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Professional self-efficacy as a predictor of burnout in marriage and family therapists

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Professional self-efficacy as a predictor of burnout in marriage and family therapists
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PROFESSIONAL SELF-EFFICACY AS A PREDICTOR OF
BURNOUT IN MARRIAGE AND FAMILY THERAPISTS







By

R. VALORIE THOMAS


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA


1996





























Copyright 1996

by

R. Valorie Thomas




























This dissertation is dedicated to Hirum.

May his spirit continue to inspire us,

as we travel on our journey.













ACKNOWLEDGMENTS
With great appreciation and gratitude I honor those individuals whose

encouragement and support were instrumental in the completion of this

dissertation. These persons have nurtured, challenged, and helped sustain me in

my journey and will always be remembered.

Foremost, I thank God; without his guidance and wisdom nothing would

be possible. I thank my husband, Donald, whose never-ending faith in me has

helped me to believe in myself and pursue my dreams.

Special thanks go to Dr. Wittmer, my chairperson, whose gentle

suggestions have spurred me to gain confidence in my own abilities; to Dr.

Amatea for always having a listening ear and enthusiastic heart; to Dr. Myrick for

his continued support and direction; and to Dr.Miller whose patience and

understanding is beyond belief.

Special thanks go to the friends who have journeyed with me in the rough

and calm waters--Elizabeth Harvey, Linda Lewis, Jennifer Castner, Sally David,

Richard Vantrease, and Susan DeFoor; to Barbara Smerage for her talents in

typing this manuscript and for her friendship over the years; and to Dr. Mark

Young for his mentorship and never-ending enthusiasm in support of this study.

A special thank you goes to my father, Robert Wasman, for giving me my

sense of humor and teaching me, through his example, perseverance in pursuit of








my goals, and to my mother, Ann Wasman, who has nurtured in me my faith in

God and encouraged me to become all that I am today.













TABLE OF CONTENTS

Pae

ACKNOWLEDGMENTS.............................................................. iv

ABSTRA CT ......................................................................................................... ix

CHAPTER

INTROD U CTION .............................................................................. .

Theoretical Fram ew ork ..................................................................... 7
Statem ent of the Problem ................................................................ 10
N eed for the Study ........................................................................... 11
Purpose .............................................................................................. 12
Research Questions .......................................................................... 13
D efinition of Term s ........................................................................... 14
Organization of the Remainder of the Study ................................ 16

I1 REVIEW OF TH E LITERA TURE .................................................... 18

Burnout--A H istorical Perspective .................................................. 18
D efinitions of Burnout ...................................................................... 23
Effects of Burnout ............................................................................ 26
Burnout in Human Service Professionals ...................................... 30
Factors A ssociated w ith Burnout .................................................... 32
Personal Factors ......................................................................... 32
Environm ental Factors .............................................................. 34
D em ographic V ariables .............................................................. 38
Self-Effi cacy Theory ......................................................................... 40
Professional Self-Efficacy ................................................................ 43
Self-Effi cacy and Burnout ............................................................... 45
M arriage and Fam ily Therapists ...................................................... 50

III M ETH OD OLO G Y ............................................................................ 52

O verview ........................................................................................... 52
Relevant V ariables ........................................................................... 53
Research H ypotheses ...................................................................... 53
Population ......................................................................................... 54








Sam ple ................................................................................................. 55
Sam pling Procedure .......................................................................... 55
Instrum entation ................................................................................. 56
D em ographic D ata Sheet .......................................................... 56
The M aslach Burnout Inventory ............................................ 56
The Counselor Professional Self-Efficacy
Scale ......................................................................................... 59
Content V alidity ....................................................................... 61
Reliability ................................................................................... 62
Self-Report ................................................................................ 64
D ata Analysis ................................................................................... 65

IV DATA ANALYSIS AND RESULTS ............................................. 66

Study and Chapter Overview ........................................................ 66
D ata Collection and Response Rates ............................................ 66
D ecision Rules .................................................................................. 68
Demographic Description of the Research Sample ...................... 69
M BI Levels ................................................................................ 69
CPSES ........................................................................................ 75
Gender, Age, Degree, Years of Experience, and Direct
W eekly Contact H ours .......................................................... 75
Racial or Ethnic Background .................................................. 75
D ifficulty Level of the Client ................................................... 76
Reliability Estimates for the CPSES and MBI .............................. 77
Intercorrelations ................................................................................ 78
Analysis Procedures ......................................................................... 82
Regression Results .................................................................... 83
Analysis by Hypotheses ........................................................... 93
Chapter Sum m ary ............................................................................. 97

V D ISCU SSION .................................................................................... 99

The Research Sam ple ....................................................................... 99
Lim itations of the Study ................................................................... 101
D iscussion of Results ........................................................................ 102
M odel 1 (H ypotheses 1, 2, 3, and 4) ......................................... 104
M odel 2 (H ypotheses 1, 2, 3, 4, and 5) ..................................... 106
M odel 3 (H ypotheses 1, 2, 3, 4, and 5) ..................................... 107
M odel 4 (Hypotheses 6, 7, and 8) ............................................. 109
Implications of the Findings and Recommendations .................... 111
Im plications for Theory ............................................................... 111
Im plications for Training and Practice ...................................... 114
Im plications for Further Research ............................................. 118
Chapter Sum m ary ............................................................................... 119








APPENDICES

A DEMOGRAPHIC DATA SHEET ................................................... 120

B HUMAN SERVICES SURVEY ...................................................... 123

C COUNSELOR PROFESSIONAL SELF-EFFICACY
SC A L E ....................................................................................... 125

D COVER LETTER ............................................................................. 128

E FOLLOW-UP LETTER ................................................................... 130

F FOLLOW-UP LETTER ................................................................... 131

G CATEGORIZATION OF MBI SCORES ....................................... 132

R EFE R EN C ES ................................................................................................... 133

BIOGRAPHICAL SKETCH ............................................................................. 142













Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

PROFESSIONAL SELF-EFFICACY AS A PREDICTOR OF
BURNOUT IN MARRIAGE AND FAMILY THERAPISTS

By

R. Valorie Thomas

May 1996

Chairperson: Joseph Wittmer
Major Department: Counselor Education

The purpose of this study was to apply components of self-efficacy theory

in an investigation of burnout in marriage and family therapists. Specifically, in

this study the researcher analyzed whether perceived professional self-efficacy

predicted burnout among marriage and family therapists. In addition, age, gender,

race, years of experience, and environmental demands, including the difficulty of

the client(s) served and the number of hours in direct client contact, were studied.

More specifically, the latter were analyzed to determine if there was a significant

direct effect on therapist burnout or an indirect effect on burnout through self-

efficacy.

The sample for the study consisted of respondents to a nationwide random

sampling of clinical members of the American Association for Marriage and Family

Therapists (AAMFT). Two hundred sixty-six (57.4% male, 42.6% female)

subjects composed the source for the data analysis.








Multiple regression procedures were utilized for analysis of the data.

Counselor professional self-efficacy, years of experience, weekly contact hours,

client difficulty level (Category 1 and 3), age, and gender were evaluated as

predictor variables. Both Counselor Professional Self-Efficacy and Maslach

Burnout Inventory scores were studied as outcome variables. The study revealed

that the results of using the multiple regression models used to test the

hypotheses were significant at the 0.0001 level. Counselor professional self-

efficacy was predictive of depersonalization and personal accomplishment scores

on the MBI.

Additionally, the marriage and family therapists in this study demonstrated

moderate levels of emotional exhaustion and depersonalization and indicated a

high sense of personal accomplishment. Furthermore, years of experience and

age predicted emotional exhaustion levels in participants. Personal

accomplishment levels were predicted by weekly contact hours while Category 3

clients and age of the therapists predicted levels of depersonalization. Finally,

years of experience, age, and gender predicted strength of professional self-

efficacy. Implications for theory, training, practice and research are also included

in this dissertation.













CHAPTER I
INTRODUCTION

My candle bums at both ends;
Embraced by the light it radiates, I follow....
The light begins to flicker; it will not survive
the demands of the night.
But oh my foes, and oh my friends
it gives a lovely light.
(Adapted from "First Fig,"
Edna St. Vincent Millay,
1939, p. 127)

Burnout--What shone so brightly no longer illuminates the world around

it. Enthusiasm, commitment, and compassion for helping others is replaced by

fatigue, apathy, frustration, and loneliness. The longing to reach out and help

remains but is veiled by a personal sense of reduced motivation, low energy, an

overwhelming feeling of helplessness, and a reduced belief in one's ability to

make a difference.

In recent years the effects of the burnout phenomenon on the performance

of the helping professions in various health, welfare, and rehabilitation services

has been widely discussed in the professional literature (Capner & Caltabioano,

1993; Dignam & West, 1988; Firth & Britton, 1989; Golembiewski &

Munzenrider, 1988; Maslach & Jackson, 1981; Schaufeli, Maslach, & Marek,

1993; Shirom, 1986; Wade, Cooley, & Savicki, 1986).

Burnout has been defined as a syndrome of emotional exhaustion,

depersonalization, and reduced personal accomplishment that can occur among









individuals who work with people in some capacity (Maslach & Jackson, 1984,

1986). Emotional exhaustion refers to feelings of being emotionally

overextended and drained by one's contact with people. Depersonalization

refers to an unfeeling and callous response toward the people who are often the

recipients of one's care. Reduced personal accomplishment refers to a decline in

one's feeling of competence and successful achievement in one's work with

people (Maslach & Jackson, 1986). Unlike depression, an emotional disorder that

influences all facets of a person's life activities, burnout has been conceptualized

as impacting human services workers' thoughts and feelings about professional

performance (Leiter & Maslach, 1988; Maslach & Jackson, 1986).

Burnout has been recognized as both an individual and societal problem

and has resulted in high job turnover (Jackson, Schwab, & Schuler, 1986;

Maslach & Jackson, 1984b), poor job performance (Jackson, Schwab, &

Schuler, 1986), absenteeism (Maslach & Jackson, 1981), family problems

(Maslach & Jackson, 1982), poor health (Burke, Shearer, & Deszca, 1984), and

possibly other types of social and personal dysfunction (Maslach & Florian,

1988).

Persons in occupations that involve providing services to others are

especially susceptible to burnout (Maslach & Jackson, 1981), and counseling has

been identified as one of these person-oriented occupations (Farber, 1983b). In

counselors burnout may mean caring less and feeling more easily frustrated by

clients' resistances or lack of progress, losing confidence in one's skills and ability

to make a difference, or feeling disillusioned about the field of psychotherapy.

The counselor may become less involved in, or cynical about, his/her professional









development and may even regret the decision to enter the field. Often, the

helping professional facing burnout even fantasizes about leaving the profession

he/she once envisioned as fulfilling (Farber, 1990).

Both personal and environmental factors have been associated with the

development of burnout, but research evidence suggests that environmental

factors, particularly demands and supports in the workplace, are more strongly

related than such factors as demographic and personality variables (Burke,

Shearer, & Deszca, 1984; Golembiewski & Munzenrider, 1988; Leiter, 1988a,

1990a, 1990b; Leiter & Maslach, 1988; Pines & Aronson, 1988).

Environmental factors that have been identified as a major source of

burnout include those involving interactions with others in the work

environment. Burnout has been correlated with a greater percentage of time in

direct care of clients (Lewiston, Conley, & Blessing-Moore, 1981, as cited in

Maslach & Florian, 1988; Maslach & Jackson, 1982), more difficult client

problems (Meadow, 1981; Pines & Maslach, 1978), a low degree of peer support

(Burke et al., 1984; Jackson, Schwab, & Schuler, 1986; Maslach & Jackson, 1986),

expectations of supervision (Davis, Savicki, Cooley, & Firth, 1989; Penn, Romano,

& Foat, 1988), involvement with coworkers (Leiter, 1988b), and perceptions of

job-related stressors which include role ambiguity and role conflict (Friesen &

Sarros, 1989; Huberty & Huebner, 1988). All of the above involve the

individuals' interactions with their environments.

Although the impact of the work environment is evident in cases of

burnout, few approaches exist that provide a theoretical framework for









understanding burnout in an organizational context. One such framework is a

specific area of Social Cognitive Theory, Bandura's self-efficacy theory.

To understand social cognitive theory, a distinction between outcome

expectancy and efficacy expectations is necessary. Bandura (1977) posited that

outcome expectancies, the extent to which a response would lead to a desired

result, and efficacy expectations, the extent to which an individual (counselor)

feels capable of adequately implementing a response, determine an individual's

behavior in a demanding situation. Outcome expectancies have to do with the

action-outcome link; if a counselor provides a certain type of therapy to a client,

the client is likely to improve. Efficacy expectations have to do with a person-

action link; does the counselor feel capable of performing his/her professional

role? Theorists espousing the transactional approach to stress (Cox, 1978;

Lazarus & Folkman, 1984) posit that limitations in either outcome or efficacy

expectations can contribute to experienced stress. This chronic stress eventually

may lead to burnout. Thus, work setting (work environment) provides a powerful

context for developing efficacy expectations.

A supportive work environment provides a maximum of positive features

that enables a professional to perform his/her work role and reach his/her

professional goals. Successfully and independently reaching one's goals

enhances one's belief in one's ability to perform one's work role. If, on the other

hand, there is a failure to achieve work goals, psychological burnout may result

(Cherniss, 1993).

Cherniss (1993) proposed a link between self-efficacy and burnout by

referring to Hall's (1976) work on psychological success. Originating in the









earlier work of Lewin (1936), Hall proposed that work motivation and satisfaction

were enhanced when an individual achieved challenging and personally

meaningful goals successfully and independently. He claimed that such

achievement led to psychological success, more work involvement, the setting of

more challenging goals, and the feeling of a higher self-esteem. Hall emphasized

that what was most important was a person's feeling of success.

Both Pines (1993) and Hall (1976) stated that not all goals are equally

significant for burnout prevention. It is, however, the attainment of personally

meaningful goals that alleviates burnout. The professional must feel efficacious in

areas that are meaningful and significant to the individual. Bandura's (1986)

work is in agreement with this view as he seemed to suggest that successful

attainment of meaningless goals will do little to increase a person's self-efficacy

(Cherniss, 1993).

In a study of 60 psychotherapists Farber and Heifetz (1982) reported that

the single most important goal therapists want to achieve is to establish a

relationship that helps a client move towards change. Lack of therapeutic

success was cited as the most stressful aspect of therapeutic work most often due

to nonreciprocaled attentiveness, giving, and responsibility demanded by the

therapeutic relationship (Farber & Heifetz, 1982). In addition, Farber cited

overwork, the difficulty in dealing with patient's problems, discouragement as a

function of the slow and erratic pace of therapeutic work, the tendency of

therapeutic work to raise personal issues in therapists themselves, the passivity of

therapeutic work, and the isolation often demanded by work as contributing to

burnout (Farber, 1983b). He suggested that therapists expect their work to be









difficult and even stressful, but they also expect their efforts to make a difference

or an impact. The constant demand of interacting without compensation of

success produces burnout (Farber, 1983a). He posited that therapists are at risk

of burnout when they experience their efforts as inconsequential.

Professionals who are doing people work of some kind share a common

existential quest, to make a difference or impact. Their tools for helping make a

difference are comprised of their interpersonal skills, attitudes, and beliefs in

addition to their professional technical abilities. The professional's relationship

with the recipient is a vehicle for change and, hence, a source of accomplishment

(or of failure). Likewise, the relationship is exhausting and demanding since most

recipients are troubled or suffering. Thus, in contrast to other types of

occupational strain, burnout may result from interpersonal processes with

recipients as well as from coworkers, supervisors, or organizational factors.

Burnout from this perspective has a specific etiology that is linked to a

professional domain.

A pivotal concern contributing to burnout is the idea that one is losing

one's belief in one's ability to perform the professional work role within a range of

competency (Cherniss, 1980a). In other words, decreased professional efficacy in

performing one's work role may be a central tenant in persons experiencing

burnout.

Researchers have suggested that links between self-efficacy and stress

exist (Jex & Ludanowski, 1992). People with stronger perceived self-efficacy

experience less stress in threatening or taxing situations, and situations are less

stressful when people believe they can cope successfully with them (Bandura,









1989b). Burnout has been regarded as a reaction to adverse, stressful demands

(i.e., interpersonal conflicts). This relationship between self-efficacy and stress

suggests a link between self-efficacy and burnout as well. Researchers have

noted the importance of empirical investigations to test this linkage. However,

limited progress has been made toward extending social cognitive theory to the

study of psychological burnout (Cherniss, 1993; Leiter, 1991; Leiter & Skol, 1989;

Meier, 1984). This research was developed to undertake such a task.

Although some researchers have suggested that self-efficacy theory can

serve as a theoretical framework in which to study burnout, no studies to date

have examined the relationship between professional self-efficacy and burnout in

mental health professionals.

In this study the researcher attempted to apply the components of self-

efficacy theory in an investigation of professional burnout in marriage and family

therapists. Specifically, professional self-efficacy was analyzed as a potential

predictor of professional burnout among marriage and family therapists. In

addition, experience level, age, gender, race, and environmental demands

including the number of hours in direct client contact and the difficulty of the

client(s) were also investigated for predictor qualities.

Theoretical Framework

As viewed in the related research literature, the approaches that are most

often used to describe the etiology, symptom formation, and treatment of burnout

have evolved from studies that have not been theoretically driven. Case studies,

survey studies, and correlational designs have been utilized most often to explore









this phenomenon. More recently, however, models of burnout have been

conceptualized by burnout researchers.

What is missing from the literature then are theoretical frameworks in

which to study this phenomenon and empirical evidence of a significant

relationship between self-efficacy and burnout. Thus, as mentioned previously,

the theory that motivated this present study was a component of Bandura's social

cognitive theory--self-efficacy theory. Bandura (1986) stated that individuals

possess beliefs that enable them to exercise a measure of control over their

thoughts, feelings, and actions, that "what people think, believe, and feel affects

how they behave" (p. 25). These beliefs make up a self system with symbolizing,

forethinking, vicarious, self-regulatory, and self-reflection capabilities, and a

person's behavior results in the interplay between this person's system and

environmental influences. Bandura creates a picture of human behavior and

motivation in which people's beliefs about themselves are a main factor.

Bandura (1986) argued that self-referent thought mediates between

knowledge and action and allows individuals to evaluate their own experience.

Of all self-beliefs, self-efficacy, "people's judgments of their capabilities to

organize and execute courses of action required to attain designated types of

performance" (Bandura, 1986, p. 392) strongly impacts the choices people make,

the effort they expend, how long they persevere in the face of challenge, and the

degree of anxiety or confidence they experience.

It would seem then that a counselor's degree of belief in his/her capability

to perform the professional work role would be related to the degree of stress

he/she experiences. Continuous exposure to demands of the professional work









role (in marriage and family counselors this would entail interactions with their

clientele, coworkers, and supervisors and their work environment) may result in a

wearing down of their coping ability and eventually lead to burnout.

Developing coping skills to deal with professional work roles is, therefore, an

essential factor in the study of burnout in marriage and family therapists.

Bandura (1986) asserted that dealing with one's environment is not simply

a matter of knowing what to do, nor is it a fixed act that one possesses in one's

behavioral repertoire. Rather, it involves a capability in which cognitive, social,

and behavioral subskills must be organized into courses of action to serve many

purposes.

Competent functioning requires both skills and self-beliefs of efficacy to

use them effectively. Operative efficacy calls for continuously improvising

multiple skills to manage ever-changing circumstances, mostly which contain

ambiguous, unpredictable, and stressful elements (Bandura, 1986). Initiation and

regulation of transactions with the environment are partly governed by

judgments of operative capabilities--what people think they can do under given

circumstances. Perceived self-efficacy is defined as people's judgments of their

capabilities to organize and execute courses of action required to attain

designated types of performances (work roles). It is concerned not with the skills

one has but with judgments of what one can do with whatever skills one

possesses. People's beliefs about their operative capabilities help to determine

their behavior, thought patterns, and emotional reactions in taxing situations.

Thus, self-beliefs contribute to the quality of a person's psychosocial functioning.









Those who judge themselves inefficacious in coping with environmental

demands dwell upon their personal deficiencies and cognize potential difficulties

as more formidable than they really are (Beck, 1976; Lazarus & Launier, 1978;

Meichenbaum, 1977; Sarason, 1975). Such misgivings create stress and

undermine effective use of competencies people possess by diverting attention

from their best to proceed to concern over personal failings and possible mishaps.

By contrast, persons who have a strong sense of efficacy deploy their attention

and effort to the demands of the situation and are spurred by obstacles to greater

effort, therefore experiencing less stress.

In summary, research into work environment variables related to the

burnout phenomenon have indicated that interactions in the workplace with

clients, coworkers and supervisors, and the organization all contribute to the

burnout process. The workers' perception of their capabilities to perform

successfully their professional work role would seem to be a central tenet of the

burnout process (Cherniss, 1993).

Given the fact that self-beliefs influence a person's ability to perform a

given task and that this belief impacts how one will interact with one's

environment, it is important to understand better the variables related to burnout

and the relationship of professional self-efficacy to this process as well.

Statement of the Problem
The focus of this research was to determine if professional self-efficacy has

any predictive properties of professional burnout among marriage and family

therapists. No researchers to date have empirically tested the relationship

between professional self-efficacy beliefs and burnout in marriage and family









therapists. Also unknown was the level of professional burnout among this

population. Additionally, experience level, age, gender, race, and the

environmental demands of the number of hours in direct client contact, and the

difficulty of the client(s) were analyzed to determine if there was a significant

direct effect on burnout or an indirect effect on burnout through self-efficacy.

Evidence, or lack thereof, of such relationships can help to determine the role of

professional self-efficacy beliefs in the burnout process and contribute to the

understanding of the etiology of professional burnout among marriage and family

therapists.

Need for the Study
Knowledge regarding the predictive nature of professional self-efficacy

beliefs and levels of burnout in marriage and family therapists should contribute

significantly to the understanding of the etiology of the burnout phenomenon.

Such knowledge would also provide empirical evidence to link self-efficacy to

the burnout phenomenon based on social cognitive theory.

Researchers have amply demonstrated that significant levels of burnout

exist in the human services professions (Golembiewski & Munzenrider, 1988;

Maslach & Jackson, 1982); however, burnout in marriage and family therapists

has not been empirically investigated. Golembiewski (1989) noted that burnout

research is lacking from national surveys on subjects in specific occupational

groups. Marriage and family therapists comprise one of these specific

occupational groups.

Marriage and family therapists are mental health professionals who serve a

wide array of clients and work in a variety of mental health settings. Specifically,







12

they assess, diagnose, and treat individuals, couples, and/or families with a variety

of mental health needs ranging in difficulty level.

Trends that may increase the risk of burnout in the mental health field

include the expanding growth of the managed care industry, the trend for

increasing numbers of individuals with difficult-to-treat character disorders

seeking treatment in agency settings, and the tendency for mental health to

become more of a business in the private sector (Farber, 1990). Due to these

trends, the role of the professional is expanding and taking on new dimensions as

the profession continues to thrive in an environment of economic and social

uncertainty. As such, recent literature suggests that stress levels are on the rise

among marriage and family therapists (Figley, 1993; Passoth, 1995; Wegmann,

1994).

The training of competent mental health professionals, therefore, continues

to be of concern to the profession as the mental health industry expands, as

indicated by Kleibier and Enzman (1990, as cited in Schaufeli, Maslach, & Marek,

1993). They noted 1,500 publications on burnout since 1983. Knowledge from

this researcher's investigation could have implications for theory, research,

training, and action in treating this phenomenon. Such knowledge would

contribute to the explanation of burnout etiology and promote further

clarification of self-efficacy theory.

Purpose

The purpose of this study was to apply components of self-efficacy theory

in an investigation of burnout in marriage and family therapists. Such an

application has not been empirically tested to date in the research literature.









More specifically, this study analyzed whether perceived professional self-

efficacy predicts burnout among marriage and family therapists. In addition, age,

gender, race, years of experience, and the environmental demands including the

difficulty of the client(s) and the number of hours in direct client contact were

analyzed to determine if there is a significant direct effect on burnout or an

indirect effect on burnout through self-efficacy.

Professional self-efficacy was measured by the Counselor Professional

Self-Efficacy Scale (CPSES), a self-report instrument designed and tested by the

researcher. This instrument was used to measure professional efficacy beliefs in

three domains of the counselor professional work role--the task domain, the

interpersonal domain, and the organizational domain. These beliefs were

evaluated to determine their relationship to levels of burnout as measured by the

Maslach Burnout Inventory (1986). In addition, years of experience, age, gender,

race, and the environmental demands including the number of hours in direct

client contact and the difficulty of the client(s) seen by the subjects were

investigated.

Research Questions

The specific questions addressed in this study were as follows:

1. What are the levels of burnout present among marriage and family

therapists?

2. Does professional self-efficacy predict burnout in marriage and family

therapists?

3. Does the number of years of experience predict burnout in marriage and

family therapists?









4. Does the number of clinical contact hours predict burnout in marriage

and family therapists?

5. Does the difficulty of the client(s) seen predict burnout in marriage and

family therapists?

6. Do age, gender, and race predict burnout in marriage and family

therapists?

7. Do years of experience predict professional self-efficacy in marriage and

family therapists?

8. Does the number of clinical contact hours predict professional self-

efficacy in marriage and family therapists?

9. Does the difficulty of the client(s) seen predict professional self-efficacy

in marriage and family therapists?

10. Do age, gender, and race predict professional self-efficacy in marriage

and family therapists?

Definition of Terms

A marriage and family therapist is a mental health professional who

provides mental health services to individual, couples, and families utilizing family

systems theory and intervention techniques. They believe that individuals and

their problems must be seen in context, that the most important context is the

family. This practitioner works in a variety of settings including agency, private

practice, and managed mental health care.

The American Association for Marriage and Family Therapy (AAMFT) is a

professional association for the field of marriage and family therapy. Since 1942,

the AAMFT has promoted the practice of marriage and family therapy through









research and education and regulated the profession through accreditation and

credentialing.

Marriage and family therapy is a distinct mental health discipline currently

licensed or certified in 31 states.

AAMFT clinical member is defined as an individual who holds a master's

degree or a doctorate in marriage and family therapy from a program accredited

by the Commission for Accreditation for Marriage and Family Therapy Education

(COAMFTE) or a graduate degree from a regionally accredited educational

institution and an equivalent course of study defined by the AAMFT Board of

Directors. This individual has a minimum of 2 years of postdegree supervised

clinical experience in marriage and family therapy.

Burnout is a syndrome of emotional, exhaustion, depersonalization, and

reduced personal accomplishment that occurs in individuals who work with

people in some capacity (Maslach & Jackson, 1984a, 1986). It is a progressive

response to chronic stress that occurs over time and ranges from low to moderate

to high degrees of experienced feelings (Maslach & Jackson, 1993).

Experienced burnout refers to the subject's range of low, moderate, and

high degrees of experienced feelings of emotional exhaustion, depersonalization,

and personal accomplishment as defined by the Maslach Burnout Inventory

(Maslach & Jackson, 1993).

Professional work role is defined as the counselor's work task which

involves not only the technical aspects of the professional role but also

interaction(s) with his or her work environment (i.e., clients, coworkers and









supervisors, and the organization) and encompasses three domains of

performance.

Professional role performance is defined as a counselor's professional

performance in three work domains--task, interpersonal, and organizational.

Task domain includes the counselor's perceived ability to perform technical

aspects of the professional role (i.e., competency in delivering mental health

services, assessment, diagnosis, treatment, and helper skills).

Interpersonal domain includes the counselor's perceived ability to work

with others (i.e., clients, coworkers, and supervisors).

Organizational domain includes the counselor's perceived ability to

influence social and political forces within work and professional organizations.

Perceived self-efficacy is defined as people's judgments of their capabilities

to organize and execute courses of action required to attain designated types of

performances. It is concerned not with the skills one has but with judgments of

what one can do with whatever skills one possesses (Bandura, 1986, p. 391).

Professional self-efficacy is a domain-specific assessment of a counselor's

belief in his or her ability to perform his or her professional role in three areas of

role performance: task, interpersonal, and organizational.

Self-efficacy is a context-specific assessment of competence to perform a

specific task, a judgment of one's capabilities to execute specific behaviors in

specific situations.

Organization of the Remainder of the Study

The remainder of this study consists of two chapters. In Chapter II the

researcher presents a review and analysis of relevant literature. Chapter III







17

contains a description of the methodology, subjects, and research design. The

results of the study are presented in Chapter IV. Chapter V concludes the study

with a discussion by the researcher of the research process, the limitations of the

study, conclusions, and recommendations for future research.













CHAPTER II
REVIEW OF THE LITERATURE

The purpose of this chapter is to summarize the professional literature

relevant to this study concerning professional self-efficacy and professional

burnout in marriage and family therapists. The literature review encompasses the

following topics: (a) burnout--a historical perspective, (b) definitions of burnout,

(c) effects of burnout, (d) causes of burnout in human service professionals, (e) an

overview of self-efficacy theory, (f) professional self-efficacy, and (g) self-efficacy

and burnout. Finally, a rationale for choosing marriage and family therapists as a

target population for this study is presented.

Burnout--A Historical Perspective

Burnout has been conceptualized in many ways including intrapsychic,

interpersonal, social, occupational, and organizational approaches. What is

evident is that while burnout continues to be a very real syndrome experienced

by certain individuals, it is by no means clearly understood.

The term burnout was first used by Herbert Freudenberger (1974) after

observing the phenomenon in himself and other human service professionals

while involved in the free clinic movement of the late 1960s and early 1970s. The

term burnout was then being used to refer to the effects of chronic drug abuse.

He defined burnout as "to fail, wear out, or become exhausted by making

excessive demands on energy, strength, and resources" (Stechmiller, 1991, p. 16)









and attributed it to the constant pressures of working with emotionally needy

and demanding individuals.

At about the same time, Christina Maslach (1976), a social psychology

researcher, was studying emotional arousal and how some individuals were able

to keep such arousal from disrupting job-related behavior. Specifically, she was

concerned with situations often characterized by crisis and chaos experienced by

hospital emergency room staff and therapists doing crisis counseling. Maslach's

(1976, 1979) original research focused on such cognitive strategies as detached

concern (which referred to the medical profession's ideal of blending compassion

with emotional distance) and dehumanization in self-defense (the process of

protecting oneself from the overwhelming emotional feelings by responding to

other people more as objects than person).

Using case study interviews and questionnaire surveys, Maslach

systematically investigated hundreds of individuals involved in a variety of

human service professions (Maslach, 1976, 1979; Maslach & Jackson, 1981).

These included mental health professionals, psychiatrists, psychiatric nurses,

hospice counselors, poverty lawyers, ministers, teachers, prison guards, and

probation officers.

Key themes emerged from these interviews. First, it became evident that

emotional experiences played an important role in the provision of health care.

Some practitioners reported experiences in providing care as rewarding while

others' experiences were emotionally stressful. Stressful experiences included

working with difficult or unpleasant patients, dealing with patient deaths,

delivering bad news to patients and their family, or having conflicts with









coworkers or supervisors. Emotional strains were many times described as

overwhelming, and practitioners discussed being emotionally exhausted and

drained of all feelings.

Secondly, a theme of detached concern, emotional distancing, described

by practitioners to distance and detach themselves from sources of emotional

strain emerged.

Finally, a general theme having to do with self-assessment of professional

competence became apparent. Many times the experience of emotional turmoil

felt by the practitioner was interpreted as a failure to be professional (i.e.,

nonemotional, cool, objective) and led individuals to question their ability to

work in a health career. Interwoven throughout the interviews was a central

focus on relationships--usually between provider and recipient but also between

provider and coworkers or family members.

Questionnaire surveys followed with the purpose of investigating larger

samples, developing more systematic assessment techniques, and studying

burnout within a situational context rather than simply as a stress experience of

the individual provider in isolation. Two studies were designed to assess

providers' emotional states and reactions to their clients and to discover if these

dimensions were correlated with certain job factors. In the mental health study

(Pines & Maslach, 1978), the focus was on the role of the recipient (patients) in

burnout. A study of day-care workers (Maslach & Pines, 1977) also investigated

caseload issues but added some organizational factors (program structure and

staff participation in decision making).









The 1980s then depicted a more focused, constructive, and empirical

period in which authors outlined working models of the phenomenon, proposed

ideas and interventions, and presented a variety of forms of evidence of the

phenomenon by supporting survey and questionnaire data, interview responses,

and clinical case studies. Standardized measures of burnout were developed,

providing researchers with more precise definitions and methodological tools for

studying the phenomenon. Specifically, the development and acceptance of the

Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1986, 1993) and the

Tedium Measure (TM) (Pines, Aronson, & Kafry, 1981) fostered research on

burnout resulting in an increased number of articles published in scholarly

journals. The MBI provides the most research-oriented definition for the

construct of burnout and has been used exclusively in recent burnout projects

(Ackerley, Burnell, Holder, & Kurdek, 1988; Friesen & Sarros, 1989;

Golembiewski & Munzenrider, 1988; Ross, Altmaier, & Russell, 1989).

A review of more recent burnout literature indicates several trends. First,

most work has continued to focus on people-oriented, human service

occupations although the variety of these occupations has expanded (i.e.,

correction officers, clinical psychologists, prison guards, and librarians). The

concept has also been extended to other types of occupations and

nonoccupational areas of life (i.e., discussion of burnout in the business world, in

sports, and within the family) (Schaufeli, Maslach, & Marek, 1993).

Secondly, empirical research has tended to focus more on job factors than

on any other types of variables. Researchers have studied variables such as job

satisfaction, job stress (work load, role conflict, and role ambiguity), job









withdrawal (turnover, absenteeism), job expectations, relations with coworkers

and supervisors, relations with clients, caseload, type of position, and time in the

job. Personal factors studied most often are demographic variables (sex, age,

marital status). Some attention was given to personality variables (locus of

control, hardiness, personal health, relations with family and friends, and personal

values and commitment). The research concluded that job factors are more

strongly related to burnout than are biographical or personal factors.

Most recently, several longitudinal studies have indicated three major

conclusions (Dignam & West, 1988; Firth & Britton, 1989; Golenbiewski &

Munzenrider, 1988; Jackson, Schwab, & Schuler, 1986; Shirom, 1986; Wade,

Cooley, & Savicki, 1986). First, the level of burnout appears stable over time, and

it is more chronic than acute. Secondly, burnout leads to physical symptoms,

absenteeism, and job turnover. Finally, role conflict and lack of social support

from colleagues and supervisors are antecedents of burnout.

Unfortunately, many studies of the burnout phenomenon, including most

recent longitudinal studies, have not been grounded in a theoretical framework.

This has resulted in an atheoretical stance, making it difficult to interpret results as

significantly related to other relevant research.

The empirical data base provided in the 1970s and 1980s, however, has

provided a foundation for comprehensive models of burnout. More specifically,

Leiter and Maslach's (1988) communication patterns model, Golembiewski and

Munzenrider's (1988) phase model, and Koeske and Koeske's (1989) integrated

model represent efforts to develop comprehensive models of burnout.









Other approaches in studying burnout have included intrapsychic,

interpersonal, social, occupational, and organizational components. At present,

burnout is recognized as a valid and meaningful psychological construct

(Golembiewski & Munzenrider, 1988; Koeske & Koeske, 1989) and has been well

documented within the human services profession. Gaps remain, however, in

developing a clear understanding of the phenomenon.

Selection of research subjects has involved mixed professions and job

categories too divergent for meaningful generalization or replication. Cherniss

(1993) posited that "given how large and varied research literature on burnout

has become, it is not clear that one theme can tie it all together" (p. 135). He

suggested a unifying conception as the concept of self-efficacy and posited that

this conceptual link between self-efficacy and burnout has not been recognized.

Leiter (1990a) recently suggested that linking burnout with self-efficacy can

point to a valuable new direction for research, theory, and action on burnout.

Definitions of Burnout

Originating as a type of job stress in the helping professional

(Freudenberger, 1974; Maslach, 1976; Maslach & Jackson, 1986), the term

burnout has received considerable attention over the last 20 years.

Freudenberger (1974) first described burnout as a state of physical and emotional

depletion resulting from work conditions. Freudenberger and Richelson (1980)

later defined burnout as follows: "to deplete oneself; to exhaust one's physical

and mental resources; to wear oneself out by excessively striving to reach some

unrealistic expectation imposed by oneself or by the values of society" (p. 16).









Cherniss (1980b) defined burnout as "psychological withdrawal from

work in response to excessive stress or dissatisfaction" (p. 16). He further stated

that burnout referred to situations formerly considered callings that merely

became a job. In other words, "the term refers to the loss of enthusiasm,

excitement, and a sense of mission in one's work" (p. 16).

Edelwich and Brodsky (1980) further described burnout as a "progressive

loss of idealism, energy, purpose, and concern as a result of conditions of work"

(p. 14). Pines, Aronson, and Kafry (1981) added that

burnout is characterized by physical depletion by feelings of
helplessness and hopelessness, by emotional drain, and by the
development of a negative self concept and negative attitudes
toward work, life, and other people.... It is a sense of distress,
discontent, and failure in the question for ideals. (p. 15)

In general, burnout is considered to occur over time and to be

multidimensional in domain. Much controversy and confusion continue to exist

in terms of definition; however, Maslach (1982b) presented the following

definitions of burnout:

(a) A syndrome of emotional exhaustion, depersonalization and
reduced personal accomplishment that can occur among individuals
who do "people work" of some kind.

(b) A progressive loss of idealism, energy, and purpose experienced
by people in the helping professions as a result of the conditions of
their work.

(c) A state of physical, emotional, and mental exhaustion marked by
physical depletion and chronic fatigue, feelings of helplessness and
hopelessness, and the development of a negative self-concept and
negative attitudes toward work, life, and other people.

(d) A syndrome of inappropriate attitudes toward clients and self,
often associated with uncomfortable physical and emotional
symptoms.









(e) A state of exhaustion, irritability, and fatigue that markedly
decreases the worker's effectiveness and capability.

(f) To deplete oneself. To exhaust one's physical and mental
resources. To wear oneself out by excessively striving to reach
some unrealistic expectations imposed by oneself or by the values
of society.

(g) To wear oneself out doing what one has to do. An inability to
cope adequately with the stresses of work or personal life.

(h) A malaise of the spirit. A loss of well-being. An inability to
mobilize interests and capabilities.

(i) To become debilitated, weakened, because of extreme demands
on one's physical and/or mental energy.

(j) An accumulation of intense negative feelings that is so
debilitating that a person withdraws from the situation in which
those feelings are generated.

(k) A pervasive mood of anxiety giving way to depression and
despair.

(1) A process in which a professional's attitudes and behavior
change in negative ways in response to job strain.

(m) An inadequate coping mechanism used consistently by an
individual to reduce stress.

(n) A condition produced by working too hard for too long in a
high-pressure environment.

(o) A debilitating psychological condition resulting from work-
related frustrations, which results in lower employee productivity
and morale. (pp. 30-31)

Although the concept of burnout has been defined in many ways, there is

a general consensus that the symptoms include attitudinal, emotional, and

physical aspects (Freudenberger, 1974; Maslach 1976; Maslach & Jackson,

1986). Maslach (1982b) further proposed that there was agreement on three

components of the burnout syndrome: (a) exhaustion--a loss of energy and

debilitation, physiologically and psychologically--a loss of trust and apathy, with









loss of feelings, concern, and spirit; (b) depersonalization--a disparaging response

to others, inappropriate attitudes towards clients, loss of ideals, irritability; and (c)

reduced personal accomplishment--characterized by unfavorable responses

toward oneself and one's personal achievements, with depression, withdrawal,

low morale, lowered production, and a decrease in effective coping.

The most common definitions today imply that burnout can be described

as a response to interpersonal stressors on the job in which an overload of

contact with people results in changes in attitudes and behaviors towards them

(Leiter & Maslach, 1988). Service providers begin to view recipients

impersonally and their own performance disparagingly. Thus, burnout can be

considered a type of job stress. The most widely used definition of burnout

comes from Maslach and Jackson (1986): "Burnout is a syndrome of emotional

exhaustion, depersonalization, and reduced personal accomplishment that can

occur among individuals who do 'people work' of some kind" (p. 1). This

definition captures a dimension of interpersonal processes that may result with

recipients but may also include coworkers, supervision, and interaction with the

organization itself. Burnout from this perspective has a specific etiology that may

be linked to a professional domain.

Effects of Burnout
Our nation's concern about the detrimental effects of prolonged job stress,

otherwise termed burnout, continue to grow (Hatfield, 1990; Matteson &

Ivancevich, 1987) and is unlikely to subside, as evident in recent publications

(Latack & Havionic, 1992). Estimates indicate that job stress resulting in burnout

is costing the American industry $50 billion to $100 billion annually in terms of









lost work time, accidents, medical services, and costs of physical health problems

related to psychological disorders (Sauter, Murphy, & Hurrell, 1990). According

to a study by the National Council on Compensation Insurance, claims for

gradual mental stress alone accounted for 11% of all claims in 1990.

Hatfield (1990) in projections for the 1990s claimed that 9 out of every 10

jobs in this decade will be in the service sector, a sector already shown to be at

risk for psychological disorders. Six of these 10 jobs will be occupied by women

whose multiple role demands put them in a high risk category. The fastest

growing occupations in the United States will be in the health service

professions.

In a review of empirical literature, Kahill (1988) concluded that the impact

of burnout on the individual, organization, and society include physical,

emotional, interpersonal, behavioral, and attitudinal costs. Her review indicated

that burnout has been linked to poor physical health including symptoms of

fatigue and physical depletion or exhaustion, sleep difficulties, back pain, and

specific somatic problems such as headaches, gastro-intestinal disturbances, colds,

and the flu.

Also, increased use of alcohol and drugs have been correlated with those

experiences. Along with emotional complaints by individuals including

emotional depletion, irritability, anxiety, guilt, depression, and feelings of

helplessness. Among all these symptoms, burnout has been most often related to

depression (Kahill, 1988).

Interpersonal symptoms involving clients, friends, family members, and the

interactions between individuals in the workplace have been documented









(Maslach, 1986; Maslach & Jackson, 1981; Pines & Maslach, 1978). Specifically,

in the workplace, burnout has been linked to inhumane practices with clients

such as telephone crisis counselors ignoring the phone, hanging up on clients,

and refusing to conference with families of runaways (Jones, 1981).

In addition, burnout's effect on the helping process has been documented.

In one of the earliest studies of burnout (Schwartz & Will, 1961), changes were

observed and recorded in staff and patient behavior in a mental hospital ward.

When organizational changes occurred in the setting, staff burnout increased.

Researchers found that as staff burnout levels increased, patients were neglected,

began to regress, and became more anxious, depressed, suicidal, and violent. The

researchers, through consultation with the nursing staff, attempted to help reduce

staff burnout and patient care improved and symptomatic behavior decreased.

Staying with the focus on the helping relationship and interactions with

others in the work environment, Traux (1966) suggested that effectiveness in

psychotherapy counseling is strongly influenced by the degree to which the

helper expresses authenticity, positive regard, and empathy toward the client. In

addition, it has been suggested that specific knowledge and skill in clinical

assessment and technique also are important in determining effectiveness (Heller

& Monahan, 1977).

The most effective helpers then would combine knowledge and skills with

warmth and empathy toward the client. However, when helpers burn out,

warmth, empathy, and positive regard toward the client decline. Thus, Truax's

work would suggest that burned-out helpers will be less effective (Cherniss,

1992).









On a behavioral level, burnout can affect the performance of human

service agencies. Burnout has been linked to turnover (Jackson & Maslach,

1982a; Jackson, Schwab, & Schuler, 1986; Maslach & Jackson, 1984b), poor job

performance (Jackson, Schwab, & Schuler, 1986), absenteeism (Maslach &

Jackson, 1981), family problems (Maslach & Jackson, 1982), poor health (Burke,

Shearer, & Deszca, 1984), all of which imply substantial costs to an organization

and to clients. Low staff morale may eventually lead to decreased job

performance, absenteeism, and turnover that can disrupt program continuity and

affect clients due to frequency changes in their primary caregivers (Cherniss,

1992). Finally, burnout can affect attitudes developed by human service

providers.

Kahill (1988) reported that individuals with high burnout levels may

demonstrate cynicism, callousness, pessimism, defensiveness, intolerance of clients,

dehumanization of clients by the use of jargon and intellectualization and

stereotyping the way they are thought about, as well as a loss of enjoyment at

work as well as going to work.

Statistically significant relationships have been reported between burnout

and a variety of negative attitudes towards clients, work, oneself, and life in

general. Pines and Kafry (1978) reported that burnout was associated with the

development of negative attitudes toward clients among social service workers,

as did Maslach and Jackson (1981) for mental health workers as assessed by

coworkers.

Other attitudinal symptoms include feelings of lack of personal

effectiveness or accomplishment at work (Miller & Potter, 1982). In their study









they concluded that 25% of highly burned-out subjects (speech language

pathologists) reported feeling ineffective on the job compared to 0% of mildly or

non-burned-out subjects reporting feeling ineffective. In addition, Maslach and

Jackson (1982) reported that burnout was related to health professionals' feelings

of success with patients.

In summary, the seriousness of burnout as a problem lies in its costs to the

individual, the organization, and society itself.

Burnout in Human Service Professionals

In industrial societies today professional organizations are performing

many of the functions traditionally fulfilled by the extended family or community,

particularly in the area of personal and interpersonal problems (Pines & Aronson,

1988). This has resulted in millions of human service professionals providing

medical, educational, social, and psychological services.

These professionals share three basic commonalities:

(1) They perform emotionally taxing work; (2) they share certain
personality characteristics that made them choose human service as
a career; and (3) they share a client-centered orientation. These
three characteristics are the classic antecedents of burnout. (Pines
& Aronson, 1988, pp. 83-84)

In the human service professions, "people work with others in emotionally

demanding situations over long period of time, are exposed to their clients'

psychological, social, and physical problems, and are expected to be both skilled

and personally concerned" (Pines & Aronson, 1988, p. 84). Thus, skills alone are

not responsible for burnout.









Burnout has been most often associated with idealistic and enthusiastic

human service professionals who work with people in some capacity. Pines,

Aronson, and Kafry (1981) stated,

We have found, over and over again, that in order to burn out a
person needs to have been on fire at one time. It follows, then, that
one of the great costs of burnout is the diminution of the effective
service of the very best people in a given profession. Accordingly,
everyone is the poorer for the existence of this phenomenon. (p. 4)

Professionals who burn out thus lack emotional resources to provide

effective services and refuse to acknowledge failure. These are people,

Freudenberger (1980) posited, who have "pushed themselves too hard for too

long, who have started out with great expectations and refused to compromise

along the way" (p. 12) whose "inner resources have been consumed as if by fire,

leaving a great emptiness inside" (p. xv). These individuals risk their physical

health and neglect their personal lives to maximize the probability of professional

success, to make a difference. For this individual, the acknowledgment of failure

is nearly impossible as it reflects on their personal worth and competence as

human beings. Their job (professional role) is an extension of their selves, their

egos, and must be successfully performed.

Thus, persons in occupations providing services to others are especially

susceptible to burnout (Maslach & Jackson, 1981), as the nature of their

professional role is taxing. Counseling has been identified as one of these

person-oriented occupations (Farber, 1983b).

In counselors, burnout may mean caring less and feeling more easily

frustrated by clients' resistances or lack of progress, losing confidence in one's

skills and ability to make a difference, or feeling disillusioned about the field of









psychotherapy. The counselor may become less involved in, or cynical about,

his/her professional development and may even regret the decision to enter the

field. Often, the helping professional facing burnout even fantasizes about

leaving the profession he/she once envisioned as fulfilling (Farber, 1990).

Farber and Heifetz (1982), in in-depth interviews with 60 therapists, cited

lack of therapeutic success as the most stressful aspect of therapeutic work.

High burnout levels were most often attributed to nonreciprocated attentiveness,

giving, and responsibility demanded by the therapeutic relationship. Additional

factors accounting for high burnout levels included overwork; difficulty in

dealing with patient problems; discouragement as a function of the slow,

repetitious, and erratic pace of therapeutic work; and the tendency of therapeutic

work to raise personal issues in therapists themselves, the possibility of

therapeutic work, and the isolation often demanded by the work.

Therapists expect their work to be difficult and even stressful, but they

also expect their efforts as pay off. Giving without experiencing success can lead

to burnout as the therapists' experience their effort as inconsequential. Farber

stated, "For most therapists, the greater satisfaction lies in helping people change"

(p. 298). Furthermore, this study suggested that mental health workers who

became burned out had, as a common character, perceptions that their efforts

were inconsequential.

Factors Associated with Burnout

Personal Factors

Personal and environmental factors have been associated with the

development of burnout. Personal factors identified have included individual









expectations, personal values, and personality characteristics (Pines & Aronson,

1988).

An individual's expectations about the job and personal achievement have

been associated with burnout. When such expectations are unrealistic or unmet,

high levels of burnout are more likely to occur (Cherniss, 1980b; Edelwich &

Brosky, 1980; Freudenberger & Richelson, 1980). In addition, personal values

such as loss of commitment and purpose in work have also been suggested as

contributing factors leading to burnout (Cherniss & Krantz, 1983).

Cherniss (1980) posited that a major source of burnout is the professional's

inability to develop a sense of competence and self-efficacy. Pines in Schaufeli,

Maslach, and Marek (1993) suggested that competence is important because it

provides the professional with a sense of existential significance. In other words,

if my work makes a difference, I make a difference.

Meaning in one's life can be derived from the belief that one's work makes

a significant contribution to the organization (or practice) in which one works, to

people in need, to society at large, and to the future of the world. Pines and

Aronson (1988) reported that lack of significance was found to be a major

determinant of hopelessness, depression, and burnout in two studies conducted,

one in a sample of 267 police officers and a second in a sample of 101 managers,

both reporting a correlation between significance and burnout being r = 0.27 (1p <

.05). The more sense of significance individuals got from their work, the less

likely they were to burn out (Pines & Aronson, 1988).

Similar findings were reported by Farber (1983a) in a study of 60

psychotherapists. He reported that most therapists (73.7%) cited lack of







34

concrete indicators of therapeutic success as the single most stressful aspect of

their work. Also 25% of the therapists in this sample admitted to feelings of

disillusionment with the field. He reported that among highly committed

professionals, the absence of tangible evidence of success contributes to feelings

of insignificance, disillusionment, and helplessness, all of which are hallmarks of

burnout.

Finally, burnout appears to be greater for people with certain personality

characteristics including low self-confidence, lack of assertiveness, inability to set

limits, a strong need for approval of others, and greater impatience and hostility.

Environmental Factors

Research evidence suggests that environmental factors, particularly

demands and supports in the workplace, are more strongly related than such

factors as demographic and personality variables (Burke, Shearer, & Deszca,

1984; Gerstein, Topp, & Correll, 1987; Golembrewski & Munzenrider, 1988;

Leiter, 1988b, 1990a, 1990b; Leiter & Maslach, 1988; Maslach & Jackson, 1984a;

Pines & Aronson, 1988). Work environments can significantly affect levels of

burnout by helping them or preventing them from reaching their goals (Pines &

Aronson, 1988). Demands of the workplace (i.e., workload, client, coworker-

supervisor, or organizational demands) can be stressful not only because they

prevent professionals from using their skills to achieve their intended goal

(Cherniss, 1980b), but also these demands can give workers a feeling that what

they do is insignificant (Pines & Aronson, 1988).









Environmental factors that have been identified as a major source of

burnout include those involving interactions with others in the work

environment.

Work load. The human service professional's work load, in terms of client

contact, is one of the most highly researched correlates of burnout. Lewiston,

Conley, and Blessing-Moore (1981, as cited in Maslach & Florian, 1988), Maslach

and Jackson (1982, 1984a), and Savicki and Cooley (1983) found that as the

amount of client contact increases, either in terms of a higher case load or a

greater percentage of time spent in direct contact with clients, burnout is more

likely to occur.

More recently, results of research efforts have been somewhat mixed.

Friesen and Sarros (1989) and Rogers and Dodson (1987) reported positive

correlations between work load and two subscales of emotional exhaustion and

depersonalization and a nonsignificant (p > .05) relationship for personal

accomplishment. Ross, Altmaier, and Russell (1989) observed only one

significant relationship that was positive, but it was between work load and

depersonalization.

Acklerley et al. (1988) also reported only one significant relationship, also

positive; however, it was between work load and sense of personal

accomplishment. Finally, Koeske and Koeske (1989) indicated they found no

significant relationships between work load and measures of burnout. In

conclusion, when a significant relationship is found, it indicates that the greater

the work load, the greater the risk for experiencing higher burnout levels.









Client. Cherniss (1993) posited that resistant clients and ones who do not

improve may cause stress to human service professionals because they may

prevent professionals from feeling competent and successful, therefore,

preventing professionals from achieving a sense of significance in their work. In

early studies Pines and Maslach (1978) reported that the higher the percentage of

schizophrenics in a human service professionals' patient population, the less

satisfaction they expressed toward their job. Also staff in settings with more

schizophrenics reported liking their work less, were less likely to view their job

situation as an ideal one, and the less consciously aware they were of everyday

goals. Subjects reported spending more time in administrative duties and

recommending pharmacological rather than psychological intervention for such

problems as suicide attempts.

Other researchers have found that working with mentally retarded persons

(Sarata, 1972), psychiatric clients (Cherniss & Egnatios, 1978), cystic-fibrosis

patients (Lewiston, Conley, & Blessing-Moore, 1981, as cited in Maslach &

Florian, 1988), and deaf children (Meadow, 1981) involves frustrations about how

time is spent, dissatisfaction with treatment outcomes and feelings of guilt about

professional failure.

Maslach (1978) and Maslach and Jackson (1982) observed that it is the

chronics that cause the most emotional stress for the human service professionals.

Many times professionals feel less equipped to handle repeatedly the more

mundane problems of clients who need mental health treatment and seem to show

small, if any, signs of improvement.









More recent research strongly suggests that as exposure to negative client

behavior increases, the professional care giver is at increased risk of higher levels

of burnout. Ackerley et al. (1988) and Koeske and Koeske (1989) reported

similar significant findings regarding relationships between burnout measures and

negative client behavior. High levels of reported emotional exhaustion and

depersonalization and low levels of sense of personal accomplishment are
reported to correlate significantly with higher levels of negative client behavior.

Supervisors and coworkers. Penn, Romano, and Foat (1988) found that

subjects with supportive supervisors and/or positive supervision contacts

experienced lower levels of emotional exhaustion and depersonalization and

higher levels of sense of personal accomplishment. Similar findings were

observed by Davis, Savicki, Cooley, and Firth (1989) and Leiter and Maslach

(1988) in studies of the relationship between negative supervisory experiences

and burnout. Both reported emotional exhaustion and depersonalization

increased with negative supervisory experiences.

In a study involving 76 mental health workers Pines and Maslach (1978)

found that when work relationships were good, staff members were more likely to

express positive attitudes toward the institution as a whole (r = .49), to enjoy

their work (r = .38), and to feel successful in it (r = .31). They also rated the

institution more highly (r = .4 1), described their reasons for being in the mental

health field as self-fulfilling (r = .41), and described chronic patients in more

positive terms.

Leiter (1988b) contended that relationships with coworkers may be a

source of support, helping to alleviate the demands of client interaction or a









source of strain in themselves. The results of his study resulted in a model that

depicts counselors' interactions as both aggravating and alleviating burnout.

Results indicated that a large number of contacts with coworkers on work-

oriented matters were related to higher feelings of accomplishment but may

contribute to higher emotional exhaustion as well. Informal contact with

coworkers was related to higher levels of personal accomplishment as well as to

increased job satisfaction.

Demographic Variables

In addition, the most often studied demographic variables have included

age, marital status, gender, and years of experience.

Age. A significant negative relationship between age and burnout has

been documented in two studies (Ackerley et al., 1988; Huberty & Huebner,

1988). Ackerley et al. (1988) concluded that "perhaps the therapists learn over

time to conserve their emotional energy so as not to feel 'used up' or to be drained

by the psychotherapeutic process" (p. 629). Likewise, Huberty and Heubner

(1981) hypothesized that as human service providers become older, they may

develop a variety of behavioral and attitudinal experience patterns that minimize

the chances of experiencing burnout. These findings are in agreement with

Maslach's (1982a) position in which she concluded from her research interviews

that "as people increase in age, they are more stable and mature, have more

balanced perspectives on life, and are less prone to the excesses of burnout" (p.

60).
Marital status. Maslach and Jackson (1982) found that either being

married or in a personal relationship correlated significantly (p < .05) with









emotional exhaustion but not to depersonalization or sense of personal
accomplishment. The study concluded that people who were single or divorced

scored higher on emotional exhaustion than those who were married or in a

relationship. Later, studies by Maslach and Jackson (1984a) and Ackerley et al.

(1988) failed to replicate these earlier findings. Ross, Altmaier, and Russell (1989)

found that the counseling center staff members who were married reported higher

levels of emotional exhaustion than those who were not married.

Gender. Maslach and Jackson (1981) found that females scored higher on

measures of emotional exhaustion while males scored higher on measures of

depersonalization and sense of personal accomplishment. In a later study

(Maslach & Jackson, 1985), however, they found the same gender difference in

emotional exhaustion but found that gender differences were not significant on

the depersonalization and personal accomplishment scales. In a recent study

using multiple regression analysis to control for certain demographic variables,

Ackerley et al. (1988) reported that a significant (p < .05) relationship between

gender and any of the three MBI subscale scores had not been observed.

Years of experience. In an early interview study, Pines and Maslach

(1978) reported that in investigating the characteristics of staff burnout in mental

health professionals,

we found that the longer the staff had worked in the mental health
field, the less they liked working with patients, the more they
avoided direct contact with them, the less successful they felt in
their work, and the more custodial rather than humanistic were their
attitudes toward mental illness. They stopped looking for self-
fulfillment in their work, good days became infrequent, and the
thing that made work worthwhile was the money and security
provided. (p. 14)









Ackerley et al. (1988), Farber (1985), and Ross, Altmaier, and Russell

(1989) reported a significant (p < .05) negative relationship between years of

experience in an individual's profession and the level of emotional exhaustion

reported. Also reported in the studies by Ackerley et al (1988) and Farber (1985)

were significant (p < .05) negative relationships between years of experience and

the depersonalization MBI subscale. No significant relationship was found

between sense of personal accomplishment and years of experience.

Self-Efficacy Theory
Self-efficacy theory is based on the assumption that psychological

procedures serve as a means of creating and strengthening expectations of

personal efficacy. Within this analysis, a distinction between outcome

expectancy and efficacy expectations is necessary. Bandura (1977) posited that

outcome expectancies, the extent to which performance of one's work role would

lead to a desired result, and efficacy expectations, the extent to which an

individual (counselor) feels capable of adequately implementing a response,

determine an individual's behavior in a demanding situation. Outcome

expectancies have to do with the action-outcome link; if a counselor provides a

certain type of therapy to a client, the client is likely to improve. Efficacy

expectations have to do with a person-action link; does the counselor feel

capable of performing his/her professional role?

Bandura (1986) stated that individuals possess beliefs that enable them to

exercise a measure of control over their thoughts, feelings, and actions, that "what

people think, believe, and feel affects how they behave" (p. 25). These beliefs

make up a self system in which people's conceptions about themselves and the









nature of things are developed through four different processes: direct

experience produced by their actions, vicarious experience of the effects

produced by someone else's actions, judgments voiced by others, and derivation

of further knowledge from what they already know by using rules of inference

(p. 27). Bandura further posited that external influences play a role not only in

the development of cognitions but in their activation as well. In other words,

different stimuli will elicit different responses. Therefore, while it is true that one's

conceptions may determine behavior, these conceptions are partly fashioned from

direct or socially mediated transactions with the environment. Thus, a persons's

behavior results in the interplay between this person's system and environmental

influences. Bandura created a picture of human behavior and motivation in

which people's beliefs about themselves are a main factor.

Bandura (1986) argued that self-referent thought mediates between

knowledge and action and allows individuals to evaluate their own experience.

Of all self-beliefs, self-efficacy,

people's judgments of their capabilities to organize and execute
courses of action required to attain designated types of performance
strongly impacts the choices people make, the effort they expend,
how long they persevere in the face of challenge, and the degree of
anxiety or confidence they experience. (Bandura, 1986, p. 392)

Bandura (1986) asserted that dealing with one's environment is not simply

a matter of knowing what to do, nor is it a fixed act that one possesses in one's

behavioral repertoire. Rather, it involves a capability in which cognitive, social,

and behavioral subskills must be organized into courses of action to serve many

purposes.









Competent functioning requires both skills and self-beliefs of efficacy to

use them effectively. Success is attained by perseverant efforts in testing

alternative forms of behavior and strategies. Differences exist between

possessing subskills and being able to use them under diverse circumstances.

Hence, different people with similar skills may perform poorly, adequately, or

exceptionally. Thus, perceived self-efficacy is a significant determinant of

performance that operates partially independent of underlying skills (Bard, 1986,

p. 391). Operative efficacy calls for continuously improvising multiple skills to

manage ever-changing circumstances, mostly which contain ambiguous,

unpredictable, and stressful elements (Bandura, 1986). Initiation and regulation

of transactions with the environment are partly governed by judgments of

operative capabilities--what people think they can do under given circumstances.

Perceived self-efficacy is defined as people's judgments of their capabilities to

organize and execute courses of action required to attain designated types of

performances (work roles). It is concerned not with the skills one has but with

judgments of what one can do with whatever skills one possesses. People's

beliefs about their operative capabilities help to determine their behavior, thought

patterns, and emotional reactions in taxing situations. Thus, self-beliefs contribute

to the quality of a person's psychosocial functioning.

People's decisions involving choice of activities are partly determined by

judgments of personal efficacy. Thus, people tend to avoid tasks and situations

they believe exceed their capabilities but undertake and perform assuredly

activities they judge themselves capable of handling (Bandura, 1977). Factors

that influence behavior choice affect the individual's personal developments.









Positive self-precepts of efficacy, therefore, enhance personal growth and

competencies while perceived self-ineffacacies direct people to reject enriching

environments.

Accurate appraisal of one's capabilities is, therefore, valuable in a person's

overall functioning, and inaccurate appraisal can lead to one experiencing

psychological failure.

Judgments of efficacy also determine how much effort people will expend

and how long they will persist in the face of obstacles. The stronger their

perceived self-efficacy, the more vigorous and persistent are their efforts to master

the challenge (Bandura & Cervone, 1983, 1986). Strong perseverance leads to

high performance attainments.

Those who judge themselves inefficacious in coping with environmental

demands dwell upon their personal deficiencies and cognize potential difficulties

as more formidable than they really are (Beck, 1976; Lazarus & Launier, 1978;

Meichenbaum, 1977; Sarason, 1975). Such misgivings create stress and

undermine effective use of competencies people possess by diverting attention

from their best to proceed to concern over personal failings and possible mishaps.

By contrast, persons who have a strong sense of efficacy deploy their attention

and effort to the demands of the situation and are spurred by obstacles to greater

effort, therefore, experiencing less stress.

Professional Self-Efficacy

Chemiss (1993) posited that self-efficacy is not a global personality trait, as

an individual can feel efficacious in one role or situation and not in another. He

defines professional self-efficacy as a professional's belief in his/her abilities to









perform in professional work roles (Chemiss, 1993, p. 141). He suggested helping

professionals spend a large percentage of time interacting with their recipients.

These interactions along with interactions with others in the work environment

(i.e., coworkers, supervisors, and the organization itself) may be an important

source of stress and burnout.

Gibson and Dembo (1984) provided an example of how professional self-

efficacy can be operationalized in their design of a 30-item Teacher Efficacy Scale

which included the task area. This area is concerned with the technical aspects of

the professional role. In the case of teachers, it relates to how competent they feel

in preparing and delivering lessons, correcting student performance, and

motivating student effort.

For purposes of this study the task component included the marriage and

family therapists' perceived ability to perform technical aspects of the professional

role (i.e., assessment, diagnosis, and treatment) based on the Dictionary of

Occupational Titles (1991).

The second area of professional self-efficacy suggested by Cherniss (1993)

relates to the professional's ability to work with others. For the purpose of this

study the interpersonal component included the marriage and family therapist's

perceived ability to interact successfully with others in his/her environment (i.e.,

clients, coworkers, and supervisors)
Finally, the third component of professional self-efficacy proposed by

Cherniss (1993) refers to the beliefs about one's abilities to influence social and

political forces within the organization. This component includes the counselor's









perceived ability to influence social and political forces within the work

environment and in professional organizations.

In conclusion, these three components comprised a total professional self-

efficacy measurement used in this study.

Self-Efficacy and Burnout

Cherniss (1993) proposed a link between self-efficacy and burnout by

referring to Hall's (1976) work on psychological success. Originating in the

earlier work of Lewin (1936), Hall proposed that work motivation and satisfaction

were enhanced when an individual achieved challenging and personally

meaningful goals successfully and independently. He claimed that such

achievement led to psychological success, more work involvement, the setting of

more challenging goals, and the feeling of a higher self-esteem. Hall emphasized

that what was most important was a person's feeling of success.

Hall (1976) contended that if a person was unable to experience

psychologically success, the person would "withdraw psychologically from those

arenas in which he or she was experiencing failure" (p. 136). More specifically,

he proposed that psychological failure would lead to a person's

1. Withdrawing emotionally from the work situation by
lowering one's work standards and becoming apathetic and
disinterested.

2. Placing increased value on material rewards and depreciating
the value of human or intrinsic rewards.
3. Defending the self-concept through the use of defense
mechanisms.

4. Fighting the organization.

5. Leaving the organization. (p. 191)









Hall described symptoms of what later has become known as burnout.

This reinforced Cherniss's sense that there may be a link between burnout and an

inability to achieve a sense of competence or success in one's work.

In his research on new professionals in the mid 1970s, Cherniss (1993)

concluded that achieving a sense of competence in one's work was an important

concern and appeared to be behind many sources of stress. For example, when

new professionals complained about clients who were resistant and did not

improve, the professionals appeared to be distressed mainly because the client's

behaviors prevented the professional from feeling competent and successful.

Likewise, when the same professional subjects complained about

excessive workloads, lack of support, and organizational constraints, the issue

again appeared to be that they could not feel successful and competent, not due

to a lack of skills or abilities, but because systemic factors prevented them from

using those skills in a way that would achieve intended outcomes (Cherniss,

1993). In 10 years these same groups of professionals were studied and

achieving a sense of competence was found still to be of great importance in

determining how professionals felt about their work (Cherniss, 1989, 1992).

In summary, Cherniss (1993) posited that factors in the individual or work

situation that enhance feelings of success and competence will reduce burnout,

while factors that promote feelings of inadequacy and failure will increase

burnout.

Theorists espousing the transactional approach to stress (Cox, 1978;

Lazarus & Folkman, 1984) posited that limitations in either outcome or efficacy

expectations can contribute to experienced stress. Although chronic demands of









the environment May contribute to stress, it is a person's belief in their ability to

cope with these demands (in this case work role), then, that influences the

cognitive appraisal process resulting in varied levels of stress.

Lazarus and Folkman (1984) defined psychological stress as "a

relationship between person and environment that is appraised by the person as

taxing or exceeding his or her resources and endangering his or her well being"

(p. 19). In the appraisal process, a person's beliefs determine his or her

understanding of the environment, thus shaping its meaning. When a belief is

lost, hope may be replaced by hopelessness, thus causing a shift in a person's way

of relating to others or to the environment (Lazarus & Folkman, 1984).

In stress theory, two categories of beliefs are relevant to the appraisal

process: beliefs that have to do with the personal control an individual believes

he or she has over events and beliefs that have to do with existential concerns

such as God, fate, and justice.

Beliefs about personal control imply feelings of mastery and confidence

and can be discussed both as generalized ways of thinking and as situation-

specific expectations. In speaking of self-efficacy, a belief of mastery and

confidence in a specific context is being measured referring to a coping-relevant

appraisal (Bandura, 1977). In this study, subjects assessed their belief in their

ability to perform their professional role which encompassed mastery and
confidence in their professional work role responsiveness. These included

knowledge and skills specific to marriage and family therapists, ability to interact

effectively with others, and ability to influence their work environment.







48

As such counselor professional self-efficacy refers to a specific domain of

the counselor's professional role. Situational appraisal of control refers to the

extent to which a person believes that he or she can shape, impact, or influence a

particular stressful person-environment relationship (Lazarus & Folkman, 1984).

They are the result of an individual's evaluations of the demands of the situation

as well as one's coping resources and ability to use needed coping strategies in

the particular situation.

Situational appraisal control parallels Bandura's concept of self-efficacy.

As noted earlier, Bandura (1977) made a distinction between outcome

expectations and efficacy expectations by noting that outcome expectancies are

the extent to which a response would lead to a desired result and efficacy

expectations, the extent to which an individual (counselor) feels capable of

adequately implementing a response, determine an individual's behavior in a

demanding situation. Thus, outcome has to do with the action-outcome link--if a

counselor provides a certain type of therapy to a client, the client is likely to

improve. Efficacy expectations have to do with a person-action link--does the

counselor feel capable of performing his or her professional role? Efficacy

expectancies can differ in magnitude, generality, and strength. Magnitude refers

to the level of difficulty of a specific task. Generality refers to the extent to which

an experience creates general expectations, and strength refers to the extent to

which an expectation is extinguishable by disconfirming experience (Lazarus &

Folkman, 1984).

Bandura (1977) further posited that efficacy expectations affect the extent

to which a person feels threatened and, in the presence of incentives, influences a









person's coping behavior. Efficacy expectancies and incentives (stakes) enter

into the person's complete evaluation of a situation. It is, therefore, the evaluated

relationship between the two factors, and not independent efficacy and incentive

factors, that determines emotion and coping.

Researchers have suggested that links between self-efficacy and stress

exist. Bandura (1989b) contended that people with stronger perceived self-

efficacy experience less stress in threatening or taxing situations, and situations

are less stressful when people believe they can cope successfully with them.

People who believe they can manage potential stressors do not, therefore, conjure

up apprehensive cognitions. Those who believe that they cannot exercise

control over stressors experience high levels of subjective distress, autonomic

rousal (Bandura, Reese, & Adams, 1982), plasma catecholamine secretion

(Bandura, Taylor, Williams, Meffor, & Barchas, 1985), and activation of

endogenous opoid systems (Bandura, Cioffi, Taylor, & Brouillar, 1988). These

studies suggested that after perceived coping efficacy is strengthened, coping

with previously intimidating tasks no longer elicits stress reactions.

Perceived self-inefficacy to fulfill desired goals that affect evaluation of

self-worth and to secure things that bring satisfaction to one's life also create

depression (Bandura, 1988a). Through rumination of thoughts, people depress

and distress themselves, impairing their level of functioning (Bandura, 1988, 1988;

Lazarus & Folkman, 1984).

Most recently, Jex and Gudanowski (1992) investigated the role of self-

efficacy in the stress process examining relations between stressors, strains, and

efficacy beliefs. Individual efficacy was found to be related to two of the four









strains investigated. Further research to continue to explore the role of self-

beliefs in the stress process was recommended.

Marriage and Family Therapists

Researchers have amply demonstrated that significant levels of burnout

exist in the human services professions (Golenbiewski & Munzenrider, 1988;

Maslach & Jackson, 1984b) and are especially prevalent among mental health

professionals (Edelwich & Brodsky, 1980; Freudenberger, 1974; Maslach, 1978);

however, the presence of burnout in marriage and family therapists has not been

empirically investigated.

Golenbiewski (1989) noted that burnout research is lacking from national

surveys on subjects in specific occupational groups. Marriage and family

therapists comprise one of these specific occupational groups. Recent literature

suggests that high stress levels are present in marriage and family therapists

(Figley, 1993; Passoth, 1995; Wegmann, 1994) as the role of the professional is

expanding and taking on new dimensions requiring more demands on the

practitioner.

These demands have included changes in insurance reimbursements and

public funding, technological innovations (i.e., E-mail, computers, fax), use of

collaborative and consulting skills, and communicating in a problem-focused

medical model (using the DSM-IV) and a solution-focused systemic model

simultaneously. Wegmann (1994) posited that the demands of the expanding

role of the clinician is leading to feelings of helplessness, increased anger towards

clients, and threatening the marriage and family therapists' sense of professional

identity.









In addition, marriage and family therapists provide direct and indirect

services to a wide array of individuals, couples, and families. The complex

therapeutic demands of working with families have increased even more with

current changes in family lifestyle and with growing numbers of single and

blended families (Friedman, 1985). Trends that may increase the risk of burnout in

the mental health field include the expanding growth of the managed care

industry, the trend for increasing numbers of individuals with difficult-to-treat

character disorders seeking treatment in agency settings, and the tendency for

mental health to become more of a business in the private sector (Farber, 1990).

As such, ethical dilemmas inherent in the counseling profession continue to

become more complex and have been documented as contributing to the stress of

counselors as a profession (May & Sowa, 1992).

Finally, family therapy in particular invokes a sense of struggle to negotiate

family relationships (Ferber, Mendelsohn, & Napier 1972). For the family

therapists, the stresses of working with families daily leaves little emotional

energy for one's own. This stress can lead to a feeling of emotional depletion

often accompanied by anxiety, depression, irritability, and psychosomatic

complaints (Jayaratne, Chess, & Kunkel, 1986).

In summary, as the role of the practitioner is being redefined in response to

changes in mental health care delivery, the marriage and family therapist may be

faced with uncertainty about the future of the profession. This uncertainty could

affect the practitioners' sense of competence and lead to burnout. It is, thus,

important to better understand factors contributing to burnout and ways to

prevent burnout in marriage and family therapists.













CHAPTER II
METHODOLOGY

Overview

The purpose of this study was to ascertain, through the use of the

Counselor Professional Self-Efficacy Scale (CPSES) and the Maslach Burnout

Inventory (Maslach & Jackson, 1986), if professional self-efficacy had any

predictive properties for burnout among marriage and family therapists. In

addition, age, gender, race, years of experience, and environmental demands

including the difficulty of the client(s) and the number of hours in direct client

contact were analyzed to determine if there was a significant direct effect on

burnout or an indirect effect on burnout through professional self-efficacy.

Specifically, levels of marriage and family therapists' professional self-efficacy

beliefs theorized to be associated with burnout were examined through the use of

the Counselor Professional Self-Efficacy Scale, a self-report instrument designed

and tested by the researcher.

Levels of burnout were examined using the Maslach Burnout Inventory

(Maslach & Jackson, 1986). The Maslach Burnout Inventory consists of 22

questions measured on a 7-point scale intended to measure three components of

burnout: emotional exhaustion, depersonalization, and reduced sense of personal

accomplishment.









This chapter contains a description of the methodology used in the

collection and analysis of the data. Included are a description of relevant

variables, research hypotheses, population, sampling procedures, instrumentation,

data collection procedures, and the proposed data analysis procedures. This

chapter concludes with a discussion of the methodological and instrumentation

limitations of this study.

Relevant Variables

The dependent variable in this study was the level of burnout in marriage

and family therapists as defined by Maslach and Jackson (1986) and as measured

by the Maslach Burnout Inventory (MBI). The MBI yields measures of three

components of the burnout syndrome: emotional exhaustion, depersonalization,

and reduced personal accomplishment.

The independent variables in this study were the degree of counselor

professional self-efficacy as measured by the Counselor Professional Self-Efficacy

Scale (CPSES), a self-report instrument designed and validated by the researcher

to measure counselor professional self-efficacy in three domains of the counselor's

professional work role: task, interpersonal, and organizational. Other variables

included the number of years of experience, age, gender, race, and the number of

hours of direct client contact, and the difficulty of the client(s).

Research Hypotheses
For the purpose of this study, the following hypotheses were examined:

Ho1 The degree of professional self-efficacy does not predict levels of burnout


in marriage and family therapists.







54

Ho2 Experience level does not predict levels of burnout in marriage and family

therapists.
Ho3 The number of clinical contact hours does not predict levels of burnout in

marriage and family therapists.

Ho4 The difficulty of the client(s) does not predict levels of burnout in marriage

and family therapists.
Ho5 Age, gender, and race do not predict levels of burnout in marriage and

family therapists.
Ho6 Experience level does not predict the level of professional self-efficacy.

Ho7 The number of clinical contact hours does not predict the level of

professional self-efficacy in marriage and family therapists.

Ho8 The difficulty of the client(s) does not predict the level of professional self-

efficacy.
Ho9 Age, gender, and race do not predict the level of professional self-efficacy

in marriage and family therapists.

Population
The population for this study was comprised of active clinical members of

the American Association for Marriage and Family Therapy (AAMFT). According

to the AAMFT membership office, as of July 25, 1995, AAMFT reported 22,605

total members comprising four membership levels (clinical, associate, affiliate, and

student). Of this total number 16,561 are reported to be clinical members. For

purposes of this investigation clinical membership status was a prerequisite for

inclusion in the sample.









Sample

An initial, presampling decision was made that the resultant sample would

consist of a minimum of 250 active clinical members of the American Association

for Marriage and Family Therapy (AAMFT). The initial sample consisted of 500

marriage and family therapists who were clinical members of the AAMFT.

Selection was based on a computer-generated random selection of therapists

purchased by the researcher from the AAMFT.

Sampling Procedure

Following the selection of the survey sample, each of the 500 potential

respondents were mailed a survey packet containing the following: a letter

describing the nature of the study and thanking the participant in advance for

their participation in the study; a demographic questionnaire, the Maslach

Burnout Inventory (MBI); the Counselor Professional Self-Efficacy Scale

(CPSES); a one dollar bill; and a postage-paid self-addressed return envelope.

Respondents were asked to return completed questionnaires to the researcher in

the postage-paid self-addressed return envelope provided. Ten days after the

mailing, a reminder letter emphasizing the importance of the study was sent to all

respondents who had not replied. Ten days later, the remaining nonrespondents

were sent a letter, again emphasizing the importance of a high rate of return and a

second packet to complete. Confidentiality was ensured by the use of a coding

system in which no names appeared on the questionnaire data.

Participation was to be voluntary. Prior to the initial mailout, permission

was granted from the University of Florida Human Institutional Review Board.

The initial plan indicated that in the event of an insufficient response rate (<250),







56

telephone follow-up would be initiated to encourage return of the survey packet

or, if misplaced, facilitate the mailing of another packet.

Instrumentation

The data gathering for this study was comprised of three components: (a)

a demographic data sheet, (b) a self-report measure of burnout, and (c) a self-

report measure of counselor professional self-efficacy. The Maslach Burnout

Inventory (MBI) was utilized to measure the level of burnout associated with

professional self-efficacy beliefs. The Counselor Professional Self-Efficacy Scale

(CPSES) assessed the strength of professional self-efficacy beliefs to carry out

professional work roles associated with burnout.

Demographic Data Sheet

The demographic data sheet (Appendix A) solicited from respondents

information including their age, gender, racial or ethnic background, level of

educational training, their total years of experience in the professional,their years

in direct client contact, the number of hours in direct client contact per week, and

the difficulty level of the client(s) seen.

The Maslach Burnout Inventory

The Maslach Burnout Inventory (MBI) (Appendix B) was selected for this

study because it is the most widely recognized assessment tool use by researchers

to assess level of burnout (Maslach & Jackson, 1986). In addition, the MBI was

selected for its self-report quality, low cost appeal, ease of administration (10 to 15

minutes to complete and no training needed to administer), and ease of scoring.

The MBI is available in two versions, the Education Form and the Human

Services Form. The latter was used in this study. To avoid biasing responses, the







57

MBI is labeled the Human Services Survey and the word burnout is consistently

avoided, with the exception of survey item number 8 which is phrased as "I feel

burned out from my work" (Maslach & Jackson, 1986).

The MBI is based on the concept of burnout as a syndrome of emotional

exhaustion, depersonalization, and reduced personal accomplishment that can

occur among individuals who work with people in some capacity (Maslach &

Jackson, 1984a, 1986). "It is a response to the chronic emotional strain of dealing

extensively with other human beings, particularly when they are troubled or

having problems" (Maslach, 1982, p. 3).

The original MBI had two response dimensions: (a) frequency and (b)

intensity. Correlation between frequency and intensity dimensions across

individual items ranged from .35 to .73, with a mean of .56. Because of the

relatively strong relationship between the two dimensions and the awkwardness

of measurement of intensity, the author chose to drop it from the inventory.

The current edition of the MBI is a 22-item self-report questionnaire. Items

are written in the form of statements indicating personal feelings or attitudes

related to the respondent's work that concern three components of the burnout

syndrome: emotional exhaustion, depersonalization, and lack of personal

accomplishment. Each component is measured by a separate subscale.

The emotional exhaustion subscale consists of nine items and is used to

assess feelings of being emotionally overextended, exhausted, and unable to meet

the interpersonal demands of one's work. The depersonalization subscale

consists of five items and is used to measure "an unfeeling, callous, or impersonal

response towards recipients of one's care, treatment, service, or instruction"









(Maslach, 1986). The personal accomplishment subscale consists of eight items

and is used to assess feelings of competence and successful achievement in one's

work with people. Burnout is not considered a dichotomous variable, being

present or absent, but rather as a continuous variable ranging from low to high

degrees of experienced feelings. The frequency with which each of the 22 items

is experienced by the respondent is measured on a 7-point Likert scale that

ranges from never (0) to every day (6).

Item content was developed from a pool of items collected from 8 years of

research. Occupations represented in this research were those where the worker

must deal directly with people about issues that either are or could be

problematic. Human services workers from such diverse occupations as nurses,

teachers, police officers, counselors, social workers, physicians, mental health

workers, psychologists, psychiatrists, and attorneys comprised this sample

(Maslach & Jackson, 1986).

Data collected were subjected to factor analysis using principal factoring

with iteration and an orthogonal (varimax) rotation. Items that were retained met

the following criteria: (a) a factor loading greater than .40 on only one of the

factors, (b) a large range of subject responses, (c) a low percentage of subjects

checking the never response, and (d) a high item total correlation (Maslach,

1986). Factor analysis, thus, resulted in reducing the MBI to its current three-

subscale, 22-item format.

Internal consistency for the MBI was estimated by Cronbach's coefficient

alpha on a sample of 1,316 respondents. The reliability coefficients for each of the

MBI subscales were .90 for emotional exhaustion, .79 for depersonalization, and









.71 for personal accomplishment. The standard error of measurement for these

subscales was 3.80 for emotional exhaustion, 3.16 for depersonalization, and 3.75

for personal accomplishment. Test-retest reliability data are available for two

samples. The first consisted of 53 graduate students in social welfare who

completed the MBI on two occasions separated by an interval of 2 to 4 weeks.

For this sample the test-retest coefficients were .82 for emotional exhaustion, .60

for depersonalization, and .80 for personal accomplishment. All coefficients were

significant beyond the .001 level (Maslach & Jackson, 1986). The second sample

consisted of 248 teachers as subjects. The two test sessions were separated by an

interval of 1 year. Reliability coefficients for each of the subscales were .60 for

emotional exhaustion, .54 for depersonalization, and .75 for personal

accomplishment (Jackson, Schwab, & Schuler, 1986).

The Counselor Professional Self-Efficacy Scale

Bandura (1986) posited that self-efficacy is a context-specific assessment

of competence to perform a specific task. Therefore, instruments should match

the task being evaluated to insure accurate measurement. Bandura (1986) alludes

to the idea that specific task efficacies may be domain-linked (Woodruff &

Cashman, 1993). Bandura (1986) posits that "perceived self-efficacy is defined as

people's judgments of their capabilities to organize and execute courses of action

required to attain designated types of performances" (p. 391). Efficacy judgments

vary on several dimensions; first, they differ on magnitude. Magnitude deals with

the belief about performance in increasingly difficult aspects of the task within a

particular domain of functioning. Perceived self-efficacy also differs in strength.

Strength refers to a person's belief in his/her own competence in maintaining









his/her behavior despite mounting difficulties. Weak self-percepts of efficacy are

easily negated by disconfirming experiences, whereas people who have a strong

belief in their own competence will persevere in their efforts despite obstacles.

In addition, perceived self-efficacy differs in generality. People may judge

themselves efficacious only in certain domains of functioning or across a wide

variety of activities and situations. Although most of the work of Bandura and

his associates has focused on very specific tasks, Bandura has stated, "some kinds

of experiences create only limited mastery expectations, while still others install a

more generalized sense of efficacy that extends beyond the specific treatment

aspect" (Bandura, 1977, pp. 84-85).

Bandura (1986), then, in his focus on task-specific self-efficacy has utilized

a "micro-analytic approach" (p. 396); however, he has spoken of efficacy at a
"domain-linked" level (p. 396), a general level, and even as a collective entity (pp.

450-452).

In this study professional self-efficacy was a domain-specific measurement

of the respondents' belief in his/her ability to perform his/her professional work

role. The professional work role has been identified as comprising three

dimensions of the professional domain: the task dimension, the interpersonal

dimension, and the organizational dimension (Gibson & Demos, 1984). Strength

of competence in each dimension contributes to the counselor's overall

professional self-efficacy score. Since no instrument currently exists to measure

counselor professional self-efficacy, the researcher constructed and tested this

domain-specific instrument.









The CPSES is a 45-item self-report questionnaire yielding one overall score

of counselor professional self-efficacy and three subscales assessing three areas of

overall professional role performance in the professional domain. Items are

written in the form of statements indicating knowledge, skills, and attitudes

related to the counselor's professional work role that concerns three domains of

professional functioning: the task (or technical skills) domain, the interpersonal

domain, and the organizational domain. The task subscale consists of 22 items

and is used to assess the counselor's perceived level of confidence in his/her

ability to perform technical aspects of his/her role (i.e., competency in delivering

mental health services, assessment, diagnosis, treatment, and helper skills). The

interpersonal subscale consists of 16 items and is used to assess the counselor's

perceived level of confidence to work with others (i.e., clients, coworkers, and

supervisors). The organizational subscale consists of 7 items and is used to

measure the counselor's perceived level of confidence to influence social and

political forces within the work setting and professional organizations.

The degree of confidence for each of the 45 items is measured on a 10-

point Likert scale that ranges from complete confidence (10) to moderate

confidence (5) to no confidence at all (0).

Content Validity

The items for competency ratings in the task, interpersonal, and

organizational dimensions of the CPSES were derived from items listed in the

Dictionary of Occupational Titles (1991), a review of related literature, and

consultation with a panel of clinical experts in the field.







62

Once the Counselor Professional Self-Efficacy Scale (CPSES) was initially

developed, the researcher contacted six clinical experts soliciting their willingness

to participate in the validation of this instrument.

These clinicians were chosen by the researcher based on their active

involvement in the profession not only as clinicians but also in professional

organizations. All experts were full-time clinicians currently practicing in the

Orlando metropolitan area. Of the six clinical experts, two were in private

practice, two worked in a managed care setting, and two worked for nonprofit

agencies. All participants were Licensed Marriage and Family Therapists and

experience levels ranged from 10 to 25 years.

At the time of the phone contact, the purpose of the research study and

the CPSES was explained to the participants and an interview time was set up. A

follow-up letter along with the CPSES was then faxed to each participant

clarifying instructions. The researcher followed up with a one-hour interview

with each participant to receive feedback.

The researcher then consolidated the responses from the clinical experts

and, where indicated, added or deleted items. In order for an item to be included

in the inventory, six out of seven experts had to agree on its inclusion. Of the 36

original items in the inventory, no items were dropped and 9 (13, 14, 18, 21, 22, 27,

37, 38, 41) were added based on the feedback. The CPSES was then revised with

a new total of 45 items.

Reliability

To obtain reliability measures, the researcher employed two methods. First,

the researcher attended the Central Florida Association for Marriage and Family









Therapists (CFAMFT) monthly meeting held in October of 1995 and asked for

volunteers from members to be part of a pilot study to determine reliability

measures. Due to a low response (5), the researcher obtained a list of members

from the CFAMFT office and contacted 30 members by phone asking them to

participate in a pilot study. The CPSES along with a cover letter and a postage-

paid return envelope was mailed or, in some cases, faxed to each volunteer.

The 30 subjects selected were members of CFAMFT. A total of 28

counselors responded to the pilot study. Of those respondents 2 were licensed

social workers, 26 were licensed marriage and family therapists, and of these 11

indicated a dual license in mental health counseling.

Internal consistency was evaluated by using Cronbach's coefficient alpha

yielding a reliability estimate on a sample of 28 respondents. The reliability

coefficient for the CPSES was 0.87. Standard error of measurement was reported

at 7.42. Reliability coefficients on subscales were also reported. The reliability

coefficients for each of the CPSES subscales were 0.84 for the task domain, 0.76

for the interpersonal domain, and 0.84 for the organizational domain. The

standard error of measurement for these subscales was 5.37 for the task domain,

5.13 for the interpersonal domain, and 3.69 for the organizational domain.

Internal consistency measures on the 266 respondents in the final analysis in this

study reported a reliability coefficient of 0.95. The standard error of measurement

was 4.40. Reliability coefficients were reported for each of the three subscales

for this larger sample of respondents as well. A reliability coefficient of 0.90 was

reported for the task domain, 0.93 in the interpersonal domain, and 0.85 for the

organizational domain. The standard error of measurement for these subscales







64

were 4.29 for the task domain, 2.29 for the interpersonal domain, and 3.69 for the

organizational domain.

Respondents were asked to rate their perceived degree of confidence in

performing each of the tasks which constitute their professional work role.

Strength ratings for each of the tasks was measured on a 10-point scale ranging

from complete confidence (10) to moderate confidence (5) to no confidence at all

(0). This procedure is slightly modified from that used by Betz and Hackett

(1981) and Shoen and Winocur (1988).

The strength score was determined by totaling the strength ratings; 0 to

365 was considered to be low, 366 to 388 to be moderate, and 389 and above to

be high. Cutoffs were established based on the pilot study. The CPSES thus is a

self-report scale yielding one overall score of counselor professional self-efficacy

consisting of three subscales assessing their areas of overall professional role

performance in the professional domain.

Self-Report

The counselor's work environment demands that much time be spent

interacting with clients, coworkers, supervisors, and the organization or practice

in which one works. These interactions are important potential sources of stress

and burnout (Cherniss, 1993). As such, the professional's response to the

demands of his/her work environment may be influenced by his/her perceived

belief in his/her ability to perform his/her work role competently. As such, self-

report instruments are most appropriate in this study.

Self-report techniques are based on the principle which supports that an

individual's perspective on reality is fundamental to understanding his/her world









view and perceptions about his/her experiences and beliefs. The individual is

viewed as not only the primary by also the best source of this information

(Anastasi, 1988).

While self-report is often used as a technique for gathering research data,

specific consideration must be given by the researcher. Merluzzi and Boltwood

(1989) suggested the following in order to decrease misinterpretations in

participants' responses often found with self-report techniques: (a) Probing for

data should be kept to a minimum to reduce the likelihood of participants to draw

causal inferences; (b) internal consistency should be monitored to insure

constructs are well measured; and (c) measures should be selected that employ

retrieval cues easily understood by the participants' scope of experience.

Data Analysis

The analysis of the data was accomplished by using the SAS General

Linear Model (GLM). Frequency distribution tables were established for all

variables. Four regression equations were used, one for each subscale

(dependent measure) of the burnout inventory and one for the Counselor

Professional Self-Efficacy Scale (CPSES).













CHAPTER IV
DATA ANALYSIS AND RESULTS

Study and Chapter Overview

The purpose of this study was to apply components of self-efficacy theory

in an investigation of burnout in marriage and family therapists. Specifically, in

this study, the researcher analyzed whether perceived professional self-efficacy

predicted burnout among marriage and family therapists. In addition, age, gender,

race, years of experience, and the environmental demands including the difficulty

of the client(s) served and the number of hours in direct client contact were

analyzed to determine if there was a significant direct effect on burnout or an

indirect effect on burnout through self-efficacy.

In this chapter the procedures for data collection, associated rates of return,

decision rules, data analysis, and results are discussed. Descriptive data are

provided where possible. Reliability coefficients for the Counselor Professional

Self-Efficacy Scale and Maslach Burnout Inventory are reported. Finally,

outcome testing of this study's research hypotheses are discussed.

Data Collection and Response Rates

Five hundred survey packets were sent to a computer-generated, national

random sample, of clinical members of the American Association for Marriage and

Family Therapists. A minimum criterion of 250 returns for the survey sample was

established to provide efficiency for data analysis. The survey packet was mailed









in a scheduled sequence utilizing first-class postage with self-addressed return

envelopes. Response was designed to be anonymous in nature.

The survey packet was mailed on November 2, 1995 (Appendices A, B, C,

D). Ten days later a follow-up letter (Appendix E) was mailed. A final follow-up

survey packet (Appendices A, B, C, D) was mailed on November 25, 1995, to

those who had not responded. In addition, a letter (Appendix F), a second MBI,

and a self-addressed envelope was mailed to 17 respondents who had failed to

complete the MBI portion of the survey packet. To be eligible for utilization in

the analysis of data, responses must have been received by December 13, 1995.

This allowed 41 days for the return of the study's data. This falls within the 7-

week sequence suggested by Dillman (1983) to provide for adequate return and

follow-up.

The total returns, including those eligible whose packets were complete,

those eligible who indicated no desire to participate, those eligible whose packets

were incomplete, those indicating a retired status, or those received after the

cutoff date totaled 327. This represented 65.4% of all persons sampled. Sixteen

people indicated no desire to participate in the study. Thirteen packets were

incomplete due to a missing MBI. Thirty-three indicated a retired status, and six

packets were received after the December 13, 1995, cutoff date.

The cumulative rate of return based on the 266 survey packets used in the

analysis for weeks 1 through 6 was 27% (87), 26% (86), 28% (93), 8% (25), 7%

(23), and 2% (8), respectively. Forty-seven percent (124) were coded in the

second week. An additional 35% (93) were coded in the third week. The









remaining 18% (49) were coded in week 6. An increase in the week 3 response

was probably attributed to the reception of the follow-up letter.

The final count of usable packets was 266. The minimum criterion of 250

packets, therefore, was exceeded.

Of the 327 packets returned, 33 indicated a retired status and, therefore,

were not eligible for participation in the study. Sixteen persons returned packets

requesting no participation. Six packets came in after the cutoff date. Six

packets were returned as undeliverable by the postal service for either expired

forwarding addresses or no such identifiable address for delivery. The addresses

provided by the American Association for Marriage and Family Therapists

(AAMFT) were the most current on record.

Criticism was offered by three persons who chose not to participate.

These included that the MBI was poorly constructed and that the $1 bill was an

insult.

Decision Rules
Three decision rules were employed to maximize the use of the return data

and create standards by which to minimize coding error in establishing choices of

scores which were absent or ambiguous in a particular questionnaire. First, in the

demographic questionnaire (Appendix A), if a respondent indicated a range of

number of clinical hours per week (15-20), an average was recorded for that

response.

Two decision rules were established to address the possible deletion of

responses on the CPSE scale. If no response or N/A was given for an item, the









item was deleted from the analysis. All respondents indicating N/A responses

indicated being in a solo practice, thus items were not applicable to them.

Next, if a total of eight or more no responses was indicated, the survey

packet was not coded for use in the final analysis. It should be noted that the

SAS (GLM) automatically eliminated from the analysis any set of data that had a

missing value for that model.

In summary, over a 6-week inclusion period, 327 research packets were

returned from the initial mailing of 500. Of the 327 returned, 33 persons indicated

a retired status; 16 persons returned packets requesting no participation; 6

packets came in after the cutoff date; and 6 packets were returned as

undeliverable by the postal service for either expired forwarding address or no

such identification address for delivery. After the deletion of the above, 266

survey packets remained eligible for statistical analysis.

1Demographic Description of the Research Sample

Tables 1, 2, and 3 provide descriptive statistics on the continuous and

categorical variables examined in this study.

MBI Levels

The MBI is designed to assess three aspects of the burnout syndrome:

emotional exhaustion, depersonalization, and lack of personal accomplishment.

Each aspect is measured by a separate subscale. Scoring for each subscale is

based on three ranges of scores. For emotional exhaustion (a) low burnout is 0-

16; (b) moderate burnout is 17-26; and (c) high burnout is 27 or over. For

personal accomplishment (a) low burnout is 39 or over; (b) moderate burnout is










Table 1

Descriptive Data on Continuous Variables


Mean Standard
Factor Score Deviation N


MBI (Burnout)

EE-Emotional Exhaustion 15.260 8.941 266

DP-Depersonalization 4.227 8.987 264

PA-Personal Accomplishment 42.181 4.369 259

CPSE-Counselor Professional
Self-Efficacy 368.936 42.656 266

Years of Experience 20.060 7.236 265

Years of Clinical Contact 19.713 7.432 265

Weekly Contact Hours 19.680 10.517 263

Age 53.940 8.452 266

Client Difficulty Level

Category 1 34.011 23.277 263

Category 2 44.175 19.865 263

Category 3 21.582 21.718 263










Table 2

Descriptive Data on Continuous Variable


Range of Experienced Burnout
Factor Tier

Low Moderate High
Total n (%) Total n (%) Total n (%)


Burnout
Emotional
Exhaustion 165 (62.0) 71(26.7) 30(11.3)

Depersonalization 206 (77.4) 46 (17.3) 14 (5.3)

Personal
Accomplishment 225 (84.6) 28 (10.5) 13 (4.9)

Counselor
Profes-
sional Self-
Efficacy 115 (43.2) 58 (21.8) 93 (35.0)










Table 3
Descrintive Data on


Categorical Variables


Factor Tier Total n (%)


Gender


Male

Female


152 (57.4)

113 (42.6)


Race or Ethnicity


Caucasian

Native American

Asian

African-American

Hispanic

Other


245 (92.1)

9(3.4)

2(0.8)

2(0.8)

3(1.1)

5(1.9)


M.A. or M.S.

Psy. D.

Ph.D.

Ed.D.

M.D.

Other


Degree


80(30.1)

3(1.1)

88(33.1)

26(9.8)

1 (0.4)

68 (25.6)


Desc. ntive Data onCategorical Variables









32-38; and (c) high burnout is 0-31. This scoring is based on a normative sample

of 11,067 subjects from seven different occupational groups.

Different cutoffs have been reported for different populations. For

purposes of interpretation, the scores in this investigation were compared to the

subgroup of mental health professionals (N = 731) in the original sample. Ranges

of scores for each subscale are as follows: emotional exhaustion (a) low burnout

is 0-13, (b) moderate burnout is 14-20, and (c) high burnout is 21 or over;

depersonalization (a) low burnout is 0-4, (b) moderate burnout is 5-7, and (c) high

burnout is 8 or over; and personal accomplishment (a) low burnout is 34 or over,

(b) moderate burnout is 33-29, and (c) high burnout is 0-28. The mean score in

this study for emotional exhaustion was 15.26 with a standard deviation of 8.94.

This is in the moderate range of experienced burnout. The reported mean score

for mental health professionals in previous studies has been reported at 16.89

with a standard deviation of 8.90. This is also in the moderate range of

experienced burnout as defined in Chapter I of this study. Mean and standard

deviations found for this study are, therefore, within range of previously reported

measures.

The mean score for depersonalization was 4.23 with a standard deviation

of 3.99. This is in the moderate range of experienced burnout. The reported

mean score for mental health participants in previous studies has been reported at

5.72 with a standard deviation of 4.62. This is in the moderate range of

experienced burnout. Mean and standard deviations found in this study are,

therefore, within range of previously reported measures.









The mean score for personal accomplishment was 42.82 with a standard

deviation of 4.37. This is in the lower range of experienced burnout. The

reported mean score for mental health participants in previous studies have been

30.87 with a standard deviation of 6.37. This is in the average range of

experienced burnout. Mean and standard deviations in this study are in the

lower range of experienced burnout than in previous studies.

Based on the overall sample in previous studies (N = 11,052), marriage and

family therapists scored in the lower range of experienced burnout in emotional

exhaustion and depersonalization as well as the low range of personal

accomplishment (indicating a high sense of personal accomplishment).

More specifically, based on the mental health sample (n = 730) in previous

studies (Maslach & Jackson, 1993), marriage and family therapists scored in the

moderate range of experienced burnout in the emotional exhaustion category, the

moderate range of experienced burnout in the depersonalization category, and

the low range of experienced burnout in the personal accomplishment category

(meaning they had a high sense of accomplishment). In addition, of the total 266

participants in this study, 165 (62.0%) scored in the low range, 71 (26.7%) in the

moderate range, and 30 (11.3%) in the high range of experienced burnout on the

emotional exhaustion subscale of the MBI; 206 (77.4%) scored in the low range,

46 (17.3%) in the moderate range, and 14 (5.3%) in the high range of experienced

burnout on the depersonalization subscale of the MBI; and 225 (84.6%) scored

in the low range, 28 (10.5%) in the moderate range, and 13 (4.9%) in the high

range of experienced burnout on the personal accomplishment subscale of the

MBI.









CPSES

The mean score on the CPSES of the 266 respondents was 368.94 with a

standard deviation of 42.66. This indicates a moderate strength score based on

the pilot study. Of the respondents participating in this study, 115 (43.2%)

scored in the lower strength range, 58 (21.8%) in the moderate strength range,

and 93 (35.0%) in the high strength range.

Gender, Age. Degree. Years of Experience, and Direct Weekly Contact Hours

Of the 266 total participants in this study, 152 (57.4%) were male and 113

(42.6%) female. The average age in years was 54. Eighty (30.1%) indicated

holding a M.A. or M.S., 3 (1.1%) a Psy.D., 88 (33.1%) a Ph.D., 26 (9.8%) an Ed.D.,

1 (0.4%) an M.D., and 68 (25.6%) fell into the Other category. For purposes of

this study, years of experience was described as the number of years of

postgraduate experience in the counseling profession. The mean total years of

experience of the participants was 20.06 years. Of these total years, the mean

number of years in direct clinical contact was 19.71 years. Due to significantly

high positive correlations between total years of experience and total years in

direct clinical contact, total years in direct clinical contact was eliminated from

further analysis in this study. Finally, the mean number of direct clinical contact

hours per week was reported at 19.68 for the participants.

Racial or Ethnic Background

Caucasians constituted 92.1% of the survey sample in this study. In order

from the most to the least represented, the following additional populations were

present: 3.4% Native American, 1.9% other, 1.1% Hispanic, 0.8% African

American, and 0.8% Asian. As a result of the low individual representations by









the nonwhite population category (a total of 26 respondents or 10% of the

sample), the researcher decided to drop this category and use only caucasians in

the final data analysis. The remainder of this study, therefore, reflects this change.

Difficulty Level of the Client

The difficulty level of participants' client(s) was delineated by using three

categories which describe functioning levels of individuals, couples, or families

using the GAF (Global Assessment of Functioning) in the DSM-IV (1994) and

family literature. Respondents were asked to indicate the average percent of

clients seen in each category with the three categories equaling 100%. Below is

a description of each category.


Category 1





Category 2





Category 3


Mild impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. If present, symptoms are transient and in
response to psychosocial stressors. Generally, individuals,
families, or couples in this category function pretty well with
slight difficulty in a few areas of life.

Moderate impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. Moderate symptoms may include flat
affect, depressed mood, occasional panic attack. Generally,
individuals, couples, or families in this category have mild to
moderate difficulty functioning in some areas of life.

Serious to severe impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. Serious to severe symptoms may include
suicidal gestures or ideations, recurrent violence, reality
impairment, obsessions, frequent shoplifting, frequent
boundary testing. Generally, individual, couples, or families
in this category have difficulty functioning in most areas of
life.


The mean percentage of clients seen in Category 1 was 34.01 with a

standard deviation of 23.28. The mean percentage of clients seen in Category 2

was 44.18 with a standard deviation of 19.87. The mean percentage of clients









seen in Category 3 was 21.72 with a standard deviation of 21.72. Due to

significantly high negative correlations among categories 1, 2, and 3, Category 2

was eliminated from further analysis in this study.

Reliability Estimates for the CPSES and MBI

Since the CPSES was developed specifically for this study, internal

consistency measures were calculated. The Cronbach's alpha formula was

utilized to account for the Likert scale items on both instruments (Mehrens &

Lehmann, 1984). The formula used was


( K S2 item

a = 1-$2 instrument


Coefficient alpha values range from 0 to 1, with 1 being a perfectly consistent

measure. The value achieved for the CPSES was 0.9505. This finding indicates

that approximately 95% of the total score variance was from true score variance.

This is also indicative that subjects' performance was consistent across items on

the CPSES.

Internal consistency for each subscale of the MBI was calculated. For

emotional exhaustion, internal consistency was reported at 0.80. This coefficient

alpha level indicates that about 80% of the variance on the subscale was

attributed to true score variance. The estimate derived in this research is

consistent with alpha's reported in prior research with similar populations. A

range of Cronbach's alpha from 0.60 to 0.90 was established (Maslach &

Jackson, 1993).









For depersonalization, internal consistency was reported at 0.60. This

indicated about 60% of the variance on the subscale was attributed to true score

variance. The estimate on this subscale is consistent with alpha's reported in prior

research with similar populations. A range of Cronbach's alpha from 0.54 to 0.79

were established (Maslach & Jackson, 1993).

For personal accomplishment, internal consistency was reported at 0.64.

This indicates that approximately 60% of the variance on the subscale was

attributed to true score variance. The estimate derived in this research is

consistent with aphas reported in prior research with similar populations. A range

of Cronbach's alpha from 0.57 to 0.80 was established (Maslach & Jackson,

1993).

Intercorrelations

Intercorrelations among the variables of age, weekly contact hours, total

years of clinical experience, difficulty level of client (i.e., Category 1, 2, or 3),

burnout (i.e., emotional exhaustion, depersonalization, and personal

accomplishment), and professional self-efficacy were computed for the entire

sample (Table 4) using the Pearson product-moment correlation calculation. Age

was significantly positively correlated with total years of experience as well as

years of clinical contact and Category 1 clients. Age was significantly negatively

correlated with Category 3 clients, emotional exhaustion, and depersonalization.

There was no significant correlation between age and weekly contact hours,

Category 2 clients, personal accomplishment, or counselor professional self-

efficacy.








Table 4

Intercorrelations of Continuous Research Variables


Age Weekly Years Years Category Category Category EE DP PA CPSE
Contact Experience Clinical 1 2 3
Hours Contact

Age 1.00 -0.05 0.47* 0.46* 0.14* -0.02 -0.14* -0.23* -0.23* 0.03 -0.05

Weekly
Contact Hours -0.05 1.00 0.09 0.11 -0.08 0.09 -0.01 -0.06 -0.08 0.19* 0.05

Years
Experience 0.47* 0.09 1.00 0.95* 0.04 0.03 -0.08 -0.27* -0.22* 0.12 0.15*

Years
Clinical Contact 0.46* 0.11 0.95* 1.00 0.05 0.06 -0.11 -0.24* -0.22* 0.16* 0.13*

Category 1 0.14* -0.08 0.04 0.05 1.00 -0.51* -0.61* -0.15" -0.20* 0.10 0.06

Category 2 -0.02 0.09 0.03* 0.55 -0.51* 1.00 -0.37* -0.03 -0.06 -0.00 -0.06

Category 3 -0.14* -0.01 -0.08 0.09 -0.61* -0.37* 1.00 0.18* 0.27* -0.11 -0.01

EE -0.23* -0.06 0.27* -0.24* 0.15* -0.03 0.18* 1.00 0.58* -0.28* -0.15"

DP -0.23 -0.08 -0.22* 0.22* -0.20* -0.06 0.27* 0.58* 1.00 -0.36* -0.22*

PA 0.03 0.19* 0.12 0.16* 0.10 -0.00 -0.11 -0.28* -0.36* 1.00 0.43*

CPSE -0.05 0.05 0.15* 0.03* 0.06 -0.06 -0.01 -0.15* -0.22* 0.43* 1.00
*1 > .05.









A significant positive correlation was found between weekly contact

hours and personal accomplishment. There were no significant correlations

between weekly contact hours and age; total years of experience; years of

clinical contact; Category 1, 2, or 3 clients; emotional exhaustion,

depersonalization, personal accomplishment, or CPSE.

A significant positive correlation was found between total years of

experience and age, years of clinical contact, and CPSE. The results of testing

indicated a significantly negative correlation between total years of experience

and emotional exhaustion and depersonalization. No significant correlations

between total years of experience and weekly contact hours, Category 1, 2, or 3

clients, or personal accomplishment were found.

A significant positive correlation was found between years of clinical

contact and age, total years of experience, personal accomplishment, and CPSE.

A significant negative correlation was found between years of clinical contact

and emotional exhaustion and depersonalization. No significant correlation was

found between years of clinical contact and weekly contact hours or Category 1,

2, and 3 clients.

The results of testing yielded a significant positive correlation between

Category 1 clients and age. A significant negative correlation was found

between Category 1 clients and Category 2 clients, Category 3 clients, emotional

exhaustion, and depersonalization. No significant correlations were found

between Category 1 clients and weekly contact hours, total years of experience,

years of clinical contact, personal accomplishment, or CPSE.









The results of testing yielded significant positive correlations between

Category 2 clients and years of experience. Significant negative correlations

were found between Category 2 clients and Category 1 and Category 3 clients.

No significant correlations were found between Category 2 clients and age,

weekly contact hours, years of clinical contact, emotional exhaustion,

depersonalization, personal accomplishment, or CPSE.

The results of testing revealed significant positive correlations between

Category 3 clients and emotional exhaustion and depersonalization. Significant

negative correlations were found between Category 3 clients and age as well as

Category 1 and Category 2 clients. No significant correlations were found

between Category III clients and weekly contact hours, years of clinical contact,

personal accomplishment, or CPSE.

The results also revealed significant positive correlations between

emotional exhaustion and years of experience, Category 1 and Category 3 clients,

as well as depersonalization. Significant negative correlations were established

between emotional exhaustion and age, years of clinical contact as well as

personal accomplishment. No significant correlation was found between

emotional exhaustion and weekly contact hours, as well as Category 2 clients.

Significant positive correlations were indicated between depersonalization

and years of clinical contact, Category 3 clients, as well as emotional exhaustion.

Significant negative correlations were established between depersonalization and

years of experience, Category 1 clients, personal accomplishment as well as CPSE.

No significant correlations were found between depersonalization and age,

weekly contact hours as well as Category 2 or 3 clients.









Significant positive correlations were confirmed between personal

accomplishment and weekly contact hours, years of clinical contact as well as

CPSE. Significant negative correlations were indicated between personal

accomplishment and emotional exhaustion and depersonalization. No significant

correlations were found between personal accomplishment and age, total years of

experience as well as Category 1, 2, or 3 clients.

Significant positive correlations were verified between CPSE and total

years of experience, years of clinical contact as well as personal accomplishment.

Significant negative correlations were confirmed between CPSE and emotional

exhaustion as well as depersonalization. No significant correlations were

revealed between CPSE and age, weekly contact hours as well as Category 1, 2,

or 3 clients.

Analysis Procedures
The analysis of data for this study was accomplished through the use of

the SAS General Linear Model (GLM). Four regression models were developed

to test the nine research hypotheses. The first model designated the level of

emotional exhaustion by the EE subscale on the MBI as the criterion (output

variable). The second model designated the level of depersonalization by the DP

subscale score on the MBI as the criterion (output variable). The third model

designated the level of personal accomplishment by the PA scale as the criterion

(output variable). Models one, two and three evaluated hypotheses 1, 2, 3, 4, and

5 for strength of main effect on the predictor (input) variables. The fourth model

designated the strength of professional self-efficacy by the CPSE score as the









criterion variable and tested hypotheses 6, 7, 8, and 9 for associations on the

input variables.

For purposes of determining levels of statistical significance, the type 1

error rate of .05 was established (Agresti, 1986). A decision to accept or reject the

specific null hypothesis was based on this predetermined attained significance

level. Source data are rounded off to the nearest ten-thousandth. The specific

variables for the regression models are described in Tables 5 and 6.

Regression Results

Model 1. Hypotheses 1, 2, 3, and 4 were tested by using three regression

equations as developed for each subscale of the MBI. The first model was used

to test hypotheses 1, 2, 3, and 4 and to measure the level of emotional exhaustion

on the MBI as the dependent variable and the independent variables of CPSE,

years of experience, weekly contact hours, client difficulty level (Category 1 and

3), age, and gender. The overall model was significant with an F(5.43), p > F =

0.0001. More specifically, significant main effects were shown for years of

experience and age. Nonsignificant effects were shown for CPSE, weekly

contact hours, Category 1 clients, Category 3 clients, and gender. Table 7

contains the source table for the model used to test the main effects with

emotional exhaustion as the dependent variable. Table 8 reflects the findings

using the regression model.
Model 2. The second model used to test hypotheses 1, 2, 3, and 4 was a

multiple regression equation which measured the level of depersonalization of the

MBI as the dependent variable and the independent variables of CPSE, years of

experience, weekly contact hours, client difficulty level (Category 1 and 3), age,










Table 5

Variables Included in Regression Models 1 and 2


Regression Model 1
Input Variables


Regression Model 2
Input Variables


CPSE

Years Experience

Weekly Contact Hours

Client Difficulty Level

Category 1

Category 3

Age

Gender


CPSE

Years Experience

Weekly Contact Hours

Client Difficulty Level

Category 1

Category 3

Age

Gender


Output Variable Output Variable
Model 1 Model 2


MBI Score MBI Score

Emotional Exhaustion (EE) Depersonalization (DP)










Table 6

Variables Included in Regression Models 3 and 4


Regression Model 3
Input Variables


CPSE

Years Experience

Weekly Clinical Contact

Client Difficulty Level

Category 1

Category 3

Age

Gender


Regression Model 4
Input Variables


Years Experience

Weekly Clinical Contact

Client Difficulty Level

Category 1

Category 3

Age

Gender


Output Variable Output Variable
Model 3 Model 4


MBI Score Counselor Professional
Self-Efficacy Score
Personal Accomplishment (PA) (CPSES)










Table 7

Source Table for the Model to Test the Main Effects with Emotional Exhaustion
as the Dependent Variable


Source DF Type IISS F Value p Value


CPSE 1 274.8287 3.86 0.0505

Years Experience 1 396.9115 5.58 0.0189*

Weekly Contact Hours 1 17.4926 0.25 0.6204

Client Difficulty

Category 1 1 18.8640 0.27 0.6070

Category 3 1 217.5454 3.06 0.0816

Age 1 331.7198 4.66 0.0318*

Gender 1 0.0670 0.00 0.9755









Table 8

Multiple Regression Analysis of Emotional Exhaustion by CPSE, Years of
Experience, Weekly Clinical Contact Hours, Client Difficulty Level (Category 1
and 3), Age. and Gender



Source R2 DF Sum of Mean F Pr>F
Squares Square Value

Model 0.13 7 2700.87 385.84 5.43 0.0001*

Error 246 17496.06 71.12

Corrected
Total 253 20196.93


Variable R2 Parameter Standard R
Estimate Error of Estimate

CPSE 0.01 -0.03 0.01 0.0505

Years of Experience 0.14 -0.21 0.09 0.0189*

Weekly Contact Hours 0.01 -0.03 0.05 0.6204

Client Difficulty Level

Category 1 0.01 -0.02 0.03 0.6070

Category 3 0.01 0.54 0.03 0.0816

Age 0.12 -0.16 0.08 0.0318*

Gender

Male 0.00 -0.03 B 1.11 0.9755

Female 0.00 0.00 0.00 0.0000

Intercept 37.23 6.35 0.0001*







88

and gender. The overall model used identified significant results with an F(8.01),

p > F=0.0001. More specifically, significant main effects were shown for CPSE,

Category 3 clients, and age. Nonsignificant effects were shown for years of

experience, weekly contact hours, Category 1 clients, and gender. Table 9

contains the source table for the model used to test the main effect with

depersonalization as the dependent variable. Table 10 reflects the findings of

using the regression model.

Model 3. The third model used to test hypotheses 1, 2, 3, and 4 was also a

multiple regression equation developed to measure the level of personal

accomplishment of the MBI as the dependent variable and the independent

variables of CPSE, years of experience, weekly contact hours, client difficulty

level (Category 1 and 3), age, and gender. The overall model was significant with

an F(10.05), p > F=0.001. More specifically, significant main effects were shown

for CPSE and weekly contact hours. Nonsignificant effects were shown for years

of experience, Category 1 and 3 clients, age, and gender. Table 11 contains the

source table for the model used to test the main effects with personal

accomplishment as the dependent variable. Table 12 reflects the findings of using

the regression model.

Model 4. Hypotheses 6, 7, 8, and 9 were tested by using one multiple

regression equation which measured professional self-efficacy strength on the

CPSE scale as the dependent variable and the independent variables of years of

experience, weekly clinical contact, client difficulty level (Category 1 and 3), age,

and gender. The overall model was significant with an F(3.00), P > F=0.0076.

More specifically, significant main effects were shown for years of experience,










Table 9

Source Table for the Model to Test the Main Effects with Depersonalization as
the Dependent Variable


Source DF Type IIISS F Value p Value


CPSE 1 132.7125 9.97 0.0018*

Years Experience 1 26.0573 1.96 0.1630

Weekly Contact Hours 1 23.8641 1.79 0.1818

Client Difficulty

Category 1 1 6.0877 0.46 0.4995

Category 3 1 111.1992 8.35 0.0042*

Age 1 69.3303 5.21 0.0233*

Gender 1 27.5518 2.07 0.1515


*12 < .05.









Table 10

Multiple Regression Analysis of Depersonalization by CPSE, Years of
Experience, Weekly Clinical Contact Hours, Client Difficulty Level (Category 1
and 3). Age, and Gender



Source R2 DF Sum of Mean F Pr>F
Squares Square Value


Model

Error

Corrected
Total


0.18


7

249


256


746.74

3314.50


4061.23


106.68

13.31


8.01


0.0001*


Variable R2 Parameter Standard R
Estimate Error of Estimate

CPSE 0.21 -0.02 0.01 0.0018*

Years of Experience 0.05 -0.05 0.04 0.1630

Weekly Contact Hours 0.05 -0.03 0.02 0.1818

Client Difficulty Level

Category 1 0.01 -0.01 0.01 0.4995

Category 3 0.19 0.04 0.01 0.0042*

Age 0.12 -0.07 0.03 0.0233*

Gender
Male 0.05 0.69 B 0.48 0.1515

Female 0.00 0.00 0.00 0.0000

Intercept 15.31 B 2.73 0.0001*


*12 < .05.




Full Text
PROFESSIONAL SELF-EFFICACY AS A PREDICTOR OF
BURNOUT IN MARRIAGE AND FAMILY THERAPISTS
By
R. VALORIE THOMAS
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1996

Copyright 1996
by
R. Valone Thomas

This dissertation is dedicated to Hirum.
May his spirit continue to inspire us,
as we travel on our journey.

ACKNOWLEDGMENTS
With great appreciation and gratitude I honor those individuals whose
encouragement and support were instrumental in the completion of this
dissertation. These persons have nurtured, challenged, and helped sustain me in
my journey and will always be remembered.
Foremost, I thank God; without his guidance and wisdom nothing would
be possible. I thank my husband, Donald, whose never-ending faith in me has
helped me to believe in myself and pursue my dreams.
Special thanks go to Dr. Wittmer, my chairperson, whose gentle
suggestions have spurred me to gain confidence in my own abilities; to Dr.
Amatea for always having a listening ear and enthusiastic heart; to Dr. Myrick for
his continued support and direction; and to Dr.Miller whose patience and
understanding is beyond belief.
Special thanks go to the friends who have journeyed with me in the rough
and calm waters-Elizabeth Harvey, Linda Lewis, Jennifer Castner, Sally David,
Richard Vantrease, and Susan DeFoor; to Barbara Smerage for her talents in
typing this manuscript and for her friendship over the years; and to Dr. Mark
Young for his mentorship and never-ending enthusiasm in support of this study.
A special thank you goes to my father, Robert Wasman, for giving me my
sense of humor and teaching me, through his example, perseverance in pursuit of
IV

my goals, and to my mother, Ann Wasman, who has nurtured in me my faith in
God and encouraged me to become all that I am today.
v

TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS iv
ABSTRACT ix
CHAPTER
I INTRODUCTION 1
Theoretical Framework 7
Statement of the Problem 10
Need for the Study 11
Purpose 12
Research Questions 13
Definition of Terms 14
Organization of the Remainder of the Study 16
n REVIEW OF THE LITERATURE 18
Burnout--A Historical Perspective 18
Definitions of Burnout 23
Effects of Burnout 26
Burnout in Human Service Professionals 30
Factors Associated with Burnout 32
Personal Factors 3 2
Environmental Factors 34
Demographic Variables 38
Self-Efficacy Theory 40
Professional Self-Efficacy 43
Self-Efficacy and Burnout 45
Marriage and Family Therapists 5 0
m METHODOLOGY 52
Overview 52
Relevant Variables 53
Research Hypotheses 53
Population 5 4
vi

Sample 5 5
Sampling Procedure 55
Instrumentation 5 6
Demographic Data Sheet 56
The Maslach Burnout Inventory 56
The Counselor Professional Self-Efficacy
Scale 5 9
Content Validity 61
Reliability 62
Self-Report 64
Data Analysis 65
IV DATA ANALYSIS AND RESULTS 66
Study and Chapter Overview 66
Data Collection and Response Rates 66
Decision Rules 68
Demographic Description of the Research Sample 69
MB I Levels 69
CPSES 75
Gender, Age, Degree, Years of Experience, and Direct
Weekly Contact Hours 75
Racial or Ethnic Background 7 5
Difficulty Level of the Client 76
Reliability Estimates for the CPSES and MB I 77
Intercorrelations 78
Analysis Procedures 82
Regression Results 8 3
Analysis by Hypotheses 93
Chapter Summary 97
V DISCUSSION 99
The Research Sample 99
Limitations of the Study 101
Discussion of Results 102
Model 1 (Hypotheses 1, 2, 3, and 4) 104
Model 2 (Hypotheses 1, 2, 3, 4, and 5) 106
Model 3 (Hypotheses 1, 2, 3, 4, and 5) 107
Model 4 (Hypotheses 6, 7, and 8) 109
Implications of the Findings and Recommendations Ill
Implications for Theory Ill
Implications for Training and Practice 114
Implications for Further Research 118
Chapter Summary 119
vii

APPENDICES
A DEMOGRAPHIC DATA SHEET 120
B HUMAN SERVICES SURVEY 123
C COUNSELOR PROFESSIONAL SELF-EFFICACY
SCALE 125
D COVER LETTER 128
E FOLLOW-UP LETTER 130
F FOLLOW-UP LETTER 131
G CATEGORIZATION OF MBI SCORES 132
REFERENCES 133
BIOGRAPHICAL SKETCH 142
viii

Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
PROFESSIONAL SELF-EFFICACY AS A PREDICTOR OF
BURNOUT IN MARRIAGE AND FAMILY THERAPISTS
By
R. Valorie Thomas
May 1996
Chairperson: Joseph Wittmer
Major Department: Counselor Education
The purpose of this study was to apply components of self-efficacy theory
in an investigation of burnout in marriage and family therapists. Specifically, in
this study the researcher analyzed whether perceived professional self-efficacy
predicted burnout among marriage and family therapists. In addition, age, gender,
race, years of experience, and environmental demands, including the difficulty of
the client(s) served and the number of hours in direct client contact, were studied.
More specifically, the latter were analyzed to determine if there was a significant
direct effect on therapist burnout or an indirect effect on burnout through self-
efficacy.
The sample for the study consisted of respondents to a nationwide random
sampling of clinical members of the American Association for Marriage and Family
Therapists (AAMFT). Two hundred sixty-six (57.4% male, 42.6% female)
subjects composed the source for the data analysis.
IX

Multiple regression procedures were utilized for analysis of the data.
Counselor professional self-efficacy, years of experience, weekly contact hours,
client difficulty level (Category 1 and 3), age, and gender were evaluated as
predictor variables. Both Counselor Professional Self-Efficacy and Maslach
Burnout Inventory scores were studied as outcome variables. The study revealed
that the results of using the multiple regression models used to test the
hypotheses were significant at the 0.0001 level. Counselor professional self-
efficacy was predictive of depersonalization and personal accomplishment scores
on the MBI.
f
Additionally, the marriage and family therapists in this study demonstrated
moderate levels of emotional exhaustion and depersonalization and indicated a
high sense of personal accomplishment. Furthermore, years of experience and
age predicted emotional exhaustion levels in participants. Personal
accomplishment levels were predicted by weekly contact hours while Category 3
clients and age of the therapists predicted levels of depersonalization. Finally,
years of experience, age, and gender predicted strength of professional self-
efficacy. Implications for theory, training, practice and research are also included
in this dissertation.
x

CHAPTER I
INTRODUCTION
My candle burns at both ends;
Embraced by the light it radiates, I follow. .. .
The light begins to flicker; it will not survive
the demands of the night.
But oh my foes, and oh my friends
it gives a lovely light.
(Adapted from "First Fig,"
Edna St. Vincent Millay,
1939, p. 127)
Burnout-What shone so brightly no longer illuminates the world around
it. Enthusiasm, commitment, and compassion for helping others is replaced by
fatigue, apathy, frustration, and loneliness. The longing to reach out and help
remains but is veiled by a personal sense of reduced motivation, low energy, an
overwhelming feeling of helplessness, and a reduced belief in one's ability to
make a difference.
In recent years the effects of the burnout phenomenon on the performance
of the helping professions in various health, welfare, and rehabilitation services
has been widely discussed in the professional literature (Capner & Caltabioano,
1993; Dignam & West, 1988; Firth & Britton, 1989; Golembiewski &
Munzenrider, 1988; Maslach & Jackson, 1981; Schaufeli, Maslach, & Marek,
1993; Shirom, 1986; Wade, Cooley, & Savicki, 1986).
Burnout has been defined as a syndrome of emotional exhaustion,
depersonalization, and reduced personal accomplishment that can occur among
1

2
individuals who work with people in some capacity (Maslach & Jackson, 1984,
1986). Emotional exhaustion refers to feelings of being emotionally
overextended and drained by one's contact with people. Depersonalization
refers to an unfeeling and callous response toward the people who are often the
recipients of one's care. Reduced personal accomplishment refers to a decline in
one's feeling of competence and successful achievement in one's work with
people (Maslach & Jackson, 1986). Unlike depression, an emotional disorder that
influences all facets of a person's life activities, burnout has been conceptualized
as impacting human services workers' thoughts and feelings about professional
performance (Leiter & Maslach, 1988; Maslach & Jackson, 1986).
Burnout has been recognized as both an individual and societal problem
and has resulted in high job turnover (Jackson, Schwab, & Schuler, 1986;
Maslach & Jackson, 1984b), poor job performance (Jackson, Schwab, &
Schuler, 1986), absenteeism (Maslach & Jackson, 1981), family problems
(Maslach & Jackson, 1982), poor health (Burke, Shearer, & Deszca, 1984), and
possibly other types of social and personal dysfunction (Maslach & Florian,
1988).
Persons in occupations that involve providing services to others are
especially susceptible to burnout (Maslach & Jackson, 1981), and counseling has
been identified as one of these person-oriented occupations (Farber, 1983b). In
counselors burnout may mean caring less and feeling more easily frustrated by
clients' resistances or lack of progress, losing confidence in one's skills and ability
to make a difference, or feeling disillusioned about the field of psychotherapy.
The counselor may become less involved in, or cynical about, his/her professional

3
development and may even regret the decision to enter the field. Often, the
helping professional facing burnout even fantasizes about leaving the profession
he/she once envisioned as fulfilling (Farber, 1990).
Both personal and environmental factors have been associated with the
development of burnout, but research evidence suggests that environmental
factors, particularly demands and supports in the workplace, are more strongly
related than such factors as demographic and personality variables (Burke,
Shearer, & Deszca, 1984; Golembiewski & Munzenrider, 1988; Leiter, 1988a,
1990a, 1990b; Leiter & Maslach, 1988; Pines & Aronson, 1988).
Environmental factors that have been identified as a major source of
burnout include those involving interactions with others in the work
environment. Burnout has been correlated with a greater percentage of time in
direct care of clients (Lewiston, Conley, & Blessing-Moore, 1981, as cited in
Maslach & Florian, 1988; Maslach & Jackson, 1982), more difficult client
problems (Meadow, 1981; Pines & Maslach, 1978), a low degree of peer support
(Burke et al., 1984; Jackson, Schwab, & Schuler, 1986; Maslach & Jackson, 1986),
expectations of supervision (Davis, Savicki, Cooley, & Firth, 1989; Penn, Romano,
& Foat, 1988), involvement with coworkers (Leiter, 1988b), and perceptions of
job-related stressors which include role ambiguity and role conflict (Friesen &
Sarros, 1989; Huberty & Huebner, 1988). All of the above involve the
individuals' interactions with their environments.
Although the impact of the work environment is evident in cases of
burnout, few approaches exist that provide a theoretical framework for

4
understanding burnout in an organizational context. One such framework is a
specific area of Social Cognitive Theory, Bandura's self-efficacy theory.
To understand social cognitive theory, a distinction between outcome
expectancy and efficacy expectations is necessary. Bandura (1977) posited that
outcome expectancies, the extent to which a response would lead to a desired
result, and efficacy expectations, the extent to which an individual (counselor)
feels capable of adequately implementing a response, determine an individual's
behavior in a demanding situation. Outcome expectancies have to do with the
action-outcome link; if a counselor provides a certain type of therapy to a client,
the client is likely to improve. Efficacy expectations have to do with a person-
action link; does the counselor feel capable of performing his/her professional
role? Theorists espousing the transactional approach to stress (Cox, 1978;
Lazarus & Folkman, 1984) posit that limitations in either outcome or efficacy
expectations can contribute to experienced stress. This chronic stress eventually
may lead to burnout. Thus, work setting (work environment) provides a powerful
context for developing efficacy expectations.
A supportive work environment provides a maximum of positive features
that enables a professional to perform his/her work role and reach his/her
professional goals. Successfully and independently reaching one's goals
enhances one's belief in one's ability to perform one's work role. If, on the other
hand, there is a failure to achieve work goals, psychological burnout may result
(Chemiss, 1993).
Cherniss (1993) proposed a link between self-efficacy and burnout by
referring to Hall's (1976) work on psychological success. Originating in the

5
earlier work of Lewin (1936), Hall proposed that work motivation and satisfaction
were enhanced when an individual achieved challenging and personally
meaningful goals successfully and independently. He claimed that such
achievement led to psychological success, more work involvement, the setting of
more challenging goals, and the feeling of a higher self-esteem. Hall emphasized
that what was most important was a person's feeling of success.
Both Pines (1993) and Hall (1976) stated that not all goals are equally
significant for burnout prevention. It is, however, the attainment of personally
meaningful goals that alleviates burnout. The professional must feel efficacious in
areas that are meaningful and significant to the individual. Bandura's (1986)
work is in agreement with this view as he seemed to suggest that successful
attainment of meaningless goals will do little to increase a person's self-efficacy
(Chemiss, 1993).
In a study of 60 psychotherapists Farber and Heifetz (1982) reported that
the single most important goal therapists want to achieve is to establish a
relationship that helps a client move towards change. Lack of therapeutic
success was cited as the most stressful aspect of therapeutic work most often due
to nonreciprocaled attentiveness, giving, and responsibility demanded by the
therapeutic relationship (Farber & Heifetz, 1982). In addition, Farber cited
overwork, the difficulty in dealing with patient's problems, discouragement as a
function of the slow and erratic pace of therapeutic work, the tendency of
therapeutic work to raise personal issues in therapists themselves, the passivity of
therapeutic work, and the isolation often demanded by work as contributing to
burnout (Farber, 1983b). He suggested that therapists expect their work to be

6
difficult and even stressful, but they also expect their efforts to make a difference
or an impact. The constant demand of interacting without compensation of
success produces burnout (Farber, 1983a). He posited that therapists are at risk
of burnout when they experience their efforts as inconsequential.
Professionals who are doing people work of some kind share a common
existential quest, to make a difference or impact. Their tools for helping make a
difference are comprised of their interpersonal skills, attitudes, and beliefs in
addition to their professional technical abilities. The professional's relationship
with the recipient is a vehicle for change and, hence, a source of accomplishment
(or of failure). Likewise, the relationship is exhausting and demanding since most
recipients are troubled or suffering. Thus, in contrast to other types of
occupational strain, burnout may result from interpersonal processes with
recipients as well as from coworkers, supervisors, or organizational factors.
Burnout from this perspective has a specific etiology that is linked to a
professional domain.
A pivotal concern contributing to burnout is the idea that one is losing
one's belief in one's ability to perform the professional work role within a range of
competency (Chemiss, 1980a). In other words, decreased professional efficacy in
performing one's work role may be a central tenant in persons experiencing
burnout.
Researchers have suggested that links between self-efficacy and stress
exist (Jex & Ludanowski, 1992). People with stronger perceived self-efficacy
experience less stress in threatening or taxing situations, and situations are less
stressful when people believe they can cope successfully with them (Bandura,

7
1989b). Burnout has been regarded as a reaction to adverse, stressful demands
(i.e., interpersonal conflicts). This relationship between self-efficacy and stress
suggests a link between self-efficacy and burnout as well. Researchers have
noted the importance of empirical investigations to test this linkage. However,
limited progress has been made toward extending social cognitive theory to the
study of psychological burnout (Cherniss, 1993; Leiter, 1991; Leiter & Skol, 1989;
Meier, 1984). This research was developed to undertake such a task.
Although some researchers have suggested that self-efficacy theory can
serve as a theoretical framework in which to study burnout, no studies to date
have examined the relationship between professional self-efficacy and burnout in
mental health professionals.
In this study the researcher attempted to apply the components of self-
efficacy theory in an investigation of professional burnout in marriage and family
therapists. Specifically, professional self-efficacy was analyzed as a potential
predictor of professional burnout among marriage and family therapists. In
addition, experience level, age, gender, race, and environmental demands
including the number of hours in direct client contact and the difficulty of the
client(s) were also investigated for predictor qualities.
Theoretical Framework
As viewed in the related research literature, the approaches that are most
often used to describe the etiology, symptom formation, and treatment of burnout
have evolved from studies that have not been theoretically driven. Case studies,
survey studies, and correlational designs have been utilized most often to explore

8
this phenomenon. More recently, however, models of burnout have been
conceptualized by burnout researchers.
What is missing from the literature then are theoretical frameworks in
which to study this phenomenon and empirical evidence of a significant
relationship between self-efficacy and burnout. Thus, as mentioned previously,
the theory that motivated this present study was a component of Bandura's social
cognitive theory-self-efficacy theory. Bandura (1986) stated that individuals
possess beliefs that enable them to exercise a measure of control over their
thoughts, feelings, and actions, that "what people think, believe, and feel affects
how they behave" (p. 25). These beliefs make up a self system with symbolizing,
forethinking, vicarious, self-regulatory, and self-reflection capabilities, and a
person's behavior results in the interplay between this person's system and
environmental influences. Bandura creates a picture of human behavior and
motivation in which people's beliefs about themselves are a main factor.
Bandura (1986) argued that self-referent thought mediates between
knowledge and action and allows individuals to evaluate their own experience.
Of all self-beliefs, self-efficacy, "people's judgments of their capabilities to
organize and execute courses of action required to attain designated types of
performance" (Bandura, 1986, p. 392) strongly impacts the choices people make,
the effort they expend, how long they persevere in the face of challenge, and the
degree of anxiety or confidence they experience.
It would seem then that a counselor's degree of belief in his/her capability
to perform the professional work role would be related to the degree of stress
he/she experiences. Continuous exposure to demands of the professional work

9
role (in marriage and family counselors this would entail interactions with their
clientele, coworkers, and supervisors and their work environment) may result in a
wearing down of their coping ability and eventually lead to burnout.
Developing coping skills to deal with professional work roles is, therefore, an
essential factor in the study of burnout in marriage and family therapists.
Bandura (1986) asserted that dealing with one's environment is not simply
a matter of knowing what to do, nor is it a fixed act that one possesses in one's
behavioral repertoire. Rather, it involves a capability in which cognitive, social,
and behavioral subskills must be organized into courses of action to serve many
purposes.
Competent functioning requires both skills and self-beliefs of efficacy to
use them effectively. Operative efficacy calls for continuously improvising
multiple skills to manage ever-changing circumstances, mostly which contain
ambiguous, unpredictable, and stressful elements (Bandura, 1986). Initiation and
regulation of transactions with the environment are partly governed by
judgments of operative capabilities-what people think they can do under given
circumstances. Perceived self-efficacy is defined as people's judgments of their
capabilities to organize and execute courses of action required to attain
designated types of performances (work roles). It is concerned not with the skills
one has but with judgments of what one can do with whatever skills one
possesses. People's beliefs about their operative capabilities help to determine
their behavior, thought patterns, and emotional reactions in taxing situations.
Thus, self-beliefs contribute to the quality of a person's psychosocial functioning.

10
Those who judge themselves inefficacious in coping with environmental
demands dwell upon their personal deficiencies and cognize potential difficulties
as more formidable than they really are (Beck, 1976; Lazarus & Launier, 1978;
Meichenbaum, 1977; Sarason, 1975). Such misgivings create stress and
undermine effective use of competencies people possess by diverting attention
from their best to proceed to concern over personal failings and possible mishaps.
By contrast, persons who have a strong sense of efficacy deploy their attention
and effort to the demands of the situation and are spurred by obstacles to greater
effort, therefore experiencing less stress.
In summary, research into work environment variables related to the
burnout phenomenon have indicated that interactions in the workplace with
clients, coworkers and supervisors, and the organization all contribute to the
burnout process. The workers' perception of their capabilities to perform
successfully their professional work role would seem to be a central tenet of the
burnout process (Cherniss, 1993).
Given the fact that self-beliefs influence a person's ability to perform a
given task and that this belief impacts how one will interact with one's
environment, it is important to understand better the variables related to burnout
and the relationship of professional self-efficacy to this process as well.
Statement of the Problem
The focus of this research was to determine if professional self-efficacy has
any predictive properties of professional burnout among marriage and family
therapists. No researchers to date have empirically tested the relationship
between professional self-efficacy beliefs and burnout in marriage and family

11
therapists. Also unknown was the level of professional burnout among this
population. Additionally, experience level, age, gender, race, and the
environmental demands of the number of hours in direct client contact, and the
difficulty of the client(s) were analyzed to determine if there was a significant
direct effect on burnout or an indirect effect on burnout through self-efficacy.
Evidence, or lack thereof, of such relationships can help to determine the role of
professional self-efficacy beliefs in the burnout process and contribute to the
understanding of the etiology of professional burnout among marriage and family
therapists.
Need for the Study
Knowledge regarding the predictive nature of professional self-efficacy
beliefs and levels of burnout in marriage and family therapists should contribute
significantly to the understanding of the etiology of the burnout phenomenon.
Such knowledge would also provide empirical evidence to link self-efficacy to
the burnout phenomenon based on social cognitive theory.
Researchers have amply demonstrated that significant levels of burnout
exist in the human services professions (Golembiewski & Munzenrider, 1988;
Maslach & Jackson, 1982); however, burnout in marriage and family therapists
has not been empirically investigated. Golembiewski (1989) noted that burnout
research is lacking from national surveys on subjects in specific occupational
groups. Marriage and family therapists comprise one of these specific
occupational groups.
Marriage and family therapists are mental health professionals who serve a
wide array of clients and work in a variety of mental health settings. Specifically,

12
they assess, diagnose, and treat individuals, couples, and/or families with a variety
of mental health needs ranging in difficulty level.
Trends that may increase the risk of burnout in the mental health field
include the expanding growth of the managed care industry, the trend for
increasing numbers of individuals with difficult-to-treat character disorders
seeking treatment in agency settings, and the tendency for mental health to
become more of a business in the private sector (Farber, 1990). Due to these
trends, the role of the professional is expanding and taking on new dimensions as
the profession continues to thrive in an environment of economic and social
uncertainty. As such, recent literature suggests that stress levels are on the rise
among marriage and family therapists (Figley, 1993; Passoth, 1995; Wegmann,
1994).
The training of competent mental health professionals, therefore, continues
to be of concern to the profession as the mental health industry expands, as
indicated by Kleibier and Enzman (1990, as cited in Schaufeli, Maslach, & Marek,
1993). They noted 1,500 publications on burnout since 1983. Knowledge from
this researcher's investigation could have implications for theory, research,
training, and action in treating this phenomenon. Such knowledge would
contribute to the explanation of burnout etiology and promote further
clarification of self-efficacy theory.
Purpose
The purpose of this study was to apply components of self-efficacy theory
in an investigation of burnout in marriage and family therapists. Such an
application has not been empirically tested to date in the research literature.

13
More specifically, this study analyzed whether perceived professional self-
efficacy predicts burnout among marriage and family therapists. In addition, age,
gender, race, years of experience, and the environmental demands including the
difficulty of the client(s) and the number of hours in direct client contact were
analyzed to determine if there is a significant direct effect on burnout or an
indirect effect on burnout through self-efficacy.
Professional self-efficacy was measured by the Counselor Professional
Self-Efficacy Scale (CPSES), a self-report instrument designed and tested by the
researcher. This instrument was used to measure professional efficacy beliefs in
three domains of the counselor professional work role—the task domain, the
interpersonal domain, and the organizational domain. These beliefs were
evaluated to determine their relationship to levels of burnout as measured by the
Maslach Burnout Inventory (1986). In addition, years of experience, age, gender,
race, and the environmental demands including the number of hours in direct
client contact and the difficulty of the client(s) seen by the subjects were
investigated.
Research Questions
The specific questions addressed in this study were as follows:
1. What are the levels of burnout present among marriage and family
therapists?
2. Does professional self-efficacy predict burnout in marriage and family
therapists?
3. Does the number of years of experience predict burnout in marriage and
family therapists?

14
4. Does the number of clinical contact hours predict burnout in marriage
and family therapists?
5. Does the difficulty of the client(s) seen predict burnout in marriage and
family therapists?
6. Do age, gender, and race predict burnout in marriage and family
therapists?
7. Do years of experience predict professional self-efficacy in marriage and
family therapists?
8. Does the number of clinical contact hours predict professional self-
efficacy in marriage and family therapists?
9. Does the difficulty of the client(s) seen predict professional self-efficacy
in marriage and family therapists?
10. Do age, gender, and race predict professional self-efficacy in marriage
and family therapists?
Definition of Terms
A marriage and family therapist is a mental health professional who
provides mental health services to individual, couples, and families utilizing family
systems theory and intervention techniques. They believe that individuals and
their problems must be seen in context, that the most important context is the
family. This practitioner works in a variety of settings including agency, private
practice, and managed mental health care.
The American Association for Marriage and Family Therapy (AAMFT) is a
professional association for the field of marriage and family therapy. Since 1942,
the AAMFT has promoted the practice of marriage and family therapy through

15
research and education and regulated the profession through accreditation and
credentialing.
Marriage and family therapy is a distinct mental health discipline currently
licensed or certified in 31 states.
AAMFT clinical member is defined as an individual who holds a master's
degree or a doctorate in marriage and family therapy from a program accredited
by the Commission for Accreditation for Marriage and Family Therapy Education
(COAMFTE) or a graduate degree from a regionally accredited educational
institution and an equivalent course of study defined by the AAMFT Board of
Directors. This individual has a minimum of 2 years of postdegree supervised
clinical experience in marriage and family therapy.
Burnout is a syndrome of emotional, exhaustion, depersonalization, and
reduced personal accomplishment that occurs in individuals who work with
people in some capacity (Maslach & Jackson, 1984a, 1986). It is a progressive
response to chronic stress that occurs over time and ranges from low to moderate
to high degrees of experienced feelings (Maslach & Jackson, 1993).
Experienced burnout refers to the subject's range of low, moderate, and
high degrees of experienced feelings of emotional exhaustion, depersonalization,
and personal accomplishment as defined by the Maslach Burnout Inventory
(Maslach & Jackson, 1993).
Professional work role is defined as the counselor’s work task which
involves not only the technical aspects of the professional role but also
interaction(s) with his or her work environment (i.e., clients, coworkers and

16
supervisors, and the organization) and encompasses three domains of
performance.
Professional role performance is defined as a counselor's professional
performance in three work domains-task, interpersonal, and organizational.
Task domain includes the counselor's perceived ability to perform technical
aspects of the professional role (i.e., competency in delivering mental health
services, assessment, diagnosis, treatment, and helper skills).
Interpersonal domain includes the counselor's perceived ability to work
with others (i.e., clients, coworkers, and supervisors).
Organizational domain includes the counselor's perceived ability to
influence social and political forces within work and professional organizations.
Perceived self-efficacy is defined as people's judgments of their capabilities
to organize and execute courses of action required to attain designated types of
performances. It is concerned not with the skills one has but with judgments of
what one can do with whatever skills one possesses (Bandura, 1986, p. 391).
Professional self-efficacv is a domain-specific assessment of a counselor's
belief in his or her ability to perform his or her professional role in three areas of
role performance: task, interpersonal, and organizational.
Self-efficacy is a context-specific assessment of competence to perform a
specific task, a judgment of one's capabilities to execute specific behaviors in
specific situations.
Organization of the Remainder of the Study
The remainder of this study consists of two chapters. In Chapter II the
researcher presents a review and analysis of relevant literature. Chapter III

17
contains a description of the methodology, subjects, and research design. The
results of the study are presented in Chapter IV. Chapter V concludes the study
with a discussion by the researcher of the research process, the limitations of the
study, conclusions, and recommendations for future research.

CHAPTER II
REVIEW OF THE LITERATURE
The purpose of this chapter is to summarize the professional literature
relevant to this study concerning professional self-efficacy and professional
burnout in marriage and family therapists. The literature review encompasses the
following topics: (a) burnout—a historical perspective, (b) definitions of burnout,
(c) effects of burnout, (d) causes of burnout in human service professionals, (e) an
overview of self-efficacy theory, (f) professional self-efficacy, and (g) self-efficacy
and burnout. Finally, a rationale for choosing marriage and family therapists as a
target population for this study is presented.
Burnout-A Historical Perspective
Burnout has been conceptualized in many w'ays including intrapsychic,
interpersonal, social, occupational, and organizational approaches. What is
evident is that while burnout continues to be a very real syndrome experienced
by certain individuals, it is by no means clearly understood.
The term burnout was first used by Herbert Freudenberger (1974) after
observing the phenomenon in himself and other human service professionals
while involved in the free clinic movement of the late 1960s and early 1970s. The
term burnout was then being used to refer to the effects of chronic drug abuse.
He defined burnout as "to fail, wear out, or become exhausted by making
excessive demands on energy, strength, and resources" (Stechmiller, 1991, p. 16)
18

19
and attributed it to the constant pressures of working with emotionally needy
and demanding individuals.
At about the same time, Christina Maslach (1976), a social psychology
researcher, was studying emotional arousal and how some individuals were able
to keep such arousal from disrupting job-related behavior. Specifically, she was
concerned with situations often characterized by crisis and chaos experienced by
hospital emergency room staff and therapists doing crisis counseling. Maslach's
(1976, 1979) original research focused on such cognitive strategies as detached
concern (which referred to the medical profession's ideal of blending compassion
with emotional distance) and dehumanization in self-defense (the process of
protecting oneself from the overwhelming emotional feelings by responding to
other people more as objects than person).
Using case study interviews and questionnaire surveys, Maslach
systematically investigated hundreds of individuals involved in a variety of
human service professions (Maslach, 1976, 1979; Maslach & Jackson, 1981).
These included mental health professionals, psychiatrists, psychiatric nurses,
hospice counselors, poverty lawyers, ministers, teachers, prison guards, and
probation officers.
Key themes emerged from these interviews. First, it became evident that
emotional experiences played an important role in the provision of health care.
Some practitioners reported experiences in providing care as rewarding while
others' experiences were emotionally stressful. Stressful experiences included
working with difficult or unpleasant patients, dealing with patient deaths,
delivering bad news to patients and their family, or having conflicts with

20
coworkers or supervisors. Emotional strains were many times described as
overwhelming, and practitioners discussed being emotionally exhausted and
drained of all feelings.
Secondly, a theme of detached concern, emotional distancing, described
by practitioners to distance and detach themselves from sources of emotional
strain emerged.
Finally, a general theme having to do with self-assessment of professional
competence became apparent. Many times the experience of emotional turmoil
felt by the practitioner was interpreted as a failure to be professional (i.e.,
nonemotional, cool, objective) and led individuals to question their ability to
work in a health career. Interwoven throughout the interviews was a central
focus on relationships—usually between provider and recipient but also between
provider and coworkers or family members.
Questionnaire surveys followed with the purpose of investigating larger
samples, developing more systematic assessment techniques, and studying
burnout within a situational context rather than simply as a stress experience of
the individual provider in isolation. Two studies were designed to assess
providers' emotional states and reactions to their clients and to discover if these
dimensions were correlated with certain job factors. In the mental health study
(Pines & Maslach, 1978), the focus was on the role of the recipient (patients) in
burnout. A study of day-care workers (Maslach & Pines, 1977) also investigated
caseload issues but added some organizational factors (program structure and
staff participation in decision making).

21
The 1980s then depicted a more focused, constructive, and empirical
period in which authors outlined working models of the phenomenon, proposed
ideas and interventions, and presented a variety of forms of evidence of the
phenomenon by supporting survey and questionnaire data, interview responses,
and clinical case studies. Standardized measures of burnout were developed,
providing researchers with more precise definitions and methodological tools for
studying the phenomenon. Specifically, the development and acceptance of the
Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1986, 1993) and the
Tedium Measure (TM) (Pines, Aronson, & Kafry, 1981) fostered research on
burnout resulting in an increased number of articles published in scholarly
journals. The MBI provides the most research-oriented definition for the
construct of burnout and has been used exclusively in recent burnout projects
(Ackerley, Burnell, Holder, & Kurdek, 1988; Friesen & Sarros, 1989;
Golembiewski & Munzenrider, 1988; Ross, Altmaier, & Russell, 1989).
A review of more recent burnout literature indicates several trends. First,
most work has continued to focus on people-oriented, human service
occupations although the variety of these occupations has expanded (i.e.,
correction officers, clinical psychologists, prison guards, and librarians). The
concept has also been extended to other types of occupations and
nonoccupational areas of life (i.e., discussion of burnout in the business world, in
sports, and within the family) (Schaufeli, Maslach, & Marek, 1993).
Secondly, empirical research has tended to focus more on job factors than
on any other types of variables. Researchers have studied variables such as job
satisfaction, job stress (work load, role conflict, and role ambiguity), job

22
withdrawal (turnover, absenteeism), job expectations, relations with coworkers
and supervisors, relations with clients, caseload, type of position, and time in the
job. Personal factors studied most often are demographic variables (sex, age,
marital status). Some attention was given to personality variables (locus of
control, hardiness, personal health, relations with family and friends, and personal
values and commitment). The research concluded that job factors are more
strongly related to burnout than are biographical or personal factors.
Most recently, several longitudinal studies have indicated three major
conclusions (Dignam & West, 1988; Firth & Britton, 1989; Golenbiewski &
Munzenrider, 1988; Jackson, Schwab, & Schuler, 1986; Shirom, 1986; Wade,
Cooley, & Savicki, 1986). First, the level of burnout appears stable over time, and
it is more chronic than acute. Secondly, burnout leads to physical symptoms,
absenteeism, and job turnover. Finally, role conflict and lack of social support
from colleagues and supervisors are antecedents of burnout.
Unfortunately, many studies of the burnout phenomenon, including most
recent longitudinal studies, have not been grounded in a theoretical framework.
This has resulted in an atheoretical stance, making it difficult to interpret results as
significantly related to other relevant research.
The empirical data base provided in the 1970s and 1980s, however, has
provided a foundation for comprehensive models of burnout. More specifically,
Lei ter and Maslach's (1988) communication patterns model, Golembiewski and
Munzenrider's (1988) phase model, and Koeske and Koeske's (1989) integrated
model represent efforts to develop comprehensive models of burnout.

23
Other approaches in studying burnout have included intrapsychic,
interpersonal, social, occupational, and organizational components. At present,
burnout is recognized as a valid and meaningful psychological construct
(Golembiewski & Munzenrider, 1988; Koeske & Koeske, 1989) and has been well
documented within the human services profession. Gaps remain, however, in
developing a clear understanding of the phenomenon.
Selection of research subjects has involved mixed professions and job
categories too divergent for meaningful generalization or replication. Cherniss
(1993) posited that "given how large and varied research literature on burnout
has become, it is not clear that one theme can tie it all together" (p. 135). He
suggested a unifying conception as the concept of self-efficacy and posited that
this conceptual link between self-efficacy and burnout has not been recognized.
Lei ter (1990a) recently suggested that linking burnout with self-efficacy can
point to a valuable new direction for research, theory, and action on burnout.
Definitions of Burnout
Originating as a type of job stress in the helping professional
(Freudenberger, 1974; Maslach, 1976; Maslach & Jackson, 1986), the term
burnout has received considerable attention over the last 20 years.
Freudenberger (1974) first described burnout as a state of physical and emotional
depletion resulting from work conditions. Freudenberger and Richelson (1980)
later defined burnout as follows: "to deplete oneself; to exhaust one's physical
and mental resources; to wear oneself out by excessively striving to reach some
unrealistic expectation imposed by oneself or by the values of society" (p. 16).

24
Cherniss (1980b) defined burnout as "psychological withdrawal from
work in response to excessive stress or dissatisfaction" (p. 16). He further stated
that burnout referred to situations formerly considered callings that merely
became a job. In other words, "the term refers to the loss of enthusiasm,
excitement, and a sense of mission in one's work" (p. 16).
Edelwich and Brodsky (1980) further described burnout as a "progressive
loss of idealism, energy, purpose, and concern as a result of conditions of work"
(p. 14). Pines, Aronson, and Kafry (1981) added that
burnout is characterized by physical depletion by feelings of
helplessness and hopelessness, by emotional drain, and by the
development of a negative self concept and negative attitudes
toward work, life, and other people. ... It is a sense of distress,
discontent, and failure in the question for ideals, (p. 15)
In general, burnout is considered to occur over time and to be
multidimensional in domain. Much controversy and confusion continue to exist
in terms of definition; however, Maslach (1982b) presented the following
definitions of burnout:
(a) A syndrome of emotional exhaustion, depersonalization and
reduced personal accomplishment that can occur among individuals
who do "people work" of some kind.
(b) A progressive loss of idealism, energy, and purpose experienced
by people in the helping professions as a result of the conditions of
their work.
(c) A state of physical, emotional, and mental exhaustion marked by
physical depletion and chronic fatigue, feelings of helplessness and
hopelessness, and the development of a negative self-concept and
negative attitudes toward work, life, and other people.
(d) A syndrome of inappropriate attitudes toward clients and self,
often associated with uncomfortable physical and emotional
symptoms.

25
(e) A state of exhaustion, irritability, and fatigue that markedly
decreases the worker's effectiveness and capability.
(f) To deplete oneself. To exhaust one's physical and mental
resources. To wear oneself out by excessively striving to reach
some unrealistic expectations imposed by oneself or by the values
of society.
(g) To wear oneself out doing what one has to do. An inability to
cope adequately with the stresses of work or personal life.
(h) A malaise of the spirit. A loss of well-being. An inability to
mobilize interests and capabilities.
(i) To become debilitated, weakened, because of extreme demands
on one's physical and/or mental energy.
(j) An accumulation of intense negative feelings that is so
debilitating that a person withdraws from the situation in which
those feelings are generated.
(k) A pervasive mood of anxiety giving way to depression and
despair.
(l) A process in which a professional's attitudes and behavior
change in negative ways in response to job strain.
(m) An inadequate coping mechanism used consistently by an
individual to reduce stress.
(n) A condition produced by working too hard for too long in a
high-pressure environment.
(o) A debilitating psychological condition resulting from work-
related frustrations, which results in lower employee productivity
and morale, (pp. 30-31)
Although the concept of burnout has been defined in many ways, there is
a general consensus that the symptoms include attitudinal, emotional, and
physical aspects (Freudenberger, 1974; Maslach 1976; Maslach & Jackson,
1986). Maslach (1982b) further proposed that there was agreement on three
components of the burnout syndrome: (a) exhaustion—a loss of energy and
debilitation, physiologically and psychologically-a loss of trust and apathy, with

26
loss of feelings, concern, and spirit; (b) depersonalization-a disparaging response
to others, inappropriate attitudes towards clients, loss of ideals, irritability; and (c)
reduced personal accomplishment-characterized by unfavorable responses
toward oneself and one's personal achievements, with depression, withdrawal,
low morale, lowered production, and a decrease in effective coping.
The most common definitions today imply that burnout can be described
as a response to interpersonal stressors on the job in which an overload of
contact with people results in changes in attitudes and behaviors towards them
(Leiter & Maslach, 1988). Service providers begin to view recipients
impersonally and their own performance disparagingly. Thus, burnout can be
considered a type of job stress. The most widely used definition of burnout
comes from Maslach and Jackson (1986): "Burnout is a syndrome of emotional
exhaustion, depersonalization, and reduced personal accomplishment that can
occur among individuals who do 'people work' of some kind" (p. 1). This
definition captures a dimension of interpersonal processes that may result with
recipients but may also include coworkers, supervision, and interaction with the
organization itself. Burnout from this perspective has a specific etiology that may
be linked to a professional domain.
Effects of Burnout
Our nation's concern about the detrimental effects of prolonged job stress,
otherwise termed burnout, continue to grow (Hatfield, 1990; Matteson &
Ivancevich, 1987) and is unlikely to subside, as evident in recent publications
(Latack & Havionic, 1992). Estimates indicate that job stress resulting in burnout
is costing the American industry $50 billion to $100 billion annually in terms of

27
lost work time, accidents, medical services, and costs of physical health problems
related to psychological disorders (Sauter, Murphy, & Hurrell, 1990). According
to a study by the National Council on Compensation Insurance, claims for
gradual mental stress alone accounted for 11% of all claims in 1990.
Hatfield (1990) in projections for the 1990s claimed that 9 out of every 10
jobs in this decade will be in the service sector, a sector already shown to be at
risk for psychological disorders. Six of these 10 jobs will be occupied by women
whose multiple role demands put them in a high risk category. The fastest
growing occupations in the United States will be in the health service
professions.
In a review of empirical literature, Kahili (1988) concluded that the impact
of burnout on the individual, organization, and society include physical,
emotional, interpersonal, behavioral, and attitudinal costs. Her review indicated
that burnout has been linked to poor physical health including symptoms of
fatigue and physical depletion or exhaustion, sleep difficulties, back pain, and
specific somatic problems such as headaches, gastro-intestinal disturbances, colds,
and the flu.
Also, increased use of alcohol and drugs have been correlated with those
experiences. Along with emotional complaints by individuals including
emotional depletion, irritability, anxiety, guilt, depression, and feelings of
helplessness. Among all these symptoms, burnout has been most often related to
depression (Kahili, 1988).
Interpersonal symptoms involving clients, friends, family members, and the
interactions between individuals in the workplace have been documented

28
(Maslach, 1986; Maslach & Jackson, 1981; Pines & Maslach, 1978). Specifically,
in the workplace, burnout has been linked to inhumane practices with clients
such as telephone crisis counselors ignoring the phone, hanging up on clients,
and refusing to conference with families of runaways (Jones, 1981).
In addition, burnout's effect on the helping process has been documented.
In one of the earliest studies of burnout (Schwartz & Will, 1961), changes were
observed and recorded in staff and patient behavior in a mental hospital ward.
When organizational changes occurred in the setting, staff burnout increased.
Researchers found that as staff burnout levels increased, patients were neglected,
began to regress, and became more anxious, depressed, suicidal, and violent. The
researchers, through consultation with the nursing staff, attempted to help reduce
staff burnout and patient care improved and symptomatic behavior decreased.
Staying with the focus on the helping relationship and interactions with
others in the work environment, Traux (1966) suggested that effectiveness in
psychotherapy counseling is strongly influenced by the degree to which the
helper expresses authenticity, positive regard, and empathy toward the client. In
addition, it has been suggested that specific knowledge and skill in clinical
assessment and technique also are important in determining effectiveness (Heller
& Monahan, 1977).
The most effective helpers then would combine knowledge and skills with
warmth and empathy toward the client. However, when helpers bum out,
warmth, empathy, and positive regard toward the client decline. Thus, Truax's
work would suggest that bumed-out helpers will be less effective (Cherniss,
1992).

29
On a behavioral level, burnout can affect the performance of human
service agencies. Burnout has been linked to turnover (Jackson & Maslach,
1982a; Jackson, Schwab, & Schuler, 1986; Maslach & Jackson, 1984b), poor job
performance (Jackson, Schwab, & Schuler, 1986), absenteeism (Maslach &
Jackson, 1981), family problems (Maslach & Jackson, 1982), poor health (Burke,
Shearer, & Deszca, 1984), all of which imply substantial costs to an organization
and to clients. Low staff morale may eventually lead to decreased job
performance, absenteeism, and turnover that can disrupt program continuity and
affect clients due to frequency changes in their primary caregivers (Cherniss,
1992). Finally, burnout can affect attitudes developed by human service
providers.
Kahili (1988) reported that individuals with high burnout levels may
demonstrate cynicism, callousness, pessimism, defensiveness, intolerance of clients,
dehumanization of clients by the use of jargon and intellectualization and
stereotyping the way they are thought about, as well as a loss of enjoyment at
work as well as going to work.
Statistically significant relationships have been reported between burnout
and a variety of negative attitudes towards clients, work, oneself, and life in
general. Pines and Kafry (1978) reported that burnout was associated with the
development of negative attitudes toward clients among social service workers,
as did Maslach and Jackson (1981) for mental health workers as assessed by
coworkers.
Other attitudinal symptoms include feelings of lack of personal
effectiveness or accomplishment at work (Miller & Potter, 1982). In their study

30
they concluded that 25% of highly burned-out subjects (speech language
pathologists) reported feeling ineffective on the job compared to 0% of mildly or
non-burned-out subjects reporting feeling ineffective. In addition, Maslach and
Jackson (1982) reported that burnout was related to health professionals' feelings
of success with patients.
In summary, the seriousness of burnout as a problem lies in its costs to the
individual, the organization, and society itself.
Burnout in Human Service Professionals
In industrial societies today professional organizations are performing
many of the functions traditionally fulfilled by the extended family or community,
particularly in the area of personal and interpersonal problems (Pines & Aronson,
1988). This has resulted in millions of human service professionals providing
medical, educational, social, and psychological services.
These professionals share three basic commonalities:
(1) They perform emotionally taxing work; (2) they share certain
personality characteristics that made them choose human service as
a career; and (3) they share a client-centered orientation. These
three characteristics are the classic antecedents of burnout. (Pines
& Aronson, 1988, pp. 83-84)
In the human service professions, "people work with others in emotionally
demanding situations over long period of time, are exposed to their clients'
psychological, social, and physical problems, and are expected to be both skilled
and personally concerned" (Pines & Aronson, 1988, p. 84). Thus, skills alone are
not responsible for burnout.

31
Burnout has been most often associated with idealistic and enthusiastic
human service professionals who work with people in some capacity. Pines,
Aronson, and Kafry (1981) stated,
We have found, over and over again, that in order to burn out a
person needs to have been on fire at one time. It follows, then, that
one of the great costs of burnout is the diminution of the effective
service of the very best people in a given profession. Accordingly,
everyone is the poorer for the existence of this phenomenon, (p. 4)
Professionals who burn out thus lack emotional resources to provide
effective services and refuse to acknowledge failure. These are people,
Freudenberger (1980) posited, who have "pushed themselves too hard for too
long, who have started out with great expectations and refused to compromise
along the way" (p. 12) whose "inner resources have been consumed as if by fire,
leaving a great emptiness inside" (p. xv). These individuals risk their physical
health and neglect their personal lives to maximize the probability of professional
success, to make a difference. For this individual, the acknowledgment of failure
is nearly impossible as it reflects on their personal worth and competence as
human beings. Their job (professional role) is an extension of their selves, their
egos, and must be successfully performed.
Thus, persons in occupations providing services to others are especially
susceptible to burnout (Maslach & Jackson, 1981), as the nature of their
professional role is taxing. Counseling has been identified as one of these
person-oriented occupations (Farber, 1983b).
In counselors, burnout may mean caring less and feeling more easily
frustrated by clients' resistances or lack of progress, losing confidence in one's
skills and ability to make a difference, or feeling disillusioned about the field of

32
psychotherapy. The counselor may become less involved in, or cynical about,
his/her professional development and may even regret the decision to enter the
field. Often, the helping professional facing burnout even fantasizes about
leaving the profession he/she once envisioned as fulfilling (Farber, 1990).
Farber and Heifetz (1982), in in-depth interviews with 60 therapists, cited
lack of therapeutic success as the most stressful aspect of therapeutic work.
High burnout levels were most often attributed to nonreciprocated attentiveness,
giving, and responsibility demanded by the therapeutic relationship. Additional
factors accounting for high burnout levels included overwork; difficulty in
dealing with patient problems; discouragement as a function of the slow,
repetitious, and erratic pace of therapeutic work; and the tendency of therapeutic
work to raise personal issues in therapists themselves, the possibility of
therapeutic work, and the isolation often demanded by the work.
Therapists expect their work to be difficult and even stressful, but they
also expect their efforts as pay off. Giving without experiencing success can lead
to burnout as the therapists' experience their effort as inconsequential. Farber
stated, "For most therapists, the greater satisfaction lies in helping people change"
(p. 298). Furthermore, this study suggested that mental health workers who
became burned out had, as a common character, perceptions that their efforts
were inconsequential.
Factors Associated with Burnout
Personal Factors
Personal and environmental factors have been associated with the
development of burnout. Personal factors identified have included individual

33
expectations, personal values, and personality characteristics (Pines & Aronson,
1988).
An individual's expectations about the job and personal achievement have
been associated with burnout. When such expectations are unrealistic or unmet,
high levels of burnout are more likely to occur (Chemiss, 1980b; Edelwich &
Brosky, 1980; Freudenberger & Richelson, 1980). In addition, personal values
such as loss of commitment and purpose in work have also been suggested as
contributing factors leading to burnout (Cherniss & Krantz, 1983).
Chemiss (1980) posited that a major source of burnout is the professional's
inability to develop a sense of competence and self-efficacy. Pines in Schaufeli,
Maslach, and Marek (1993) suggested that competence is important because it
provides the professional with a sense of existential significance. In other words,
if my work makes a difference, I make a difference.
Meaning in one's life can be derived from the belief that one's work makes
a significant contribution to the organization (or practice) in which one works, to
people in need, to society at large, and to the future of the world. Pines and
Aronson (1988) reported that lack of significance was found to be a major
determinant of hopelessness, depression, and burnout in two studies conducted,
one in a sample of 267 police officers and a second in a sample of 101 managers,
both reporting a correlation between significance and burnout being r = 0.27 (p <
.05). The more sense of significance individuals got from their work, the less
likely they were to burn out (Pines & Aronson, 1988).
Similar findings were reported by Farber (1983a) in a study of 60
psychotherapists. He reported that most therapists (73.7%) cited lack of

34
concrete indicators of therapeutic success as the single most stressful aspect of
their work. Also 25% of the therapists in this sample admitted to feelings of
disillusionment with the field. He reported that among highly committed
professionals, the absence of tangible evidence of success contributes to feelings
of insignificance, disillusionment, and helplessness, all of which are hallmarks of
burnout.
Finally, burnout appears to be greater for people with certain personality
characteristics including low self-confidence, lack of assertiveness, inability to set
limits, a strong need for approval of others, and greater impatience and hostility.
Environmental Factors
Research evidence suggests that environmental factors, particularly
demands and supports in the workplace, are more strongly related than such
factors as demographic and personality variables (Burke, Shearer, & Deszca,
1984; Gerstein, Topp, & Correll, 1987; Golembrewski & Munzenrider, 1988;
Leiter, 1988b, 1990a, 1990b; Leiter & Maslach, 1988; Maslach & Jackson, 1984a;
Pines & Aronson, 1988). Work environments can significantly affect levels of
burnout by helping them or preventing them from reaching their goals (Pines &
Aronson, 1988). Demands of the workplace (i.e., workload, client, coworker-
supervisor, or organizational demands) can be stressful not only because they
prevent professionals from using their skills to achieve their intended goal
(Chemiss, 1980b), but also these demands can give workers a feeling that what
they do is insignificant (Pines & Aronson, 1988).

35
Environmental factors that have been identified as a major source of
burnout include those involving interactions with others in the work
environment.
Work load. The human service professional’s work load, in terms of client
contact, is one of the most highly researched correlates of burnout. Lewiston,
Conley, and Blessing-Moore (1981, as cited in Maslach & Florian, 1988), Maslach
and Jackson (1982, 1984a), and Savicki and Cooley (1983) found that as the
amount of client contact increases, either in terms of a higher case load or a
greater percentage of time spent in direct contact with clients, burnout is more
likely to occur.
More recently, results of research efforts have been somewhat mixed.
Friesen and Sarros (1989) and Rogers and Dodson (1987) reported positive
correlations between work load and two subscales of emotional exhaustion and
depersonalization and a nonsignificant (p > .05) relationship for personal
accomplishment. Ross, Altmaier, and Russell (1989) observed only one
significant relationship that was positive, but it was between work load and
depersonalization.
Acklerley et al. (1988) also reported only one significant relationship, also
positive; however, it was between work load and sense of personal
accomplishment. Finally, Koeske and Koeske (1989) indicated they found no
significant relationships between work load and measures of burnout. In
conclusion, when a significant relationship is found, it indicates that the greater
the work load, the greater the risk for experiencing higher burnout levels.

36
Client. Chemiss (1993) posited that resistant clients and ones who do not
improve may cause stress to human service professionals because they may
prevent professionals from feeling competent and successful, therefore,
preventing professionals from achieving a sense of significance in their work. In
early studies Pines and Maslach (1978) reported that the higher the percentage of
schizophrenics in a human service professionals' patient population, the less
satisfaction they expressed toward their job. Also staff in settings with more
schizophrenics reported liking their work less, were less likely to view their job
situation as an ideal one, and the less consciously aware they were of everyday
goals. Subjects reported spending more time in administrative duties and
recommending pharmacological rather than psychological intervention for such
problems as suicide attempts.
Other researchers have found that working with mentally retarded persons
(Sarata, 1972), psychiatric clients (Cherniss & Egnatios, 1978), cystic-fibrosis
patients (Lewiston, Conley, & Blessing-Moore, 1981, as cited in Maslach &
Florian, 1988), and deaf children (Meadow, 1981) involves frustrations about how
time is spent, dissatisfaction with treatment outcomes and feelings of guilt about
professional failure.
Maslach (1978) and Maslach and Jackson (1982) observed that it is the
chronics that cause the most emotional stress for the human service professionals.
Many times professionals feel less equipped to handle repeatedly the more
mundane problems of clients who need mental health treatment and seem to show
small, if any, signs of improvement.

37
More recent research strongly suggests that as exposure to negative client
behavior increases, the professional care giver is at increased risk of higher levels
of burnout. Ackerley et al. (1988) and Koeske and Koeske (1989) reported
similar significant findings regarding relationships between burnout measures and
negative client behavior. High levels of reported emotional exhaustion and
depersonalization and low levels of sense of personal accomplishment are
reported to correlate significantly with higher levels of negative client behavior.
Supervisors and coworkers. Penn, Romano, and Foat (1988) found that
subjects with supportive supervisors and/or positive supervision contacts
experienced lower levels of emotional exhaustion and depersonalization and
higher levels of sense of personal accomplishment. Similar findings were
observed by Davis, Savicki, Cooley, and Firth (1989) and Leiter and Maslach
(1988) in studies of the relationship between negative supervisory experiences
and burnout. Both reported emotional exhaustion and depersonalization
increased with negative supervisory experiences.
In a study involving 76 mental health workers Pines and Maslach (1978)
found that when work relationships were good, staff members were more likely to
express positive attitudes toward the institution as a whole (r = .49), to enjoy
their work (r = .38), and to feel successful in it (r = .31). They also rated the
institution more highly (r = .41), described their reasons for being in the mental
health field as self-fulfilling (r = .41), and described chronic patients in more
positive terms.
Leiter (1988b) contended that relationships with coworkers may be a
source of support, helping to alleviate the demands of client interaction or a

38
source of strain in themselves. The results of his study resulted in a model that
depicts counselors' interactions as both aggravating and alleviating burnout.
Results indicated that a large number of contacts with coworkers on work-
oriented matters were related to higher feelings of accomplishment but may
contribute to higher emotional exhaustion as well. Informal contact with
coworkers was related to higher levels of personal accomplishment as well as to
increased job satisfaction.
Demographic Variables
In addition, the most often studied demographic variables have included
age, marital status, gender, and years of experience.
Age. A significant negative relationship between age and burnout has
been documented in two studies (Ackerley et al., 1988; Huberty & Huebner,
1988). Ackerley et al. (1988) concluded that "perhaps the therapists learn over
time to conserve their emotional energy so as not to feel 'used up' or to be drained
by the psychotherapeutic process" (p. 629). Likewise, Huberty and Heubner
(1981) hypothesized that as human service providers become older, they may
develop a variety of behavioral and attitudinal experience patterns that minimize
the chances of experiencing burnout. These findings are in agreement with
Maslach's (1982a) position in which she concluded from her research interviews
that "as people increase in age, they are more stable and mature, have more
balanced perspectives on life, and are less prone to the excesses of burnout" (p.
60).
Marital status. Maslach and Jackson (1982) found that either being
married or in a personal relationship correlated significantly (p < .05) with

39
emotional exhaustion but not to depersonalization or sense of personal
accomplishment. The study concluded that people who were single or divorced
scored higher on emotional exhaustion than those who were married or in a
relationship. Later, studies by Maslach and Jackson (1984a) and Ackerley et al.
(1988) failed to replicate these earlier findings. Ross, Altmaier, and Russell (1989)
found that the counseling center staff members who were married reported higher
levels of emotional exhaustion than those who were not married.
Gender. Maslach and Jackson (1981) found that females scored higher on
measures of emotional exhaustion while males scored higher on measures of
depersonalization and sense of personal accomplishment. In a later study
(Maslach & Jackson, 1985), however, they found the same gender difference in
emotional exhaustion but found that gender differences were not significant on
the depersonalization and personal accomplishment scales. In a recent study
using multiple regression analysis to control for certain demographic variables,
Ackerley et al. (1988) reported that a significant (p < .05) relationship between
gender and any of the three MBI subscale scores had not been observed.
Years of experience. In an early interview study, Pines and Maslach
(1978) reported that in investigating the characteristics of staff burnout in mental
health professionals,
we found that the longer the staff had worked in the mental health
field, the less they liked working with patients, the more they
avoided direct contact with them, the less successful they felt in
their work, and the more custodial rather than humanistic were their
attitudes toward mental illness. They stopped looking for self-
fulfillment in their work, good days became infrequent, and the
thing that made work worthwhile was the money and security
provided, (p. 14)

40
Ackerley et al. (1988), Farber (1985), and Ross, Altmaier, and Russell
(1989) reported a significant (p < .05) negative relationship between years of
experience in an individual's profession and the level of emotional exhaustion
reported. Also reported in the studies by Ackerley et al (1988) and Farber (1985)
were significant (p < .05) negative relationships between years of experience and
the depersonalization MBI subscale. No significant relationship was found
between sense of personal accomplishment and years of experience.
Self-Efficacy Theory
Self-efficacy theory is based on the assumption that psychological
procedures serve as a means of creating and strengthening expectations of
personal efficacy. Within this analysis, a distinction between outcome
expectancy and efficacy expectations is necessary. Bandura (1977) posited that
outcome expectancies, the extent to which performance of one's work role would
lead to a desired result, and efficacy expectations, the extent to which an
individual (counselor) feels capable of adequately implementing a response,
determine an individual's behavior in a demanding situation. Outcome
expectancies have to do with the action-outcome link; if a counselor provides a
certain type of therapy to a client, the client is likely to improve. Efficacy
expectations have to do with a person-action link; does the counselor feel
capable of performing his/her professional role?
Bandura (1986) stated that individuals possess beliefs that enable them to
exercise a measure of control over their thoughts, feelings, and actions, that "what
people think, believe, and feel affects how they behave" (p. 25). These beliefs
make up a self system in which people's conceptions about themselves and the

41
nature of things are developed through four different processes: direct
experience produced by their actions, vicarious experience of the effects
produced by someone else's actions, judgments voiced by others, and derivation
of further knowledge from what they already know by using rules of inference
(p. 27). Bandura further posited that external influences play a role not only in
the development of cognitions but in their activation as well. In other words,
different stimuli will elicit different responses. Therefore, while it is true that one’s
conceptions may determine behavior, these conceptions are partly fashioned from
direct or socially mediated transactions with the environment. Thus, a persons's
behavior results in the interplay between this person's system and environmental
influences. Bandura created a picture of human behavior and motivation in
which people's beliefs about themselves are a main factor.
Bandura (1986) argued that self-referent thought mediates between
knowledge and action and allows individuals to evaluate their own experience.
Of all self-beliefs, self-efficacy,
people's judgments of their capabilities to organize and execute
courses of action required to attain designated types of performance
strongly impacts the choices people make, the effort they expend,
how long they persevere in the face of challenge, and the degree of
anxiety or confidence they experience. (Bandura, 1986, p. 392)
Bandura (1986) asserted that dealing with one's environment is not simply
a matter of knowing what to do, nor is it a fixed act that one possesses in one's
behavioral repertoire. Rather, it involves a capability in which cognitive, social,
and behavioral subskills must be organized into courses of action to serve many
purposes.

42
Competent functioning requires both skills and self-beliefs of efficacy to
use them effectively. Success is attained by perseverant efforts in testing
alternative forms of behavior and strategies. Differences exist between
possessing subskills and being able to use them under diverse circumstances.
Hence, different people with similar skills may perform poorly, adequately, or
exceptionally. Thus, perceived self-efficacy is a significant determinant of
performance that operates partially independent of underlying skills (Bard, 1986,
p. 391). Operative efficacy calls for continuously improvising multiple skills to
manage ever-changing circumstances, mostly which contain ambiguous,
unpredictable, and stressful elements (Bandura, 1986). Initiation and regulation
of transactions with the environment are partly governed by judgments of
operative capabilities—what people think they can do under given circumstances.
Perceived self-efficacy is defined as people's judgments of their capabilities to
organize and execute courses of action required to attain designated types of
performances (work roles). It is concerned not with the skills one has but with
judgments of what one can do with whatever skills one possesses. People's
beliefs about their operative capabilities help to determine their behavior, thought
patterns, and emotional reactions in taxing situations. Thus, self-beliefs contribute
to the quality of a person's psychosocial functioning.
People's decisions involving choice of activities are partly determined by
judgments of personal efficacy. Thus, people tend to avoid tasks and situations
they believe exceed their capabilities but undertake and perform assuredly
activities they judge themselves capable of handling (Bandura, 1977). Factors
that influence behavior choice affect the individual's personal developments.

43
Positive self-precepts of efficacy, therefore, enhance personal growth and
competencies while perceived self-ineffacacies direct people to reject enriching
environments.
Accurate appraisal of one's capabilities is, therefore, valuable in a person's
overall functioning, and inaccurate appraisal can lead to one experiencing
psychological failure.
Judgments of efficacy also determine how much effort people will expend
and how long they will persist in the face of obstacles. The stronger their
perceived self-efficacy, the more vigorous and persistent are their efforts to master
the challenge (Bandura & Cervone, 1983, 1986). Strong perseverance leads to
high performance attainments.
Those who judge themselves inefficacious in coping with environmental
demands dwell upon their personal deficiencies and cognize potential difficulties
as more formidable than they really are (Beck, 1976; Lazarus & Launier, 1978;
Meichenbaum, 1977; Sarason, 1975). Such misgivings create stress and
undermine effective use of competencies people possess by diverting attention
from their best to proceed to concern over personal failings and possible mishaps.
By contrast, persons who have a strong sense of efficacy deploy their attention
and effort to the demands of the situation and are spurred by obstacles to greater
effort, therefore, experiencing less stress.
Professional Self-Efficacy
Chemiss (1993) posited that self-efficacy is not a global personality trait, as
an individual can feel efficacious in one role or situation and not in another. He
defines professional self-efficacy as a professional's belief in his/her abilities to

44
perform in professional work roles (Cherniss, 1993, p. 141). He suggested helping
professionals spend a large percentage of time interacting with their recipients.
These interactions along with interactions with others in the work environment
(i.e., coworkers, supervisors, and the organization itself) may be an important
source of stress and burnout.
Gibson and Dembo (1984) provided an example of how professional self-
efficacy can be operationalized in their design of a 30-item Teacher Efficacy Scale
which included the task area. This area is concerned with the technical aspects of
the professional role. In the case of teachers, it relates to how competent they feel
in preparing and delivering lessons, correcting student performance, and
motivating student effort.
For purposes of this study the task component included the marriage and
family therapists' perceived ability to perform technical aspects of the professional
role (i.e., assessment, diagnosis, and treatment) based on the Dictionary of
Occupational Titles (1991).
The second area of professional self-efficacy suggested by Cherniss (1993)
relates to the professional's ability to work with others. For the purpose of this
study the interpersonal component included the marriage and family therapist's
perceived ability to interact successfully with others in his/her environment (i.e.,
clients, coworkers, and supervisors)
Finally, the third component of professional self-efficacy proposed by
Cherniss (1993) refers to the beliefs about one's abilities to influence social and
political forces within the organization. This component includes the counselor's

45
perceived ability to influence social and political forces within the work
environment and in professional organizations.
In conclusion, these three components comprised a total professional self-
efficacy measurement used in this study.
Self-Efficacv and Burnout
Cherniss (1993) proposed a link between self-efficacy and burnout by
referring to Hall's (1976) work on psychological success. Originating in the
earlier work of Lewin (1936), Hall proposed that work motivation and satisfaction
were enhanced when an individual achieved challenging and personally
meaningful goals successfully and independently. He claimed that such
achievement led to psychological success, more work involvement, the setting of
more challenging goals, and the feeling of a higher self-esteem. Hall emphasized
that what was most important was a person's feeling of success.
Hall (1976) contended that if a person was unable to experience
psychologically success, the person would "withdraw psychologically from those
arenas in which he or she was experiencing failure" (p. 136). More specifically,
he proposed that psychological failure would lead to a person's
1. Withdrawing emotionally from the work situation by
lowering one's work standards and becoming apathetic and
disinterested.
2. Placing increased value on material rewards and depreciating
the value of human or intrinsic rewards.
3. Defending the self-concept through the use of defense
mechanisms.
4. Fighting the organization.
5. Leaving the organization, (p. 191)

46
Hall described symptoms of what later has become known as burnout.
This reinforced Chemiss's sense that there may be a link between burnout and an
inability to achieve a sense of competence or success in one's work.
In his research on new professionals in the mid 1970s, Cherniss (1993)
concluded that achieving a sense of competence in one's work was an important
concern and appeared to be behind many sources of stress. For example, when
new professionals complained about clients who were resistant and did not
improve, the professionals appeared to be distressed mainly because the client's
behaviors prevented the professional from feeling competent and successful.
Likewise, when the same professional subjects complained about
excessive workloads, lack of support, and organizational constraints, the issue
again appeared to be that they could not feel successful and competent, not due
to a lack of skills or abilities, but because systemic factors prevented them from
using those skills in a way that would achieve intended outcomes (Cherniss,
1993). In 10 years these same groups of professionals were studied and
achieving a sense of competence was found still to be of great importance in
determining how professionals felt about their work (Cherniss, 1989, 1992).
In summary, Cherniss (1993) posited that factors in the individual or work
situation that enhance feelings of success and competence will reduce burnout,
while factors that promote feelings of inadequacy and failure will increase
burnout.
Theorists espousing the transactional approach to stress (Cox, 1978;
Lazarus & Folkman, 1984) posited that limitations in either outcome or efficacy
expectations can contribute to experienced stress. Although chronic demands of

Al
the environment may contribute to stress, it is a person's belief in their ability to
cope with these demands (in this case work role), then, that influences the
cognitive appraisal process resulting in varied levels of stress.
Lazarus and Folkman (1984) defined psychological stress as "a
relationship between person and environment that is appraised by the person as
taxing or exceeding his or her resources and endangering his or her well being"
(p. 19). In the appraisal process, a person's beliefs determine his or her
understanding of the environment, thus shaping its meaning. When a belief is
lost, hope may be replaced by hopelessness, thus causing a shift in a person's way
of relating to others or to the environment (Lazarus & Folkman, 1984).
In stress theory, two categories of beliefs are relevant to the appraisal
process: beliefs that have to do with the personal control an individual believes
he or she has over events and beliefs that have to do with existential concerns
such as God, fate, and justice.
Beliefs about personal control imply feelings of mastery and confidence
and can be discussed both as generalized ways of thinking and as situation-
specific expectations. In speaking of self-efficacy, a belief of mastery and
confidence in a specific context is being measured referring to a coping-relevant
appraisal (Bandura, 1977). In this study, subjects assessed their belief in their
ability to perform their professional role which encompassed mastery and
confidence in their professional work role responsiveness. These included
knowledge and skills specific to marriage and family therapists, ability to interact
effectively with others, and ability to influence their work environment.

48
As such counselor professional self-efficacy refers to a specific domain of
the counselor's professional role. Situational appraisal of control refers to the
extent to which a person believes that he or she can shape, impact, or influence a
particular stressful person-environment relationship (Lazarus & Folkman, 1984).
They are the result of an individual's evaluations of the demands of the situation
as well as one's coping resources and ability to use needed coping strategies in
the particular situation.
Situational appraisal control parallels Bandura's concept of self-efficacy.
As noted earlier, Bandura (1977) made a distinction between outcome
expectations and efficacy expectations by noting that outcome expectancies are
the extent to which a response would lead to a desired result and efficacy
expectations, the extent to which an individual (counselor) feels capable of
adequately implementing a response, determine an individual's behavior in a
demanding situation. Thus, outcome has to do with the action-outcome link—if a
counselor provides a certain type of therapy to a client, the client is likely to
improve. Efficacy expectations have to do with a person-action link—does the
counselor feel capable of performing his or her professional role? Efficacy
expectancies can differ in magnitude, generality, and strength. Magnitude refers
to the level of difficulty of a specific task. Generality refers to the extent to which
an experience creates general expectations, and strength refers to the extent to
which an expectation is extinguishable by disconfirming experience (Lazarus &
Folkman, 1984).
Bandura (1977) further posited that efficacy expectations affect the extent
to which a person feels threatened and, in the presence of incentives, influences a

49
person's coping behavior. Efficacy expectancies and incentives (stakes) enter
into the person's complete evaluation of a situation. It is, therefore, the evaluated
relationship between the two factors, and not independent efficacy and incentive
factors, that determines emotion and coping.
Researchers have suggested that links between self-efficacy and stress
exist. Bandura (1989b) contended that people with stronger perceived self-
efficacy experience less stress in threatening or taxing situations, and situations
are less stressful when people believe they can cope successfully with them.
People who believe they can manage potential stressors do not, therefore, conjure
up apprehensive cognitions. Those who believe that they cannot exercise
control over stressors experience high levels of subjective distress, autonomic
rousal (Bandura, Reese, & Adams, 1982), plasma catecholamine secretion
(Bandura, Taylor, Williams, Meffor, & Barchas, 1985), and activation of
endogenous opoid systems (Bandura, Cioffi, Taylor, & Brouillar, 1988). These
studies suggested that after perceived coping efficacy is strengthened, coping
with previously intimidating tasks no longer elicits stress reactions.
Perceived self-inefficacy to fulfill desired goals that affect evaluation of
self-worth and to secure things that bring satisfaction to one's life also create
depression (Bandura, 1988a). Through rumination of thoughts, people depress
and distress themselves, impairing their level of functioning (Bandura, 1988, 1988;
Lazarus & Folkman, 1984).
Most recently, Jex and Gudanowski (1992) investigated the role of self-
efficacy in the stress process examining relations between stressors, strains, and
efficacy beliefs. Individual efficacy was found to be related to two of the four

50
strains investigated. Further research to continue to explore the role of self¬
beliefs in the stress process was recommended.
Marriage and Family Therapists
Researchers have amply demonstrated that significant levels of burnout
exist in the human services professions (Golenbiewski & Munzenrider, 1988;
Maslach & Jackson, 1984b) and are especially prevalent among mental health
professionals (Edelwich & Brodsky, 1980; Freudenberger, 1974; Maslach, 1978);
however, the presence of burnout in marriage and family therapists has not been
empirically investigated.
Golenbiewski (1989) noted that burnout research is lacking from national
surveys on subjects in specific occupational groups. Marriage and family
therapists comprise one of these specific occupational groups. Recent literature
suggests that high stress levels are present in marriage and family therapists
(Figley, 1993; Passoth, 1995; Wegmann, 1994) as the role of the professional is
expanding and taking on new dimensions requiring more demands on the
practitioner.
These demands have included changes in insurance reimbursements and
public funding, technological innovations (i.e., E-mail, computers, fax), use of
collaborative and consulting skills, and communicating in a problem-focused
medical model (using the DSM-IV) and a solution-focused systemic model
simultaneously. Wegmann (1994) posited that the demands of the expanding
role of the clinician is leading to feelings of helplessness, increased anger towards
clients, and threatening the marriage and family therapists' sense of professional
identity.

51
In addition, marriage and family therapists provide direct and indirect
services to a wide array of individuals, couples, and families. The complex
therapeutic demands of working with families have increased even more with
current changes in family lifestyle and with growing numbers of single and
blended families (Friedman, 1985). Trends that may increase the risk of burnout in
the mental health field include the expanding growth of the managed care
industry, the trend for increasing numbers of individuals with difficult-to-treat
character disorders seeking treatment in agency settings, and the tendency for
mental health to become more of a business in the private sector (Farber, 1990).
As such, ethical dilemmas inherent in the counseling profession continue to
become more complex and have been documented as contributing to the stress of
counselors as a profession (May & Sowa, 1992).
Finally, family therapy in particular invokes a sense of struggle to negotiate
family relationships (Ferber, Mendelsohn, & Napier 1972). For the family
therapists, the stresses of working with families daily leaves little emotional
energy for one's own. This stress can lead to a feeling of emotional depletion
often accompanied by anxiety, depression, irritability, and psychosomatic
complaints (Jayaratne, Chess, & Kunkel, 1986).
In summary, as the role of the practitioner is being redefined in response to
changes in mental health care delivery, the marriage and family therapist may be
faced with uncertainty about the future of the profession. This uncertainty could
affect the practitioners' sense of competence and lead to burnout. It is, thus,
important to better understand factors contributing to burnout and ways to
prevent burnout in marriage and family therapists.

CHAPTER III
METHODOLOGY
Overview
The purpose of this study was to ascertain, through the use of the
Counselor Professional Self-Efficacy Scale (CPSES) and the Maslach Burnout
Inventory (Maslach & Jackson, 1986), if professional self-efficacy had any
predictive properties for burnout among marriage and family therapists. In
addition, age, gender, race, years of experience, and environmental demands
including the difficulty of the client(s) and the number of hours in direct client
contact were analyzed to determine if there was a significant direct effect on
burnout or an indirect effect on burnout through professional self-efficacy.
Specifically, levels of marriage and family therapists' professional self-efficacy
beliefs theorized to be associated with burnout were examined through the use of
the Counselor Professional Self-Efficacy Scale, a self-report instrument designed
and tested by the researcher.
Levels of burnout were examined using the Maslach Burnout Inventory
(Maslach & Jackson, 1986). The Maslach Burnout Inventory consists of 22
questions measured on a 7-point scale intended to measure three components of
burnout: emotional exhaustion, depersonalization, and reduced sense of personal
accomplishment.
52

53
This chapter contains a description of the methodology used in the
collection and analysis of the data. Included are a description of relevant
variables, research hypotheses, population, sampling procedures, instrumentation,
data collection procedures, and the proposed data analysis procedures. This
chapter concludes with a discussion of the methodological and instrumentation
limitations of this study.
Relevant Variables
The dependent variable in this study was the level of burnout in marriage
and family therapists as defined by Maslach and Jackson (1986) and as measured
by the Maslach Burnout Inventory (MBI). The MBI yields measures of three
components of the burnout syndrome: emotional exhaustion, depersonalization,
and reduced personal accomplishment.
The independent variables in this study were the degree of counselor
professional self-efficacy as measured by the Counselor Professional Self-Efficacy
Scale (CPSES), a self-report instrument designed and validated by the researcher
to measure counselor professional self-efficacy in three domains of the counselor's
professional work role: task, interpersonal, and organizational. Other variables
included the number of years of experience, age, gender, race, and the number of
hours of direct client contact, and the difficulty of the client(s).
Research Hypotheses
For the purpose of this study, the following hypotheses were examined:
HOj The degree of professional self-efficacy does not predict levels of burnout
in marriage and family therapists.

54
Ho., Experience level does not predict levels of burnout in marriage and family
therapists.
Ho3 The number of clinical contact hours does not predict levels of burnout in
marriage and family therapists.
Ho4 The difficulty of the client(s) does not predict levels of burnout in marriage
and family therapists.
Ho5 Age, gender, and race do not predict levels of burnout in marriage and
family therapists.
Ho6 Experience level does not predict the level of professional self-efficacy.
Ho? The number of clinical contact hours does not predict the level of
professional self-efficacy in marriage and family therapists.
Hog The difficulty of the client(s) does not predict the level of professional self-
efficacy.
Ho9 Age, gender, and race do not predict the level of professional self-efficacy
in marriage and family therapists.
Population
The population for this study was comprised of active clinical members of
the American Association for Marriage and Family Therapy (AAMFT). According
to the AAMFT membership office, as of July 25, 1995, AAMFT reported 22,605
total members comprising four membership levels (clinical, associate, affiliate, and
student). Of this total number 16,561 are reported to be clinical members. For
purposes of this investigation clinical membership status was a prerequisite for
inclusion in the sample.

55
Sample
An initial, presampling decision was made that the resultant sample would
consist of a minimum of 250 active clinical members of the American Association
for Marriage and Family Therapy (AAMFT). The initial sample consisted of 500
marriage and family therapists who were clinical members of the AAMFT.
Selection was based on a computer-generated random selection of therapists
purchased by the researcher from the AAMFT.
Sampling Procedure
Following the selection of the survey sample, each of the 500 potential
respondents were mailed a survey packet containing the following: a letter
describing the nature of the study and thanking the participant in advance for
their participation in the study; a demographic questionnaire, the Maslach
Burnout Inventory (MBI); the Counselor Professional Self-Efficacy Scale
(CPSES); a one dollar bill; and a postage-paid self-addressed return envelope.
Respondents were asked to return completed questionnaires to the researcher in
the postage-paid self-addressed return envelope provided. Ten days after the
mailing, a reminder letter emphasizing the importance of the study was sent to all
respondents who had not replied. Ten days later, the remaining nonrespondents
were sent a letter, again emphasizing the importance of a high rate of return and a
second packet to complete. Confidentiality was ensured by the use of a coding
system in which no names appeared on the questionnaire data.
Participation was to be voluntary. Prior to the initial mailout, permission
was granted from the University of Florida Human Institutional Review Board.
The initial plan indicated that in the event of an insufficient response rate (<250),

56
telephone follow-up would be initiated to encourage return of the survey packet
or, if misplaced, facilitate the mailing of another packet.
Instrumentation
The data gathering for this study was comprised of three components: (a)
a demographic data sheet, (b) a self-report measure of burnout, and (c) a self-
report measure of counselor professional self-efficacy. The Maslach Burnout
Inventory (MBI) was utilized to measure the level of burnout associated with
professional self-efficacy beliefs. The Counselor Professional Self-Efficacy Scale
(CPSES) assessed the strength of professional self-efficacy beliefs to carry out
professional work roles associated with burnout.
Demographic Data Sheet
The demographic data sheet (Appendix A) solicited from respondents
information including their age, gender, racial or ethnic background, level of
educational training, their total years of experience in the professional,their years
in direct client contact, the number of hours in direct client contact per week, and
the difficulty level of the client(s) seen.
The Maslach Burnout Inventory
The Maslach Burnout Inventory (MBI) (Appendix B) was selected for this
study because it is the most widely recognized assessment tool use by researchers
to assess level of burnout (Maslach & Jackson, 1986). In addition, the MBI was
selected for its self-report quality, low cost appeal, ease of administration (10 to 15
minutes to complete and no training needed to administer), and ease of scoring.
The MBI is available in two versions, the Education Form and the Human
Services Form. The latter was used in this study. To avoid biasing responses, the

57
MBI is labeled the Human Services Survey and the word burnout is consistently
avoided, with the exception of survey item number 8 which is phrased as "I feel
burned out from my work" (Maslach & Jackson, 1986).
The MBI is based on the concept of burnout as a syndrome of emotional
exhaustion, depersonalization, and reduced personal accomplishment that can
occur among individuals who work with people in some capacity (Maslach &
Jackson, 1984a, 1986). "It is a response to the chronic emotional strain of dealing
extensively with other human beings, particularly when they are troubled or
having problems" (Maslach, 1982, p. 3).
The original MBI had two response dimensions: (a) frequency and (b)
intensity. Correlation between frequency and intensity dimensions across
individual items ranged from .35 to .73, with a mean of .56. Because of the
relatively strong relationship between the two dimensions and the awkwardness
of measurement of intensity, the author chose to drop it from the inventory.
The current edition of the MBI is a 22-item self-report questionnaire. Items
are written in the form of statements indicating personal feelings or attitudes
related to the respondent's work that concern three components of the burnout
syndrome: emotional exhaustion, depersonalization, and lack of personal
accomplishment. Each component is measured by a separate subscale.
The emotional exhaustion subscale consists of nine items and is used to
assess feelings of being emotionally overextended, exhausted, and unable to meet
the interpersonal demands of one's work. The depersonalization subscale
consists of five items and is used to measure "an unfeeling, callous, or impersonal
response towards recipients of one's care, treatment, service, or instruction"

58
(Maslach, 1986). The personal accomplishment subscale consists of eight items
and is used to assess feelings of competence and successful achievement in one's
work with people. Burnout is not considered a dichotomous variable, being
present or absent, but rather as a continuous variable ranging from low to high
degrees of experienced feelings. The frequency with which each of the 22 items
is experienced by the respondent is measured on a 7-point Likert scale that
ranges from never (0) to every day (6).
Item content was developed from a pool of items collected from 8 years of
research. Occupations represented in this research were those where the worker
must deal directly with people about issues that either are or could be
problematic. Human services workers from such diverse occupations as nurses,
teachers, police officers, counselors, social workers, physicians, mental health
workers, psychologists, psychiatrists, and attorneys comprised this sample
(Maslach & Jackson, 1986).
Data collected were subjected to factor analysis using principal factoring
with iteration and an orthogonal (varimax) rotation. Items that were retained met
the following criteria: (a) a factor loading greater than .40 on only one of the
factors, (b) a large range of subject responses, (c) a low percentage of subjects
checking the never response, and (d) a high item total correlation (Maslach,
1986). Factor analysis, thus, resulted in reducing the MBI to its current three-
subscale, 22-item format.
Internal consistency for the MBI was estimated by Cronbach's coefficient
alpha on a sample of 1,316 respondents. The reliability coefficients for each of the
MBI subscales were .90 for emotional exhaustion, .79 for depersonalization, and

59
.71 for personal accomplishment. The standard error of measurement for these
subscales was 3.80 for emotional exhaustion, 3.16 for depersonalization, and 3.75
for personal accomplishment. Test-retest reliability data are available for two
samples. The first consisted of 53 graduate students in social welfare who
completed the MBI on two occasions separated by an interval of 2 to 4 weeks.
For this sample the test-retest coefficients were .82 for emotional exhaustion, .60
for depersonalization, and .80 for personal accomplishment. All coefficients were
significant beyond the .001 level (Maslach & Jackson, 1986). The second sample
consisted of 248 teachers as subjects. The two test sessions were separated by an
interval of 1 year. Reliability coefficients for each of the subscales were .60 for
emotional exhaustion, .54 for depersonalization, and .75 for personal
accomplishment (Jackson, Schwab, & Schuler, 1986).
The Counselor Professional Self-Efficacy Scale
Bandura (1986) posited that self-efficacy is a context-specific assessment
of competence to perform a specific task. Therefore, instruments should match
the task being evaluated to insure accurate measurement. Bandura (1986) alludes
to the idea that specific task efficacies may be domain-linked (Woodruff &
Cashman, 1993). Bandura (1986) posits that "perceived self-efficacy is defined as
people's judgments of their capabilities to organize and execute courses of action
required to attain designated types of performances" (p. 391). Efficacy judgments
vary on several dimensions; first, they differ on magnitude. Magnitude deals with
the belief about performance in increasingly difficult aspects of the task within a
particular domain of functioning. Perceived self-efficacy also differs in strength.
Strength refers to a person's belief in his/her own competence in maintaining

60
his/her behavior despite mounting difficulties. Weak self-percepts of efficacy are
easily negated by disconfirming experiences, whereas people who have a strong
belief in their own competence will persevere in their efforts despite obstacles.
In addition, perceived self-efficacy differs in generality. People may judge
themselves efficacious only in certain domains of functioning or across a wide
variety of activities and situations. Although most of the work of Bandura and
his associates has focused on very specific tasks, Bandura has stated, "some kinds
of experiences create only limited mastery expectations, while still others install a
more generalized sense of efficacy that extends beyond the specific treatment
aspect" (Bandura, 1977, pp. 84-85).
Bandura (1986), then, in his focus on task-specific self-efficacy has utilized
a "micro-analytic approach" (p. 396); however, he has spoken of efficacy at a
"domain-linked" level (p. 396), a general level, and even as a collective entity (pp.
450-452).
In this study professional self-efficacy was a domain-specific measurement
of the respondents' belief in his/her ability to perform his/her professional work
role. The professional work role has been identified as comprising three
dimensions of the professional domain: the task dimension, the interpersonal
dimension, and the organizational dimension (Gibson & Demos, 1984). Strength
of competence in each dimension contributes to the counselor's overall
professional self-efficacy score. Since no instrument currently exists to measure
counselor professional self-efficacy, the researcher constructed and tested this
domain-specific instrument.

61
The CPSES is a 45-item self-report questionnaire yielding one overall score
of counselor professional self-efficacy and three subscales assessing three areas of
overall professional role performance in the professional domain. Items are
written in the form of statements indicating knowledge, skills, and attitudes
related to the counselor's professional work role that concerns three domains of
professional functioning: the task (or technical skills) domain, the interpersonal
domain, and the organizational domain. The task subscale consists of 22 items
and is used to assess the counselor's perceived level of confidence in his/her
ability to perform technical aspects of his/her role (i.e., competency in delivering
mental health services, assessment, diagnosis, treatment, and helper skills). The
interpersonal subscale consists of 16 items and is used to assess the counselor's
perceived level of confidence to work with others (i.e., clients, coworkers, and
supervisors). The organizational subscale consists of 7 items and is used to
measure the counselor's perceived level of confidence to influence social and
political forces within the work setting and professional organizations.
The degree of confidence for each of the 45 items is measured on a 10-
point Likert scale that ranges from complete confidence (10) to moderate
confidence (5) to no confidence at all (0).
Content Validity
The items for competency ratings in the task, interpersonal, and
organizational dimensions of the CPSES were derived from items listed in the
Dictionary of Occupational Titles (1991), a review of related literature, and
consultation with a panel of clinical experts in the field.

62
Once the Counselor Professional Self-Efficacy Scale (CPSES) was initially
developed, the researcher contacted six clinical experts soliciting their willingness
to participate in the validation of this instrument.
These clinicians were chosen by the researcher based on their active
involvement in the profession not only as clinicians but also in professional
organizations. All experts were full-time clinicians currently practicing in the
Orlando metropolitan area. Of the six clinical experts, two were in private
practice, two worked in a managed care setting, and two worked for nonprofit
agencies. All participants were Licensed Marriage and Family Therapists and
experience levels ranged from 10 to 25 years.
At the time of the phone contact, the purpose of the research study and
the CPSES was explained to the participants and an interview time was set up. A
follow-up letter along with the CPSES was then faxed to each participant
clarifying instructions. The researcher followed up with a one-hour interview
with each participant to receive feedback.
The researcher then consolidated the responses from the clinical experts
and, where indicated, added or deleted items. In order for an item to be included
in the inventory, six out of seven experts had to agree on its inclusion. Of the 36
original items in the inventory, no items were dropped and 9(13, 14, 18, 21, 22, 27,
37, 38, 41) were added based on the feedback. The CPSES was then revised with
a new total of 45 items.
Reliability
To obtain reliability measures, the researcher employed two methods. First,
the researcher attended the Central Florida Association for Marriage and Family

63
Therapists (CFAMFT) monthly meeting held in October of 1995 and asked for
volunteers from members to be part of a pilot study to determine reliability
measures. Due to a low response (5), the researcher obtained a list of members
from the CFAMFT office and contacted 30 members by phone asking them to
participate in a pilot study. The CPSES along with a cover letter and a postage-
paid return envelope was mailed or, in some cases, faxed to each volunteer.
The 30 subjects selected were members of CFAMFT. A total of 28
counselors responded to the pilot study. Of those respondents 2 were licensed
social workers, 26 were licensed marriage and family therapists, and of these 11
indicated a dual license in mental health counseling.
Internal consistency was evaluated by using Cronbach's coefficient alpha
yielding a reliability estimate on a sample of 28 respondents. The reliability
coefficient for the CPSES was 0.87. Standard error of measurement was reported
at 7.42. Reliability coefficients on subscales were also reported. The reliability
coefficients for each of the CPSES subscales were 0.84 for the task domain, 0.76
for the interpersonal domain, and 0.84 for the organizational domain. The
standard error of measurement for these subscales was 5.37 for the task domain,
5.13 for the interpersonal domain, and 3.69 for the organizational domain.
Internal consistency measures on the 266 respondents in the final analysis in this
study reported a reliability coefficient of 0.95. The standard error of measurement
was 4.40. Reliability coefficients were reported for each of the three subscales
for this larger sample of respondents as well. A reliability coefficient of 0.90 was
reported for the task domain, 0.93 in the interpersonal domain, and 0.85 for the
organizational domain. The standard error of measurement for these subscales

64
were 4.29 for the task domain, 2.29 for the interpersonal domain, and 3.69 for the
organizational domain.
Respondents were asked to rate their perceived degree of confidence in
performing each of the tasks which constitute their professional work role.
Strength ratings for each of the tasks was measured on a 10-point scale ranging
from complete confidence (10) to moderate confidence (5) to no confidence at all
(0). This procedure is slightly modified from that used by Betz and Hackett
(1981) and Shoen and Winocur (1988).
The strength score was determined by totaling the strength ratings; 0 to
365 was considered to be low, 366 to 388 to be moderate, and 389 and above to
be high. Cutoffs were established based on the pilot study. The CPSES thus is a
self-report scale yielding one overall score of counselor professional self-efficacy
consisting of three subscales assessing their areas of overall professional role
performance in the professional domain.
Self-Report
The counselor's work environment demands that much time be spent
interacting with clients, coworkers, supervisors, and the organization or practice
in which one works. These interactions are important potential sources of stress
and burnout (Chemiss, 1993). As such, the professional's response to the
demands of his/her work environment may be influenced by his/her perceived
belief in his/her ability to perform his/her work role competently. As such, self-
report instruments are most appropriate in this study.
Self-report techniques are based on the principle which supports that an
individual's perspective on reality is fundamental to understanding his/her world

65
view and perceptions about his/her experiences and beliefs. The individual is
viewed as not only the primary by also the best source of this information
(Anastasi, 1988).
While self-report is often used as a technique for gathering research data,
specific consideration must be given by the researcher. Merluzzi and Boltwood
(1989) suggested the following in order to decrease misinterpretations in
participants' responses often found with self-report techniques: (a) Probing for
data should be kept to a minimum to reduce the likelihood of participants to draw
causal inferences; (b) internal consistency should be monitored to insure
constructs are well measured; and (c) measures should be selected that employ
retrieval cues easily understood by the participants' scope of experience.
Data Analysis
The analysis of the data was accomplished by using the SAS General
Linear Model (GLM). Frequency distribution tables were established for all
variables. Four regression equations were used, one for each subscale
(dependent measure) of the burnout inventory and one for the Counselor
Professional Self-Efficacy Scale (CPSES).

CHAPTER IV
DATA ANALYSIS AND RESULTS
Study and Chapter Overview
The purpose of this study was to apply components of self-efficacy theory
in an investigation of burnout in marriage and family therapists. Specifically, in
this study, the researcher analyzed whether perceived professional self-efficacy
predicted burnout among marriage and family therapists. In addition, age, gender,
race, years of experience, and the environmental demands including the difficulty
of the client(s) served and the number of hours in direct client contact were
analyzed to determine if there was a significant direct effect on burnout or an
indirect effect on burnout through self-efficacy.
In this chapter the procedures for data collection, associated rates of return,
decision rules, data analysis, and results are discussed. Descriptive data are
provided where possible. Reliability coefficients for the Counselor Professional
Self-Efficacy Scale and Maslach Burnout Inventory are reported. Finally,
outcome testing of this study's research hypotheses are discussed.
Data Collection and Response Rates
Five hundred survey packets were sent to a computer-generated, national
random sample, of clinical members of the American Association for Marriage and
Family Therapists. A minimum criterion of 250 returns for the survey sample was
established to provide efficiency for data analysis. The survey packet was mailed
66

67
in a scheduled sequence utilizing first-class postage with self-addressed return
envelopes. Response was designed to be anonymous in nature.
The survey packet was mailed on November 2, 1995 (Appendices A, B, C,
D). Ten days later a follow-up letter (Appendix E) was mailed. A final follow-up
survey packet (Appendices A, B, C, D) was mailed on November 25, 1995, to
those who had not responded. In addition, a letter (Appendix F), a second MBI,
and a self-addressed envelope was mailed to 17 respondents who had failed to
complete the MBI portion of the survey packet. To be eligible for utilization in
the analysis of data, responses must have been received by December 13, 1995.
This allowed 41 days for the return of the study's data. This falls within the 7-
week sequence suggested by Dillman (1983) to provide for adequate return and
follow-up.
The total returns, including those eligible whose packets were complete,
those eligible who indicated no desire to participate, those eligible whose packets
were incomplete, those indicating a retired status, or those received after the
cutoff date totaled 327. This represented 65.4% of all persons sampled. Sixteen
people indicated no desire to participate in the study. Thirteen packets were
incomplete due to a missing MBI. Thirty-three indicated a retired status, and six
packets were received after the December 13, 1995, cutoff date.
The cumulative rate of return based on the 266 survey packets used in the
analysis for weeks 1 through 6 was 27% (87), 26% (86), 28% (93), 8% (25), 7%
(23), and 2% (8), respectively. Forty-seven percent (124) were coded in the
second week. An additional 35% (93) were coded in the third week. The

68
remaining 18% (49) were coded in week 6. An increase in the week 3 response
was probably attributed to the reception of the follow-up letter.
The final count of usable packets was 266. The minimum criterion of 250
packets, therefore, was exceeded.
Of the 327 packets returned, 33 indicated a retired status and, therefore,
were not eligible for participation in the study. Sixteen persons returned packets
requesting no participation. Six packets came in after the cutoff date. Six
packets were returned as undeliverable by the postal service for either expired
forwarding addresses or no such identifiable address for delivery. The addresses
provided by the American Association for Marriage and Family Therapists
(AAMFT) were the most current on record.
Criticism was offered by three persons who chose not to participate.
These included that the MBI was poorly constructed and that the $1 bill was an
insult.
Decision Rules
Three decision rules were employed to maximize the use of the return data
and create standards by which to minimize coding error in establishing choices of
scores which were absent or ambiguous in a particular questionnaire. First, in the
demographic questionnaire (Appendix A), if a respondent indicated a range of
number of clinical hours per week ( 15-20), an average was recorded for that
response.
Two decision rules were established to address the possible deletion of
responses on the CPSE scale. If no response or N/A was given for an item, the

69
item was deleted from the analysis. All respondents indicating N/A responses
indicated being in a solo practice, thus items were not applicable to them.
Next, if a total of eight or more no responses was indicated, the survey
packet was not coded for use in the final analysis. It should be noted that the
SAS (GLM) automatically eliminated from the analysis any set of data that had a
missing value for that model.
In summary, over a 6-week inclusion period, 327 research packets were
returned from the initial mailing of 500. Of the 327 returned, 33 persons indicated
a retired status; 16 persons returned packets requesting no participation; 6
packets came in after the cutoff date; and 6 packets were returned as
undeliverable by the postal service for either expired forwarding address or no
such identification address for delivery. After the deletion of the above, 266
survey packets remained eligible for statistical analysis.
% Demographic Description of the Research Sample
Tables 1, 2, and 3 provide descriptive statistics on the continuous and
categorical variables examined in this study.
MBI Levels
The MBI is designed to assess three aspects of the burnout syndrome:
emotional exhaustion, depersonalization, and lack of personal accomplishment.
Each aspect is measured by a separate subscale. Scoring for each subscale is
based on three ranges of scores. For emotional exhaustion (a) low burnout is 0-
16; (b) moderate burnout is 17-26; and (c) high burnout is 27 or over. For
personal accomplishment (a) low burnout is 39 or over; (b) moderate burnout is

70
Table 1
Descriptive Data on Continuous Variables
Factor
Mean
Score
Standard
Deviation
N
MBI (Burnout)
EE-Emotional Exhaustion
15.260
8.941
266
DP-Depersonalization
4.227
8.987
264
PA-Personal Accomplishment
42.181
4.369
259
CPSE-Counselor Professional
Self-Efficacy
368.936
42.656
266
Years of Experience
20.060
7.236
265
Years of Clinical Contact
19.713
7.432
265
Weekly Contact Hours
19.680
10.517
263
Age
53.940
8.452
266
Client Difficulty Level
Category 1
34.011
23.277
263
Category 2
44.175
19.865
263
Category 3
21.582
21.718
263

71
Table 2
Descriptive Data on Continuous Variable
Factor Tier
Range of Experienced Burnout
Low
Total n (%)
Moderate
Total n (%)
High
Total n (%)
Burnout
Emotional
Exhaustion
165 (62.0)
71 (26.7)
30(11.3)
Depersonalization
206 (77.4)
46(17.3)
14(5.3)
Personal
Accomplishment
225 (84.6)
28(10.5)
13(4.9)
Counselor
Profes¬
sional Self-
Efficacy
115(43.2)
58 (21.8)
93 (35.0)

72
Table 3
Descriptive Data on Categorical Variables
Factor
Tier
Total n (%)
Gender
Male
152 (57.4)
Female
113(42.6)
Race or Ethnicity
Caucasian
245 (92.1)
Native American
9 (3.4)
Asian
2 (0.8)
African-American
2 (0.8)
Hispanic
3(1.1)
Other
5(1.9)
Degree
M.A. or M.S.
80 (30.1)
Psy. D.
3(1.1)
Ph.D.
88 (33.1)
Ed.D.
26 (9.8)
M.D.
1 (0.4)
Other
68 (25.6)

73
32-38; and (c) high burnout is 0-31. This scoring is based on a normative sample
of 11,067 subjects from seven different occupational groups.
Different cutoffs have been reported for different populations. For
purposes of interpretation, the scores in this investigation were compared to the
subgroup of mental health professionals (N = 731) in the original sample. Ranges
of scores for each subscale are as follows: emotional exhaustion (a) low burnout
is 0-13, (b) moderate burnout is 14-20, and (c) high burnout is 21 or over;
depersonalization (a) low burnout is 0-4, (b) moderate burnout is 5-7, and (c) high
burnout is 8 or over; and personal accomplishment (a) low burnout is 34 or over,
(b) moderate burnout is 33-29, and (c) high burnout is 0-28. The mean score in
this study for emotional exhaustion was 15.26 with a standard deviation of 8.94.
This is in the moderate range of experienced burnout. The reported mean score
for mental health professionals in previous studies has been reported at 16.89
with a standard deviation of 8.90. This is also in the moderate range of
experienced burnout as defined in Chapter I of this study. Mean and standard
deviations found for this study are, therefore, within range of previously reported
measures.
The mean score for depersonalization was 4.23 with a standard deviation
of 3.99. This is in the moderate range of experienced burnout. The reported
mean score for mental health participants in previous studies has been reported at
5.72 with a standard deviation of 4.62. This is in the moderate range of
experienced burnout. Mean and standard deviations found in this study are,
therefore, within range of previously reported measures.

74
The mean score for personal accomplishment was 42.82 with a standard
deviation of 4.37. This is in the lower range of experienced burnout. The
reported mean score for mental health participants in previous studies have been
30.87 with a standard deviation of 6.37. This is in the average range of
experienced burnout. Mean and standard deviations in this study are in the
lower range of experienced burnout than in previous studies.
Based on the overall sample in previous studies (N = 11,052), marriage and
family therapists scored in the lower range of experienced burnout in emotional
exhaustion and depersonalization as well as the low range of personal
accomplishment (indicating a high sense of personal accomplishment).
More specifically, based on the mental health sample (n = 730) in previous
studies (Maslach & Jackson, 1993), marriage and family therapists scored in the
moderate range of experienced burnout in the emotional exhaustion category, the
moderate range of experienced burnout in the depersonalization category, and
the low range of experienced burnout in the personal accomplishment category
(meaning they had a high sense of accomplishment). In addition, of the total 266
participants in this study, 165 (62.0%) scored in the low range, 71 (26.7%) in the
moderate range, and 30 (11.3%) in the high range of experienced burnout on the
emotional exhaustion subscale of the MBI; 206 (77.4%) scored in the low range,
46 (17.3%) in the moderate range, and 14 (5.3%) in the high range of experienced
burnout on the depersonalization subscale of the MBI; and 225 (84.6%) scored
in the low range, 28 (10.5%) in the moderate range, and 13 (4.9%) in the high
range of experienced burnout on the personal accomplishment subscale of the
MBI.

75
CPSES
The mean score on the CPSES of the 266 respondents was 368.94 with a
standard deviation of 42.66. This indicates a moderate strength score based on
the pilot study. Of the respondents participating in this study, 115 (43.2%)
scored in the lower strength range, 58 (21.8%) in the moderate strength range,
and 93 (35.0%) in the high strength range.
Gender. Age. Degree. Years of Experience, and Direct Weekly Contact Hours
Of the 266 total participants in this study, 152 (57.4%) were male and 113
(42.6%) female. The average age in years was 54. Eighty (30.1%) indicated
holding a M.A. or M.S., 3 (1.1%) a Psy.D., 88 (33.1%) a Ph.D., 26 (9.8%) an Ed.D.,
1 (0.4%) an M.D., and 68 (25.6%) fell into the Other category. For purposes of
this study, years of experience was described as the number of years of
postgraduate experience in the counseling profession. The mean total years of
experience of the participants was 20.06 years. Of these total years, the mean
number of years in direct clinical contact was 19.71 years. Due to significantly
high positive correlations between total years of experience and total years in
direct clinical contact, total years in direct clinical contact was eliminated from
further analysis in this study. Finally, the mean number of direct clinical contact
hours per week was reported at 19.68 for the participants.
Racial or Ethnic Background
Caucasians constituted 92.1% of the survey sample in this study. In order
from the most to the least represented, the following additional populations were
present: 3.4% Native American, 1.9% other, 1.1% Hispanic, 0.8% African
American, and 0.8% Asian. As a result of the low individual representations by

76
the nonwhite population category (a total of 26 respondents or 10% of the
sample), the researcher decided to drop this category and use only Caucasians in
the final data analysis. The remainder of this study, therefore, reflects this change.
Difficulty Level of the Client
The difficulty level of participants' client(s) was delineated by using three
categories which describe functioning levels of individuals, couples, or families
using the GAF (Global Assessment of Functioning) in the DSM-IV (1994) and
family literature. Respondents were asked to indicate the average percent of
clients seen in each category with the three categories equaling 100%. Below is
a description of each category.
Category 1 Mild impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. If present, symptoms are transient and in
response to psychosocial stressors. Generally, individuals,
families, or couples in this category function pretty well with
slight difficulty in a few areas of life.
Category 2 Moderate impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. Moderate symptoms may include flat
affect, depressed mood, occasional panic attack. Generally,
individuals, couples, or families in this category have mild to
moderate difficulty functioning in some areas of life.
Category 3 Serious to severe impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. Serious to severe symptoms may include
suicidal gestures or ideations, recurrent violence, reality
impairment, obsessions, frequent shoplifting, frequent
boundary testing. Generally, individual, couples, or families
in this category have difficulty functioning in most areas of
life.
The mean percentage of clients seen in Category 1 was 34.01 with a
standard deviation of 23.28. The mean percentage of clients seen in Category 2
was 44.18 with a standard deviation of 19.87. The mean percentage of clients

77
seen in Category 3 was 21.72 with a standard deviation of 21.72. Due to
significantly high negative correlations among categories 1, 2, and 3, Category 2
was eliminated from further analysis in this study.
Reliability Estimates for the CPSES and MBI
Since the CPSES was developed specifically for this study, internal
consistency measures were calculated. The Cronbach's alpha formula was
utilized to account for the Likert scale items on both instruments (Mehrens &
Lehmann, 1984). The formula used was
]T S item
items
S' instrument j
Coefficient alpha values range from 0 to 1, with 1 being a perfectly consistent
measure. The value achieved for the CPSES was 0.9505. This finding indicates
that approximately 95% of the total score variance was from true score variance.
This is also indicative that subjects' performance was consistent across items on
the CPSES.
Internal consistency for each subscale of the MBI was calculated. For
emotional exhaustion, internal consistency was reported at 0.80. This coefficient
alpha level indicates that about 80% of the variance on the subscale was
attributed to true score variance. The estimate derived in this research is
consistent with alpha's reported in prior research with similar populations. A
range of Cronbach's alpha from 0.60 to 0.90 was established (Maslach &
Jackson, 1993).
a =
k-1

78
For depersonalization, internal consistency was reported at 0.60. This
indicated about 60% of the variance on the subscale was attributed to true score
variance. The estimate on this subscale is consistent with alpha's reported in prior
research with similar populations. A range of Cronbach's alpha from 0.54 to 0.79
were established (Maslach & Jackson, 1993).
For personal accomplishment, internal consistency was reported at 0.64.
This indicates that approximately 60% of the variance on the subscale was
attributed to true score variance. The estimate derived in this research is
consistent with aphas reported in prior research with similar populations. A range
of Cronbach's alpha from 0.57 to 0.80 was established (Maslach & Jackson,
1993).
Intercorrelations
Intercorrelations among the variables of age, weekly contact hours, total
years of clinical experience, difficulty level of client (i.e., Category 1, 2, or 3),
burnout (i.e., emotional exhaustion, depersonalization, and personal
accomplishment), and professional self-efficacy were computed for the entire
sample (Table 4) using the Pearson product-moment correlation calculation. Age
was significantly positively correlated with total years of experience as well as
years of clinical contact and Category 1 clients. Age was significantly negatively
correlated with Category 3 clients, emotional exhaustion, and depersonalization.
There was no significant correlation between age and weekly contact hours,
Category 2 clients, personal accomplishment, or counselor professional self-
efficacy.

Table 4
Intercorrelations of Continuous Research Variables
Age
Weekly
Contact
Hours
Years
Experience
Years
Clinical
Contact
Category
1
Category
2
Category
3
EE
DP
PA CPSE
Age
1.00
-0.05
0.47*
0.46*
0.14*
-0.02
-0.14*
-0.23*
-0.23*
0.03
-0.05
Weekly
Contact Hours
-0.05
1.00
0.09
0.11
-0.08
0.09
-0.01
-0.06
-0.08
0.19*
0.05
Years
Experience
0.47*
0.09
1.00
0.95*
0.04
0.03
-0.08
-0.27*
-0.22*
0.12
0.15*
Years
Clinical Contact
0.46*
0.11
0.95*
1.00
0.05
0.06
-0.11
-0.24*
-0.22*
0.16*
0.13*
Category 1
0.14*
-0.08
0.04
0.05
1.00
-0.51*
-0.61*
-0.15*
-0.20*
0.10
0.06
Category 2
-0.02
0.09
0.03*
0.55
-0.51*
1.00
-0.37*
-0.03
-0.06
-0.00
-0.06
Category 3
-0.14*
-0.01
-0.08
0.09
-0.61*
-0.37*
1.00
0.18*
0.27*
-0.11
-0.01
EE
-0.23*
-0.06
0.27*
-0.24*
0.15*
-0.03
0.18*
1.00
0.58*
-0.28*
-0.15*
DP
-0.23
-0.08
-0.22*
0.22*
-0.20*
-0.06
0.27*
0.58*
1.00
-0.36*
-0.22*
PA
0.03
0.19*
0.12
0.16*
0.10
-0.00
-0.11
-0.28*
-0.36*
1.00
0.43*
CPSE
-0.05
0.05
0.15*
0.03*
0.06
-0.06
-0.01
-0.15*
-0.22*
0.43*
1.00
*]2 > .05.
—j
so

80
A significant positive correlation was found between weekly contact
hours and personal accomplishment. There were no significant correlations
between weekly contact hours and age; total years of experience; years of
clinical contact; Category 1, 2, or 3 clients; emotional exhaustion,
depersonalization, personal accomplishment, or CPSE.
A significant positive correlation was found between total years of
experience and age, years of clinical contact, and CPSE. The results of testing
indicated a significantly negative correlation between total years of experience
and emotional exhaustion and depersonalization. No significant correlations
between total years of experience and weekly contact hours, Category 1, 2, or 3
clients, or personal accomplishment were found.
A significant positive correlation was found between years of clinical
contact and age, total years of experience, personal accomplishment, and CPSE.
A significant negative correlation was found between years of clinical contact
and emotional exhaustion and depersonalization. No significant correlation was
found between years of clinical contact and weekly contact hours or Category 1,
2, and 3 clients.
The results of testing yielded a significant positive correlation between
Category 1 clients and age. A significant negative correlation was found
between Category 1 clients and Category 2 clients, Category 3 clients, emotional
exhaustion, and depersonalization. No significant correlations were found
between Category 1 clients and weekly contact hours, total years of experience,
years of clinical contact, personal accomplishment, or CPSE.

81
The results of testing yielded significant positive correlations between
Category 2 clients and years of experience. Significant negative correlations
were found between Category 2 clients and Category 1 and Category 3 clients.
No significant correlations were found between Category 2 clients and age,
weekly contact hours, years of clinical contact, emotional exhaustion,
depersonalization, personal accomplishment, or CPSE.
The results of testing revealed significant positive correlations between
Category 3 clients and emotional exhaustion and depersonalization. Significant
negative correlations were found between Category 3 clients and age as well as
Category 1 and Category 2 clients. No significant correlations were found
between Category III clients and weekly contact hours, years of clinical contact,
personal accomplishment, or CPSE.
The results also revealed significant positive correlations between
emotional exhaustion and years of experience, Category 1 and Category 3 clients,
as well as depersonalization. Significant negative correlations were established
between emotional exhaustion and age, years of clinical contact as well as
personal accomplishment. No significant correlation was found between
emotional exhaustion and weekly contact hours, as well as Category 2 clients.
Significant positive correlations were indicated between depersonalization
and years of clinical contact, Category 3 clients, as well as emotional exhaustion.
Significant negative correlations were established between depersonalization and
years of experience, Category 1 clients, personal accomplishment as well as CPSE.
No significant correlations were found between depersonalization and age,
weekly contact hours as well as Category 2 or 3 clients.

82
Significant positive correlations were confirmed between personal
accomplishment and weekly contact hours, years of clinical contact as well as
CPSE. Significant negative correlations were indicated between personal
accomplishment and emotional exhaustion and depersonalization. No significant
correlations were found between personal accomplishment and age, total years of
experience as well as Category 1, 2, or 3 clients.
Significant positive correlations were verified between CPSE and total
years of experience, years of clinical contact as well as personal accomplishment.
Significant negative correlations were confirmed between CPSE and emotional
exhaustion as well as depersonalization. No significant correlations were
revealed between CPSE and age, weekly contact hours as well as Category 1, 2,
or 3 clients.
Analysis Procedures
The analysis of data for this study was accomplished through the use of
the SAS General Linear Model (GLM). Four regression models were developed
to test the nine research hypotheses. The first model designated the level of
emotional exhaustion by the EE subscale on the MBI as the criterion (output
variable). The second model designated the level of depersonalization by the DP
subscale score on the MBI as the criterion (output variable). The third model
designated the level of personal accomplishment by the PA scale as the criterion
(output variable). Models one, two and three evaluated hypotheses 1, 2, 3, 4, and
5 for strength of main effect on the predictor (input) variables. The fourth model
designated the strength of professional self-efficacy by the CPSE score as the

83
criterion variable and tested hypotheses 6, 7, 8, and 9 for associations on the
input variables.
For purposes of determining levels of statistical significance, the type 1
error rate of .05 was established (Agresti, 1986). A decision to accept or reject the
specific null hypothesis was based on this predetermined attained significance
level. Source data are rounded off to the nearest ten-thousandth. The specific
variables for the regression models are described in Tables 5 and 6.
Regression Results
Model 1. Hypotheses 1, 2, 3, and 4 were tested by using three regression
equations as developed for each subscale of the MBI. The first model was used
to test hypotheses 1, 2, 3, and 4 and to measure the level of emotional exhaustion
on the MBI as the dependent variable and the independent variables of CPSE,
years of experience, weekly contact hours, client difficulty level (Category 1 and
3), age, and gender. The overall model was significant with an F(5.43), p > F =
0.0001. More specifically, significant main effects were shown for years of
experience and age. Nonsignificant effects were shown for CPSE, weekly
contact hours, Category 1 clients, Category 3 clients, and gender. Table 7
contains the source table for the model used to test the main effects with
emotional exhaustion as the dependent variable. Table 8 reflects the findings
using the regression model.
Model 2. The second model used to test hypotheses 1, 2, 3, and 4 was a
multiple regression equation which measured the level of depersonalization of the
MBI as the dependent variable and the independent variables of CPSE, years of
experience, weekly contact hours, client difficulty level (Category 1 and 3), age,

84
Table 5
Variables Included in Regression Models 1 and 2
Regression Model 1
Regression Model 2
Input Variables
Input Variables
CPSE
CPSE
Years Experience
Years Experience
Weekly Contact Hours
Weekly Contact Hours
Client Difficulty Level
Client Difficulty Level
Category 1
Category 1
Category 3
Category 3
Age
Age
Gender
Gender
Output Variable
Output Variable
Model 1
Model 2
MBI Score
MBI Score
Emotional Exhaustion (EE)
Depersonalization (DP)

85
Table 6
Variables Included in Regression Models 3 and 4
Regression Model 3
Input Variables
Regression Model 4
Input Variables
CPSE
Years Experience
Years Experience
Weekly Clinical Contact
Weekly Clinical Contact
Client Difficulty Level
Client Difficulty Level
Category 1
Category 1
Category 3
Category 3
Age
Age
Gender
Gender
Output Variable
Model 3
Output Variable
Model 4
MBI Score
Personal Accomplishment (PA)
Counselor Professional
Self-Efficacy Score
(CPSES)

86
Table 7
Source Table for the Model to Test the Main Effects with Emotional Exhaustion
as the Dependent Variable
Source
DF
Type IIISS
F Value
p Value
CPSE
1
274.8287
3.86
0.0505
Years Experience
1
396.9115
5.58
0.0189*
Weekly Contact Hours
1
17.4926
0.25
0.6204
Client Difficulty
Category 1
1
18.8640
0.27
0.6070
Category 3
1
217.5454
3.06
0.0816
Age
1
331.7198
4.66
0.0318*
Gender
1
0.0670
0.00
0.9755
*g < .05.

87
Table 8
Multiple Regression Analysis of Emotional Exhaustion by CPSE. Years of
Experience. Weekly Clinical Contact Hours. Client Difficulty Level (Category 1
and 3). Age, and Gender
Source R2 DF Sum of Mean F Pi>F
Squares Square Value
Model 0.13
7
2700.87
385.84
5.43
0.0001*
Error
246
17496.06
71.12
Corrected
Total
253
20196.93
Variable
R2
Parameter
Estimate
Standard
Error of Estimate
E
CPSE
0.01
-0.03
0.01
0.0505
Years of Experience
0.14
-0.21
0.09
0.0189*
Weekly Contact Hours
0.01
-0.03
0.05
0.6204
Client Difficulty Level
Category 1
0.01
-0.02
0.03
0.6070
Category 3
0.01
0.54
0.03
0.0816
Age
0.12
-0.16
0.08
0.0318*
Gender
Male
0.00
-0.03 B
1.11
0.9755
Female
0.00
0.00
0.00
0.0000
Intercept
37.23
6.35
0.0001*
*p < .05.

88
and gender. The overall model used identified significant results with an F(8.01),
g > F=0.0001. More specifically, significant main effects were shown for CPSE,
Category 3 clients, and age. Nonsignificant effects were shown for years of
experience, weekly contact hours, Category 1 clients, and gender. Table 9
contains the source table for the model used to test the main effect with
depersonalization as the dependent variable. Table 10 reflects the findings of
using the regression model.
Model 3. The third model used to test hypotheses 1, 2, 3, and 4 was also a
multiple regression equation developed to measure the level of personal
accomplishment of the MBI as the dependent variable and the independent
variables of CPSE, years of experience, weekly contact hours, client difficulty
level (Category 1 and 3), age, and gender. The overall model was significant with
an F( 10.05), p > F=0.001. More specifically, significant main effects were shown
for CPSE and weekly contact hours. Nonsignificant effects were shown for years
of experience, Category 1 and 3 clients, age, and gender. Table 11 contains the
source table for the model used to test the main effects with personal
accomplishment as the dependent variable. Table 12 reflects the findings of using
the regression model.
Model 4. Hypotheses 6, 7, 8, and 9 were tested by using one multiple
regression equation which measured professional self-efficacy strength on the
CPSE scale as the dependent variable and the independent variables of years of
experience, weekly clinical contact, client difficulty level (Category 1 and 3), age,
and gender. The overall model was significant with an F(3.00), g > F=0.0076.
More specifically, significant main effects were shown for years of experience,

89
Table 9
the Dependent Variable
Source
DF
Type HISS
F Value
p Value
CPSE
1
132.7125
9.97
0.0018*
Years Experience
1
26.0573
1.96
0.1630
Weekly Contact Hours
1
23.8641
1.79
0.1818
Client Difficulty
Category 1
1
6.0877
0.46
0.4995
Category 3
1
111.1992
8.35
0.0042*
Age
1
69.3303
5.21
0.0233*
Gender
1
27.5518
2.07
0.1515
*P < .05.

90
Table 10
Multiple Regression Analysis of Depersonalization bv CPSE. Years of
Experience. Weekly Clinical Contact Hours. Client Difficulty Level (Category 1
and 3). Age. and Gender
Source R2 DF
Sum of
Mean F
Pr>F
Squares
Square Value
Model 0.18 7
746.74
106.68 8.01
0.0001 =
Error 249
3314.50
13.31
Corrected
Total 256
4061.23
Variable
R2
Parameter
Standard
p
Estimate
Error of Estimate
CPSE
0.21
-0.02
0.01
0.0018*
Years of Experience
0.05
-0.05
0.04
0.1630
Weekly Contact Hours
0.05
-0.03
0.02
0.1818
Client Difficulty Level
Category 1
0.01
-0.01
0.01
0.4995
Category 3
0.19
0.04
0.01
0.0042*
Age
0.12
-0.07
0.03
0.0233*
Gender
Male
0.05
0.69 B
0.48
0.1515
Female
0.00
0.00
0.00
0.0000
Intercept
15.31 B
2.73
0.0001*
*2 < -05.

91
Table 11
Source Table for the Model to Test the Main Effects with Personal
Accomplishment as the Dependent Variable
Source
DF
Type IIISS
F Value
p Value
CPSE
1
705.4803
46.63
0.0001*
Years Experience
1
8.1931
0.54
0.4625
Weekly Contact Hours
1
124.3541
8.22
0.0045*
Client Difficulty
Category 1
1
5.3346
0.35
0.5532
Category 3
1
14.9768
0.99
0.3207
Age
1
0.1938
0.01
0.9100
Gender
1
11.9369
0.79
0.3753
*p < .05.

92
Table 12
Experience. Weeklv Clinical Contact Hours. Client Difficulty Level (Category 1
and 3). Age. and Gender
Source R2 DF
Sum of
Mean F
Pr>F
Squares
Square Value
Model 0.22 7
1063.99
152.00 10.05
0.0001s
Error 244
3691.20
15.13
Corrected
Total 251
4755.19
Variable
R2
Parameter
Standard
B
Estimate
Error of Estimate
CPSE
0.57
0.04
0.01
0.0001*
Years of Experience
0.01
0.03
0.04
0.4625
Weekly Contact Hours
0.19
0.07
0.02
0.0045*
Client Difficulty Level
Category 1
0.01
0.01
0.01
0.5532
Category 3
0.03
-0.01
0.01
0.3207
Age
0.00
0.00
0.03
0.9100
Gender
Male
0.02
-0.46 B
1.51
0.3753
Female
0.00
0.00
0.00
0.0000
Intercept
26.01 B
2.93
0.0001*
*p < .05.

93
age, and gender. Nonsignificant effects were shown for weekly contact hours
and Category 1 and 3 clients. Table 13 contains the source table for the model to
test the main effects with CPSE as the dependent variable. Table 14 reflects the
findings of using the regression model.
Analysis by Hypotheses
Hypothesis 1: The degree of professional self-efficacy does not predict
levels of burnout in marriage and family therapists.
Multiple regression models 1, 2, 3, and 4 were used to test this hypothesis
and to present statistical evidence to reject null hypothesis 1. In this study,
participants' levels of depersonalization and personal accomplishment were
predicted by the strength of professional self-efficacy and null hypothesis 1 was
rejected at the .05 level of significance. Levels of emotional exhaustion could not
be predicted by the strength of the counselor's professional self-efficacy.
Hypothesis 2: Experience level does not predict levels of burnout in
marriage and family therapists.
Multiple regression models 1, 2, 3, and 4 were used to test this hypothesis.
Levels of emotional exhaustion were predicted by experience level. Null
hypothesis 2, then, was rejected at the .05 preset alpha level. Participants' levels
of depersonalization and personal accomplishment could not be predicted by the
counselor's years of experience.
Hypothesis 3: The number of weekly clinical contact hours does not
predict levels of burnout in marriage and family therapists.
Models 1, 2, and 3, previously presented, were used to test this hypothesis.
Levels of personal accomplishment were predicted by the counselor's number of

94
Table 13
Source Table for the Model to Test the Main Effects with Counselor Professional
Self-Efficacv as the Dependent Variable
Source
DF
Type HISS
F Value
p Value
Years Experience
1
22267.6841
12.79
0.0004*
Weekly Contact Hours
1
278.8931
0.16
0.6893
Client Difficulty
Category 1
1
3986.6875
2.29
0.1315
Category 3
1
1241.7791
0.71
0.3991
Age
1
10832.5049
6.22
0.0133*
Gender
1
8123.2779
4.67
0.0317*
*j> < .05.

95
Table 14
Experience. Weekly Clinical Contact Hours. Client Difficulty Level (Category 1
and 31. Age. and Gender
Source R2 DF
Sum of
Mean
F
Pr>F
Squares
Square
Value
Model 0.07 6
31317.34
5219.56
3.00
0.0076*
Error 252
438693.82
1740.85
Corrected
Total 258
470011.16
Variable
R2
Parameter
Standard
P
Estimate
Error of Estimate
Years of Experience
0.23
1.55
0.43
0.0004*
Weekly Contact Hours
0.00
0.10
0.25
0.6894
Client Difficulty Level
Category 1
0.05
0.22
0.14
0.1315
Category 3
0.02
0.13
0.15
0.3991
Age
0.13
-0.90
0.36
0.0133*
Gender
Male
0.10
-11.67 B
5.40
0.0317*
Female
0.00
0.00
0.00
0.0000
Intercept
381.83
19.83
0.0001*
*p < .05.

96
weekly clinical contact hours, thus rejecting null hypothesis 3. Participants' levels
of emotional exhaustion and depersonalization, however, could not be predicted
by the counselor's weekly clinical contact hours.
Hypothesis 4: The difficulty of the client(s) does not predict levels of
burnout in marriage and family therapists.
Multiple regression models 1, 2, 3, and 4 were used to test this hypothesis,
and the results of testing presented statistical evidence to reject null hypothesis 4.
Levels of depersonalization were predicted by Category 3 clients. Participants'
levels of emotional exhaustion and personal accomplishment could not be
predicted by the difficulty level of the client (Category 1 or 3).
Hypothesis 5: Age, gender and race/ethnicity do not predict levels of
burnout in marriage and family therapists.
As indicated earlier, race/ethnicity were dropped as a relevant variable in
this study due to a small response rate. Multiple regression models 1, 2, 3, and 4
were used to test this hypothesis, and null hypothesis 5 was rejected at the .05
level of significance. Levels of emotional exhaustion and depersonalization were
predicted by age in this study but could not be predicted by gender. Levels of
personal accomplishment could not be predicted by age nor gender.
Hypothesis 6: Experience level does not predict the degree of professional
self-efficacy.
Model 4 was used to test this hypothesis, and the results of testing
presented evidence to reject null hypothesis 6. Strength of professional self-
efficacy was predicted by years of experience. Thus, null hypothesis 6 was
rejected.

97
Hypothesis 7: The number of clinical contact hours does not predict the
degree of professional self-efficacy in marriage and family therapists.
Multiple regression model 4 was used to test this hypothesis, and the
results of testing presented no significant statistical evidence to reject null
hypothesis 7. The strength of professional self-efficacy was not predicted by the
number of weekly clinical contact hours. Thus, the results of testing failed to
reject null hypothesis 6 at the alpha level set.
Hypothesis 8: The difficulty of the client(s) does not predict the degree of
professional self-efficacy in marriage and family therapists.
Multiple regression model 4 was used to test this hypothesis, and the
results of testing presented no significant statistical evidence to reject null
hypothesis 8. The strength of professional self-efficacy was not predicted by the
difficulty of the client(s). Thus, the results of testing failed to reject null
hypothesis 8 at the .05 significance level.
Hypothesis 9: Age, gender, and race/ethnicity do not predict the degree of
professional self-efficacy in marriage and family therapists.
As indicated earlier, the researcher dropped race/ethnicity as a relevant
variable in this study due to a small response rate. Model 4 was used to test this
hypothesis and to present enough significant statistical evidence to reject null
hypothesis 9. Strength of professional self-efficacy was predicted by both the
age and gender of participants in this study, and null hypothesis 9 was rejected.
Chapter Summary
In this chapter the researcher has presented a discussion of the procedures
for data collection, associated rates of return, decision rules, data analysis, and

98
results of this research. Estimates of reliability on both research measures were
presented. Finally, outcome testing to accept or reject the study's nine null
hypotheses was examined. Statistical evidence derived from the analysis of data
supported the rejection of hypotheses 1, 2, 3, 4, 5, 6, and 9.

CHAPTER V
DISCUSSION
In this study the researcher assessed levels of burnout experienced by
marriage and family therapists. Additionally, the strength of professional self-
efficacy in these professionals was measured. This investigation sought to
expand the knowledge of burnout in marriage and family therapists and
evaluated the role of professional self-efficacy in burnout as postulated by
theorists espousing to the self-efficacy theory. In this chapter a review of the
research sample, the limitations of the study, a discussion of the results of testing
using each regression model, implications of the study, and recommendations for
future research are presented.
The Research Sample
Five hundred survey packets were sent to a computer-generated national
random sample of clinical members of the American Association for Marriage and
Family Therapists. The survey packet consisted of the Maslach Burnout
Inventory (MBI) and the Counselor Professional Self-Efficacy Scale (CPSES)
along with a demographic inventory. The survey packet was distributed by first-
class mail in three parts over a 3-week period. In a sequence of 1-week intervals,
the research sample were sent a cover letter and research questionnaire, a follow¬
up letter, and a second cover letter and research questionnaire.
99

100
Participant response was designed to be anonymous by prestamped and
self-addressed envelopes. A total of 307 research packets were returned. After
observing requests for nonparticipation, incomplete packets, those indicating
retired status, those received after the cutoff date, and incorrect addresses, a total
of 266 usable questionnaires remained eligible for use in the data analysis.
The information from the demographic sheet regarding the subjects who
participated in this study generated the following data:
Of the 266 total respondents in this study, 152 (57.4%) were male and 113
(42.6%) female. The mean age was 54. Of the respondents, 80 (30.1%) indicated
holding an M.A. or M.S., 3 (1.1%) a Psy.D., 88 (33.1%) a Ph.D., 26 (9.8%) an
Ed.D., 1 (0.4%) an M.D., and 68 (25.6%) fell into the Other category. The number
of years of experience was described as the total number of years of postgraduate
experience in the counseling profession. The mean total years of experience of
the participants was 20.06 years. Of these total years, the mean number of years
in direct clinical contact was 19.71. It is interesting to note that respondents gave
essentially the same answer to both questions (with a .05 difference between the
two questions), resulting in the elimination of years in direct clinical contact for
further analysis in this study.
The mean number of direct clinical contact hours for the participants per
week was reported at 19.68. The racial/ethnic background for the subjects in this
study was predominately (a) Caucasian (92.1%), (b) with those of Native
American background accounting for 3.4%, (c) those with Hispanic background
accounting for 1.1%, (d) those with African-American background accounting for

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0.8%, (e) those with Asian background accounting for 0.8%, and (f) those who
marked Other 1.9%.
The difficulty level of participants' client(s) was divided into three
categories. Category 1 indicated mild impairment in functioning; Category 2
indicated moderate impairment in functioning; and Category 3 indicated severe
impairment in functioning. Respondents indicated seeing clients in an average of
34% in Category 1, 44% in Category 2, and 22% in Category 3. Due to high
negative intercorrelations between Categories 1, 2, and 3, Category 2 was
eliminated for further analysis in this study.
In conclusion, the average marriage and family therapist who responded to
surveys and research instruments used in this study was Caucasian, in his/her mid
50s, holding an M.A., M.S., or Ph.D. and had been in practice for 20 years. The
individual was actively involved in clinical practice seeing an average of 20
clients per week. Of the clients seen by the average participant, 34% were mildly
impaired, 44% were moderately impaired, and 22% severely impaired in their level
of functioning.
Limitations of the Study
Limitations are inherent in survey research and, thus, may have affected
the outcome of this study. For example, since measures of burnout were obtained
by self-report, mail-in questionnaires, the resultant sample constituted a volunteer
sample. As such, those professionals who may have been experiencing higher
levels of burnout may be less motivated to complete the materials. Likewise,
professionals who may be experiencing lower degrees of professional self-
efficacy may not perceive they are making an impact by responding.

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Second, through restricting the sampled subjects to a specifically defined
population (professionals who are clinical members of the AAMFT), the
conclusions are limited to this defined population and are not necessarily
generalizable beyond this population.
Third, the average age of the respondent was 54. Thus, the relationships
among variables reported in this study may be skewed toward those older
practitioners who may feel more efficacious in their profession.
Fourth, methodological limitations exist due to a self-report format. The
selection of a widely known and used instrument to measure burnout with
appropriate reliability estimates and validity coefficients was done to reduce the
potential limitations. Since no instrument existed to measure strength of
professional self-efficacy, the Counselor Professional Self-Efficacy Scale was
constructed and tested by the researcher for this investigation. Internal
consistency measures were reported at 0.95 significance level. Further evaluation
of this newly constructed instrument needs to be undertaken with similar
populations as this is the first and only trial for this instrument.
Finally, self-report responses are subject to biases, dishonest responses, and
limitations in understanding.
Discussion of Results
Four regression models were developed and used to evaluate the data
generated by the marriage and family therapist respondents on the two research
instruments and the demographic inventory. Regression equation 1 (Model 1)
was used to measure the prediction of emotional exhaustion level based on
professional self-efficacy strength, years of experience, weekly clinical contact

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hours, client difficulty level (i.e., Category 1 and 3), age, and gender. The
participants' level of depersonalization was investigated as the criterion variable
in Model 2 with professional self-efficacy strength, years of experience, weekly
clinical contact hours, client difficulty level (i.e., Category 1 and 3), age, and
gender as independent predictor variables. Regression equation 3 (Model 3) was
used to measure the prediction of personal accomplishment level based on
professional self-efficacy strength, years of experience, weekly clinical contact
hours, client difficulty level (i.e., Category 1 and 3), age, and gender. The fourth
multiple regression (Model 4) was used to measure the prediction of professional
self-efficacy strength based on years of experience, weekly clinical contact hours,
client difficulty level (i.e., Category 1 and 3), age, and gender.
Dependent variable data were derived from the three subscale scores of
the Maslach Burnout Inventory (MBI): (a) emotional exhaustion, (b)
depersonalization, and (c) personal accomplishment. The MBI is based on the
concept that burnout is a syndrome of emotional exhaustion, depersonalization,
and reduced personal accomplishment that can occur among individuals who
work with people in some capacity (Maslach & Jackson, 1984b, 1986). It is a
progressive response to chronic stress that occurs over time and ranges from low
to moderate to high degrees of experienced feelings (Maslach & Jackson, 1993).
Emotional exhaustion refers to feelings of being emotionally overextended and
drained by one's contact with people. Depersonalization refers to an unfeeling
and callous response toward the people who are often the recipients of one's
care. Reduced personal accomplishment refers to a decline in one's feelings of

104
competence and successful achievement in one's work with people (Maslach &
Jackson, 1986).
The mean score for emotional exhaustion in the research sample was 15.26
suggesting moderate levels of emotional exhaustion. This is within the range of
previously reported measures in similar populations.
The mean score for depersonalization in the research sample was 4.23
indicating a moderate level of depersonalization. This score also is within range
of previously reported measures in similar populations.
The mean score for personal accomplishment in the research sample was
42.82 indicating a low level of personal accomplishment. This score is in the low
range of experienced burnout (meaning they had a high sense of perceived
accomplishment) and within range of previously reported measures in similar
populations.
The mean score of the 266 respondents on the CPSE scale was 368.94
suggesting a moderate strength of professional self-efficacy. This is congruent
with moderate emotional exhaustion, depersonalization and low personal
accomplishment scores. The higher the strength of PSE, the lower the emotional
exhaustion and depersonalization expected and the lower sense of personal
accomplishment expected.
Model 1 (Hypotheses 1. 2. 3. and 41
Hypotheses 1, 2, 3, and 4 were tested by the use of three regression
equations, one for each subscale of the MBI. The first model was used to
evaluate the predictive qualities of the independent variables of CPSE, years of
experience, weekly contact hours, client difficulty level (Category 1 and 3), age,

105
and gender with the level of emotional exhaustion the dependent variable.
Results of the multiple regression procedure used established a statistically
significant (p = .0001) main effect for the model as a whole. Specifically, as a
result of testing, significant main effects were shown for years of experience and
age. This suggests that years of experience and age were the strongest predictors
of the level of emotional exhaustion reported by participants. It seems to make
sense that the more years of experience one has in the field and the older one is,
the better coping mechanism one may develop, thus attributing to a lower
emotional exhaustion score. Unlike the study by Pines and Maslach (1978)
indicating the longer the mental health professionals worked in the field the less
contact they had with clients, the current study results indicated the practitioner's
years of experience was practically equivalent with consistent client contact. The
findings of this current study support previous studies denoting a significant (p <
.05) negative relationship between years of experience in an individual's
profession and the level of emotional exhaustion reported (Ackerley et al., 1988;
Farber, 1985; Ross, Altmaier, & Russell, 1989).
Consistent with other studies (Ackerley et al., 1988; Huberty & Huebner,
1988), findings in this study also demonstrated a significant negative relationship
between age and levels of emotional exhaustion. These findings further support
Maslach's (1982a) position that "as people increase in age, they are more stable
and mature, have more balanced perspectives on life, and are less prone to
excesses of burnout" (p. 60). As a result of testing, nonsignificant effects were
revealed for CPSE, weekly contact hours, Category 1 and 3 clients, and gender.

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Model 2 (Hypotheses 1. 2. 3. 4. and 5)
Multiple regression equation 2 was used to evaluate the predictive
qualities of the independent variables of CPSE, years of experience, weekly
contact hours, client difficulty level (Category 1 and 3), age, and gender with the
level of depersonalization as the dependent variable. Results of the multiple
regression procedure used established a significant (p = .0001) main effect for the
model as a whole. Specifically, significant main effects were reported for CPSE,
Category 3 clients, and age. This indicated that CPSE, Category 3 clients, and
age are the strongest predictors of the level of depersonalization experienced by
respondents in this study.
Findings of this study support the concept of professional self-efficacy
suggested by Chemiss (1993) in that it demonstrates that the strength of
professional self-efficacy is a strong predictor of the depersonalization level.
Depersonalization refers to an unfeeling and callous response towards people
with which one interacts. Chemiss (1993) suggested that one's competence in
interacting successfully with one's environment (i.e., clients, counselors,
supervisors) may predict levels of burnout.
The stronger one's perceived sense of competence in performing one's
professional role, the more able one is in interacting successfully with one's
recipients. Traux (1966) suggested that effectiveness in psychotherapy
counseling is strongly influenced by the degree to which the helper expresses
authenticity, positive regard, and empathy. Thus, high professional self-efficacy
may be a strong predictor of one's ability to be successful in maintaining a helping
relationship.

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Furthermore, in this study, counselor professional self-efficacy was
negatively correlated with depersonalization indicating the higher the strength of
professional self-efficacy, the lower the score on depersonalization. In support of
the self-efficacy theory, Bandura (1986) stated that individuals possess beliefs
that enable them to exercise a measure of control over their thoughts, feelings,
and actions, and that "what people think, believe, and feel affects how they
behave" (p. 25). Therefore, the more competent one feels about performing one's
professional role, one would expect that this would influence how he/she would
behave (in this case, interact with clients, coworkers, supervisors).
In addition, clients seen by participants in this study in Category 3 had a
positive significant relationship with levels of depersonalization. This indicated
that clients in the severe category of functioning were related to high levels of
depersonalization reported by respondents. This finding concurs with previous
studies that also reported high levels of depersonalization as being correlated
with higher levels of negative client behavior (Ackerley et al., 1988; Koeske &
Koeske, 1989). It should be noted that the age of the participants in this study
was negatively correlated with depersonalization indicating that the older the
participant, the less depersonalization experienced. This further supports
Maslach's (1982a) findings.
Finally, nonsignificant main effects were shown for years of experience,
weekly contact hours, Category 1 clients, and gender.
Model 3 (Hypotheses 1. 2. 3. 4. and 5)
Multiple regression equation 3 was used to evaluate the predictive
qualities of the independent variables of CPSE, years of experience, weekly

108
contact hours, client difficulty level (Category 1 and 3), age, and gender with the
level of personal accomplishment. Results of the multiple regression procedure
established a significant (p = .0001) main effect for the model as a whole.
Specifically, significant main effects were shown for CPSE and weekly contact
hours. This connotes that CPSE and weekly contact hours were the strongest
predictors of the level of personal accomplishment experienced by respondents in
this study.
Furthermore, findings in this study suggest that the stronger the CPSE
score, the lower the personal accomplishment level (meaning the respondent had
a high sense of accomplishment). This supports the self-efficacy theory which
proposes that the stronger a person's perceived self-efficacy, the more persistent
he/she is in efforts to master challenge, thus leading to high performance
attainments (Bandura & Cervone, 1983, 1986). Positive self-precepts of efficacy,
therefore, enhance personal growth and competencies and promote higher
personal accomplishments. Personal accomplishment here refers to one's feelings
of competence and successful achievement in one's work with people (Maslach
& Jackson, 1986).
In addition, the results of this investigation indicate that the number of
hours in direct clinical contact is a strong predictor of level of personal
accomplishment. This is one of the most highly researched correlates of burnout
as depicted in the literature. Weekly contact hours in this study was significantly,
positively correlated with levels of personal accomplishment suggesting that the
more clients one sees weekly, the higher the level of personal accomplishment.
Unlike earlier studies (Levinston, Conley, & Blessing-Moore, 1981, as cited in

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Maslach & Florian, 1988; Maslach & Jackson, 1982; Savicki & Cooley, 1983),
denoting that as the amount of client contact increases, either in terms of a higher
case load or a greater percentage of time spent in direct contact with clients,
burnout is more likely to occur, the results of testing in this investigation revealed
only one significant positive relationship, that between weekly contact hours and
personal accomplishment and no significant relationships between weekly
contact hours and emotional exhaustion or depersonalization were found. Similar
findings have been presented by Koeske and Koeske (1989).
Finally, nonsignificant main effects were shown for years of experience,
Category 1 and 3 clients, age, and gender.
Model 4 (Hypotheses 6. 7. and 8)
Multiple regression model 4 was used to test the predictive qualities of the
independent variables of years of experience, weekly contact hours, client
difficulty level (Category 1 and 3), age, and gender with the strength of counselor
professional self-efficacy as the dependent variable. Results of the multiple
regression procedure established a significant (p = .0076) main effect for the
model as a whole. Specifically, significant main effects were shown for years of
experience, age, and gender. This indicates that years of experience, age, and
gender are the strongest predictors of the strength of professional self-efficacy
reported by the respondents in this study. It would seem probable that age and
years of experience would strongly predict a person's self-efficacy in that as one
gets older and attains more experience in the field, the more successful he/she
would see oneself in performing the role competently.

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Gender was a strong predictor of counselor professional self-efficacy in
this investigation. Gender differences are likely to arise in response to gender-
stereotypical tasks, activities, and careers, that is, in domains where women are
unlikely to have efficacy-building experiences or in which gender-role pressures
may undermine perceived efficacy (Betz & Hackett, 1983).
It should be noted that CPSE scores were negatively, significantly
correlated with the depersonalization subscale of the MBI. Therefore, the
stronger the respondent's sense of professional self-efficacy, the lower his/her
depersonalization score. In addition, CPSE was positively significantly correlated
with personal accomplishment. The stronger the respondent's sense of
professional self-efficacy, the lower his/her personal accomplishment score
(indicating a high sense of personal accomplishment). The above findings
support the theory that professional self-efficacy is correlated with levels of
burnout, a concept proposed by Cherniss (1993) based on self-efficacy theory
tested in this study. No significant main effects were shown for weekly contact
hours or client difficulty level (Category 1 and 3) in this study.
In conclusion, hypotheses 1, 2, 3, 4, 5, 6, and 9 were rejected. The results of
testing failed to reject null hypotheses 7 and 8. Professional self-efficacy strongly
predicted depersonalization and personal accomplishment but not levels of
emotional exhaustion among the participants in this study. Years of experience
predicted emotional exhaustion; however, it did not predict depersonalization or
personal accomplishment levels. The results of testing revealed that weekly
clinical contact hours predicted personal accomplishment but not emotional
exhaustion or depersonalization levels. The difficulty level of client (Category 3)

Ill
predicted depersonalization but did not predict levels of emotional exhaustion
and personal accomplishment. Age predicted levels of emotional exhaustion and
depersonalization while gender did not predict level of emotional exhaustion and
depersonalization. Age and gender did predict personal accomplishment levels in
this study. Years of experience, age, and gender predicted professional self-
efficacy. Weekly contact hours and Category 1 and 3 clients did not predict
professional self-efficacy in this study.
Implications of the Findings and Recommendations
Completion of this research has added to an increased understanding of
the role of counselor professional self-efficacy in the burnout process and will
have contributed to a better understanding of marriage and family therapists.
There are several implications for theory, training, practice, and further research
resulting from the findings of this study.
Implications for Theory
The results of this investigation support the existence of an empirical link
between professional self-efficacy and burnout coinciding with Bandura's (1989)
self-efficacy theory. This conceptual link has been discussed by Chemiss (1989a,
1992) and has been reinforced by the earlier works of Hall (1976) and Lewin
(1936).
Bandura (1989) defined perceived self-efficacy as "people's beliefs about
their capabilities to exercise control over events that affect their lives" (p. 175).
He showed that stronger self-efficacy leads to setting more ambitious goals and
leads to more effort and persistence in pursuing these goals. In addition, his
research has suggested strong links between self-efficacy and stress. Bandura

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asserted that people with stronger professional self-efficacy experience less stress
in taxing situations, and the situations are less stressful when people believe they
can cope successfully with them. Due to the fact that burnout is typically
regarded as a reaction to stressful situations, the relationship between self-
efficacy and stress has suggested a link between self-efficacy and burnout as
well. Bandura further suggested that perceived self-efficacy involves cognitive,
affects, and behavior aspects of a person. Our strength of efficacy in a particular
domain of functioning then may contribute to how we think about ourselves,
how we react in stressful situations, and may contribute to the behavior we
choose to exhibit. A pivotal concern which may contribute to burnout is the idea
that one is losing one's belief in one's ability to perform his/her professional role in
a range of competency. As such, one's strength of professional self-efficacy may
suggest levels of experienced burnout. This investigation sought to determine if
professional self-efficacy played a role in contributing to explain the burnout
phenomenon. The results indicate that counselor professional self-efficacy
strongly predicts the therapist's level of depersonalization and personal
accomplishment. High professional self-efficacy scores predict low
depersonalization scores. This suggests that the more competent the therapist
perceived himself/herself to be, the lower his/her level of depersonalization on the
MBI. In addition, low personal accomplishment scores (indicating a high sense of
personal accomplishment) were predicted by high professional self-efficacy
scores.
It is interesting to note that multiple regression models 1, 2, 3, and 4, which
were used to test the variables in this study, were all significant at the 0.0001

113
alpha level in predicting the emotional exhaustion, depersonalization, and
personal accomplishment subscales of the MBI. The variables tested in these
models included counselor professional self-efficacy, years of experience, direct
weekly contact hours, difficulty of the client(s) (Category 1 and 3), age, and
gender. More specifically, professional self-efficacy was a strong predictor of
depersonalization and personal accomplishment.
In addition, professional self-efficacy was significantly, positively
correlated with personal accomplishment and significantly negatively correlated
with depersonalization as well as emotional exhaustion. According to theory
(Bandura, 1989), one would expect a strong sense of professional self-efficacy to
be strongly predictive of high levels of personal accomplishment, low levels of
depersonalization, and low levels of emotional exhaustion.
It should be acknowledged that emotional exhaustion is considered to
have the greatest impact in contributing to burnout, with personal
accomplishment second, and depersonalization having the least overall impact on
experienced burnout (Golembiewski & Munzenrider, 1988).
The results of this study indicate that those marriage and family therapists
participating have a moderate level of emotional exhaustion. Golembiewski and
Munzenrider (1988) suggested that emotional exhaustion is the most potent
contributor to burnout and that it should be considered as a concern if it is in the
moderate range and certainly in the high range of the subscale.
In summary, this investigation has provided some empirical evidence to
support a linkage between professional self-efficacy and burnout based on

114
Bandura's (1989) self-efficacy theory. Further investigations confirming this
linkage should be undertaken.
Implications for Training and Practice
The findings of this study indicate that professional self-efficacy predicts
levels of depersonalization and personal accomplishment, two aspects of the
burnout syndrome. Again, all four regression models used to test variables in this
study were significant at the .0001 level in predicting aspects of the burnout
syndrome. It would seem, then, that finding ways to increase or enhance
counselor professional self-efficacy may prevent high levels of experienced
burnout among mental health care providers. Counselor professional self-efficacy
has been defined as the counselor's perceived competency to perform his/her
professional role in three areas of the professional domain: the task, interpersonal,
and the organizational. Each area is discussed, along with suggested ways to
increase strength in each aspect below.
Increasing self-efficacy in the task domain may include ongoing training in
assessment, diagnostic, helper, and treatment skills. Updating these skills is a
continuous process which must be emphasized in mental health service provider
training programs and in settings in which one is providing services. Many
assessment tools are available in print which help the practitioner gain a picture of
the individuals, couple, or family and make critical judgments with regard to
immediate treatment. Emphasis in crisis management of difficult clients is a must
as more people are accessing mental health care.
Marriage and family practitioners, although schooled in a systemic model,
must be competent in applying DSM-IV diagnosis in the care of their clients. This

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diagnosis is important in that it serves as a universal language in which all
persons providing services to the client(s) can communicate. Counselor
preparation programs should move to incorporate the DSM-IV diagnosis in
marriage and family assessment courses.
With regard to treatment issues, continued education about brief therapy
models is inevitable. More importantly, the therapist's belief in this concept is
critical. Marriage and family therapists in training should be taught brief therapy
models and be able to apply the models with a variety of cases from beginning to
the end of treatment. The therapist should become familiar with implementing
outcome studies with agreed-upon and measurable goals in order to chart a
client's progress. This helps the client(s) and therapist to see progress and meet
treatment goals established at the onset of therapy.
Further, with regard to helper skills, receiving feedback from client(s)
regarding the perceived level of care demonstrated by the therapist can be
enhancing. At the conclusion of the therapy process a check-off can be
completed by the client to provide such feedback. This can also be done in a
group setting where the therapist receives feedback from clients in verbal form.
Finally, marriage and family therapists should be encouraged to keep a
treatment notebook with a variety of ways to work with difficult clients. Helping
professionals need to learn how to better form a mental picture of themselves and
their ability to assess, diagnose, and treat client(s), recognizing their own
limitations and emphasizing this aspect of professional development as a
continuous process throughout their professional life span.

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With regard to the interpersonal domain, which refers to the counselor's
perceived ability to interact with client(s), coworkers, and supervisors, the
following may be useful in increasing professional self-efficacy. First, the
practitioner must become aware of his/her interpersonal style and its effect on
others. This can be attained through the use of small groups in combination with
interpersonal training. This would allow individuals to give and receive feedback
openly on how each is experienced by the group. This can help the practitioner
understand him/herself better and how to relate more effectively with others.
Again, this type of professional growth experience should be encouraged
throughout the professional life span.
Secondly, effective consultation skills are a must in the mental health
industry as it continues to evolve. More and more mental health practitioners are
interacting with a variety of disciplines in an effort to provide quality care to
his/her client(s). Collaboration with other providers of care is becoming more
common as more difficult-to-treat clients are presenting with mental health issues
and more clients are obtaining mental health services via use of managed care
products.
Assertiveness training may be helpful as well. Mental health practitioners
are finding themselves interacting with professionals from a variety of disciplines
(i.e., psychiatry, psychology, medicine, dentistry, etc.) and lacking assertiveness
skills due to perceived societal hierarchical standards. Assertiveness skills can be
addressed in training by the use of role plays, interviewing professionals within
other disciplines, and the use of multidisciplinary treatment teams in mental health
care settings.

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Third, professional self-efficacy can be enhanced by learning to make an
impact in the setting in which the practitioner works or professional organizations
in which one belongs. This can be obtained by developing leadership skills
through the use of workshops or advanced course work. In addition, learning
goal setting and planning skills could be incorporated into training programs.
Continued encouragement in professional organizations and active involvement
in one's community are other ways to promote high professional self-efficacy.
It is important for professionals in training to become familiar with
recognizing healthy working environments as well. Environments that provide
professional development opportunities, encourage the practitioner to expand his
or her repertoire by providing continuing educational moneys, and provide
opportunities for autonomy are some of the things to look for in a healthy
environment.
Furthermore, Bandura (1982) suggested three ways of enhancing
professional self-efficacy. First, he suggested that the most direct and important
way is through performance mastery experience. For example, marriage and
family therapists who successfully implement changes in the organization in
which they belong or interact or who are successful in interacting with clients,
coworkers, and/or supervisors are likely to believe they can do this again.
Secondly, Bandura suggested vicarious experiences as a mechanism for
developing professional self-efficacy. For instance, if a professional sees a
colleague, perceived with similar ability, make changes and succeed in the system
or with a client, coworker, and/or supervisor, the professional in question may
develop greater professional self-efficacy. One way this can be addressed in the

118
profession is through the use of mentoring, peer supervision, and the
development of study clubs and personal support groups outside one's work
setting.
Finally, although regarded as less effective than the above, Bandura
asserted verbal persuasion and other types of social influences as a final way of
enhancing self-efficacy.
Implications for Further Research
There are several directions for future research based on the results of this
study. First, it has been suggested by other researchers that multiple measures of
burnout be employed. Future studies could use multiple measures to assess the
dependent variable, thus giving a fuller measure of this complex syndrome.
Secondly, due to a low response rate (26 total) in nonwhite respondents, further
research might employ a larger, more diverse population to determine if significant
differences exist in burnout levels and to test the predictor qualities of the
variables in this study in a comparison of nonwhites to the Caucasian race.
Third, since no national studies have been undertaken to study burnout in
marriage and family therapists, future research should be done to determine if
burnout levels are moderate as well. Comparisons could be made between
marriage and family therapists and other mental health practitioners to determine
if theoretical orientation is responsible for differences in burnout levels.
Fourth, qualitative responses in how to cope with burnout and what
contributes to high self-efficacy could be valuable to this study. These responses
could shed light on strategies that may be employed to prevent burnout. Finally,
future studies might further test the predictor quality of professional self-efficacy

119
and emotional exhaustion to determine if the variations found in this study were
due to sampling or other types of error.
Further studies need to be employed to support the internal consistency of
the Counselor Professional Self-Efficacy Scale to be used in future studies. This
could also help to determine further the most appropriate cutoff points for the
scale. Furthermore, similar studies with similar populations should be undertaken
to test further the linkage of professional self-efficacy to experienced burnout
based on social cognitive theory.
Other measures of professional self-efficacy specific to the professions
being studied should be undertaken to determine predicting quality of the
concept of professional self-efficacy to burnout in other professional realms.
Chapter Summary
A discussion was presented in this chapter of the results of the statistical
analysis of dependent variables (a) emotional exhaustion, (b) depersonalization,
(c) personal accomplishment and the independent variables of (a) counselor
professional self-efficacy, (b) experience level, (c) weekly client contact hours, (d)
client difficulty level, (e) age, and (f) gender. Finally, implications of the results
were discussed with regard to theory, training, practice, and research.

APPENDIX A
DEMOGRAPHIC QUESTIONNAIRE
1. Age: (years)
2. Gender: (circle one) (l)Male (2) Female
3. Ethnic background: (circle one)
l=Native American
4=African American
2=Caucasian
5=Hispanic
3=Asian
6=Other
4. Highest academic degree: (circle one)
1=M.A. or M.S.
4=Ed.D.
2=Psy.D.
5=M.D.
3=Ph.D.
6=Other
5. How many total hours per week (on the average) do you spend in direct
face-to-face contact with individuals, couples, families, or in group
therapy?
Please select the statement that best indicates your satisfaction with
the number of client contact hours you see.
I would like to see more clinical contact hours.
I would like to see less clinical contact hours.
I am satisfied with the current number of clinical hours I see.
120

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6. How many total years of post-graduate experience do you have in the
counseling profession?
year(s)
Out of these total years (post-graduate), how many years of face-to-face
clinical experience do you have?
year(s)
7. Listed below are different categories which describe functioning levels of
individuals, couples, or families using the GAF in the DSM IV (1994) and
family literature. In the space provided indicate the average percent of
client(s) you see in that category. (Note: Total should equal 100%.)
Category I Mild impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. If present, symptoms are transient and in
response to psychosocial stressors. Generally, individuals,
families or couples in this category function pretty well with
slight difficulty in a few areas of life.
%
Category II Moderate impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. Moderate symptoms may include flat
affect, depressed mood, occasional panic attack. Generally,
individuals, couples, or families in this category have mild to
moderate difficulty functioning in some areas of life.
Category III Serious to severe impairment in problem-solving capabilities,
communication, role flexibility, affective responsiveness,
behavioral control. Serious to severe symptoms may include
suicidal gestures or ideations, recurrent violence, reality
impairment, obsessions, frequent shoplifting, frequent
boundary testing. Generally, individuals, couples, or families
in this category have difficulty functioning in most areas of
life.
%
100% Total

122
8.Recent literature has indicated that the role of the marriage and family
therapist is expanding and taking on new dimensions due to health care
reform. As such, the profession continues to thrive in an environment of
economic and social uncertainty. Keeping this in mind, please circle the
number that indicates how confident you are in your ability to respond to
these changes.
0123456789 10
< >
No Moderate Complete
Confidence Confidence Confidence
OPTIONAL
The following questions are included to give you an opportunity to discuss your
experiences and make suggestions helpful to the study.
9.What do you do to cope with stress associated with your professional
role?
10.How do you feel about the future of the counseling profession?
THANK YOU VERY MUCH FOR YOUR COOPERATION.
PLEASE MAKE SURE YOU HAVE ANSWERED ALL THE QUESTIONS.
RETURN THE MATERIALS IN THE ENCLOSED SELF-ADDRESSED
STAMPED ENVELOPE.

APPENDIX B
HUMAN SERVICES SURVEY
HOW OFTEN:
0
1
2
3
4
5
6
Never
A few times
Once a
A few
Once a
A few
Every
times a year
month
times
week
times
day
or less
or less
a month
a week
HOW OFTEN
0-6 Statements:
1. I feel emotionally drained from my work.
2. I feel used up at the end of the work day.
3. I feel fatigued when I get up in the morning and have to face another day on
the job.
4. I can easily understand how my recipients feel about things.
5. I feel I treat some recipients as if they were impersonal objects.
6. Working with people all day is really a strain for me.
7. I deal very effectively with the problems of my recipients.
8. I feel burned out from my work.
9. I feel I'm positively influencing other people's lives through my work.
10. I've become more callous toward people since I took this job.
11. I worry that this job is hardening me emotionally.
12. I feel very energetic.
13. I feel frustrated by my job.
123

124
HOW OFTEN:
0
Never
1 2 3 4 5 6
A few times Once a A few Once a A few Every
times a year month times week times day
or less or less a month a week
14. I feel I'm working too hard on my job.
15. I don’t really care what happens to some recipients.
16. Working with people directly puts too much stress on me.
17. I can easily create a relaxed atmosphere with my recipients.
18. I feel exhilarated after working closely with my recipients.
19. I have accomplished many worthwhile things in this job.
20. I feel like I'm at the end of my rope.
21. In work, I deal with emotional problems very calmly.
22. I feel recipients blame me for some of their problems.
(administrative use only)
EE: DP: PA:

APPENDIX C
COUNSELOR PROFESSIONAL SELF-EFFICACY SCALE
Listed below are tasks that have been identified as comprising marriage and
family therapists' professional work roles. Read through the list and think about
your degree of confidence in your ability to perform the task given in each item.
Place a number in the blank to the right of the item indicating the degree of
confidence in your ability to successfully perform that behavior. Use the
following scale to make your ratings.
0123456789 10
No Moderate Complete
Confidence Confidence Confidence
You must use one of the numbers listed above (e.g., 0, 1,2, etc.) to make your
rating. NOTICE that all ratings after "0" represent increasing levels of confidence.
Strength
Column
1. Writing or dictating case notes.
2. Collecting pertinent clinical data.
3. Providing individual counseling.
4. Providing marital counseling.
5. Providing family counseling.
6. Assessing an individual's mental health needs.
7. Assessing a couple's mental health needs.
8. Assessing a family's mental health needs.
9. Accurately diagnosing individuals.
10. Accurately diagnosing couples.
125

11. Accurately diagnosing families.
12. Accurately identifying client's personal and
interactive problems.
13. Using the DSM-IV in making a diagnosis.
14. Using recent technology (i.e., e-mail, fax, computer)
in the organization, agency, or practice in which I work.
15. Providing crisis intervention.
16. Making a difference in my client's life.
17. Formulating treatment plans appropriate to the
presenting problem.
18. Writing measurable behavioral objectives based on a
formulated treatment plan.
19. Delivering treatment interventions to the
individual, couple, or family.
20. Treating a variety of presenting problems.
21. Measuring individual's, couple's, and family's
progress towards their treatment goals.
22. Interpreting and applying the mental health laws in
the state in which I practice.
23. Establishing a therapeutic relationship with a variety
of clients.
24. Listening actively to my clients.
25. Maintaining therapeutic relationships.
26. Expressing caring to my clients.
27. Expressing a sense of respect to my clients.
28. Expressing warmth to my clients.
29. Expressing empathy to my clients.
30. Communicating a sense of competency/authority/
trustworthiness to my clients.

127
31. Collaborating and consulting with colleagues
about cases.
32. Relating to colleagues professionally.
33. Communicating effectively with other professionals
(i.e., other therapists, psychiatrists, psychologists
etc.).
34. Gaining support from coworkers/supervisors.
35. Accepting supervisory/colleague feedback.
36. Asking my supervisor/colleagues for assistance
when needed.
37. Coordinating referrals to other professionals when
appropriate.
38. Demonstrating a sense of respect to my colleagues
and/or supervisor.
39. Making a difference in the setting in which
I work.
40. Influencing the decision making of the organization,
agency, or practice in which / work.
41. Influencing the decision making of the organization,
agency, or practice in which 1 interact.
42. Gaining support from the organization, agency,
or practice in which I work.
43. Influencing the professional organizations
in which I belong.
44. Pursuing professional interests in the organization,
agency, or practice in which I work.
45. Contributing to the determination of goals in the
organization, agency, or practice in which I work.
PLEASE MAKE SURE YOU HAVE RESPONDED TO ALL ITEMS

APPENDIX D
COVER LETTER
November 2, 1995
Dear Marriage and Family Practitioner:
I am writing to invite you to participate in a study investigating the demands and
effects of the professional role on marriage and family therapists. Your name was
randomly selected from a list of 16,561 practitioners in the nation who are clinical
members of AAMFT.
I am a marriage and family therapist in the state of Florida and a doctoral
candidate at the University of Florida in the department of counselor education.
As a clinician who has worked with a diverse number of clients in individual,
couple, and family counseling, I have experienced the impact of stressors unique
to our professional work role due to our involvement with clients, coworkers, and
supervisors and the organization in which 1 work.
It is my hope that the results of this study will help our profession to better
understand the demands of our professional work role and the effect of those
demands on the practitioner.
I anticipate your participation in the study would take no more than 20 minutes
to fill out the enclosed survey. Participation is completely voluntary. You are
asked to respond to the questionnaire anonymously. You may be certain your
identity will be kept confidential. Your identification will be at no time
transferred to the packet materials. A coding system will be used for determining
follow-up mail outs. Information from the study will be reported in aggregate
format only. While there are no direct benefits to you for your participation, you
will be contributing to knowledge that will benefit therapists and the clients
which you see.
128

129
If you have questions regarding the study, you can contact me by phone, fax, or
mail.
Phone: (407) 644-0596
Fax: (407) 644-0592
Mail: Valorie Thomas, Ed.S., L.M.F.T.
300 Seneca Trail
Maitland, FL 32751
I appreciate your time and assistance.
Sincerely,
Valorie Thomas, Ed.S., L.M.F.T.
P.S. Enclosed is a $1 bill. Kick up your feet and have a cup of decaf on me!
Approved for use through October 23, 1996.

APPENDIX E
FOLLOW-UP LETTER
November 12, 1995
Dear Marriage and Family Practitioner:
Recently you may have received a letter and questionnaire requesting your
participation in a study involving marriage and family therapists and the demands
and effects of the professional role on the practitioner.
If you have already completed and returned this questionnaire, I want to thank
you for participating in this study.
If for some reason you have not yet returned your questionnaire in the postage-
paid, preaddressed envelope, I want to encourage you to do so.
I am very interested in answering any question you may have about this study.
You may reach me (or my answering machine) by phone (407) 644-0596.
Fax: (407) 644-0592
Mail: Valorie Thomas, Ed.S., L.M.F.T.
300 Seneca Trail
Maitland, FL 32751
Thank you very much for your time and assistance.
Sincerely,
Valorie Thomas, Ed.S., L.M.F.T.
Principal Investigator
130

APPENDIX F
FOLLOW-UP LETTER
November 25, 1995
Dear Marriage and Family Practitioner,
Recently you responded to a survey involving marriage and family therapists and
the demands and effects of the professional role on the practitioner. I want to
thank you for taking the time to complete the survey as your response is
important to the results of this study. In order for your responses to be included,
however, it is necessary for you to complete the HUMAN SERVICES SURVEY. I
have, therefore, enclosed this survey along with a self-addressed postage paid
envelope.
Your response to the Human Services Survey will make your survey packet
complete and usable in this study. I thank you in advance for your time and
assistance.
Sincerely,
Valorie Thomas, Ed.S., L.M.F.T.
Principal Investigator
PLEASE POSTMARK BY DECEMBER 8, 1995
131

APPENDIX G
CATEGORIZATION OF MBI SCORESl
Range of Experienced Burnout
MBI
Subscales
Low
Average
High
Overall Sample
EE2
< 16
17-26
>27
DP
< 6
7-12
> 13
PA
>39
38-32
<31
Occupational subgroups
Mental Health
EE
< 13
14-20
>21
DP
< 4
5-7
> 8
PA
>34
33-29
<28
Occupations represented in the normative sample include 4,163 teachers
(elementary and secondary, grades K-12); 635 postsecondary educators (college,
professional schools); 1,538 social workers (social workers, child protective
service workers); 1,104 medical workers (physicians, nurses); 730 mental health
workers (psychologists, psychotherapists, counselors, mental hospital staff,
psychiatrists); and 2,897 other (legal aid employees, attorneys, police officers,
probation officers, ministers, librarians, and agency administrators).
2 (EE) Emotional Exhaustion
(DP) Depersonalization
(PA) Personal Accomplishment
132

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423-432.

BIOGRAPHICAL SKETCH
R. Valone Thomas was born on February 14, 1956, in Miami, Florida. She
is the third oldest of 10 children born to Robert and Ann J. Wasman.
In 1974 she graduated from Bishop Moore High School in Orlando,
Florida. She attended the University of Central Florida and graduated in 1981
with a degree in elementary education. In 1983 she completed her Master of
Education in Instructional Technology degree from the University of Central
Florida. She and her husband, Don, moved to Gainesville in 1983 after his
acceptance into the University of Florida dental school where she continued to
teach school for a total of 7 years, the last 4 serving as chairperson of the science
department. In 1986 she enrolled at the University of Florida and completed her
Specialist in Education degree in 1988. Upon graduation she began working as a
marriage and family therapist and continued study toward the doctoral degree in
counselor education.
Valorie has been working in a managed care setting providing counseling
services to a wide variety of clients for the last 7 years. In addition, she is an
adjunct instructor in the graduate school at Stetson University in Deland, Florida.
Valorie is a licensed marriage and family therapist, a licensed mental health
counselor, and a nationally board-certified counselor. She is a clinical member of
the American Association for Marriage and Family Therapists and the Association
for Counseling and Development. She is also a member of Chi Sigma Iota, the
142

143
Central Florida Association of Marriage and Family Therapists, the Association for
Counselor Education and Supervision, the American Mental Health Counselors
Association, the Association for Specialists in Group Work, and the International
Association of Marriage and Family Counseling.
Valorie's professional interests include counseling women, group therapy,
and supervision and training. Her hobbies include photography, tennis, snow
skiing, and traveling.

I certify that I have read this study and that in my opinion it conforms to
acceptable standards of scholarly presentation and is fully adequate, in scope and
quality, as a dissertation for the degree of Doctor of Philosophy.
Joseph Wittmer
Distinguished Service Professor of
Counselor Education
I certify that I have read this study and that in my opinion it conforms to
acceptable standards of scholarly presentation and is fully adequate, in scope and
quality, as a dissertation for the degree of Doctor of Philosophy.
M. David Miller
Associate Professor of Foundations of
Education
I certify that I have read this study and that in my opinion it conforms to
acceptable standards of scholarly presentation and is fully adequate, in scope and
quality, as a dissertation for the degree of Doctor of Philosophy.
Professor of Counselor Education
I certify that I have read this study and that in my opinion it conforms to
acceptable standards of scholarly presentation and is fully adequate, in scope and
quality, as a dissertation for the degree of Doctor of Philosophy.
Robert D. Myrickv'
Professor of Counselor Education

This dissertation was submitted to the Graduate Faculty of the College of
Education and to the Graduate School and was accepted as partial fulfillment of
the requirements for the degree of Doctor of Philosophy.
May 1996
¡J /y?
Dean, College of
Dean, Graduate School

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