Systematic review of relationships between burnout and consciously-initiated autonomous self-care interventions in psychotherapists; and, Is psychotherapist self-care self-determined? The roles of autonomous motivation, work demands, professional stigma, high standards, and self-sacrifice

Abstract

Psychological interventions and the psychotherapists who provide them are crucial to meeting existing and escalating global mental health demand. Unfortunately, psychotherapists are at high risk of experiencing occupational distress, particularly burnout. Detrimental impacts affect both psychotherapists themselves, and their ability to effectively provide psychological interventions. Remediating psychotherapists’ occupational distress and burnout at work is therefore a priority. Unfortunately, research of this kind in psychotherapists is limited, particularly in terms of effective, individually-targeted interventions. This literature gap conflicts notably with widely-shared and common assertions that psychotherapists can prevent burnout themselves via self-care. While self-care is indeed an ethical and professional imperative for psychotherapists, demonstrates emerging wellbeing benefits, and is therefore worthy of promotion, evidence regarding its impacts on burnout requires further investigation.

The first chapter of this thesis presents the results of a systematic review evaluating extant evidence of relationships between consciously initiated, autonomous self-care interventions and burnout in psychotherapists. A systematic literature search identified 18 published and unpublished studies which were included in a narrative synthesis of findings. Most studies were of questionable quality, and all used cross-sectional designs, limiting overall inference. Results however found the greatest support for a negative relationship between burnout and self-care interventions promoting work-life balance. More broadly, findings highlighted the possible importance and utility of more restorative and preventative approaches for reducing burnout, particularly those involving self-regulation and self-awareness to promote recovery from work and boundaries between work and home life. Practical clinical implications were discussed and recommendations for future research were made based on review findings and noted literature limitations.

The second chapter of this thesis reports the results of a cross-sectional empirical study investigating factors identified from the literature which may inhibit or promote psychotherapists’ self-care. Expected self-care barriers included work demands (both objective and subjective), professional stigma, and psychotherapists’ internalised tendencies towards high performance standards and self-sacrifice. The role of autonomous motivation towards self-care, conceptualised in line with Self-Determination Theory, was also considered as a possible self-care facilitator. Findings of correlational and hierarchical regression analyses were mixed, highlighting that distinct variables related differently to distinct self-care domains. Specifically, self-care in broadly personal domains was most strongly negatively related to perceived workload demands, whereas professional self-care was mostly negatively related to perceived workplace stigma. Autonomous motivation toward selfcare appeared to positively relate to self-care, though was seemingly most impactful when perceived workplace demands and stigma were lower.

Both chapters collectively highlighted the importance of self-care specifically for maintaining psychotherapists’ daily balance, as it was both the most clearly negatively related to burnout, but also the form of self-care most likely detrimentally impacted by identified barriers. This thesis further extended findings in the general occupational and health psychology literatures to the issues of psychotherapist wellbeing and self-care, and highlighted factors worthy of practical consideration and future research prioritisation.