determine the relationship

between their resources for coping and emotional exhaustion. The conservation of

resource theory was used to help determine relationships. They noted resources were

positively associated with active coping strategies, while negatively associated with

avoidance strategies.

Karatepe (2015) stated emotional exhaustion happens when resources of any

nature are not available to the individual. Karatepe (2015) further stated individuals in

hospitality settings, or helping settings are often burdened with emotional exhaustion as

they have very demanding customer needs-based jobs. Furthermore, any type of stressful

job demand or obstacle can lead to negative emotions and loss of job interest (Oppenauer,

& Van De Voorde, 2018). Oppenauer and Van De Voorde (2018) also noted job

responsibilities can lead to emotional exhaustion when the workload is high.

Oppenauer and Van De Voorde (2018) conducted a study with 360 employees,

their study found job responsibility reduced emotional exhaustion, whereas work-

overload was more likely to lead to emotional exhaustion. Research has shown when one
 44

conceals their emotions or does not deal with them directly, then emotional exhaustion is

more likely to happen (Li, Wong, & Kim, 2017). Finally, the consequences of emotional

exhaustion are still being researched, but job quality is seriously reduced when one

experiences emotional exhaustion (Lam, Huang, & Janssen, 2010).

Emotional work. Emotional work as described by Seery and Corrigall (2009)

involves three major tenets that need to be considered they are (a) work environment, (b)

customer engagements, (c) emotional displays. They further stated emotional work can

also take place within any setting as it is the emotional taxing of any type of job one does

(Seery, & Corrigall, 2009). These three tenets are discussed further below.

Work environment. Cuellar, Krist, Nichols, and Kuzel (2018) conducted a study

with 165 individuals who either worked in solo practices or worked within a hospital-

owned practice setting, their study examined if there were differences within each type of

work environment. What they found was those who worked within a hospital-owned

practice had a higher amount of positive work environment and less burnout. While those

found within solo practice had higher levels of negative work environments and more

burnout. Additionally, they noted those within solo practices should build a plan to create

a positive work environment as they must create their own work environment. Galletta et

al. (2016) stated the work environment one works within is not always within their

control, but a positive work environment goes a long way in the reduction of burnout

experience.

Wan Li, Zhou, and Shang (2018) interviewed 778 experienced nurses from seven

hospitals and found that 35.9% of them had a turnover intention, meaning leave their job.

This was directly related to their work satisfaction and work environment. Wan et al.
 45

(2018) noted negative work environments that placed too much workload upon an

individual were more likely to see burnout of employees and the loss of those employees.

Furthermore, Kundu and Lata (2017) argued supportive work environments and

organizational engagement helped to reduce burnout and helped to increase employee

retention.

Customer engagements. When employees lack positive engagement with

customers it can break an organization's bottom line. However, when the employee is

engaged and practicing positivism, positivity will then spill over to others, and customers

will be more inclined to do business with the organization (Auh, Menguc, Spyropoulou,

& Wang, 2016). While MHPs, especially those who treat trauma, are directly responsible

for customer engagement, staying positive can lead to quicker experiences of burnout,

without an outlet for the high demands of positive customer [Link], if a

client is not satisfied with services, they are likely to spread the word, and this can

encroach on capitals an MHP makes, which can further lead to experiences of burnout

(Menguc, Auh, Yeniaras, & Katsikeas, 2017).

Additionally, Söderlund (2017) found displays of burnout were directly linked to

the satisfaction and engagement of customers. He noted employees' display of burnout

led to negative customer engagement. Wu and Shie (2017) argued when an individual

must endure customers who are belligerent, rude, or disrespectful, the individual is more

likely to experience less customer engagement as enduring this type of behavior

consistently will lead to burnout.

 46

Emotional displays. Hopfensitz, and Mantilla (2019) described emotional displays

as any interaction between individuals where emotion is visible. Positive emotional

displays, such as happiness, joy, excitement, and love are more likely to invoke those

same positive emotions in others, while negative emotions such as anger, hatred, disgust,

and contempt are all likely to reflect the same negative emotions (Hopfensitz, & Mantilla,

2019). van Kleef and Fischer (2016) discussed an interesting take on group emotions.

They stated group emotions are a collective of individual's different emotions, but

individuals within the group will mirror other’s emotions and behaviors, much in the

same way groupthink happens. Emotional suppression and expression can cost

individuals significantly as the ability to express emotions is a necessary component of

emotional work, while suppression of those emotions, can and often does lead to less

productivity, and eventually burnout (Ashforth, & Humphrey, 1993).

Burton and Bonanno (2016) noted one must be flexible with emotional displays,

however, they must also be able to express and suppress them when needed, or they are

more likely to experience burnout. These three tenets are a large part of what emotional

work entails for an MHP. MHPs must be able to engage with customers, work in a

positive environment, and display or suppress their emotions to better avoid burnout, and

help their clients (Seery, & Corrigall, 2009). Emotional work has been described as an

emotional dissonance between one’s emotions which are expressed and one’s emotions

that are suppressed (Edward, Hercelinskyj, & Giandinoto, 2017). Moreover, emotional

work is often triggered by the act of caring for another, and as such those within the

helping professions often experience emotional work (Edward, et al., 2017).

 47

Additionally, Pandey and Singh (2016) stated emotional work is the management

of one’s emotions to match their job role. They further stated emotional work is done

within 2 levels and those are surface and deep level. Within surface acting one dons a

“mask” or fakes the emotion needed for the job, while the deep level one tries to become

the role they are expected to play (Pandey, & Singh, 2016). Emotional work is not only

expected within every profession, but these acts are considered mandated emotional

displays and are requirements of the job (Montgomery, Panagopolou, De Wildt, &

Meenks, 2006). Furthermore, high levels of emotional work within any job setting can

lead to burnout (Montgomery, et al., 2006).

Emotional overload. Emotional overload has been described as the experience of

employees being weighed down by the emotional toll their workload takes on them.

Much like emotional exhaustion in features, emotional overload, however, is when one

cannot handle the emotions that surface due to the workload demands (Grandey, Rupp, &

Brice, 2015; Greenglass, Burke, & Fiksenbaum, 2001). Furthermore, the culture in which

the workload takes place is a large determinant of whether one will experience emotional

overload (Pavlish, Brown-Saltzman, Fine, & Jakel, 2015). Lastly, Hoffmann (2015) noted

in their research those who owned their own business were less likely to experience

emotional overload as they were able to freely express emotions they felt. This reflects on

how work settings can lead to burnout.

Emotional disassociation. Emotional disassociation is described as the distancing

of one’s self, from not only their emotions but also their work. Research also shows the

suppressing of emotions can lead to negative psychological functioning as well (Mauss,

et al., 2011). Adherence to specific emotional displays can lead to emotional

 48

disassociation. Additionally, engaging in emotional labor for long hours will tax an

individual’s ability to display necessary emotions, and thus emotional disassociation will

happen (Scheibe, Stamov-Roßnagel, & Zacher, 2015).

Austen (2016) stated some detachment from one's emotions allows for

individuals to be able to continue work within their specified field, and may reduce

burnout, as individuals may not be fully invested in the emotions, or work one is doing,

thus protecting themselves from burnout. While this is an interesting theory, most

researchers of burnout and emotional exhaustion would disagree, as it is believed

emotional detachment keeps one from fully engaging with those around them, and

themselves (Austen, 2016; Maslach, & Golberg, 1998; Maslach, & Leiter, 2016).

Interestingly Skovholt and Rønnestad, (2003) argued imposing boundaries upon one’s

self, and their work can help to prevent emotional disassociation.

Empathy fatigue. Empathy fatigue is what happens when one can no longer work

within the setting they are in, thus resulting in them leaving their work. However, with

empathy fatigue one can still show concern for their client, even if they cannot work in

the setting, they are in (Ferri, et al., 2015). This is frequently seen within individuals who

work in trauma settings, especially those within the mental health field (Slocum-Gori,

Hemsworth, Chan, Carson, & Kazanjian, 2011).

Furthermore, MHPs who work with trauma clients or highly distressed clients are

more likely to experience empathy fatigue, which is described as the strain and

exhaustion from dealing with others' distress over time (Turgoose, & Maddox, 2017).

According to Hansen et al. (2018) empathy is an important part of any therapeutic

relationship, but when individuals expend high levels of emotional empathy for extended
 49

timeframes they are more susceptible to experiencing empathy fatigue and eventually

burnout. Additionally, Hansen et al. noted that being empathetic does not prevent or

protect individuals from experiencing empathy fatigue.

Gill, Schaddelee, Ramsey, Turner, and Naylor (2018) suggested the cost of

empathy fatigue not only affects organizations, and individuals on the monetary level, but

it can also affect relationships with family members, and financially strain families as

well. Research has shown the longer an individual works within a trauma setting the

better they are protected as they will have had the skills built up to avoid empathy fatigue

(Deighton, Gurris, & Traue, 2007). Thompson, et al. (2014) argued the very

fundamentals that make a good counselor are also the same fundamentals that could

cause them negative repercussions. They explained how one would expect to find

counselors are empathetic, compassionate, and caring, but if these fundamentals are put

under strain, then the counselor will lack empathy, compassion, or caring.

Moreover, Stebnicki (2007) explained how empathy fatigue is the result of a

counselor’s wounds continually being revisited by the treatment of their client’s life

stories. Stebnicki further stated that when a counselor has unresolved work of their own,

they are more likely to suffer from empathy fatigue. While this could be plausible, it does

not explain the possibility of other types of employees who do not work with trauma

victims’ experiences of empathy fatigue, and thus this is something that needs further

examination (Cocker, & Joss, 2016).

Secondary trauma. Secondary trauma is trauma that is experienced by MHPs

who treat individuals who have experienced some form of trauma themselves (Boscarino,

Adams, & Figley, 2010). MHPs can suffer psychological distress, and emotional
 50

difficultly, however, it should also be noted other professions who treat individuals in

stressful environments can also experience secondary trauma (Boscarino, et al., 2010).

Dagan, Itzhaky, and Ben-Porat, (2015) suggested personal variables, environmental

resources, and professional-organizational resources are all determinants as to whether an

individual experiences secondary trauma.

Furthermore, Bercier and Maynard (2015) argued MHPs who work with trauma

victims will likely experience symptomology similar in nature to the clients due to

listening to the victim recount their trauma. This experience repeated daily can not only

harm an MHP, but it can lead to things such as nightmares, anger, sadness, disturbing

images, and even PTSD. Manning-Jones, De Terte, and Stephens (2016) suggested

individuals who engage in the practice of utilizing coping strategies, are less likely to

suffer from secondary trauma and are more likely to experience positive psychological

effects. Beckerman and Wozniak (2018) stated secondary trauma refers to the harmful

changes that change the way an individual sees other people and themselves, and the

world, due to the exposure of graphic and traumatic content of their client’s situation.

When an MHP suffers from their own trauma, it is more likely they will

experience secondary trauma from working with a trauma victim (Devilly, Wright, &

Varker, 2009; Halevi, & Idisis, 2018; Ivicic, & Motta, 2017). Additionally, it is believed

those who work with active and veteran military individuals, will likely have some form

of secondary trauma (Maguire, & Byrne, 2017). These individuals often have

experienced some form of trauma, PTSD, or some other debilitating situation that has

caused them great harm (Bride, & Figley, 2009; Maguire, & Byrne, 2017). McLean,

Wade, and Encel (2003) argued an MHPs beliefs about therapy and secondary trauma is
 51

something that could lead to the MHP experiencing secondary trauma, or it could help

them to diminish it. Wade et al. (2003) noted that very condition an MHP is treating

could be the very thing that leads them to experience that condition.

PTSD development. This disorder is known as posttraumatic stress disorder. This

is a direct result of extreme or repeated exposure to aversive details of a traumatic event,

whether or not the event happened to the individual, or was simply caused by repeatedly

hearing about the traumatic event (May, & Wisco, 2016). Additionally, it should be noted

that not all experiences of indirect exposure to trauma will lead to PTSD, simply put, the

mechanisms by which an individual copes with the traumatic exposure will determine

whether or not PTSD happens (May, & Wisco, 2016). Furthermore, specific training, on-

the-job support from peers, debriefing, and supervision all play a role in reducing the

likelihood of PTSD (Finklestein, Stein, Greene, Bronstein, & Solomon, 2015).

Job stressors. In a study by Kumar et al. (2011) they found individuals who did

not manage their workload, or their hours of work were more likely to be less satisfied

with their work, and more likely to experience some form of burnout. Job stressors are

defined as the physical and emotional damage a person experiences when the work does

not match the needs of the employee (Bakker, et al., 2005; Demerouti, et al., 2001; Riaz,

et al., 2016). Moreover, job stressors lead to a lack of employee production, employee

turnover, unhappiness, and a lack of employee interest in the company (Bowden, et al.,

2015; Henson, 2017). When the stress of a job is too high, individuals will protect

themselves by avoiding the stress, the job, or anything else to ensure they are safe (Li,

Eschenauer, & Persaud, 2018).

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Adverse public health conditions. Situations such as SARS, H1N1, MERS,

Ebola, and the COVID-19 pandemic are public health situations that contribute to the

burnout of frontline workers (Rosen, Preisman, Hunter, & Maunder, 2020). Public health

crises such as these also contribute to burnout due to the uncertainty about job stability.

This is also associated with a deterioration in mental health of frontline workers

(Sasangohar, Jones, Masud, Vahidy, & Kash, 2020). Furthermore, research indicates that

during public health crises healthcare workers experience significant distress levels

(Rosen et al., 2020). Years after outbreaks, such as those noted above, can have lingering

effects for individual workers such as: depression, anxiety, drinking, smoking,

problematic behaviors, and missed workdays, insomnia, and ptsd (Rosen et al., 2020).

Additionally, the added stress of navigating public health crises with the public as

it is being experienced can lead to burnout also (Rodriguez, et al., 2020). Rodriguez et al.

(2020) noted that public health crises not only lead to burnout, but the conditions the

crises produce such as childcare concerns, homeschooling demands, economic impacts,

and changing healthcare are all variables that can contribute to burnout. Hoffman,

Garner, Koong, and Woodward (2020) noted that caregiving responsibilities and

technology issues are the top experiences of negativity with working from home during a

public health crisis such as COVID-19. Hoffman et al. (2020) also noted that the blurring

of personal life and work life create a challenging condition for unplugging from work.

Technology integration. In today’s world technology plays a large role in the

everyday lives of individuals (Mheidly, Fares, & Fares, 2020). Additionally, the uptake in

telecommunication during a public health crisis can lead people to spend more time

facing their computers, tablets, and phones (Mheidly et al., 2020). Furthermore,
 53

telecommunications utilized for homeschooling, and telehealth, during public health

crises lead to more time being spent using technology that can be detrimental to an

individual’s well-being and can increase stress levels thus resulting in burnout (Mheidly

et al., 2020). Additionally, the more time that is spent utilizing technology, the more

physical ailments arise that could also lead to burnout (Rodriguez, et al., 2020)

Job satisfaction. Job satisfaction is largely dependent upon an individual’s

disposition, and the job itself. When an individual does not enjoy the job they do, they are

less likely to have job satisfaction, even if they have a great disposition (Butler, Carello,

& Maguin, 2017; Saari, & Judge, 2004). Furthermore, Abdulwahab (2016) noted when

an employee is satisfied with their job, they are more productive. Abdulwahab (2016)

also stated employees who have high levels of job satisfaction are engaged with their

work, communicate with their bosses and colleagues, and have meaning to the work that

motivates them. Additionally, Peng and Mao (2015) suggested part of job satisfaction is

having the right fit of a person for the job. Meaning, if the person does not mesh with the

culture of the job, the nature of the work, and the bosses who hire them, then they will

not likely have satisfaction in their job and will be more likely to experience stress.

Coping strategies. Coping strategies are the mechanisms by which an individual

manages or deals with the stresses of a job, or burnout from their job (Labrague, et al.,

2017). Labrague et al. (2017) also noted problem-solving and avoidance are two of the

most common coping mechanisms employed by individuals when they are newly

entering a career field. Moreover, individuals who engage in, mindfulness, cognitive

behavior, or use support systems, are all utilizing forms of coping strategies (Anderson,

2000; Lee, Kuo, Chien, & Wang, 2016).

 54

Additionally, Wood and Bhatnagar (2015) mentioned there are two styles of

coping; they are, active and passive, and those who engage in active coping are usually

able to reduce the burnout experience. They argued active coping builds resilience, while

passive coping exacerbates both physical and mental problems that arise from stress.

They further mentioned within their research, how the differences in sexes played a role

in the coping style.

Gupta, Paterson, Lysaght, and von Zweck (2012) suggested one method of coping

with burnout is to have pieces of training that explain stress management, balancing

workloads, and focusing on relationships with clients. Stangor and Walinga (2014)

suggested an individual will base their method of coping upon their perception of the

stress they are under. Utilizing appraisals of the situation is necessary, to determine how

to act accordingly. The above-mentioned review of coping strategies indicates coping

strategies are necessary to combat the effects of burnout and there are many ways of

coping. Furthermore, the review indicated there are two main styles of coping which are

active, and passive. Therefore, the answer to the research question of “How do MHPs,

who treat trauma, in the U.S., describe their experiences of using coping strategies?”

offered valuable insight into how MHPs described their experiences of using coping

strategies to manage burnout. The following sections discussed many subthemes related

to coping strategies.

Negative coping. Negative coping strategies range from avoidance to denial, and

even substance abuse (Agha, 2020). People often look for easy or simple solutions to

their problems, which in some cases involves avoidance (Agha, 2020). While substance

abuse and avoidance are two negative coping mechanisms, religious denial is one that is
 55

becoming more commonplace (Soler-González, San-Martín, Delgado-Bolton, &

Vivanco, 2017). Soler-González et al. (2017) also noted that a range of negative effects

can happen when individuals do not practice positive coping. Furthermore, Wachholtz

and Sambamoorthi (2011) noted that those who deny religion as a coping method are

those who are often not religious and as such prayer is not utilized as frequently. Agha

(2020) also noted that the amount of denial is higher for females than for males when

utilizing negative coping mechanisms.

Self-care. Self-care can range from anything like a haircut to a manicure, to going

to the gym. Self-care is pertinent for any profession where compassion for others is a

necessity, but self-care is often not a focus for individuals when working within the

helping professions (Brady, 2017; Mills, Wand & Fraser, 2015; Storlie, & Baltrinic,

2015). Bloomquist et al. (2015) stated self-care is a means to protect against the many

stressors of the mental health professions. They also suggest self-care helps to contribute

to overall wellness.

Figley (2002) noted when a therapist does not engage in self-care, they risk

becoming incompetent where clients are concerned, up the risk of turnover, and they

unduly cause their clients’ harm. Self-care according to Figley (2002) is the practice of

desensitizing oneself to their work and is critical to surviving any type of work that

places high demands on the individual. According to Dalphon (2019) self-care involves

all aspects of an individual’s life; spiritual, psychological, physical, emotional, relational,

and professional. If self-care does not reach all these aspects, then the individual runs a

greater risk of experiencing burnout. Self-care must be individually tailored to the MHP

as each will have different needs and will require different things (Rokach, & Boulazreg,
 56

2020). Furthermore, neglecting self-care has adverse effects on both the MHP, and the

client (Figley, 2002). The more personal burdens the MHP faces, the more the therapeutic

alliance will suffer (Rokach, & Boulazreg, 2020).

Self-compassion. Self-compassion has been described as kindness one displays

towards themselves. Self-compassion has three branches to it, and they are common

humanity versus isolation, self-kindness versus self-judgment, and mindfulness versus

over-identification (Neff, et al., 2007). Self-compassion is caring for one’s well-being,

but self-compassion and well-being are tied to one another, as you cannot have one

without the other (Makadia, Sabin, & Turpin, 2017; Zessin, Dickhäuser, & Garbade,

2015). Moreover, self-compassion is a means of promoting self-care that is on the rise.

Self-compassion helps to promote psychological, and professional well-being,

while also helping build resilience to stressors (Finlay-Jones, Rees, & Kane, 2015). It is

also worthwhile to mention self-compassion is a necessity to engage in when working

with clients as their well-being is dependent upon the MHPs well-being (Neff, et al.,

2007). Therefore when an MHP does not practice compassion towards one’s self, they

are less likely to be able to practice it with their client and thus end up experiencing

compassion fatigue (Myers, et al., 2016). Additionally, self-compassion needs to be

practiced as shame is often an experienced feeling when MHPs are burned out (Neff, et

al., 2007).

When MHPs are overly critical of themselves they experience more shame and

practice less self-compassion (Neff, et al., 2007). Self-compassion is the caring and

positive attitude one has towards themselves in the face of shortcomings and failures

(Zessin, et al., 2015). Furthermore, practicing self-compassion is associated with reduced

 57

feelings of shame, lower levels of anxiety, and lower levels of depression (Finlay-Jones,

et al., 2015). Lastly, Myers et al. (2016) noted that MHPs who have high self-compassion

tend to engage more in positive behaviors that facilitate the enhancement and

sustainability of their work. This then in turn leads to maintaining factors such as

spending time with family, a sense of humor, self-awareness, a work-life balance, and

control of their responsibilities at work.

Mindfulness. Mindfulness is exactly what it sounds to be. Being cognizant of

what one is doing while they are doing it. Their thoughts are focused on the task they are

completing and are thinking of that task while they are doing it, always present in the

moment (Langer, & Moldoveanu, 2000). Being mindful of one’s thoughts, actions,

surroundings, beliefs, and emotions is how one can practice mindfulness. This practice of

being aware of these things helps individuals to combat burnout (May, & O'Donovan,

2007; Prakash, Hussain, & Schirda, 2015; Shapiro, Carlson, Astin, & Freedman, 2006).

Furthermore, mindfulness is the act of seeing things in the moment as they truly

are. However, mindfulness under this description has been compared akin to the practice

of Buddhist monks, in that one is training their mind to see things for what they are

without distractions (Hyland, Lee, & Mills, 2015). Hyland et al. (2015) also noted

mindfulness bears a similar nature to what meditation does, meaning one is taking the

time to center themselves and focus on the here and now of a situation. According to

Haun, Nübold, and Bauer (2018) being able to utilize mindfulness during off-job hours

can help to promote recovery, well-being, and productivity when one returns to work.

Additionally, mindfulness can help to reduce burnout when practiced daily (Haun, et al.,

2018).
 58

Brown, Ryan, and Creswell (2007) suggested mindfulness when practiced every

day will draw awareness to daily life. Interestingly, they stated when practicing

mindfulness, one utilizes all their senses and this helps to heighten their awareness, which

is the foundation for mindfulness. Miller, and Sprang (2017) suggested future research

should focus on the use of mindfulness as a mediator for reducing burnout.

Peer support. Peer support has been described within much literature; however,

the definition varies across disciplines. Peer support is described within the mental health

field as the flexibility to seek supervision, the ability to leave work when needed, or to

converse with other colleagues. For MHPs who treat trauma peer support often means

finding other MHPs who understand the stress of the job, and the importance of having

peer support (Pulido, 2012). Moreover, many MHPs are uncomfortable admitting when

they need support and often do not seek it. However, some agencies have systems in

place where individuals can anonymously request or suggest peer support for others or

themselves (Shapiro, & Galowitz, 2016).

Furthermore, Lane et al. (2018) suggested individuals who work in public settings

are more likely to have systems in place individuals can utilize should they need them.

Those within public domains may need to build their peer support system up, by leaning

on others in the field, finding groups where they can discuss their need (such as Facebook

or LinkedIn), or make their own group they could utilize (Lane, et al., 2018). Those

within private settings however must be creative with how they seek or build peer support

systems (Harrington, 2013; Lent & Schwartz, 2012).

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According to Pratt, and Jachna (2015) research has shown supporting peers is not

always beneficial, as it is not always known what is needed. Peer support systems often

lack an understanding of the specific situation that led to the need for peer support in the

first place (Pratt, & Jachna, 2015). Those who work with traumatized populations often

need support from those who understand the strain of working with this population, and

thus supervisory support is often the best form of support (Miller & Sprang, 2017).

Family support. Family support is exactly as described, it is the support one

receives from their family members during situations of stress, and strain. In addition,

family support allows for the reduction of the experience of burnout (Rupert, Stevanovic,

& Hunley, 2009). Research by Allen (2001) suggested family-friendly benefits are

essential to reducing the burnout individuals can experience at work. However, Allen also

noted organizations don’t always offer these types of benefits, and if they do, not every

individual will utilize it to help in their time of need, as family supports that are a part of

an organization are not usually common. Family support also is dependent upon the

family's demands and dynamics as to whether an individual will be able to rely on their

family (Jennings, Sinclair, & Mohr, 2016).

Finally, Hilbrecht (2016) argued for individuals who are self-employed support

can come in two main forms they are formal and informal. In formal support, the

individual often relies upon city or government programs to provide support. While

informal can include things such as financial support from family, childcare, friends,

family relationships, and each gender has a different perception of what is best in terms

of familial support. It is also important to note that formal supports are what are most

often utilized by agencies (Allen, 2001; Hilbrecht, 2016; Peled-avram, 2017).

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Resilience. Resilience is believed to be one of the most utilized resources as many

individuals continue with their work, even in the face of adverse, or traumatizing events

(Fredrickson, 2011; Pereira, Barkham, Kellett, & Saxon, 2017). Moreover, resilience can

be beneficial when utilized as a coping mechanism, or it can be harmful when it is not

utilized for coping (Matheson, Robertson, Elliott, Iversen, & Murchie, 2016). Resilience

can be broken down into three sets of features and each serves a different purpose to the

whole of resilience (Grafton, Gillespie, & Henderson, 2010). The three features of

resilience are considered; resilience as a set of characteristics, resilience as a dynamic

process, and resilience as an innate life force (Grafton, et al., 2010). Each feature of

resilience is discussed further below.

Resilience as a set of characteristics. With resilience as a set of characteristics,

resilience is defined as a set of personality characteristics that help an individual cope

with difficult situations. It is believed resilience is a preprogrammed set of boundaries

and guidelines individuals already have. Acting through those built-in set of

characteristics, resilience is then able to help individuals to change their thoughts and

behaviors and navigate difficult situations (Delany, et al., 2015; Grafton, et al., 2010).

Resilience as a dynamic process. When resilience is considered a dynamic

process, it serves to function as a coping means for individuals (Pereira, et al., 2017). It is

the process by which an individual utilizes their resources to help them through difficult

situations (Delany, et al., 2015; Grafton, et al., 2010; Pereira, et al., 2017). Furthermore,

it is believed age and experience levels of an individual possibly play a role in how

resilience is used as a method to cope (Frey, Beesley, Abbott, & Kendrick, 2017; Pereira,

et al., 2017).
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Additionally, factors such as caseloads, training, time in the specific field, years

on the actual job, and personality factors are all a part of the utilization of resilience

(Treglown, et al., 2016). Many individuals believe resilience is simply not letting adverse

events keep them from doing their jobs. Research has shown however, resilience is a

complex set of features and processes which come together to create the whole of

resilience (Delany, et al., 2015; Fredrickson, 2011; Frey, et al., 2017; Grafton, et al.,

2010).

Resilience as an innate life force. Resilience when considered as an innate life

force, simply means the relationship between external support, and internal strengths

(Grafton, et al., 2010). Moreover, when resilience is an innate life force it is more likely

that those who have less pleasant personality factors such as anger, sadness, bitterness,

poor-attitude, inflexible, unadaptable, lack humor, or are pessimistic, are going to be

more likely to experience resilience in a negative means (Treglown, et al., 2016).

According to Matheson et al. (2016) resilience is a sign of a healthy individual and

includes such facets as flexibility and adaptability, a sense of self-worth, being a team

worker, optimism, initiative, organizational skills, tolerance, confidence/assertiveness,

keeping within professional boundaries, and humor. Resiliency is the act of responding to

challenges with actions that are aimed to correct the situation, and prevent it from

occurring again (Rokach, & Boulazreg, 2020). Moreover, concreting resilience in

healthcare workers can help improve their well-being and allows them to be able to keep

working with the focus and dedication their jobs require (Rosen et al., 2020).
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Mentoring. Mentoring while not a common method of coping, has shown in

current literature to have some benefits to those who do the mentoring and for those who

receive it as well, thus mentoring for burnout could be perceived as a benefit for MHPs in

both the giving of and receiving of forms (Chan, et al., 2015). Mentoring is not a new

practice, it has been around for centuries, while it has been around for a long period, its

use as a coping mechanism for burnout is still new and relatively unresearched and

should be explored further in future research (Dantzer, 2017). Mentoring is much like

what MHPs do daily within their work practices, so it would stand to argue mentoring

would not be beneficial as a coping mechanism to burnout. However, according to

Dantzer (2017) mentoring does have benefits to those who both give and receive it.

Those benefits are as follows: mentors take on leadership positions and those positions

instill a sense of pride when helping others. Also, psychological well-being is heightened

when mentoring individuals who are close in age and helps to build relationships.

Chan et al. (2015) argued, however, mentors who are not the same race, are less

likely to receive any benefits from mentoring as the relationship that is built during

mentoring will be harder to form due to less communal factors with the mentee, and

fewer communication capabilities. Their beliefs are, for a mentor to receive any type of

benefit the mentor must be of the same race. Chan et al. (2015) however, did not suggest

age played a role in the benefits of mentors, as it is not as important as communication

abilities are. If mentoring is to become a successful resource that individuals can utilize

to help them manage burnout, much more research needs to be conducted, and this would

be a good area for future researchers to consider.

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Prayer, religion, and spirituality. Utilization of prayer is not a new concept for

coping. Prayer is often utilized when dealing with adverse situations such as health

issues, depression, burnout, and loss (Wachholtz, & Sambamoorthi, 2011). Religious

beliefs can be strengthened after a traumatic event, just as they can be diminished (Ter

Kuile, & Ehring, 2014). However, religion utilized for coping allows individuals to

regulate emotions, find meaning in the situation, and to receive support. It also allows a

feeling of being in control (Ter Kuile, & Ehring, 2014). According to Wachholtz, and

Sambamoorthi (2011) when individuals engage in positive health behaviors, they are

more likely to engage in prayer or some form of religion. Agha (2020) noted that using

religion as a coping mechanism, allows an individual to seek comfort; this often helps

individuals to navigate their own lives, gain motivation, and manage their own emotional

problems.

Physical activity. Physical activity has long been considered a resource in the

reduction of stress. By doing regular physical activity, individuals may experience lower

stress, higher self-efficacy, which can spill over to their work, and they are better

equipped to cope with stress (Naczenski, de Vries, van Hooff, & Kompier, 2017).

Participants who take part in rigorous physical ctivity regularly often have lower levels of

stress and are at lower risk for future stress (Naczenski, et al., 2017). Moreover, the more

participation in physical activity, the less burnout. Individuals who take the time to be

physically active have better overall health, higher reasoning skills, higher competence

levels to perform their jobs, and better abilities to cope (Naczenski, et al., 2017).
 64

Physical activity allows for recovery of occupational stress by encompassing four

tenets: 1) control; the opportunity for individuals to make their own decisions during

physical activity, 2) mastery; feeling successful and achieving success during

challenging situations, 3) psychological detachment; this is the opportunity for

individuals to have time away from work, and to leave work behind, and 4) relaxation;

completing activities that add to the experience of reducing sympathetic activations

(Gerber, et al., 2020). Additionally, workplace initiatives should include promotion of

physical activity as it leads to better productivity in work, and reduced stress in

employee’s (Gerber, et al., 2020).

Therapy for the MHP. Many MHPs have therapists of their own. It is not

uncommon, as many MHPs need an outlet to release all the emotions, and tensions held

from seeing clients (Macran, Stiles, & Smith, 1999). Therapy for the MHP, has long been

considered as a mechanism to cope with burnout; however, it is undeniable that as an

MHP, one must work on themselves before helping a client with their work (Macran, et

al., 1999). As an MHP, there must be a higher level of self-awareness that allows for the

combination of skills and theory; therefore, it stands to reason that future MHPs could

benefit from their own therapy to better help those they serve (Malikiosi-Loizos, 2013).

Furthermore, self-questioning and self-reflection by MHPs, are qualities that are

characteristic of securely attached MHPs.

Securely attached MHPs often have higher levels of mindfulness and produce

better client results, than MHPs who have anxious or avoidant attachments (Bennett-

Levy, 2019). Additionally, empirical studies on the effectiveness of personal therapy

during training of MHPs, suggested that personal therapy can improve self-esteem, social
 65

life, improvement of symptoms, and can improve work functions. Personal therapy is

thought to be a positive experience that facilitates the process and preparation of MHPs.

MHPs can benefit from personal therapy that helps therapeutic relationships, minimizes

countertransference, and develops empathy, genuineness, tolerance, patience and warmth

of the MHP (Malikiosi-Loizos, 2013). Lastly, when MHPs utilize going to their own

therapy, they are able to Bennett-Levy, 2019; Macran, et al., 1999; Malikiosi-Loizos,

2013).

Animals as sources of support. Animals have long been thought to be a source of

comfort. Individuals utilize animals not only as a pet, but as a companion (Crossman,

2017). Additionally, strategies that can improve morale within the workplace and has the

potential to reduce burnout experiences is by provided opportunities for animal-assisted

support programs (Etingen et al., 2020). Furthermore, the use of animals as a coping

measure for burnout, suggests that the type of animal does not matter. Animals can range

from llamas, birds, rabbits, guinea pigs, farm animals such as cows, goat, or sheep,

dolphins, horses, ferrets, and even donkey’s (Kazdin, 2017). The use of animals has been

shown to have many physical benefits such as lowering blood pressure, providing

feelings of joy and happiness, and creating a sense of pride in caring for another life

(Crossman, 2017).

Methodology and instrumentation/data sources/research materials. This

section of the literature review discusses and synthesizes the methodological frameworks

and instrumentation methods utilized within other studies to justify the suitability of the

proposed methodology in this study and the instruments which were used to collect data

in the study. Past studies mentioned in this literature review, display a mixture of
 66

methodologies in burnout and coping research. Ernst Wood et al. (2017) utilized a

quantitative methodology to compare the usability of, acceptability of, and effectiveness

of a free mobile application for provider resilience, to reduce provider burnout and was

designed by the National Center for Telehealth and Technology. They used an app to

examine provider resilience, then followed up with questionnaires. Eliacin et al. (2018)

conducted a qualitative study with 40 participants taking part in interviews to examine

how work-place environments impact burnout. They used interviews to gather data about

the provider's experiences of burnout. While Dyrbye et al. (2010) used a quantitative

method for their study to compare the causes of burnout between two different groups of

individuals and utilized surveys to collect data.

Emery et al. (2009) utilized 190 Australian therapists to explore the validity

measures of the Therapist Belief Scale (TBS) and to examine the contributions of

demographics, work variables, and individuals’ factors to burnout. Their study found the

scale had three factors relating to distress that lowered overall personal accomplishment,

while the examination of variables contributing to burnout showed significant variations

in the causes of burnout. They utilized questionnaires to collect the data. Skorupa and

Agresti (1993) conducted a quantitative study that sought to examine the relationship

between ethical beliefs, professional practices, and the levels of burnout. They used both

surveys and questionnaires to collect their necessary data.

Rosenberg and Pace (2006) conducted a quantitative study of 116 marriage and

family therapists (MFT’s). Their goal was to explore the predictors and prevalence of

burnout. By utilizing a questionnaire and a burnout inventory, they were able to collect

data about the prevalence and predictors of burnout. Ackerley et al. (1988) conducted a
 67

quantitative study to examine the extent of burnout and its correlates. They used 562

licensed clinical psychologists and found more than a third of the sample of psychologists

reported high levels of burnout. They used questionnaires, and two burnout inventories to

gather their data.

Galek et al. (2011) conducted a quantitative study that explored the extent of

work-related variables predictions on burnout, and secondary trauma, and the degree to

which social support mitigated those. They used the compassion fatigue scale self-report

measure to gather data from 331 chaplains who counseled individuals. Piedmont (1993)

conducted a quantitative study that explored the contribution of personality to the

experience of burnout. Piedmont utilized not only the Maslach Burnout Inventory but

also the Neo Personality Inventory and the Work Environment Scale to gather data.

While Ballenger-Browning et al. (2011) also conducted a quantitative study, they

utilized 97 military mental health providers to explore the levels and predictors of

burnout. They collected data through surveys and the MBI. Finally, Farber and Heifetz

(1982) conducted a qualitative study to investigate the experience of 60 psychotherapists'

therapeutic experiences. Data was collected through semi-structured interviews.

The heavy utilization of quantitative studies to identify factors related to burnout,

or relationships of burnout factors, suggested the use of qualitative methodologies was

appropriate for this study. This study intended to explore the described experiences of

burnout in mental health providers who treat trauma, and thus a qualitative methodology

was appropriate (Archibald, Radil, Zhang, & Hanson, 2015). The in-depth investigation

of the phenomenon, from participants' perspectives and recountings through interviews,

and through the use of a qualitative methodology, allowed for a detailed examination of
 68

the participants' described experiences of burnout and their use of coping strategies to

manage the burnout (Hammarberg, Kirkman, & De Lacy, 2016).

Gupta et al. (2012) utilized a quantitative and qualitative methodology to examine

the burnout experiences of occupational therapists and to describe the practice

implications and coping strategies used. Gupta et al. (2012) used a mixed methodology,

they used the MBI and the Areas of Work-Life survey for the quantitative portion, while

using a focus group, and semi-structured interviews for the qualitative portion. Anderson

(2000) conducted a quantitative study with 151 CPS workers to measure coping strategies

and burnout syndrome. Their research showed neither active nor passive coping strategies

reduced or prevented burnout from happening. They utilized questionnaires and the

Coping Strategies Inventory.

Almost every study found on burnout and coping was quantitative. This study was

looking to understand the described experiences of burnout and the use of coping

strategies; therefore, a qualitative methodology was more appropriate as this study was

not seeking to understand a relationship, explore causes or correlations of burnout and

coping, or to explore or predict cause or levels of burnout (Bradshaw et al., 2017). There

was various instrumentation utilized throughout each of the studies discussed in the

literature review. However, this study intended to look at the described experiences of

burnout and the methods of collecting data was a questionnaire and interviews. Eliacin et

al. (2018) noted to gather the best data of a phenomenon, interviews are ideal. Eliacin

also noted that interviews garner the best in-depth details about an individual’s

experience.
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Summary

The review of the literature suggests burnout is something many helping

professionals experience and the use of some form of coping strategy is necessary to

reduce the experience, and effects of burnout (Eliacin, et al., 2018; Ernst Wood, et al.,

2017; Li, et al., 2017; Oppenauer, & Van De Voorde, 2018). Ernst- Wood et al. (2017)

stated burnout of mental health professionals is associated with higher degrees of

physical and mental problems, turnover rates, and decreases in available providers.

However, Eliacin et al. (2018) noted the environment in which providers work is a large

factor in whether burnout is experienced, they further stated, personal and job-specific

reasons can also contribute to the experience of burnout. Despite risks associated with

working in helping fields, many individuals continue to enter the helping professions (Li,

et al., 2017). Furthermore, burnout can affect every part of an individual’s life, including

personal, professional, and even to some degree spiritually (Dyrbye, et al., 2010; Lim, et

al., 2010).

Burnout is also directly caused by the emotional overload individuals within high

demand jobs face. The demands placed upon them are unable to be met, and thus burnout

develops (Grandey, et al., 2015). Additionally, when an individual is unable to display

the emotions needed for the job, they run a greater risk of developing burnout, as

emotional suppression can hinder one’s ability to be compassionate (Burton, & Bonanno,

2016). Moreover, Hansen et al. (2018) noted compassion fatigue or empathy fatigue is

likely to accompany burnout when an individual is expected to act or behave a certain

way but must also suppress their own emotions. Certain job environments, such as those
 70

that MHPs work in, may expect certain behaviors, and as such job stressors, and job

satisfaction can be a large determinant of burnout (Bowden, et al., 2015).

Additionally, work environments are directly responsible for the type of coping

strategies one may develop as those who work within traumatic settings will have a

higher need for coping strategies (Wan, et al., 2018). However, individuals must be able

to find ways to cope with burnout, as it is a constant within professions with high

demands (Lee, et al., 2016). Coping strategies are a necessity within any profession

which can experience burnout. There is a plethora of ways individuals can cope and even

more ways they can develop plans to help them to cope with the effects of burnout

(Labrague, et al., 2017). Development of things such as self-care plans that implement

means of caring for all aspects of one’s self can help to mitigate the effects of burnout

one may experience when working in high-stress professions (Dalphon, 2019).

Furthermore, having a support system in place such as peer support or family

support will further help individuals to combat the effects of burnout (Jennings, et al.,

2016; Shapiro, & Galowitz, 2016). Moreover, practicing mindfulness, by being aware of

one’s thoughts and emotions, can help to mitigate the experience of burnout (Dalphon,

2019). This can also help individuals to develop self-compassion which will help them to

address not only their emotions but their physical state as well (Hyland, et al., 2015;

Trepal, et al., 22016).

Finally, one can mitigate the effects of burnout by entering into a mentoring

relationship, as being a mentor or mentee can provide benefits and guidance to both

parties, by allowing the experience to be conversed about (Dantzer,2017). Mentoring also

allows for other perspectives to be considered. In addition, new ideas for ways to cope
 71

may be gained that may not have been done or discovered, and new support systems

could then be formed (Dantzer, 2017). Lastly, Individuals who experience burnout over

time may find ways to build resilience, they may have strategies in place already to help

them cope, but they may have learned to recognize the signs of burnout and mitigate it

before it begins. Resilience allows individuals to minimally be impacted by the effects of

burnout (Pereira, et al., 2017).

A review of the methodological frameworks utilized within some studies cited

within the literature review suggested the use of the qualitative methodology to determine

the experience of a phenomenon was appropriate. While many were quantitative the

purpose of this study was to examine the described experiences of burnout and the use of

coping strategies, rather than to examine relationships or variables, or causes of burnout

(Bradshaw, et al., 2017; Eliacin, et al., 2018; Ernst Wood, et al., 2017; Halevi, & Idisis,

2018; Ivicic, & Motta, 2017; Turgoose, & Maddox, 2017). The review of the literature

also noted several types of instrumentation were utilized, however, most utilized were

questionnaires and surveys. There were a few studies that utilized interviews. Interviews

are the instrumentation of choice when examining a phenomenon that has been

experienced (Eliacin, et al., 2018; Farber & Heifetz, 1982; Gupta, et al., 2012;

Hammarberg, et al., 2016).

The use of a questionnaire and interviews, as data collection methods in this

qualitative study, was appropriate as this study was looking to examine the described

experiences of burnout, and the use of coping strategies. The job demands- resource

model provided a method for examining the experience of job demands that cause

burnout, as burnout is directly caused by job situations that affect physical,

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psychological, social, and organizational aspects that then lead to strain which is placed

upon an individual. Additionally, this model allowed for the examination of how coping

takes place by examining the resources individuals used to mitigate job demands that

cause strain and burnout (Bakker, et al., 2005; Demerouti, et al., 2001). As highlighted in

the literature review, there was little research that illuminated the specific experiences of

burnout, and the specific uses of coping strategies. This study provided a valuable

contribution to research by addressing the gap in information about burnout experiences,

and coping strategies of MHPs who treat trauma.

Chapter three expands on the methodology and the research design this study

employed. Specifically, the chapter presents the problem statement and the research

questions under investigation in this study. Chapter three also discusses in detail the

methodology, research design, population that was studied, and details about the sample

selected. Chapter three also provides details about sources of data for the study, and how

the elements of trustworthiness in the study were addressed. In addition, how the data

was analyzed is discussed. Chapter three also provides a discussion of the pertinent

ethical considerations that were applied to protect participants of the study and supported

the integrity of the research. Finally, the chapter presents the limitations of the study and

summarizes the main points of the chapter.

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Chapter 3: Methodology

Introduction

The purpose of this qualitative descriptive study was to explore how MHPs, who

treat trauma, in the U.S., described their experience of burnout and their use of coping

strategies. Burnout is a direct result of repeated high-stress encounters that place

emotional demand upon an individual (Butler, 2017; Kaeding, et al., 2017). Moreover, by

utilizing coping strategies, MHPs are more likely to be able to mitigate the effects of

burnout (Coleman, et al., 2016; Luken, & Sammons, 2016; Mohamed Saleh Baqutayan,

2015). Despite several sectors being affected by burnout, it continues to be a problem

among the healthcare sector, and coping mechanisms are still considered the preferred

tools for mitigating burnout (Bogiatzaki, et al., 2019). These facts underlined this study’s

investigation to explore the described experiences of burnout in mental health

professionals who treat trauma and their use of coping strategies.

The participants for the study were MHPs who treated trauma. This study

employed a descriptive design (Sandelowski, 2000), to explore the described experiences

of burnout in MHPs who treat trauma, and their use of coping strategies. This study

broadened the understanding of the burnout experience and the use of coping strategies to

mitigate burnout. The remainder of this chapter presents the problem statement of the

study and explains the research questions under investigation.

The chapter discusses the methodology, research design, and the population

studied. The chapter also provides details about the sample selection and data sources

used within the study. The chapter outlines how the study addresses the trustworthiness

of the data collected. Additionally, how the data was analyzed is discussed as well. The
 74

next to the last section of chapter three discusses the critical pieces of ethical

considerations applied to protect participants and support the integrity of the research.

Lastly, the chapter is finished out with discussions of the limitations and delimitations of

the study, while summarizing the chapters main points.

Statement of the Problem

It was not known how MHPs, who treat trauma, in the U.S., described their

experiences of burnout and their use of coping strategies. MHPs often experience

burnout, as job demand is high and self-care is often low (Coleman, et al., 2016). The

main issue MHPs, who treat trauma is, that support networks need to often include

sources of support that understand the experience of working in traumatic settings.

Caseloads often included being exposed to repeated traumatic experiences as retold by

clients, and thus burnout experiences are often much higher (Schaufeli, et al., 2017).

The specific problem was it was not known how MHPs, who treat trauma, in the

U.S., described their experiences of burnout, and their use of coping strategies. MHPs

who treat trauma are more likely to experience burnout (Mills, et al., 2015). The

strategies used for coping with burnout that could have been uncovered within this study,

could help to reduce the number of burnout experiences MHPs who treat trauma

experience. These strategies could have also helped MHPs who treat trauma to recognize

the early signs of burnout and develop self-care plans that would help them to mitigate

the effects of burnout.

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Research Questions

The overarching research question which guided this qualitative descriptive study

was intended to help address the problem statement of it was not known how MHPs, who

treat trauma, in the U.S., described their experiences of burnout. An additional research

question supported the overarching research question and was aligned with the

understanding that MHPs experienced burnout and they used coping strategies to manage

burnout. Below are the following research questions for this study where RQ1 was the

overarching research question and RQ2 was the supporting research question.

RQ1: How do MHPs, who treat trauma, in the U.S., describe their experience of

burnout?

RQ2: How do MHPs, who treat trauma, in the U.S., describe their use of coping

strategies?

The goal of this qualitative descriptive study was to explore how MHPs, who treat

trauma, in the U.S., described their experiences of burnout and their use of coping

strategies. Simionato et al. (2019) stated both job, individual, and organizational factors

are often the leading cause of burnout. However, Rupert et al. (2015) suggested MHPs

who create self-care plans and who are cognizant of the emotional state of their work are

less likely to experience burnout. Additionally, Wood and Bhatnagar (2015) noted

individuals will have different coping mechanisms that work for them, and this could

mean burnout still happens for some individuals.

Burnout in MHPs poses significant risks to the well-being of themselves and their

clients (Jergensen, 2018). Furthermore, those who are in high-demand, high-stress jobs

are more likely to experience burnout than those who are not (Paiva, et al., 2017).
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Moreover, MHPs who work with traumatized populations are more likely to experience

burnout as well (Hessels, et al., 2017). Additionally, Hamidi et al. (2018) noted there are

significant costs to providers experiencing burnout, it affects not only them, but others

around them, and their careers, clients, and more. Therefore, it was necessary to ask the

overarching question in this study, “How do MHPs, who treat trauma, in the U.S.,

describe their experience of burnout?”.

Mills et al. (2015) stated self-care is the first line of defense against the effects

and experience of burnout. Moreover, Myers et al. (2016) stated self-compassion is

something most individuals who work within the health system lack, they hold

compassion for others, but not themselves. Accordingly, Lee et al. (2016) argued having

coping mechanisms in place can help to regulate and reduce the burnout health

professionals experience. By asking “How do MHPs, who treat trauma, in the U.S.,

describe their use of coping strategies?”, new coping strategies may have been

uncovered, and a better understanding of the use of these strategies may have been

identified.

The research questions were derived from the literature regarding MHPs

experiences of burnout and their use of coping strategies. The research questions were

intended to develop data specific to how MHPs described their experienced burnout and

their use of coping strategies. Such insights into burnout and the use of coping strategies

to manage burnout allowed this research to identify, explore, explain, and recommend

strategies for reducing burnout and strategies to cope with burnout. Data sources for the

proposed study consisted of a questionnaire and semi-structured interviews with 18

MHPs.
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Descriptive designs require two sources of data, a questionnaire and interviews

were enough data sources (Kim, et al., 2017; Magilvy, & Thomas, 2009; Sandelowski,

2000). The questionnaire was a self-report questionnaire based on burnout. The

interviews were focused on gaining an understanding of how MHPs, specifically those

who treat trauma, described their experiences of burnout, and their uses of coping

strategies. The researcher gathered data about the phenomenon of burnout through a

questionnaire and semi-structured interviews with the MHPs through videoconferencing

software. Interviews are the primary source of gathering data within qualitative studies

(Tessier, 2012). This format of data collection was appropriate to qualitative descriptive

studies as they allowed for the most in-depth data to be gathered (Sandelowski, 2000).

Information about the phenomenon under investigation was gained by

interviewing participants about their burnout experiences and their use of coping

strategies. This was done through having them fill out a self-report questionnaire and

taking part in interviews. Interviews utilized the interview protocols (See Appendix H) to

ensure data about the description of the experience of burnout and coping strategies used,

were what was being conveyed (Hunter, 2012). This allowed a deeper understanding of

the phenomenon to unfold (Dempsey, et al., 2016).

The researcher recorded the interviews and transcribed them. The transcripts

produced from the interviews were thoroughly analyzed and were sent to participants for

checks to ensure the correctness of the data gathered (Chase, 2017; Reilly, 2013).

Additionally, member checks were utilized to ensure that what was captured was what

was meant and was true (Chase, 2017). The data from the questionnaires and the
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interviews were thoroughly analyzed through the four-step analysis process. This was to

ensure that all data collected answered the research questions posed in this study.

Research Methodology

This study utilized a qualitative methodology. McCusker, and Gunaydin (2015)

stated qualitative methods are useful when researchers want to understand the experience

or attitudes of individuals. Hammarberg et al. (2016) argued qualitative methods are

appropriate when the researcher wishes to answer questions about experiences, meanings,

or perspectives, these are most often from the viewpoint of the participants. Furthermore,

Bradshaw et al. (2017) noted qualitative methods are appropriate when the information

that is needed, should be directly from those experiencing the phenomenon under

investigation. Sherman and Webb (2005) noted qualitative methodology is vital when

looking at direct experiences.

This allowed for the overarching research question of “How do MHPs, who treat

trauma, in the U.S., describe their experience of burnout?” To answer the overarching

research question, this study examined the phenomenon of burnout from the viewpoint of

MHPs who had experienced it. The qualitative approach was appropriate for gaining an

in-depth understanding of the phenomena (Snelson, 2016). Additionally, this allowed for

new research to also emerge (Chauvette, Schick-Makaroff, & Molzahn, 2019).

This study intended to explore how MHPs, who treat trauma, in the U.S.,

described their experiences of burnout and their use of coping strategies. This study was

descriptive and was not intended to measure any variables; therefore, the quantitative

method of research was not appropriate for this study (Zachariadis, Scott, & Barrett,

2013). Seidman (2013) argued the narrowness of quantitative methods limits the depth
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and breadth of detail-rich data that is needed to understand the participant's experience

with a phenomenon that qualitative studies entail. Furthermore, Ellis and Levy (2010)

stated most researchers agree, utilizing qualitative methods of research allows meaning to

be attached to a phenomenon by participants’ own accord. The quantitative approach

does not allow for rich detailed experiences to be revealed (Yilmaz, 2013).

Scholars note the qualitative method does have some issues such as researcher

bias, as qualitative studies often are examining a phenomenon or experience that the

researcher has experienced themselves (Mabila, 2017). While quantitative research

methods are looking at causes, variables, or relationships, which is usually numerical

(Qu, & Dumay, 2011). Therefore, qualitative measures are most appropriate when

exploring experiences or phenomena (Mabila, 2017; Qu, & Dumay, 2011; Smythe,

2012). Researchers consider the qualitative method of research necessary for

understanding the non-quantitative accounts of participants, and the meaning they attach

to their experiences (Cope, 2014).

Cope (2014) also explained when a participant can attach a meaning to a

phenomenon, then researchers can better understand those meanings and the

phenomenon. The use of qualitative methods was appropriate for this study to explore the

described experiences of burnout in MHPs who treat trauma, and their use of coping

strategies. McCusker and Gunaydin (2015) noted qualitative research involves the

researcher, and their personality and integrity are key components in ensuring the quality

of the data gathered. There are however many criticisms of qualitative methods such as

bias, vulnerability, the lack of reproducibility, and generalizability. There are however
 80

strategies researchers can employ to ensure rigor and the legitimacy of qualitative

research (Luciani, et al., 2019a).

In this study, participants had the ability to review their statements to ensure they

were correct and free from error, they accurately depicted their words, views,

experiences, and ideas. This was to minimize the influences of bias, subjectivity, and

personal impressions in the data collection and analysis (Ebe Kalu, 2019). The researcher

sent the questionnaire to participants through email to fill out. While interview transcripts

were sent to participants only after being transcribed to confirm their experiences were

correctly captured. The questionnaires, interviews and their transcriptions carefully

maintained through an audit trail ensured the reproducibility of this study (Kornbluh,

2015).

This study could have lacked generalizability due to MHPs, who treat trauma

being the only subjects utilized, this is a known limitation of qualitative studies (Hays,

Wood, Dahl, & Kirk-Jenkins, 2016). The focus of this study was to explore how MHPs,

who treat trauma, in the U.S., described their experiences of burnout and their use of

coping strategies. Given there are many types of MHPs and many different client settings

they work in which could experience burnout, the necessary descriptive study exploring

the described burnout of MHPs, directly applied only to those who treat trauma.

Understanding MHPs experiences of burnout and their use of coping strategies

made it possible to explore appropriate strategies that addressed the issues of burnout and

coping strategies. The qualitative approach helped to facilitate an examination of how

participants gave meaning to their experiences of burnout, and their use of coping

strategies (Jiggins Colorafi, & Evans, 2016). As this research showed, participants'
 81

experiences of burnout influenced their views of burnout. Their experiences also

influenced their views on coping strategies. By identifying these experiences, it made it

possible to extract their role in influencing the experience of burnout and copings

strategies used for mitigating burnout.

The phenomenon under consideration was predefined in this study, and it was

necessary to understand the phenomenon without theoretical assumptions. Researchers

such as Eliacin et al. (2018) and Ernst- Wood et al. (2017) argued mental health providers

hold concerns about the experience of burnout. The framework of this study, using a

qualitative approach, disclosed there are factors associated with mental health care that

fuel the concerns for burnout. MHPs accountings of their experiences relevant to burnout

and coping strategy use were necessary to reveal participants' hidden concerns related to

burnout and coping strategy use.

McGrath et al. (2019) noted qualitative research allows for interview questions to

be semi-structured allowing participants to tell of their experiences and further the

research. By utilizing self-report questionnaires and open-ended interview questions, it

allowed participants to recount their experiences while attaching their meanings to the

experience (Zhang, Kuchinke, Woud, Velten, & Margraf, 2017). Answers to the open-

ended questions helped to illuminate participants' views, feelings and thoughts, and

descriptions about burnout, and coping strategies, thereby providing insights into burnout

threats MHPs faced. Understanding participants’ experiences regarding burnout required

an in-depth examination of their recounting.

Grossoehme (2014) stated recounting experiences allows for authentic and

participant-driven descriptions that are a first-hand recounting of participants'

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experiences, which allows for a deep examination of the meaning participants have

attached to those experiences. The qualitative methodology was quite suitable to gain an

understanding of participants’ descriptions of the experience (Clark, & Vealé, 2018). The

qualitative approach provided the means to uncover not only what burnout meant to the

participants, but also how they described their experiences of burnout (Wu et al., 2016).

This research aimed to assist readers in understanding the threats of burnout to MHPs and

strategies to manage burnout. The qualitative approach was appropriate and necessary to

make sense of and explain MHPs experiences of burnout and to discover the ways

burnout is mitigated.

Research Design

Due to the nature of the proposed study, this study utilized a descriptive design. A

descriptive design is a method of research that turns to people’s experiences to better

understand a specific phenomenon (Merriam & Tisdell, 2016). Descriptive studies are

utilized as they place an emphasis on the experiences of the individual without the

addition of preconceived or assumed ideas (Sandelowski, 2000). The goal of this study

was to explore how MHPs, who treat trauma, in the U.S., described their experiences of

burnout and their use of coping strategies. The descriptive design was appropriate for the

phenomenon under study as well, as it allowed for the researcher to generate knowledge

from the participant's perspective (Yin, 2015).

Merriam and Tisdell (2016) stated descriptive designs are an appropriate research

design as it stays close to the data derived from participants descriptions of a

phenomenon. The descriptive design allows for the data to be examined in a naturalistic

worldview, which minimizes the interpretation of the data (Merriam, & Tisdell, 2016).
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The descriptive design was therefore proper for the study that asked, “How do MHPs,

who treat trauma, in the U.S., describe their experience of burnout and their use of coping

strategies?” This study focused on understanding the experiences of burnout in MHPs.

Therefore, it was necessary to use a research design that allowed for in-depth, and

detailed recounting of participants’ described experiences of the phenomenon. This made

it possible to explore, examine, understand, and interpret the phenomenon of burnout

through the subjective experiences of participants (Bradshaw, et al., 2017).

Case studies examine or develop an understanding of social processes or

organizational processes (Baxter, & Jack, 2008), so a case study was not used. This study

was not trying to examine or develop an understanding of social processes or

organizational processes, but rather an understanding of participants' described

experiences, a case study was not used. Furthermore, this study was not trying to tell

narratives of the participants' burnout experience, while this design could have worked it

did not allow for the detailed data about burnout experiences that descriptive designs

allowed for (Butina, 2015). Narrative designs are focused on the telling of a narrative or

story of the participant's experience and as such was not chosen (Anderson, &

Kirkpatrick, 2015).

In addition, this study was not aiming to develop a theory or model of illness, so a

grounded theory was not used (Kolb, 2012). Grounded theory looks to develop a theory

or model of illness, it was discarded as it was not appropriate for gaining an

understanding of participants described experiences (Kolb, 2012). Lastly, this study was

not aiming to explore a shared lived experience of a phenomenon (Finlay, 2009), so a

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phenomenological study was not chosen. This study sought to explore the described

experiences of burnout that MHPs had and therefore, a descriptive design was chosen.

Magilvy and Thomas (2009) reported descriptive research is commonly disagreed

about, specifically its uses, amongst scholars. Sandelowski (2000) argued described

experiences stay close to the data and rely upon descriptions of a phenomenon. Kim et al.

(2017) suggested since descriptive designs are based in descriptions of a phenomenon

there is less inferred meaning. However, Jiggins Colorafi and Evans (2016) suggested

description is concerned with the described experiences, and those experiences need to be

described precisely by the participants who experienced them, it is a useful design when

researchers want detailed descriptions of an experience.

This study’s use of descriptive design was appropriate to gather described

experiences from the participants. The advantages of using descriptive design outweigh

the disadvantages. Sandelowski (2000) suggested a descriptive design is useful when the

researcher is concerned with the described experiences by people. This study was

exploring the described experiences of burnout in mental health professionals; therefore,

the use of descriptive design was appropriate to gain an understanding of those

experiences as described by the participants.

This research followed the naturalistic inquiry set out by Lincoln and Guba (1985)

and was set within the naturalistic worldview. This was especially important as

naturalistic inquiry requires that there be no manipulation of data on the part of the

inquirer and that during the investigation it is void of inferred outcomes. This study was

rooted in the basis of naturalistic inquiry in that individuals’ realities are shaped by the
 85

world they live in and cannot be examined outside of the setting in which experiences

take place (Lincoln, & Guba, 1985; McInnes, Peters, Bonney, & Halcomb, 2017).

McInnes et al. (2017) noted in naturalistic inquiry it is important to understand the

problem being investigated from the perception of those experiencing it. Lincoln and

Guba (1985) noted naturalistic worldviews help to build a dialogue with participants, as

the researcher has no preconceived ideas of the phenomenon and does not infer meanings

the participants attach to the phenomenon. The use of the descriptive design was

necessary to gain a detail-rich description of the phenomenon under investigation

pertinent to the study and provide a deeper understanding of the phenomenon under

investigation (Kim, et al., 2017).

The descriptive design was appropriate for the current study as it allowed for

naturalistic investigation (Lincoln & Guba, 1985). Conditions such as the participant's

place and type of work are pertinent to the phenomenon of burnout. However, the

phenomenon and the context within which the setting where the phenomenon occurs do

not have distinguishable boundaries between one another (Bradshaw, et al., 2017;

Lincoln & Guba, 1985; McInnes, et al., 2017). The experiences of burnout in participants

were not the same, and each participant had their own meaning attached to the

phenomenon of burnout, therefore, it was necessary to explore many different

interpretations of the data that were gathered (McInnes, et al., 2017).

The phenomenon under investigation was best suited to collect qualitative data

through real-life contexts (Mandal, 2018). Qu and Dumay (2011) noted that effective

interviewing is considered the data collection method in which to broaden and deepen

professional knowledge by mining for the experiences of individuals. The data collection
 86

process included a self-report questionnaire that measured compassion satisfaction,

burnout, and secondary traumatic stress and open-ended, semi-structured interviews of 18

MHPs. The researcher recruited 18 MHPs to take part in the study. Seidman (2013)

suggested researchers must be engaging with participants to gain the necessary detailed

data. This provided the research with rich details and insights into the description of the

burnout phenomenon.

Some previous studies have utilized descriptive methods; however, those studies

were focused on other healthcare sectors. Gregory, Feder, Taket, and Williamson (2017)

used a qualitative descriptive design to study the personal impact on those provided

informal support to DV survivors, they found that supporters of any type of trauma are at

risk of burnout. While West, Liang, and Spinazzola (2017) used the descriptive design to

explore how trauma-sensitive yoga could act as a self-care form for those who experience

trauma. Yuguero, Marsal, Esquerda, Vivanco, and Soler-González (2017) conducted a

qualitative descriptive study in which they sought to better understand factors associated

with burnout that could be mitigated by resilience and empathy.

Tanaka, Hasegawa, Nagayama, and Oe (2018) conducted a qualitative descriptive

study of community mental health nurses and their exposures to emotionally difficult

situations, suffering and death, and anxiety, thus putting them at greater risk of burnout.

Turk, et al. (2019) conducted a descriptive study in which they sought to examine how a

web-based resource (care companion) could provide support of informal careers. The

examples while within other health sectors, support the use of the descriptive design for

the proposed study.

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Population and Sample Selection

This study explored the described experiences of burnout in mental health

professionals who treat trauma, and their use of coping strategies. The general population

of this study consisted of mental health professionals in the United States. The target

population for this study consisted of MHPs who treat trauma. MHPs are individuals who

work within the mental health sector, these professionals can range from licensed

counselors to social workers, to psychologists, to psychiatrists. These individuals play a

role in managing their careers within the mental health sector by being in the helping

profession. These individuals are more familiar with their experiences of burnout and the

implementation of their coping strategies, than other members who are workers within

the agency setting.

MHPs who work in trauma are experts in mental health and possess expert

capabilities to answer questions that pertain to their experience of burnout, and their use

of coping strategies to manage the burnout. In this study, the term expert referred to

MHPs who had a large body of knowledge about the mental health profession (Wardle, &

Mayorga, 2016). MHPs who treat trauma are highly experienced in mental health, but

they also have a large understanding of how trauma affects individuals. As a result of

this, they possess a great deal of knowledge of the stresses of working with traumatic

populations every day as well as the stresses of being a therapist. These two things

combined also makes them experts on the experiences of burnout as they are more

susceptible to experiencing it being the therapist and being exposed to traumatic settings.

The selection of participants for this study focused on MHPs with documented expertise

in mental health and trauma treatment.

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The sample consisted of 18 MHPs who treat trauma, who were fully licensed

within the United States and were currently working as an MHP treating trauma within

the United States. MHPs were familiar with burnout being in the mental health field and

possessed the knowledge of what burnout was and what coping strategies were.

According to Malterud, Siersma and Guassora (2015) and Patton (2015) the sample size

should be such that it is large enough and varied enough to elucidate the study’s aim.

Furthermore, the purpose and objectives of this qualitative descriptive study were

important factors for the selection of the sample in this study (Gentles, Charles, Ploeg, &

McKibbon, 2015).

A larger sample size could limit the manageability of the research for just one

researcher; a smaller sample size may reduce the generalizability of the study’s results.

As this was a qualitative study, this study was not intended to be generalizable, but rather,

it was intended to provide an understanding of related knowledge of the phenomenon

under examination (Mason, 2010). The small sample size was typical of what is found in

qualitative studies, and thus made the management of the research easier (Marcus,

Weigelt, Hergert, Gurt, & Gelléri, 2016; Marshall, et al., 2013; Patton, 2015;

Sandelowski, 1995; Vasileiou, Barnett, Thorpe, & Young, 2018). Furthermore, the

narrow focus of the phenomenon that was under investigation in this study did not

warrant a larger sample size to achieve the purpose of the research, therefore it was not

chosen.

The selection of 18 MHPs who treat trauma was purposeful (Benoot, Hannes, &

Bilsen, 2016). Purposeful sampling aims to select information-rich cases whose study

will illuminate the questions under study (Robinson, 2013; Van Rijnsoever, 2017, p. 2).
 89

Purposeful sampling allowed for the selection of individuals who not only possessed

knowledge and experiences that were related to the phenomenon of interest, but ones who

were also willing and able to participate in the study (Palinkas, et al., 2013; Robert, 2015;

Sibona, & Walczak, 2012).

To identify MHPs who were most familiar with burnout and coping strategies,

eight basic criteria were used. Qualifying participants must have a). Been between the

ages of 20-65. b). Had a current and valid, full mental health license (No intern licenses).

c). Had been in practice for at least 2 years and were currently practicing. d) Treated

trauma. e). Had experienced burnout to some degree. f). Were located within the United

States. g). Were unknown to the researcher. and h.) Agreed to be recorded. This ensured

that only participants who met the criteria were able to take part in the study.

The sample selection process began by reaching out to the administrator of a

Facebook group for therapists the researcher was a part of, to explain the study, and to

gain permission to recruit participants from the group. The purpose of reaching out to the

administrator was twofold. The first was to explain in detail the purpose of the study, and

the second was to gain permission to gather participants from the group. The

administrator and the researcher agreed to the researcher utilizing the group. The

administrator of the Facebook therapist group also agreed to sign the site authorization

form to ensure that she agreed to the researcher utilizing the group. (See Appendix A).

Golder, Ahmed, Norman, and Booth (2017) stated social media has become a

commonplace practice for the gathering of research participants, as it allows for a further

reach, and almost everyone is connected on some form of social media in this day.

Golder et al. (2017) also stated social media does not require site authorization and
 90

allows a researcher to reach a broader base of participants, it cuts the time to complete

research dramatically. However, the researcher did seek administrator permission as this

was a requirement for utilizing groups in any social media group. In addition, the use of

social media allows people to participate in research convenient to them.

It was agreed upon by both the administrator and the researcher, the administrator

would be notified when the researcher was going to make the initial post in the group for

recruitment, and the post would note it was with permission from the administrator. The

researcher explained she would be looking for participants who had experienced burnout

as a therapist who treated trauma and that they had utilized some form of a coping

strategy to help manage the burnout. The researcher also explained participants who were

gathered from the group would be contacted through personal messages and participants'

identities would be protected by using personal means of contact rather than posts in the

group. Moreover, participants who met the criteria, and whose personal experience

focused on burnout and coping were gathered from the group.

The purposive sampling of participants also focused on participants who treated

trauma. The purposive sampling of participants focused on their availability to schedule

participation, as they had to be available to be interviewed at minimum for an hour. The

collection took place for the present study between May 2020 and June 2020. Although

the selection process focused on participants who treated trauma and had experienced

burnout, the availability of possible participants who matched these criteria was factored

into the selection process.

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The email addresses of identified participants were gained by personally

messaging those who responded to the initial post within the respective Facebook group.

The researcher responded by personal message and asked for the possible participant's

email. The researcher explained it was voluntary participation in the study. When

possible participants emails were gained, the researcher sent the informed consent, then

once the informed consent was returned a follow-up email containing the demographic

survey, and the questionnaire was sent. The researcher also explained these forms needed

to be filled out completely and returned to the researcher before interviews could be

scheduled. Once these forms were returned, the researcher then scheduled a time for a

videoconferencing call to take place that was convenient for the participant.

Should not enough participants have been gathered from the respective group the

researcher did have permission to gather participants from another Facebook group they

were a part of. The backup Facebook group was for a specific state, therefore the

researcher intended to utilize snowball sampling, to ensure that more participants were

gathered. The use of snowball methods by asking individuals to share the study with

others they may know who met the criteria for participation, allowed for more

participants to be reached that were needed.

Sources of Data

This study utilized two sources of data. Data from self-report questionnaires and

data, more specifically transcripts from semi-structured interviews, ensured no mistakes

in meanings or statements were present (Moser, & Korstjens, 2018). Questionnaires

examined burnout, while interviews examined both burnout and coping strategies. Both
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sources of data helped to examine the described experiences of burnout and coping These

sources allowed for the in-depth examination of burnout, and coping strategies.

Data source one: questionnaire. The questionnaire for this study was the

PROQOL questionnaire created by Stamm (2009). (See Appendix G). The questionnaire

is a self-report measure and contains subscales for burnout, compassion satisfaction, and

secondary traumatic stress, which are components of burnout. Participants marked each

question on a scale from 1-5 with 1 being never and 5 being very often. The researcher

then scored the participants' answers for each subscale based upon the recommended

scoring by Stamm (2009). The questionnaire was aligned with the gap as it was designed

to explore the burnout level of individuals. The questionnaire was also aligned with the

theory, as the theory, the job demands model, and the questionnaire related to aspects of

job demands that could lead to burnout.

The questionnaire being self-report should have taken participants no longer than

10-15 minutes to complete. The use of a Likert-type scale questionnaire measuring

burnout, compassion satisfaction, and secondary traumatic stress helped with the

descriptive statistics while analyzing the data of the study (Stamm, 2009). The

questionnaire was emailed to participants. Participants were reminded to retrieve the

attachment and fill out the questionnaire. Participants who returned the questionnaire by

email were invited to participate in interviews.

Partially filled out questionnaires were not utilized in the study, additionally,

participants who did not complete the questionnaire were not utilized for the study as the

questionnaire was a prerequisite of scheduling and completing an interview. Participants

received an updated version of the PROQOL, as the tool was updated, and the original
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tool participants were emailed was no longer in use. The use of a large geographical

location allowed for the researcher to meet with many participants that otherwise may not

have been able to participate in the study (Snelson, 2016).

Data source two: interviews. Semi-structured interviews with the 18 MHPs

focused on participants' described experiences of burnout, and their use of coping

strategies. The researcher originally planned for 15-20 participants. The interview

questions were derived from the theory and the research questions of the study and were

therefore aligned with the gap, as both the research questions and the theory were derived

from the gap on burnout of trauma therapists. The interview questions were designed to

explore the burnout that trauma MHPs experienced. Furthermore, because the interview

questions were derived from the theory, they were then aligned with the theory.

Interviews were set to take between 60-90 minutes. Arsel (2017) noted while a

researcher may have questions guiding the interviews, participants should have control

over the descriptions of their experiences. As well as what they want to say and how they

want to say it. McGrath et al. (2019) suggested researchers take time to build rapport with

participants before they begin the interview process. Much like how therapy sessions take

place, building rapport is crucial to the interview, which enables the participant to

provide a rich, and detailed account of their experience that is the heart of the study.

Questionnaires were self-report and were filled out by participants, while

individual semi-structured interviews took place through videoconferencing software.

This provided the convenience of location to the participant as they and the researcher did

not have to agree upon a specific meeting place (Dowling, Lloyd, & Suchet-Pearson,

2016). The researcher utilized a large geographic location, this allowed the ability to meet
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with many participants that otherwise may not have been able to participate in the study

(Snelson, 2016). The researcher also utilized a recording device such as her phone, or a

tape recorder, to ensure multiple sources of recordings were available in case of failure of

any device. The researcher let participants know that should any device fail the researcher

would reach back out to them to redo or reschedule the interview. The use of

videoconferencing software allowed for the recording of the interview to take place.

Upon completing each interview, the researcher stored the recording in a folder

on a password-protected laptop which was transferred onto a password-protected flash

drive and stored in a lockbox only the researcher had access to. The researcher provided

transcript copies to each participant to check for any mistakes, to ensure what they meant

was present, to allow for any corrections to be made, and to ensure the most correct

depiction of their experience was present (Reilly, 2013). Chase (2017) and Patton (1999)

suggested member checking helps to not only ensure the credibility of the study, but it

also ensures validity and is the best way to confirm the truth of the participant’s account

of their experience.

Drabinski and Walter (2016) noted the best way to gather data that is rich in detail

and thick in description is to ask the right questions. What constitutes the right questions

will depend upon what the study is looking to examine (Castillo-Montoya, 2016). The

researcher utilized open-ended interview questions to answer the research questions about

participants' described experiences of burnout and their uses of coping strategies. During

interviews, the researcher asked follow-up and probing questions as necessary, such as

“can you explain what you mean?” “why?” and “how?” to assess the saturation of

interview responses. Saunders et al. (2018) noted researchers should choose sample sizes
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that allow for data saturation to be achieved. Saturation within interviews is necessary to

collect data that is in-depth. (Sechelski, & Onwuegbuzie, 2019; Thorne, 2020).

Data saturation. The researcher asked participants to compound upon their

responses to ensure the detail-rich depiction of their experience had emerged. The

examination of saturation during interviews ensures researchers are confident that data

obtained are sufficient in their richness of information and they conclude nothing new

will be gained from further gathering data and that any additional data gathering would

be redundant (Gentles, et al., 2015; Patton, 2015; Sandelowski, 1995, 2000; Thorne,

2020). Van Rijnsoever (2017) noted collecting data past the point that all relevant

information that is needed to gain complete insights risks being counterproductive to the

purpose of the study. Furthermore, Fusch and Ness (2015) suggested data saturation has

been reached when a study has enough information to be replicated when no new

information is gained, and when researching further does not make sense. To help attain

data saturation the researcher asked each participant the same interview questions.

Arsel (2017) argued interview protocols should be created to outline the

interview, its key points of exploration, and should include probing questions and the

initial questions. The questionnaire (See Appendix G) and interview protocols for this

study (See Appendix H) were intended to explore the described experiences of burnout

and the use of coping strategies. This study was a qualitative descriptive study that was

looking to explore and gain an understanding of described experiences of a phenomenon,

the use of a questionnaire and open-ended, semi-structured interviews were the primary

sources of data which added credibility to the study.

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Interview protocols were examined by an expert panel through the VREP tool

with permission from the creator of the tool (See Appendix D). Expert panel members

were therapists and knew the qualitative interview process. Expert panel members did not

know one another. Expert panel members were individually emailed the interview

protocols and the VREP tool. Expert panel members also offered suggestions as to how

to reframe some of the interview protocols, so they were more open-ended (See

Appendix I). They related that the protocols should garner enough evidence and had

minimal suggestions other than to reframe some of the wording. All experts agreed the

original interview questions were enough to answer the research questions of the study.

The researcher followed the suggestions for changing the wording of some questions to

enhance the interview protocols.

Trustworthiness

As with any research study, there must be confidence in the research and will be

different depending upon the type of study done (Saxena, 2017). For a qualitative study,

this comes in the form of trustworthiness, which encompasses four parts that equate to

validity and reliability. The four parts are as follows: credibility, transferability,

dependability, and confirmability (Amankwaa, 2016). Each of these components is

necessary for qualitative research (Stewart, Gapp, & Harwood, 2017).

There were two sources of data for this proposed study, a questionnaire, and

interviews. The PROQOL questionnaire by Stamm (2009) which is a validated

instrument for assessing burnout and is free for public use. The questionnaire being a

validated instrument helped to ensure that the data collected from the questionnaire was

trustworthy. The interview protocols for this study were the researcher's own interview
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questions that were derived from the theoretical model and the research questions of the

study. They were examined by an expert panel of three individuals who hold terminal

degrees and had expertise in not only mental health but qualitative methods as well.

Having the interview protocols examined by the expert panel helped to ensure the

trustworthiness of the interview questions.

Credibility. Stewart, et al. (2017) stated the quality of a research study is gained

by “vigorous processes of all the relevant information that is needed to gain complete

insights into a topic have been found” (p. 9). A trustworthy study is one that is also

credible (Korstjens, & Moser, 2018). Korstjens and Moser (2018) further stated that

trustworthiness simply asks can the data be trusted? To ensure the credibility of this study

and the findings were accurate depictions of the participants’ actual experiences it was

necessary to follow operational procedures found within similar studies (Shenton, 2004).

To further ensure the credibility of the study the researcher engaged in reflexivity or

being aware of preunderstandings of the phenomenon that may have been brought into

the study. To examine these the researcher used bracketing which allowed the researcher

to address any preconceived ideas or notions about the phenomenon before engaging with

participants (Ebe Kalu, 2019).

Subjective judgments were not the goal of the study and thus bracketing and

reflexivity allowed the researcher to remain objective. This helped to ensure subjectivity,

bias or ambiguous data did not skew the results of this study’s findings. By maintaining a

chain of evidence, the credibility was increased in this study (Leung, 2015; Shenton,

2004). In this study, a questionnaire, recorded interviews, transcripts, and notes related to

the phenomenon, provided several sources of evidence, and a chain of evidence also
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serves to improve the credibility of the study. In a qualitative study, credibility is

concerned with the truth-value of the study’s findings, and thus shows there is

trustworthiness within the study (Korstjens, & Moser, 2018). The researcher examined

participants' experiences and the meanings they attached to their experiences.

The researcher also employed member checking to ensure participants could

review the interpretations of their experiences and could comment on them, noting any

changes that may have needed to be made (Chase, 2017). Reilly (2013) noted member

checking is a common tool utilized within qualitative studies to help eliminate researcher

bias and helps researchers to set aside any preconceived ideas about the phenomenon

they may have, to be open to participants' experiences. Furthermore, member checking

also allows participants to ensure the correct understanding of their experience was

conveyed and reported (Chase, 2017).

Transferability. Transferability refers to the research being able to be transferred

to another context (Korstjens, & Moser, 2018). In addition, Vaismoradi, and Snelgrove

(2019), stated the description provided within a study should be clear and concise enough

that it should be able to transfer to other settings, and with other participants. The

researcher was not planning for generalizability of the study; but rather the research was

focused on understanding the knowledge of the phenomenon in the study. However, the

proposed study was clear enough in its descriptions that transferability was possible in

other contexts (Mandal, 2018).

Detail-rich descriptions allow readers to form their own judgments about

transferability to other contexts (Ebe Kalu, 2019). Anney (2014) noted detail-rich

descriptions of the entire research process, from participant sampling to data collection,
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methodology, and analysis, help other researchers to replicate the study with similar

conditions in other contextual settings. To further improve the transferability of this study

to other settings, the researcher minimized errors and biases that could have arisen by

utilizing member checking and bracketing and careful documentation of the study’s

processes and results. This ensured any future researchers could follow the step-by-step

process and transfer the results to another context (Kalu, & Bwalya, 2017).

Dependability. Dependability asks the question is the study stable over time

(Anney, 2014). Anney (2014) also suggested, “dependability involves participants

evaluating the findings and the interpretation and recommendations of the study to make

sure that they are all supported by the data received from the informants of the study” (p.

278). Anney (2014) further stated utilizing member checks as referred to above, and audit

trails, and code-recode strategies, will ensure a study has dependability. This study

followed the suggestions of Shenton (2004) who suggested there should be sections

devoted to a) describing what is planned and then executed, b) describing what is done

while within the field while gathering data, and c) describing the evaluation of the

effectiveness of the entire process.

Shenton (2004) also suggested in-depth descriptions will allow readers to

determine if proper steps have been taken in the research, but also allows for readers to

be able to replicate the work. According to Morrow (2005) “carefully tracking the

emerging research design and through keeping an audit trail, which is, a detailed

chronology of research activities and processes; influences on the data collection and

analysis; emerging themes, categories, or models; and analytic memos” allows for the

greatest dependability within studies (p. 252). By keeping a step-by-step- process

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documentation other researchers can follow the set forth procedures and steps, and this

allows for further dependability of the study. This allows researchers to follow what was

done and to replicate the study in other settings.

Confirmability. Confirmability refers to the ability of others to confirm the

findings of the study to be true (Hayashi, Abib, & Hoppen, 2019). To improve the

confirmability of the proposed study, the researcher utilized varying documentations.

Hayashi et al. (2019) highlighted when a researcher maintains their awareness of the

study by documenting and recording everything, they can maintain credibility within the

research. Documentation of this study began by 1) identifying the site that was utilized

for data collection and gaining permission to utilize said site, 2) introducing the

researcher and the study’s purpose to participants, 3) purposefully selecting individuals

who met participation requirements, 4) getting interested participants to agree and

consent to participation in the study, 5) collecting data through self-report questionnaires

and recorded interviews with the participants, 6) collecting and organizing data, 7)

securing and storing data onto a password-protected flash drive, and storing in a lockbox

(Morrow, 2005; Shenton, 2004).

The researcher called upon three expert panel members who all held doctorates to

review, comment, and make suggestions on the interview questions connected with each

research question in the study (See Appendix I). The researcher revised the interview

questions based upon the feedback of the expert panel members. The use of an expert

panel develops further and refines further the interview questions and helps to support the

dependability, credibility, and confirmability of the study (Anney, 2014; Korstjens, &

Moser, 2018; Morrow, 2005; Shenton, 2004).

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This research followed a naturalistic approach of qualitative descriptive research

in the analysis of data collected on the basis that reality is subjective to the experiencer,

and therefore susceptible to contextual and personal influences (McInnes, et al., 2017).

Lincoln and Guba (1985) suggested suspending subjectivity and avoid a researcher

bringing in their personal biases they can utilize bracketing, which allows the researcher

to set aside what they already know about the phenomenon. To minimize subjectivity and

bias the researcher employed reflexivity. Reflexivity is the act of noting personal biases,

opinions, assumptions, perceptions, which can all affect the data collected and the

analysis of that data (Lincoln, & Guba; Noble, & Smith, 2015).

Utilizing reflexivity helped the researcher to remain objective and allowed for

participants' own untainted meanings of the experiences to shine through (Schonfeld, &

Bianchi, 2016). Lomangino (2015) noted keeping notes, journals, or a diary can aid a

researcher in not only minimizing bias but also it can help a researcher to develop a

deeper understanding of their own opinions and perceptions over a phenomenon.

The researcher employed a naturalistic approach to analyze the data collected in the study

to ensure the findings of the study emerged from significant themes that were embedded

in the raw data (Hayashi et al., 2019). Naturalistic approaches are non-interpretive

approaches and therefore it was necessary to utilize bracketing and reflexivity to ensure

the confirmability of the study (Lincoln, & Guba, 1985).

Data Collection and Management

Permissions and informed consent. Prior to conducting any data collection, the

researcher sought permission from the Institutional Review Board (IRB) of Grand

Canyon University (GCU). After IRB approval of the study (See Appendix B), the
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researcher contacted the authorized Facebook site administrator to let her know posting

for participants selection was taking place. The researcher again at that time reviewed the

purpose of the study, and the procedures for gathering participants, as well as ensuring

participants' identities would be protected. Inclusion criteria for participation were

provided to the administrator of the Facebook group. The researcher let the administrator

know she was posting the study and would contact any interested participants using

private messages to ensure confidentiality was maintained.

Potential participants were private messaged to obtain emails from them. Once

emails were obtained an invitation asking for their voluntary participation in the study

was sent (See Appendix E). The email also included the informed consent for participants

to fill out. The consent form was derived from GCU’s provided template (See Appendix

C). The email included a reminder to retrieve the informed consent from the email

attachment, and to fill out and then return the form to the researcher.

The informed consent stated the nature of the research study and its purpose, the

voluntary nature of the participant's participation, the time it would take for their

participation, and that participants would need to consent to be recorded. The informed

consent also stated potential risks and benefits to participants because of their voluntary

participation. The informed consent also specified the confidentiality procedures that

would protect participants' information, and it explained to participants who they could

contact if they felt any issues arose. The follow-up email also included an attachment to

the demographic survey (See Appendix F) and the self-report questionnaire (See

Appendix G). Participants were reminded to retrieve this document as well.

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Subject selection. The researcher planned for 15-20 participants who responded

to the initial post and email invite and provided the signed informed consent would take

part in filling out the demographic survey and the self-report questionnaire, and the

recorded interviews for the study. 18 MHPs who met the criteria and completed all

necessary steps participated. Participants who wished to sign the informed consent with a

wet signature were encouraged to sign within the document and return it if possible, to

ensure the researcher was able to sign as well. It was noted in the email to participants

that this was however fine for them to do, and that they could print off the form from the

attachment, sign it and then send it back as an attachment.

The researcher placed all returned informed consent forms onto the password-

protected flash drive. Participants who signed the informed consent and agreed to take

part in the study were given alphanumeric code identifiers to ensure their identity

protection. No data collected in this study contained a participant’s name or identifying

information. Each participant's alphanumeric codes were assigned as S1, S2 and so forth

and were referenced as such in all documentation and parts of the study.

Data collection. Data collected from a questionnaire and interviews were used in

this qualitative descriptive study. A self-report questionnaire created by Stamm (2010),

and available for public use, and open-ended, semi-structured interviews were the sources

of data for this study. Descriptive studies require two sources of data, one of which

should be the experience as described by the individual (Magilvy, & Thomas, 2009).

Interviews are the primary source of gathering data within qualitative studies (Tessier,

2012).
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Questionnaire. The questionnaire for this study was the PROQOL questionnaire

created by Stamm (2009). (See Appendix G). The questionnaire is a self-report measure

over burnout for participants to fill out. The questionnaire was emailed to participants.

Participants were reminded to retrieve the attachment and fill out the questionnaire.

Participants who returned the questionnaire by email were scheduled for an interview.

The questionnaire was a requirement to complete an interview. Partially filled out

questionnaires were not utilized in the study.

Interview protocols. Interview questions were used through recorded interviews,

to collect data from the research participants (See Appendix H). Before conducting

interviews, the researcher contacted an expert panel. Members had a deep knowledge of

qualitative research and mental health practices. These individuals were contacted to

review, validate, and make suggestions to improve the interview questions (See

Appendix I). These three experts utilized the Validation Rubric for Expert Panel (VREP)

instrument. Dr. Marilyn K. Simon granted permission for the use of the tool within this

study (See Appendix D).

The expert panel members who reviewed the interview questions were emailed

and asked to do so and were each asked at different periods to avoid any group think as

each panel member was a graduate of GCU (Castillo-Montoya, 2016; Majid, Othman,

Mohamad, Lim, & Yusof, 2017). The experts offered suggestions for wording changes

and the removal of a couple of questions that were too similar. They each noted that the

presented interview questions should be sufficient to answer the research questions and

garner in-depth interview responses. The researcher considered the panel's suggestions

and followed them accordingly.

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Videoconferencing interviews. Semi-structured, open-ended, recorded interviews

provided a data source related to the described experiences in MHPs of the phenomenon

of burnout. Interviewing is considered the primary source of qualitative research as it

allows for participants to give descriptions of the phenomenon under examination as

experienced by them (Kim, et al., 2017). A descriptive study is about the described

experience of a phenomenon by the participant (Sandelowski, 2000). The researcher

decided due to several factors the use of videoconferencing, rather than actual face-to-

face interviews was more suitable. This allowed for participants to have control over

where the interview was taking place, the researcher could reach a broader set of

participants.

Irani (2019) noted videoconferencing or video recorded interviews allow for

researchers to reach a greater geographical set of participants, it eliminates time

constraints, and it helps to ensure trust as participants are in a location of their choosing.

Irani (2019) also noted videoconferencing is convenient for those who cannot conduct

face-to-face interviews. In this study, 18 interviews took place over videoconferencing

software. Each interview was one-on-one with the participant in a private location of their

choosing so others could not hear the conversation.

Interview preparation. Before each interview, the participants were asked to

verbally consent to the video recording of the interview. An informed consent letter was

signed by each participant (See Appendix C). Irani (2019) noted recording an interview

can provide effective measures for capturing data from the interview process. The

videoconferencing software had a feature that allowed for video to be turned off. This

feature provided further protection of the participants’ identities. Participants were

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notified of this so they understood that no identifying information would be present

during the interview process. Each interview was set to last between 60-90 minutes.

Data protection. A new password-protected flash drive was used for this study.

The researcher gave the flash drive a password that only she knew. The password was

eight characters long and included one alphanumeric character. A password of this length

meets the criteria for many password security standards of websites. The flash drive

contained the alphanumeric code of the participant and their respective questionnaire and

interview as well as their transcript. A backup flash drive would have been utilized

should there not have been enough room on the first. Using alphanumeric codes for the

questionnaires and interview sessions for the participant allowed for their identities to be

protected. The flash drives were locked inside a lockbox within the researcher’s home

while not in use. The researcher was the only one who had access to the box.

This kept with IRB standards in that data would be kept for three years from the

date of publication and would be protected during that time. Only after the three-year

timeframe would the data then be destroyed by either electronic deletion or shredding if

paper. Pursuant to IRB research requirements, the researcher also would maintain

documentation explaining when what, and how all data from the study would be

destroyed. This ensured the policies of GCU’s IRB were correctly followed.

To maximize the security, privacy, and confidentiality of the recordings, the

researcher transcribed the recordings by hand. This ensured that there would not be a

third party involved and that data was protected. Videoconferencing software Zoom was

used, the privacy policies of zoom also applied. The method of hand transcription was

utilized as it allowed the researcher to have control over the data, while also allowing for
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fewer individuals to be in contact with the data. In addition, this allowed for the

protection of the participants as well as only the researcher had access to the interview

data.

Ethical considerations. This study posed minimal known risks to participants’

mental, physical, or emotional health or well-being. This study conformed to the ethical

principles outlined within the Belmont Report. The Belmont Report requires that

researchers who utilize human participants, need to adhere to the ethical principles of

respect, justice, and beneficence. To eliminate the presence of coercion or

preferentialism, participants that were known to the researcher were not utilized (Belmont

Report, 1979). As a study involving human subjects, the researcher considered the ethical

adherence to the principles of research prescribed in the Belmont Report as a legal,

ethical, and binding obligation. The researcher conscientiously followed these principles

throughout the conduct of this study.

Self-report questionnaires provided the initial set of data while individual semi-

structured, open-ended interviews provided the primary source of data to examine MHPs

described experiences of burnout, and their use of coping strategies. The questionnaires

were emailed to participants to fill out and return to the researcher. Interviews were

arranged and conducted individually with participants. There was not a possibility of

influence by others on participants' statements since participants were individual

therapists even if working within a group setting. Participants were emailed individually;

therefore, minimal possibilities of participants' statements being shared with other

participants existed. Email services could hold onto copies of emails between the
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researcher and the participant. The researcher reminded participants of this possible risk

and asked them to refrain from sharing sensitive information through emails.

As a qualitative descriptive study, this study sought to produce a credible

knowledge of understandings of described experiences (Sandelowski, 2000). During the

data collection and data analysis periods of this study, a neutral approach was necessary.

Remaining aware of any potential bias was also necessary (Belotto, 2018). The researcher

made every possible effort to ensure personal beliefs, feelings, assumptions, and

perceptions were set aside and did not influence any aspect of the study. The researcher

treated all participants with respect, dignity, and in an equal and fair manner.

Data Analysis Procedures

The goal of this qualitative descriptive study was to explore how MHPs, who treat

trauma, in the U.S., described their experiences of burnout and their use of coping

strategies. This study included the following research questions below, where RQ1 was

the overarching research question and RQ2 specified the supporting research question.

RQ 1: How do MHPs, who treat trauma, in the U.S., describe their experience of

burnout?

RQ2: How do MHPs, who treat trauma, in the U.S., describe their use of coping

strategies?

The two research questions guided the collection of data and the analysis of the

data used within this study. The researcher explored the research questions through

themes that developed from the qualitative data collected in this study. Data in this study

were interviews, interview transcripts, and a self-report questionnaire. The two research

questions were supported by the data that was collected and analyzed from the self-report
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questionnaire and interview transcripts. As noted in Table 1, data gathered through a self-

report questionnaire and interviews were used to answer each of the research questions.

Table 1.

Research Questions with Related Sources of Data

Research Questions Data Source
RQ1: How do MHPs, who treat trauma, in the U.S., Questionnaire, Interview Transcripts
describe their experience of burnout?

RQ2: How do MHPs, who treat trauma, in the U.S., Questionnaire, Interview Transcripts
describe their use of coping strategies?

Data in this study were coded by hand using descriptive coding, rather than

coding in MAXQDA, a tool for analyzing text and qualitative data, and were analyzed

with Saldaña’s four-step thematic analysis. Descriptive coding condenses a set of text of

qualitative data contained within a word or sentence or phrase (Saldaña, 2015). Clarke

and Braun (2013) highlighted thematic analysis allows for many different types of

qualitative data to be coded, thus maximizing the potential of themes and codes to be

discovered. Similarly, Green (2014) explained thematic analysis is not tied to any one

theoretical framework, making it not only the most utilized method for analysis but also

making it the most flexible method utilized to analyze qualitative data.

Belotto (2018) stated researchers should utilize the method of analysis that aligns

with their study. Thematic analysis is a beneficial analysis method for summarizing

characteristics of large data sets, which forces researchers to take a well-built approach to

handle the data, which in turn helps to produce a clear and organized final report

(Nowell, et al., 2017). Thematic analysis suited this study as uncovering themes in the

data relating to MHPs described experiences of burnout and uses of coping strategies was

necessary to address and answer the two research questions of this study.
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Data from the questionnaires were coded first, then interview transcripts were

coded using descriptive coding. The codes generated from both data sets were organized,

categorized, and analyzed with thematic analysis individually, and then were combined,

organized, categorized, and analyzed together with thematic analysis to generate themes,

which delivered meaning in the data related to the research questions of this study

(Vaughn, & Turner, 2016). The thematic analysis approach as outlined by Saldaña (2015)

was used to guide the data analysis procedure. Saldaña (2015) suggested that individuals

should identify codes in the data, categorize those codes, then develop comprehensive

themes relevant to the inquiry through high-level categorization of categories.

Per Saldaña’s step-by-step guidelines the researcher followed the four-step

process for analysis for each set of data: 1) identify codes within the data, 2) create

categories of codes, and develop high-level categories, 3) review high-level categories

and synthesize them to generate themes through analytic memos, 4) apply revealed

themes to the research questions of the study.

Four step process.

Step 1: Identify codes in the data: in this step, the researcher summarized

segments of data using codes. Questionnaires were coded by summarizing the segments

of the data. Transcripts of the interviews were coded by summarizing segments of the

data. The researcher noted any impressions or ideas that came up during the examination

of the data of either source. Maguire and Delahunt (2017) noted at this stage the data

should be very familiar to the researcher. MAXQDA was used to assign codes or

descriptive labels to segments of data from the questionnaires and the interview

transcripts. After the self-report questionnaire was coded, the interview transcripts were
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coded. Codes were identified by examining the questionnaire data line-by-line,

highlighting the key phrases, words, explanations, and ideas that were relevant to the

research questions. Then codes for the transcripts were identified by examining the data

line-by-line, highlighting the key phrases, words, explanations, and ideas that were

relevant to the research questions.

Step 2: Create categories of codes, develop high levels of categories: this is the

point of examination when codes are categorized. Maguire and Delahunt (2017)

highlighted researchers can create categories that relate specifically to the research

questions. Additional codes that were of importance were added as well. This included

any codes relevant to the study regarding burnout and coping. In this step, the

commonalities between codes were identified, grouped into categories of meaning, and

high-level categories were developed. Vaismoradi, Jones, Turunen, and Snelgrove (2016)

noted meaning and meaning categories should be descriptors and have a level of depth to

them, this ensures that the researcher has not prematurely stopped data analysis.

Step 3: Review high-level categories and synthesize them to generate themes

through analytic memos. Clarke and Braun (2013) stated a theme is characterized by its

significance. The themes can be anything that relates to one another, relates to an overall

idea, or is relating specifically to a certain code (Maguire, & Delahunt, 2017). The

researcher examined high-level categories to look for themes and used analytic memos to

consider and conceptualize the relationship between any of the high-level categories.

Step 4: Apply revealed themes to the research questions of the study. This step

involved considering the themes that emerged and the relevance of those themes in

answering the research questions of the study. After this step, a descriptive study report
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was written surrounding the findings of the themes that emerged in relation to the

research questions of the study. Once the researcher reached this stage the results were

written up within chapter 4 of the dissertation with discussions of the process.

Merging of data. The four-step process took place for each set of data from the

questionnaires and the transcripts. Once all the codes were identified in each source of

data, codes from the questionnaires and codes from the interview transcripts were then

combined to become one set of codes. Codes from both data sets that repeated, such as

words, key phrases, explanations, and ideas were identified and were merged together to

form one set of codes. The resulting data from combining the two data sets was then

examined through the four-step process, thus ensuring that all data were thoroughly

examined, coded, reviewed, and analyzed for themes.

Data saturation. The researcher utilized the concept of data saturation to enhance

the trustworthiness of the proposed study. Cleary, Horsfall, and Hayter (2014) suggested

data saturation may not be achieved with small amounts of participants. While Saunders

et al. (2018) noted data saturation, is the point when no new codes are found in the data

and that codes are beginning to repeat. In following the idea of Saunders et al, data

saturation was achieved when no new codes presented themselves, and codes began to

overlap one another.

Ethical considerations. The ethical concerns of this qualitative descriptive study

were minimal. Before conducting the proposed study, the researcher completed extensive

and necessary ethical training. Collaborative Institutional Training Initiative (CITI) is one

such training tool that is utilized by researchers (Cugini, 2015; Lotto, 2018; Ngozwana,

2018). This tool provides researchers the basic understanding and knowledge of the
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requirements that are needed to abide by the ethical standards of the research process. In

addition, CITI training is often required not only by universities but also by the

Institutional Review Board, before research can be conducted (Ketefian, 2015).

Furthermore, the Belmont Report (1979) requires that researchers who utilize

human participants need to adhere to the ethical principles of respect, justice, and

beneficence. To eliminate the presence of coercion or preferentialism, participants that

were known to the researcher were not utilized. Furthermore, participants were selected

on a volunteer basis, were adults, and were of sound mind. Moreover, participants were

informed that to protect their anonymity and confidentiality participants would be

assigned alphanumeric codes S1, S2 and so on. The researcher also informed participants

that they had the choice to stop at any time with no repercussions to them.

The researcher protected all participants and followed all guidelines set forth by

the IRB of Grand Canyon University (GCU). The researcher submited the proposed study

to the IRB for approval to ensure the study addressed all possible ethical implications.

The following items also ensured the ethical conduct of this study.

1. The approval of the IRB was gained before completing any research steps
outlined in this study.

2. The administrator of the Facebook group had approved the use of the group to
gather participants (See Appendix A).

3. Informed consent documentation was signed by each participant before research

began.

4. The use of alphanumeric codes were assigned to participants to ensure

confidentiality in both the self-report questionnaire and the transcripts, the
reporting of the data analysis, and the portions of recordings from the interviews
as well.

5. Data about the study, such as questionnaires, transcripts, audio files, consent
forms, and email communications were maintained on a password-protected flash
drive and placed into a lockbox in the researcher’s home that only the researcher
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had access to. Data was kept for the timeframe required (3-years after publication
of the dissertation.), and at the end of that timeframe would be destroyed either by
electronic deletion or shredding. Data was saved during the entirety of the
dissertation process on the password-protected flash drive and would only be
deleted once the dissertation was published and the required timeframe had
passed.

6. Confirmation of the participants' understanding of their participation in this study

and their right to withdraw at any time ensured minimal risks to the ethical
considerations afforded participants.

7. Participants' contributions to the study would remain as they were presented and
not changed.

8. Participants had the right to decline to answer any questions or could skip any that
were uncomfortable for them. However, the researcher tried to ensure that no
questions would be asked that could have invoked any feelings of negativity.

9. Reviewing transcripts ensured that they were accurate and did not contain any
mistakes.

10. The researcher gave the data collected in this study fair and unbiased
considerations.

11. The researcher was conducting this research for educational purposes only with
the participants.

Limitations and Delimitations

Limitations are a part of research no matter the method chosen and are going to be

present in research as every part of the research cannot be controlled (Wargo, 2015).

Limitations are imposed restrictions that are out of the control of the researcher

(Theofanidis, & Fountouki, 2019). Wargo (2015) noted limitations can impact the

outcomes of a study. There was a possibility of design limitations within this study.

Theofanidis and Fountouki (2019) noted with the use of descriptive designs there are

limitations to the scope of responses that could be gathered, meaning participants may

have answered what they believed the researcher wished to hear.

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Personal assumptions about the concept of burnout that the researcher may have

brought to the study could have made it difficult to convince readers the conclusions

drawn in this study were free from bias. This was also related to the descriptive design as

nothing was inferred within descriptive designs but rather descriptions were kept as close

to the data as possible. Readers of the current study may have argued that a descriptive

design and only 18 MHPs was not a large enough sample of the MHP population to

examine the phenomenon of burnout in depth.

By doing a descriptive study with only 18 participants, this limited the amount of

data to be collected for this study and this limited the extent that the findings of this study

would have, and the conclusions that could be drawn from the findings. Additionally, by

only utilizing 18 MHPs for the questionnaire and semi-structured interviews, this also

limited the range of data that could be collected, had a larger sample size been chosen.

The deliberate selection of MHPs who treat trauma could have limited the array of

participants' backgrounds and diversity. The utilization of purposive sampling to select

the MHPs for the study could have raised questions as to whether a greater understanding

of the phenomenon under investigation could have been achieved. Despite this limitation,

purposive sampling helped to find participants who met the criteria and were well-

informed of the phenomenon being studied.

This study had data collection instrument limitations. The questionnaire was a

self-report measure and therefore participants experience of burnout may not have been

generalizable to other contexts. Even though the interview protocols for participants had

been reviewed and approved by a panel of mental health professional experts, the

interviews were not face-to-face in a traditional method, as videoconferencing software

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was used to conduct the interviews. This may have contributed to a lack of trust between

the participants and the researcher as there was not personal interactions, but impersonal

interactions. Furthermore, there were also time limitations to this study as with any study,

and the interviews were therefore scheduled for a time that was convenient for both

parties.

A further limitation of this study was that individual MHPs were interviewed

singularly. They may have been able to share their responses with others should they

have chosen but were not interviewed with any other MHPs. It was unlikely that this

limitation would undermine the results of this study. Additionally, gender could have

been considered a limitation, however, since there was not a specific gender being

examined within this study, this was not considered a limitation of the study.

Furthermore, participants who did not engage, or who withheld information could

have limited the results related to the research questions. In addition, participants may not

have been honest in their description of their experience of burnout which could have

limited the data garnered to answer the research questions. There was not a way to verify

if the information the participants shared was true, therefore the use of interviews ensured

that there was the reliability of the information being presented (Jacob, & Furgerson,

2012).

Delimitations are situations or factors the researcher can control (Turner, &

Crane, 2016). They are deliberate choices the researcher makes to the research study

(Theofanidis, & Fountouki, 2019). Further, delimitations to this study were necessary to

ensure that specific criteria for participation were met (Luciani, et al., 2019a). The

proposed study was delimited by several points; they were: MHPs must have been fully
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licensed within the United States. Interns were not included as they did not have the

clinical experience needed for participation. MHPs must have treated trauma, this was

directly related to the gap, and as such, this was a requirement. MHPs must have been

still currently practicing as an MHP, as retired MHPs experiences of burnout were not

current, and thus held no merit for understanding the phenomena of burnout in MHPs.

Moreover, MHPs must have been between the ages of 20-65 as this age range allowed for

a deeper understanding of the phenomena of burnout to be gathered.

Data sources were delimited to questionnaires and interviews. Although there

may have been alternative data sources to gather information from, such as surveys, or

focus groups, questionnaires and interview data were the data sources chosen, as it

allowed for the most in-depth details of the phenomena to be gathered (Arsel, 2017;

Clark, & Vealé, 2018). Although burnout in MHPs remains a concern (Ballenger-

Browning, et al., 2011), this study was delimited to MHPs who treat trauma to examine

their described experiences of burnout. A descriptive design was best suited for a singular

researcher and allowed for the most flexibility of garnering an understanding of the

phenomenon of burnout. By delimiting this study to MHPs who treat trauma, it allowed

for this study to identify strategies for managing and coping with burnout that would be

useful for MHPs who treat trauma or would-be treating trauma.

The researcher did not intend to generalize the results of this study beyond mental

health professionals who treat trauma due to the limited extent of data that was collected

from the small sample. However, burnout could affect every individual who works within

the healthcare setting (Wardle, & Mayorga, 2016). This study was however delimited to

the United States to ensure that a broad depiction of mental health professionals'
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descriptions of the experience of burnout was being gathered. This delimitation ensured

that various mental health professionals could be reached and could share their

experiences of burnout. This also allowed for a broader base of professionals across the

United Statese to be reached.

Summary

The rationale for conducting this qualitative descriptive study was to explore and

examine a) what are the described experiences of burnout in mental health professionals

who treat trauma in the U.S.? and b) what are the described experiences of mental health

professionals who treat trauma, in the U.S., uses of coping strategies? To examine the

research questions, it was necessary to understand, explore, and explain the participants'

described experiences of burnout, and their use of coping strategies. This study employed

a qualitative methodology as it allowed for an understanding of human experiences,

beliefs, and cultures (Kalu, & Bwalya, 2017; Luciani, et al., 2019b). Qualitative research

allowed for examining how participants attached meaning to their experiences of a

phenomenon (Cope, 2014).

This study focused on understanding burnout, and the use of coping strategies to

manage burnout. Sandelowski (2000) noted descriptive designs are appropriate when

trying to gain an understanding of a described experience, as described by an individual.

Bradshaw et al. (2017) stated descriptive designs help a researcher to answer the how and

why questions of a phenomenon. Moreover, Kim et al. (2017) stated a descriptive design

allows for a line of examination of the phenomenon as described by individuals who have

experienced it. Given burnout is still not a well-understood phenomenon, a descriptive

design was appropriate for this study.

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Self-report questionnaires and individual, open-ended, semi-structured interviews

provided necessary data to answer the research questions within this study (Qu, &

Dumay, 2011). Tessier (2012) stated interviews are the main source of data collections,

especially when considering qualitative methodology, or human research. The researcher

recorded and transcribed interviews of individuals who participated in this study. Data

from the self-report questionnaire was analyzed. Transcripts from the interviews were

reviewed for data analysis also and the data from both sources was coded then combined

to examine for themes. The researcher recruited 18 MHPs who treat trauma to participate

in the study.

The participation of individuals was voluntary, and participants had the option of

withdrawing from the study at any point in time. Before participating in the study each

participant signed and submitted to the researcher an informed consent. Grady (2015)

stated informed consent is the legal authorization of participation in an activity that is

based on the understanding of what that activity will entail. The informed consent should

also detail the purpose of the research, the voluntary choice to participate, the time

constraints of the study, and note that interviews will be recorded (Lentz, Kennett,

Perlmutter, & Forrest, 2016). The informed consent for this study presented all these facts

to the participants.

To maintain confidentiality, the researcher utilized a password-protected flash

drive to store participants' questionnaires, recorded interviews, transcripts, informed

consents, and any other study information. Participating in the questionnaires and

interviews signified that information gathered from the interviews were private. The
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researcher reminded participants that their information would be held for three years, and

then would be destroyed. The researcher reminded participants that their identity would

be protected through the utilization of alphanumeric codes. The researcher reminded

participants to refrain from sending any sensitive information through emails.

The sources of data that were used to answer the research questions for this study

were a self-report questionnaire, interviews, and their transcripts. The thematic analysis

as outlined by Saldaña (2015) was utilized to guide the analysis of the data. The

researcher followed the four-step thematic analysis process: 1) identify codes within the

data, 2) create categories of codes, and develop high-level categories, 3) review high-

level categories and synthesize them to generate themes through analytic memos, 4)

apply revealed themes to the research questions of the study. The thematic analysis

approach provided the ability to uncover themes, which relayed the meaning in the data

that was related to the study’s research questions. Heracleous and Fernandes (2019) noted

utilizing a software program can help researchers to manage multiple sets of data.

To ensure the trustworthiness of the study, the researcher ensured that there were

no subjective judgments present in the research that could affect it. The researcher

utilized member checking to further improve the trustworthiness of the study. Opinions,

perceptions, and assumptions were set aside as possible, to collect the data in an unbiased

manner. The researcher stored the questionnaires and transcripts on a password-protected

flash drive to ensure further the trustworthiness of the study (Shenton, 2004). The

researcher utilized three expert panel members who held doctorates, to review, comment,

and offer suggestions on the interview questions as to their ability to answer the research
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questions in this study. This further supported the trustworthiness of this study (Stewart,

et al., 2017).

This research had minimal risks to participants. The researcher conducted a

morally sound and ethical study that contributed to the highest practice of qualitative

research. This research followed the principles of the Belmont Report to ensure

participants were granted respect, justice, and beneficence. This assured that participants

were protected.

Chapter 4 reports the findings of this study based on the thematic analysis of the

data collected. Chapter 4 provides a discussion of the data gained from the open-ended,

self-report questionnaires and semi-structured interviews. Chapter 4 also contains the

analysis of the data collected in the study and the answers to the research questions.

While chapter 5 discusses the results and provides future recommendations.

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Chapter 4: Data Analysis and Results

Introduction

Previously to this research it was not known how mental health professionals,

(MHP) who treat trauma, in the U.S., described their experience of burnout and their use

of coping strategies. Burnout is often caused by individual, organizational, or specific job

factors (Simionato, et al., 2019). MHPs are often left to their own means for coping with

burnout; stress levels are often higher, and MHPs often maintain a high client caseload

(Schaufeli, et al., 2017). There is a small body of empirical research on burnout that

indicates the toll burnout can have on MHPs, however empirical research on burnout

continues to grow (Maslach, & Leiter, 2016). Researchers suggested that creation of a

self-care plan can be of use to mitigate burnout MHPs may face (Neff, et al., 2007;

Nelson, et al., 2017). Regardless of these suggestions, studies have shown burnout to be a

continued problem within helping professions (Coleman, et al., 2016; Vlachou et al.,

2016). Therefore, there was a need to explore how MHPs, who treat trauma, in the U.S.

described their experience of burnout and their use of coping strategies.

The purpose of this qualitative descriptive study was to explore how MHPs, who

treat trauma, in the U.S., described their experience of burnout and their use of coping

strategies. High rates of burnout are leading to a turnover in MHPs (Benuto, et al., 2019).

Given there is a high number of MHPs that leave the field due to burnout (Hamidi et al.,

2018), this study provided useful understandings of specific strategies that were most

likely to minimize the experience of burnout. Specific strategies that addressed burnout

and coping that were uncovered in this study helped to illuminate ways to mitigate the

experience of burnout in MHPs, who treat trauma within the U.S.

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This study utilized a qualitative descriptive methodology. This was necessary to

gain a deeper understanding of the phenomenon under study (Kim, et al., 2017).

Descriptive design was appropriate for this study as the focus of this design is to gain an

understanding of how individuals described the experience of certain events, such as

those this study explored, wherein participants described experiences of burnout (Kim, et

al., 2017; Magilvy, & Thomas, 2009). This study aimed to gain an understanding of

individuals described experiences pertaining to burnout, and to explore strategies to

manage burnout. This study was exploratory, and therefore qualitative methodology and

a descriptive design were the most appropriate for this study.

The research questions which guided this qualitative descriptive study were

intended to help address the problem statement of it was not known how MHPs, who

treat trauma, in the U.S., described their experiences of burnout. This study included the

research questions below where RQ1 was the overarching research question and RQ2

specified the supporting research question.

RQ 1: How do MHPs, who treat trauma, in the U.S., describe their experience of

burnout?

RQ2: How do MHPs, who treat trauma, in the U.S., describe their use of coping

strategies?

To answer the research questions, data was gathered from two different sources.

The first data source was a self-report questionnaire that measured burnout, compassion

satisfaction and secondary traumatic stress. The second source of data came from semi-

structured interviews with 18 MHPs who treat trauma, in the U.S. The merging of data

from these two sources allowed for evaluation and association of pertinent information
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within this study concerning burnout and the use of coping strategies (Atmowardoyo,

2018). The merging of the two data sources allowed for improved trustworthiness of the

study as well (Anney, 2014).

Chapter 4 presents the comprehensive and thorough explanation of the findings of

this qualitative descriptive study. The chapter explains the process of thematic analysis

that was used to analyze the data gathered in this study. Lastly, the chapter provides a

concise summary of the results of the study.

Descriptive Findings

This section provides a narrative summary of the characteristics and

demographics of the participants in the study, and the amount of data that were gathered

in the study. A purposeful sample of 18 MHPs, who treat trauma, in the U.S. were

selected to participate in the study. Eligible participants were those which met the

following criteria: (a) were between the ages of 20-65; (b) Had a current and valid, full

mental health license (No intern licenses.); (c) Had been in practice at least 2 years and

were currently practicing; (d) Had experienced burnout of some degree; (e) Provided

trauma therapy of some form; (f) Were located within the United States; (g) Were

unknown to the researcher, and (h) Agreed to be recorded. This study was limited to

include only MHPs in the U.S. that treated trauma. MHPs in this study were from varied

practice settings throughout the U.S.

Setting. This study was conducted from the researcher’s home office over Zoom

videoconferencing software. Due to the pandemic (COVID-19) that was taking place,

most activities had to be done remotely, thus individual participants were in their own

respective office setting. To allow for the greatest number of participants, and because
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the entire United States was included within the geographic location, videoconferencing

software was best suited to conduct the interviews. The administrator of a Facebook

group for therapists helped facilitate the initial contact of participants by allowing the

researcher to post the recruitment script to the group..

During the interviews, the office door was closed. Interviews were conducted

with headphones plugged into the researcher’s laptop to prevent any individuals from

hearing the interview. The office door also had a do not disturb sign on the door.

Interviews were recorded with Zoom. Zoom was set up to have a required password to

enter the waiting room, participants had to be let in by the researcher, and the meeting

was locked once individuals were in the meeting.

In the instance that the videoconferencing software cut out or cut off the

researcher paused the recording until participants were back in the Zoom interview. Then

the researcher asked for participants to repeat their answers, or the researcher repeated the

question once the interference was finished. Interviews were recorded and as such the

researcher asked participants if they gave consent to be recorded. Consent was given

prior to the start of the interviews. Interviews took place over the course of the summer of

2020.

Participant profiles. Data in the study were gathered from MHPs that had

experience with treating trauma. An initial post was created within the Facebook group

for therapists, with the recruitment script attached to the post. Participants who met the

criteria reached out through private message or email, and the informed consent was sent

to the participant through email, which was asked for during initial contact with those

who utilized private messages. Originally the researcher planned that the first 15-20
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individuals who returned the signed informed consent would participate however, three

individuals did not respond back to the email which contained the consent form, and two

emailed and backed out. Participants signed the informed consent with the sign feature in

the pdf document and sent it back in pdf form.

Upon return of the informed consent, individuals were emailed a demographic

survey, and a self-report questionnaire. Participants who did not return the demographic

survey (which asked for background information such as their age, gender, race,

ethnicity, and highest degree level) or the burnout questionnaire, did not participate as

each was necessary to schedule an interview. Once the necessary paperwork was

completed, an interview was then scheduled for a time that was convenient for the

participant.

The 18 MHPs who participated in the study sent back, through email, signed PDF

copies of the informed consent forms. Upon receiving the signed form, the researcher

opened a password protected folder on their password protected laptop, labeled

participants and placed the consent form into the respective subfolder that was created for

the participant. Subfolders were labeled S1, S2, and so forth all the way to 18. To ensure

that confidentiality was maintained, all participants were given alphanumeric identifiers

such as S1, S2, and so forth, and were referred to as such throughout all documents

within the study. No data gathered were associated with the participants name or

identifying information.

Individuals who participated in the study ranged from self-employed MHPs to

supervisory MHPs, in settings of private practice, and within agencies. Of the 18

participants, two were male and the other 16 were female. The following states were
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represented in this study: Pennsylvania, Kansas, California, Nevada, Arizona, North

Carolina, Michigan, Texas, Maryland, Tennessee, and Ohio. Figure 2 below depicts the

states listed in this study, and the number of years participants had been in practice. All

participants had a license and had been practicing for at least two years and were still

currently practicing. Each state governing board specifies the requirements to hold a

license (Burns, & Cruikshanks, 2018). Since states hold such differing licenses and

qualifications to receive those licenses, table 2 depicts the license that was held by each

respective participant, and their gender. Links to each state governing board site for the

states represented in this study are listed in Appendix Q.

Participants years in
States represented practice
Kansas S1- 8 years
S2- 20 years
Pennsylvania
S3- 15 years
California
S4- 7 years
Texas
S5- 12 years
Maryland S6- 12 years
Nevada S7- 14 years
North- Carolina S8- 16 years
Ohio S9- 7 years
Arizona S10- 16 years
Michigan S11- 10 years
S12- 6 years
Tennessee
S13- 12 years
S14- 20 years
S15- 3 1/2 years
S16- 6 years
S17- 6 years
S18- 14 years

Figure 2. States represented and participants years in practice.

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Table 2.

License Held and Gender of Participants

Subject License Held Gender
S1 LPC Female
S2 LCMHCS, LCASA, CCSOTS Female
S3 LSCSW Female
S4 LMFT Female
S5 LMFT Female
S6 LCDC Female
S7 LICSW Female
S8 LPC, MHSP Female
S9 LSCSW Female
S10 LCPC Female
S11 MFT Female
S12 LASAC Female
S13 LPC Female
S14 LCSW Male
S15 LSW Female
S16 MSW, LSCSW Female
S17 LCPC Male
S18 LMFT Female
Note. License acronym definitions available in table P14 in Appendix P.

Data sources. Two different sources of data were utilized in this qualitative

descriptive study. The first source of data was a self-report questionnaire. The second

source of data was from semi-structured, open-ended interviews. Additionally,

participants completed a demographic survey for background information purposes as

well. This ensured that participants met the minimum criteria for participation.

Questionnaires. 40 participants were originally sought for filling out the self-

report questionnaires, however, due to the pandemic only 18 participants were gained to

fill out the questionnaire. Due to the restrictions the pandemic led to, and the population

of this study being mental health professionals who were doing teletherapy, Zoom fatigue

from being on teleconferencing software led to the reduced number of 18 participants for
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the questionnaires (Bailenson, 2021). The self-report questionnaires were emailed to

participants once informed consent was signed and returned. The self-report

questionnaire contained 30 questions relating overall to burnout, within those 30

questions were questions intended to also measure compassion satisfaction and secondary

traumatic stress. Participants answered the questions using a five-point Likert-type scale,

where 1 was never, 2 was rarely, 3 was sometimes, 4 was often, and 5 was very often.

Participants rated their answers to each statement using the Likert-type scale. The

researcher then scored the participants answers for each subscale based upon the

recommendations by Stamm (2009).

Table 3 depicts the questions used for each subscale and scoring levels (low,

moderate, or high) based upon Stamm’s scoring. (See Appendix K for individual

participant scores). These scores were then analyzed to examine the level of burnout for

each participant, which aided in the creation of codes relating to the data of the study.

Table 3.

Questionnaire Scoring
*indicates to reverse score ex.
Scoring Question Numbers
1=5 instead
Burnout 3, 6, 12, 16, 18, 20, 22, 24, 27
CS 1*, 4*, 8, 10, 15*, 17*, 19, 21,
26, 29*
STS 2, 5, 7, 9, 11, 13, 14, 23, 25, 28
Totals 22 or less = low 23-41 = moderate 42 or more = high

Interviews. Semi-structured open-ended interviews provided the primary source

of data that related to the phenomenon of MHPs described experiences of burnout and

use of coping strategies. All 18 interviews were conducted over Zoom videoconferencing

software. Each of the 18 interviews were conducted privately with the respective

participant, within the private home office of the researcher and the private office of the
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participant. The office door of the researcher’s office was closed, and a do not disturb

sign was placed upon the door. Additionally, the researcher had headphones plugged into

the computer so that no one could hear the participants responses.

The interviews with participants were recorded through Zoom. The average time

of interviews was approximately 47 minutes. The total combined interview times with all

participants was 845 minutes. It was determined through conversations with the

researcher’s previous chair, and AQR reviewer that three extra participants would need to

be interviewed to account for the shorter interview times to ensure that saturation was

reached. This brought the total participants from 15 to 18. Because this was during the

pandemic there was trouble in gaining participants, as the population were therapist that

were doing telehealth and were experiencing burnout from Zoom itself, which made it

harder to get to the intended 60 minutes.

The researcher hand transcribed the interviews to allow for more control of the

transcription, and to help eliminate possible errors. A total of 267 pages of transcripts

were produced from all recorded interviews. The average transcript produced from each

participant’s interview was approximately 15 pages. Samples of interview transcripts are

included in Appendix R.

Table 4 depicts the date, time, length of interview, and the number of transcribed

pages. Each transcription was single-spaced, and were done in Times New Roman font,

font size of 12. Transcripts were thoroughly reviewed to pinpoint key words, phrases,

descriptions, and explanations which added to the formation of themes that were present

in the data.
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Table 4.

Interviews of Study Participants

Number of Transcribed
Date and Time of Pages
Subject # Length
Interview (single Spaced)

Subject 1 07/24/20 1:00 p.m. 34 11

CST
Subject 2 08/07/20 3:00 p.m. CST 40 13
Subject 3 08/15/20 1:00 p.m. CST 49 14
Subject 4 07/25/20 1:00 p.m. CST 50 15
Subject 5 07/26/20 12:30 p.m. 40 12
CST
Subject 6 07/26/20 4:00 p.m. CST 77 16
Subject 7 07/31/20 6:00 p.m. 52 13
CST
Subject 8 08/13/20 5:00 p.m. CST 45 14
Subject 9 07/29/20 10:30 a.m. 47 12
CST
Subject 10 07/30/20 10:00 a.m. 48 13
CST
Subject 11 08/02/20 10:30 a.m. 42 13
CST
Subject 12 08/02/20 3:00 p.m. CST 41 12
Subject 13 08/07/20 12:00 p.m. 35 15
CST
Subject 14 08/17/20 2:00 p.m. CST 38 11
Subject 15 08/19/20 5:30 p.m. CST 50 18
Subject 16 08/24/20 1:00 p.m. CST 59 15
Subject 17 08/29/20 2:30 p.m. CST 53 16

Subject 18 09/10/20 1:00 p.m. CST 45 16

Average 47 15
(Rounded)
Total 845 minutes 267 pages

Data Analysis Procedures

This study sought to explore, gain an understanding, and illuminate the

phenomenon of burnout experiences through the subjective descriptions of participants.

Data gathered through self-report questionnaires, and semi-structured, open-ended

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interviews provided a comprehensive understanding of the phenomenon under study. All

data collected in the study were prepared, organized, and analyzed to answer the research

question of the study. Each source of data went through the four-step thematic analysis.

This ensured that the data was sufficiently analyzed to garner the themes of the study.

Preparing the data. The researcher printed the completed self-report

questionnaires from each participant. The questionnaires for each participant were

labeled with their assigned alphanumeric code and were stored with their respective

transcript. This ensured that the correct questionnaire was aligned with the correct

participant. The researcher hand transcribed interviews by listening to the recordings of

the interviews and typing up what was heard. When there were questions as to what was

heard the researcher replayed the audio several times. Additionally, when it was unclear

what was said because the Zoom software cut out, or there were other types of

interference that made it indistinguishable, it was noted as inaudible. Furthermore, names

and locations when presented were redacted to ensure confidentiality of the participants

identifying information. Additionally, any explicit words were labeled as such.

The researcher listened repeatedly and carefully to each interview minute by

minute to ensure that the transcript produced were as correct as possible. Transcription

took place from the end of September 2020 to the end of October 2020. Transcripts were

sent to participants to ensure that everything was correct and there were no mistakes

present in the transcripts and that what was said was correctly captured. Participants had

a week to review the transcripts and confirm the accuracy. Only one participant had any

changes that were requested, and the changes were related to spelling errors.
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Analyzing the data. This section further expands upon the data analysis

procedures noted within chapter 3. Data collected through questionnaires, and interviews

were individually coded using descriptive coding. Descriptive coding condenses passages

of data that contain specific words or key phrases that are contained in the data (Saldaña,

2015). Codes from the two data sources were combined, grouped into categories, placed

into higher-level categories, and then were analyzed across all data with thematic

analysis, to generate themes which expressed meaning in the data that was related to the

research questions of the study. The two research questions of the study were supported

by the data that was collected and analyzed from both data sources.

According to Miles, Huberman, and Saldaña (2014) codes are described as labels

that give symbolic meaning to the data of the study. Codes are often attached to chunks,

or segments of data (Saldaña, 2015). Miles et al. (2014) noted that coding is often the

links between collection of data and their explanations of meaning. Categories serve to

organize and group together codes which have similar characteristics or appear that they

go together; whereas high-level categories serve to organize and group categories for the

purpose of identifying themes that present in the data (Miles, et al., 2014; Saldaña, 2015).

A theme is described as a phrase or a word that explains what a specific piece of data is

about (Saldaña, 2015).

In the given study codes were utilized to give clear, illustrative labels to chunks,

or segments of data to identify ideas, views, and constructs that were ingrained in the

data. Categories were created to group together like codes and they also provided the

foundation to organize, and group related coded data into a category based upon shared

or similar qualities. Categories were grouped, and high-level categories were created;
 134

high-level categories offered a means to understand and establish meaning rooted in the

data (Miles, et al., 2014; Saldaña, 2015). Themes allowed for an in-depth description of

participants’ experiences and aided in answering the research questions of the study.

Thematic analysis as outlined by Saldaña (2015) was utilized to analyze the data

that was gathered in the study. Saldaña (2015) noted that individuals should identify

codes within the data, categorize similar codes, and develop higher level categories that

are relevant to the investigation, which will allow for comprehensive themes to emerge.

An example of Saldaña’s thematic analysis method is shown below. (See Figure 3.)

Data Codes

High-level
Categories
categories

Themes

Figure 3. An example of thematic analysis for identifying themes in qualitative data.

The purpose of thematic analysis used in this study was to illuminate themes,

which conveyed meaning in the data, which was related to the research questions of this

study (Clarke, & Braun, 2013; Miles, et al., 2014; Saldaña, 2015). As per Saldaña’s

outlined principles, the researcher followed the four-step thematic analysis process to

analyze all the data of this study to answer the research questions of this study. Themes

that emerged from the data analysis related to the descriptions MHPs detailed about their
 135

burnout experience and their descriptions of utilizing coping strategies to mitigate their

burnout. The eight themes that emerged answered the two research questions of the

study.

Four step process. Step 1: Identifying codes in the data. This step involves using

the proper coding methods to apply descriptive and identifying labels to chunks or

sections of the data to highlight and capture significant concepts, and ideas in the data.

Saldaña (2015) recommended using an amalgamation of coding methods likely to

produce significant findings in the data.

Step 2: Creating categories of codes and developing higher-level categories. In

this step codes are organized into meaningful categories. Combining codes together based

upon relation, or similarity is recommended (Saldaña, 2015). For example, the codes

“Fatigue”, “Exhaustion”, and “Oversleeping” could belong to the same category as each

word seems to describe a symptom.

Step 3: Reviewing high-level categories and synthesizing them to produce themes

through analytical memos. The focus in thematic analysis is to identify, analyze and

chronicle themes within the data (Clarke, & Braun, 2013). In this step connections

between high-level categories are established and themes are looked for. Miles et al.

(2014) noted that analytic memos often provide clarity and epiphany like moments, as

such analytic memos allowed for capturing crucial meanings in the data and helped to

recognize developing themes.

Step 4: Applying emerged themes to the research questions of the study. In this

step the focus is on reflecting on themes that were produced in the previous step, and

their relevance to answering the study’s research questions. Jotting down ideas related to
 136

the coded data can help capture and help recognize essential meanings (Braun & Clarke,

2006). Moreover, Saldaña (2015) noted that utilizing memos allows for reflection on how

themes may answer the research questions of the study. Analytic memos offered a

method for unearthing meaning (Braun, & Clarke, 2006). According to Miles et al.

(2014) memos allow the researcher to think more feely, and openly about the emerging

themes, which then allows for a deeper insight into the phenomenon under study. The

four-step process is depicted in Figure 4.

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Step 1: Identifying
codes in the data Examples of codes identified: Examples of codes identified:
(descriptive) Questionnaires: Interview Transcripts:
Engagement Boundaries
Workload COVID/Telehealth
Fatigue open-minded
Therapist roles Conversations on burnout
Set on edge Called to career
Balance Workplace environment
Communication Mindfulness/Meditation

Step 2: Creating categories of codes and developing high-level categories

Creating Examples of High-level categories below:
categories Workplace environments. Being Mindful.
of codes and Lack of control. Taking care of the MHP.
developing Telehealth and the pandemic Being an MHP is a calling.
high-level Questioning Career and self. Continuing as an MHP.
categories:
Friends, family, and animals Addressing the stigma of burnout.
being open and honest about burnout. Education on burnout starting in school.

Step 3: Reviewing and synthesizing high-level categories to generate the following

Reviewing emerged themes:
high-level Conditions as described by MHP’s that resulted in burnout
Burnout as described by MHP’s that was induced by COVID
categories and Characteristics of burnout as described by MHP’s
combining them Staying motivated in the face of burnout as described by MHP’s
to generate Strategies and tool utilized for coping as described by MHP’s
themes through Beneficial types of support systems utilized as described by MHP’s
analytic Utilizing open communication to cope with burnout as described by MHP’s
memos. Utilizing education and preparation for coping with burnout as described by
MHP’s.

Using a grid display of themes to reflect on and apply emerged

Step 4: Applying themes to the research questions of the study.
emerged Reviewing quotes from transcripts that support theme.
themes to the Reflecting on the emerged themes and writing analytic memos on how
research the finding of the themes address both research questions.
questions

Figure 4. An illustration of the four-step process followed in the thematic data anlysis of
this study.
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Questionnaire: Step 1 (identify codes in the data). Participants in this study

responded to the PROQOL, a self-report questionnaire that was created by Stamm

(2009). The researcher printed off answered questionnaires and examined each

participant’s answer to the questions. Prior to coding the researcher created a chart with

each participant’s alphanumeric code. The chart contained the scores for each subscale

(compassion satisfaction, burnout, and secondary traumatic stress) for each participant

(See Appendix K). Once each subscale was scored the researcher explored each question

related to each subscale and applied a descriptive label to key words, phrases, or subscale

scores that reflected concepts or ideas related to the research questions. Codes created

were then organized by relevance to the research questions of the study. Because the

questionnaire is designed to measure burnout elements each question pertained to the

research questions of the study.

Descriptive coding techniques were utilized in this study’s coding process

(Saldaña, 2015). For example, a statement read: “I find it difficult to separate my

personal life from my life as a helper” The code “work and home balance” was created

because it succinctly summarized the meaning of the statement. In another example the

statement read: “My work makes me feel satisfied” The code “Satisfaction” was given to

this statement as this label summarized the statements meaning and because this code

applied to other questions as well. Codes identified within the questionnaires were

created and organized by hand coding rather than within MAXQDA as noted in chapter

3, this allowed for the researcher to have more control over the data analysis process.
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Interview transcripts: Step 1 (identifying codes in the data). Participants in the

study responded to questions created by the researcher, through videoconferencing

interviews. The transcripts of each participant’s interview were organized regarding the

research questions of the study. Each interview transcription was printed for hand coding

to allow for more control of the data, and to have a hard copy to create analytic memos,

which reflect what was observed, what was perceived, and what some participants said

that was of importance. Analytic memos allowed the researcher to reflect on what was

discovered and presented (Miles, et al., 2014).

Prior to coding the researcher read each transcript line-by-line multiple times to

gain a better understanding of their content. As the researcher examined each transcript

line-by-line descriptive labels (also known as codes) were applied directly on the

transcripts, to key phrases, words, ideas, explanations, and descriptions reflecting views,

meanings, or relationships that were relevant to the research questions of the study.

Codes that were written and identified within the transcripts were organized in a

notebook. This allowed for better control of the data during the data analysis process and

minimized the chances of errors in the coding process.

Descriptive coding was utilized for the transcripts (Saldaña, 2015). For example, a

passage within the transcript read: “I don’t enjoy caring for humans in a way where

they’re numbers necessarily, or where I have to try and say this treatment is justified for

this person based on this diagnosis, and kind of play that game.” Utilizing descriptive

coding the label “Lack of control” was applied to this passage because the participant was

explaining the requirements of insurance panels, they must meet to get paid. Because

they had to meet specific requirements, they did not have control of how the client was
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treated. “Lack of control" summarized the passage of text in the transcript. In another

example a passage read: “Burnout is not wanting to get out of bed and go to work. It’s

just like, and then feeling guilty about it, like really dreading going to work and doing

your job”. Using descriptive coding the word “Dread” was selected from the passage and

identified as a code because the participants use of the word while explaining how they

felt about their job when burned out, best summarized the embodiment of the segment of

data.

Completing step 1. After codes were identified from both data sources,

(transcripts, and questionnaires) the codes were written on paper. Through the three

iterations of coding, codes were combined to be one code if they repeated. Codes were

removed because they were not reflective of the data. Codes were renamed to better

describe the segment or phrase from the data. Once coding was complete the final codes

were reviewed to combine like or similar codes into categories. Miles et al. (2014) noted

that coding is a method of unearthing, which means it is a repetitious process. Following

Saldaña’s outline, some codes were renamed. For example, the code “Burnout Training”

was changed to “Preparedness” because the code “Preparedness” captured more

efficiently the essence of the text “Burnout Training” referred to. Codes were written on

paper through the three iterations of coding. The final revised codes were merged into a

table of codes created in a Word document (See table L10 in appendix L).

Completing step 2. (creating categories of codes and developing high- level

categories). During this step, codes were fully examined and re-examined to discover

categories within which codes could possibly fall. A category for all related codes was

created. These codes were organized in a table of categories created in a Word document
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(See table M11 in Appendix M). The procedure of creating the categories of codes was

focused on 1) arranging codes that were connected to similar content, 2) sorting codes

that appeared to go together, and 3) grouping codes that shared meaning regarding the

two research questions of the study. For example, the codes “Lack of control”, “Demand

of the job”, “Continuous strain”, “Unpredictability”, and “Conflict” were paired together

as they seemed to go together. Likewise, the codes “Colleagues”, “Supportive

supervisors”, “Collaborative team”, “Work family”, and “Professional networks” were

grouped together and given the category “Support system” because the text passages the

codes referred to were related to support systems.

After all codes were organized and categorized, the categories were then

reworked and explored for similarities, shared characteristics, and commonalities

between them. This included categories that shared meaning relating to the two research

questions of the study, and ideas within the passages of text codes the categories

represented. For example, the categories “Causes of burnout”, “Workloads and burnout”,

“Requirements placed on the MHP”, and “Trauma and burnout”, were all combined

forming the high-level category “Lack of control” because each of these categories are

relevant to the experience of burnout, and these are often situations or conditions that are

out of the control of the MHP. The categorizing of categories led to a smaller number of

high-level categories.

Completing step 3. (examining high-level categories and synthesizing them to

generate themes through analytical memos). The 25 high- level categories produced in

step two decreased the final number of categories to a smaller set of 15 high- level

categories, which were more indicative of the data. Analytical memos were used to
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explore high- level categories and ascertain how they could be grouped to form themes.

A table of high-level categories with analytical memos was created in a Word document.

Through the researcher’s previous knowledge and understanding of the phenomenon

under examination, and the researcher’s reflection on the concepts and ideas, as well as

the incisive connections that were observed within the data, the high- level categories

were merged and given more conceptual theme names (See table N12 in Appendix N).

Table 5 below shows the themes that were identified through the merging of high- level

categories. Once themes were identified, the procedure of applying the themes to the

research questions took place.

Table 5.

Step 3: Themes with Related High- Level Categories

Theme High Level Category
Conditions as described by MHPs that resulted in Workplace environments; Lack of control
burnout
Burnout as described by MHPs that was induced Telehealth and the pandemic
by COVID-19
Characteristics of burnout as described by MHPs Physical, and emotional symptoms of burnout;
Questioning career and self
Staying motivated in the face of burnout as Continuing as an MHP; Being an MHP is a calling
described by MHPs
Strategies and tools utilized for coping as Being mindful; Taking care of the MHP
described by MHPs
Beneficial types of support Systems utilized for Colleagues, professional networks, and therapy;
coping with burnout as described by MHPs Friends, family, and animals
Utilizing open communication to cope with Addressing the stigma on burnout;
burnout as described by MHPs Being open and honest about burnout

Utilizing education and preparation for coping Education on burnout starting in school; creating
with burnout as described by MHPs personalized self-care plans

Step 4. (applying the emergent themes to the research questions of the study). In

this step of the four-step analysis the focus was on reflecting on the emerged themes and

their relevancy to answering the research questions of the study. The researcher looked
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for common ties amongst the themes relevant to the research questions. A grid display

was created in a Word document to consider the themes through analytical memos. (See

table O13 in Appendix O). The grid displays integrated quotes from study participants’

that supported the themes, and the researcher’s memos that reflected, and related the

themes to the study research questions. As demonstrated in Table 6, the eight themes that

developed from the thematic analysis substantiated the research questions of the study.

Lastly, a descriptive study report was written up with the findings of the themes

regarding the research questions. The results section provides a thorough discussion of

these findings.

Table 6.

Step 4: Research Questions with related themes

Research Questions Themes
RQ 1: How do MHPs, who treat trauma, in the Conditions as described by MHPs that resulted in
U.S., describe their experience of burnout? burnout
Burnout as described by MHPs that was induced
by COVID
Characteristics of burnout as described by MHPs
Staying motivated in the face of burnout as
described by MHPs

RQ 2: How do MHPs, who treat trauma, in the Strategies and tools utilized for coping as
U.S., describe their use of coping strategies? described by MHPs
Beneficial types of support systems utilized for
coping as described by MHPs
Utilizing open communication to cope with
burnout as described by MHPs;
Utilizing education and preparation for coping
with burnout as described by MHPs

Data merging. Fusch and Ness (2015) noted that merging results from multiple

sources of data help to minimize researcher bias, as well as improving the trustworthiness

of a study. While Yin (2015) suggested that findings that are supported with more than
 144

one source, improves the trustworthiness of the study. Furthermore, Miles et al. (2014)

highlighted that using multiple different sources of data and seeing the same results

across those sources adds to the credibility of a study. Miles et al. also noted that having

different measures that all point to the same conclusion ensures the study is credible.

Data merging was used to ensure the confluence of findings in this study. This

was aligned with the descriptive design (Magilvy, & Thomas, 2009). Yin (2015) noted

that utilizing multiple sources can help to ensure the quality of the research and the

credibility of the research. Two data sources were analyzed within this study, they were

self-report questionnaires, and semi-structured interviews. Questionnaires were coded

first. The researcher applied a descriptive label to key words, phrases, or subscale scores

that reflected concepts or ideas related to the research questions. Interviews were then

coded.

The merged analysis from both sources of data garnered eight themes from the

coded data. Findings from the two data sources, established through the merging of data,

enhanced credibility of the study. The results section highlights the findings that were

garnered through themes that developed from the analysis of the merged data sources.

The merging of data in this study allowed this descriptive study to portray the participants

described experiences of burnout more precisely.

Trustworthiness. The quality of research produced with qualitative studies can

be assessed by the trustworthiness of the research (Anney, 2014). Through the journey of

this research steps were taken to ensure the trustworthiness of the study. Amankwaa

(2016) noted that trustworthiness encompasses four distinct criteria they are: 1)

credibility, 2) transferability, 3) dependability, and 4) confirmability. The following

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section highlights and the approaches taken in this study to ensure that these four criteria

were met, and that trustworthiness was present in the analysis of data. These four criteria

are explained in detail below.

Transcript checking. Participants in the study were sent copies of their

respective transcripts and were asked to ensure that everything was correct and there

were no mistakes present in the transcripts. Confirming the transcripts were correct with

the participants ensured trustworthiness of the study. Participants were given a week to

respond to the transcripts with any changes needed, only one participant requested any

changes, and those were in reference to spelling errors. All other transcripts were

confirmed to be accurate.

Member checking. The researcher utilized member checking to confirm the

accuracy of the study’s findings (Chase, 2017). Reilly (2013) stated that member

checking allows for a clear depiction of the participants experiences to be put forth.

Findings from the semi-structured interviews were utilized to send participants a

summary of the themes generated from the data in the study. Participants were asked to

confirm the study’s findings and the quotes ascribed to them and to respond back with

any changes that were necessary. Participants were given four days to respond back with

any comments or suggestions. When there was no feedback received it was assumed the

findings were reflective of the participants’ experiences and were accurate.

Thick description. The results section illuminates the findings garnered through

themes that developed from the data analysis. The researcher included in-depth

descriptions of the study’s findings to support appropriateness of transferring the study’s

findings to other contexts (Korstjens, & Moser, 2018). The researcher followed the
 146

suggestions of Shenton (2004) who suggested devoting sections to a) describing what is

planned and then executed, b) describing what is done while within the field while

gathering data, and c) describing the evaluation of the effectiveness of the entire process.

The researcher followed these steps which heightened the dependability of the study.

To add to the credibility of the study the researcher employed several different

methods of documentation including written notes, and graphs. The researcher also

utilized a notebook to write any biases down. The researcher followed recommendations

of a panel of experts to rework the interview questions used to collect interview data, thus

lending credibility and dependability to the study. This allowed for readers to be able to

replicate the work in other contexts and ensure the trustworthiness of the study.

Data saturation. There was a total of 18 MHPs who participated in the study.

Data saturation was achieved when no new codes presented themselves, and codes began

to overlap one another (Saunders, et al., 2018). Through the interview process, the

researcher utilized probing questions such as “can you elaborate’, “can you explain what

you mean”, “how”, and “why?” to garner more information from the participants. After

15 out of 18 interviews, the researcher evaluated that the interviews were reaching the

point of saturation as answers began to repeat and overlap. Three additional participants

were interviewed to ensure that saturation had indeed been reached. The examination of

saturation during the interviews concentrated on the absence of new information and

whether it would be counterproductive to continue more interviews (Van Rijnsoever,

2017).
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During the analysis stage of the study, the researcher coded, and re-coded the data

until no new codes were witnessed in the data (Onwuegbuzie, & Leech, 2007). Data

saturation was achieved when the codes began to overlap one another, and when no new

codes were apparent in the data (Gentles, et al., 2015). Data saturation ensured that the

quality and trustworthiness of the study was present.

The trustworthiness of the study was reliant upon there being no biased

assessments of the theoretical principles inherent in the study (Saxena, 2017). Subjective

judgments were not part of the study, bracketing and reflexivity allowed the researcher to

remain objective (Schonfeld, & Bianchi, 2016). Reflexivity allowed for participants'

personal meanings of the experiences to stand out (Noble, & Smith, 2015). The

researcher employed a naturalistic approach to analyze the data of the study, which also

helped to ensure the findings of the study emerged from significant themes that were

embedded in the raw data (Hayashi et al., 2019).

Potential sources of error. During the study, the researcher strived to minimize

potential errors. Tessier (2012) noted that mistakes in transcription of participants

experiences can lead to serious impacts during the data analysis process and could lead a

researcher to come to incorrect conclusions. Furthermore, Crichton, and Childs (2005)

argue that utilizing a combination of methods to convey participants accounts reduces the

inherent risks of misrepresentation of participants experiences, errors in the

transcriptions, and losses of context. Interview protocols, recorded interviews, and

transcripts helped to guide the examination of experiences related to burnout of MHPs,

and the prospect of possible strategies to address the problem.

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The video recordings of the interviews provided a valuable recounting of

participants experiences (Tessier, 2012). Transcripts of interviews were carefully

generated by the researcher within a word document. The transcripts produced from

recorded interviews ensured that the transcripts were complete and accurate. Moreover,

participants were given precise copies of transcripts to confirm the responses.

A possible limitation that arose during data collection was the need to reschedule

some participants interviews. All interviews were conducted through Zoom

videoconferencing software. Originally it was planned that the interviews would take

place during the participants respective time availability; however, three interviews were

scheduled according to both the participant and the researcher’s availability due to virtual

work schedules because of the pandemic. The use of Zoom meant that impersonal

interactions were taking place. The use of Zoom limited the interaction with participants

and limited the ability to build rapport with participants and gain their trust.

Another possible limitation that arose during data collection was regarding sample

size. Due to COVID-19, it was difficult to gain participants due to their virtual work

demands. The pandemic itself caused burnout of MHPs from being on Zoom

continuously, which made it difficult to schedule convenient times for participation

(Bailenson, 2021).

A purposive sampling was utilized to select MHPs who participated in the study;

this was necessary to ensure the specific goal of the research was met (Robert, 2015). It

was initially planned that 20 MHPs would participate in the study; While 40 would

complete questionnaires, of those 20, 18 agreed to participate. Of the expected 40 for the

questionnaire, 18 filled out the questionnaire. The smaller sample size limited the amount
 149

of data that was collected in the study; however, this had some benefits. The smaller

sample size meant that the research was easier to manage (Palinkas, et al., 2013).

Robinson (2013) noted that within qualitative studies smaller sample sizes are not

uncommon. Additionally, the limited focus of the phenomenon under examination in this

study did not require a larger sample size to accomplish the purpose of the research.

Results

The purpose of this qualitative descriptive study was to explore how MHPs, who

treat trauma, in the U.S., described their experience of burnout and their use of coping

strategies. To accomplish the purpose of this study, it was essential to identify and

illustrate (1) how do MHPs, who treat trauma, in the U.S., describe their experience of

burnout? And (2) how do MHPs, who treat trauma, in the U.S., describe their use of

coping strategies? Data gathered from self-report questionnaires, and semi-structured

interviews were coded, analyzed, and merged to answer these research questions. Eight

major themes arose from the data, their findings were applied to the research questions

(see Table 7).

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Table 7.

Research Questions with Related Themes and High-Level Categories

Research Questions Themes High-Level Category
RQ 1: How do MHPs, who treat Conditions as described by Workplace environment; Lack of
trauma, in the U.S., Describe MHPs that resulted in burnout control
their experience of burnout?
Burnout as described by MHPs Telehealth and the pandemic
that was induced by COVID

Characteristics of burnout as Physical and emotional

described by MHPs symptoms; Questioning career
and self
Staying motivated in the face of Continuing as an MHP; Being
burnout as described by MHPs an MHP is a calling

RQ2: How do MHPs Who treat Strategies and tools utilized for Being mindful; Taking care of
trauma, in the U.S., describe coping as described by MHPs the MHP
their use of coping strategies
Beneficial types of support Colleagues, professional
systems utilized for coping as networks, and therapy; Friends,
described by MHPs family and animals

Utilizing open communication to Addressing the stigma on

cope with burnout as described burnout; Being open and honest
by MHPs about burnout

Utilizing education and Education on burnout starting in

preparation for coping with school; Creating personalized
burnout as described by MHPs self- care plans

Research question 1. The overarching and first research questions of this study

was: How do MHPs, who treat trauma, in the U.S., describe their experience of burnout?

Questionnaires and interviews revealed four major themes. (1) Conditions as described

by MHPs that resulted in burnout, (2) Burnout as described by MHPs that was induced by

COVID, (3) Characteristics of burnout as described by MHPs, and (4) Staying motivated

in the face of burnout as described by MHPs.

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Theme 1: Conditions as described by MHPs that resulted in burnout. This

theme related to the role that workplace environments and a lack of control plays in the

burnout experience of MHPs. A strong agreement arose amongst participants, that having

more control over their careers, would greatly serve to diminish the experience of

burnout. Participants shared the belief that if they had a better workplace environment it

would significantly reduce the experience of burnout. Participants noted that the lack of

control was a large factor for experiencing burnout.

S9 stated:

I served on the governor’s child welfare system task force in my state. During

testimony, there were individuals in leadership from the organizations that serve

the child welfare system, and they were talking about turnover. Their response

was this is how this works. This is how our program works. this should be

successful on paper, of course it is. On paper, anything can be successful. When

you don’t recognize the fact that an individual has a caseload of 65-80 clients, and

they have requirements of making face-to-face contact, and doing paperwork, and

documenting all of that, you tend to disregard the fact that you are creating a

system that leads to burnout.

Participants indicated that the lack of control is not just because of the

environment in which the participants work. It is from state requirements, and insurance

requirements that do not allow for the MHP to have control of their career. Participants

mentioned that the lack of control over their career led to higher instances of burnout.

S11 noted:
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It’s like someone that has to spend more time justifying their job than actually

being present with their client. Like, there’s not many jobs out there when you

think about it. But that’s essentially what I feel like healthcare is, is you have to

spend a large majority of the time with the client justifying what you’re even

doing and saying, and engaging with them on, more than the actual like content

being exchanged and the rapport being built between you and the client. That’s

what insurance has done to the process.

Participants noted that lack of control happens in both agency settings and private

practice settings. The lack of control had many forms according to the participants. The

lack of control for each participants work environment varied, as noted by S18’s

response:

Working in agencies that pay little amounts for lots of high output

expectations; or in a private practice setting, where I am now, like the

insurance companies not paying what a normal rate would be for the

type of work I am doing. So, I have to increase the volume of services in

order to stay afloat.

According to participants of this study setting boundaries was one the best ways

to assert control back into their careers. S17 stated:

I'm not working so late sometimes. Or, you know, if I have a busy week trying to

make it so that Fridays, I can skip out early so I can go home. I have been a lot

firmer on boundaries with, when it comes to like scheduling, where before it was

like, okay, yeah, I know, you're struggling, you know, come on in and everything

where now it's like, you know, it's past a certain time. I'm not gonna do that.
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Another participant noted that saying no not only to their supervisors, but saying

no to others has helped to take some control of their career as noted by S1:

I have specific work hours now. I really try to only schedule within those

hours. I say no more often”. S2: stated that “the power to say no, I don’t want to

do something. Sometimes it really doesn’t, it’s not I cannot, it’s a I don’t want to.

Theme 2: Burnout as described by MHPs that was induced by COVID. This

theme was related to the current pandemic the United States was experiencing. The

unknowns of the situations, the mandates, and safety precautions led to MHPs

experiencing burnout. The pandemic was not only affecting the MHPs clients, but they

were navigating the pandemic at the same time their clients were.

As noted by S15:

When COVID happened, I, part of my, goes like submerging myself in research

like, okay, how do we provide telehealth? How do you assess someone via video,

really submerging myself in that because it made the other things feel less

uncomfortable.

Several participants of this study noted that they reached a space of burnout when

COVID hit because they were navigating the pandemic at the same time their clients

were, and with the uncertainty of COVID it led to burnout quicker as noted by S18:

“We're walking through something at the same time, as our clients are or the people that

were treating them are”.

S15 stated:

Whenever there's these community traumas, we have a huge surge in clients. It

really is hard, because we're dealing with that as well, and that leads to burnout.
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So, there's no relay time, we're thinking like a video tape or like a recording. This

is real life recording; I am responding as I'm reacting and that's really hard.

S8 stated:

Pre-pandemic I felt good and balanced, and effective, and present, and grounded.

And all the things that I strive to be as a therapist and still connected with family

and friends and all of that. It was just such a dramatic shift. I also co-own and so

we were in charge of making all of the decisions not just for our clients, but our

employees and ourselves and. So that, that was such a huge shift.

Participants of this study noted that because the pandemic brought such unknown

circumstances, they had to find their own ways, that they were comfortable with, to

navigate the pandemic.

S18 noted:

For me, the feelings at home are like if I'm at home, and let's say the news is on,

or I haven't been out in a couple of days. It's like, oh, my gosh, the world is scary.

But if I go pick up the mail, and I see that my neighbors outside, I'm like, oh,

okay, things are fine. So, having that even with people's comfort levels with

exposure, like just at least walking down the road or seeing other people out in the

world or, finding ways to connect are really important.

Participants noted that working from home due to COVID brought new

challenges with separating work and home life. S13 stated:

When I went virtual, I was like, wow, I think a lot of my clients are doing better.

Like then what if we were in person. But I find the constant just right now the

way things are, it's just gloom and doom. And that's what's making, and we are
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being asked as clinicians to do something that we were taught not to do. We are

helping people through something that we are also, and in the immediate time

going through.

Theme 3: Characteristics of burnout as described by MHPs. This theme was

related to the many different characteristics of burnout. Individuals experience

characteristics specific to them, however, there are characteristics of burnout that most

individuals will experience. This was evident as several participants relayed similar

characteristics they experienced.

S16 mentioned:

Definitely, I think guilt is a big part of it, feeling like we haven't done enough.

Shame is probably a really big one there too. Because the idea is that we're

supposed to talk to our peers and ask for help and you know, normal things.

Several participants in the study noted that fatigue was present in their burnout

experiences. Several noted that fatigue was how they realized they were at the point of

burnout. As noted by S2: “I would describe it as fatigue. That's expressed in your body

where you have low energy. Cognitively where you feel foggy, and you, that maybe, well

I, in me, a little bit more irritable or feeling overwhelmed”. S10 stated: “I think like

fatigue. avoidance, I think is one. I'm just like, depression, depressed feelings. Like

feeling numb and wanting to sleep a lot. Just lack of energy”.

Shame was another consistent characteristic that participants noted they felt when

they experienced burnout. The feeling that they were ashamed to be burned out because

burnout just doesn’t happen to MHPs.

S14 mentioned:
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Recognizing whether shame is part of that, where, you know, well, this is what

you should be doing, you should be showing up every day. And if you're not able

to do that, then there's something wrong with you and your horrible therapist.

S15 stated:

I think burnout is not wanting to get out of bed and go to work. It's just like, and

then feeling guilty about it, like really dreading going to work and doing your job.

But then also having a lot of shame and guilt around that feeling. I think it's a

really isolating emotion. It's hard to admit too. It's really similar to trauma and a

lot of ways.

Another characteristic commonly mentioned among participants was depression,

many stated when describing what the symptoms were of burnout that depression was the

most mentioned.

S5 noted:

Burnout feels like depression. I think it's very similar. So, you know, some, some

couples talk about pulling up in their driveway, not wanting to get out and go

home. Mine's like that for work. You know, so it's the days that I just, I don't want

to do it. I'm like, there are 100 things that I'd rather do than walk into my office

today.

S15 stated:

Some people shut down and go into that depression mode, but I'm like, you know

what, maybe if I just keep piling, you know, different things on, then it will be

okay to like, rejuvenate that sense of purpose. And that just makes it worse.
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Additionally, participants noted that they sometimes questioned why they were in

this career. They related this to imposter syndrome in which they question themselves

and felt as though they are not qualified to be in this field. Several participants noted that

questioning their self and their career happened more when they were burned out. As

noted by S4: “This week, I have been like, ah, gosh, why am I still doing this job? And I

haven't only been doing this, though, all that long. I mean, I think all told, about like,

seven years”.

S5 stated:

Sometimes I feel like I have tried everything in my toolkit, even if it's an older,

kiddo. I've tried everything in my toolkit, and I don't, what do I do now? You

know what I mean, so sometimes I'm just like, maybe imposter syndrome? Like

whom says that I can? I could be the one to help this one. I don't know.

S13 mentioned:

I think being a therapist, one of the biggest parts of burnout is not feeling like you

can express it. Because if you express it, then you're going to be looked at as

being weaker, or not a good therapist, or not healthy enough, or it's that imposter

syndrome.

Theme 4: Staying motivated in the face of burnout as described by MHPs. This

theme related to the motivation to continue as an MHP, knowing that there was the

possibility of experiencing burnout. The motivation varied for participants, but

participants shared the belief that being an MHP is a calling.

S3 mentioned:
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Because I find it to be one of the greatest honors of my life to have somebody

invite me on the healing journey. If I can be invited on that journey and help

guide or just witness it. Then I'm doing something worthwhile, on a micro level

when I feel so powerless on a macro level.

S12 mentioned: “I love the patients we see. I love treating substance abuse and

trauma and any other co-occurring disorder. I love watching people heal. I love watching

people graduate from programs. It gets me excited for them”.

Participants agreed being an MHP is not something that you go into to get rich,

but rather that you go into being an MHP with the goal to enrich the client’s life and give

them the tools to solve their problems. S8 noted: “I love human, humans. And really want

to see people have an opportunity to live their best self, whatever that is”.

S10 stated: “I think it's just, like, knowing that the benefits are greater, like

helping the families and the kids are greater. And it's worth, like, the risk of that. I

feel like, you know, just like the day to day enjoying what I do”.

Table eight provides a further look into the experience of burnout by providing

additional comments from MHPs about what burnout is to them.

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Table 8.

Participants Comments on Burnout

Participants Comments
S13 Burnout is soul exhaustion that leads to physical
repercussions and physical exhaustion. Like,
you're not legitimately physically exhausted, like,
you could get up and do something. But you're so
mentally exhausted that your body hurts. it's
crying when you're just like, I don't even know
why I'm crying right now.

S15 Burnout it's when your body is overtaxed, your

brain is overtaxed with something in your
environment that you don't feel like you have the
skills to cope with in that moment. So, you kind of
revert you kind of go, okay, I'm gonna shut down.
or I'm gonna get really anxious.

I would describe it as just constantly feeling

S7 exhausted, constantly feeling like you're not
present with anything. When I'm burnt out, I, tend
to isolate a lot more. It's very isolating in itself. I
think feeling burnt out. It's just an overall like,
sense of dread and like negativity. You know, you
can’t, kind of pull yourself out of like the feeling
of dread.

Research question 1 conclusion. Conditions as described by MHPs that resulted

in burnout, burnout as described by MHPs that was induced by COVID, characteristics of

burnout as described by MHPs, and staying motivated in the face of burnout were the

four major themes that developed after the careful analysis of the data that addressed and

answered the overarching research question: How do MHPs, who treat trauma, in the

U.S., describe their experience of burnout? MHPs that participated in this qualitative

descriptive study identified the workplace conditions and the lack of control as the most

challenging facets of addressing burnout. Participants that worked within the agency

setting noted that gaining control over their careers was a necessary process to mitigate

the experience of burnout. Participants also mentioned that in addition to not having
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control over their careers the low pay and high caseload output that agencies expect also

are contributors to burnout. MHPs in private practice shared the belief that the pay is a

contributor to burnout, due to insurance companies not paying the MHPs rates, thereby

requiring them to have a higher caseload. Additionally, those who were in private

practice noted that because insurance companies have such strict standards and

requirements to get paid, they do not have the control of their career.

The second major theme that emerged after careful analysis of the data was

burnout as described by MHPs that was induced by COVID. Individuals noted that the

current pandemic, and the uncertainty surrounding the national health crisis, made the

experience of burnout more prevalent. Participants noted that they were navigating the

pandemic along with their clients, and that alone was enough to cause burnout. Several

noted that there was an uncertainty regarding the use of telehealth and the standard of

care while utilizing telehealth systems. Furthermore, several participants noted that

because of restrictions put in place, they were unable to do some things for self-care that

they would have utilized before the pandemic hit.

The third theme to emerge after careful analysis of the data was characteristics of

burnout as described by MHPs. Participants noted that characteristics most common of

burnout was fatigue. Several participants mentioned the feeling of being tired and

exhausted as being indicators for burnout. Other participants mentioned that when they

began to dread going to work, they knew they were becoming burned out.

Furthermore, many other participants suggested that burnout seemed like

depression to them, because burnout came with fatigue, not wanting to do anything, and

avoidance of certain tasks. Some other characteristics participants mentioned were shame
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and guilt. Participants noted that when they reached the point of burnout where they

dreaded going to work, shame for feeling that way followed. Several participants noted

that the shame and guilt made it hard to talk about their burnout. Additionally,

participants noted that feeling shame about being burned out was a contributing factor to

their experience of burnout, due to burnout being stigmatized, and the thoughts that as an

MHP they should not be burned out.

Staying motivated in the face of burnout as described by MHPs was the fourth

and final theme that emerged after careful analysis of the data. Participants had differing

views and opinions about what motivated them to continue being an MHP knowing they

could face burnout. However, every participant suggested that they were called to being

an MHP. Other participants noted that walking along the journey with the client was

rewarding. Some participants mentioned that they wanted the client to fire them, because

that meant they had done their job and that gave them pleasure. Other participants said

they were honored to be a part of their client’s journey. Additionally, some participants

noted that people are important, and in some way connecting to a person they were

helping, motivated them to continue being an MHP.

Research question 2. The second research question of this study was: How do

MHPs, who treat trauma, in the U.S., describe their use of coping strategies? This

research question was proposed to support the overarching question of the study. This

research question was intended to explore participants experiences related to utilizing

coping strategies. Understanding the types of coping strategies used helped explore the

strategies that were likely to address the problem. Data gathered through self-report

questionnaires, and semi-structured interviews related to coping strategies revealed four

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themes that addressed this research question. The four major themes were (1) Strategies

and tools utilized for coping as described by MHPs, (2) Beneficial types of support

systems utilized for coping as described by MHPs, (3) Utilizing open communication to

cope with burnout as described by MHPs, and (4) Utilizing education and preparation for

coping with burnout as described by MHPs.

Theme 1: Strategies and tools utilized for coping as described by MHPs. MHPs

who participated in this qualitative descriptive study identified a plethora of coping

strategies they used to minimize burnout. This presented theme related to their

descriptions of utilizing coping strategies. Participants in this study recognized that

coping strategies were necessary to help mitigate the experience of burnout.

S14 stated:

I use a meditation app every day. I learned a long time ago that I needed to do my

own work. So, I actually left and worked as a medical social worker in a hospital

for a while. During that time, I took advantage of going and doing my work,

going into therapy, and doing my stuff.

S11 noted: “Know my limits, period, and not compromise on them”.

S5 noted:

Exercise is a big one. in the past, I was involved with a lot of organizations within

my church. Especially like working with like, the youth groups in my church.

Prayer/meditation. I like to watch the Big Bang Theory, it's humor, we're not

talking about anything trauma related. Playing with my daughter. Having as much

family time as I possibly can.

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Participants shared the view that mindfulness is one of the best coping strategies

to minimize burnout. As noted by S2: “I used to be able to meditate a lot better than I do

now but practicing mindfulness. When I'm not feeling positive on the inside, I'll start

asking myself reflective questions”. S4 stated: “I'm not good with the whole guided

meditation stuff, but I'm trying to, increase my ability to do more meditation in that way

and sort of, some mindfulness stuff”.

Participants of this study mentioned a litany of coping mechanisms that helped

them to minimize burnout. The most mentioned cooping strategy was exercise. S8

mentioned: “connection with friends and family, and exercise and hiking, adventures and

traveling, all the things we can't do that because of the pandemic. But new foods, and like

adding a lot of variety to our experience feels really helpful”. S15 noted: “Exercise is

really important. Taking my dog for walks and just giving myself space”.

Other participants noted that not all coping strategies are ones that are positive,

and several participants mentioned that alcohol and substance use were those negative

coping mechanisms. S4 noted that:

The maladaptive coping strategy that everyone uses is substances. At the back of

the magazine, there's all of the infractions, that people are experiencing, where

their license is being suspended or whatever. I calculated at one point that close to

65% of the things in the back of the book, the legal issues had to do with

substance abuse.

S3 mentioned: “During that time of burnout, I started drinking quite a bit”.

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Several participants noted that they themselves were in recovery and that helped

aid them in understanding having positive coping strategies. S6 stated: “I'm 30 plus years

in recovery. So, if I can do it, anybody can do it”.

S14 stated:

I'm in recovery myself, and I've noticed that there aren't really a whole lot of 12

step groups, for therapists or for professionals. I think it's important for therapists,

because. I think I can't go to any of the 12 step groups that are local, because my

clients go.

S12 noted:

I'm also in recovery myself, I've been in recovery for eight and a half years. I live

with somebody I met in treatment, and she's in recovery, too. She's always here

to, we have many AA meetings here. She's a good support for me. Participants

agreed that having the necessary tools to help them disengage from the experience

of burnout was crucial.

Theme 2: Beneficial types of support systems utilized for coping as described by

MHPs. The second emerged theme after careful analysis of the data was beneficial types

of support systems MHPs utilized for coping. Participants agreed that having a good

support system makes all the difference in minimizing burnout.

S18 stated:

I prefer personal support systems versus a big networking type of support

systems. My introvert self gets really drained by those things. So, I don't enjoy

those, but the smaller kind of one-on-one or peer support, things are helpful. But

also having mentors.

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S9 noted:

I wish I had learned in school, the importance of a cohort. I have a group of

friends and they've named themselves the tribe for life. There are, three, four

social workers in there. But it would be great for other individuals. I've seen

people I've graduated with, like my friend that ended up teaching, I feel like if she

had had a cohort, they could have helped her prevent burnout.

S7 stated:

If you can be a member of what do you call it, a professional group. I think

friends and family are really important. They kind of, at the end of the day have to

be your soft place to land, so to speak.

S13 mentioned: “People who are working with the same population that you are.

So, that they completely understand where you're coming from”. Participants agreed that

having a good support system can make all the difference in experiencing burnout or not.

Several participants even noted that having their own therapist served as a form of

support.

S4 noted:

I am also in therapy; I think that's a really important thing that we all need to be

in. It can be easy to fall off the wagon and not be in therapy. But I do think

sometimes that's really an important self-care, or coping strategy.

S8 stated: “I'm in therapy. I can't imagine me being a therapist and not having a

therapist”. Almost all participants agreed that having an animal can serve as a support

when experiencing burnout. S15 stated: “I cuddle with my dog noodle, she's seven

pounds, and I love her”.

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S4 noted:

I take my dog for a walk every morning, and every night, he at sometimes will be

at the door, because this is where I have my office and usually have the door

closed, but around six o'clock, he'll start whining at the door, like it's time for a

walk. So, kind of just knowing that, I get to do that with him is kind of helpful.

S12 stated: “I have my dogs here, walking in and seeing their faces kind of lifts,

the yuckiness from the day sometimes”. S1 mentioned: “I have a dog and two cats. My

dog always knows whenever I'm upset”.

Theme 3: Utilizing open communication to cope with burnout as described by

MHPs. The third theme that emerged after careful data analysis was regarding

communication. This theme related to being able to communicate about the burnout

experience, but also communication about coping strategies, self-care, and addressing the

stigma on burnout.

S15 noted:

We have a weekly meeting for all therapists. We talk about how we are taking

care of ourselves. It is a part of every meeting for us to check in and say how

we're taking care of ourselves, if we're taking time off, what our upcoming

vacation plans might be. Then we do a mindful activity. Part of vicarious trauma

and burnout is almost like not trusting other people and feeling like you're alone.

S12 mentioned: “I have lots of conversations when I'm struggling. God is my go-

to. I have lots of out loud, sometimes in public, conversations it really just helps me

process information”.

S10 noted:
 167

I have some, friends where we try to help each other If somebody else seems like

they're getting really discouraged, are in a place where maybe they're not really

enjoying the work anymore; just trying to process that with each other and maybe

coming up with some strategies or ways to deal with it, that are healthy ways. I've

had some of those conversations with friends that are therapists.

S11 stated: “There'll be some people, where we'll do phone calls. You know,

during this whole COVID thing, there's been phone calls, and then talking about how

overwhelmed everyone is with everything”.

S8 noted:

I talk with all my supervisees. All of our employees we talk about it (burnout) a

lot. It comes up in every staff meeting. We're the ones bringing it up asking how

people are and what they're noticing, and what their symptoms are, and kind of

normalizing it. I find myself in those conversations pretty regularly, even with my

mentors, not just about my burnout, but just kind of talking about it as a concept

that this is something that happens, in a way to kind of caretake each other.

Theme 4: Utilizing education and preparation for coping as described by

MHPs. The fourth and final theme that emerged was regarding using preparation and

education to help reduce burnout. This related to preparing MHPs to recognize the signs

and symptoms of burnout by educating them before they ever enter the field. This theme

also related to the creation of self-care plans which help to prepare MHPs for entering the

field. Several participants noted that education on burnout and self-care should be

required when starting in school to be an MHP. S15 stated: “By being vulnerable about it.

I think normalizing it is huge, and actually having open conversations about what it looks
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like and being proactive in it. looking back, you know, what have been the signs that

you've had burnout”.

S14 mentioned:

Being able to talk about it. When they have their annual different training

meetings, or different organizations that provide certifications, making sure that

that's part of the curriculum. Making sure that that's emphasized more in when

they're getting their degree.

S8 noted:

I think we need to talk about it openly and honestly. Without, infusing our own

shame, and the narrative. I think that's important. I think also ask, clearly and

openly, asking about it. With our colleagues that we know, like, and trust. I think

it just needs to be part of our conversation.

Several participants mentioned that they did not have any kind of education on the

concepts of burnout or self-care and mentioned that building those as classes into degree

programs, could help prevent burnout for future MHPs.

As noted by S17:

Talking about the stigma that goes with it and starting to try and put an end to it.

Doing a better job of educating the students when they're in school. Talking about

burnout honestly, when they're in school versus the short, yeah, you're probably

gonna get burned out, you need to go on vacation, and then you'll be fine.

S6 stated:

I think that a lot of times, a counselor goes in a mental health group and they're

really excited, and they're really gung-ho, and everything is great and wonderful.
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Then they hit the first roadblock, a hard case, person that doesn't want to listen,

whatever. They feel like they should know how to deal with it. But they've never

dealt with it before because they're brand new in the field. Maybe they're scared,

or ashamed, or nervous. I think in that case, having a mentor that you every day,

or every other day, you have a check in with and talk to them about what

happened. So that when you have a situation like that happen, you might feel

nervous about it, but it won't prevent you from talking to them.

Several participants noted that they did not receive any education about self-care

during schooling, but if they had, it might have made prevention of burnout easier.

Several participants noted that this is a change that needs to happen at an educational

level so that those entering the MHP profession will have that understanding of what

burnout is, and why it is necessary to have self-care plans.

S4 noted:

I think there needs to be kind of a systemic education of the consequences of

burnout. In the school process. I do think that that's a major missing piece. I think

having some sort of education around, this is what burnout is, this is what it looks

like. Have you experienced burnout in any shape or form in your life? How will

you know that you're starting to experience burnout? These are the things that you

can do to kind of mitigate burnout. I think that education needs to happen. At the

training level.

S12 stated:

I'm sure we talked about self-care and the importance of self-care. But, you know,

not like it should be discussed. Not like burnout. It should be an entire class that
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we talk about burnout and self-care; or at least half of the class or part of a class,

or something that it is really ingrained in us about what that is.

Table 9 depicts participants additional comments on the types of coping strategies

that are utilized to mitigate burnout.

Table 9.

Participants Comments on Coping Strategies

Participants Comments
S9 Music is huge for me. Absolutely huge. I listened
to anything and everything. If I hear it, and I like
it, and it gives me a feeling, then I'm going to
listen to it.

S6 Making sure I get enough sleep. If I am tired, it is

not a good thing. I'm meditating every day, usually
in the morning before I go to work, occasionally
on my lunch hour. I used to ride my horse. I try to
get all my clients done in four days; I do four 10-
hour days. So that most days, most weekends, I
have a three-day weekend, but it is not an eight-
hour day so I can sleep in.

S1 Alone time, and it's not isolating, but just alone

time. Being happy with your own company. This
finite self with nobody else around like, I really
enjoy my alone time now.

Research question 2 conclusion. Strategies and tools utilized for coping as

described by MHPs, beneficial types of support systems utilized for coping as described

by MHPs, utilizing open communication to cope with burnout as described by MHPs,

and utilizing education and preparation for coping with burnout as described by MHPs

were the four major themes that developed after the careful analysis of the data that

addressed and answered the research question: How do MHPs, who treat trauma, in the

U.S., describe their use of coping strategies? The purpose of this research question was to

explore MHPs descriptions of using coping strategies to minimize burnout. This was
 171

necessary to investigate how MHPs use of coping strategies was likely address the

problem. MHPs who participated in this study described several different strategies they

utilized to cope with burnout. They identified that there is a lack of education on what

burnout is, and how to manage it.

Participants agreed that being open and honest about the experience of burnout

and talking about it helps to take away the stigma surrounding burnout. The participants

determined that exercise is one of the best coping strategies to mitigate burnout.

Participants noted that several strategies they normally utilize for coping were ones which

they were unable to utilize with the current and ongoing pandemic and they had to find

other strategies that worked for them in the meantime.

Participants noted things such as walking their dog, journaling, yoga, hiking,

prayer, movies, and music were some of the strategies they used to cope with burnout. the

most common strategy participants used was mindfulness, and meditation. This strategy

allowed participants to ground themselves and be present in the moment. Participants

stated that being mindful was helpful to minimize the experience of burnout, and to be

cognizant of their surroundings, their emotional states, and their physical states.

Participants described support networks as some of the mechanisms utilized for

coping with burnout. While the types of support systems varied between participants,

they agreed that professional networks, friends, family, pets, and colleagues were

considered the most effective at mitigating the experience of burnout. Furthermore,

participants noted that communicating to others, to supervisors, to their own therapist,

and colleagues was a beneficial step towards normalizing communication about burnout.

Participants disclosed that burnout needs to be talked about, MHPs need to not be or feel
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shamed about experiencing burnout, and that being vulnerable and talking about it is a

step in removing the stigma surrounding burnout.

Additionally, participants noted that there was minimal education or preparation

when entering the field that taught them what burnout was, or what it could look like, or

the importance of having a self-care plan. Participants stated that burnout is something

that should be addressed at the educational level to help prepare incoming MHPs. It was

noted that having a mentor can also help to mitigate experiences of burnout, because it

requires burnout to be directly addressed. Several participants stated that they

continuously speak with those whom they supervise about the experience of burnout and

addressing how supervisees are taking care of themselves. Several note that this helps

them to address their own burnout.

Summary

Chapter four reported the findings of this research based upon the analysis of data

collected in this study. Thematic analysis as defined by Saldaña (2015) was used as a

blueprint in the analysis of data in this study. As per Saldaña’s outline, the researcher

followed the four-step process in the data analysis stage. Step 1 comprised summarizing

passage of text using codes. Step 2 involved identifying similarities between codes,

combining codes into meaningful categories, and developing high-level categories. Step 3

included thoroughly reviewing the high-level categories and looking for themes.

Analytical memos were utilized through this step to form connections between high-

level categories. Step 4 included deliberating on presented themes and the relevance they

had to answering the research questions of the study.

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The first and overarching questions of the study was: How do MHPs, who treat

trauma, in the US., describe their experience of burnout? Through careful and thorough

analysis of the data collected in the study. Four major themes arose which addressed this

research question. The first theme was conditions as described by MHPs that resulted in

burnout. This encompassed high-level categories of workplace environments and lack of

control. The second theme was burnout as described by MHPs that was induced by

COVID. This encompassed the high-level category of telehealth and the pandemic.

The third theme was characteristics of burnout as described by MHPs. This

encompassed the high-level categories of physical and emotional symptoms, and

questioning career and self. The fourth and final theme was staying motivated in the face

of burnout as described by MHPs. This encompassed the high-level categories continuing

as an MHP and being an MHP is a calling. These themes identified MHPs described

experiences and perspectives about burnout.

The second research question, intended to support the first and overarching

research question, was: How do MHPs, who treat trauma, in the U.S., describe their use

of coping strategies. After the careful analysis of the data, four major themes arose which

addressed the research question. The first theme was strategies and tools utilized for

coping as described by MHPs. This encompassed high-level categories being mindful and

taking care of the MHP.

The second theme was beneficial types of support systems utilized for coping as

described by MHPs. This encompassed the high-level categories of colleagues,

professional networks, and therapy, and friends, family, and animals. The third theme

that arose was utilizing open communication to cope with burnout as described by MHPs.
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This encompassed the high-level categories addressing the stigma on burnout and being

open and honest about burnout. The fourth and final theme that arose was utilizing

education and preparation for coping with burnout as described by MHPs. This

encompassed the high-level categories education on burnout starting in school and

creating a personalized self-care plan.

This research focused on understanding MHPs described experiences related to

burnout and the coping strategies used. Trustworthiness of this study relied upon an

unbiased examination of the theoretical concepts, and ideas underlying the study

(Shenton, 2004). The researcher took precautions to ensure that no subjective judgements

were part of the research design, data collection, and the analysis of the study (Hayashi,

et al., 2019). Data gathered from self-report questionnaires, and semi-structured

interviews were coded, analyzed, and merged. Data merging was utilized to ensure the

confluence of findings in this study, which aligned with the qualitative descriptive design

(Sandelowski, & Leeman, 2012).

One possible limitation identified in this study was related to the need to

reschedule some participants interviews. Interviews were conducted through Zoom

videoconferencing software. It was originally planned that the interviews would take

place during the participants respective time availability; however, three interviews were

scheduled according to both the researcher’s and the participant’s availability. The use of

Zoom limited the interaction with participants. This limited the ability to build rapport

with participants and to gain their trust.

Another limitation was related to the sample size; a purposive sampling was used

to select MHPs who participated in the study. This was necessary to ensure the specific
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goal of the research was met (Robert, 2015). The researcher initially planned that 20

MHPs would participate in the study; of these, 18 agreed to participate. All 18

participants were interviewed. The smaller sample size limited the amount of data that

was collected in the study; however, this had some benefits. The smaller sample size

meant that the research was easier to manage (Palinkas, et al., 2013). These limitations

had no negative effect on the outcome of the study.

Chapter 5 starts with a complete summary of the study. The chapter provides an

extensive summary of the findings in the study and notes the conclusions that were drawn

from the findings. Chapter 5 additionally, provides an inclusive explanation of the

theoretical and the practical implications of this qualitative descriptive study. Lastly the

chapter finishes with recommendations for both future research and future practice.
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Chapter 5: Summary, Conclusions, and Recommendations

Introduction and Summary of Study

Many researchers agree that having coping strategies in place is useful to help

mitigate the experience of burnout (Bogiatzaki et al., 2019; Dreison et al., 2018;

Hammond et al., 2018; Ivicic & Motta, 2017; Paiva, et al., 2017). Wood and Bhatnagar

(2015) stated that there are two forms of coping, active and passive. Agha (2020) noted

that passive coping often means avoidance or denial of the situation. According to

Stangor and Walinga (2014) individuals should base the form of coping upon their own

needs after evaluation of the situation. Mental health professionals who treat trauma

patients are at high risk for burnout due to the nature of their work (Halevi & Idisis,

2018). Until now, no conclusive empirical studies existed in the literature addressing

MHPs who treat trauma and their experiences of burnout and coping strategies. The

purpose of this qualitative descriptive study was to explore how MHPs, who treat trauma,

in the U.S., described their experiences of burnout and use of coping strategies.

Burnout of MHPs has led to high turnover rates and has led to a decrease in

MHPs entering trauma-based therapy positions (Bethea, Samanta, Kali, Lucente, &

Richmond, 2019). This qualitative descriptive study was necessary to explore much

needed strategies MHPs could use to mitigate the experience of burnout and to fill the

gap in the literature regarding the experience of burnout in trauma MHPs. Burnout is a

known possibility when working in the helping professions and coping strategies are

known as the tools to reduce burnout (Coaston, 2017). Given that up to 67% of mental

healthcare workers suffer from burnout (Simionato, et al., 2019), effective strategies to

reduce burnout could help to change the field of mental healthcare. This qualitative
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descriptive study was essential and contributed to the body of existing knowledge of

burnout and coping strategies. Hessels et al. (2017) and Malkina-Pykh (2017) argued that

burnout among those who treat trauma is a major concern in the mental healthcare sector;

the results of this study illuminated the need for adoption of individual specific coping

strategies within the mental healthcare sector.

This study addressed the problem statement of it was not known how MHPs, who

treat trauma, in the U.S., described their experience of burnout and use of coping

strategies. To address the problem of this study, it was necessary to examine the

significant issue of burnout from the perspective of trauma MHPs (Ben-Porat, & Itzhaky,

2014; Bethea, et al., 2019). MHPs within the trauma setting were familiar with burnout

and what coping strategies were; therefore, they were the best suited to contribute

valuable understanding into the phenomenon. This study included the following research

questions, where RQ1 specified the overarching research question and RQ2 specified the

supporting question.

RQ1: How do MHPs, who treat trauma, in the U.S., describe their experience of

burnout?

RQ2: How do MHPs, who treat trauma, in the U.S., describe their use of coping

strategies?

Information provided within chapter 1included the background of the study, the

problem statement, the purpose of the study, the rationale for the methodology, the

research design, and the definition of terms. Chapter 1 also presented assumptions,

limitations, and delimitations that were relevant to the study. Chapter 2 presented a

thorough examination of the literature surrounding burnout experiences of trauma MHPs.

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Chapter 2 additionally provided the conceptual framework that guided the explanation to

the core problem of the study. The job demands-resources model (JD-R) provided the

conceptual framework for this study (Demerouti, et al., 2001). Chapter 3 provided an

explanation of the research questions under examination, the methodology, and the

research design that was used to perform the examination. The chapter also supplied

details about sample selections and the sources of data for the study.

Chapter 4 supplied a complete and comprehensive explanation of the findings of

this qualitative descriptive study. The thematic analysis that was employed to analyze the

data gathered in the study was also explained in chapter 4. The chapter provided a

concise summary of the results from the study. Chapter 5 focuses on the findings and the

conclusions drawn in this study. The chapter expounds on the theoretical, practical, and

future implications. The chapter also expounds on the strengths and weaknesses of the

study. Recommendations for future research and practice complete chapter 5.

There is an expanding body of literature that suggests that mental healthcare

therapists who treat trauma are more likely to experience burnout from repeated exposure

to traumatic experiences and stories of those they treat (Hessels, et al., 2017). Allsbrook

et al. (2016) and Coleman et al. (2016) noted that those in the MHP profession are at

higher risk to develop burnout due to the high stress nature of the work. Gerhart et al.

(2016) noted that MHPs who treat trauma are most at risk for developing burnout and

suggested that creation of a self-care plan is pertinent for those who work in trauma

settings. Burnout directly impacts the quality of work of MHPs and negatively affects the

care they provide to their patients (Joshi, & Sharma, 2020).

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Burnout is the number one cause of job turnover within the healthcare sectors, and

it affects both at the individual level and the professional level (Bianchi, et al., 2014;

Dyrbye, et al., 2010; Emery, et al., 2009; Halbesleben, & Buckley, 2004; Leiter, &

Harvie, 1996; Lim, et al., 2010). Self-care plans are the foundational blocks for

alleviating burnout (Nelson, et al., 2017). For MHPs treating trauma, not adopting the

creation of self-care plans puts both the MHP and the patient at risk (Berg, et al., 2016).

Personalizing coping mechanisms and creating self-care plans reduces the risk to both the

MHP and those they treat (Simionato, et al., 2019). Recent empirical studies have

recognized that burnout can affect all aspect of an MHPs life if left untreated (Halevi, &

Idisis, 2018).

Agreement exists between researchers that burnout of the MHP is likely if they do

not have a plan in place to help them alleviate burnout before it begins (Råbu, et al.,

2016; Rosenberg, & Pace, 2006). When an MHP has no control over their schedule or

caseload they are at higher risk to experience burnout, and less likely to have a self-care

plan set in place (Coleman, et al., 2016). Limited control over schedules and caseloads

also limits the time MHPs have available to practice self-care (Glennon, Pruitt, &

Rouland-Polmanteer, 2019). Furthermore, MHPs who work with trauma may have to

relive the trauma through settings such as court, documentation, notes, or treatment plans;

when this happens MHPs without a strategy for coping will experience burnout quicker

(Nelson, et al., 2017). This study was proposed to investigate the problem of burnout

from trauma MHPs perspectives and to explore the use of coping strategies to address the

problem.
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Literature proposes several strategies and mechanisms to address the problem of

burnout in trauma MHPs. Hyland et al. (2015), Haun et al. (2018) and Brown et al.

(2007) all suggested mindfulness, when practiced every day, will draw awareness to daily

life. Additionally, mindfulness can help to reduce burnout when practiced daily. Rosen et

al. (2020) noted that concreting resilience in healthcare workers can help improve their

well-being and allows them to be able to keep working with the focus and dedication

their jobs require. Furthermore, Agha (2020) suggested that using religion as a coping

mechanism, allows an individual to seek comfort; this often helps individuals to navigate

their own lives, gain motivation, and manage their own emotional problems. Wachholtz,

and Sambamoorthi (2011) suggested when individuals engage in positive health

behaviors, they are more likely to engage in prayer or some form of religion. Hammond

et al. (2018) stated being well informed about what precursors and risks are of burnout

can help to prevent it. Nonetheless burnout remains a concern for MHPs (Paiva, et al.,

2017).

This study utilized a qualitative descriptive methodology to examine how MHPs,

who treat trauma, in the U.S., described their experience of burnout. Investigating the

phenomenon of burnout from the perspective of trauma MHPs concentrated the study on

the experience of burnout, and the strategies that were likely to help circumvent burnout.

The qualitative methodology as well as the descriptive design allowed the researcher to

distinguish and depict: (1) how do MHPs, who treat trauma, in the U.S., describe their

experience of burnout? and (2) how do MHPs, who treat trauma, in the U.S., describe

their use of coping strategies? These two questions helped to examine, comprehend, and

illuminate participants’ experiences of burnout and their use of coping strategies uses.
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The target population for this study consisted of MHPs who treat trauma. An

administrator of a Facebook group for therapists, helped to provide individuals who could

participate in the study. A purposive sampling of 18 MHPs who treated trauma were

selected to participate in the study. Vasileiou et al. (2018) noted that smaller sample sizes

are commonplace with qualitative studies. The smaller sample size of this study made

management of the research study easier (Marshall, et al., 2013; Patton, 2015).

Furthermore, the limited focus of the phenomenon under investigation in this study did

not warrant a larger sample size to achieve the purpose of the research, therefore it was

not chosen. Through self-report questionnaires and semi-structured interviews, MHPs

shared their experiences of burnout and use of coping strategies.

This study used interview protocols designed by the researcher to help guide the

collection of data in this study (Majid, et al., 2017). Interview protocols were examined

and reviewed by an expert panel of three individuals who did not know one another. They

provided feedback and suggestions for interview questions and related that the interview

questions should garner enough evidence. All experts agreed the original interview

questions were enough to answer the research questions of the study. Hunter (2012)

stated that having protocols ensures that issues are addressed before interviews take

place. Expert panel members reviewed the protocols through the VREP tool with

permission from the creator of the tool.

Before collecting data from participants, each participant was emailed an

informed consent form to sign. The form described the nature of the research study, the

purpose of the study, and that participation was voluntary in nature. Additionally, the

consent included specifications for confidentiality procedures that were in place to

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protect the participants information. To ensure confidentiality of all participants

information, alphanumeric codes were assigned. Dempsey et al. (2016) noted that

whenever sensitive information is being given, reasonable, appropriate, and protective

measures must be taken to ensure the reduction of risk to confidentiality and privacy of

the participants information. Data collected in this study were not linked to any

participants identifying information. All participants were given alphanumeric identifiers

such as S1, S2 and so forth and were referred to as such within all documentation of the

study.

Data in this study were collected through a self-report questionnaire and semi-

structured interviews utilizing Zoom videoconferencing. All interviews were recorded

with permission from the participants. Interviews were transcribed by the researcher to

ensure control over the data. In addition, transcripts were sent to participants to ensure the

correctness of the transcript.

Thematic analysis as outlined by Saldaña (2015) was utilized as a roadmap in the

analysis of data in this study. Per Saldaña’s outline, a four-step process was followed

during the data analysis process. Step 1 was to identify codes in the data sources, step 2

was to create categories of codes, and develop higher-level categories, step 3 was to

review higher-level categories, combine them, and generate themes through analytical

memos, and step 4 was to apply the emerged themes to the research questions of the

study. After this four-step process, a descriptive report was written surrounding the

findings of the emerged themes in relation to the research questions of the study.

The remaining sections of chapter 5 outline key findings and conclusions of the

study. Additionally, chapter 5 presents theoretical, practical, and future implications of

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the study. Strengths and weaknesses of the study are also discussed. Chapter 5 finishes

out with relevant recommendations for future practice and research.

Summary of Findings and Conclusion

The purpose of this qualitative descriptive study was to explore how MHPs, who

treat trauma, in the U.S., describe their experience of burnout and their use of coping

strategies to mitigate burnout. This study explored MHPs experiences related to burnout

and their uses of coping strategies. Jiggins Colorafi and Evans (2016) stated that

descriptive studies focus on the described experiences as told by the participants;

therefore, the descriptive design was appropriate for the phenomenon under examination

in this study. A total of 18 individual trauma MHPs participated in the study by providing

data through self-report questionnaires, and semi-structured interviews. Following careful

review and analysis of the data gathered in the study, eight major themes developed that

addressed the two research questions of the study. This section details the noteworthy

advancements to scientific knowledge generated because of answering the research

questions of the study.

Research question 1. The first and overarching question of the study was: how

do MHPs, who treat trauma, in the U.S., describe their experience of burnout? This

research question was pertinent to examine how MHPs described their experiences of

burnout. The data analysis process revealed four major themes that pertained to this

research question: (1) Conditions as described by MHPs that resulted in burnout, (2)

Burnout as described by MHPs that was induced by COVID, (3) Characteristics of

burnout as described by MHPs, and (4) Staying motivated in the face of burnout as

described by MHPs.
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Theme 1: Conditions as described by MHPs that resulted in burnout. This

theme answered research question one. This theme reflected the many different situations

and settings within which burnout takes place. Participants in both agency, and private

settings experienced some form of burnout, which led to this emerged theme. As noted in

in the literature review, individuals work environments may not be within their control,

but having a positive work environment often aides in the reduction of burnout

experience (Galletta, et al., 2016). Therefore, as participants of this study noted the work

environment is a major condition in which burnout can happen.

Summary of findings. In conditions as described by MHPs that resulted in

burnout, the workplace environments and a lack of control played a role in the burnout

experience of MHPs. A strong agreement amongst all 18 participants was that having

more control over their careers, would be a catalyst for diminished experiences of

burnout. Participants shared the belief that if they had a better workplace environment it

would significantly reduce the amount of burnout experiences. Participants noted that the

lack of control in their career was a large factor for the experience of burnout. S5, S7, and

S13 all focused on the work environment being a significant contributing factor to their

burnout because of unsupportive supervisors. All 18 participants regardless or workplace

setting noted that high workloads, lack of control, and negative work environments led to

burnout quicker. Several participants noted that because they carried such a high caseload

of trauma clients, they burned out faster as they had a minimum number of clients to see

a week. The information gathered from participants verified that understanding

conditions as described by MHPs that resulted in burnout is integral to minimizing the

experience of burnout.
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Significance of findings. Several findings of the theme conditions as described by

MHPs that resulted in burnout, supported findings from similar previous studies. Wardle

and Mayorga (2016) noted that individuals who carry high caseloads, experience

managed protocols for work such as insurance requirements or a specified number of

cases, and lack of control of their job are all situations that can lead to burnout. The

findings of this research show that it is necessary to create positive work environments

and to set boundaries to maintain control of one’s career which will help to reduce

conditions that result in burnout.

Additionally, the findings of the theme conditions as described by MHPs that

resulted in burnout matched findings by Eliacin et al. (2018) that stated that the

environment, personal experiences and job-specific reasons can all contribute to the

experience of burnout. They argued that workplace settings contribute to burnout of

MHPs, and that creating a positive work environment is necessary for both the MHP and

those they treat. In prior research by Lim et al. (2010) they found that the workplace

setting is associated with burnout. Furthermore, agency settings, as opposed to private

practice settings, often present many obstacles to MHPs these can include, paperwork,

administrative duties, and a lack of control over their work, which increase the risk for

burnout.

Theme 2: Burnout as described by MHPs that was induced by COVID. This

theme also answered research questions one. This theme was related to the current public

health crisis. The findings of this study indicated that all 18 of the participants, through

semi-structured interviews, shared the same view that the public health crisis had affected

their work and their clients. Participants agreed that the burnout experienced from the
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public health crisis was present as they were navigating the pandemic alongside their

clients, thus substantiating this theme. All 18 participants noted that the pandemic led to

an uptick in clients needing sessions, and that the constant use of teleconferencing

sessions led to Zoom fatigue.

Summary of findings. In burnout as described by MHPs that was induced by

COVID, most participants agreed that the current pandemic was a factor for the

experience of burnout. The unknowns of what would happen with the pandemic and

walking through the situation at the same time as clients, were factors for burnout. S17

elucidated participants’ point of view when he noted:

When COVID first hit we went on more of a shutdown than anything else. So, for

a while, clients were, unless they were severe cases, they weren't really allowed to

be coming in. So almost everybody was doing telehealth that wanted to. If I

would see normally, six clients in a day in person, four felt like, eight. When we

were doing everything over video. I mean, that leads a lot to burnout too. I think

part of that has to do with the amount of screen time you end up doing because I

think that screen time drains you as well.

S5 during her interview stated:

We're dealing with this, and that was something that was totally over our head.

She (supervisor) didn’t understand. So, then I was right back in that burnout

space. With the pandemic being what it is I'm also tapped out. So, I'm not doing

what I should be doing.

To address the theme, burnout as described by MHPs that was induced by

COVID, participants identified the need for more creative self-care during the pandemic
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to avoid the experience of burnout, as restrictions limited participants self-care routines.

Participants additionally noted that having clear directions on what was expected of them

during the public health crisis would have aided in mitigating burnout. Numerous

participants mentioned that having regulations for things such as telehealth and

guidelines for seeing clients were helpful in reducing burnout; but, the unknowns of the

pandemic, working from home, navigating telehealth, uptake in clients, and restrictions

made burnout worse. Participants agree the pandemic made them more susceptible to

experience burnout, thus substantiating participants views regarding this theme.

Significance of findings. In prior research, Bradley, Whisenhunt, Adamson, and

Kress (2013) noted that mental health professionals must be creative in the process of

self-care. They argued that creative self-care strategies can provide the MHP the ability to

reflect on what their state of mind is. Additionally, it could provide ways to improve their

outlook professionally, while also providing them unique techniques to document their

journey as an MHP.

The findings from this research show the need to practice self-care in creative

ways, especially when facing adverse public health conditions. The findings of the theme

burnout as described by MHPs that was induced by COVID matched those of Leider,

DeBruin, Reynolds, Koch, and Seaberg (2017) that stated while there has been an

increase in public health preparedness, with increasing attention to crisis standards of

care, the crisis standards of care have rarely been utilized or implemented in the United

States to date. This fell in line with participants stating if they’d have had guidance

during the pandemic on what was expected of them, they would have had less burnout,

thus further substantiating the theme.

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Prior research by, Rosen et al. (2020) noted that health care professionals face

more challenges that up their possibility of burnout. Health care professionals not only

have to cope with rapidly changing policies, managing uncertainty, and adapting their

work scope, but they also must work with clients during the pandemic while they are

walking through it themselves. Thus, further substantiating participants views regarding

this theme.

Theme 3: Characteristics of burnout as described by MHPs. Additionally, this

theme answered research question one. This theme was related to the characteristics of

burnout. Participants mentioned differing characteristics of burnout during interviews.

The results of this study indicated that participants all believed that understanding and

knowing what burnout looks like is pertinent to mitigating the experience of burnout.

Participants had similar answers as to what the characteristics of burnout were, however,

there was cohesion between participants that the characteristics of burnout need to be

known to prevent it. Thus, substantiating this theme.

Summary of findings. In characteristics of burnout as described by MHPs all 18

participants noted that fatigue was the number one characteristic of burnout. all 18

participants noted that the fatigue was mental as well as physical. S17 illuminated

participants view of this theme when he stated:

Fatigue, a lot of fatigue. Because one, it's hard to get out of bed. Even if you've

slept, the full night's sleep, you still don't want to get out of bed, the days you

know you have to be there. Lethargy. You're moving at just this slow, slow pace,

because you're dragging your feet and you don't have the motivation to be there.
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S12 illuminated this when she noted: “exhaustion, anxiety, stress. Sometimes

headaches. Fatigue. I never got really sick or anything. But just a lot of exhaustion and

anxiety, stress”. An additional characteristic mentioned was depression. 16 out of 18

participants when describing what the symptoms of burnout were, depression was the

most mentioned. S14 illuminated this when he mentioned

The symptoms look very much like depression, or having difficulty getting out of

bed in the morning. Having a sense of hopelessness, thoughts of am I making any

difference whatsoever? I'm probably not making a difference at all, and probably

not helping anybody anyway. Feelings of exhaustion and tiredness.

S5 stated “I kind of become even more introverted than I may typically be. I feel like it's

a depression. It’s withdrawal, being very sluggish, a lack of motivation, little happiness,

little fulfillment”. To address the theme characteristics of burnout as described by MHPs,

several participants noted that when they began to blur their boundaries and when they

began to dread work it was key characteristics that they were beginning to burnout.

Participants noted that there is a need to be strict with boundaries and practice some form

of self-care to prevent burnout.

Significance of findings. Participants in this study noted one consistent

characteristic of burnout was exhaustion. A review of prior literature noted that burnout

has many characteristics an individual may experience, but exhaustion is usually present.

For example, Ballenger-Browning et al. (2011) noted that burnout is a syndrome defined

by three primary factors 1) mental and physical exhaustion, 2) dissatisfaction with

oneself, or negative attitude, and 3) cynicism that is directed towards clients. In another

study Ghannam et al. (2020) mentioned that burnout is a state of physical, mental, and
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emotional exhaustion. This exhaustion arises from the constant exposure to stress. They

further noted that this constant exposure can lead to no motivation, helplessness and

disengagement which are features most commonly present in depression. The findings in

this study, that there are many different characteristics of burnout, added to the collection

of burnout characteristics listed within prior research (Ballenger-Browning et al., 2011;

Campagne, 2012; Everall, & Paulson, 2004; Ghannam et al., 2020).

15 out of 18 participants in this study elucidated that shame is a characteristic

connected to burnout. Participants mentioned when they were burned out to the point

they dreaded going to work, they were ashamed for feeling that way, which effected

client care, and kept participants from speaking up about their burnout. This finding

confirmed Pratt and Jachna’s (2015) findings that when clinicians experience guilt,

shame, or fear it is likely to keep them from seeking help. This then leads to burnout, and

a decrease in the quality of care the clinician provides. Comparably Bercier and Maynard

(2015) noted that for MHPs, burnout is often surrounded in shame and isolation, as

professionals avoid speaking out, for fear of being labeled, due to the stigma attached to

burnout. The findings of this study aligned with that of Bercier and Maynard’s findings.

Theme 4: Staying motivated in the face of burnout as described by MHPs. This

theme was the last theme that answered research question one. This theme was related to

participants finding motivation to continue as an MHP even though they were burned out.

The results of this study indicated that participants agreed that motivation for continuing

as an MHP helped to mitigate their burnout. While participants had varying motivations,

the consensus was that the clients were ultimately what motivated them to continue as an

MHP. Participants agreed that the benefits outweighed the risk of burnout.
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Summary of findings. Participants in this study all identified the client’s journey

as being the motivation for continuing as an MHP. S12 acknowledged this when

recounting as follows: “I love the clients. I love the patients we see. I love watching

people heal. I love watching people graduate from programs. It gets me excited for

them”. S5 further confirmed this when noting “The clients. I mean, that's why I got into

the job. I didn't get into the mental health field to be rich. Nobody's going to be rich off

this. So, it's for them”. Participants had other motivations for continuing as an MHP, such

as clients living their best life S8 indicated this when stating their motivation for

continuing “I love humans. I really want to see people have an opportunity to live their

best self, whatever that is”.

Another motivation for participants was seeing the client make progress, as noted

by S13 who stated, “Seeing a client make progress motivates me”. S17 noted “when the

clients that I've been working with start showing progress, it feels good”. Many

participants noted that they were drawn to the field or that this was a calling as noted by

S14 who stated “I just kept having this calling, a feeling like pulling on me. I love what I

do. I love watching people experience growth and change the light in their life it excites

me”. Additionally, S6 mentioned “You don't become a counselor because you want huge

paychecks. You do it because you have to. You can do lots of other stuff, but it's always

going to be calling to you”.

Significance of findings. All 18 participants emphasized that the client was their

main motivation for continuing as an MHP. Existing research by Abdulwahab (2016)

suggested that individuals who have high levels of satisfaction in their jobs are more

engaged with their work and have given meaning to the work that motivates them.
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Similarly, Coaston (2017) noted that tracking progress and small changes by clients can

help motivate the counselor when discouraged. This is in line with the findings of this

research. Participants in this study also identified that sharing in the client’s journey was

rewarding for them and a motivation for continuation as an MHP. This finding confirmed

Råbu et al. (2016) findings that therapists experienced enrichment of their lives through

having the opportunity to take part in the personal lives and growth of their clients.

Research question 2. The second research question of this study was: how do

MHPs, who treat trauma, in the U.S., describe their use of coping strategies? This

research question was pertinent to examine how participants described their uses of

coping strategies. The data analysis process revealed four major themes that pertained to

this research question: (1) Strategies and tools utilized for coping as described by MHPs,

(2) Beneficial types of support systems utilized for coping as described by MHPs, (3)

Utilizing open communication for coping with burnout as described by MHPs, and (4)

Utilizing education and preparation for coping with burnout as described by MHPs.

Theme 1: Strategies and tools utilized for coping as described by MHPs. This

theme answered research questions two. This theme related to the strategies and the tools

that participants used to help mitigate their burnout. According to Labrague et al. (2017)

strategies utilized for coping vary by individual and the level of burnout the individual is

experiencing, but commonly seen strategies are exercises, watching movies, and eating.

Gupta et al. (2012) noted that external coping strategies include things such as talking to

someone, talking to relatives and friends, and praying. Data collected in this study

established that effective coping strategies contain several elements that are tailored
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specifically to the MHP. Data revealed that having specific and tailored strategies can

help greatly reduce the burnout experience.

Summary of findings. All 18 participants in this study shared the same view that

doing something that they enjoyed was beneficial in helping to cope with burnout.

Several participants noted that doing something creative was beneficial for them to

mitigate their burnout. This included strategies such as exercise, walking the dog, and

mindfulness. S7 noted “I personally use mindfulness meditation a lot myself. I'll listen to

mindfulness meditation, even if it's while I'm going to sleep, and it just helps me to calm

my mind”.

S12 stated:

I have my dogs here. Walking in and seeing their faces kind of lifts the yuckiness

from the day sometimes. I walk in the door, and they're there at the door waiting

for me. I'm like, oh you know nothing else matters right now.

Exercise was the second most frequently mentioned coping strategy. Almost

every participant noted exercise as being something that has helped them with their

burnout as noted by S17:

I'm running, weightlifting, something like that. Because the other stuff that goes

with it that rigorous exercise, just tires your body out enough that it just let’s go of

a lot of things. So, then you're not carrying all that with you.

S3 mentioned “I took a course in mindfulness and meditation. I did it for myself,

but it has over overflowed into my work, which is very beneficial working with trauma

survivors. So, developing a practice of meditation was super important”.

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Significance of findings. 16 out of the 18 participants in this study revealed that

practicing mindfulness is one of the best strategies to mitigate burnout, as it keeps you

aware of everything in the moment. Haun et al. (2018) noted that mindfulness both at

home and at work can act as a buffer to the harmful effects of job demands. May and

O’Donovan (2007) suggested that mindfulness through everyday activities such as

washing the dishes, walking, and sitting allows for individuals to be present in the

moment and the feelings and sensations attached to those moments. An important finding

of this theme, strategies and tools utilized for coping as described by MHPs, was that

when participants practiced mindfulness, they experienced more awareness of their

burnout. An additional finding was that when participants practiced with mindfulness it

encompassed other aspects of their life. These findings aligned with those of Haun et al’s.

study in which mindfulness helped to work as a buffer to permit better disconnection

from work and allowed a work-life balance even though work demands are high.

Theme 2: Beneficial types of support systems utilized for coping as described by

MHPs. This theme also answered the second research question. This theme was related

to the types of support systems utilized used by MHPs that helped to manage their

burnout. Pulido (2012) noted that supervision, peer support, and trainings are some of the

best forms of support that are effective at ameliorating stress symptoms that lead to

burnout. Hilbrecht (2016) mentioned that close personal relationships, business networks,

or both of these can provide support to MHPs when facing burnout.

Summary of findings. In addressing the theme beneficial types of support systems

utilized for coping as described by MHPs, MHPs were varied about what was a good

support system. However, all 18 participants said that having a network of colleagues in
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the same line of work was the best support system for coping. Participants indicated that

having a colleague who understands what they are going through made it easier to rely on

them for support. S13 mentioned “People who are working with the same population that

you are, so that they completely understand where you're coming from are the most

beneficial support systems”. S7 stated that “Just kind of expanding your professional

networks to get support that way, from others in your field of expertise, whatever that is”.

Participants also noted that friends are a good source of support as described by S1:

“Having really good friends that don't care if you just want to hang out and not talk about

anything, just drink wine, or just want to chat”.

The most beneficial type of support system as noted by S14 are:

Ones that are unconditionally loving and supportive. So, if you have a significant

other, that would be really great. Obviously, you don't go home and talk about

your cases with your significant other but being able to go home and having a

conversation with him or her and saying, hey, it was a really tough day to day.

These are some of the things that came up for me today, or wow, I was in the

session and this is what I need. And asking for what we need from our significant

other is helpful.

Significance of findings. All 18 participants in this study indicated that having a

strong support system is necessary to reduce burnout. Participants believed that having a

network of colleagues in the same field were the best support system. Pratt and Jachna

(2015) noted that sources of support are often professional colleagues of some degree,

followed by a mental health professional or a psychologist. An important finding of this

theme, beneficial types of support systems utilized for coping as describe by MHPs, was
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that colleagues who worked in the trauma field were most likely to talk to someone who

also worked in trauma. This was in line with the findings from Pratt and Jachna’s study,

with specific measures for peer-to-peer support that were likely to reduce the experience

of burnout.

Theme 3: Utilizing open communication to cope with burnout as described by

MHPs. Additionally, this theme answered research question two. This theme related to

the MHP communicating with others that they were experiencing burnout. Gerhart et al.

(2016) suggested that when a clinician is skilled at communicating, they can identify

concerns and can communicate their burnout to others, which in turn allows for them to

provide effective care to their clients. When they are unable to communicate their

concerns or communicate when they are burned out, they are unable to provide adequate

care. The results of this study indicated that not communicating about burnout is a risk.

All 18 participants agreed that it was not always easy to communicate about burnout, for

fear of being judged, it having a stigma attached to it, or because their supervisors just

didn’t care.

Summary of findings. 17 out of 18 participants of this study indicated that it is

crucial to discuss burnout and communicate about burnout, to keep the risk for burnout

low. Participants noted that communicating about burnout is the best tool to help prevent

it. S3 mentioned that the best tool to prevent burnout is to have:

Open and earnest communication about what they are experiencing. I think being

open to feedback and being alert to what those symptoms are for them, so that you

can either help them recognize that or receive that feedback, so you can see it in

yourself.
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Participants noted that ways to prevent burnout should include talking about it

more as noted by S10 “I think just having more talk, talking more about it in general.

Having more discussions about it, and just making it something that we in our field, that's

talked about more often”.

Significance of findings. 12 of the 18 participants in this study indicated that there

is. a stigma attached to burnout, and that it is taboo to talk about being burned out. S6

mentioned:

I think in some ways, it's like talking about mental health issues was back in the

40's and 50's. You didn't talk about that. That was taboo. Well, no, it's not taboo

and talking about burnout isn't taboo. It's a normal thing when you are a mental

health professional.

Prior research by Dalphon (2019) acknowledged that honest communication with

others allows for conversations to take place. They suggested that honesty about one’s

burnout, allows others to be open and honest with them. An important finding of the

theme, communication, was that communication about burnout can minimize the amount

of burnout the MHP experiences. Another important finding was that communicating

about burnout allows it to be addressed without judgment and removes the stigma of it

not being talked about. These findings aligned with Dalphon’s study with specified

strategies that were likely to maximize the communication about burnout.

Theme 4: utilizing education and preparation for coping with burnout as

described by MHPs. This was the last theme that answered research question two. This

theme was related to MHPs using education about burnout to help them cope with the

experience of burnout. Additionally, this theme related to creation of self-care plans with
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specific steps for managing burnout, which helped to prepare them to reduce the number

of burnout experiences. By recognizing the signs and the symptoms of burnout MHPs

were better equipped to cope with burnout.

Summary of findings. In addressing utilizing education and preparation for coping

with burnout as described by MHPs, all 18 participants in this study indicated the need

for education on burnout before becoming an MHP. All 18 participants felt that some

kind of education on burnout was a good coping strategy as it would help to prepare

individuals for what to expect if they became burned out.

S10 indicated when speaking about education on burnout:

I think just having more talk. Talking more about it, in general. Having more

discussions about it, and just making it something that we in our field, that's

talked about more often. Because I don't feel like it is very much.

Participants identified that preparing new MHPs to recognize burnout signs is

necessary to prevent the experience of burnout. This would ensure that MHPs were

educated in signs and symptoms of burnout and would be prepared with a personalized

self-care plan. When asked about creating self-care plans as new MHPs S3 had this to say

“I guess, you know planning out, like coping ahead and DBT. We cope ahead, right, so I

can see the value and benefit of that creating that together”. Two participants S15 and

S18 noted that education about burnout is the best way to normalize that it happens. S18

explained: “I think it would start definitely in school. So, I think that we could do a better

job as a profession, talking about our own mental health and normalizing it”.

Significance of findings. All 18 participants in this study indicated that some form

of education surrounding burnout is necessary to help prepare MHPs to cope with

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burnout, but also to reduce the amount of burnout that is experienced. Bloomquist et al.

(2015) acknowledged that educational content regarding self-care practices should be

built into MHPs educational curriculum as a means for promotion of occupation

longevity in the field for MHPs. An interesting finding of the theme utilizing education

and preparation for coping with burnout as described by the MHP, was that education

about burnout can help minimize the experience of burnout and can help with coping

with burnout. Another finding in this study was that educating MHPs about the need for

self-care helps to provide proactive strategies that MHPs can utilize for coping with

burnout.

These findings were in line with Lim et al. (2010) findings that utilizing education

about burnout early in the MHPs career is beneficial at reducing burnout. The findings of

this study were in line with the findings from Bloomquist et al’s study which noted that

engaging in actions that contribute to wellness and the reduction of stress are beneficial

self-care strategies for MHPs. Bloomquist also noted that there are five primary forms of

self-care practice. These include professional self-care, spiritual, psychological, physical,

and emotional self-care.

Summary. Burnout of the MHP can lead to serious problems such as depression,

sleep issues, anxiety and can cause poor physical health, memory issues, and even

substance abuse (Ernst Wood et al., 2017). Moreover, as prior researchers have noted,

burnout can be detrimental for the MHP, their client, and even organizations (Eliacin, et

al., 2018; Lim, et al., 2010). Despite MHPs have coping strategies, burnout continues to

be a pervasive factor in the mental health field (Bianchi, et al., 2014; Dyrbye, et al., 2010;

Eliacin et al., 2018; Ernst Wood et al., 2017). A review of the literature performed in this
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study showed that the possibility of MHPs experiencing burnout remains an obstinate

issue (Bogiatzaki, et al., 2019; Cocker, & Joss, 2016; Ivicic, & Motta, 2017; Jergensen,

2018; Paiva, et al., 2017). In this study it was not known how MHPs, who treat trauma, in

the U.S., described their experiences of burnout, and their use of coping strategies.

This qualitative descriptive study examined burnout of MHPs who treat trauma

and their uses of coping strategies. To address the problem of the study, the purpose of

the study, and the unfulfilled need as outlined within the literature review section of this

study, there were two research questions that were proposed. RQ1 was the overarching

question of the study, while RQ2 was the supporting research question of the study.

RQ1: How do MHPs, who treat trauma, in the U.S., describe their experience of

burnout?

RQ2: How do MHPs, who treat trauma, in the U.S., describe their use of coping

strategies?

In addressing the first research question four major themes arose a) conditions as

described by MHPs that resulted in burnout, b) burnout as described by MHPs that was

induced by COVID, c) characteristics of burnout as described by MHPs, and d) Staying

motivated in the face of burnout as described by MHPs. These themes offered an

understanding of how MHPs described their experience of burnout. The data were

gathered through self-report questionnaires and semi-structured interviews. The

responses from participants confirmed that understanding the conditions that resulted in

burnout were crucial to being able to mollify it. Participants indicated that burnout which

was induced by the pandemic was harder to manage due to several restrictions and

constant Zoom sessions with clients. Participants indicated that knowing the
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characteristics of burnout are necessary to recognize it when it happens and to help in

reducing it. Lastly responses from participants confirmed the finding that staying

motivated even though there was a risk of burnout, was useful in the reduction of the

burnout experience.

The findings of themes a) conditions as described by MHPs that resulted in

burnout, b) burnout as described by MHPs that was induced by COVID, c) characteristics

of burnout as described by MHPs, and d) staying motivated in the face of burnout as

described by MHPs, all supported findings of earlier research on burnout (Jaracz et al.,

2017; Maslach, & Leiter, 2016; Sansbury, et al., 2015). Given that burnout continues to

be an issue, MHPs may not have the sufficient tools to manage burnout.

The findings that addressed and answered RQ1 were significant to understanding how

MHPs described their experiences of burnout. In addressing RQ2 the data were gathered

through self-report questionnaires and semi-structured interviews designated that utilizing

self-care strategies, support systems, and communication about burnout were all

fundamental strategies to reduce burnout experiences.

Four major themes arose 1) strategies and tools utilized for coping as described by

MHPs, 2) beneficial types of support systems utilized for coping as described by MHPs,

3) utilizing open and communication to cope with burnout as described by MHPs, and 4)

utilizing education and preparation for coping with burnout as described by the MHP.

The data revealed that mindfulness was the best coping strategy for mollifying burnout.

Furthermore, that data illuminated that a professional network of colleagues in the same

line of work were the best support systems for reducing burnout. Data further revealed

that having open and honest communication about burnout is necessary to keep burnout
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at bay. Lastly, data revealed that educating and preparing for burnout before it happens is

a proactive and necessary coping measure for MHPs, which helps to ensure that MHPs

have lessened experiences of burnout.

The findings of the themes 1) strategies and tools utilized for coping as described

by MHPs, 2) beneficial types of support systems utilized for coping as described by

MHPs, 3) utilizing open communication to cope with burnout as described by MHPs, and

4) utilizing education and preparation for coping with burnout as described by MHPs

supported findings of prior research on coping strategies for mitigating burnout

(Anderson, 2000; Lee, et al., 2016). Given the little research on beneficial coping

strategies, the coping strategies acknowledged in addressing and answering RQ2

provided beneficial acumen. The findings that answered RQ2 were significant to

understanding how MHPs described their experience of coping strategy uses.

Implications

The purpose of this qualitative descriptive study was to explore how MHPs, who

treat trauma, in the U.S., described their experience of burnout and their use of coping

strategies. To address the purpose of this study, the researcher examined MHPs described

experiences related to burnout, and coping strategies to address the problem of the study.

The research employed a qualitative methodology, and a descriptive design to carry out

this study (Kim, et al., 2017; Magilvy, & Thomas, 2009; Marshall, et al., 2013; Moser, &

Korstjens, 2018; Onwuegbuzie, & Leech, 2007). The descriptive design allowed for

MHPs own accounting of their described experiences relating to the phenomenon of

burnout the study was exploring. The findings of this study advanced the understanding

and knowledge of burnout MHPs experienced, and the coping strategies MHPs were
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likely to utilize during burnout. Additionally, the findings of this study likely provided

MHPs strategies they can use to help avoid experiencing burnout. This section describes

the practical, theoretical, and future implications as well as strengths and weaknesses of

the study.

Theoretical implications. The job demands-resource model (JD-R) provided the

conceptual framework for this study (Demerouti, et al., 2001). Research on burnout has

displayed that there is a high rate of burnout among the MHP professions. More

specifically, MHPs who treat trauma. Therefore, the purpose of this study was to explore

the described experiences of burnout, and uses of coping strategies of MHPs who treat

trauma, in the U.S.

The JD-R model was chosen as the theoretical foundation for this study because

as previous researchers have explained, the JD-R is a model that can be applied to a large

range of job demands and job resources (Demerouti, et al., 2001). The JD-R can also be

utilized to study the different profiles of job demands, and resources that could be typical

for burnout in specific occupations such as MHPs (Demerouti, et al., 2001). The two

segments of the JD-R were (1) job demands, and (2) resources.

The demands portion of the JD-R are the organizational aspects, the physical,

emotional, and social aspects of a job that require sustaining both mental and physical

effort, and therefore are associated with physiological and psychological costs to an

individual, or burnout (Demerouti, et al., 2001; Maslach, 1998). The resources segment

of the JD-R refers to the physical, psychological, organizational, or social aspects of a job

that can perform any of the following a) reduce the job demands associated with both the

physical and psychological costs to the individuals, b) function in achieving work goals,
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and c) stimulate growth and development in the individual (Demerouti, et al., 2001). The

themes conditions resulting in burnout, characteristics of burnout, and strategies and tools

that arose in the study were aligned with the job demands-resource model.

The findings of this study aligned with the JD-R model. As the participants of this

study noted, they utilized resources both personal and professional, when the demands of

their jobs were high. The JD-R noted that the model may be applicable in workplace

interventions that are aimed at the prevention or reduction of burnout (Demerouti, et al.,

2001). Furthermore, participants of this study suggested that when they have high

workloads, they utilized more personal resources to help prevent burnout. Participants in

this study noted that things such as exercise, hiking, biking, walking their dog, music,

movies, and art were best at reduction of burnout. Participants also noted that colleagues

were a good resource to mitigate burnout as well. This aligned with the findings of

Bakker et al. (2005) who noted that there are certain resources which are connected to the

goals of most individuals.

Many findings of this study aligned with the segments of the JD-R model. The

JD-R provided the theoretical foundation for exploring participants described experiences

of burnout and uses of coping strategies. This study presented an important step in

understanding the experiences of burnout, and the strategies that may be used to mitigate

burnout. The theoretical implication of this study while validated, were that when job

demands are high, individuals will utilize resources specific to them to mitigate the

stressors or demands of their specific job. This ties back to the theme conditions as

described by MHPs that resulted in burnout. This additionally ties back to the theme

strategies and tools utilized for coping as described by MHPs.

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12 out of the 18 participants for this study when they described their experience of

burnout noted that high job demands led to the need for specific coping strategies. This

study advanced the JD-R by recognizing strategies and resources that are specific to the

MHP are the most beneficial safeguards against burnout. Furthermore, data gathered in

this study established the usefulness of the JD-R model in relation to understanding

burnout of MHPs by demonstrating how job demands and resources that are utilized for

coping have a long-term effect on the experience of burnout.

Practical implications. The results of this study established that MHPs

continually face multiple causes of burnout. Moreover, the results confirmed that MHPs

could benefit from creating specific self-care plans that would help them to mitigate the

experience of burnout. This was illustrated through the theme utilizing education and

preparation for coping as described by MHPs. Furthermore, the results of this study

showed that creating classes that explore burnout and the necessity of self-care plans

could benefit new MHPs before they enter the field. This was also illuminated in the

theme utilizing education and preparation for coping with burnout as described by MHPs.

Previous research has recommended that creating educational courses to prepare well-

trained graduates in both masters and doctoral level programs, can aid in the prevention

of burnout. Additionally, courses for budding MHPs should include educating them on

wellness behaviors, as well as discussions about the many variables that could lead to

burnout as a new MHP (Wardle, & Mayorga, 2016).

The possibility of burnout in MHPs challenges the possible benefits that could be

gained from educational training, therefore, strategies for coping with burnout, such as

those advanced in this study, have several practical implications for MHPs, specifically
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those who treat trauma. This study found that while MHPs utilized coping strategies,

burnout still was present. The creation of a tailored self-care plan aimed at reducing

burnout represented the best set-forth strategy for mitigation of burnout. The practical

implication of this study is that MHPs should consider creating a specific and tailored

self-care plan before entering into the profession. This strategy could be designed as a

possible way to prevent burnout before it begins.

The belief that burnout is influenced by several factors including work-related, as

noted by O’Connor et al. (2018) was accurate in this study. Key findings of this study

were that several conditions were present that led to burnout, most were work-related,

including a lack of control. This study found that MHPs who worked either in an agency,

or under someone typically experienced more burnout than those who were in private

practice. Additionally, those who did not have control over their career experienced

burnout more than those who had control over their career.

Participants in this study shared the view that the lack of control over their career

was a large determinant of their burnout experience. This finding was in line with earlier

studies (Bethea, et al., 2019; Deighton, et al., 2007; Maslach & Goldberg, 1998; Parola,

et al., 2016). A practical implication of this finding is the need for at organizations could

take actions to help MHPs have more control over their career, beginning with their

workload. This was illuminated in the theme conditions as described by MHPs that

resulted in burnout, and the theme utilizing education and preparation for coping with

burnout as described by MHPs. Moreover, organizations could include the findings of

this study into training for MHPs that helps reduce burnout and helps create self-care

plans.
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Finally, a practical implication related to how MHPs utilized coping strategies to

manage burnout. 18 out of 18 participants of this study suggested that communicating

with either a supervisor or a colleague was one of the best coping methods for managing

burnout. Colleagues who worked in the same field of trauma were considered by

participants to be a better measure for coping as they understood the nature of trauma

work. Participants determined that it was easier to talk to colleagues about their

experience of burnout if they were in the same line of work.

MHPs both in private practice and agency practice could apply the findings of this

study to create a network of colleagues who work in the same area of expertise to help

reduce the experiences of burnout and improve the likelihood of them communicating

openly about burnout. This was illuminated in the theme utilizing open communication

for coping with burnout as described by MHPs. This study shows a need for programs

that educate and prepare MHPs for burnout. Programs such as these could decrease the

likelihood that MHPs experience burnout.

Additionally, programs designed to support the MHP during their experience of

burnout could increase the likelihood that less MHPs experience burnout. Participants

determined that having resources such as education programs would help minimize the

experiences of burnout. Additionally, it was determined by participants that having a

support system they could rely on during burnout was necessary to help them minimize

it. MHPs both current, and new to the profession could apply the findings of this study to

create programs that both educate and encourage the building of support systems.
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Future implications. This study addressed the problem statement of it was not

known how MHPs, who treat trauma, in the U.S., described their experiences of burnout.

This qualitative descriptive study established that strategies for mitigating burnout could

prove beneficial for other sectors of work that could experience burnout. The chosen

methodology and design to conduct this study was qualitative methodology and

descriptive design (Bradshaw, et al., 2017; Jiggins Colorafi, & Evans, 2016; Mabila,

2017; Magilvy & Thomas, 2009; Qu, & Dumay, 2011; Sandelowski, 2000; Smythe,

2012). This permitted the exploration of MHPs individual accounts of their burnout

experiences, which were crucial to answering the research questions presented in this

study. As previously mentioned, the researcher planned for 15-20 MHPs to take part in

the study; of those 18 agreed to participate. The smaller sample size allowed for more

control of the data; however, this could have decreased the generalizability of the study’s

results. A future study reproducing this research could incorporate a larger sample size,

while including MHPs from other areas of expertise; a study such as that could

substantiate the findings of this study.

This qualitative descriptive study was limited to MHPs who treat trauma. Possible

future studies should consider different areas of expertise. Additionally, this study

utilized the entire United States, future studies could focus on a singular geographical

area. While this study did not consider gender to be a factor in this study, participants

were both male and female. While this had no bearing on the results of this study, future

studies could focus singularly on male MHPs which could expand both perspectives, and

experiences disclosed by participants. Male MHPs in a future study could further

heighten the body of knowledge of burnout.

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Strengths and weaknesses of the study. Careful formulation of the research

process bolstered the study. Previous to any collection of data the researcher submitted

the proposed study to the IRB for approval. This confirmed all possible ethical

implications were addressed. To safeguard confidentiality, participants of the study were

given alphanumeric codes such as S1, S2 and so forth. No data that were collected in the

study were associated with the participants’ names or identities. Procedures that ensured

this confidentiality were shared with participants. Steps were taken throughout the study

to ensure that confidentiality was maintained, this encouraged more details to be shared

by participants.

A strength of importance of this study was the use of member checking. This

minimized possible errors regarding the findings of this study. The researcher utilized

member checking to confirm the understanding of participants responses. Participants in

the study were sent a summary of the results which included the themes that arose from

the data analyzed within the study. Participants were asked to confirm the findings of the

study and the quotes ascribing to them, and to respond back with any suggestions or

comments. Member checking diminished misinterpretation and misunderstanding of the

participants experiences (Chase, 2017). Additionally, member checks served to ensure

trustworthiness of the study, which contributed to the strength of the study (Korstjens, &

Moser, 2018).

A further strength of this study was related to the researcher’s professional

background and experience as an MHP. McCusker and Gunaydin (2015) noted

qualitative research involves the researcher, and their personality and integrity are key

components in ensuring the quality of the data gathered. As an MHP, the researcher
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understood the concept of burnout, and coping strategies. This permitted the researcher to

investigate the research questions which supported the purpose of this study. Being

familiar with the issues encompassing burnout, allowed the researcher to understand

vocabularies and expressions used by MHPs who participated in this study.

A possible weakness of this study that arose was the need to reschedule some

participants interviews. Three interviews were scheduled according to both the

participant and the researcher’s availability due to the pandemic. Utilizing Zoom

videoconferencing software meant that impersonal interactions were taking place. The

utilization of Zoom limited the interactions with participants and limited the ability to

build rapport with participants and gain their trust. A further weakness of this study was

related to the sample size; purposive sampling was utilized to select MHPs that treat

trauma who participated in this study. This was to ensure that specific criteria were met

before participation in the study (Robinson, 2013).

It was originally planned that 15-20 MHPs would participate in the interviews,

and 40 would participate for the questionnaire; of those 18 MHPs agreed to take part

fully in the study. The pandemic led to issues gaining participants due to virtual work

schedules, and burnout from using Zoom for therapy sessions. Having a smaller sample

size limited the range of data that could be collected. However, the smaller sample size

made the research easier to manage. Data collected from the 18 MHP participants

through way of questionnaires and semi-structured interviews, provided sufficient data to

substantiate the conclusions made in this study.

The use of a qualitative methodology and a descriptive design during this study

illuminated the participants own recounting of their experiences with burnout, and their
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uses of coping strategies. This method allowed participants of this study to share their

perspectives about burnout and coping strategies that were likely to address the problem

of the study. Data for this study were garnered through questionnaires and semi-

structured interviews. The data sources were analyzed separately, then were analyzed

together after merging the data. Merging of the data ensured amalgamation of the

findings in this study, which was in line with the nature of qualitative descriptive designs

(Sandelowski, 2000). The findings of this study were bolstered by evidence from several

sources, thus strengthening the value and the trustworthiness of the findings.

Recommendations

The intention of this research was to address a gap in the literature regarding

burnout of MHPs who treat trauma, in the U.S. This study significantly contributed to the

body of knowledge by elucidating the phenomenon of burnout, and the strategies used to

address the problem. The outcomes of this study revealed that there are chances for future

researchers to further examine burnout and the strategies used to mitigate it, that this

study uncovered and their suitability in other contexts. Additionally, experts could apply

the finding of this study in future practice. The suggestions as noted below would add to

the body of knowledge regarding burnout and the coping strategies used to mitigate it.

Recommendations for future research. This study advanced the body of

knowledge on burnout experiences and the specific coping strategies MHPs utilize to

mitigate burnout. This study employed a qualitative descriptive design to study MHPs

throughout the United States. The initially planned sample size was 15-20 MHPs

purposely selected from a Facebook group for therapists, 18 agreed to take part in the

study. A future study should attempt to replicate this study with a larger sample of MHPs
 212

from a specific location. This qualitative descriptive study was delimited to MHPs in the

United States and included private and agency settings.

A possible future study should consider specific types of mental health MHPs

treat to confirm the suitability of this study’s findings in other contexts. Additionally, a

future study could consider research with clinical, intern, and retired MHPs to determine

if there is a difference in the degree of burnout experienced. A further area of future study

should focus on the number of years that an MHP has been in practice to determine if

expertise reduces the experience of burnout. Lastly, future research should consider

mentoring to determine if it is beneficial at reducing burnout.

While this study did not consider gender a factor of the research 16 participants

were female and two were male. There was no evidence suggesting that gender had any

impact on the results of this study. Nonetheless, inclusion of more male MHPs in a future

study could widen the depth and breadth of experiences and perspectives shared by

participants. Male MHPs who treat trauma could further advance the body of knowledge.

Therefore, more research involving male MHPs who treat trauma is needed to provide an

in-depth understanding into the phenomenon of burnout and coping strategies used to

mitigate it.

The results of this study offered empirical evidence of the usefulness of the jobs-

demand resource model. The results were aligned with the two segments of the JD-R: (1)

job demands, and (2) resources. The findings of this study illuminated the strengths of the

JD-R regarding the job demands of MHPs working in trauma settings. Future researchers

should consider incorporating the findings of this study into the JD-R model to aid in
 213

creation of a workplace intervention that is aimed at the prevention of burnout. This

could benefit MHPs by offering them extra support to continue with their work.

Recommendations for future practice. The two research questions of this study

were 1) how do MHPs, who treat trauma, in the U.S., describe their experience of

burnout? and 2) how do MHPs, who treat trauma, in the U.S., describe their use of coping

strategies? The answers to these research questions produced valuable understandings

into burnout MHPs face and their use of coping strategies to reduce it. Moreover, answers

to the research questions provided opportunities for future researchers to conduct

additional studies that would make coping strategies more streamlined and beneficial to

agencies.

In consideration of the findings of this qualitative descriptive study, a future

practice recommendation if for MHPs to consider the creation of a self-care plan to help

guard against burnout. The JD-R noted that high job demands, and limited resources will

always result in burnout. The reduction of burnout depends upon the MHP. Creation of

self-care plans could integrate the findings of this study to ensure that burnout is handled

effectively, and efficiently.

A further recommendation relates to the need for training on burnout. Leaders,

whether at agencies, or private practices should allocate time for specific trainings on

burnout. Agency leaders, and supervisory MHPs can integrate the findings from this

study into trainings over burnout that would help to educate MHPs. Furthermore,

trainings directed at open communication policies should be considered as well. Agency

leaders and supervisory MHPs can integrate the findings of this study into trainings for

open communications practices. This recommendation was in line with recommendations

 214

in prior research (Caringi, et al., 2017; Kaeding, et al., 2017; Maslach, & Goldberg, 1998;

Sansbury, et al., 2015) that indicated open and honest communication is key to

preventing burnout, as well as trainings focused on burnout, compassion fatigue, and

vicarious trauma. Training MHPs to recognize the signs of burnout, and training MHPs to

communicate openly about it, are necessary steps that need to be taken to reduce the

amount of burnout MHPs experience.

 215

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Appendix A.

Site Authorization Letter(s)

Site authorization(s) on file at Grand Canyon University.

 267

Appendix B.

IRB Approval Letter

 268

Appendix C.

Informed Consent

Grand Canyon University

College of Doctoral Studies
3300 W. Camelback Road
Phoenix, AZ 85017
Phone: 602-639-7804
Email: irb@[Link]

INFORMED CONSENT FORM

INTRODUCTION
The title of this research study is, “Exploring Mental Health Professionals Described
Experiences of Burnout and Coping Strategy Uses”.

I am Heather James, a doctoral student under the supervision of Dr. Orenthio Goodwin in the
College of Doctoral Studies at Grand Canyon University. The purpose of this study is to
explore the described experiences of burnout of mental health professionals and their use of
coping strategies.

KEY INFORMATION
This document defines the terms and conditions for consenting to take part in this research study.
o You can participate in this study if you:
▪ Are between the ages of 20-65.
▪ Have a current and valid, full mental health license (No intern
licenses.)
▪ Have been in practice at least 2 years and are currently practicing.
▪ Treat trauma.
▪ Have experienced burnout of some degree.
▪ Are located within the United States.
▪ Are unknown to the researcher.
▪ Agree to be recorded.
o You cannot participate in this study if you:
▪ Are not between the ages of 20-65.
▪ Do not have a current and valid, full mental health license (No intern
licenses.)
▪ Have not been in practice at least 2 years and are not currently
practicing.
▪ Do not treat trauma.
▪ Have not experienced burnout of some degree.
▪ Are not located within the United States.
▪ Are not unknown to the researcher.
▪ Do not agree to be recorded.
• What am I being asked to do? you will be asked to:
o Fill out this informed consent.
o Fill out a Demographic Survey (age, gender, race, ethnicity, education level.)
For background information purposes
 269

o Fill out a burnout questionnaire.

o Recount through a recorded interview, your experience of burnout and coping
strategies used.
o Be interviewed for at least 60-90 minutes.
o When: After informed consent is signed and returned, demographic and
burnout questionnaires will be sent, when returned, interviews will be
scheduled.
o Where: Informed consent, demographic survey, and burnout questionnaire
will be sent in email attachments. Interviews will take place through
conferencing software.
o How: Demographic Survey and burnout questionnaire are self-report and will
take 10-15 minutes. Interviews will take place with the researcher and
participant through conferencing software and will take between 60-90
minutes.
o Questions can be skipped if necessary.
o You have the right to withdraw from the study at any time should you choose.

Audiotaping:

I would like to use a voice recorder to record your responses. You cannot take part if
you do not wish to be recorded. You will be assigned an alphanumeric code to protect
your identity if you choose to part.

Videotaping:

I would like to use a video camera to record your actions. Because this tape will show
who you are, these extra steps will be taken: The video can be turned off. Interviews
will be labeled with the assigned alphanumeric code.
Interviews will be stored on a password-protected flash drive.
Data will be kept for 3 years. Then, shredded if paper and deleted if electronic data.
You cannot take part if you do not wish to be recorded.

• Who will have access to my information? myself, and/or, my dissertation chair,

and/or my dissertation committee.
Participation is voluntary. However, you can leave the study at any time, even if you
have not finished, without any penalty or loss of benefits to which you are otherwise
entitled. If you decide to stop participation, you may do so by: emailing me at
hsmith09@[Link] If so, I will not use the information I gathered from you.
• Any possible risks or discomforts? If you decide to take part in this study, then you
may face some risks such as: Emotional Distress. To decrease the impact of risks, you
can: Skip any item in the interview and/or stop participation at any time, and/or refuse
to answer any interview questions that make you uncomfortable. If at any time you feel
distressed during the process the following site/number may be of help:
/[Link]/Find-Support/NAMI-HelpLine or the NAMI helpline 1-800-950-6264 as a
participant you agree you understand the privacy policies of social media.
[Link] and [Link]
• Any direct benefits for me? Possibility to learn more about burnout and coping
strategies.
• Any paid compensation for my time? There is no cost to you to take part in this
study, nor is there a payment for your participation.
 270

• How will my information and/or identity be protected? All participants will be

assigned alphanumeric codes. All collected data will be placed onto a password-
protected flash drive. The flash drive will be stored in a lock box in the researcher’s
home. Data will be kept for 3 years then shredded if paper and deleted if electronic.

PRESENTATION OF INFORMATION COLLECTED

All data collected from this study will be presented within a published dissertation. Data will
be individual data.

PRIVACY AND DATA SECURITY

• Will researchers ever be able to link my data/responses back to me? No

• Will my data include information that can identify me (names, addresses, etc.)?
No identifying information will be collected.
• Will researchers assign my data/responses a research ID code to use instead of my
name? Yes
o If yes, will researchers create a list to link names with their research ID
codes? N/A. All portions of data will utilize participants alphanumeric id.
o If yes, how will researchers secure the link of names and research ID
codes? How long will the link be kept? Who has access? Approximate
destroy date? N/A.

• How will my data be protected (electronic and hardcopy)? Where? How long?
Who will have access? Approximate destroy or de-identification date? Electronic
data will be kept on a password-protected flash drive and placed into a lockbox in the
researcher’s home that only the researcher has access to. Paper will be placed into the
same lockbox. Data will be kept for 3 years and destroyed after the 3 years has passed.
• Where and how will the signed consent forms be secured? Signed consent forms
will be placed onto a password-protected flash drive and will be placed in the lockbox.
Consent forms will be stored with the specified participants data.

FUTURE RESEARCH

Once the study is completed the data collected from this study could be used for future research
studies or distributed to other investigators for future research studies without additional
informed consent from you or your legally authorized representative.

STUDY CONTACTS

Any questions you have concerning the research study or your participation in the study, before
or after your consent, will be answered by Heather James, hsmith09@[Link], (316) 650-
1307

If you have questions about your rights as a subject/participant in this research, or if you feel
you have been placed at risk, you can contact the Chair of the Human Subjects Institutional
Review Board, through the College of Doctoral Studies at IRB@[Link]; (602) 639-7804.
 271

VOLUNTARY CONSENT

PARTICIPANT’S RIGHTS
• You have been given an opportunity to read and discuss the informed consent and ask
questions about this study.
• You have been given enough time to consider whether or not you want to participate.
• You have read and understand the terms and conditions and agree to take part in this
research study.
• You understand your participation is voluntary and that you may stop participation at
any time without penalty.
Your signature means that you understand your rights listed above and agree to
participate in this study.

____________________________________________________ ___________
Signature of Participant or Legally Authorized Representative Date

INVESTIGATOR’S STATEMENT
"I certify that I have explained to the above individual the nature and purpose, the potential
benefits and possible risks associated with participation in this research study, have answered
any questions that have been raised, and have witnessed the above signature. These elements of
Informed Consent conform to the Assurance given by Grand Canyon University to the Office
for Human Research Protections to protect the rights of human subjects. I have provided
(offered) you a copy of this signed consent document."

(Your signature indicates that you have ensured the participant has read, understood, and has had
the opportunity to ask questions regarding their participation.)

Signature of Investigator__________________________________ Date_____________

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Appendix D.

Copy of Instruments and Permissions Letters to Use the Instruments

273
 274

Appendix E.

Recruitment Script

Grand Canyon University

College of Doctoral Studies
3300 W. Camelback Road
Phoenix, AZ 85017
Phone: 602-639-7804
Email: irb@[Link]

RECRUITMENT
Dear Participant:

I am Heather James, a doctoral student under the guidance of Dr. Orenthio Goodwin.
My research title is. Exploring Mental Health Professionals Described Experiences of
Burnout and Coping Strategy Uses. The purpose of this study is to explore the described
experiences of burnout in mental health professionals who treat trauma and their use of
coping strategies. To take part the below criteria must be met.

I am recruiting individuals that meet these criteria:

Are between the ages of 20-65.

• Have a current and valid, full mental health license (No intern licenses.)
• Have been in practice at least 2 years and are currently practicing.
• Have experienced burnout of some degree.
• Provide trauma therapy of some form.
• Are located within the United States.
• Are unknown to the researcher.
• Agree to be recorded.

You cannot be in this study if:

• Are not between the ages of 20-65.
• Do not have a current and valid, full mental health license (No intern
licenses.)
• Have not been in practice at least 2 years and are not currently practicing.
• Have not experienced burnout of some degree.
• Have not provided trauma therapy of some form.
• Are not located within the United States.
• Are not unknown to the researcher.
• Do not agree to be recorded.

The activities for this research project will include:

• signing an informed consent form, through email if willing to participate.

 275

• Completing through email, a 5-question Demographic Survey to collect

information such as age, gender, ethnicity, and degree level.
• completing a burnout questionnaire through email, which should take no longer
than 10-15 minutes.
• being in a recorded interview. Through video conferencing software. The
interview should take no longer than 60-90 minutes.

Your participation in this study is voluntary. No identifying information will be used. You
may withdraw from the study at any time without consequence to you. Your participation
could help in aiding others to recognize and understand burnout and coping
experiences.

All data in this study will be protected by: Questionnaires and recordings of interviews
will be transferred onto a password-protected flash drive and will be locked in a safe box
within the researcher’s home.
Information/Recordings will be kept for a period of three years. Then shredded if paper
or erased if electronic.

If you are interested in participating in this study, please contact me Heather James at
(316) 650-1307 or hsmith09@[Link] Thank you!
 276

Appendix F.

Demographic Survey

1. What is your current age?

20-30 ____ 31-45____ 46-50 ____ 51-65 ____

2. What is your Gender?

M ___ F ____ Prefer not to answer ____

3. What is your race?

American Indian Or Alaskan ___ Asian ___ Black or African American ___

Native Hawaiian or Other Pacific Islander ____ White ____ Prefer not to

answer____

4. What is your Ethnicity?

Hispanic or Latino ___ Not Hispanic or Latino ___ Prefer not to answer ____

5. What is your highest degree level?

High School ___ Some College ____ Graduate School_____

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Appendix G.

Questionnaire

1. Do you currently hold a valid mental health professional license?

If so, what is the type of license you hold? (ex. LPC, MSW, LCSW, Intern

licensing is excluded from participation in this study.)

2. How many years have you held your current license?

3. How many years have you been practicing mental health? (Must still be

currently practicing.)

4. Do you currently treat trauma? (Must provide some form of trauma therapy.)

5. Have you experienced burnout of some degree during your time as a mental

health professional? Yes ___ No___ If no you do not qualify for this study.

Professional Quality of Life Scale (ProQOL)

When you [help] people you have direct contact with their lives. As you may have found,

your compassion for those you [help] can affect you in positive and negative ways.

Below are some questions about your experiences, both positive and negative, as a

[MHP]. Consider each of the following questions about you and your current work

situation. Select the number that honestly reflects how frequently you experienced these

things in the last 30 days.

1=Never 2=Rarely 3=Sometimes 4=Often 5=Very Often

__ 1. I am happy.

__ 2. I am preoccupied with more than one person I [help].

__ 3. I get satisfaction from being able to [help] people.

__ 4. I feel connected to others.

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__ 5. I jump or am startled by unexpected sounds.

__ 6. I feel invigorated after working with those I [help].

__ 7. I find it difficult to separate my personal life from my life as a [MHP].

__ 8. I am not as productive at work because I am losing sleep over traumatic experiences

of a person I [help].

__ 9. I think that I might have been affected by the traumatic stress of those I [help].

__ 10. I feel trapped by my job as a [MHP].

__ 11. Because of my [helping], I have felt "on edge" about various things.

__ 12. I like my work as a [MHP].

__ 13. I feel depressed because of the traumatic experiences of the people I [help].

__ 14. I feel as though I am experiencing the trauma of someone I have [helped].

__ 15. I have beliefs that sustain me.

__ 16. I am pleased with how I am able to keep up with [helping] techniques and

protocols.

__ 17. I am the person I always wanted to be.

__ 18. My work makes me feel satisfied.

__ 19. I feel worn out because of my work as a [MHP].

__ 20. I have happy thoughts and feelings about those I [help] and how I could help

them.

__ 21. I feel overwhelmed because my case [work] load seems endless.

__ 22. I believe I can make a difference through my work.

__ 23. I avoid certain activities or situations because they remind me of frightening

experiences of the people I [help].

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__ 24. I am proud of what I can do to [help].

__ 25. As a result of my [helping], I have intrusive, frightening thoughts.

__ 26. I feel "bogged down" by the system.

__ 27. I have thoughts that I am a "success" as a [MHP].

__ 28. I can't recall important parts of my work with trauma victims.

__ 29. I am a very caring person.

__ 30. I am happy that I chose to do this work.

This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold.

©B. H. Stamm, 2009. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). [Link].
 280

Appendix H.

Interview Protocols

Interview Date: ______________

Interviewee Code: ____________

Start Time: ____________

End Time: ____________

Thank you for taking the time to participate in this study. The purpose of this

research is to explore experiences of burnout in mental health professionals and their use

of coping strategies. Your participation is important to this study and is appreciated. For

concerns with privacy, your identity will be confidential, and all participants will be

referred to as S1, S2, and so forth. You may choose to end the interview at any time; all

information gathered will be discarded. As a reminder, your interview will be recorded.

Do I have your consent to record the interview?

Do you have any questions or concerns before we begin the interview?

1. Can you describe any specific experiences as a mental health professional that

treats trauma that resulted in burnout?

2. What are some feelings associated with providing mental health care to

individuals that could lead to burnout?

3. What are some barriers you have faced while providing mental health care that

could contribute to burnout?

4. What are some of the factors related to treating trauma that could contribute to

burnout?

5. How did you express your feelings and emotions after treating a difficult case?
 281

6. How do you define or describe what burnout is?

7. How would you describe symptoms of burnout?

8. What kind of interactions or conversations have you had with other mental

health professionals regarding burnout?

9. What are some steps you have taken to minimize the experience of burnout?

10. What motivates you to continue your job within the mental health field,

knowing you could face burnout?

11. What resources were provided to you during schooling, if any, that have

helped you to understand the necessity for coping strategies to reduce burnout?

12. What strategies can mental health professionals use to help themselves and

other mental health professionals, prevent burnout?

13. What resources do you utilize, if any, for coping with burnout as a mental

health professional?

14. What types of coping strategies are most helpful to minimize the experience

of burnout?

15. What type of support system do you feel would be beneficial in helping to

minimize the effects of burnout?

16. How can mental health professionals help prepare other mental health

professionals, recognize the signs of burnout?

Before we end the interview, are there any additional thoughts or comments that

you would like to add to the discussion? I would like to thank you again for taking the

time to participate in this study.

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Appendix I.

Expert Panel Review

Reviewer 1:
283
 284

Reviewer 2:
285
 286

Reviewer 3:
287
 288

Appendix J.

Mental Health Support Resources

[Link]

NAMI Helpline: 1-800-950-6264

 289

Appendix K.

Individual Participant Scales

Subscales: Compassion Satisfaction Burnout Secondary Traumatic Stress Totals

S1 High Low Moderate 48, 17, 30

S2 High Low Low 47, 15, 15

S3 Moderate Low Low 38, 21, 22

S4 Moderate Low Low 39, 22, 17

S5 Moderate Moderate Moderate 26, 37, 29

S6 High Low Low 46, 17, 22

S7 High Moderate Moderate 44, 28, 25

S8 High Moderate Moderate 45, 23, 25

S9 High Low Low 50, 17, 21

S10 Moderate Moderate Moderate 40, 27, 30

S11 High Low Low 43, 18, 16

S12 High Low Low 46, 13, 19

S13 Moderate Moderate Low 29, 32, 18

S14 High Low Low 42, 22, 22

S15 Moderate Moderate Moderate 41, 23, 23

S16 Moderate Moderate Moderate 39, 24, 27

S17 Moderate Low Low 37, 21, 19

S18 High Moderate Moderate 44, 27, 24

Scores: Low- 22 or less, Moderate- 23-41, High- 42 or more.

 290

Appendix L.

List of Codes

Table L10.

Step 1: List of Codes

Questionnaire Interview Transcripts
Satisfaction Therapy for the therapist
Workload Pandemic
Worn down Boundaries
Fatigue Agency
Exhaustion Private practice
Work and home balance Education
Emotional exhaustion Support from others
Intrusive thoughts Stigma on burnout
Connection to others Dread
Communicating with others Overworked
Depression Telehealth
Set on edge COVID-19
Productive No education on burnout
Caseload Shamed/Shame
Overworked Mindfulness
Proud Meditation
Questioning self Imposter syndrome
Happy with career Alone time
Engagement Colleagues
Stuck in job Self-talk
Secondary Traumatic Syndrome Work harder than the client
Leaving work at work Decompress
Feelings about trauma Reflection
Enjoyment of Job Walking the dog
Work setting Professional networks
Successful Be more tolerant
Therapist roles Child cases
Helping Uncertainty of situation
Happiness Agency VS. private practice
Context of case Open-minded
Question career It’s a calling
Caring Watching the client progress
Shopping
Visualization
Nature
Yoga
Vent frustration
Always on call
 291

Defeat
God
Church
Spirituality
Stigma or taboo
Irritability
Practice what you preach
Leave the position
Change niche
Shutdown
Isolation
Screening clients
Negativity due to COVID-19
Classes to educate on burnout
Dancing
Supportive supervisors
Avoidance
Keeping busy
Blurred boundaries
Exposure to trauma everyday
Overscheduled
Despair
Self- validation
Open-door Open-mind policy
Asking for help
Traveling
Hiking
Self- inventory
Self- awareness
Reading
Substance abuse
Alcohol
Organizational education
Family
Friends
Having a hobby
Years in the field
Experienced MHPs
Type of trauma being treated
Emotional toll
Engaged leadership
Checking in with self
Guilt
Responsible for the clients
Lack of resources
Dialogue with supervisors
Worry
 292

No reserves left
Giving too much of self
Strenuousness due to COVID
Brain exhaustion
Impersonal interaction
Lack of support
Cost prohibitive
Low pay
Powerless
Emotional rollercoaster
Share in healing journey
Time management
Misjudging severity of case
Financial struggles
No other job is appealing
Pulled back to job
Reminded why I do what I do
Pressure
No education on self- care
Fear
Population worked with
Demand of the job
Binge eating
Oversleeping
Avoiding social interactions
Problem solver
Insurance expectations
Play therapy
Art
Music
Field experience training
Unknown outcome of cases
Collaborative teams
Build rapport with colleagues
Career change
Take the focus off the client
Short temper
Agitation
Anxiety
Sickest have the least options
There’s a monopoly on pay
Not processing the situation
Receiving empathy
Silence
Hands on training
Obligations to the client
No feelings
 293

Feels like a chore

Time barriers
Emotional discharge
Afraid to speak up
Dogs
Journaling
Be vulnerable
Not being authentic
Cooking
Administrative duties
Struggling to find balance
Feeling safe at work
Work family
Judgment from others
Normalizing burnout
COVID barriers to therapy
Navigating COVID together
Enjoyment of work
Being a supervisor to others
Being honest about burnout
Following own advice
Wanting the client to fire you
Taking time off
Doing something fun
Create a self- care plan
Lack of understanding
Animals
No joy
Expectations
Being a mentor to others
Positive client interactions
Preparedness
Modeling behavior for others
Walking
Receiving love from animals
Home office
Praying
Conflict
Reading the Bible
Confusion
Vacations
Take breaks frequently
Good night’s sleep
Personality of the client
Fogginess
Love to see people heal
Unfocused
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Frustrated
Miscommunication
Misunderstanding
Too many requirements
Flexibility of roles
Consultation
Let down
Distress
Resentment
Anger
Help to guide the client
Honored to help the client heal
Open communication
Talk about the risks of burnout
Be alert to symptoms
Be open to feedback
Toxic environment
Unfulfilled
Lack of respect
Humor
Podcasts
Apps for therapists
Puzzles
Lack of privacy concerns
Isolation
Non- productive
Numbness
Disconnected
Leadership opportunities
Women leaders
Setting a schedule
Nature of the work
Conditions of the client
Bad work atmosphere’s
Caring about the client
Validation
Acknowledging burnout
Advocate to others
Having a ritual
Sluggishness and heaviness
Seeing the best self
Fascinated by the experience
Diversity of treatments
Blending of roles
Not shaming others
Holding onto client stories
Disregard
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Not superhero’s
Creative connections
Ability to follow dreams
Teaching and mentoring others
Exploring self- limits
Empowering others
Putting pressure on self
Worth the risk of burnout to help others
Spreading self too thin
Higher pay
Less time with the client
Justifying treatments
Judgmental of the clients
Unsure of self
Lack of focus
Run away from the job
More tolerance
Ruminating thoughts
Religion
Gym time
Supportive roommates
Recovery meetings
Feeling miserable
Leave the position
Being supportive as a leader
Giving too much
Teachable moments
Movement
Be relatable
Allow emotions to happen
Repeatedly stuck clients
For the money
Good at the job
Supportive groups
Hopelessness
Pounding heart
Fearing the process
Self- disclosure
Stress of using Zoom
Feeling like a robot
Saying yes, a lot
Ambition for the work
Cohorts in and out of work
Transformative imaging
Planners for schedule
Disheartened
Faith is motivating
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On the journey with the clients

Having a purpose
High turnover rates
Funding of non- profits
Institutional issues
Lack of comprehension
Leaders don’t get the job
Gardening and plants
Questioning was enough done
Overreaction
Not asking for help
Get behind on notes
Importance of people
Importance of connection
Shadow seasoned MHPs
Teach statistics on burnout
Know your own emotions
Continued crisis management
Burnout won’t happen to me
Don’t put on a front
Keeping an ethical balance
Not minimizing your role
MHPs are wounded healers
Unsure of what to do
Drained
Burdened
Lethargic
Be willing to ask for time off
Be willing to take time off
Administrator and the MHP
Continuous strain
Complexity of trauma cases
No longer enjoy the work
Heart centered hypnotherapy
Grounding rituals
Nature retreat
Bogged down with work
Heart is in the work
Enjoy helping supervisee’s
News in relation to COVID
Restricted community interactions
Not prepared for the situation
Safety of the client and the MHP
Unknown standards of care
Internships for clinical hours
Shared experience of burnout
Find and utilize resources
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Feelings of being a failure

Bad mental health system
Pushing the client along
Massages
Unpredictability of the work
Staying active
Creating burnout education to help others
Pay constraints due to COVID
Addressing the stigma of burnout
Creating space to talk about burnout
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Appendix M.

Categories and Related Codes

Table M11.

Step 2: Categories and Related Codes

High-Level Category Categories Related Codes
Workplace environments Settings leading to burnout Engaged leadership; Agency;
Private- practice; Work
environment; Insurance
expectations; Unknown
standards of work; Toxic
environment; Administrative
duties; Lack of respect; Bad
mental health system; High
turnover rates; Institutional
issues; Administrator and MHP;
Lack of - comprehension;
Funding of non-profit; Restricted
community interactions; Higher
pay; Feeling safe at work; Safety
of client and MHP; Lack of
support; Cost prohibitive; Over
scheduled; Leave position; Low
pay; Lack of understanding;
Work environment; Monopoly
on pay.

Lack of control Causes of burnout Caseload; Workload; Blurred

boundaries; Conflict; Lack of
control; Demand of the job;
Continuous strain; Spreading
myself thin; Unsure what to do;
Not prepared for situation; Focus
off of client; Time barriers;
Misunderstanding;
Unpredictability; Financial
struggles; No education on Self-
care; Putting pressure on self.

Workloads and burnout Work and home balance; Leave

work at work; Blending of roles;
Less time with client; Unknown
outcomes of case; Struggle to
find balance; Non-productive;
Give too much of self; Lack of
resources; Work harder than the
client; Context of case; Nature of
the work.
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Requirements placed Always on call; Keep an ethical

on the MHP. balance; Not minimizing role;
Teachable moments; Obligation
to client; Expectations; Too
many requirements; Responsible
for client.

Type of trauma being treated;

Trauma and burnout MHPs are wounded healers;
Being in recovery; Complexity
of trauma; Repeatedly stuck
clients; Continued crisis
management; Personality of
client; Condition of the client;
Pushing client along; The sickest
have least resources; Misjudging
severity of case; Population
working with; Uncertainty of
situation; Exposure to trauma
every day.

Pandemic; Telehealth;
Telehealth and the COVID related issues
COVID19; Overworked;
Pandemic Unpredictability; Isolation; Lack
of privacy with COVID;
Impersonal interactions; Lack of
control of career; Negativity due
to COVID- 19; Learning curve;
Strenuousness due to COVID;
COVID barriers to therapy;
Navigating COVID together;
Stress of using Zoom; Pay
constraints due to COVID;
Complications of COVID; News
in relation to COVID;
Community interaction
restrictions; Not prepared for the
situation; Emotional
rollercoaster; Not processing the
situation.
Physical and emotional What burnout looks like Worn down; Fatigue;
symptoms of burnout Exhaustion; Emotional
exhaustion; Intrusive thoughts;
Depression; Set on edge; Stuck
in job; STS; Dread;
Overworked; Keep busy;
Despair; Confusion; Defeat;
Shut down; Isolation; Conflict;
Worry; Brain exhaustion;
Emotional rollercoaster; Fear;
Pressure; Unpredictability;
Binge eating; Oversleeping;
Avoid social interactions; Short
temper; Agitation; No feelings;
No joy; Feels like a chore; Feel
 300

too much; Not processing the

situation; Unfocused; Frustrated;
Let down; Distress; Resentment;
Anger; Numbness; Sluggish and
heavy; Holding stress and
tension; Disregard; Not a
superhero; Lack of focus;
Miserable; Ruminating thoughts;
hopelessness; Pounding heart;
Feeling like a robot; Saying yes,
a lot; Disheartened;
Overreaction; It won’t happen to
me; Drained; Lethargic;
Burdened; Bogged- down.

Questioning career Imposter Syndrome Question self; Feelings about

and self trauma; Dread; Shame; Imposter
syndrome; Question career;
Avoidance; Screening clients;
Guilt; Worry; Powerless;
Unfulfilled; Putting self, last;
Disconnected; No passion;
Judgmental of client; Unsure of
self; Fear the process.

Continuing as an Motivation for continuing Productive; Happy with career;

MHP in the Job Helping; Engagement;
Enjoyment of job; Happiness;
Years in the field; No other job
is appealing; Pulled back to job;
Reminded why I do what I do;
Problem solver; Love to see
people heal; Validation;
Fascinated by the experience;
Ability to follow dreams; Worth
the risk to help; Making a
difference; For the money; Good
at the job; Ambition for the
work; Faith is motivating;
Importance of people; Hearts in
the work; Importance of
connection.

Satisfaction; Self- validation; It’s

Being and MHP Being a helping a calling; Experienced MHP;
is a calling professional Being a supervisor to others;
Leadership; Women leaders;
Empower others; Enjoy helping
supervisee’s; Leadership
possibilities; Be a mentor to
others; Having a purpose
Help guide the client; Want the
The client and
client to fire you; See the best
the MHP journey self; Diversity of- treatment; On
 301

the journey with the client; Share

in the healing journey.

Being mindful Self-care strategies Mindfulness; Meditation; Self-

talk; Reflection; Self- inventory;
Yoga; Self- awareness;
Visualization; Massage;
Spirituality; Practice what you
preach; Check in with self;
Prayer; Modeling behaviors for
others; Movement; Church;
Transformative imaging; Hope;
Grounding rituals; Religion;
Music; Take breaks; Good
night’s sleep; Gym time; Heart
centered hypnotherapy.

Therapy for the therapist; alone

Taking care of the MHP Coping mechanisms time; apps for therapists; Self-
validation; Staying active;
Traveling; Reading; Having a
hobby; Shopping; Nature; God;
Reading the bible; Dancing;
Substance abuse; Alcohol; Time
management; Play therapy; Art;
Music; Career change;
Receiving empathy; Silence;
Journaling; Cooking; Taking
time off; Doing something fun;
Walking the dog; Receiving love
from animals; Humor; podcasts;
Set a schedule; Have a ritual;
Creative connections; Gym time;
Explore self-limits; Recovery-
meetings; Planner for a
schedule; Garden and plants; Be
willing to ask for time off;
Nature retreat; Find and utilize
resources; Flexibility of roles.

Colleagues, professional Support systems Connection to others; Support

networks, and therapy from others; Colleagues;
Supportive supervisors;
Collaborative team; Work
family; Focused social groups;
Cohorts in and outside of work;
Professional networks; Support
groups; Engaged leadership;
Therapy for the therapist
Experienced MHPs; Receiving
empathy; Consultation;
Leadership.
 302

Friends, family, and animals Family; Friends; Cats; Dogs;

Love from animals; Supportive
roommate; Children.

Addressing the stigma of Stigma surrounding burnout Communicating with others;

burnout Addressing the stigma of
burnout; Asking for help; Vent
frustrations; Stigma or taboo;
Normalizing burnout; Build
rapport with colleagues;
Acknowledging burnout; Talk
about the risk of burnout;
Advocate to others; Be relatable;
Self- disclosure; Not putting on a
front; Shared experience of
burnout; Create space to talk
about burnout; Open- door open-
mind policy; Consultation.

Being open and honest about Shame and guilt about burnout Dialogue with supervisors;
burnout Afraid to speak up; Being honest
about burnout; Not shaming
others; Not asking for help;
Willing to say I need time off;
Consultation.

Education on burnout starting in Education about burnout Education; Create education on

school
burnout; Classes to educate
about burnout; Being vulnerable;
Be alert to symptoms; Teach and
mentor others; Teach statistics of
burnout; Research burnout;
Being a supervisor to others;
Being a mentor to others;
Modeling behavior for others.

Stopping burnout before it Field experience training; Hands

Creating personalized self-care begins on training; Have a variety of
plans supports; Be alert to symptoms;
Be open to feedback; Teach and
mentor others; Be more tolerant;
Be a supportive leader; Allow
emotions; Class on self-care;
Shadow seasoned MHPs; Know
your own emotions; Internships
for clinical hours; Creating self-
care plans; Being a supervisor to
others; Being a mentor to others;
Modeling behavior for others.
 303

Appendix N.

Emerged Themes

Table N12.

Generating themes through Analytic Memos

Theme High level Category Analytic Memo
Conditions as described Workplace Agency jobs seem to
by MHPs that resulted environments have more negative
in burnout work environments for
Lack of control MHPs.
It appears that agency
positions are where
MHPs have the least
control, but the highest
caseloads.
It is interesting how
several MHPs say that
they have supervisors
who do not understand
the job and are
unsupportive of them.
MHPs working in
agency settings may
have many individuals
involved in a client
case, and have no
control of that client’s
case as they are not
the only one working
with the client.
MHPs in private
practice have no control
right now due to
regulation that the
pandemic has created.
MHPs in both settings
seem to not have
control of the client’s
case when they accept
insurance, as
insurance companies
expect certain
requirements to be met
before they pay the
MHP.
S13 stated “I was in
facility working so, the
support, like when we
would see a particular
case, where I would
 304

believe A, B, C needed
to be done, and then
you go to the higher up,
and they’re like No, we
don’t do that. So, it led
to burnout very
quickly”.

Burnout as described by Telehealth and the It is interesting how the

MHPs that was induced pandemic
worldwide pandemic
by COVID
has led to burnout
quicker for many MHPs
due to being home
rather than in
an office setting.
Many MHPs reported
that it was difficult to
leave work at work, as
sessions have been at
home. Many
participants noted that
having to do telehealth
created its own set of
problems that further
contributed to burnout
such as spotty internet,
dropped Zoom calls,
looking at a screen for
multiple hours per day,
and the impersonal
interactions with
clients.
S6 stated “telehealth is
hard with adults, but
they understand it. With
kids it is at times
impossible. Because if
they’re used to being in
an office where there
are toys and games, and
art supplies, and you
can draw while you’re
talking and all of a
sudden you have to sit
in a chair or couch to
talk to somebody it’s
difficult. I mean, you
can do the intake, but
it’s hard to establish
rapport, because you’re
not sitting there face to
face”.
 305

It is interesting how
during the pandemic
MHPs were going
through the situation
alongside their clients
which also contributed
to the experience of
burnout.
S18 stated “we’re
walking through
something at the same
time as our clients are”.
“how do we hold onto
a feeling of hope or
goals for the future
when we have no idea
what the paradigm is
that we’re stepping
into”.
Characteristics of Physical and emotional
burnout as described by symptoms of burnout Almost every
MHPs participant had the
same response when
Questioning career and
asked to describe
self
burnout. Most said that
there was fatigue, and
exhaustion.
Additionally, MHPs
noted that burnout is
like depression due to
the symptoms being
common, such as
fatigue, sadness, no
motivation, and dread.
S14 stated “some of the
symptoms may look
very much like b
depression, or having
difficulty getting out of
bed in the morning.
having a sense of
hopelessness. Thoughts
of am I even making
any difference
whatsoever? I’m
probably not making a
difference at all, and
probably not helping
anybody anyway.
Feelings of exhaustion.
Tiredness. That’s what
comes to mind”.
 306

It seems that MHPs

when burned out are
hard on themselves, and
can display what is
known as imposter
syndrome.
S8 stated “I started
really thinking that I
should go be a secretary
and do something
mindless. I was just
craving not to be with
people”.
S16 stated “it's always
been the feeling; I have
this person in my
office, theoretically, for
about an hour. What
can I possibly do in an
hour that will satisfy
this somehow, just
however, it is”?
Participants all seemed
to have at some point
questioned if they were
meant to be in the field
and if they really
wanted to be an MHP.
It seems as though there
is shame connected to
questioning the career
choice.
Staying motivated in Continuing as an MHP Participants seemed to
the face of burnout as have similar reasons for
described by MHPs Being an MHP is a being an MHP. Most
calling noted that when they
doubted, something
would remind them
why they became an
MHP.
Participants mentioned
that being an MHP is
something they are
called to do.
Participants stated that
this is not something
everyone can do, and
that they did not get
into this field for the
money.
S17 stated” I like what I
do. I don’t think any of
us would keep doing
 307

this if it stayed
miserable”.
S4 stated “it’s that
underlying thing of I
know fundamentally,
I’m helping people. I
know that at the end of
the day, I’m the person
they’re reaching out to
for help. sometimes
that’s the most
important thing, that’s
the most important
factor that keeps me
going.”
S12 stated: “I love the
patients we see. I love
treating substance
abuse and trauma and
any other co-occurring
disorder. I love
watching people heal. I
love watching people
graduate from
programs. It gets me
excited for them”.
S5 stated “the clients.
That’s why I got into
the job. I didn’t get into
the mental health field
to be rich. Yeah,
nobody’s gonna be rich
off this. So, it’s for
them.
S18 stated “my hearts
in it as far as being a
therapist and helping
people to walk towards
Strategies and tools Being mindful change”.
utilized for coping as
It is interesting how
described by MHPs Taking care of the most of the participants
MHP noted how they utilize
some form of
mindfulness to help
prevent burnout. Being
mindful is to be aware
of one’s surroundings
and to be present in the
moment.
S10 stated “I also think
mindfulness of your
body, of when you’re
starting to get those
symptoms of higher
 308

agitation or struggling
focusing. It’s a
requirement in
everything in my
opinion. Burnout as
well, because again, if
you don’t even know
that it’s happening to
you, then it’s just going
to”.
S2 stated “I used to be
able to meditate a lot
better than I do now but
practicing mindfulness.
When I know that I'm
not feeling positive on
the inside, I'll start
asking myself reflective
questions.
Participants had
different methods for
taking care of
themselves.
It seems as though
some type of physical
activity such as going
to the gym, walking the
dog, or doing yoga
were the best ways to
take care of the MHP,
as these were the most
commonly mentioned
activities for self-care.
S4 stated “I am just
starting to do
yoga, I’m not very good
at that. I take my dog
for a walk every
morning and every
night. Just knowing that
I get to do that with him
is kind of helpful.
S1 stated “I make sure
that I do self-care,
either taking my dog
for a walk, or I'm
biking”.
S13 stated “I have dogs,
so I utilize my dogs a
lot. Walking. Getting
out into nature, for me
helps. And yoga.
S14 stated “I use a
meditation app. I’ve
 309

been trying to use that

every day. I’m trying to
exercise, going into the
gym”.
Beneficial types of Colleagues,
support systems utilized professional networks, It is interesting how
for coping as described and therapy varied support systems
by MHPs the participants utilized
are. Almost all
participants mentioned
having a therapist as a
source of support.
It seems as though
participants had varying
opinions about the
most beneficial type of
Friends, family and support.
animals S6 stated “support
groups for therapists, or
therapy for the
therapist”.
S13 stated “people who
are working in the same
population that you are,
so they completely
understand where you
are coming from”.
S7 stated “If you can be
a member of a
professional group. So
just kind of expanding
your professional
networks to get support
that way, from others in
your field of expertise”.
It seems that a lot of
participants have an
animal that is a great
support source for
them. It is interesting
how not all participants
believed family was a
good support system.
S12 noted “I have a
really great support
system. I have my dogs
here, which walking in
and seeing their faces
kind of lifts the kind of
yuckiness from the day
sometimes”.
S10 stated “My family's
wonderful. They
understand my job and
what I do. My mom
 310

especially, she's really

supportive. She always
is checking in on me to
make sure how I’m
doing, and she knows
being a single parent
and doing the work I do
it's a lot”.
S13 Stated “I love my
family, but when you're
done with sessions, and
then you have to go
deal with your family
and they want to talk to
you, and you’re like I
got to take a breath. So,
I love my family, but
no. No, they're not a
good source of like
relaxation”.
S2 mentioned “Having
friends, that I can just
be myself. Whether it's
I don't get something as
a therapist or having
friends that I can say I
get it, but I'm still mad,
or this ticked me off.
Just being able to have
that safety net so it's not
all stuck in me”.
S15 stated “When I
became a therapist, I
had to set a lot of
boundaries with my
friends. Now I'm in a
place where I've really
set good boundaries
with my friends and
they're really great
support. So, they are
really great. But I know
in the beginning it was
stressful because I was
like, this is gonna be
shift for everyone,
because now I'm setting
these boundaries that I
normally wouldn't
have”.
Utilizing open Addressing the stigma
communication to cope on burnout The number one thing
with burnout as that participants
described by MHPs mentioned was the need
 311

Being open and honest for communicating

about burnout about burnout.
It is interesting how as
an MHP it is expected
that they have
everything all together
and should not
experience burnout.
S3 stated
“Communication is so
important to me. Being
able to communicate
authentically what I am
experiencing and
having the support to be
able to do that”.
S17 mentioned “The
best strategy MHPs can
have is talking open
openly and honestly.
Being willing to tell
somebody that they
need to take time off
without being afraid of
hurting their feelings”.
S6 stated “I think,
normalizing the fact
that yes, you as a
mental health
professional, are going
to get burned out. You
are going to get tired.
There are days when it's
going to be really
tough. But I think that
in some ways, it's like
talking about mental
health issues was back
in the 40's and 50's.
You didn't talk about
that. That was taboo.
Well, no, it's not taboo.
And talking about
burnout isn't taboo. It's,
it’s a normal thing.
When you are a mental
health professional”.
It is interesting how all
participants agreed that
talking about burnout
openly and honestly is
the best way to mitigate
the experience of
burnout.
 312

It seems that there is a

definitely a stigma
when it comes to
burnout.
Utilizing education and Education on burnout
preparation for coping starting in school It is interesting how all
with burnout as participants mentioned
described by MHPs that they were never
Creating a personalized
taught anything about
self-care plan
burnout or the need for
self-care to prevent it.
All participants agreed
that there was minimal
teaching about what
the experience of
burnout could look like.
S12 noted “I don't
remember any, but I
may not have realized
how important it was at
the time. I don't
remember anything
specific going in depth
about talking about
self-care. I'm sure we
talked about self-care
and the importance of
self-care, but not like it
should be discussed”.
S2 stated “Absolutely
none. We had general
conversations of self-
care. But none.
S11 mentioned “I'm
sure there was some
stuff, I'm sure there
was. I don't think I
personally was in a
space where I was
hearing it. I think you
started being taught that
when you would go to
your internships”.
It seems that while
education is lacking
about burnout, many
participants talked
about the need to
educate those entering
into the field of mental
health. Several
participants mentioned
that there should be
classes that center on
 313

burnout and the need to

teach about self-care.
S9 stated “Some self-
exploration would be
great at the very
beginning. I personally
think that needs to be
built into the education
programs, simply
because you're so busy
trying to get all of the
social work stuff and
the helping profession
stuff, that you kind of
push self-care out of the
way to make room for
all that. And there's no
balance”.
Some participants
relayed that their
experiences as a new
MHP, led to them
becoming supervisors
so that they were able
to teach others about
the need for self-care.
S18 stated “I didn't get
a whole lot of
resources, which I
think, is why my heart
is in supervising and
helping kind of build
those responses for
others. Kind of a
corrective emotional
experience for me and
helpful for the
profession”.
S3 stated “I guess,
planning out, like
coping ahead and DBT.
We cope ahead, right?
So, I can see the value
and benefit of creating
that together. Having
something concrete”.
S15 stated “I have a
planner, my coworkers’
kind of make fun of me.
I have a passion
planner; she is my
favorite. It's broken
down by the hour. I will
look at my calendar for
the week, I will
 314

schedule self-care.
Then I reflect. The
reason I like having a
planner is because I
will look at my
calendar for the past
week. Its color coded so
I can see how I'm
dividing my time and
reflect on how that was
for me and if I need to
adjust anything”
 315

Appendix O.

Display of Themes

Table O13.

Relating Themes to the Research Questions

Sample Quotes
Research Question Theme Analytic Memo
Supporting the theme
RQ 1: How do MHPs, Conditions as described S7: My direct It seems that many
who treat trauma, in the by MHPs that resulted supervisors I work with agencies have
U.S., describe their in burnout don’t have a lot of supervisors and
experience of burnout? direct clinical work directors that are not
experience. qualified for their
S5: High caseloads that positions, and that they
all lead to little time to do not understand what
perform self-care. MHPs are dealing with.
Participants mention of
not having control over
their schedules, or
having unsupportive
supervisors led to
burnout quicker.

COVID not only kept

Burnout as described by S1: At least whenever participants from
MHPs that was induced I’m in the office, I can leaving work at work,
by COVID lock up and come but it made keeping
home, and I’m away boundaries hard. It
from it. Now I shut my seems like COVID also
computer, and I’m still changed how coping
sitting on my couch. strategies were utilized
S9: Since COVID it has by the participants.
been a lot more Some participants noted
challenging dealing that working from
with our trauma clients. home allowed for
S8: Pre-pandemic I felt things such as laundry,
good and balanced, and walking the dog, taking
effective, and present a catnap; that they
and grounded. All the would otherwise not
things I strive to be as a have been able to do,
therapist. It was just had they not been
such a dramatic shift. working from home.
The dramatic shift to
doing teletherapy seems
to have caused a shift in
the balance between
home and work for
several MHPs.
 316

Characteristics of S10: Fatigue, avoidance Participants all

burnout as described by I think is one. I’m just mentioned feeling
MHPs like depression. Feeling fatigued and feeling
numb. Wanting to sleep depression. It appears
a lot. Lack of energy. that fatigue is a major
Avoiding social inter- characteristic of being
actions. burned out among the
S17: Fatigue, a lot of MHPs who participated
fatigue. Hard to get out in this study.
of bed. Lethargy. Several participants
Dragging feet. No noted that when they
motivation to do began to question why
anything they do what they do,
that was a good sign to
them that they were
burned out.

Many participants said

that seeing the clients
Staying motivated in S3: It is the greatest heal was their
the face of burnout as honor of my life to have motivation to continue,
described by MHPs somebody invite me on even knowing that they
the healing journey. could become burned
S12: I love the clients. I out.
love the patients we It seems that helping
see. I love watching others on the healing
people heal. It gets me journey outweighs the
excited for them. possibility of becoming
burned out. MHPs care
deeply about those they
help.
It seems that the
participants agreed it is
rewarding when the
client no longer needs
them.

Participants listed
RQ 2: How do MHPs, S13: I have dogs. I
Strategies and tools various tools and
who treat trauma, in the utilize my dogs a lot.
utilized for coping as strategies they use for
U.S., describe their use Walking. Getting out
described by MHPs coping. The most
of coping strategies? into nature. Yoga. commonly mentioned
Allowing myself to feel tool was exercising It
things without being seems that there are
harsh with myself about overlaps with what
it. participants utilized for
S9: I will journal. I self-care, and as a
crochet, which is mind coping strategy.
numbing. I have a Some participants noted
cohort that I check in that being creative was
with regularly. a significant coping tool
that helped them with
minimizing their
burnout experience.
 317

S12: I go to the gym. The gym was

The gym is probably frequently mentioned as
one of my greatest a useful coping
coping mechanisms. I strategy.
put music in. When the It seems that utilizing
weather is nice, I love the gym was a way to
to my windows down, decompress and served
open my sunroof and to release stress.
turn my music up really Several participants
loud. noted that music was a
useful coping strategy.
Several participants
also noted that
practicing mindfulness
was a big part of
minimizing burnout.

Many participants
Beneficial types of S11: colleagues,
stated that having a
support systems utilized people in your field that group of individuals
for coping as described understand. that worked in the same
by MHPs S18: One-on-One field as them, was a
support systems. good support system.
Having a mentor. Participants were split
Friends who can hold about family being a
space and say “let’s go good source of support.
get a coffee. Those are Most agreed that family
a really good source of was a good source of
support. support to help them
S16: Family. A kind of not focus on work, but
work Family. to enjoy time together.
S14: Colleagues, one’s Many participants
who love you noted that having
unconditionally. Just therapy for themselves
having someone there was a good system of
to hold space for us. support.
S1: I walk my dog. I Several participants.
have a dog, and two noted that their animals
cats, and two lizards. provided them support.
S4: I take my dog for a It is interesting to
walk every morning consider the concept of
and every night. therapy as a source of
support.
Many participants
S10: Having more talk stated that preparing
Utilizing open
about burnout, and other professionals to
communication to cope
what you’re dealing recognize the signs of
with burnout as
with. Having more burnout requires more
described by MHPs
discussions about it, conversations about it.
and just making it Several participants
something in our field noted that if students
that’s talked about more were taught about
often. burnout while they
were still in school that
 318

Acknowledgement that could reduce the risk of

it’s okay to be burned burnout.
out. Many participants had
S6: Having a mentor the same thought about
that you every day or preparing other MHPs
every other day, that to recognize and
you check in with and prevent burnout.
talk to them about what The number one thing
happened. that was suggested, was
to talk more about
burnout.

The consensus between

Utilizing education and S2: Making people participants is that by
preparation for coping aware that it can educating and preparing
with burnout as happen. Especially at students early about
described by MHPs the college level. There burnout, and its
has to be some self- consequences, there
awareness on your part. will be less risk for
You have to know experiencing burnout.
when you have too It seems as though the
much on your plate, or best prevention method
when this particular and the best strategy to
population isn’t right prevent burnout is to
for you. talk about it with others
S15: Being vulnerable Participants mentioned
about it. that talking about the
I think normalizing it is signs, and symptoms of
huge, and actually, burnout, and what it
having open and honest could potentially look
conversations about like, could help prevent
what it looks like and it for those newly
being proactive in it. entering the mental
Removing the stigma of health field.
burnout, a little bit. It seems as though there
That it is okay, that we is need for a class
all have these feelings solely about burnout, to
and they’re really be included in
normal. Just that, it schooling for becoming
an MHP.
goes a long way.
 319

Appendix P.

License Acronym Definitions

Table P14.

License Definitions
Acronym Definition
LPC Licensed Professional Counselor
LCMHCS Licensed Clinical Mental Health Counselor
Supervisor
LCASA Licensed Clinical Addiction Specialist Associate
CCSOTS Clinically Certified Sex Offender Treatment
Specialist
LSCSW Licensed Specialist Clinical Social Worker
LMFT Licensed Marriage and Family Therapist
LCDC Licensed Chemical Dependency Counselor
LICSW Licensed Independent Clinical Social Worker
MHSP Mental Health Service Provider
LCPC Licensed Clinical Professional Counselor
MFT Marriage and Family Therapist
LASAC Licensed Associate Substance Abuse Counselor
Licensed Clinical Social Worker
LCSW
Licensed Social Worker
LSW
Master of Social Work
MSW
 320

Appendix Q.

Licensing Board Sites

Pennsylvania: [Link]

Kansas: [Link]

California: [Link]

Nevada: [Link]

Arizona: [Link]

North Carolina: [Link]

Michigan: [Link]

Texas: [Link]

Maryland: [Link]

[Link]

Tennessee: [Link]

Ohio: [Link]
 321

Appendix R.

Sample Transcripts

Interview with S18:

Heather James: Thank you for participating. I really appreciate that.

S18: Sure. Absolutely.

Heather James: As you know, the study is obviously exploring burnout with mental
health professionals and their use of coping strategies. So, this is much appreciated, and
it's important. If you have any concerns about privacy, all participants are being referred
to as s one, s two, and so forth. If at any point in time you decide you want to stop the
interview, you can, and I will discard any information up to that point. You can also turn
off your video, should you feel the need to. As a reminder, the video is obviously being
recorded. So, do I have your consent to continue recording.

S18: Yes, absolutely.

Heather James: Perfect. Do you have any questions or concerns before we go ahead and
start?

S18: I don't think so.

Heather James: All right. I'm here with subject number 18. It is September 10, 2020. And
the time is 1:01 pm central time. So, can you describe any specific experiences as a
mental health professional that treats trauma that could have resulted in burnout?

S18: Yeah, and the most recent one, I think was during the, I'm in (location redacted). So,
during the 10/01 shooting time, I was a clinician at a larger agency, and the, the intense
need for services at that time. And throughout that time really contributed kind of to a
sense of burnout. Just being needed in police stations and with performers and a lot of
different things to provide that service and then not necessarily having the support on the
back end of that. Either because it wasn't built in with the agency or because they just
didn't know. But it was kind of everybody scrambling.

Heather James: Yeah, I can imagine. I was just going to ask you about that with the
support. So, I'm glad you elaborated. I can only imagine during that setting how chaotic
it must have felt. Just because you had so many unknowns and it wasn't a system that was
set up for that.

S18: Yeah, yeah, absolutely. I mean, it was you know, from the higher ups it was like
take care of yourself, but like we need you in all of these 800 different places at one time.
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Heather James: Like multiple roles and being stretched in different directions. I could
see that. Well, what are some feelings associated with providing mental health care that
could have led to burnout?

S18: I think kind of piggybacking on that, like, the not necessarily feeling supported at
that time by the infrastructure of an agency. What else? It was interesting, because I was
walking through, we're walking through a process and similarly with pandemic life, too.
We're walking through something at the same time, as our clients are, or the people that
were treating them are.

Heather James: So, would you classify that maybe as like the feelings of unknown,
uncertainty of what's going to happen or is happening?

S18: Sure. Sure. Yeah. It could be under the uncertainty. And also, kind of a nervous
system feeling of overwhelmed too.

Heather James: Yeah, I think COVID for a lot of the people that I've talked to has been
not that great of a source for improving their therapy. But it's been a source of burnout
itself because there's so many different unknowns that are coming with it.

S18: Yeah, absolutely. And there's this looming sense. I think, and even in the population
that I'm serving currently, that's like this hopelessness, right. So how do we hold on to a
feeling of hope or goals for the future when we have no idea what the paradigm is that
we're stepping into? And so that resourcefulness, what can I hold on to that's true for me.
How do I get on, myself?

Heather James: Yeah, exactly. Because you have to navigate it, like you said exactly, as
the clients are navigating this. So, it's this uncertainty of like, what am I supposed to be
doing?

S18: Yeah, yeah, absolutely. And the validation of like, yeah, I understand you're
definitely going through it. And I'm feeling at the same way.

Heather James: Well, what are some barriers you face while providing mental health
care that could have led to burnout?

S18: I think for me, finances and money is one of the barriers that definitely increases a
sense of burnout for me. So, either working in agencies that pay little amounts for lots of
high output expectations, or more in a private practice setting; which is where I'm at now,
like insurance companies not paying what a normal rate would be for the type of work
that I'm doing. So, I have to increase the volume of services in order to be able to stay
afloat.

Heather James: Right. Do you feel like the, the insurance itself, like having to deal with
them could contribute to that overall experience of burnout?
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S18: Absolutely. If it were up to me, and I think at a certain point I'm going to. I think it's
called de-credential or unpanel myself with insurance companies. Because I don't enjoy
caring for humans in a way where they're numbers necessarily, or where I have to try and
say that this treatment is justified for this person based on this diagnosis and kind of play
that game.

Heather James: Yeah, I think that's something that is common throughout a lot of
therapists, that once they get paneled, and they realize like all the stipulations that those
insurance companies put, that it's too much of a burden for them honestly.

S18: Yeah. It's not worth it. And you aren't able to treat in the way that you feel like
maybe what would be best for clients?

Heather James: Yeah. I've heard that a lot actually. I know it.

S18: I'm sure that you have and that (inaudible).

Heather James: It was something as a therapist that I was like, no, I can't take
insurance. But the area that I'm at, doesn't allow for private pay. Like it's lower
socioeconomic individuals. So, they can't afford that. So, they rely on that insurance.

S18: Yeah. And I think for me, the double bind is that I really enjoy working with people
who are in the lower socioeconomic status and kind of creating change at that level for
people in their lives to help create those systemic changes. And so, there's where the bind
is, and because the private pay wouldn't be afforded and being able to serve those
populations.

Heather James: Exactly. It's that, that balancing act. Well, what are some factors related
to treating trauma specifically that could have caused burnout?

S18: I have found, so I got trained in EMDR. I've also been trained in more recently,
something called heart centered hypnotherapy. I think the lack of training initially. So, I
wasn't trained in EMDR, during 10/01. And so, I have been a talk therapist since then.
And with some trauma background, and all those things and trauma treatment, but more
in the talk therapy realm than, in the other realms. And I think that that definitely
contributed, because it's a different way of conceptualizing and holding a case and
holding a person's story and walking through that trauma with them.

Heather James: Yeah. Do you feel like, that maybe there's a sense of, not necessarily that
you're unqualified, but maybe like an imposter syndrome? Because you're not trained to
do that other stuff, but maybe like, you felt like there was no other options, but talk
therapy?

S18: I didn't necessarily feel like imposter syndrome came up for me with that. I felt like
for me, the way that I held space was a very psychodynamic and humanistic approach.
And so, holding space with them while they're walking there. Felt like that was a big
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burnout thing because it's a lot of space to hold. So EMDR and hypnotherapy has created
different containers for me, in how I hold or conceptualize the cases, if that makes sense.

Heather James: Oh, it does.

S18: But the humanistic of just like trudging through with somebody in their journey and
not being aware of trauma in the nervous system, and how that impacts, and not being
able to bring that skill set into the room. That's something that I really enjoy being able to
integrate now.

Heather James: I was just curious, because I know a lot of people that I've talked to who
said that they felt like without lack of training that they felt like an imposter. Because I
guess it's more because they were expected to do a type of therapy that they weren't fully
trained in, I guess. Which makes sense to me. That's why I was curious. Because I think
everybody experiences that stuff differently.

S18: Yeah, yeah. And for me, that's not necessarily where the imposter syndrome stuff
would come in.

Heather James: Where would it come in?

S18: I think it would come in more like within the community itself. So, in interacting
with peers.

Heather James: Okay. Would you say that that situation then can be a source of
burnout?

S18: Absolutely. So, I originally was licensed in (location redacted). And that's where my
training was, and I worked in (location redacted), and then moved here to (location
redacted), and the culture is very different here in the therapy world. And it's very much
more of business and less of the healing art. And there's more ego that's entrenched in
things. And so, that's definitely been a source of burnout for me. Yeah.

Heather James: I would assume that it probably would be because you're having to try
to adapt to that difference.

S18: Yeah. And it's more about who you know, and what, you know, here. Instead of the,
the art form of it, or the really honoring that healing process with people that I was raised
in.

Heather James: Yeah. I think just from my knowledge about the mental health field, that
every state is so completely different in how they view the mental health field. So, there's
not only that sense of like having to learn something new when you move to a new state,
but that sense of ... I could see where that could then be the like imposter syndrome
because you feel like, well, maybe I'm not qualified to do this, you know?
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S18: Sure. Sure. Yeah, absolutely. That's what it was here.

Heather James: Yeah.

S18: And then the amount of resources too. So, that's another thing that contributed to
burn out more here was in (location redacted), there are homeless shelters. And there are
places where more of an abundance of resources that maybe I took for granted there.
Because when I moved here and was looking for a resource, even for somebody who was
experiencing homelessness, who was pregnant, I couldn't find a space for them in the
summer. So just those kinds of levels of access to resources and the priority in the state
for how they view mental health and what they're willing to put into it as well.

Heather James: Well, how do you express your feelings after treating a difficult case?

S18: I use. I work in a collegial environment. So, we have built in sounding boards and
consultations. I also have my own therapy as well. So, if there are things that arise as part
of my work with somebody else, that I need to address for myself, I make sure that I have
a safe space for that.

Heather James: Would you say that having that therapy yourself is a good source of
support for you?

S18: Absolutely. So, I am a state approved supervisor for interns and trainees as well.
And that's something that I push consistently that I think is so important. Because it's my
belief that we can only take people as far as we've gone. And in our own deep dives. So, I
think it's really important to be able to attend to our own stuff in the midst of helping
others.

Heather James: Absolutely, you’ve got to take care of yourself before you can take care
of others.

S18: Yep. Otherwise, we get faced with a client who comes in, who mirrors everything
that's going on with us in the shadows, and it's just not good.

Heather James: I love that idea of therapists helping other therapists though. For me it
was so hard to go see another therapist because I found myself, therapizing myself
honestly. So, it was like, why am I paying you?

S18: Yeah, absolutely. So, for me, I had to find somebody that I didn't do that with. So, it
takes a lot of like hunting and feeling like okay, can I actually, and then also keeping that
critic self out and being like you're not welcome in this. And I need to feel sitting on the
couch and feel what it's like to get asked hard questions, and work through all of that.

Heather James: Absolutely. Would you say that from being the client perspective, that
it's harder to separate that? That maybe even that could lead to some burnout.
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S18: Being the client in therapy?

Heather James: Yeah.

S18: I hadn't thought of that. I don't think so. For me, in my head, because I have it kind
of in a spot where it's like, this is what came up for me and I'm very intentional in how to
use my time with my therapist as opposed to re-traumatizing myself by replaying a story.
I think maybe if somebody was replaying stories constantly that that could really re-
traumatize.

Heather James: Well, how would you define or describe what burnout is? So, if
somebody didn't know what it was, or what it looked like, how would you describe that to
them?

S18: For me, what does it feel like? It feels like being very tired. It feels like if I was
trudging through mud that was kind of knee deep.

Heather James: So, I don't know, how would you describe that, like bogged down
maybe?

S81: And knowing that you still… I think one of the hardest things for me in the midst of
burnout times has been; I still have an obligation to my clients and to their well-being.
And at the same time, I'm feeling really burnt out either because of the stressors or what's
going on in my personal life or financially. That’s the things that ping my burnout, that
even despite those I still need to come in and show up. Similarly, for them.

Heather James: Would you describe that as, not necessarily like dread, but maybe the
struggle with avoidance, so like, the avoiding of work?

S18: Tell me about the avoiding of work, what you mean by that?

Heather James: So.

S18: Because dread, yes. There's a feeling of like, oh, I don't want to.

Heather James: Okay, so yeah, with that, I mean do you feel…

S18: It's more the idea of work, than the actual. So, it would be the idea of what it is. But
once I get into the room and I'm doing my thing and working with my clients, I'm like,
yeah, this is fine. But the dread comes in the wake up in the morning, and I am already
saturated.

Heather James: Okay, that's exactly what I was meaning. So, I'm glad (inaudible).

S18: Yes.
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Heather James: Sometimes this stuff doesn't come out the way I mean it.

S18: It's okay. Totally fine.

Heather James: Well, how would you describe what the symptoms of burnout are,
besides just tiredness?

S18: So, I noticed at home that maybe I'm not as engaged with my wife. I'm more in like
a retreat mode. I'm not reaching out as much to like social opportunities. That I need
more recharge time, more quiet time. And so, sensory outputs are really an indicator for
me about like, I'm burnt out, because if the news is on anywhere, I don't want to be a part
of that. I mean, right now, I really don't want to anyway, but during burnout times that
would be part of that.

Heather James: Yeah, I could see that. Because the news tends to not report anything
good. And now, especially in this time. Do you feel like with the COVID being the
constant source of the news like that just exacerbates the experience of burnout?

S18: Yeah, absolutely. So, I've really, and I think clients not necessarily burnout in the
same way. But I think that sense of dread and doom that there's that piece that I'm
working with them as well, like how do we minimize our exposure to things that are
increasing those feelings?

Heather James: Right, that could be triggers for them. Yeah. I really think that this
whole thing with COVID, it’s made that worse for some people because they're stuck in
that isolation. And they can't get away from it.

S18: Right, right. And for me, the feelings at home are like if I'm at home, and let's say
the news is on, or I haven't been out in a couple of days. It's like, oh, my gosh, the world
is scary. But if I go pick up the mail, and I see that my neighbors outside, I'm like, oh,
okay, things are fine. So, having that even with people's comfort levels with exposure,
like just at least walking down the road or seeing other people out in the world or, finding
ways to connect are really important.

Heather James: Do you feel like with all of the stuff that's going on right now, it's made
it hard to separate work and home?

S18: I think initially, for me it was. Just because of the platforms. So, I'm using zoom
more often than in person. And there were certain times in (location redacted) where we
couldn't have people in our offices at all, or it didn't feel safe to. And so, it felt like I was
working all the time. And then also, clients were needing things all of the time. So, I
think maybe the first month or two it was, there was a little bit more overlap. And then I
decided that it was good for me to come into my office to have sessions regardless of if
they were zoom or in person. And really kind of creating those stricter containers.

Heather James: So almost like making sure that the boundaries stayed in place?
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S18: Yes, yes. And re-establishing boundaries and normalizing that, okay, we all have
different kinds of access to each other now. In this time.

Heather James: Do you feel like, it was the lack of control that you had during that time,
because you were at the mercy of whatever was being done?

S18: I felt like I didn't know what the standard was. I think if there was somebody that
came forward, even from the board, or somebody who came forward and said, this is
what the expectation is. And I know the APA did later, like the informed consent and all
of those things. And yes, I can utilize these. This feels great. But it was the lack of this is
what the industry standard is, this is where our best practices are.

Heather James: Yeah, I agree with that, because I heard so many things from this group
that is for therapists, and it was our board here. They weren't allowing the
reimbursement of telehealth through the insurance companies. So, it was that fight to get
that pushed because that was the only way that we had to do it. Because in (location
redacted), we weren't allowed to be in the offices at that point. So, everything's continued
to be over Zoom. And if they decided they were going to do in person, it was all these
standards and safety precautions had to be in place. And most of the people here they've
just decided they're just gonna keep doing teletherapy.

S18: Sure, sure.

Heather James: It's definitely the lack of standard, I could definitely understand that.

S18: And just looking to see, like, what is the industry standard? And where am I
protected or not? Because as a business owner and owning a small nonprofit, I don't want
to get shut down.

Heather James: Right. Exactly. That was something that a lot of the people in that group
were bringing up that, well, you're affecting all these small businesses by shutting this
down. How are we supposed to deal with this? But I think that on the therapy front, it was
bad to think about, you could get shut down. But the point of being able to still continue
therapy over that platform was like, okay, I might have a little bit of a safety net. So, I
think for me personally, it was the okay, COVID could screw up a lot of stuff.

S18: Yeah. Yeah, absolutely.

Heather James: Makes me glad I'm not actually practicing right now. Because that's
like, oh my God, my friends might be out of work.

S18: Right. And also, like clients. So, managing the ethical responsibility of not
abandoning as well. And honestly, I'm in this because my heart's in it as far as being a
therapist and helping to walk people towards change. So, abandoning, that doesn't feel
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good for me. So, it's like, okay, well, we're just gonna figure it out. However, this looks
like

Heather James: I'm just taking some notes.

S18: Yeah, you're totally fine.

Heather James: Well, what kind of interactions or conversations have you had with other
mental health therapists about burnout? Because I know, you said you have colleagues
that you can utilize.

S18: Yeah. What I think especially during the pandemic, it's just, it's more, and there's a
whole bunch of colleagues in the building too. Lots of therapists that walk around here.
So, it's more about having some shared experience and having a normalized experience
that's helpful.

Heather James: So, people who understand what burnout feels like?

S18: Sure, sure, or somebody who walks by and is just like, oh my gosh, yeah, I
understand that feeling. Yeah. But that also comes with safety, right? So, if I'm in another
environment that's not like this, where I don't necessarily feel safe to be transparent, or it
could be weaponized, then I'm going to lock things down and that could increase my
feelings of burnout and also might increase my feelings of isolation.

Heather James 24:13

Okay, I had a question. I forgot what I was gonna ask now. Oh, I know what it was. Do
you feel like with your colleagues, they do they treat trauma themselves?

Heather James: Okay. So, they understand the experience then of trauma. Do you feel
like that understanding of treating trauma, actually helps them then to understand the
experience of burnout that you guys could possibly experience?

S18: Yeah, absolutely. Absolutely. Because then I can… So, for instance, in my heart
centered hypnotherapy training, they talked a lot about shock. And we, it was a very
experiential six-day training and so we were treating our own shock; while we were
working through as being like a mock client, or even the therapist. And so, having that
language and that awareness now allows me that tool, even in session, to treat my own
shock, should it come up.

Heather James: What did you call that therapy?

S18: It was called heart centered hypnotherapy. It's through the wellness Institute in
Washington.

Heather James: Alright, I'll check that out. That sounds pretty interesting.
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S18: It's an amazing. So, it's got definitely an energy psychology type realm to it as well.
So, if people are comfortable in the woo-woo realms, that's definitely my jam.

Heather James: I like that. Well, what are some steps you've taken to help minimize the
experience of burnout?

S18: Therapy has definitely been one, my own therapy. Gardening. So, getting back in
touch with things that feel good for me. So, in the beginning, even just with COVID it
was okay, let me, even in the middle of the desert in (location redacted), like, let's figure
out some tomatoes and some basil and things like that, getting in touch with the earth.
That feels great.

Heather James: Yeah, I think that gardening is such a relaxing hobby. And then that
pride that comes with, oh look what I grew.

S18: Right, this little, tiny tomato, that tastes so good and cost me like $3 million. But
they didn't feel scraped.

Heather James: Are there any other things that you've done to help minimize your
experience of burnout?

S18: So, it was doing things even if I didn't want to. So, if I don't have the bandwidth,
even though I have a pool in my backyard, like the idea, I’m in the middle of huge
burnout, was like, I can't even make it to the pool. I just want to fall into my bed, and I
want to watch Netflix. But making myself do those things regardless. And pushing
through.

Heather James: Well, what motivates you to continue in this field, knowing you could
face burnout? I know, you said that your heart's in it, and that you enjoy that experience
of walking through the journey with the client. But what else motivates you?

S18: What else does? I think helping, for me, being a supervisor and helping supervisees
in a really safe way. Because that wasn't necessarily my experience, but like, in a way
that they could come to me and be like, hey, (name redacted), I think I screwed up. Or, I
don't know how to handle this, or I felt uncomfortable in a session, and really walking
with them in a way that helps them and their resilience.

Heather James: So almost like mentoring them? Would you say that being the
supervisor, and mentoring your supervisees is like a source of support to help you with
your burnout?

S18: Sometimes it contributes to it. So, if I have, in this state here I can have 20 interns.
So, they have primary and secondary. So, I've got 20 different kind of mentees that are
under my umbrella in different varying ways. But if I'm going through a whole lot
personally, or if I've got some professional burnout, and then they have cases, sometimes
that can feel like oh, this is a lot to hold.
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Heather James: So, it could almost have that dual role where it contributes to it, but it
helps?

S18: Yes, absolutely.

Heather James: I was just curious, because I've talked to a few other people that have
supervisees. And the commonality that I saw between most of them, was that they looked
at it, because they're mentoring, that it's a source of support for them. But I'm curious
whenever people say that they're supervisors because I think that experience along with
burnout is different for everyone.

S18: Absolutely. And for me, a lot of my interns are the ones who gravitate towards me,
are having similar experiences. And so sometimes if they don't have the ability to hold
their own things, it's definitely a lot of triage. You got to go find your own therapist, or
you need to work on this. And so, it's a good testament for boundaries. Yeah, and at the
same time, can be a lot.

Heather James: Well, what resources were provided to you during schooling, if any were
that helps you understand the necessity for having coping strategies?

S18: Hmm. So, (location redacted) provided this awesome incentive initially, in my
internship, not necessarily in the schooling, but the internship, that your own individual
therapy was like a bogo. So, if you had one hour of individual therapy it counted for two
hours towards the 3000 hours.

Heather James: That's awesome.

S18: So that was amazing. And definitely helpful.

Heather James: That is totally cool. I wish they would do something like that here.
Because here you have to have, I want to say it was 2000 additional hours to get to the
clinical license, and you can't do it in less than two years. But that would be totally cool
if they could do something like that.

S18: Yeah. And I found that that helps with like the health of the community too, of
therapists, because it was really normalized as part of the experience. Like, yeah you go
to therapy as an intern, you're dealing with your junk.

Heather James: Yeah. I mean, I think that that would help to serve incoming therapists;
you're not just throwing them out into the field like, here you go.

S18: Right, right. I didn't get a whole lot of resources, which I think why my heart is in
supervising and helping kind of build those responses for others. Kind of a corrective
emotional experience for me and helpful for the profession.
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Heather James: Yeah, for sure. I just wish that like they could get a nationalized
requirement for licenses, almost like driver's license. So that there's just that consistency
across every state, that every therapist has to do the same thing to get that license. I think
that would, not necessarily help to reduce burnout; but I feel like if there weren't all these
expectations placed on all the therapists in every different state, that it might reduce the
experience of burnout.

S18: Right. Because, honestly, as we're talking the things that are coming up for me that
contribute to burnout are the establishment, not the clients, not what I'm treating. Not the
trauma that's in the room, but is my community safe? Do I have people to reach out to?
And do I feel supported?

Heather James: Yeah. 100%. And I think that's something for me, why I'm glad I'm not
practicing right now. Because I don't feel like there's a lot of that here. But I wonder how
that is with every different state? Like, are the agencies supplying stuff? Or is it different
when you're in private practice? And I think that's something that, with the concept of
burnout, has to be explored.

S18: Sure, absolutely. The lack of the health of larger agencies here was part of what led
me to a smaller private practice type setting.

Heather James: Do you feel like you have more control over, like your client setting,
your administrative duties, working in private practice?

S18: Absolutely.

Heather James: Do you feel like some of those could have led to burnout though,
because you're the one taking care of it?

S18: No. I think for me, it was more of, these are all the ceilings that I'm going to hit
constantly. Here's how I have to advocate for a client. Working in an unhealthy agency,
where maybe the higher ups are more, they don't have a therapy background. Which is
pretty common here. But those were some of the stressors.

Heather James: That's actually something that I've heard from a lot of people that I've
talked to that the agency higher ups don't have therapy experience.

S18: Oh, yeah. The CEOs here are like, bankers and things like that. And so, it's more
about their money, which is completely…

Heather James: Totally strange concept that they would have someone whose not
therapy related, being the CEO of an agency.

S18: Mm hmm. And the agencies are very top heavy here with administration too. So,
like CEO, CFOs, all of these really big, high paying positions. And then the people that
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are on the front lines are not getting paid necessarily a livable wage. Because their
student loans and everything else.

Heather James: Oh, my god yes. They're all about, how much money can we bring in
and push these number of clients, because that's where our funding comes.

S18: Right. So, you get used to like the 36 and a half hours being a requirement for your
40-hour work week of that being billable. And that's just not sustainable doing trauma
work.

Heather James: No. I don't think that's sustainable in any kind of work that you'd be
doing, just because that puts so much burden on you. But yeah. What strategies can
mental health professional use to help other mental health professionals prevent
burnout?

S18: Let's see. I think normalizing. So, some of the most helpful experiences are having a
place where people are like, yeah, I'm struggling with this too. Or this is something that's
necessarily been helpful for me or not, or you're not alone in it. I think.

Heather James: So, like talking about it?

S18: Yeah. Having conversation about it. Having it be a normal part of supervision or
check in or just a part of the culture even in consultations.

Heather James: I would agree. I think because a lot of people, when they do go to the
schooling for this, they don't get that understanding of the necessity. Like, what is self-
care? How does the burnout look? What are you gonna do to take care of it?

S18: Right, it's so entrenched to be like this blank slate as well, which is so, for me at
least, is so against being a human being. So, be this blank slate. Nobody can, you can't
have a reaction, you can't be yourself, you have to hold all of this. That was a lot of my
training.

Heather James: Yeah. Same. And it's like when you're taught that stuff, it's how am I
supposed to be a good therapist if I can't react?

S18: Like, worksheets. And those don't work, right. (inaudible)

Heather James: I don't know that may work well, for any therapist. But I do wonder
about that. How can you not react? Humans are emotional beings. I know from my
perspective, having been a client, I want to see that a therapist has that empathy and
understanding and that what I'm telling them does make them react. Because I know
they're gonna do that much better to help me with this stuff.

S18: Of course, of course. One of the best supervision experiences I had; I was working
at an agency in (location redacted), and everybody was talking about like not glorifying
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by any means, but like hey, I met with my psychiatrist, and I had a med change, or this or
that, there was a very normalized experience of our own mental health while we were
treating others. And I found that to be so helpful. And I think that that is kind of the
community that I try and create in my little pockets here.

Heather James: Yeah. I think that there's such, not just with the mental health itself
having the stigma, but there's a stigma with therapists. Like if you experienced burnout,
something's wrong with you, you can't talk about it. And I think that that's the problem
because there's this expectation that we're supposed to be these perfect little therapists,
and we know all the answers.

S18: Right. And when you close the door, it's just all gone. You know.

Heather James: Yeah. And it's not the reality of how things work at all. I do think that
there's the necessity to talk about it.

S18: Yeah, absolutely. And to have the safety. Yes, for sure.

Heather James: Well, what resources do you utilize for helping to minimize burnout?

S18: Resources like?

Heather James: Self-care, coping mechanisms, any of them.

S18: Yeah, I make sure for me that, and this was taught to me by an energy psychologist,
one of my mentors, is after each session I go to the bathroom, wash your hands and you
just imagine all of the energy of that session, kind of coming off of you. And so, I'll have
a ritual, kind of in between each session. That is something that I can ground myself with.

Heather James: So, I was gonna say, would you consider that like grounding, reflecting?

S18: Yep, grounding.

Heather James: Perfect.

S18: And scale. So, I use scaling too. So, I'll do a scaling technique for myself of, where
is my own anxiety at? Where is my own depression at? Where is my sense of dread? So
that I know and can be mindful that that's not impacting the session, or that I can
minimize the impact in the session. And also, if my anxiety does pop up in session, I can
be like, well, I was already at a four to today, so it's okay.

S18: So, just kind of having that self-reflection and the second attention awareness that
happens in session, that's really helpful. Having friends that don't take a whole lot of
therapy energy, or aren't looking for me to be their therapist, so that's something over the
years that definitely my friend circles have shifted.
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Heather James: Same.

S18: Or just like if you need me to be your therapist, I have, my tape is gone. Like it’s
been years, and years of me doing this. This isn't here anymore.

Heather James: Here, we can't do that. Because it's unethical. So, it's like, I can't see
you. I know you.

S18: Yeah, absolutely. Same here.

Heather James: Would you say that your friends are a good source of support?
Obviously, you can't tell them about the experience of therapy, but they can help you with
other things.

S18: Yeah, absolutely. I can. The friends that are able to hold space, I think if I can just
say I’ve had a hard day. Or they can say let's just go out to coffee or something like that,
that those are a really good sense of support.

Heather James: Awesome. Well, what types of support systems do you feel are the most
beneficial?

S18: For me, I prefer like personal support systems versus like a big networking type of
support systems. My introvert self gets really drained by those things. So, I don't enjoy
those. But the smaller kind of one on one, or peer support things are helpful. But also
having mentors. So, I have a few people that I can reach out to in varying states who have
different levels of mentorship with me, where I can ask for them to hold space too.

Heather James: Do you think family is a good source of support?

S18: It depends. I think it's one way or the other. Sometimes our families activate certain
things, or activate certain things within me, where I'm like yeah, that doesn't feel
supportive. And mom, I don't want to listen to you. versus them being in a space where I
can ask for some support.

Heather James: Absolutely. I've heard that from multiple people, that it's either yes or
no. I know, for some, it's a struggle for the family to be support; where it's, I've had a
hard day, but they say, yes, their support, because they can take me out, and we can do
stuff. And we can forget about it.

S18: Yeah. So, for me, it's about who can, not offer like as in, and using people as a
utility, but like, who can offer me what? So maybe I can get just a good space with this
person to hold space, and maybe somebody else is going to take me out? Or maybe I'm
going to be able to do this with this person. So, making sure I have a variety.

Heather James: Yeah. I think that's a good thing, too, because then you have those
multiple layers of support systems that you're not having to rely on just one.
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S18: Yeah, absolutely.

Heather James: Well, what would you say is the most beneficial coping strategy to help
minimize burnout?

S18: Beneficial coping strategy? I think, I mean, it just really varies by each person.
Obviously, it's like, healthcare is the umbrella. And I think for me, it varies based on the
season and what's going on for me. So, sometimes it'll be more nature. Sometimes it'll be
retreat.

Heather James: And that's fine.

S18: Yeah. Sometimes it'll be learning something new even. Like getting into a new
training or something like that, getting excited about the field. That was one of the heart
centered hypnotherapy. For me, I feel like I'm a little stagnant, and I don't like being in
this place. I want to actually be excited about something. So, let me find something that
feels like it's definitely going to be good for me personally, and also help my clients. So
that's where that came from for me.

Heather James: Perfect. Well, I only have one question left. So, how can mental health
professionals help prepare other mental health professionals to recognize the signs of
burnout?

S18: I think it would start definitely in school. So, I think that we could do a better job as
a profession, talking about your own mental health and normalizing. I think, I really
appreciate, in the EMDR community, (name redacted), and she talks about her own levels
of dissociative experiences and all of those things, but it's also like this super (expletive)
powerhouse. But, having that be more of the norm.

Heather James: I agree. I've had a bunch of people tell me that. I think that goes back to
there's that stigma attached to it and right, it's not something that you're taught in school.
I think if they had that start with school, that there might be a better understanding of
what burnout actually looks like.

S18: Even if we could understand… So, if there was a class, even where you could
understand your own mental health and understand what the entrenched stigmas are about
accessing mental health services and the varying communities and how mental health is
viewed.

Heather James: Yeah, I think we just need to have mental health therapists, plan the
curriculum for schools and teach it. The ones that have been entrenched in the fields;
they know what happens.

S18: Right. Right. Because there's a different application than academia sometimes.
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Heather James: Yeah. I think that's something that I'm finding through this research,
that I'm noticing; needs to be something that's focused, not necessarily that it's a coping
strategy, but something that will just help the field in general. So, it's an effective tool.

S18: Sure.

Heather James: Well, do you have anything you want to add or comment about?

S18: No, I don't think so. This has been fun, kind of just having this conversation and it
gives me a lot to think about and kind of springboard off of as well for myself.

Heather James: Well, I appreciate you taking the time to do this with me. I really do
appreciate it.
Interview with S4:

Heather James: Well, I want to thank you for taking time to participate in the study.

S4: Oh, my pleasure.

Heather James: The purpose, of course is to research and explore the experiences of
burnout, in mental health professionals, and the use of coping strategies. And your
participation is important to the study. It's also very much appreciated. So, thank you for
that.

S4: You're welcome.

Heather James: If you have any concerns about your privacy or identity, it will be kept
confidential. All participants will be referred to as s one or s two, and so forth, you can
choose to shut off the camera also, if that's something you wish to do. You can choose to
end the interview at any time also, and any information I collect from you will then be
discarded.

S4: Okay.

Heather James: as a reminder your interview is being recorded. So, do I have your
consent to continue recording?

S4: Yes, you do.

Heather James: Perfect. Do you have any questions or concerns before we begin the
interview?

S4: I do not.

Heather James: All right. Well, I'm here with subject number four, it is July 25, 1 p.m.
central time. So, let's get started.
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S4: Alrighty.

Heather James: Can you describe any specific experiences as a mental health
professional who treats trauma that has resulted in burnout?

S4: Any specific experiences? None. None. Specifically, I think overall, burnout is a
cumulative experience, right. So, the more the more trauma that you treat, the less you
take time to engage in self-care and things like that. The more it builds and becomes a
problem. So, I can't think of anything specific that would have, tripped me into a burnout
phase. Maybe other than just like the general feeling of being overwhelmed, like having a
lot of clients in one week, or having, a lot of clients that are maybe all activated at the
same time or all, experiencing distress at the same time.

Heather James: Okay. I was trying to think if I had any follow ups to that, yeah. You
actually answered that pretty well, for me, actually.

S4: Thanks.

Heather James: So, what are some feelings that are associated with providing mental
health care to individuals that could possibly lead to burnout?

S4: For individual feelings? Like for the therapist?

Heather James: Yeah, that works.

S4: Okay. I think one of the big, it's not necessarily a feeling, but I think maybe one of
the major issues that might lead to burnout among mental health professionals is
countertransference. So, if I personally have experienced any kind of emotional, sexual,
physical abuse, and I'm dealing with somebody that has brought in a story that maybe
resonates with me, because it's similar to mine, that might kind of create that
countertransference that kind of activates my own traumas, which then might cause the
path to burn out. I think. If that makes sense.

Heather James: It does, it absolutely. Makes sense. Do you think that certain, different
types of trauma that are treated are more likely to lead to the feelings of that?

S4: Absolutely. Again, I think like a major thing is… For me, I know what my traumas
were. And I also know where I'm at in processing my own traumas. So, I know which
types of clients would not necessarily be a good fit for me because of that. But I do think
that sometimes when we're in the room with somebody, and we're listening to them talk
about recounting their horrific experiences in any kind of dynamic…I can give you kind
of an example of a couple of weeks ago. I'm working with a couple right now, where
there was a domestic violence incident that led to like separation charges, it's a pretty
significant domestic violence situation. And a couple of weeks ago, we ventured into the
event. And so, listening to both of them share their experience of that event, and I have
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experienced domestic violence in my own life, at a certain point I had to manage my

countertransference to be able to stay present into their trauma. But I could see how it'd
be super easy to slide into that.

Heather James: Do you think that as a trauma counselor that having that experience
with that specific type of trauma, it helps you to understand how to help them manage
through that?

S4: I think yes, and no. I think it can be really productive. I'm personally somebody that
believes countertransference can be a valuable tool in treating clients. And it can also be
an impediment if you don't pay attention to it. So, in that instance, I've never experienced
anything to the degree that they were describing; but having had some experience with
domestic violence in my own life, it gave me sort of a heightened sense of empathy
which maybe is a little bit different, and kind of is a protective factor against the having a
lead to a burnout kind of scenario.

Heather James: Okay.

S4: If that makes sense.

Heather James: Yeah, that does. Okay. What are some barriers you have faced while
providing mental health care that could have led to burnout?

S4: Some barriers? Can you be more specific with what you mean by barriers?

Heather James: So, just things that that kept you from... Maybe processing the situation
or things that... Yeah, I guess that's really what I mean, like when I say barriers, like
things that made it where you couldn't handle the burnout, or like, that led to the burnout.
Things that made it harder for…to keep the experience of burnout happening. And I know
you're the first person that's asked, asked me about what I mean by barriers.

S4: Right. Because I kind of think of multiple different types of barriers right. Like, your
distress tolerance skills. If I don't have any distress tolerance skills that might be a barrier.
I think it depends on the circumstance and what's being presented. Because I mean, I've
experienced burnout, but not to the extent that I've had to step away from my practice.
Everybody takes vacations because they get to that place of like, oh, my God. I feel
burned out; I need to need a break. But I've never experienced it to the degree that it has
incapacitated, my ability to be present with my clients. I haven't reached a place of
depersonalization with them. Or I guess sometimes maybe it kind of impacts that sense of
accomplishment. Right. Like, when you have a client that you're trying to help, and
nothing seems to be working it kind of call you into that place of feeling like, why am I
doing this? Am I the most effective person to be doing this? What was I thinking going
into this profession, or things like that? So, I don't know if that answers your question.

Heather James: No, it does.

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S4: I think maybe a sense of self efficacy could be a barrier when you get to a place
where you have clients that are resistant. Especially those that come into treatment and
say I want to work on my trauma, and then you kind of provide them all of the different
things and interventions and a lot of different… I have a lot of different resources, tools,
interventions, etc., to work with trauma. Then if you have a client that's like, I want to
work on my trauma, and then you start and they're like, I don't want to work on my
trauma, I can't go there. I don't want to touch on emotions, etc., then, you know, I guess
that that's kind of a barrier too I just sort of talked in a circle. Sorry.

Heather James: No, that's fine. Actually, I was gonna say, could you elaborate further
on your experience with when a client comes in and wants to work on the trauma, but
then decides that they don't? Do you feel like that sometimes could lead to burnout?

S4: It can if you don't recognize that… If I'm working harder than my clients, I absolutely
believe that could lead to burnout. Absolutely. Because if I'm trying to pull somebody to
their trauma, then what's the reason behind that? Is that my agenda? Is it theirs? And then
I'm working harder, that might lead me to that place of exhaustion. And where I'm gonna
kind of go down that path of burnout. I absolutely do have clients that are like, I want to
work on my trauma and then they're like, except I don't want to feel uncomfortable.

Heather James: Okay. I mean, that, that's a great answer. What do you think are some
the factors that are related specifically to treating trauma that could lead to burnout?

S4: Well, I think the major factor is vicarious trauma. I think it has to do with the content
that you experience. If I'm listening to somebody describe in horrific detail what their
trauma is. And I have not identified a way to kind of, for lack of a better word, kind of
compartmentalize my emotional response to that, then it's far more likely that I'm going
to experience that as a secondary trauma. That might lead to burnout particularly. I think
that's one of the major challenges of burnout for mental health professionals is vicarious
trauma, and compassion fatigue, quite frankly, that's the other one that I think is really
highly contributes to burnout. Because if I've heard the same trauma again and again and
again, even from just the same person, and they're not willing, or able or not mostly
willing to actually do the things that they say they want to do to work on their trauma,
then you get to a place of well what are we doing? I can't be doing this with you. And
then I can see how that might lead to more depersonalization?

Heather James: Absolutely. Do you think that as a therapist in the specific field of
treating trauma, that hearing multiple cases of trauma over and over as you explain,
being what's the word, being exposed to that stuff on a continuous basis, that a mental
health professional who treats trauma, is at higher risk to experience secondary trauma,
compassion fatigue, exhaustion, which are all components of burnout?

S4: I would actually think that somebody that treats trauma may be less likely to
experience it than more likely only because you've kind of been… It depends on maybe
why you got into treating trauma in the first place. But I think that when you treat trauma,
you're kind of more trauma informed. And so, you can be a little more cautious with how
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you approach traumas as well as how you process them yourself. If I were actually… I
think one of my first experiences as a mental health professional, when I was an intern,
one of my very first sessions with one of my very first clients, she came in and just word
vomited all of the traumas that she'd experienced in her life. And at that point, I was just
like a trainee, I wasn't even an intern. So, I only had a little bit of information. That client
overwhelmed me because I had no protective skills. At that point, I had no idea of what
to do to kind of handle somebody else throwing all of their trauma at you.

S4: So, I think if, as a trauma therapist, I think we are more aware of what is going to be
in the room with us, than as somebody that maybe doesn't necessarily on a typical basis,
treat trauma. That being said, I think fundamentally all of us do work with trauma, just
because the very nature of some of the secondary things that people experience are
usually based in trauma in the first place.

Heather James: Do you think treating trauma on a continuous basis almost has the effect
of desensitizing us to the trauma?

S4: Great question. I think that's probably one of the best questions I've ever heard.
Absolutely. Because I think that you can become, if I see a steady stream of people that
have all experienced sexual abuse, maybe not that I have, if I have seen, then maybe by
the 20th client, I'm like, whatever. So, I do think it's possible that at a certain point, you
might get to, I guess maybe that falls under sort of compassion fatigue, but I'm not
entirely sure. But I do think that's a possibility that you can desensitize to the trauma.

Heather James: Do you think it's also a possibility that it depends on the person who's
treating the trauma? I know, like you said, most trauma therapists have had some type of
trauma themselves. But do you think that it plays a big part in the person and how they
deal with that stuff?

S4:100%.

Heather James: Okay.

S4: The reason I say that is, I have experienced with colleagues that there's no underlying
or obvious reason why there would be a difficult Alliance. So, kind of questioning well,
wait, why are you struggling to help this person? What is it about this person that's
activating you? The only conclusion is, well, this person is too close to what you've
experienced in your own life. So, it's hard to be present and be effective. In that case, we
refer out, but I've seen that firsthand with other colleagues and thought like, what is going
on? You've treated other people with something like this, why is this person somebody
that's outside of your scope or reach?

Heather James: So, would you say that dependent upon the person, that them having
experience with trauma could be a positive? Or them not having experience with trauma
could be a positive?
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S4: Yes, I think both are true. I think if, if, if I have experienced with trauma, I might be
more, more sensitive to what it might feel like to be on the other end of having somebody
exploring trauma with me. At the same time, if I don't have experience with trauma, I
might be more willing to go in places that I wouldn't necessarily think of going if I, if I
did. If that makes sense.

Heather James: Yep, that sure does. How do you express your feelings and emotions
after treating a difficult case?

S4: Well, first of all, if I'm in the room with somebody and they're sharing a really
profound traumatic event; I know some therapists are like, oh my gosh, it's terrible if you
cry with the client, or whatever. But I think one of the most important things is
authenticity. So, if the story that you're sharing with me evokes emotion in me, I'm going
to reflect that and say wow, that was really painful for you. I can hear it. Or that really
touched me or whatever. And then after that what I would typically do is; I have a bunch
of different colleagues that I am in practice with. And so sometimes we do like case
consults, or that kind of decompression between sessions kind of thing.

Heather James: So, when you have those consults, can you kind of elaborate further on
what they would entail?

S4: First of all, I think if I had a client that just shared something really immense and it
was overwhelming emotionally; what I might say to another client is, wow that was a
really tough session. Can I talk to you for a second? Okay, this brought up this for me,
etc., etc. So, not necessarily any details about it, but just expressing to another therapist,
this is what I'm experiencing right now. What works for you to kind of come down from
that?

Heather James: Okay.

S4: If that makes sense.

Heather James: Nope, that does. How would you define or describe what burnout
actually is?

S4: That's a great question. So, I think, burnout in general is when we get to that sense of
being…this may actually be an unfair question to ask me. And I'll tell you why in a
second. But that when you get to that place of being overwhelmed; overwhelmed with
exhaustion, feeling like you're disconnected from your clients, and feeling like you're not
making any kind of accomplishment. Like burnout is that feeling of I just can't do it
anywhere anymore for a multitude of different reasons. But it’s kind of is the culmination
of all of those three things together, because if I'm just a little bit exhausted I might be
okay. If I'm just feeling like a little bit disconnected from my clients, I might be okay. If I
feel just a little bit like I'm not advancing or whatever it might be okay. But all of those
three things together, really kind of encapsulates burnout.
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Heather James: Would you say that the way that it's described or experienced is different
for every counselor?

S4: Yes, I do think that it probably is. I think that's why it's hard to measure. But I also
think that there's other factors that could contribute to burnout, that are difficult to
pinpoint. So, what's going on at home? If I have a home situation that's particularly
stressful, it might be causing additional stress in the work environment. If I'm in a work
environment, the factors in the organization might be contributing to the stress of the
organization. So, I think there's a… and I also do think that there's individual differences
when it comes to resiliency and being able to kind of manage your own emotions or
whatever.

Heather James: How would you describe the symptoms of burnout, because this also
goes back into that it's different for every person, so how would you describe them?

S4: For me, there's a few different kinds of symptoms. So, the first one is I start noticing
that I'm getting further and further behind in my administrative stuff. So, I need more
distance between the practice, and all of the aspects of the practice and me. And so, when
I noticed that I'm really behind administratively that's like the number one oh gosh, I
might need a break. Secondly, is exhaustion. That feeling of emotional fatigue. And then,
I hate to say this, but I think that we all have some clients that are more taxing on us than
others. And so, if I find myself really feeling burned out, I might be, unfortunately, kind
of dreading one or two different appointments just because of the level of exhaustion and
exertion that comes along with that. And I hate saying that out loud. But I know that's
true.

Heather James: Yeah, I understand 100%.

S4: Okay.

Heather James: I think that we've all been there. I think that's why the exploration of
burnout is so interesting, because everyone gets to that point at sometime within the
degree of burnout, whether they experienced differently or not.

S4: Absolutely.

Heather James: What kind of conversations or interactions have you had with other
mental health professionals regarding burnout?

S4: Conversations?

Heather James: Like whether it's about their experience of it. What it means to them.
Your experience of it. Just conversations in general regarding burnout.

S4: I think part of the challenge... I've had a lot of conversations with people about
burnout. I think that one of the challenges is that people use the word burnout very
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loosely. And it's kind of like oh, I'm OCD about cleaning my house. Like, no you're not,
you might be meticulous about cleaning your house, but you're not OCD. So, let's just not
lump that in there. And I think that burnout has the same kind of experience where people
are like, I am so burned out right now. And really, it's because you had a 12-hour day.
But it's not got all of the components that would lead to the diagnosis of burnout
personally. So, I think it depends on the person. I mean I've had many conversations with
somebody that just had a long day. And they're like, I feel so burned out right now. So,
again, it's more generalized and not necessarily anything really specific. I don't think
unless you are a burnout researcher, you really know the difference.

Heather James: Right. So, in those conversations, do you feel like that's the most
common thing you see is that they, they misinterpret what the experience of burnout is?

S4: That's a good question. But then that's my own subjective assessment of them, isn't
it? So, it's tough to say because, one man’s ceiling is another man's floor. So, maybe
you're telling me you're burned out? I'm like, why you have the easiest week ever? You
just saw five clients. So, I guess there's a little bit of subjective assessment when it comes
to somebody else telling you that they're burned out.

Heather James: Okay.

S4: And it might not always also be easy to validate other therapists? Right. Primarily.

Heather James: Do you think that there's a stigma attached to having conversations
about burnout?

S4: No, I don't think so. I think it's becoming more and more common. And I think that,
particularly because we've all been really overwhelmed these past four months; I think
that that's a conversation that's increasing. Because the workload for all of us has
continued to escalate, the pressure has continued to escalate. And yeah, I think that's just
something that we're talking about more because of what we're experiencing.

Heather James: Do you think that being a trauma therapist, that knowing what clients
deal with, while dealing with the traumas that the situation that everybody's in now, has
just made that worse for them?

S4: Yes, I do. I do. Because I think what I'm seeing in my client population is the
increased isolation has led to more depression, which has led to more time to ruminate
around maybe unprocessed trauma. So, I do think it's been very problematic for some of
the clients that I have that have more traumas than those that are garden variety stress.

Heather James: Would you say that the situation that we're all in now has made it
harder to minimize the effects of burnout?

S4: For me, no. And partly, that's because of the environment that I'm in. Some days, it's
really hard. Some days, it's back-to-back clients from 10 to six, right. So, you've got your
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10-minute break in between, you're trying to get everything done. But because I'm home,
there's some other perks around that. I can get some stuff done. I can throw a load of
laundry in. I can take the dog outside. I can do lots of different things. So, I have a little
bit more, I guess, more time for the things that are helpful for me to kind of decompress,
than I would normally have if I were just in my office all day.

Heather James: Okay. What are some specific steps you've taken to minimize your
experience of burnout? I know, you said, you have that time to step away. But what are
some specific things that you've done?

S4: I actually have, especially this last four months, I've actually started being much
more mindful about spending time working out, getting more fitness, getting that chance
to do that. I take my dog for a walk every morning, and every night. He at sometimes will
be at the door because this is where I have my office and usually have the door closed,
but around six o'clock, he'll start whining at the door, like it's time for a walk. So, kind of
just knowing that I get to do that with him is kind of helpful. Then also, sometimes, like I
said, there's some days where it's like oh, gosh. I try not to put all of the difficult clients
on the same day. Or the client. And I don't mean that like they're difficult, I just mean that
heavy cases. I try not to put them all on the same day. So, that you get kind of a break a
little bit. So, it's not so overwhelming all the time. And then if there's particularly difficult
experiences, then I do talk to my other counselor friends and have that sense of support
and community. And I do think that having other therapists, it's kind of… it's very helpful
to have other therapists that understand what you're experiencing to be able to kind of
validate and things like that. So those are the maybe the top three things that I do
personally.

Heather James: Okay. What motivates you to continue your job within this field,
knowing you could face burnout?

S4: That's a great question. This week has been a rough week, I will tell you this week I
have been like, ah gosh, why am I still doing this job? And I have only been doing this all
that long. I mean, I think all told about like, seven years. So, I just met with a colleague
yesterday, that's been doing this for 40 years. And, and she works with end-of-life people,
like people that are dealing with their families or dying or whatever, and I can't imagine.
Is that what you do?

Heather James: I do grief. Yeah.

S4: Okay. But she works with caregivers, that are working with people that are like
dementia, and all of that, where they are in their final stages. She's done that for decades.
And I can't imagine that, because of the level of grief. I can't imagine, how do you
prevent your own burnout? Because you're taking on so much grief and losing people?

Heather James: Right.

S4: So, I forgot what the question was.

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Heather James: Oh. What motivates you to continue in this field?

S4: Oh, yeah. Overall, it's that underlying thing of I know, fundamentally I'm helping
people. I know that at the end of the day I'm the person that they're reaching out to for
help. Sometimes that's the most important thing, that's the most important factor that
keeps me going.

Heather James: So, would you say that knowing that you're doing good by helping
people, it outweighs the risk of possibly experiencing burnout?

S4: I think yes. And I'll say that I think that we all experienced burnout, no matter what
profession that we're in. And if I look at this profession versus the profession I did before
this. I was much more burned out in that profession and nobody cared. So as long as
you're beating yourself to death in corporate working 12-14-hour days. Nobody cares if
you're burned out. I think this is different, because everybody's aware of if you're burned
out, you will be less effective. And so, there's a lot more compassion, I think.

Heather James: I was just gonna ask that, if you felt like there was more compassion
from others knowing that this is something that we face.

S4: Yes. I mean just you saying, oh my gosh 100%. I completely understand what you're
talking about with those clients that might be like, not today? So just having somebody
say that Oh, thank God it’s not just me, feels so much better. Whereas in like a corporate
environment, you often get the experience of it's just you. You're the only one that feels
overwhelmed.

Heather James: I feel like, and I don't know what your opinion on this is. But I feel like
with those situations, it's kind of more stigmatized to talk about burnout. Because it’s not
something that they acknowledge almost. As opposed to the profession that we're in
where it is definitely something that we know we're going to face at some point and being
able to discuss about it makes all the difference.

S4:100%. Agree. Yeah.

Heather James: So that kind of brings me to the next question. What resources were
provided to you during schooling, if any, that helped you understand the necessity for
coping strategies? Because I know for a lot of us, there was not anything provided.

S4: 31:16
Yeah, resources were zero. So, literally, nothing. Nothing.

Heather James: So, with that being said. How did you learn that having a coping
strategy of some sort was a necessity for dealing with burnout?
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S4: Part of it is my age. I'm a little bit older than some of the students that I went to
school with. So, I'm thinking back to like my school experience. And I think that the
biggest attempt that they had at helping us kind of mitigate our burnout, as students was a
group therapy, or not group therapy group… what do you call it? Group supervision.
Where you're talking about what you experienced, etc., etc. But even that was kind of…
it didn't really go far enough. So, it for me, it was just I know what I need when I start
feeling overwhelmed by things. Oh, the other thing I forgot to say, the other thing that I
do is, I am also in therapy. I think that's a really important thing that we all need to be in.
And it can be easy to fall off the wagon and not be in therapy. But I do think sometimes
that's really an important self-care, or what was the term used? As a coping strategy?

Heather James: What other strategies can mental health professionals use to help
themselves and others to prevent burnout?

S4: I think in general… I think one of the main strategies is really having a deep sense of
self awareness of what is my breaking point. And what are the steps along the way? So, if
my breaking point is the deep end of the pool, and I'm standing in the five-foot section,
I'm just barely above water than I need to know how to how to get myself back to the
shallow end. So, I need to know what those things are going to be that that might push me
over the edge.

Heather James: Could sharing those types of steps help other mental health
professionals who may not recognize that they're getting burned out?

S4: I think so. I think increasing the awareness, like if we say one of the major factors or
dimensions of burnout is depersonalization; if I say that to somebody, they don't know
what the heck we mean by that. So, if the way that I describe it to somebody is, on some
days, I just can't even listen to my clients talk. It's like, I hear them talking, but I'm not in
the room. I'm thinking what do I need to do for dinner? Oh my gosh, I got to pick up my
kids. I'm just going through the motions. So, if we explain to them what burnout, the
dimensions are in more humanistic terms, I think that creates a better dialogue with this is
how you know you're starting to get burned out. If you're in the middle of a session with
somebody and you start noticing that your mind is totally wandering to oh my gosh, I
forgot to pick up the dry cleaning. You might be experiencing some of the red flags that
you're headed towards burnout.

Heather James: I know we kind of talked about this a little bit, but what resources do you
utilize if any for coping with burnout?

S4: I've been trying to meditate more. I'm not very good at meditating. I'm terrible with
visualization. When people say like, oh, close your eyes and picture a crystal blue stream.
I'm like, I close my eyes I see black. I don't visualize. So, I don't… I'm not good with the
whole guided meditation stuff. But I'm trying to increase my ability to be more… do
more meditation in that way and sort of some mindfulness stuff. Let's see what else, I
just… I'm just doing lots of different things to just try and be, feel more fulfilled. And, in
a lot of different areas. Maybe it's reading a book that isn't necessarily about enhancing
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your skill as a therapist, maybe it's a smutty novel, I don't know. So, I don't know what
else I do. Those are the main things, I think. I just am starting doing yoga. I'm not very
good at that, either. I'm not very flexible. I'm trying to do the things that I asked my
clients to do, quite frankly.

Heather James: That makes sense.

S4: Yeah, I'm telling you go meditate. And I'm like, but I don't do that. That's kind of
sucky.

Heather James: What kind of coping strategies are most helpful to minimize the
experience of burnout?

S4: For me? or just in general?

Heather James: I mean, both honestly.

S4: Okay. Because I think for me, it is really about recognizing when I'm in the deep end.
And kind of employing the coping strategies. Then, of course, the maladaptive coping
strategy that everyone uses is substances. And I don't know about you, but you're in
(location redacted)?

Heather James: Mm hmm.

S4: So, in (location redacted), we have our association of marriage and family therapists,
and they put out a magazine every month. And at the back of the magazine, there's all of
the infractions, that people are experiencing, where their license is being suspended or
whatever. And I calculated at one point that close to 65% of the things in the back of the
book, the legal issues had to do with substance abuse. I would say that, and we have a lot
of therapists in (location redacted), like a lot. So, I would say that that's this coping
strategy that many therapists use, but it's not necessarily a good coping strategy.

Heather James: Right.

S4: So, and, and I'm guilty of that as well. I mean, there's been times where I've had a
particularly really stressful day and I've called my husband on the way home and said, get
the tequila ready. But that's not the coping strategy. I forgot the question. I'm sorry.

Heather James: Oh, what types of coping strategies are most helpful to minimize the
experience of burnout? So that was a general one. But what about ones that you use
yourself? Which ones are the most helpful to you, do you feel?

S4: I think the most helpful one is talking to other people. I really do. Because I think
having the sense of, I'm not in this alone, I don't feel like I'm floating out there without
any kind of validation or support. I think that's the number one thing that I use.
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Heather James: So, I'm glad you brought up the point of support because that's actually
my next question. What type of support system do you feel would be beneficial in helping
to minimize the effects of burnout?

S4: I think it's multifaceted. I think having a strong support system, in your organization.
I mean, I think if I'm in private practice, and I'm an n of one practitioner, where I don't
have anyone else to bounce my experience off of; that might be harder to work through
burnout, and then having more than one person around that you can get together with or
you can talk with. So, I think that having like a stronger network of other professionals
that you can talk to and share experiences with is maybe the number one thing. I also
think having a strong support system at home is really important. Because maybe I'm
really burnt out at home, and it's bleeding over into work. Because I have too much going
on at home to be to be able to focus on what I have to do at work. So, I think having like
support in both aspects is really important. And I also think just having friends that you're
able to go have fun with, kind of you let off the steam. A little bit tricky right now. But
that's not a joke.

Heather James: It definitely is. So, I guess, how if in the situation we're in, how would
you utilize that as a specific support system with your friends? I mean, would you guys
zoom? Would you...

S4: We have, we have zooms. So, what we've been doing it, we haven't done it in about a
month. But when we've done, we've had like, virtual happy hours. So, we all like get
together. And we'll talk. And then we also have had like virtual case consultation. So, we
get a chance to kind of get together and share what have you been experiencing. Which
has been particularly helpful because you don't have the opportunities, the hallway
conversations to say okay, I have this client coming in and last week, this is what
happened, and I don't know what to do. Can you… what do you think I should do? So,
we've kind of converted over to the virtual waiting room sort of thing.

Heather James: So, would you say that that has helped to kind of keep the experience of
burnout down for you?

S4: Yes, but I also am really aware of burnout. So, I tend to be more mindful of it than
most.

Heather James: Okay. So, my last question, how can mental health professionals help
prepare other mental health professionals recognize the signs of burnout? So how could
we, as counselors, help other counselors that may have already been in this profession or
coming into the profession? How can we help them to recognize the signs of burnout?

S4: I think there needs to be kind of a systemic education of the consequences of burnout.
In the school process. I do think that that's a major missing piece. Because I think that, I
don't know if you're on any of the Facebook well you are because we connected with you.

Heather James: I am, I'm on some of them.

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S4: But I don't know if you're on any of the like mental health Facebook post. Groups.

Heather James: I think I'm on one or two, maybe, but I don't get in there very often.

S4: Right. So, I think having some sort of education around, this is what burnout is. This
is what it looks like. Have you experienced burnout in any shape or form in your life?
How will you know that you're starting to experience burnout? These are the things that
you can do to kind of mitigate burnout. I think that education needs to happen. At the
training level.

Heather James: Right.

S4: I think that's really important. The reason why I brought up the Facebook groups is
that sometimes I see people posting in there, stuff like I lost a client this week to suicide.
And then the person is talking about their experience with it. Well, my guess is that
person is going to burn out very quickly, unless they have the support that they need to be
able to overcome that. And if I'm posting about that in a Facebook group, I don't have
support somewhere.

Heather James: Go ahead.

S4: Well, but that's kind of the thing. I think that that's fundamentally the education part
of it, but also trying to build more networking opportunities for therapists in at a
community level to be able to feel like I can talk to you about this this and this.

Heather James: So, with everything going virtual then too, would you say that having
those groups on Facebook can also like be utilized as a coping strategy?

S4: Probably they can. Some are right now.

Heather James: Okay.

S4: Yeah, they probably are. That said, with every Facebook group, you also have the
people that are like, oh, my God, I can't believe you said that. That's too much
information about (inaudible). So, it can also be invalidating. But I do think that it's
something that people are grasping towards, because what else do we have right now?

Heather James: Right.

S4: But fundamentally, I think that the having some level of education around it at the
school level is really important. Secondarily, a lot of therapists’ work in agency settings.
And I think those of us that are burnout researchers that are also mental health
professionals need to educate organizations into, this is what the consequences are, you're
going to lose people. They're going to… you're going to have consequences to your
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patient’s outcomes. There are significant issues that you as an organization are going to
face if you don't tackle this head on.

Heather James: Do you feel like there's higher rates of burnout in agencies as opposed
to those who work in like private practices?

S4: I think so. I think, think so and the reason I think so is because of the caseload. It
tends to be heavier; the documentation requirement tends to be more intrusive. I think it's
possible that they experience burnout in a much, maybe faster way. So that would be my
guess.

Heather James: Do you think that those therapists may have a harder time coming up
with coping strategies or support systems? Because they have such higher caseloads and
more expected of them?

S4: I don't know if they have a harder time. I think they may have a harder… I think they
have less opportunity to utilize them. Because if I'm being expected to work 40 hours a
week, and 35 of those hours is client hours, where's the downtime for me? (inaudible).

Heather James: Right.

S4: What I've heard 35 hours.

Heather James: Right. Okay. Well, before I end, do you have anything that you want to
ask? Any thoughts or comments you'd like to add?

S4: I do think in the instance of full disclosure. I do want you to know that my
dissertation was actually on burnout and mental health professionals, and specifically
organizational culture. So, when I say I really do understand this topic, that's part of the
reason why, is that I've been studying it for three years. So, I get. I think that's why I'm
more aware of my own burnout is because I've really been in it. So that's just the full
disclosure there.

Heather James: Well, I appreciate that, it does give me a better insight into, I guess,
your experience of it, because you are so fully versed in it. So, I appreciate you sharing
that with me, and I appreciate you taking the time to participate in this study.

S4: Oh, my pleasure, I am actually looking forward to seeing the results.

Heather James: I am looking forward to putting them all together.

S4: I feel like it's not going to get better. Not anytime soon. And I don't know if you're
aware, but the World Health Organization added burnout to their ICD 11 that's coming on
2022.

Heather James: I did not know that.

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S4: Yeah. It's actually being added to the ICD 11. And I think it comes out in January
of… it's either January 2021, or January 2022. And it formalizes the connection between
burnout and workplace stress.

Heather James: Well, that's interesting. I was wondering about that myself with all of the
stuff that's going on. I know that just in general, more people are being burned out, and
especially therapists, because they're having so much to deal with, with all of their clients
in this situation.

S4: Yeah. They added that before the COVID. So, this that came about last May.

Heather James: So interesting.

S4: Yeah.

Heather James: Well, that's good that it's being recognized now, though. So then, people
do know that it is a real thing, that it does get experienced by many different professions.

S4: Yeah. I do think part of the challenge that we experience in particular, is the
difference between the United States perceptions of burnout versus the rest of the world.
In the rest of the world, burnout is actually something that is taken very seriously because
they recognize the consequences of it. I think that the stigma that we have in our country
around needing help or asking for help, as a weakness or vulnerability, makes it really
hard for people that are experiencing burnout to feel like they can come forward. We as
mental health professionals are able to do that more because we work in a field where
we're sharing what we feel and we're hearing what other people feel, but overall, in
general, it's a rampant thing that is not appreciated, understood or respected.

Heather James: I agree with that.

S4: Just my two cents.

Heather James: Well, I appreciate you taking the time to talk with me today.

Interview with S8:

Heather James: Well, thank you for taking the time to participate. I really appreciate it.

S8: Yeah, yeah.

Heather James: As you know the study is exploring burnout and mental health
professionals and their use of coping strategies. So, any information you give me is
obviously important. If you have concerns about privacy, all participants will be kept
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confidential and referred to as s one, s two and so forth. You can obviously shut your
camera off at any point in time if you feel the need to. And if you feel the need to stop
participating at any point in time, that is perfectly okay. And I will discard any
information I've gathered up until now. So also, as you notice, this is being recorded. So,
do I have your consent to continue recording?

S8: Yes.

Heather James: Perfect. Do you have any questions or concerns before we start?

S8: I don't think so.

Heather James: Okay, wonderful. I am here with participant number eight. It is August
13, 2020. And it is 5:03 pm central time. And let's go ahead and get started. Can you
describe any specific experiences as a mental health professional who treats trauma that
could have resulted in your burnout?

S8: That seems really broad, ask one more time.

Heather James: Can you describe any specific experience as a professional, who treats
trauma that could have resulted in burnout?

S8: Yeah, the most recent experience was with the pandemic. And with so much extra
and unexpected change, so like the quick shift that was really quick.

Heather James: Do you feel like with this pandemic, that it actually caused more of the
possibility of experiencing burnout for some?

S8: For sure, it did for me. Pre-pandemic I felt good and balanced, and effective, and
present, and grounded. And all the things that I strive to be as a therapist and still
connected with family and friends and all of that. And it was such a… it was just such a
dramatic shift. I also co-own and so we were in charge of making all of the decisions not
just for our clients, but our employees and ourselves. So that was such a huge shift.

Heather James: Would you even…Would you say that having to do everything telehealth
and then working from home, that it made it harder to leave work at work? Which was
also a possibility for burnout.

S8: Absolutely. Yeah. So, the blending of the roles. Like before that most recent burnout
experience, I had very clear boundaries in my world. Work was at work, home was at
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home, play was at play, things like that. And then all of that got shifted into one very tiny
room, doing yoga, and my meditation practice. And my clients are now welcomed into
my personal space. And yeah, so that separation was hard.

Heather James: I understand that.

S8: And the cats. They're like, oh we want to join in. I'm not used these distractions.
Yeah.

Heather James: I totally get it. What are some feelings associated with providing mental
health care that could lead to burnout?

S8: So, like the judgments around being burnt out? Is that what you're asking?

Heather James: So, like, feelings that are associated with it?

S8: Oh, yeah, just hopeless and a little bit of helplessness. It for me, it felt a little bit like
depression. A little bit of lethargy, tired. And it felt really hard to care.

Heather James: Okay. When you say depression, because I know that looks different for
everybody, how would that look for you?

S8: Yeah, for me it looks like oversleeping. Being later than I'm unusually late showing
up to things. Yeah, and all of my self-care just kind of went away. Like eating well, and
moving and just going for a walk, felt like really laborious.

Heather James: So, would you classify that as maybe like, no motivation?

S8: Yeah. Yeah. Kind of emotionally flat.

Heather James: Okay. I know, it's different for everybody. Everybody experiences
depression differently. So just like they've experienced burnout differently. What would
you say? Oh, go ahead.

S8: I was just gonna say it was different because it wasn't, didn't have a sad quality to it.

Heather James: That makes sense. What would you say are some barriers you've faced
while providing mental health care that could have led to burnout?
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S8: Yeah, not having the separation. Boundaries that got blurred. Working too much.
Kind of an over focus on that was really key. Yeah. So, overworking and working more
than I know is healthy for me.

Heather James: Okay. Would you say that, when you say working too much, I guess. Can
you kind of explain what you mean by working too much?

S8: Yeah. So, I took on a couple more clients than I know I should have. In private
practice I'm used to seeing 15 or 16, I was up to 18-20, a couple of weeks. On top of the
administrative role of kind of running the business and trying to buy masks and doing all
these new skills of hunting down toilet paper and things like that, that were new and
pressured.

Heather James: Would you say that having that dual role also makes it harder to avoid
the burnout? Because you're doing so many different things?

S8: Oh, for sure. Yeah, the switching, every time I put one hat on and put another one,
like switch hats. It takes a toll on me. I think earlier in my career, for some reason that
felt okay. And there was an earlier experience of burnout that just showed me that that
was just not okay. And so, I was able to structure my day. So that admin stuff only lives
in this corner. And clients definitely live in this corner. And then anytime those two
categories get blended for whatever reason, or too close together, I start to get extra tired
and my creative forces don't operate at their full capacity. And those are sort of those
beginning symptoms.

Heather James: Would you say that there's even some avoidance that could be
experienced?

S8: Yeah. Yeah. I would say that that happens. Like it feels overwhelming. So, some
things just don't get done. Yeah.

Heather James: Okay. What are some of the factors related specifically to treating
trauma that could contribute to burnout?

S8: I think holding on to the stories and the narratives can get really heavy really quickly.
Kind of getting roped into a client's narratives. And that was part of what had happened
earlier in my career. With burnout was not having that self and other boundary really
clear.
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Heather James: So, when you say, drawn into their story and their narrative, can you
kind of elaborate on that?

S8: Yeah. Like getting overly involved in the problem solving for them, instead of with
them. And feeling a little more responsible for them. I remember early, there's one client
that she just needed an answer. And trauma doesn't operate that way. But I got roped into
that healer, savior complex of well maybe I can find that. And that, I mean, that's an
impossible position to put myself in.

Heather James: Absolutely. I think sometimes with the treating trauma because you feel
for the people and their stories, it's hard to separate that boundary that needs to be there.

S8: Absolutely,

Heather James: So that makes sense. How do you express your feelings and emotions
after treating a difficult case?

S8: I do a lot of consultation with my partner who is also a trauma person. I have three or
four more colleagues and mentors that I talk with pretty regularly. So, I just always have
those channels of communication open with them. I do a lot of journaling. Meditation,
and that is really helpful and just letting all the things kind of bubble up to be looked at
and sorted through. I'm in therapy so sometimes I process that there. If it's too big.

Heather James: Would you say that that could be a good form of like a support system?
Being in therapy yourself?

S8: Oh, for sure. Yeah. Yeah. I can't imagine being a therapist… I can't imagine me
being a therapist and not having a therapist.

Heather James: I was always told; every therapist has a therapist. So, I've had a few
people that tell me no, no, no, I don't want to go to a therapist. I don't see any use in it. I
listen to people all day long. I don't want to spoil my own stuff.

S8: Oh, sign me up.

Heather James: I think that that's a great, not only a support system, but it's a great
coping measure, because then you're not holding that tension that comes from treating
trauma, and you're able to then release it.
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S8: Yeah, I think the countertransference that happens with trauma work is so sneaky.
And I think it’s worth my time to take a look at it, I’m the one, I'm on the couch. Yeah.

Heather James: I agree. How would you define or describe what burnout is? So, if you
had to tell somebody hey, this is what burnout is. How would you describe that to them?

S8: That's a good question. I would say that burnout is the moment past when it's hard.
That it's like a heavier experience of compassion fatigue. Which I think is really a pretty
normal thing. But it's a more… a heavier experience, where maybe we start to dissociate
a little bit, where we just can't be present and start to do harm to clients.

Heather James: So, would you say that, not just necessarily the client, but it could also
have the adverse effect of causing yourself harm?

S8: Oh, for sure. Yeah.

Heather James: Okay. You're actually the first person who's even mentioned that, you
know, there could be the possibility that you do more harm to the client than good. So,
I'm glad that it got brought up. Because I think that's something that's really important
for therapists to understand that when you're at that point, you're not doing anybody any
justice. Because you have to take care of you before you can try to take care of others.
So, I'm glad you brought that up.

S8: Yeah, I think it's hard for us to say that we're doing harm because we're such helpers
and helping people. We want the best for our clients. And we don't want to admit that
maybe I'm not fit.

Heather James: Would you say that there’s? Go ahead.

S8: I have that conversation a lot with my supervisees. Where, if you're burnt out, you're
not fit to be with people. It doesn't mean you're permanent. Doesn't mean you're
incompetent. It just means you got to do something different.

Heather James: Yeah, absolutely. Would you say that, I guess, let me see how do I word
this? I guess there's no other way to say it. Do you feel like there's a stigma attached
being a therapist to talk about burnout? Almost like, we're not supposed to experience
that. Because we're supposed to have it all together. We're supposed to know what needs
to be done.
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S8: Oh, yeah. I feel like it's like a scarlet letter. Like, we've done something terrible if it
happens to us, or we're a bad therapist, or we're not skilled or we're not competent. Or if I
just try harder. I think that's sort of a meritocracy. You know, where culture is if I just
care more than, then I can make it through burnout. And that's actually the… I think that's
the opposite of truth there.

Heather James: Yeah. I do too. How would you describe the symptoms of burnout?
Cause I know again, that looks different for everyone.

S8: Yeah, I think for me, those times I've experienced it. It was really slow to start and it
just felt where work became heavy. And this last time, it was a lack of motivation,
passion for the field and being creative with my clients was just slowly, like air coming
out of a balloon, just being deflated. And for me, it was not realizing I was deflating until
I was already halfway gone.

Heather James: So not realizing you were burning out?

S8: Yeah, it was almost like it just felt… well, life's hard right now. But looking back at
it there were six weeks of symptoms that I wasn't paying attention to.

Heather James: Would you say that, not just like the feeling heavy, or the not taking care
of, like not having the interest in in the clients. Would you say that it could also be that
you question whether you should stay in the field?

S8: Yeah. Yeah, that happened the first time. I was for sure that there was no way I
could do this for 30 years. I started really thinking that I should go be a secretary and do
something mindless. I was just craving not to be with people.

Heather James: Yeah.

S8: Yeah. That didn't happen this time. I'm not entirely sure why yet, but that was
different.

Heather James: What kind of interactions or conversations have you had with other
mental health professionals about burnout?

S8: I talk with all my supervisees, all of our employees, we talk about it a lot. It comes up
in every staff meeting. And we're the ones bringing it up asking how people are and what
they're noticing and what their symptoms are, and kind of normalizing it. I find myself in
those conversations pretty regularly, even with my mentors, not just about my burnout,
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but just kind of talking about it as a concept that this is something that happens in a way
to kind of caretake each other. Because if we're not seeing it, we need somebody who's
close enough to us to say hey, something's not right here.

Heather James: For sure. So, when you say, not just in the concept, would you say that
you kind of, when you do talk about it, you kind of acknowledge and explain, here's what
some of it could look like? Because like you said, it may not be that the person notices it,
but others that are with them might.

S8: Yeah.

Heather James: Do you think that that's important for like newer therapists to know?
Like, hey, this is what it could look like for you? Knowing my experience, and most of the
people I've talked to, you just kind of get thrown into the field with no flotation device,
and you're just supposed to kind of… Like hindsight is 2020. And then you realize after
the fact.

S8: Yeah. Yeah, absolutely. The first agency I worked for the first position I had; I was
sort of out on my own. So, I was just with my own excitement. I was really unsupported.
But I was like, okay, this new thing, I'm really gonna figure this out. And then I got
thrown into an office full of six or eight completely burned-out clinicians. It was such a
shock. I still physically remember being taken aback going, is this what happens, is this
where therapists go to die? What happens after 30 years? I didn't sign up for this.

Heather James: I know for me, when I started, I am completely like anti agency. I knew
what it looked like from having, through my internship and working with other people
where that's where they started and just knowing the experience of that, that there was
more likelihood that I was not going to want to. I was fairly well versed because of that
knowing hey, this is what burnout would look like. I just steered clear of it because I
didn't want to experience that. And then as things just got going, I experienced it anyhow.
Because just one thing on top of another, and I haven't been practicing for a while. So,
it's interesting to see the people who still are, you know, describe their experience of it,
because it's not so far different from what I've experienced. And I think that's the great
thing about researching burnout is you learn, like the experience of it may not change,
but the reasons why it's experienced may.

S8: Right.

Heather James: So, I love that somebody else understands that whole concept right
there.
 360

S8: Yeah, yeah.

Heather James: Well, what are some steps you've taken specifically to help minimize the
experience of burnout? I know we talked about a few.

S8: Yeah. I think the most important one was kind of taking a look at my boundaries.
And making sure that I'm connected with friends and passions outside of work. I get
really excited about trauma work and neurobiology, and I think, left to my own devices, I
could read that stuff all day long. But then I would last another six months in the field
before (inaudible). And just keeping track of my boundaries.

Heather James: Okay.

S8: It's been really important.

Heather James: I know, some people have said that actually completing more trainings
on how to implement some of the things that they learn for treating trauma, has been
some ways that have helped them cope with not experiencing burnout. Would you say
that that could actually be a good coping strategy? Because they're learning not only the
other methods to help treat it, but how to actually implement that?

S8: Yeah, no, I think that's a really interesting idea. I could certainly see how like,
increasing your competence. So, there's less of that internal pressure, less of that not
knowing and self-judgment and self-doubt going on inside. While we're working with
people, that could certainly be helpful.

Heather James: Okay. I was curious because I've been hearing it quite frequently. So, I
kind of want everybody's take on it just to kind of see what they think.

S8: Yeah, I don't think that's anything…. that's not something I've been... that I've used,
but it makes sense.

Heather James: I've always heard that you can never be too trained on this stuff because
things completely change. I mean, that's why… hence why we do continuing education.
But I do think if from get go, you have more training. And you have not only the training
on the subject, but on how to implement these other components, that it could certainly
do that. So, I was curious, because like I said, I keep hearing that.
 361

S8: I think about, there's a couple of my supervisees, who right out of the gate, they're put
into these really big roles, working with lots and lots of trauma with kids. And they didn't
have any of that education in school. And they didn't have any of that post graduate
education that first year I worked with them. They were just in this constant state of
overwhelm. Until we worked on their competence or their skill set. And their confidence
is a lot higher now. And they're a lot less ragged.

Heather James: Would you say that coming fresh out of the gate into such a heavy
section of mental health is just setting yourself up to experience that burnout?

S8: Oh, for sure.

Heather James: See, that's what I wondered. Because you really don't get that training in
school. Like you mentioned. You just kind of get told, here's the basic thing, which you
do. But not, hey, here's how you need to approach this.

S8: Yeah, absolutely. My personal education journey has been a little different. And so,
getting thrown to the wolves, I guess that's the saying I hear from a lot of new therapists.
I didn't experience that exactly the same, because I've had a really fantastic undergraduate
degree that actually gave me more clinical work than my master's degree did. With a lot
of oversight. A lot of oversight. So, I think my personal experience of it is a little
different.

Heather James: Would you say with that schooling that within it, did they show you or
teach you how important it is to have those resources for coping?

S8: For sure.

Heather James: Okay, great. You're the first person who's told me that. Because I know
a lot of us, the school, it may just be the programs. We had a brief here, you got to
practice self-care, eat good, exercise get plenty of sleep. But it wasn't stressing the
importance of having resources to help you cope or things like that. So, I love that you
did have that experience.

S8: Yeah, right out of the gate, my very first, no it was my second semester, in college, I
was, just turned 19. And they put me in a group in a, what they used to call a battered
women's shelter. And I was in charge of co- leading group therapy there. And, I was
paired with a more seasoned clinician, also we had weekly supervision around it. They
came and saw my work. We talked about it in class, we did lots of like practicing how to
leave work at work. Like those, those emotional boundaries, right from that very start.
 362

Heather James: I love that.

S8: Yeah, it was really good. I'm really thankful.

Heather James: Yeah, I think that there needs to be more thought put behind that also.
That for clinicians that are new to this field and coming into it. I think that that would be
something that's beneficial for them, not just to hear a little blip about hey, take care of
yourself. But to really dig deep into what that looks like.

S8: Right, here’s how you do it. Let's do it together.

Heather James: Like setting self-care plans for themselves. I think that if that was
something that was part of the education, maybe we wouldn't have as many clinicians
that are experiencing burnout. And we might not have as many clinicians that are turning
over either. So, it's definitely something that I'm interested in researching further. Well,
what would you say motivates you to continue in this field knowing that burnout can
happen? I know that's a loaded question.

S8: It is, but I also have a very simple answer. I just love… I love human, humans. And
really want to see people have an opportunity to live their best self, whatever that is. And
the body and how our nervous system works is just fascinating to me. And it feels like a
really exciting time in the field. Where a lot of the research that was done 10 or 20 years
ago is being translated into usable methodologies. And to see how it can look different
for every clinician and every client. And yeah, I think the diversity of treatment is just
really, that's really motivating to me.

Heather James: I love that answer. Most people just say, oh I love what I do, or I love
helping people, or I love to see them succeed. So, to see something that focuses more on
the side of not the client, but the clinician, I love that. Because it really is a very personal
experience for what motivates people to stay in the field. So, I love that you look at it
from the side of you and not here's why I do it. It's so refreshing.

S8: That's good. It's that is what I just remind myself, like this is just what I like.

Heather James: Yeah. I think it kind of goes… for me too like with the degree, people
always ask me, why are you getting a doctorate? Why would you want to put yourself
through that? Because, I may hit these bumps and these twists and turns through the
whole process, but the end result for me, outweighs all of that. And it's kind of the same
thing with therapy. I didn't become a therapist because I wanted to help people. I became
 363

a therapist because somebody did that for me. And I see the value in helping people get to
that place where they want to be that end result. Yeah. So, I love that someone else thinks
kind of the same way.

S8: Yeah. Yeah.

Heather James: What strategies do you think mental health professionals can use to help
themselves and others prevent burnout?

S8: I think my favorite strategy is kind of using an IFS take where (name redacted) says,
that compassion is; okay, these are not his words, this is how I interpret it. But
compassion is an endless pit. You can't run out of it, we have this term called compassion
fatigue, and it's a really normal thing. And he says that we experience compassion fatigue
when we're not connected to the self-state. And so, I think that whatever the things are
that help each therapist or healthcare professional or client connect and strengthen that
self-energy is going to prevent and treat burnout.

Heather James: So, would you say, practicing like compassion for yourself is a good
strategy then?

S8: Absolutely.

Heather James: Through my research, that was something that came up in several
different studies where they were talking about that there's a lack of self-compassion. And
because of that, people experienced burnout more. So, I think that that connection with
yourself, the reflection of yourself that's a definite good strategy to have.

S8: Yeah, I think that's connected to how judgmental we are of being burnt-out and how
much we just don't want to admit it, or look for it, or are afraid of it. We're afraid to say
I'm doing harm to my clients. I'm not fit to work. That's definitely connected to a lack of
self-care, self-compassion.

Heather James: I agree. What resources do you utilize for coping?

S8: Oh, all the things.

Heather James: What are all the things?

S8: Family. I have a lot of rituals with my partner.

 364

Heather James: Can you elaborate what you mean by rituals?

S8: So, he's a therapist too trauma. We're both trauma therapists,

Heather James: Oh, good grief, I feel for you.

S8: But we have a happy little house. So, we consult with each other on occasion about
different things we work on (inaudible). But we have these really important rituals of
coming home to each other. Literally, we make sure that as soon as we both walk in the
door, we drop everything, and we connect. And I think that is really helpful for both of us
just to remember that each other and ourselves are the most important thing here. Even
though the work we do feels really big. It can kind of bring it back down, our focus
down. Yeah, so that connection and connection with friends and family. And exercise and
hiking, and adventures and traveling. All the things we can't do that because of the
pandemic. But new foods, and like adding a lot of variety to our experience feels really
helpful.

Heather James: Because not everybody has someone who understands what it's like. So
that's, that's awesome that you have that.

S8: Yeah. And the first time I went through burnout, I didn't have someone, and I was in
really toxic relationship. And that was (Speaking at same time) it did, it really did. There
was just, wasn't a safe space to go to. And I do attribute, oh yeah, these last years of being
with him that, that has been helpful.

Heather James: Good. I love that.

S8: Yeah. Yeah.

Heather James: What coping strategies do you think are the most helpful to minimize
burnout?

S8: Maybe self-reflection. Mindfulness practice, and boundaries and clear

communication.

Heather James: Clear communication is the key to everything.

S8: It is. It is
 365

Heather James: What types of support systems do you feel are the most beneficial to
helping minimize your burnout? I know, you gave me quite a few already. But which ones
do you think are the most beneficial?

S8: I think, probably friends. And what I think is most helpful is having a hobby network.
I don't know how else to say that.

Heather James: What do you mean by a hobby network?

S8: I'm a musician. And being able to play music and connect with those people in a
completely different way, is so good for me.

Heather James: So almost like people, who join like a craft group or something?

S8: Yeah.

Heather James: So, would you classify that as maybe, like a social group?

S8: Yeah. But like a focus. It’s not just an open we like each other. But kind of a focused
to kind of pull that attention away from things.

Heather James: I love that. I like that's the first time anybody said that to me. So, I kind
of like that. Because I do think you're right. I think if you have something that you're
passionate about outside of therapy, and you have that ability to share with others that
are like minded, then your attention then becomes on that. I love that. That's great. Well,
I only have one question left. How can mental health professionals help prepare other
mental health professionals to recognize the signs of burnout?

S8: I think we need to talk about it.

Heather James: That's the key one that everybody tells me.

S8: Openly and honestly. Without infusing our own shame, and the narrative. I think
that's important.

Heather James: So, would you say don't necessarily shame, not just yourself, but others,
if they come to you about it?

S8: Absolutely.
 366

Heather James: Okay.

S8: Yeah. And I think also ask, clearly and openly asking about it. With our colleagues
that we know, like, and trust. I think it just needs to be part of our conversation.

Heather James: I agree. I think if you have that ability too, to know that you're not going
to be shamed, or looked down upon like, you're less than. That more people will start
talking about it, because it is very stigmatized, and it shouldn't be.

S8: Yeah. One of our employees came to us. This was maybe a year and a half ago. She's
like (name redacted) I need to have a one on one, and she was very heavy. And she's like,
(name redacted), I'm burning out. I'm like, great. Go home. Let's talk about it but go
home first.

Heather James: Go take care of you.

S8: Yeah. I wish we had that celebratory attitude around that. Like, just (inaudible). It's
great to know it and yeah, let's support each other.

Heather James: Yeah, for sure. Well, that was all I had. Do you have anything you want
to add any comments?

S8: I don't think so.

Heather James: Okay. Well, I want to thank you for taking the time to participate. I
really appreciate it.

S8: 45:18
You're welcome. Thank you for doing this research it feels really important.
 ProQuest Number: 28721325

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