1 PERCEIVED WORKING CONDITIONS AND PERSONAL RESOURCES PREDICTING MENT AL HEALTH COUNSELOR WELL BEING By ISABEL A. THOMPSON 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 2012
2 2012 Isabel A. Thompson
3 To my families and teachers you illuminate my life
4 ACKNOWLEDGMENTS I am grateful to so many people for this completion of this dissertation. I want to thank my friends near and far! I want to thank Kacy Mixon for being there for me through so many phases of this doctoral journey her consistent kindness mean s so much to me. I thank Adrienne Baggs for her sweet texts and int uitive understanding of the support that I needed. My sincere gratitude goes to Magaly Freytes for her support and care and offering stress relief through Zumba! Than ks to Cheryl Pence Wolf for her inspiration and support. Thanks to Aar on Majuta for leadin g the way. Thanks to Jennifer Pereir a for her encouragement. Thanks to the many other doctoral students who paved the way. Thanks to Amy Loomis for spurring me on Thanks to Phil Nelson for his technical expertise and support. Thanks also to m y counseling colleagues at LCS for their understanding and support. I want to express my gratitude to Dr. Ana Puig for joining my committee at the eleventh hour and helping me graduate! And for taking the time to talk with me anytime that I stopped by your office. Tha nks to Dr. Mark E. Young for consistently supporting me, encouragi ng me, and believing in me his mentoring means the world to me. Thanks to Dr. Sondra Smith Adcock for serving on my committee, taking a genuine interest in my ideas and pursuing publicati ons with patience and perseverance! Thanks to Dr. Lou Ritz for serving on my committee, for granting Eric and I the amazing opportunity to co teach the Min dful Living course, and for his generou s heart and deep caring for his students. Thanks to Dr. Ellen S. Amatea it is difficult to find the words to expre ss my gratitude to her. She has seen me grow from a scared first year Ph.D. student into a doctoral candidate with years of teaching, supervising, research and w riting under her belt. Thanks to Dr. Amat ea for being a role model of wisdom and
5 compassion. Thanks a lso to Dr. Cyndi Garvan for her suppo rt and interest in my research. I want to thank Dr. Lesley Hull, my clinical supervisor, for her support. I appreciate t he counselors who took the time to pa rticipate in this study. Their work on behalf of their clients is what inspired this dissertation. I also thank the many colleagues and friends who helped me to recruit participants. I also thank my teachers: Sant Rajinder Singh Ji Maharaj, Sant Darshan Si ngh Ji Maharaj, H.H. the Dalai Lama and B. Allan Wallace Many thank s to my wonderful families Thanks to my brother, Nicholas S. Thompson, for believing in me and my future as a researcher. I want to thank my dear parents for their unconditional love. M any, many thanks to my mother, Ellen G. Thompson she deserve s an honorary Ph.D.! Her support has helped me complete this Ph.D. and I am so grateful to her Thanks to my dearest father Graham C. Thompson Jr. for his support and reminding me that there is more to life. His belief in me has sustained me during this process. Thanks to my dear siste r in law Sarah Thompson for her support and love and understanding the joys and sorrows of the writing life. Thanks to my dear brother in law Hunter Thompson for his enthusiasm and humor. Thanks to my step mot her in law Pat Thompson for her love, support and understanding. Thanks to my fath er in law Larry Thompson for his kindness and caring. Thanks to my moth er in law Francie Adams for her love and reminding me to have fun and get massages too! Thanks to my step father in law Jim Adams for his love, caring, and handyman support Thanks to our dear uncle Bob Faria for visiting us and being the sweetest uncle in the world!
6 It is difficult to put into words my gratit ude to my husband Eric S. Thompson. I coul d not have done this without him I thank him for being a dear friend, colleague and statistical consultant during this doctoral journey. I am glad we are on this journey together I thank him for all the million things that he do es each day as my husband and his sustaining love
7 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ .. 4 LIST OF TABLES ................................ ................................ ................................ .......... 10 LIST OF FIGURES ................................ ................................ ................................ ........ 11 LIST OF TERMS ................................ ................................ ................................ ........... 12 ABSTRACT ................................ ................................ ................................ ................... 14 CHAPTER 1 INTRODUCTION ................................ ................................ ................................ .... 15 Scope of the Problem ................................ ................................ ............................. 17 Perception of Working Conditions ................................ ................................ .... 20 Length of Time in the Field ................................ ................................ ............... 21 Gender ................................ ................................ ................................ ............. 22 Compassion Satisfaction ................................ ................................ .................. 24 Type of Coping Strategy ................................ ................................ ................... 24 Mindfulness ................................ ................................ ................................ ...... 26 Population of Interest ................................ ................................ ....................... 27 Theoretical Framework ................................ ................................ ........................... 29 Need for the Study ................................ ................................ ................................ .. 32 Purpose of the Study ................................ ................................ .............................. 33 Research Questions ................................ ................................ ............................... 33 Overview of the Study ................................ ................................ ............................. 34 2 REVIEW OF THE RELATED LITERATURE ................................ ........................... 36 Negative Consequences of Counselor Job Stress ................................ .................. 36 Workplace Contributors to Counselor Stress ................................ .......................... 39 Workplace Resources Buffering Job Stress ................................ ............................ 45 Personal Contributors to Counselor Stress ................................ ............................. 48 Personal Resources Buffering Job Stress ................................ .............................. 50 Type of Coping Strategy ................................ ................................ ......................... 58 Mindfulness ................................ ................................ ................................ ............. 58 Summary ................................ ................................ ................................ ................ 67 Conclusion ................................ ................................ ................................ .............. 69 3 METHODOLOGY ................................ ................................ ................................ ... 71 Study Design and Relevant Variables ................................ ................................ .... 71 Perceived Working Conditions ................................ ................................ ......... 72
8 Length of Time in the Field ................................ ................................ ............... 72 Gender ................................ ................................ ................................ ............. 72 Type of Coping Strategy ................................ ................................ ................... 72 Mindfulness ................................ ................................ ................................ ...... 73 Compassion Satisfaction ................................ ................................ .................. 73 Compassion Fatigue ................................ ................................ ........................ 74 Burnout ................................ ................................ ................................ ............. 74 Population and Sample ................................ ................................ ........................... 75 Sampling Procedures ................................ ................................ .............................. 77 Resultant Sample ................................ ................................ ................................ ... 78 Demographics of the Resultant Sample ................................ ................................ .. 80 Gender ................................ ................................ ................................ .................... 80 Age ................................ ................................ ................................ ................... 80 Race/Ethnicity ................................ ................................ ................................ .. 81 Relationship Status ................................ ................................ .......................... 81 Hours Worked Per Week ................................ ................................ .................. 82 Counselor Length of Time in the Field ................................ .............................. 83 Length of Time at Current Job ................................ ................................ .......... 83 Work Setting ................................ ................................ ................................ ..... 83 Salary/Income from Counseling Work ................................ .............................. 84 Geographic Distribution of Sample ................................ ................................ ... 84 Membership in Professional Organizations ................................ ...................... 85 Data Collection Procedures ................................ ................................ .................... 85 Instrumentation and Operationalized Variables ................................ ...................... 87 Counselor Perceived Working Conditions Scale ................................ .............. 87 Instrument Validation ................................ ................................ ........................ 93 Professional Quality of Life Scale ................................ ................................ ..... 94 Brief COPE ................................ ................................ ................................ ....... 95 Mindful Attention Awareness Scale ................................ ................................ .. 99 Demographic Questionnaire ................................ ................................ ........... 101 Hypotheses ................................ ................................ ................................ ........... 102 Summary ................................ ................................ ................................ .............. 102 4 DATA ANALYSIS AND RESULTS ................................ ................................ ........ 107 Descriptive Statistics for the Study Variables ................................ ........................ 108 Reliability Statistics ................................ ................................ ............................... 109 Relationships among the Variables ................................ ................................ ...... 110 Hypothesis Testing ................................ ................................ ............................... 111 Summary ................................ ................................ ................................ .............. 115 5 DISCUSSION ................................ ................................ ................................ ....... 122 Research Sample ................................ ................................ ................................ 123 Discussion of Results ................................ ................................ ............................ 124 Burnout and Compassion Fatigue ................................ ................................ .. 124 Counselor Working Conditions, Burnout, and Compassion Fatigue ............... 125
9 Gender Effect on Working Conditions, Burnout and Compassion Fatigue ..... 126 Effects of Counselor Length of Time in Field ................................ .................. 128 Influence of Working Conditions and Personal Resources on Burnout .......... 129 Implications for Practice ................................ ................................ ........................ 134 Implications for Counselor Preparation ................................ ................................ 136 Addressing Work Contextual Factors ................................ ................................ .... 137 Enhancing Personal Resources ................................ ................................ ............ 138 Implications for Theory ................................ ................................ .......................... 140 Implications for Research ................................ ................................ ..................... 143 Study Limitations ................................ ................................ ................................ .. 146 Conclusion ................................ ................................ ................................ ............ 149 APPENDIX A INFORMED CONSENT DOCUMENT ONLINE VERSION ................................ 151 B COUNSELOR PERCEIVED WORKING CONDITIONS ................................ ........ 154 C SURVEY PART II ................................ ................................ ................................ 157 D PROFESSIONAL QUALITY OF LIFE ................................ ................................ ... 159 E MINDFUL ATTENTION AWARENESS SCALE ................................ .................... 160 F DEMOGRAPHIC QUESTIONNAIRE ................................ ................................ .... 162 G CO UNSELOR PERCEIVED WORKING CONDITIONS SCALE ........................... 168 LIST OF REFERENCES ................................ ................................ ............................. 172 BIOGRAPICAL SKETCH ................................ ................................ ............................ 179
10 LIST OF TABLES Table page 3 1 Participant age range ................................ ................................ ....................... 104 3 2 Participant race/ethnicity ................................ ................................ .................. 104 3 3 Relationship status of resultant sample ................................ ............................ 104 3 4 Hours worked per week as a counselor ................................ ............................ 105 3 5 Work setting ................................ ................................ ................................ ...... 105 3 6 Geographic distribution of resultant sample ................................ ..................... 106 4 1 ................................ ................... 117 4 2 ................................ ......................... 117 4 3 Gender and burnout regression model summary ................................ ............. 117 4 4 Gender and burnout regression coefficients ................................ ..................... 118 4 5 Gender and compassion fatigue regression model summary ........................... 118 4 6 Gender and compassion fatigue regression coefficients ................................ .. 118 4 7 Burnout predicted by years in field regression model summary ....................... 118 4 8 Burnout predicted by years in field regression ................................ .................. 118 4 9 Compassion fatigue predicted by years in field regression model summary .... 119 4 10 Compassion fatigue by years in field regression model coefficients ................. 119 4 11 Burnout regression model summary ................................ ................................ 119 4 12 Burnout regression model coefficients ................................ .............................. 119 4 13 Compassion fatigue regression model summary ................................ .............. 120 4 14 Compassion fatigu e regression model coefficients ................................ ........... 120 4 15 Summary of hypothesis testing results ................................ ............................. 121
11 LIST OF FIGURES Figure page 1 1 Model of burnout and compassion fatigue ................................ .......................... 35
12 LIST OF TERMS A PPRAISAL The transactional process of evaluating perceived harm, threat or challenge in the environment (Lazarus & Folkman, 1984 p. 294 ). B URNOUT Emotional exhaustion, depersonalization, and lack of personal accomplishment ( Maslach, Schaufeli, & Leiter 2001), "the process of physical and emotional depletion resulting from conditions at work or, more concisely, prolonged job stress" (Osborn, 2004 P.319 ). C OMPASSION F ATIGUE Compassion fatigue is conceptualized as emotional fatigue brought on by caring for traumatized clients; it emerges as the 1995). C OMPASSION S ATISFA CTION Compassion satisfaction is a term that describes the sense of satisfaction that mental health professionals experience as a result of their clinical work with clients (Stamm, 2002). C OPING "The person's constantly changing cognitive and behavioral e fforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the person's resources" (Folkman, et al., 1986 p. 993 ). C OWORKER S UPPORT perception of emotional and instrumental support from coworkers. E MOTION F OCUSE D C OPING healthy coping strategies focused on managing the emotional response to the perceived stressor, through processes such as social support and exercise programs G ENDER L ENGTH OF TIME IN FIELD clinical services in the counseling field, excluding internship hours M ALADAPTIVE C OPING unhealthy coping strategies that may address the perceiv ed stressors in the short term, but lead to negative effects overall (e.g. substance use, self describes the negative outcomes that certain types of coping strategies may have. M INDFULNESS paying complete attention in the pr esent moment, with moment to moment non judgmental awareness (Kabat Zinn, 1994).
13 N EGATIVE WORKING CONDITIONS workplace factors such as difficult or distressing clientele, lack of administrative and collegial support, unsupportive overall work environmen t. P OSITIVE W ORKING CONDITIONS workplace factors such as the nature of clientele, the nature of administration, collegial support, overall work climate, and other working conditions. P RIMARY APPRAISAL the process by which an individual evaluates a situat ion to determine if it irrelevant, benign positive, or stressful (Lazarus & Folkman 1984). P ROBLEM F OCUSED C OPING healthy coping strategies using concrete solutions to address the perceived problem directly. P SYCHOLOGICAL S TRESS the person and the envir onment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well Folkman, 1984 p.21 ). S ECONDARY A PPRAISAL The process in which an individual assess es how to resp ond to a situation (Lazarus & Folkman, 1984). S ELF CARE PRACTICES Self care practices are the means by which people renew and energize themselves by continually replenishing the sources that care means finding ways to replenish the se Skovholt, 2001 p 147 ). S TRESS occurrence, or factor causing this Dictionary.com) T RANSACTION A transaction is basically a challenge that creates an adap tive response W ELL BEING distress (i.e., anxiety or depression) and the presence of positive emotional states (i.e., general positive affect and p.23 ).
14 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 PERCEIVED WORKING CONDITIONS AND PERSONAL RESOURCES PRED ICTING MENT AL HEALTH COUNSELOR WELL BEING By Isabel A. Thompson August 2012 Chair : Ellen S. Amatea Major: Mental Health Counseling This study examined the influence of counselor perceived working conditions, length of time in field, counselor gender, mi ndfulness attitudes, compassion satisfaction, emotion focused coping, problem focused coping, and maladaptive coping on levels of burnout and compassion fatigue in a sample of 213 mental health counselors. Cross sectional survey research methods were used. Counselor perceived working conditions, length of time in the field, gender, mindfulness, compassion satisfaction, emotion focused coping, problem focused coping, and maladaptive coping were predictive of 66.9% of the amount of variance in reported burnou t scores among mental health counselors in this sample. However, these same factors were predictive of only 33.1% of the variance in the level of compassion fatigue reported by mental health counselors in this sample. Discussion of the results and implicat ions for counseling training and practice are presented along with recommendations for future research.
15 CHAPTER 1 INTRODUCTION There is a growing awareness of the possible hazards of working in the counseling profession. The qualities that make counsel ors effective with clients such as their empathy, connection, and caring also make them vulnerable to the hazards of burnout, compassion fatigue, secondary traumatic stress, and vicarious trauma tization Moreover, mental health counselors are likely to counsel clients who have been traumatized due to the prevalence of trauma in this country, even if they do not specialize in trauma therapy (Williams, Helms, & Clemens, 2012). O ver the past two decades researchers have used a variety of approaches to st udy the nature of counselor job stress and its consequences. Initially, researchers attempted to identify the potentially negative consequences of caring for others through the conceptualization of the phenomena of burnout and compassion fatigue (Figley, 1 995). Not only did researchers devote time to identifying the characteristics of burnout (e.g. emotional exhaustion, depersonalization, and excessive emotional detachment) and compassion fatigue (e.g. lack of appropriate empathetic response to clients ) ; t h ey also examine d the extent and prevalence of burnout and compassion fatigue and the possible ca uses and contributors Fo r example, researchers examined the working conditions that might contribute to counselor stress by studying the volume, nature, and se verity of client problems. A second line of research focused on identifying salient work place characteristics that serve to buffer counselors from negative working conditions, such as the impact of workplace staff support ( Ducharme, Knudsen, & Roma n, 200 8). A third line of research has focused on exploring c ounselor characteristics that buffer stressful working conditions and contribute to counselor well
16 being, such as individual wellness choices or the use of self care practices (Venart Vassos, & Pritch er Heft, 2007; Skovholt, 2001). Researchers have also begun to examine the positive effects of working as a therapist, such as compassion satisfaction (Stamm, 2010) and post traumatic growth ( Tedeschi & Calhoun ,1 996 ). Another area of research has focused on the usefulness of mindfulness attitudes and practices in reducing stress levels. For example, there has been an increase of mindfulness research occurring with the advent of Jon Kabbat Based Stress Reduction (MBSR) program. This rese arch has begun to enter the counseling arena, as researchers have examined the impact of mindfulness training in counselor preparation For example, Greason and Cash well (2009) examined connections between self efficacy, attention, and empathy and mindfuln e ss among counselors in training care and well being has also been explored (Richards, Campenni, & Muse Burke, 2010). Despite research linking mindfu lness to stress reduction outc omes (Carlson & Garland, 2005), research exploring mindfulness and its potential impact on counselor compassion fatigue and burnout is needed. The current study seeks to explore how rnout and compassion fatigue. W hat has been missing from conceptualizations of counselor stress coping and well being work condition, their perception of their personal and env ironmental r esources for coping with this condition and their actual stress reaction. Transactional stress and coping theory (Lazarus & Folkman, 1984) provides such a lens by conceptualizing both
17 the contextual factors that counselors may experience as st ressors and the importance of perception itself in the stress response process. The use of th is theoretical lens allows for a more nuanced exploration of the interaction between perceived working conditions and particular personal resources that may impact level and well being. Hence in this study, the theoretical lens of transactional stress and coping theory was used to examine the collective impact of counselor working conditions and personal coping resources upon the levels of burno ut and compassion fatigue reported by mental health counselors Mindfulness and compassion satisfaction were examined as personal resources. Emotion focused, problem focused, and maladaptive coping were also assessed. Burnout and compassion fatigue were ex amined in this study as two distinct counselor stress outcomes. Burnout has been conceptualized as consisting of three primary aspects: emotional exhaustion, depersonalization, and lack of persona l accomplishment ( Maslach, Schaufeli, & Leiter 2001). C omp assion fatigue has been conceptualized as a secondary traumatic stress process that results from caring for t raumatized clients resulting in a to be compassionate towards client s. Symptoms may include hyper vigilance and re experiencing traumatic material shared by clients (Figley, 1995). Scope of the Problem Counselors work directly with people at intimate levels of personal disclosure, building a therapeutic relationship and assisting clients with self reflection and posit ive change. Counseling and psychotherapy professions are unique in the vulnerability and empathy require d to build effective relationships with clients As Ducharme and her associates (2008) note t
18 and maintenance of meaningful relationships with clients in the trust based context of the therapeutic allia p. 98 ). Moreover, t he person of the therapist is emphasized in many counseling theories as the primary tool of therapeutic change. Counsel ing is a profession in which the person of the counselor serves as the instrument for the work we do. As counselors, we are taught to see the empathy, and to connect to our clien pain when they are vulnerable. That level of connection, commitment, and caring are among the greatest strengths that we as counselors bring to the work that we do, and they are also among the characteristics that may make us vulnerable. Witnessing the fatigue, vicarious trauma, and burnout are a few of the potential consequences of that risk (Lawson, Venart, Hazler, & Kottler, 2007 p 5 ). The qualities that make counselors effecti ve their empathy, connection, and caring for the client can make them vulnerable to negative consequences associated with the stress of the profession. Experienced, effective counselors are not immune to the stresses of the profession. ounselors may have increased susceptibility to burnout because of their training to be empathic, which is essential to the formation of a Lambie, 2006 p 32 ). Empathy, which is essential to professional competence, can also leave counselors v ulnerable to various forms of distress Given the personally and professionally intense nature of counseling work, counselors face unique job stressors and the associated risks of professional impairment, burnout, compassion fatigue, secondary traumatic st ress, and vicarious trauma tization These states negatively affect counselor well being and negatively impact their job performance and the care they provide to clients. There is an emerging con sensus that a counselor s wellness or lack thereof affects cou nse lor performance and client outcomes (Lawson,
19 being deteriorates professional performance can be compromised, resulting in burnout or even impairment (Young & Lambie, 2007). Emotional exhaustion, dep ersonalization, and excessive emotional detachment accompanied by a lack of personal accomplishment are aspects of burnout with potentially profound negative consequences fo r the counseling relationship (Maslach et al. 2001). The inclusion of ethical co des emphasizing the importance of counselor self monitoring for well being and impairment to protect clients underscores the scope of this problem for the profession. The American Counseling Association Code of Ethi cs (2005) mandates that professional coun selors self monitor for impairment due to the possible risks clients face if they receive serv ices from impaired clinicians. An understanding of the risks of clinician impairme nt has led to movements in the field to explore the negative consequences of job stress and to conduct research on the various forms of professional impairment, including burnout and compassion fatigue. Research bears out the widespread nature of the problem of counselor impairment and the importance of counselor well being. In a nat ional survey of counselors conducted in 2007, Lawson found that 5.2% of counselors surveyed met the cutoff for burnout and 1 0.8% met the cutoff scores for compassion fatigue This indicates that approximately 1 out of 10 counselors surveyed was experiencin g compassion fatigue while still providing counseling services. Moreover, counselors and therapists who return surveys are not likely to be representative of the entire population (Linley & Joseph, 2007), so these numbers may under represent the actual pre valence of counselor im pairment in various forms. These results provide a picture of counselors who meet criteria for b urnout or compassion fatigue but fail to account for counselors
20 who experience job stress at less severe levels. Therefore, further stud y of co unselor working conditions and the use of particular coping resources in response to those conditions is needed to accurately portray the scope and impact of counselor job stress. Perception of Working Conditions Researchers have suggested that co unseling work can have negative consequences for counselors due to potentially stressful working conditions including factors such as a clientele with severe presenting problems (Young & Lambie, 2007 ), large client caseloads (Lawson, 2007; Lee et al., 2010 ) and the intimate nature of the work itself ( Ducharme et al., 2008; Lawson et al., 2007 ). Other aspects of the work environment that counselors may perceive as stressful have not been explored in much detail. For example, research that explores a broad ar ray of both positive and negative working conditions is lacking. Several researchers have examine d the outcomes of counselor job stress and draw n conclusions as to the workplace factors or conditions associated with these outcomes. For example, Lawson (20 07) gathered info rmation about caseload size and work setting and correlated these factors with counselor burnout and compassion fatigue. Lawson & Myers (2011) also examined the impact of work setting, caseload size, and caseload composition on counselor o utcomes, but did not assess other workplace factors. These examination s fail to include other factors such as coworker support, workplace climate, and sense of workplace community that may buffer the impact of such stressors The current study fill ed a ga p in the literature by assessing a broader range of both positive and negative counselor working conditions. Coworker support is a positive aspect of counselor working conditions that is also examined in this study. There is evidence in the literature for examining co worker
21 support and its relationship with counselor stress outcomes. In a study of over 1,800 greater coworker support was associated (Ducharme et al., 2008 p. 95 ). These results suggest that coworker support buffers counselor s from the emotional ex haustion that can be a consequence of counseling work The current study examines co worker support as an aspect of counselor working condi tions to contextualize mental health counselors stress experience s and outcomes Length of Time in the Field Length of time in the field is term that refers to the total amount of time a counselor has been working in the counseling field. It has been repo length of time in the field is associated with stress outcomes. In a study of 156 t herapists who reported a greater length of time working as a therapist reported more negative psycho logical changes (r = .16, p < .05) and more compassion (Linley & Joseph, 2007, p.395) as compared to therapists reporting less overall time working as therapists While length of time in the field may put counselors at greater r isk for burnout and compassion fatigue, Leonard (2008) reported that more years of clinical experience are associated with higher levels of compassion satisfaction. In a study of 98 trauma therapists, Leonard reported that more years of experience was asso ciated with higher levels of compassion satisfaction In this study the influence of counselor length of time working in the field in predicting levels of reported burnout and compassion fatigue was examined.
22 Gender There is a trend toward most mental health professions becoming feminized which has been noted in the psychology field from the 1990s as the ratio of women to men in t he profession changed, with women becoming the majority (Ostertag & McNamara, 1991) M ore recently this trend has been not iced among psychologists in South Africa (Skinner & Louw, 2009) G iven the over representation of female mental health professionals, it has been difficult to assess t he relationship between gender, and urnout. As Sprang et al (2007) [compassion fatigue] CS [compassion satisfaction] and burnout have been equivocal and limited by an overrepresen p. 272). The predominance of females as participants in research on mental health professionals has made drawing conclusions about gender differences more challenging. Purvanova & Muros ( 2010 ) conducted a meta analysis of 183 research studies which included partici pants from various professions to determine whether: (a) women experience higher levels of emotional exhaustion resulting from their work than do men, (b) whether men experience higher levels of depersonalization than women and (c) whether burnout ha d bee Muros, 2010 p.169 ) They also sought to explore the impact of contextual factors on the relationship betwe en emotional exhaustion, depersonalization and gender, specifically by examining the impact o f varying labor policies on these relationships. Purvanova and Muros (2010) reported that women scored higher on the emotional exhaustion dimension of burnout, supporting their first hypothesis corresponding to 54% of women experience emotional exhaustio They
23 further reported that men scored higher on the depersonalization dimension of burnout (Purvanova & Muros, 2010 p.175 ). They also repor ted that women scored higher on overall burnout than did men in the stud ies included in this meta analys is (Purvanova & Muros, 2010). However, they discuss how these results reflect the differences in how women and men experience burnout, with women report ing more emotional exhaustion than men. They further reported that a connection between conservative social policies in the USA that women in the USA are significantly more emotional ly exhausted than men in the USA in contrast to women in the European Un i on, where there are more liberal social policies in place (Purvanova & Muros, 2010). This finding suggests that experiences of emotional exhaustion at work. A limitation of t he results of this study was that it was not specific to counselors ; it included individuals from a broad range of professions. In a study examining factors associated with therap ist well being, Linley and Joseph (2007) reported that women who participated in their study reported greater levels of personal growth more positive changes than the men in their study sample (p. 395). These reported results suggest that there may be gender differences in how therapists respond to their role as counselors with women experiencing greater gains personally Linley and Joseph (2007) did not provide a detailed discussion of these results. Further research in this area is needed to more fully understand these possible interactions between gender and positive ou tcomes for the therapist associated therapeutic work.
24 Compassion Satisfaction Despite the stressors and risks, many counselors experience a sense of satisfaction associated with their therapeutic work. Many counselors are drawn to the field because of thei r interest in helping others a sense of caring and altruism that is not to be underestimated. A growing body of literature depicts the positive impacts of clinical work such as compassion satisfaction, the satisfaction that professionals experience in th eir helping roles (Stamm, 2010). Compassion satisfaction has been material (Collins & Long, 2003). Lawson and Myers (2011) explored compassion satisfaction as an outco me and reported that counselor wellness is associated with compassion satisfaction. In the current study compassion satisfaction was conceptualized as a counselor personal resource impacting counse lor stress outcomes Type of Coping Strategy Despite links between the use of adaptive and maladaptive types of coping strategies and strain outcomes, maladaptive coping strategies have not been explored sufficiently in the counselor population Instead, t he existing research literature has focused upon counselor use of adaptive coping strategies labeled counselor self care or career sustaining behaviors and their impact on counselor professional quality of life and wellness (Lawson & Myers, 2011). In another study Kraus (2005) surveyed 90 mental health profes sionals working with adolescent sex offenders, exploring self care behaviors, compassion fatigue, burnout, and compassion satisfaction using an instrument developed from two self care lists developed by Pearlman (1995) to assess clinician self care. In ea c h of these studies, the behaviors assessed were not based upon existing coping theor ies or research.
25 In contrast to these efforts, the current study employed a theoretically derived typology of three types of coping behaviors: emotion focused, problem fo cused, and maladaptive coping behaviors Each type of coping behavior included both positive and negative strategies that counselors use to manage perceived stressors and offers a more detailed picture of the current state of mental health counselor coping In a study examining the college student coping, adjustment and well being, researchers examined how 171 undergraduates (Schmidt & Welsh, 2010). These researchers used the emotion focused scales of the COPE instrument (Carver, Scheier, & Weintraub, 1989) because of their interest in how t cannot be changed by active coping methods (Schmidt & Welsh, 2010) ; t hese researchers did not include a maladaptive coping category, but did separate each c oping strategy. The transactional theory of stress and coping has been used by psychologists and counselors to expl ore numerous phenomena, including client stressors. In one study exploring stressors ex perienced by Haitians immigrating to the United States, Belizaire and Fuertes (2011) used the transaction al theory of coping coping strategies in the face of acculturative stress Examples of emotion focused coping include seekin g emotional support from others or using particular self c are practices that help regulate emotions. Examples of problem focused coping include addressing the source of stress, such as talking directly to someone who can help resolve a problem or tackling the problem head on. Examples of maladaptive coping include behavioral disengagement, substance use, and self
26 blame. Researchers studying individuals with mental health difficulties have reported that the maladaptive coping strategies of behavioral disenga gement and self blame are linked to negative psychological outcomes (Meyer, 2001). In a longitudinal study examining the validity and reliability of the Brief COPE among care givers of people with dementia, researchers reported that the use of dysfunctiona l coping strategies was associ ated with avoidant attachment (Cooper, Katona, & Livingston, 2008) As a result, this appr oach to assessing types of coping strategies distinguished this study from previous studies. This study sought to fill the need to und erstand how counselors cope with specific workplaces stresses of the p rofession, rather than reporting on their self care practices or career sustaining behaviors on a global level. The use of a theoretically derived and validated instrument to as sess type of coping strategy was intended to provide a picture of counselor coping that has been lacking in the more general research explorations of self care. Type of coping strategy has not been researched in the context of counselor burnout and compassion fati gue. Moreover, exploring type of coping strategy use d in a specific circumstance could reveal how certain behavior patterns may contribute to negative counselor outcomes. The current study addressed this theoretical and methodological oversight by using th e construct of coping and measuring it with a validated instrument. Mindfulness Although there is a growing body of literature exploring mindfulness and its positive impact on stress levels (Carlson & Garland, 2005), research exploring mindfulness and its potential impact on counselor compassion fatigue and burnout is lacking. While Linley and Joseph (2007) examine d various counselor beliefs and
27 attitudes, they did not examine the impact of mindfulness on therapist stress outcomes. Mindfulness has been expl ored in the context of counselor self efficacy, attention, and empathy (Greason & Cashwell, 2009). It has also been explored in connection with counselor self care and well being (Richards, Campenni, & Muse Burke, 2010). However, mindfulness has not been s tudied within a transactional framework as a personal resource in a sampl e of mental health counselors. Mindfulness may allow individuals to remain open to contextual clues and have a han assuming that something that was stressful in the past will be stressful again, mindfulness processes may allow an individual to become aware of both t he external stimuli and internal stimuli such as thoughts that arise in conjunction with it, without assuming that the thoughts associated with the external stimuli are necessarily an accurate representation of reality. conditions and levels of burnout and compassion fati gue was examined. Population of Interest This study focused exclusively on the work life and stress outcomes of professional mental health counselors. Various states use differing terminology to designate this profession. For the purposes of this study, th e term mental health counselor is inclusive of other professionals whose standards of practice and professional identity are comparable (e.g. licensed professional counselor) Research on the job stress of helping professionals frequently includes profes sionals fro m multiple fields with different standards of professional preparation and practice. For example, Sprang et al (2007) included a diverse group of helping professionals including psychiatrists and social workers as well as pr ofessional
28 counselor s. However, the working conditions of mental health counselors may differ from the working conditions experienced by psychiatrists, social workers, and other mental health professionals. Hence in this study, it was determined that an exclusive focus on me perceptions of their positive and negative working conditions, the impact of their personal resources, and their levels of burnout and compassion fatigue would provide important information to the mental health counseling field E ven studies focusing on counselors, such as the one conducted by Lawson and Myers (2011), have included both school counseling professionals and mental health counselors. An un derlying premise of the current study was that mental health counselors have uni que training experiences, and work in particular job positions that may be distinct from other helping professions. Mental health counselors frequently work in agency and community mental health settings and have roles that are distinct from social workers or psychologists who may also work in such settings. Moreover, mental health counselors may experience a lower level of social status than coworkers status within a work organization may impact their work assignments, perceptions of these working conditions and the power they have to change unfavorable working conditions. Thus, part of the rationale for this study was to examine the working conditions that mental health counselors experience and not assume that the working conditions other mental health professionals experience will be equivalent to those of mental health counselors. This study filled a gap in the literature on counselor burnout and compassion fatigue by focusing on a national sample of mental health counselors.
29 Benefits of the study include adding to our understanding of the impact of working conditions on counselor job stress outcomes, which could lead to motivation within an organization to improve cou nselor work environments. For example, if it is found that perceptions of positive working conditions such as coworker support are related to lower levels of compassion fatigue and burnout, this finding might motivate work organizations to enhance working conditions of mental health counselors. It could also add to the existing literature by providing information about the current job settings and positive and negative working conditions that mental health counselors experience, the personal resources that they use to cope, and their stress outcomes. Theoretical Framework The t heoretical framework that guided the development of this study is the Tran sactional Theory of Stress and C oping (Lazarus & Folkman, 1984). This theory emphasize s the significance of c ognitive appraisal in an stress and coping (Lazarus & Folkman, 1984). Cognitive appraisal is the transactional process by which individuals assess a situation as manageable or excee ding their perceived resources. Primary appraisa benign and their own capacity to cope with it (Lazarus & Folkman, 1984 p.53 ). Stressful appraisals can fall into one of three categories : harm/loss, threat, or challenge (Lazarus & Folkman, 1984 p. 53 ). p. 53 ). Appraisal is essential to this theoretical under standing of stress and these two appraisals processes are interdependent (Lazarus & Folkman, 1984) Rather than assuming that stress is inherent in the enviro nment or in the individual, this transactional model focuses on the
30 relationship between the indiv idual and environment in the stress reaction process (Lazarus & Folkman, 1984 ). This theoretical approach takes into account the contextual factors of the environment and the appraisal factors of the individual in the experience of stress Further, Lazarus and Folkman (1987) describe a theoretical movement towards understanding stress in terms of emotions and coping, rather than focusing on This approach offers a nuanced understanding of the recursive nature of the process of emotional res ponse to the environment. By acknowledging the role that perception s have in shaping how we experience external events as stressors, the use of this theory in the exploration of counselor stress opens up new avenues of inquiry, including those that examine coping practices may shape their perceptions, which in turn shape their lived experience of the work environment in a transactional process. According to Lazarus and Folkman (1984) s tress cannot be viewed independen tly from appraisal or coping. They a relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well p. 21). The underlying assu perceived personal resources. Using this th eoretical lens, this study examine d how experience of job stress is influen ced by the ir perception of their working conditions and sp ecific personal resources. Type of coping strategy is one such personal resource. Lazarus and Folkman (1987) define two types of coping problem focused and emotion focused The use of problem focused coping strategies involves appl ying
31 concrete solutions to address the perceived problem directly. In contrast, emotion focus ed coping strategies focus on managing the emotional response to the perceived stressor, through processes such as social support and exercise programs. For example, a counselor facing a n extremely heavy caseload might use a problem focused coping strategy to modify the source of their stress, such as talk ing directly to the supervisor about the problem and discussing what might be done to reduce the caseload or handle it in a more effect ive way. A counselor f acing the same problem might use an emoti on focused coping strategy to reduce their level of stress by seeking emotional support from other staff members, engaging in exercise (e.g. running ) or using particular self care practices su ch as meditation. These two coping approaches are not mutually exclusive ; in fact, they can be complementary. context is essential to understanding the appropriateness of the application of each type appraisal of a situation as well as his/her emotional reaction in response to this cognitive appraisal. Emotion focused coping strategies can be defined as dysfu nctional or maladaptive if they are applied inappropriately to the context (e.g. w hen the perceived problem needs to be addressed directly). The same can be said of problem focused coping. For example, if a person dealing with a chronic illness dete rmines that nothing can focused coping strategy such as mindfulness meditat ion would be an appropriate coping approach.
32 In the current study transactional stress theory was used to explore whether counselor s p erception s of their working conditions and personal resources imp act ed their level s of burnout and compassion fati gue Need for the Study Professional counselors are frequently called upon to help individuals, couples, families, students, and communitie s in distress. Much has been written about the potential negative consequences for professionals working with people in distress and the need to buffer professio nals from these stresses yet burnout and compassion fatigue continue to impact the profession Although counselors are ethically bound to monitor themselves for signs of impairment (C.2.g., American Counseling Association Code of Ethics, 2005), compassion fatigue and burnout are still impairment issues facing the profession (Lawson, 2007; Sprang et al., 2007). Sprang et al., (2007) found that 13% of professionals sampled were at high risk for the development of compassion fatigue or burnout and emphasized the need for further research of counselor and contextual characteristics that may impact the d evelopment of these conditions. This continued impact on the profession indicates that more research is needed to determine which specific working conditions counselors perceive as stressful and how they can more effectively cope with them. Moreover, great er understanding of the relationship counseling field is also needed. Another poten tial benefit of the results of this study is the application of findings in the professional preparation of counselors and therapists Counselors in training could benefit fro m a greater understanding of the impact of positive and negative counse lor
33 workin g conditions the personal resources that counselors use to cope with negative conditions, an d the outcomes they experience. Data from the current study could also be used to underscore the need for specific curriculum designed to aid counselors in trainin g in develop ing specific coping skills to meet the challenge s/demands of their chosen profession Purpose of the Study The purpose of this study was to use the transactional stress and coping perspective to ex plore the influence of mental health counselor appraisal of their work ing conditions and personal coping resources on the levels of burnout and compassion fatigue the y experience (see Figure 1) The influence of both positive and negative wor king conditions w ere examined in addition to five personal r esource s : use of adaptive problem focus ed coping strategies, adaptive emotion focused coping st rategies maladaptive coping strategies compassion satisfaction, and mindfulness attitudes. The influence of counselor gender and overall length of time in the field was also examined. Research Questions The following research questions w ere used to examine the variables of interest in the study: Is there a relationship perc eptions of their working condition s and their reported l evel of burnout ? Is there a relationship perce ptions of their working conditions and their reported level of compassion fat igue ? What is the influence of counselor gender on the perceived working conditions burnout relati onship in mental health counselors? What is the influence of counselor gender on the perceived working conditions compassion fatigue relationship in mental health counselors?
34 What is the influence of counselor length of time in field on the perceived w orking conditions burnout relationship in mental health counselors? What is the influence of length of time in field in the perceived working conditions compassion fatigue relationship in mental health counselors? What is the influence of counselor perceiv ed working conditions, length of time in field, gender, mindfulness, compassion satisfaction, emotion focused coping, problem focused coping and maladaptive coping in predicting the level of burnout in mental health counselors? What is the influence of cou nselor perceived working conditions, length of time in field, gender, mindfulness, compassion satisfaction, emotion focused coping, problem focused coping and maladaptive coping in predicting the level of compassion fatigue in mental health counselors? O ve rview of the Study Chapter 1 provides an introduction to the scope of the problem, the topic of the proposed study as well as the theoretical framework used to explor e the topic. Chapter 2 provides a review of the relate d literature. Chapter 3 details the study methodology, including the research design, recruitment of participants, sampling procedures, data collection process, instrumentation for the study and demographics of the resultant sample Chapter 4 reports the results of the study. Chapter 5 prov ide s a discussion of the findings, limitations, and implications of the study and an overview of directions for future research based on the results of the study.
35 Figure 1 1. Model of burnout and compassion fatigue
36 CHAPTER 2 REVIEW OF THE REL ATED LITERATURE In the following review of the related literature, research on the incidence of counselor burnout and compassion fatigue are reviewed along w ith research examining the work ing conditions and personal factors that either contribute to or see m to buffer counselors from the negative consequences of perceived work place stress. In addition, examined. The current research on personal coping resources and self care practices will also be reviewed. In addition, the research on the impact of gender and length of time in the counseling field on co unselor stress outcomes are examined. Negative Consequences of Counselor Job Stress The negative consequences of counselor j ob stress can be severe. U nhealthy stress reactions, over time, can lead to states such as burnout and compassion fatigue: p. 1434 ). There is a large body of literature describing the various costs to the professional associated with providing therapeutic services T here are a variety of terms in common usage to describe the unhealthy and unbalanced states to which counselors are susceptible, including impairment, burnout, compassion fatigue, vicarious trauma and secondary traumatic stress Impairment is considered a deterioration of professional functioning and competence caused by the ost, Baum, Jackson, & Jarvis 1987) Impairment signifies that a counselor or mental health professional is offering therapeutic services that do not meet professional standards of practice The American Counseling Association includes an ethical code
37 mandating that professional counselors monitor themselves fo r signs of impairment and stop providing therapeutic services when their impairment could result in harm: C.2.g. Impairment Counselors are alert to the signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when such impairment is likely to harm a client or others. They seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until such time it is determined that they may safely resume their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provi de consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients. (American Counseling Association, Code of Ethics, 2005) T he inclusi on of this ethical code recognizes counselor impairment as a problem that merits ongoing attention from the profession. This ethical code also mandates that the counseling community remain vigilant to prevent and ameliorate counselor impairment in order to protect clients. B urnout is a severe form of impairment that is associated with the stress of the professional role itself and impact s counselors, therapists and other helping professionals (Skovholt, 2001) .There are multiple dime nsions associated with burnout: emotional exhaustion, depersonalization, and lack of personal accomplishment ( Mas lach et al. 2001 ), all of which can have detrimental effects on the therapeutic relationship and on treatment outcomes. Burnout has also been defined as: "the process of physical and emotional depletion resulting from conditions at work or, more concisely, prolonged job stress" (Osborn, 2004 p.319 ). This definition of burnout describes it as a process of depletion resulting from prol onged job stress Burnout among counselors can be es pecially detrimental: burnout, conceptualized as a combination of multiple emotional and physical ailments manifesting cognitively or within the workplace, could ensue and jeopardize both the
38 counselor's well being and Lee, Seong, Kissinger, & Ogle, 2010 p. 131 ). This definition includes the potential negative o utcomes of burnout, both for counselo r themselves and for the people that they treat The literature regarding potential negative consequen ces of working with clients who have experienced trauma is extensive. Several terms describing the potential negative impact on therapists have emerged from this body of research. Compassion fatigue, secondary traumatic stress, and vicarious traumatization are three of the main terms that are found in the literature to describe this phenomenon (Stamm, 2010). Compassion fatigue is conceptualized as emotional fatigue brought on by caring for traumatized clients; it emerges as the result of hearing about clien experiences (Figley 1995). It involves the loss of interest or capacity to be compassionate towards the client (Figley, 1995). Compassion fatigue is often further characterized by symptoms that are similar to posttraumatic stress disorder s uch as hyper vigilance and re stories (Figley, 1995). Vicarious traumatization is generally used to describe the long term negative consequences which counselors who work with victimized clients may experienc e (Schauben & Frazie r, 1995). While there is some overlap between the terms secondary traumatic stress and vicarious traumatization, Baird and Kracen (2006) define various others, and the world, as a result of exposure to the graphic and/or traumatic material of their clients (p. 181). T hese various terms exist because of the need to articulate and address the potentially negative impact of caring for traumatized clients o n therapists. While not all counselors work with traumatized clientele, it has been suggested that
39 mental health counselors are working with more traumatized clients d ue to the prevalence of trauma (Williams, H elms, & Clemens, 2012), such as sexual abuse, interpersonal violence, and natural disasters (Trippany, White Kress, & Wilcoxon, 2004 ). Stamm (2010) describes conceptual overlap between the terms compassion fatigue, secondary traumatic stress, and vicarious trauma: there are issues associated with th e various terms used to describe negative effects. There are three accepted terms: compassion fatigue, secondary traumatic stress, and vicarious trauma. There do seem to be nuances between the terms but there is no delineation between them sufficient to sa y that they (pg. 9 ). In this study, the term compassion fatigue will be used as a synonym for secondary traumatic stress, due to stress as the name for the subscale that was previously called the compassion fatigue scale (Stamm, 2010). In addition to examining the impact of working with traumatized clientele on counselors, r esearch ers ha ve also articulated the workplace stressors that counselors from m any different specialties experience. Workpla ce Contributors to Counselor Stress It has been well documented that p rofessional counselors face a myriad of potential stressors that can lead to states of chronic stress and eventual burnout if not managed eff ectively The size of their caseload (Lawson, 2007; Lee et al., 2010) t heir length of time in the field (Linley & Joseph, 2007) severity of client problems (Young & Lambie, 2007), type of clientele (Lawson, 2007), and theoretical orientation (Linley & Jo seph, 2007) are factors that can contribute to counselor job stress
40 Managing large caseloads is one of the challenges that counselors frequently health status is connected t o the size of their caseloads and the type of clients they see (Walsh & Walsh, 2002, as cited in Lawson 2007). Large caseloads, among other factors, may contribute to the experience of burnout (Lee et al., 2010). Length of time in the field may also increa therapist well being, researchers reported that therapists who had been working in the field for a longer time were more likely to experience burnout than new professionals, suggesting a cum ulative, negative effect associated with providing therapy over the course of many years (Linley & Joseph, 2007). In addition to factors explored above, it has been reported that working with c ertain types of clientele and c lient problems can also impact c ounselors sense of well being Working with clients with severe presenting problems can be particularly stressful (Young & Lambie, 2007). In contrast, having a varied caseload has been reported to be a protective factor, shielding coun selors from burnout (Lawson, 2007). T he addictions field has been identified as a particularly stressful specialty in which counselors may be more likely to experience burnout are prone to high rates of relapse, yielding frustration among clinicians who invest significant emotional resources in buil et al., 2008 p.83 ). on that investment. Working with traumatized clients may also be especially taxing for mental health professio nals The literature on compassion fatigue, secondary traumatic stress,
41 vicarious traumatization, and other forms of therapist distress associa ted with working with traumatized clients is testament to the potentially taxing nature of this work. As mentioned previously the terminology used to describe the potentially negative impact of working with traumatized clients can vary Counselors who wor k with abused children or clients who have been traumatized by violence may also be at high risk for developing compassion fatigue and vicarious traumatization (Cunningham, 2003; Creamer & Liddle, 2005 as cited in Sprang, Clark, & Whitt Woosley, 2007). Wo rking with children who have been sexually abused can be particularly stressful for clinicians (Drouet Pistori us Feinauer Harper Stahmann, & Miller, 2008). Moreover, counselors who have a caseload consisting of trauma survivors are reported to be at gre ater risk of developing of vicarious traumatization (Cunningham, 1999 as cited in Lawson, 2007). In a qualitative study examining the impact of counseling abused children on clinicians, researchers interviewed ten female therapists (Drouet Pistorius et a l., 2008). The researchers reported that two overarching themes emerged from the data analysis: ways of coping with the stress o f this work. Negative impact s described by therapists included descriptions of vicarious traumatization and compassion fatigue The researchers repo rted that therapists spoke of an increased awareness of dangers and unpleasant aspects of life and an increase level of fearfulness. Researchers r eported For example, therapists discussed having to be careful what they shared about the e consequences, such as appreciation for life and personal growth and professional
42 development (Drouet Pistorius et al., 2008). The researchers reported that therapists identified several main coping resources: support systems, personal therapy an d willing ness to address personal issues, spirituality, humor, use of compassion and empathy in therapy, and practicing self care. These researchers reported that therapists cited several workplace factors as contributing to their successful coping: agency environm ent, teamwork, supervision, and training (Drouet Pistorius et al., 2008). These qualitative results indicat e that counseling sexually abused children may impact female re sults indicated that the work environment can play an important role in helping therapists cope with stress. Therapy work can also impact the beliefs of those who work with traumatized clients (Tehrani, 2007). In a study that aimed to examine the effect o f working with Tehr ani (2007) surveyed care workers (defined as caring professionals from a variety of fields including counseling and psychology) whose caseload s consisted of traumatized clients Of the over 4 00 professionals contacted to participate via email or by professional contacts, 319 completed the survey. The 21 item survey consisted of items about spiritual and religious beliefs as well as support and supervision, including items regarding negative be liefs that the researchers adapted from the Trauma Belief Inventory (Scott & Stradling, 1992 as cited in Tehrani, 2007 ). The researchers included survey items Post Traumatic Growth I p.331 ). Participants were also asked about
43 the type of supervision they receive whether managerial, personal, professional, or peer. Tehrani (2007) sought to explore the impact of this clinical work and the secondary t rauma that ma values and beliefs. The results reported that care workers commonly reported positive beliefs, for example, 91% of 2007 p. 331 ). However, over 60% of care workers surveyed reported changes in their beliefs in a negative direction some of the time. Participants reported the follow ing the carer should have coped better (60%), feeling overwhelmed (60%) and the belief that the world was a dangerous place (64% 2007 p. 331 ). These changes in care wo reported that this impact can have a negative effect, particularly in care workers with less confidence in their ability to handle challenging client interactions (2007). A strong point of the Tehrani study is t he preventative focus on changes in care worker beliefs that may be precursors to the development of burnout and compassion fatigue. Whereas many studies on burnout and compassion fatigue f ocus on symptomology, Tehr ani (2007) aimed to understand the impact of working with traumatized clients before it gets to the level of symptomatic stress. Although counselors and psychologists were included as survey participants, this study had a of the study was the broad range of professions surveyed, as differences across
44 professions were not well accounted for in the research design nor in the results. While the results of this study reve al a broad picture of impact of trauma work on workers from many different specialties, it does not provide a detailed account of the impact on the rapists. This study was designed to explore the impact of caring work with traumatized clients on caring work er research exploring the impact of job stress is needed. In a study examining compassion fatigue, burnout, and compassion satisfaction among mental he alth professionals, researchers conducted a survey by mail in which 1,121 professionals living in a rural state returned their completed questionnaires, (a 19.5% response rate) (Sprang et al., 2007). Participants completed a 102 item questionnaire that inc luded the Professional Quality of Life Scale among other demographic questions. Gender was linked to higher levels of compassion fatigue, with women more likely to report it than men. Specialized training impacted reported compassion satisfaction, as couns elors with specialized training in trauma work reported higher levels of compassion satisfaction than counselors without such specialized training. This result suggests the importance of specialized training for those who work with traumatized clientele. T his study also explored these three phenomena across professional field s and they found that psychiatrists reported higher levels of compassion fatigue than other mental health professionals. The researchers reported that approximately 13% of the professi onals sampled are at high risk of compassion fatigue or burnout and emphasize the need for continued research to understand the impact of provider characteristics and contextual characteristics as related to
45 compassion fatigue and burnout (Sprang, et al., 2007). Further, these researchers recommend that future research explore the impact of gender role socialization on fatigue and burnout, as well as their reporting of burnout and compassion fatigue (Sprang, et al., 2007). Workplace Resources Buffering Job Stress In addition to the stressful working conditions described above, researchers have begun to identify positive working conditions that seem to buffer mental health profes sionals from job stress. One of the most prominent of these positive working conditi ons is the presence of coworker support. Coworker Support In a study examining rates of burnout and turnover in the human services occupations, Ducharme, Knudsen and Roman (2008) explored the role of coworker support as a potential positive working condition buffering counselors from the job stress associated with this work. Co worker support was found to be a protective factor among counselors working in the addictions fie ld, with increased coworker support associated with decreased emotional exhaustion and turnover (Ducharme et al., 2008). The study included survey data from over 1,800 substance abuse treatment counselors. (Ducharme et al., 2008 p.82 ). They also reported that lack of coworker support was can be a significant protective factor, buffering individu al counselors from the emotional exhaustion that can be a consequence of counseling work, and also providing the employer protection from high turnover rates. These findings suggest that co worker
46 support can be an important resource positively impacting c ouns job demands In a study designed to examine factors associated with therapist positive and negative well being, Linley and Joseph (2007) defined positive well growth, positive psychological changes and compassi They sent out questionnaires to 400 therapists and psychologists in Great Britain whose names were gathered from professional directorie s and then entered into a randomizing computer program for random inclusion in the study (Linley & Jospeh, 2007). They had a response rate of 40%, with 156 questionnaire packets returned (Linley & Joseph, 2007). This sample consisted of therapists engaging in an average of 30 hours per week of providing direct therapeutic services (Linley & Joseph, 2007). Linley and Joseph (2007) used the Crisis Support Scale to measure social support, the Jefferson Scale of Physician Empathy to measure empathy, and the Wor king Alliance Inventory Form T Bond subscale ( WAI Bond ) was used to assess personal connection between therapist and client. The Professional Quality of Life Scale was used to assess the factors comprising professional quality of life burnout, compassion satisfaction, and compassion fatigue. The Sense of Coherence Scale Short form was used as a Posttraumatic Growth Inventory was used to assess the therapist personal gro wth, specifically in connection to their therapeutic work. Finally, Linley and Joseph (2007) used the Changes in Outlook Questionnaire to examine changes in outlook and belief ve the
47 researchers a broad picture of therapist well being, both positive and negative, as well as the factors associated with it. Linley and Joseph (2007) had participants indicate whether they received clinical supervision, attended personal therapy (cur rently or previously), and whether they had a personal trauma history. Participants were also asked to indicate their gender. The training orientations, therapeutic practice o rientations, length of time working as a therapist, hours worked per week as a therapist, and outcome variables (personal growth, positive changes, compassion satisfaction, negative changes, compassion 2007 p p 391 392 ). These researchers reported several factors that were associated with therapist positive well being: therapists who self reported current or previous personal therapy also reported higher levels of personal growth and positive change an d lower levels of burnout. Therapists who received clinical supervision and endorsed having a personal trauma history also showed greater levels of personal growth. Female therapists in this sample had greater levels of personal growth and positive changes associated with their occupational role than male therapists (Linley & Joseph, 2007). Theoretical orientation is another factor that has been reported to play a role in being, and susceptibility to burno ut and other forms of impairment. Linley and Joseph (2007) reported that therapists identifying themselves as cognitive behavioral were more likely to experience burnout than therapists who identified themselves as transpersonal or humanistic in their appr oach. They suggested that further research is needed to examine whether this
48 difference is due to theoretical orientation per se or the stresses associated with working with client populations in which a particular theoretical lens is more prevalent (Linle y & Joseph, 2007). While Linley and Joseph (2007) examined numerous factors associated with therapist well being, both positive and negative, they did not account for the impact of the work environment on therapist attitudes and behaviors in a complex wa y. While the inclusion of the variable of social support expanded this research beyond individual factors impacting well being, this study did not provide a detailed account of the Rese arch e outcomes is needed. The interaction between stressful working conditions and personal factors can lead to compromised client care whe n a counselor is not copin g well with professional stress. For example, i t has been reported that burnout can spread among staff members and level burnout among counselors and nurses has been associated with lower client 2; Vahey et al. 2004 as cited in Ducharme et al., 2008). This suggest s that negative states such as burnout can be spread between and among staff members, indicating the need for additional research explo ring the interaction between perceived working con ditions personal resources and stress outcomes Personal Contributors to Counselor Stress In addition to the contextual workplace factors described above, personal factors on to
49 events can also contribute to the likelihood that they will develop an adverse reaction to job stress such as compassion fatigue or burnout (Collins & Long, 20 03). In a literature review examining the impact of working with traumatized patients on health care workers, Collins and Long (2003) found that personal trauma history typically increased the likelihood of an adverse stress response unless the counselor h the personal trauma experience (p. 422). Moreover, personal stress may interfere with related stress (Bell, 2003). Therefore, o cope with perceived stressful working conditions is warranted. In a qualitative study on secondary trauma among social workers who work with domestic violence survivors, researchers used a strengths perspective to explore their lthough examining the potential stresses of such work, use of a strengths perspective allowed an examination of the strategies and personal and environmental resources that allowed counselors to maintain their enthusiasm and he researchers interviewed 30 counselors in depth to explore counselor strengths. Each participant was interviewed twice, the second interview taking place approximately one year after the first. During the first interview, participants were asked to share their reactions to recent work events, including a positive event, a situation they felt was stressful, as well as a situation when they including previous trauma th at participants felt might impact their reactions to current have more effect on counsel work
50 2003, p. 517). The r esearchers divided participant results into three groups based on their reported stress level a low stress group, a medium stress group, and a high stress group. Six of the counselors were included in the low stress group and reported less extreme stress in their personal and professional lives. Most of the counselors interviewed in this study (n=19) were included in a medium stress group, indicating that they identified perceived stressors and also identified resources to handle these perceived stressors These counselors were able to draw upon personal and interpersonal resources when facing stressors. The high stress group included five counselors, who had a high level of reported stress and/or somatic symptoms of stress such as physical pain. Some in t his group attributed their stress to primarily personal issues, some to work issues and some endorsed a combination of personal and work related stress (Bell, 2003). Overall, these qualitative outcomes indicate that personal and environmental resources ame liorate the effects of stress, results which suggest the need for additional research in this area. Personal Resources Buffering Job Stress Researchers have identified several personal resources that seem to buffer counselors from jo b stress. Three of th ese resources are compassion satisfaction, self care prac tices, and specific mindfulness attitudes and practices. Research on coping strategies will also be discussed, although this construct has not yet be en studied in a counselor population. These person al resources are explored below. Compassion Satisfaction Compassion satisfaction is a term that describes the sense of satisfaction that mental health profe ssionals experience as a result of their clinical work with clients (Stamm, 2002 ). This conceptualiza tion emerged from the compassion fatigue literature,
51 as researchers sought to articulate how some clinicians seemed to experience a sense of fulfillment from therapeutic encounters that might fatigue others (Stamm, 1998). Compassion satisfaction has been s hown to reduce the risk of burnout (Kraus, 2005). In addition to reducing the risk of burnout, compassion satisfaction has also been reported as a buffer against the negative impact of stress and exposure to counseling traumatized clients (Collins & Long, 2003). Compassion satisfaction is a concept that represents the positive side of therapeutic encounters and the fulfillment that many mental health counselors derive from their professional roles as helpers. Compassion satisfaction can be considered a pers onal resource from the transactional framework, as it allows counselors to effectively cope with workplace stress. In a correlational study of 90 mental health professionals who provide clinical interventions for adolescent sex offenders, Kraus explored t he relationship between self care, compassion satisfaction, compassion fatigue, and burnout ; specifically whether clinician self care behaviors buffered compassion fatigue and burnout and increased compassion satisfaction (Kraus, 2005) Self care behaviors were assessed with a list adapted from two self care lists developed by Pearlman (1995). Clinicians were asked to rate on a scale of 1 to 6 how helpful they had found forty activities listed to be during the past six months. The Compassion Satisfaction an d Fatigue (CSF) test is comprised of three subscales used to assess compassion fatigue, burnout and compassion satisfaction. Kraus (2005) reported that t hese subscales have alpha coefficients of .87 for compassion fatigue, 90 for burnout, and .87 for comp assion satisfaction. Kraus (2005) reported that self ). Kraus reported that self care was not
52 significantly related to either compassion fatigue or burnout. Kraus (2005 ) also reported th based on these correlational findings, compassion satisfaction may play a role in decreasing burnout (Kraus, 2005). These results indicate that reported self care behaviors influence may in turn reduce levels of burnout ( Kraus, 200 5). Kraus (2005) acknowledge d the limited generalizability of correlational data and stressed the need for additional research examining the relationship between compassion satisfaction and self care. Kraus (2005) acknowledged that the reported results run counter to previous researc h by Stamm (2002) indicating the importance of self care in ameliorating negativ e consequences of helping Kraus acknowledged the lack of clear valida tion of the self care lists used as a limitation of the study. The lack of a clear definition of sel f care is also a weakness of this study. Despite these limitations, specific self care practices, particularly in relation to compassion satisfaction In the current study, type o f coping strategy was explored, allowing for a theoretically grounded exploration of counselor behaviors in response to stress. In a study surveying 509 members of American Counseling Association, Lawson and Myers (2011) explored wellness, professional qu ality of life, and career sustaining behaviors. Career sustaining behaviors are defined as specific strategies that help the counselor function effectively and maintain a positive attitude in their professional (Lawson & Myers, 2011, p. 166) T he 5F Wel was used to assess wellness levels. The
53 Professional Quality of Life Scale ProQol (Version III) was used to explore professional quality of life, consisting of three distinct subscales measuring compassion fatigue, burnout and c ompassion satisfaction The Career Sustaining Behaviors Questionnaire in which counselors rate the importance of strategies listed for positive professional functioning was used to measure career sustaining behaviors. Over two thirds of the participants in this study were lic ensed professional counselors (Lawson & Myers, 2011). Most participants reported working in private practice (39.3%), while 23.5% reported working in community mental health agencies 20.6% reported working in K 12 schools 11.7 % working in college or uni versity settings and the remaining 4.9% in hospital or residential settings (Lawson & Myers, 2011). Lawson and Myers reported that counselors who had higher wellness scores also had higher levels of compassion satisfaction and reported more engagement in career sustaining behaviors (2011). These results suggest a connection between wellness, compassion satisfaction, and career sustaining behaviors. Further research focusing solely on mental health counselors is needed to provide a more detailed account of this unique group. Self Care Practices In the counseling field, self care has been the primary means by which counselor coping practices have been explored. Much has been written about the necessity of caring for the self for professionals in high touch fields such as counseling, teaching, and health care (Skovholt, 2001). Fu rther, authors have reported that many counselors espouse a holistic philosophy, yet often struggle to maintain their own well being or find time for the self care practices they pro mote for their clients (Cummins et al., 2007). Professional counselors are helpers by choice. Moreover, they are trained to care about
54 others and show that caring through their words, non verbal behavior, and attitude. This attitude of caring, if it not ba lanced by self care, can lead to various imbalances that result in stress, distress and eventually burnout. Although self care has been lauded as a key factor in preventing burn out, reducing the likelihood of impairment among practitioners, and ameliorati ng vicarious trauma (Cummins e t al., 2007), validated measures to accurately assess counselor self care are lacking. Defining self care can also be challenging, as researchers have often utilized varying definitions (Richards, Campenni, & Muse Burke, 2010) (2000) linked self describes three components of therapist self aware ness, self and conceptualizes self care as comprising the processes of self awareness and self regulation and the balance of connections among self (involving the psychological, physical, and spiritual, as well as the professional ), others (including personal and professional relationships) and the larger community (encompassing civic and professional involveme Skovholt (2001) considers self care as an ongoing process essential to counselor well being and views the ou tcome more important than the particular practic e used According to Skovholt (2001) the term self care describe s the means by which counselors renew and energize themselves by continually replenishing the sources that care means find ing ways to replenish the self. p. 147) Skovholt (2001) care should focus in part on producing feelings of zest, peace, euphoria, excitement, happiness, A ssessment of self care practices is crucial for counselors to evaluate their status along the continuum of well, stressed, distressed and impaired, to recognize their own
55 vulnerability, and to take actions to address it (Cummins et al., 2007). Kraus (2005) reported that s elf care practices h elped mental health professionals experience more compassion satisfaction in their work and may act as a protective factor against burnout and compassion fatigue. Because defining self care can be challenging, a review of the literature revealed that self care practices, strategies and behaviors may be researched under other definitions. Self sustaining Counseling Associa tion members completed surveys to assess their levels of wellness and impairment, as well as their practice of career sustaining behaviors. The Career Sustaining Behaviors Questionnaire (CSBQ; Stevanovic & Rupert, 2004) assesses eir importance in helping the counselor to function effectively and maintain 2007 p. 23 ). Although not defined as self care, many of the careers sustaining behaviors measured by this instrument are consistent with self care b ehaviors as defined by other researchers ( see Richards et al., Professional Quality of Life Scale Third Edition Revised ( Pro QOL III R; Stamm 2005) was used to assess compassion satisfaction, compassion fatigue, and burnout. A demographic questionnaire was also included to gather information about gender, ethnicity, age, and level of education, clinical setting, c aseload characteristics, and personal and professional support (Lawson, 2007).
56 Lawson and Myers (2011) re ported that 8.9% of participants in their sample scored below the cut off point of the c ompassion satisfaction subscale, 6.1% scored above the burnout subscale cut off point, and 10.3% scored above the compassion fatigue subscale cutoff point Based on the cut off scores described by Stamm (2005) these reported results indicate that almost 9% of participants were not getting satisfaction from their work, approximately 6% were experiencing burnout, and approximately 10% were experiencing compassion fatigue. In addition to overall prevalence, Lawson and Myers (2011) reported that counselors working in private practice settings had higher compassion satisfact ion scores and lower burnout scores than counselors working in other settings such as K 12 schools, college or university settings, or community agencies These researchers also reported correlations between caseload variables and burnout scores. Counselo rs who reported a higher percentage of trauma survivors on their caseloads had higher burnout scores, as did counselors who reported a higher percentage of high risk clients (Lawson & Myers, 2011). Additionally, these researchers reported a negative correl ation between a high risk client caseload and counselor compassion satisfaction (Lawson & Myers, 2011). Lawson and Myers (2011) reported that participant total wellness score on the 5F Wel was positively correlated with c ompassion satisfaction and negativ ely correlated with bo th burnout and compassion fatigue They also reported that counselors who scored higher on the total wellness scores also rated the career sustaining behaviors as more important to them While these researchers report that wellness a nd compassion satisfaction are related, this study does not provide a typology of career sustaining
57 behaviors characteristic of counselors who experience more compassion satisfaction and wellness. Further, t he use of the career sustaining behavior construc t does not allow for a nuance d exploration of when and how counselors engage in these strategies. In a qualitative study exploring wellness and resiliency among mental health professionals, researchers interviewed ten peer nominated expert practitioners i n the mental health field (Skovholt, 2001). The interview questions were designed to elicit professional stressors, emotional wellness, and professional resiliency. The inductive data analysis process resulted in five thematic catego ries: 1) professional stressors, 2) emergence of the expert practitioner, 3) creating a positive work structure, 4) protective factors, and 5) nurturing the self through solitude and relationships. The fifth category included the following themes: a) foste ring professional stability by nurturing a personal life, b) investment in a broad array of restorative activities, c) building positive personal relationships, and d) valuing an internal focus (Mullenbach 2000, as cited in Skovholt, 2001 pp. 164 185 ). T he researchers concluded that participants who were peer identified as expert practitioners level skill in accessing valuable p.186 ) For example, Skovo lt (2001) reported that thes e practitioners are skilled at self observation and proactively addre ss stressors Moreover, (p. 186). These results suggest that expert clinicians may utilize coping resour ces such as self care and peer support more effectively than other clinicians.
58 Type of Coping Strategy Coping is a term that is frequently used in the stress management literature. It refers to "person's constantly changing cognitive and behavioral effort s to manage specific external and/or internal demands that are appraised as taxing or exceeding the person's resources" (Folkman, et al., 1986 p. 993 ). Type of coping strateg y refers to the specific cognitive, affective, and behavioral coping practices th at individuals engage in. Lazarus and Folkman (1984) identified two distinct types of coping problem focused coping and emotion focused coping. In addition to these two coping approaches, researchers has also identified some coping strategies as adaptiv e or maladaptive (Meyer, 2001). Adaptive coping strategies are associated with positive outcomes such as reduced stress and greater well being whereas maladaptive coping strategies are associated with negative outcomes (Meye r, 2001 ). Research on non counse lor populations has reported associations between coping strategies and strain outcomes. Despite these associations, type of coping strategy has not been explored in the context of counselor burnout or compassion fatigue. Mindfulness Defining mindfulness poses a challenge, as there are multiple dimensions associated with mindfulness (Richards et al., 2010). Mindfulness has been studied as both a trait and a state in quantitative studies and confusion about how to operationalize mindfulness must be address ed ( Lau et al., 2006). Contemporary liter ature describes mindfulness as paying complete attention in the present moment, with moment to moment non judgmental awareness (Kabat Zinn, 1994). A ccording to a more traditional Buddhist definition, mindfulness mea ns without forgetful 2006 p. 13 ). The traditional definition is
59 highly applicable in the context of meditative practice, in which practitioners focus on a specific meditative obje ct and return their attention to that object repeatedly through the use of mindfulness. Most literature in the fields of counseling and psychology focuses on the contemporary Western understanding of mindfulness pioneered by Jon Kabat Zinn Over the past decades, several prominent mindfulness based interventions have emerged, including mindfulness based stress reduction (MBSR; Kabat Zinn 1990) and mindfulnes s based cognitive therapy (MBCT; Segal, Williams, & Teasdale 2002) There has also been the develop ment of systems of therapy which seek to cultivate mindfulness skills: acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) and dialectical behavior therapy (DBT; Linehan, 1993). The expanding use of mindfulness based interventions incl uding MBSR and MBCT exists within broader movemen ts of holistic approaches to mental health and well being through the use of mindfulness practices and attitudes. These interven tions conceptualize mindfuln ess as a set of skills that can be learned and pra cticed in order to reduce psychological symptoms and increase health and well being. MBSR and MBCT rely heavily on formal meditation practices, in which participants spend u p to 45 minutes each day direct ing their attention in spec ific ways. In contrast, D BT and ACT rely on a wide variety of shorter exercises in which mindfulness related skills can be practiced without necessarily engaging in meditation. The empirical literature increasingly supports the effi cacy of mindfulness based interventions (Baer, Sm ith, Hopkins, Krietemeyer & Toney, 2006 p. 27 ). Several quantitative measures of the construct of mindfulness have been were originally designed to assess mindfulness as a trait like quality that is manifest as a general tende ncy to be p.1447 mindfulness can be viewed as a mode, or state like quality, that is maintained only when attention to experience is intentionally cultivated with an open,
60 nonjudgm (Lau et al., 2006 p. 1447 ). In a research study designed to validate a measure of mindfulness, Lau et al. (2006) propose the following two component definition of mindfulness: (a) the intentional self regulation of attention to facilitate greater awaren ess of bodily sensations, thoughts, and emotions; and (b) a specific quality of attention characterized by endeavoring to connect with each object in awareness (e.g., each bodily sensation, thought, or emotion) with curiosity, acceptan ce, and opennes s to experience ( p. 1447). As discussed above, mindfulness can be understood both as a trait and a state and is also used as a term describing the skills and/or practices that contribute to such a state. While the term mindfulness is relatively new in th e fields of psychology and counseling, it has been suggested that there may be some overlap between the term self awareness and mindfulness (Richards et al., 2010). There are also important distinctions whereas self awareness is typically understood as a wareness directed to the subjective individual experience, mindfulness can be applied to inner experiences (in which case it overlaps with the concept of self awareness) as well as outer experiences, including sensations and perceptions. The construct of m indfulness is also considered distinct from other self focused states such as self preoccupation (Bishop, Lau, Shapiro, Carlson, & Anderson, 2004). Mindfulness practices have gained prominence in the health care field, particularly based on the extensive research on the m indfulness based stress reduction program (MBSR) developed by Jon Kabat Zinn. For example, participation in the MBSR program has been reported to reduce sleep and mood disturbance, while improving quality of sleep and significantly reducin g stress levels among outpatient cancer patients (Carlson & Garland, 2005). In a systemic assessment of the research on the use of MBSR as supportive therapy for cancer patients, researchers concluded that MB SR is a useful
61 intervention that cancer patients can administer themselves (Smith, Richardson, Hoffman, & Pilkington, 2005). Mindfulness interventions have also gained acceptance in the mental health field. A qualitative study exploring the impact of a mindfulness group on participants in an inpatient psychiatric facility was conducted (Winship, 2007). In this study, mindfulness intentionally developing an awareness of moment to moment experience through meditation exercises, reflecting on the findings and gaining insight into the cognitive, emotional, and physical internal processes which underlie our p. 603 ). There were eight participants in the group who were interviewed for the study. The researchers used thematic analysis. The research ers reported that the following themes emerged from the data analysis: cognitive changes; concentration; increase sense of peace and relaxation; acceptance; exposure to problematic thoughts, beliefs and feelings; awareness; and self management (Winship, 20 07). The researchers also reported that theme of using mindfulness after being discharged from the inpatient facility. Some participants discussed negative experiences wi th mindfulness, such as misunderstanding the practice and having unmet expectations of (Winship, 2007). they began to understand the concepts and practices through their engagement in the group. Overall, the results of this study i ndicate the usefulness of mindfulness groups within the context of inpatient psychiatric facilities. R esea rch has begun to explore mindfulness in the context of counselor and psychologist preparation and training, both as a means to reduce stress (Schure,
62 Christopher, & Christopher, 2008) and as a means to increase therapeutic attending and presence in session ( McCullom & Gehart, 2010; Tannen, 2009;). For example, in a exp lored three hypothesized connections between mindfulness, self care, self awareness, and well being (Richards et al., 2010). Richards et al (2010) describe self care in terms of four domains of experience: physical, psychological, spiritual, and support. They identify self awareness as a possible outcome of self care pra c tices. They also c ite various definitions of self awareness that may overlap with the term self consciousness. They connect mindfulness and self awareness in several ways. These researcher s also distinguish mindfulness from self awar ( 2003 ) definition of self ( as cited in Richards et al., 2010 p.823 ). They operationalized mindfulness as The se researchers hypothesized that self awareness and mindfulness would be positively correlated, that mindfulness would mediate the relationship between self care and well being, and that th from self care to self awareness to well being will be significantly stronger than direct path from self care to well p. 252 ). In this study, potential participants were recruited in two ways either because they were lis ted in the phonebook as mental health professionals or via personal contacts (Richards et al., 2010). Surveys were distributed by mail, with a return rate of 35.7%. Researchers measured self care using a scale they designed for the study. Self awareness w as assessed by the Self Reflection and Insight Scale, mindfulness by the Mindful Attention Awareness Scale and well being by the Schwartz Outcomes
63 Scale 10. The researchers reported a positive correlation between the mental health care and mindfulness scores. They also reported that mindfulness appeared to function as a mediator between self care and well being. These results suggest that mindfulness may have a potentially powerful role to play in preventing burnout and other forms of i mpairment. A significant weakness of this study was that there was wide range of educational levels among participants level counselors and doctoral counseling interns as well as professional mental health counselors Hence, some par ticipants in the study were completing internships as part of their educational programs whereas other participants were already licensed professionals. These research ers recommen d that future research gather detailed demographic information from their par ticipants regarding educational level and work setting so that the potent ial impact of these factors on behaviors such as self care can be evaluated Therefore, f uture quantitative research that explores the connection between mindful ness and self care and accounts for differences in educational levels and work setting is needed (Richards et al., 2010) A qualitative study exploring the use of mindfulness practices by professional counselors suggests that counselors who practice mindfulness cultivate intent ional living, experience a feeling of connectedness, abundant gratitude, and want others to share in these benefits. Rothuapt and Morgan (2007) recruited six participants, three men and three women, from the Rocky Mountain Association of Counselor Educator s and Supervisors. All of the participants identified as White, all worked as counselors, and four of the six also worked as counselor educators (Rothuapt & Morgan, 2007). The participants in this study practiced mindfulness in different ways, yet all spok e of the
64 importance of breath awareness and bodily cues about their current state of mind (Rothaupt & Morgan, 2007). This qualitative study indicated that the cultivation of a being. Further research with a more diverse participant group is needed to explore the potential impact being and response to job stress. In a qualitative study exploring yoga as a self care practi ce, Valente and Marotta (2005) reported that yoga can help counselors learn how to reduce the negativ e impact of stress and increase self awareness. The results of t his study suggest that therapists who have a regular yoga practice increase their self awar eness and capacity to relax, thereby avoiding burn out and creating a more healing environment for their clients (Valente & Marotta, 2005). These two studies included small populations of counselors who were alr eady engaged in these particular self care p ractices. Further studies that explore the impact of mindfulness practices and other self care practices among counselors are needed. Moreover, research exploring the efficacy of these and other mindfulness practices among counselors who do not already asc ribe to these practices is needed. In addition, quantitative resear ch linking counselor self care practices and level s of reported stress is needed. While the stressors faced by counselors in the field are distinct from the stressors that counselors in tra ining fac e, several research studies on mindfulness and self care among counselors in training sheds light on research direc tions that may be fruitful to explore with professional counselors. For example, i n a quantitative study surveying 179
65 Master leve l and doctoral level counselors in training Greason and Cashwell (2009) reported that m indfulness was predictive of counsel ing self efficacy. Greason and Cashwell (2009) use d Larson and Daniels (1998) definition of counseling self efficacy as iefs or judgments about his or her capabilities to effectively counsel a ). Greason and Cashwell (2009) state of being attentive to experience that is characterized by an attitude of openness and acc d how mindfulness practices have been used to increase attention, concentration, and affect tolerance tolerate difficult feelin ). The se researchers hypothesized t hat attention and empathy would mediate the relationship between mindfulness and self efficacy, and that mindfulness would be predictive of counseling self efficacy. The researchers used the Five Factor Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkin s, Krietemeyer & Toney, 2006) to assess mindfulness. They used the Counselor Attention Scale (CAS; Greason, 2006) to measure attention and the Interpersonal Reactivity Index to measure empathy. Self efficacy was measure by the Counselor Activity Self Effic acy Scales (CASES; Lent, Hill & Hoffman, 2003). The researchers suggested that this study be replicated with a professional counselor population to see if these results are applicable to professional counselors (Greason & Cashwell, 2009). In a four year q ualitative study, Schure, Christopher, and Christopher (2008 ) explored the impact of teaching counseling graduate students hatha yoga, meditation, and qigong as part of a fifteen week elective 3 credit hour mindfulness based stress reduction and self care course The researchers stated that the course was loosely based on the MBSR program (Schure et al., 2008). Schure et al. (2008) used journal
66 data from students and reported themes including positive physical, emotional, attitudinal/mental, and interperson al changes as well as changes in spiritual awareness In exploring the effect of particular self care practices, Schure et al. (2008) asked students to explore the following journal prom pt: which one are you Schure et al. (2008) described how students reported that yoga practice increased body awareness, flexibility, energy, mental clari ty and concentration. Meditation generated experiences of increased awareness and acceptance of emotions, increased mental clarity and organization, greater tolerance for physical and emotional pain, as well as an enhanced feeling of relaxation (Schure et al., 2008). Students cited benefits such as increased centeredness and enhanced awareness of the mind body emotion connection resulting from their qigong practice (Schure et. al, 2008). A weakness of this study is that the researchers based their course on the MBSR program yet did not ask participants about the impact of the course activities on their perceptions of stress and/or reactions to stress. To address the impact of the course on therapeutic practice the researchers asked l, has this course affected your work with clients, both in terms of being in the room and thinking about the t (Schure et al., 2008 p.49 ). Student s reported greater comfort with silence, increased capacity to attend to the therapy process, and changes in their view of therapy (Schure et al., 2008). These results indicate that the course activities and practices had substantial benefits for participating counseling students, both for their personal self care and professional
67 practice as counsel ors. These results suggest that use of self care practices such as meditation impacts how counselors in training approach their work with clients. Summary Given the ethical considerations and research results outlined above, there is a need for further u nderstanding of how counselors can successfully navigate the demands of the profession. Although much is now known about the risks of counselor impairment in its various forms, research on counselors perceptions of positive and negative working conditions and the personal resources that serve to buffer them from potential negative working conditions is needed. There has been a trend in the literature to examine counselor factors that impact their str ess levels. perceptions of working conditions could help the field understand counselors experiences of their working conditions rather than assuming that certain working conditions are in herently stressful and lead to burnout and compassion fatigue Therefore, the current study e xamined the relationship of working conditions and their levels of burnout and compassion fatigue A systemic understanding of the burnout process recognizes the power of the apac ity to help others as well as their perception of their own capacity to cope with perceived stressors. More nuanc ed examination of counselor working conditions is needed to assess the impac t of the workplace on counselor stress outcomes research resu lts which could lay the groundwork for burnout preventio n interventions at the organizational level, not just at the individual level. Counselor perception of c oworker support is another workplace factor which needs further research Ducharme et al (200 8) explored co worker support and found
68 that it buffered substance abuse counselors from emotional exhaustion; r esearch examining coworker support as a positive working condition among mental health counselors is needed Therefore, the current study examin ed the influence of a broad range of workplace factors on counselor stress outcomes. Research on counselor coping to highlight counselors personal resources rather than their deficits is also needed As described in the literature review, compassion satis faction, coping strategie s, and mindfulness attitudes can be considered personal resources that may reduce the negative effects of counselor job stress. Recognition of the need for effective counselor coping acknowledges both the challenges of the professi on as well as counselor strengths and resources Therefore, the current study examine d the influence of counselor s pe rceptions of working conditions and specific personal resources in predicting their stress outcomes. While it can be argued that there is enough information about the negative consequences that may occur when counselors fail to effectively cope with stress, research exploring the interaction between c working conditions and specific coping strategies in respon se to a challenging working condition is lacking Moreover, although t here is research data to suggest that self care is important the const ruct of self care has been defined inconsistently There fore, the current study use d a specific coping typology gro unded i n transactional stress and coping theory to explore how counselors cope with specific working conditions Counselor mindfulness is another area for additional research exploration. Researchers who have studied counselors in training suggest that research exploring the impact of mindfulness on attention, empathy and counselor self efficacy among
69 professional counselors is needed (Greason & Cashwell, 2009). Therefore, the current study examined the influence of counselor mindfulness att itudes on their stress outcomes Conclusion The current study sought to explore the transactional nature of the counselor stres s experience The current study was grounded in the transactional model of stress and coping to further un derstanding of the relationship between cou nselor p erceptions of positive and negative working conditions, personal resources, and resulting burnout and compassion fatigue levels. Moreover, because research concerning the relationship between gender and counselor stress outcomes has been con tra dictory, the current study examined the effect of gender. The influence of counselor years of experience in the field and the impact of this on cou nselor stress outcomes was also explored The current study was intended to examine the role of mindfulness a nd coping in counselor perception of job stress This research could inform the development of intervention programs designed to address the interaction between personal resources (e.g. coping strategies an d attitudes such as mindfulness ) and working condi tions that impact the development of counselor burnout and compassion fatigue. This review of the literature indicates the need for research that examines the impact of pe rceptions of working conditions and personal resources on counselor burnout and compa ssion fatigue. Moreover, the specific personal resources highlighted in this literature review compassion satisfaction, mindfulness, and coping strategy warrant further research. The current study was intended to meet this need by examining how counse perceptions of workplace stressors and the personal
70 resources of compassion satisfaction, mindfulness and type of coping strategy, impact their level burnout and compassion fatigue. Exploration of the role of m indfulness and other counselor attitudes on their percepti on of job stress was a major objective of the current study that built on the existing li terature on counselor working conditions burnout, and compassion fatigue.
71 CHAPTER 3 METHODOLOGY Th is study was designed to explore the impact of c ounselor perception of certain working conditions and personal resources up on the reported levels of burnout and compassion fatigue of mental health counselors The impact of the following eight predictor variables was assessed : (a) perceived working condi tions (b) leng th of time in field, (c) counselor gender, ( d ) emotion focused coping, ( e ) problem focused coping, ( f ) maladaptive coping ( g ) mindfulness, and ( h ) compassion satisfaction Study Design and Relevant Variables T his study use d a cross sec tion al survey design to explore perceptions of working conditions their length of time in the field, their gender, a nd their use of five personal resources predict ed their levels of burnout and compassion fatigue Cross sectional studies exami ne data that is gathered at one point in time, in contrast to longitudinal studies in which data is gathered across time (Gall, Gall & Borg, 2007). Cross sectional studies allow for examining a diverse group of participants without the problems of attriti on associated with longitu dinal studies (Gall et al. 2007). In this study, a diverse sample of professional mental health counselors of different ages, with dif fering levels of experience who work in differing job contexts participate d This study examin e d whether the following independent variables perceived working conditions length of time in field, gender, mindfulness, compassion satisfaction, and three type s of coping strategies predict ed the dependent variables of counselor burnout and compassi on fatigue.
72 Perceived Working Conditions Perceived working conditions are workplace factors such as the nature of clientele, the nature of administration, collegial support, overall work climate, and other working conditions that counselors experience i n their work environment The emphasis is on a working condition as relevant to their experience as a counselor A self report instrument designed by the researcher to depict specific aspects of the work context of mental hea lth counselors w as us ed to assess counselor perceptions of the ir work environmen t (Appendices C and H). Length of Time in the Field Length of time in field has been associated with counselor stress outcomes in previous studies (Linley & Joseph, 2007) a nd w as conceptualized in this study as a predictor variable influencing counselor work stress outcomes D ata regarding length of time in field w as collected from participants through a question on the demographic questionnaire Gender Gender was conceptual ized as predictor variable influencing counselor work stress outcomes Participants were asked to indicate their gender on the d emographic questionnaire, which was reported categorically for demographic purposes as male or female. For subsequent data analy sis, gender was coded numerically ; males were Type of Coping Strategy Coping has been defined as a person's constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the person' s resources" (Folkman, et al., 1986 p.
73 993 ). Hence, coping can be understood as the way in which individuals attempt to manage perceived stressors. Type of coping strategy refers to the specific ways in which individuals enact coping cognitively affectively and behaviorally The t ype of c oping strategy used by the study participants w as assessed using the Brief COPE inventory, an abbreviated version of the original COPE inventory (Carver, 1997) and organize d into three categories: (a) problem focused coping, (b) emotion focused coping, and (c) maladaptive coping The organization of coping strategies into these three categories was guided by the transactional framework of the study as well as previous resear ch results in which the 14 subscales of the brief COPE were grouped into three categories of emotion focused, problem focused and dysfunctional coping ( Meyer, 2001 ). Mindfulness Mindfulness, for the purposes of this study, wa s defined as paying complete attention in the present moment, with moment to moment non judgmental awareness and was defined as an open and receptive approach to live in the present moment Given this conceptualization of mindfulness as a dispositional characteristic it was assumed that an attitude of mindfulness c ould positive ly influence the stress appraisal process, thereby allowing an individual to asses s a situation as more of a challenge than a threat. Mindfulness w as assessed using the Mindfulness Attention Awareness Scale, t rait version, which was developed based on the contemporary definition of the construct of mindfulness (MAAS; Brown & Ryan, 2003). Compassion Satis faction Compassion satisfacti on refers to the sense of satisfaction and fulfillment that professionals expe rience during the helping process itself and as a result of their work
74 (Stamm, 2010). Compassion satisfaction represents the positive side of the act of being compassionate, the benefits and sense of success that clinicians can experience as a result of ex tending their compassion to others. Compassion satisfaction w as measured by a subscale of t he Professional Quality of Life Scale Version 5 that was designed to measure this construct and has been previously validated (ProQOL; Stamm 2009) Compassion Fatigu e Compassion fatigue is defined as emotional fatigue brought on by caring for traumatized clients; it is conceptualized as a secondary traumatic stress process result ing from Compassion fatigue w as mea sured by the secondary traumatic stress subscale (formerly called the compassion fatigue scale) of the ProQOL 5 (ProQOL; Stamm, 2009) In the 5 th version of the ProQOL (Stamm, 2010), the constructs of burnout and secondary traumatic stress are conce ptualized as both contributing to a broader construct labeled compassion fatigue. For the purposes of this study, comp assion fatigue is considered synonymous with secondary traumatic stress and the second ary traumatic stress subscale was used to measure th is construct. Compassion fatigue w as examined as an outcome variable in this study. Burnout Burnout has been defined as "the process of physical and emotional depletion resulting from conditions at work or, more concisely, prolonged job stress" (Osborn, 2004 p. 319 ). Burnout is characterized by e motional exhaustion, depersonalization, and lack of personal accomplishment at work (Maslach et al., 2001) Burnout w as examined as an outcome variable in this study and w as measured by the burnout subscale of th e
75 ProQOL which was designed to measure this construct and has been previously validated (ProQOL; Stamm, 2010 ) Population and Sample The populati on of interest in this study were mental health counselors in the United States of America Mental health coun seling is a unique profession with its own professional identity and professional association the American Mental Health Counselors Association (AMHCA) According to the Bureau of Labor Statistics Occupational Employment and Wages webpage, there are appro ximately 114,180 mental health counselors employed in the United States ( http://www.bls.gov/oes/current/oes211014.htm retr ieved May 20th, 2012 ) Mental health counseling is a profes sion distinct from social work and marital and family therap y. The Occupational Employment and Wages webpage states that m ental health ork with individuals and groups to promote optimum mental and emotional health. May help individuals deal wi th issues associated with addictions and substance abuse; family, parenting, and marital problems; stress management; self esteem; and ag http://www.bls.gov/oes/current/oes211014.htm #nat retrieved July 10, 2011 ). Mental health counselors provide clinical interventions including clinical services such as counseling and consultation to individuals, couples, groups, families and organiz ations. They are trained to diagnose and treat me ntal disorders. The mental health profession is also characterized by a developmental approach to help ing clients re establish mental well being Me ntal health counselors must complete counseling, community counseling, or a closely related field to be eligible for licensure as a mental health or professional counselor. While each state has its own licensure
76 process, there has been a professional movement towa rd standardization and licensure portability represented by the National Board for Certified Counselors, which has implemented a national certification pr ocess for the profession In addition, at the counselor preparation level, the Council for Accreditation of Counseling and Related Educati on Programs accredits counse lor education programs to ensure that all counselors in training receive the needed coursework and practicum experiences to be prepared for their professional roles and to meet state standards to pursue professional licensure As of 2009, all 50 state s hav e licen sure for counselors (ACA, http://www.counseling.org/AboutUs/OurHistory/TP/Milestones/CT2.aspx ?, retrieved July 2, 2011 ) Mental health counselors practice in a vari ety of work settings. They may work in private practice settings, seeking clients either individually, in family units, or in groups. Mental Health Counselors may also work in community agencies providing mental health counseling services. Mental health co unselors also work in crisis stabilization facilities, higher education settings, college counseling centers, and some work in alternative and public school settings providing mental health services to children. Mental health counselors are also called to provide services in disaster situati ons, including school shootings and natural disasters of various kinds. Study p articipants w ere drawn from a national sample of mental health counselors and were required to meet the sampling criteria described below to be included in the study Participants w ere required to have completed a degree) in mental health counseling or community counseling or closely related field Moreover, participants w ere required to be work ing a minimum of 20 h ours a week or
77 more as a counse lor in a clinical setting and to be paid counselors, not volunteer or unpaid counselors. P articipants w ere also required to have worked a minimum of six months at their current job setting Finally study participants were re quired to be currently serving in a clinical capacity providing direct services to clients, rather than serving in solely administrative or other non clinical professional roles. Sampling Procedures A combined approach to sampling was used, consisting of a convenience sample of mental health couns elors as well as a randomized sample drawn from the American Mental Health Counselors Association Membership rol l s Convenience sampling is the process of including participants who are accessible and willing to part icipate in the study, who also meet the criteria for a given study (Gall et al. 2007). An advantage of this sampling procedure is that it allows for recruitment of participants through multiple avenues. A disadvantage of this sampling procedure is tha t it is a non probability sampling procedure (Gall et al., 2007). P articipants were recruited using a variety of different strategies Potential participants were drawn from the American Mental Health Counseling Association (AMHCA) membership email rol l s the AMHCA Facebook page, newsletters and email announcements sent to AMHCA state and local membership, and local, state and national contacts The first strategy was to recruit AMHCA members via individual email invitation. A second strategy was to recrui t participants by posting a general invitation and request to participate in the research study on the AMHCA Facebook webpage. A third strategy was to recruit participants by contacting leaders of AMHCA divisions and requesting that they include general in formation about the study in newsletters and/or email announcements. A fourth strategy was to contact professionals in the mental
78 health counseling field, including counselors employed in private practice and community agencies, and request that they annou nce the study to their colleagues. The researcher provide d these profess ionals with information about how potential participants could access the survey. Although AMCHA was one of the primary means of recruiting participants, individuals d id not need to be AMHCA members to be included in the study. The first three recruitment efforts focus ed on members of the American Mental Health Counselors Association (AMCHA) The American Mental Health Counseling Association is the only professional organization in the United States of America that is solely dedicated to the mental h ealth counseling profession and has approximately 6,000 members: growing community of almost ( http://www.amhca.org/about /default.aspx, retrieved July 5, 2011 ). This pool of potential participants was sought because it represents a national sample of mental health counselors, the population of interest in the current study. Following an informed co nsent process in which participants were given general informatio n about the nature of the study, participants were invited to complete the survey online or via paper and pencil ( see Appendices A and B). The desired sample size was based on the statistical analyses that were conducted. Given the total number of variables to analyzed, a sample of 200 250 counselors was sought. Resultant Sample There were 361 responses to the survey invitation. Of those, one person indicated that they did not consent to take the study and therefore did not complete the survey.
79 Forty seven people read and agreed to the informed consent, but did not complete any other part of the survey, resulting in a group of 313 participants who started the survey. A further 61 were excluded due to incomplete survey responses. A further 19 participants who completed surveys were excluded because they self reported that they did not meet the study criteria of working at least 20 hours per week. Three survey participants were excluded because th ey did not meet the study criteria of having been at their current j ob setting for a t least six months. In addition, 1 6 more participants were excluded because they self reported that they did not meet criteria of being a professional mental health counsel or ( licensed marriage and family therapist ( LMFT ) 1 participant; LMFT intern 1 participant; certified rehabilitation counselor ( CRC ) 1 participant; advanced registered nurse practitioner ( ARNP ) 1 participant; social work professionals 4 participa nt s ; clinica l psychologist 1 participant; and s chool counseling professionals 7 participants) One participant was excluded because they and were still completing an s degree program A total of 21 3 participants who completed the survey met the study criteria for inclusion in the data analysis The exact response rate is not known due the convenience sampling procedures used to recruit the participants. However, alth ough an exact response rate is not available, information about the listservs and email addresses that the survey was sent to is detailed below. The survey invitation was posted twice to the University of Florida Counselor Education listserv: February 23 2012 and April 26 2012 to 450 email addresses. The survey invitation was poste d twice to the Counselor Education and Supervision Network Listserv (CESNET L): February
80 27 2012 to 2181 email addresses and April 1 2012 to 2220 email addresses. The invitat ion was also posted twice to the Association for Spiritual, Religious and Ethical Values in Counseling listserv which had 867 subscribers as of June 15 2012 (R. Watts, personal communication, June 15, 2012 ): first on March 1 2012 and then re posted on M arch 12 2012. T he survey invitation was sent one time directly to 1,933 random email address es from the American Mental Health Counseling Association membership r oll s The survey invitation was sent one time via listserv to the email addresses of 496 prof essional members of the Ohio Counseling Association ( S. Grime, personal communication, April 27, 2012 ) The survey invitation was sent one time to Alabama Counseling Association listserv which includes approximately 1,900 individual email addresses ( E. Wo od, personal communication, April 24, 2012 ) While an exact response rate is not known, an approximate response rate of 20% is estimated based on the total number of individual emails reached and the 361 responses to the invitation. Demographics of the Res ultant Sample G ender Participants were asked to self report their gender. The resultant sample of 213 was approxi mately male and female, with 51 male participants and 162 female participants included in the final sample. Thus, approximately 24 % of the sample was male and 76% of the sample was female. Age Participants were asked to type in their age. The participants were grouped into age categories by decade: 1 ) 25 and younger, 2) 26 35, 3) 36 45, 4) 46 55, 5) 56 65 and 6) 66 and older. Eight partici pants were 25 and younger (approximately 4 % of the
81 sample) 60 participants were between ages 26 35 (28% of the sample) 3) 36 participants were between the ages of 36 45 (17%) 4) 41 participants were 46 55 (19%) 5) 54 participants were 56 65 (25%), and 6) 14 participants were 66 and older (7%) The age ra nge was from 24 years old to 78 years old. There was a wide variability of ages (s ee Table 3 1 ) Race/Ethnicity Participants were asked to indicate their race and/or ethnicity. Participants were able t o select multiple categories among the following: Native American/Alaskan Native, Asian, Black/African American, Latino/a, White/Caucasian American, Native Hawaiian ask ed to specify This was not a required quest ion, so a participant could elect not to indicate their race/ethnicity. Approximately 84% of the sample self reported as White/Caucasian (n=179), 9% black/African American (n=19), 4% Latino(a) (n=9), .5% Asian ( n=1), and 1 % multiethnic (n=2). Participants were able to choose more than one category. Two participants, consisting approximately 1 % of the sample, indicated multiple categories: one identified as both Hawaiian/Pacific Islander and White/Caucasian, whi le the other participant, approximately .5 % of the sample, chose not to identify a category (see T able 3 2 ). Relationship Status Partic i pants were asked to indicate their relationship status. Participants could not select multiple relationships statuses. Approximately 13% of the sample (n=27) self and approximately 7% (n= 14 )
82 relationship Another approximately 8% of the sample (n= 16 ) self reported that they were Approximately 62% of the sample (n=131) reported that they were married, approximately 8% of the sample (n= 18 ) reported that they were divorce d while 2% (n= 5 ) reported they were ing 1% of the sample (n=2) self and the other specified being in a non monogamous committed relationship (See Table 3 3) Hours Worked Per Week Parti cipants we re asked to report the number of hours per week that they work ed as a counselor. Participants who indicated that they worked less than 20 hours per week were not included in this study because working more than 20 hours per week was a criterion for partici pation Participant responses were grouped into categories consisting of increments of five hours per week. Approximately 12% (n=25) of the sample reported working between 20 and 25 hours per week. Approximately 9% (n=20) of the sample reported working bet ween 26 and 30 hours per week, while another 9% (n=20) reported working between 31 and 35 hours per week. Approximately 41% of the sample (n=87) reported working between 36 and 40 hours per week. Approximately 14% (n=30) reported working between 41 45 hour s per week, 7% (n=15) reported 46 50, 4% (n=8) reported working 51 55 hours, 2% (n=4) reported working 56 60, .5% (n=1) reported 61 65, .5% (n=1) reported 66 70 and the remaining 1% (n=2) reported working 80 85 hours per week. The largest percentage, appr oximately 41%, reported working between 36 40 hours per week. Some p articipants indicated that they worked a range of hours per week. The researcher used the following d ecision rule the mean of the range reported by the
83 participant was selected as repres enting thei r average number of hours. Participant responses were then grouped in the category that included that mean. If participants indicated that they worked more than a p articular amount for instance, a self report of e next category up (41 45 hours per week) (See Table 3 4). Counselor Length of T ime in the Field Participants were asked to indicate the total number of years that they had worked in the counseling field, excluding any clinical experience they gained dur ing their Respond e nts reported an average of 12.58 years of experience in the field, with the least experienced respond ents reporting half a year of experience and the most experienced res pondent reporting 53 years of experiences. Length of T ime at Current Job Participants were asked to indicate the number of y ears or months that they had worked at their current job setting Participants who reported less than six months at their current j ob setting were not included in the data analysis for the current study. Work Setting Participants were asked to indicate the nature of their work setting. Almost a third of the sample reported working in a private practice setting, 31.93%, (n=68). Anot her third of the sample reported working in community mental health agencies, 30.52% (n=65). The remaining percentage reported working in the following settings: 6.10% in College Counseling Centers (n=13), 2.82% in hospital settings (n=6), 1.41% in Crisis Stabilization Units (n=3), 5.16% in substance abuse treatment centers (n=11), 1.41% in
84 their work setting (n=44) (s ee Table 3 5) Salary/Income from Counseling Work Part icipants were asked to indicate how much money they make from their counseling work. Five participants elected not to respond. Two hundred and eight participants completed this question. Approximately 25 % of the sample (25.48%, n=53) reported earning betw een $35,000 and $44,999 dollars per year from their counseling work. The second largest percentages reported earning between $25,000 and $34,999 (17.31%, n=36). The next largest percentage was 16.83% (n=35) of participants who reported earning between $45, 000 and $54,999 dollars per year. After that, 12.02% of participants (n=25) reported earning between $55,000 and $64,999. Then, 7.69% (n=16) reported earning between $10,000 and $24,999 dollars per year. There remaining percentages were as follows: 5.77 % (n=12) reported earning between $65,000 and $74,999 per year, 4.81% (n=10) participants reported earning $ 75,000 $84,999, 3.37% (n=7) reported earning between $85,000 and $94,999, and 4.81% (n=10) reported earning 95,000 or more. Two participants (0.96% ) reported earning Ge ographic Distribution of Sample Participants were asked to indicate their city and state of residence. There were participants from 43 out of 50 states a s well as Puerto Rico. The largest percentage was from Florida (21.13%) followed by Alabama (13.15%), Ohio (9.39%) and Texas (4.69%) The remaining percentages were less than five percent of the total sample. A full representation of the geographic distri bution of the sample with p repor ted state of residence is included in Table 3 6.
85 Membership in Professional O rganizations Participants were asked to indicate if they were members of the American Counseling Association (ACA) or the American Me ntal Health Counselors Association (AMHCA). Approximately 56% (n=119) of the sample reported that they were members of ACA while the remaining 44% (n=94) reported that they were not members of ACA. Approximately 38% (n=80) of the sample reported that they were members of AMHCA and 62% (n=133) reported that they were not members of AMHCA. Data Collection Procedures Upon approval by the doctoral committee, approval from the University of Florida Institutional Review Board (IRB) was sought to conduct this stud y. After gaining IRB approval, recruitment of participants began on February 23 rd 2012 The informed consent process for both the online and paper and pencil formats of the survey include d a letter describing the nature of the study and an informed consent document (See Appendix A ) In the online version, participants were asked to check a box indicating that they consent ed to completing the survey and participat ing in the study. Once they ha d given their informed consent, participants were invited to compl ete the survey online or via paper and pencil. Participants did not have access to the online survey until they ha d provided their consent. An invitational letter providing a brief overview of the study and informed consent information was created to pr ece de both the online and paper and pencil versions of the survey. In the online version, participants who elect ed t o participate in the study check ed a box to provide informed consent to participate in the study before they proceed ed to the survey itself. Re sponses to the online survey are confidential because participants w ere not asked to provide their names. In the paper and pencil version, participants were asked to sig n the informed consent document (see
86 Appendix B). No participants elected to complete t he survey in the paper and pencil version Online survey distribution represents an innovation in survey methods that has become increasingly popular (Cooper, 2000, as cited in Kaplowitz, Hadlock & Levine, 2004). Advantages of using online survey methods include elimination of the costs of printing and mailing paper and pencil surveys, elimination of the cost and time associated with manual data entry of participant responses, the potential to reach a broad range of participants in multiple sites, and redu ction of the overall time needed to collect data from a chosen sample (Dillman, 2000). Despite these advantages, there are also some disadvantages to using the online survey format. One disadvantage is that access is limited to people who have access to co mputers with I nternet connections. In a study comparing response rates to online versus paper mail distribution of surveys, researchers reported that while the substantive data procured from both methods was comparable, the mean age of respondents to the o nline version was younger than the mean age of respondents to the paper mail version (K aplowitz et al 2004). Hence, a potential disadvantage of the use of online surveys is that older part icipants may be less likely than younger participants to complete the survey. Therefore, the study employ ed both online distribution of surveys as well as paper and pencil distribution of surveys was protected throughout the entire research process, from initial recruitment, through data co llection, analysis and any future publications that may result from this research. Online survey responses were stored in a password protected accoun t tha t only the researcher had access to Paper versions of the survey would have been returned in stamped envelopes by mail to the researcher s home
87 address or handed to the researcher in person if administered in person Data collected from the paper and pencil version of the survey would have been manually entered into the data analysis software. However, no participants elected to complete the paper and pencil survey, so the online procedures to protect confidentiality apply to all participants. Instrumentation and Operationalized Variables The study s urvey wa s composed of five dif ferent instruments: a) t he Perceived Working Conditions Scale (developed by the researcher for this study b ) t he Professional Quality of Life Scale (ProQOL; Stamm, 2010), c ) t he Brief COPE (Carver, 1997), d ) t he Mindful Attention Awareness Scale (MAAS; Brown & Ryan 2003), and e ) a demographic questionnaire developed for this study by the researcher to gather descriptive information about the individual, their educational background, and work environment These five instruments are described in detail in the following section. Coun selor Perceived Working Conditions Scale Counselor p erc ep t ions of their working conditions were measured by a n instrument designed for this study titled the Perceived Working Conditions Scale This instrument is designed to provide a window into an individ perceptions of the working conditions at their job setting. This instrument was designed to measure the occurrence and frequency with which counselors perceive and experience specific positive a nd negative working conditions. Unlike instruments designed to assess the strain consequences of perceived stressors, this instrument was xperience of working conditions that are both positive and negative Further, r ather than assuming that only cert ain variables are stressful such as caseload size or clientele this measure describe s a variety of workplace factors that counselors might experienc e Respondents are asked to rate the
88 frequency with which they experience the working conditions described by each item. The re s ponse format is a 5 point L ikert type scale with 1 2 meaning Sample items include: I have the freedom to choose how I conduct my c lin ical Colleagues take the time to consult with me regarding c The instrument was comprised of 5 0 items with 2 5 positive items and 2 5 negative items describing specific working conditions t hat mental health counselors may experience. It assesses counselor perceptions of positive and negative working conditions in the following five domain: a) Characteristics of Clientele, b) Clinical Efficacy and Preparedness, c) Nature of Coworker Relatio nships, d) Nature of Job Tasks (subdivided in Private Practice and Agency), and e) Nature of Administration and Overall Atmosphere. The inclusion of items in each of these domains was guided by exploration of the research literature and examination of exis ting instruments. Client characteristics have been discussed in the literature as a possible fact or in counselor stress outcomes and therefore items related to this domain were included. There is a literature regarding counselor perceived self efficacy and sense of preparedness, therefore items were included that tap this domain of counselor functioning. Inclusion of the domain assessing the nature of coworker relationships was inspired by the research of Ducharme, et al., 2008 who reported a relationship b etween higher levels of co worker support and lower levels of emotional exhaustion in a study of over 1, 800 substance abuse counselors. In the occupational stress literature, there is evidence that the type of job tasks a worker completes throughout the d ay and their occupational roles impact their stress level (Layne, Lohenhil, & Singh, 2004) therefore
89 this domain was included. The nature of administration and overall atmosphere domain positive or negative perception of the broader work context in which they work. An example of this making. There is a precedent in the counselor burnout literature to examine the impact of the broader context on the counselor (Lee, Baker et al. 2007). Th e Counselor Working Conditions Scale follows in this tradition of examining context while including items that further assess specific working conditions such as counselor perceptions of clientele, administration, and positive aspects of the work context su ch as coworker support and effective supervision. Due to the dearth of existing instruments me asuring specific counselor working conditions, the teacher stress literature and occupati onal stress literature were examined. The Teacher Stress Inventory was of particular relevance in the develo pment of this instrument because it examines specific teacher working conditions (Shurtz & Long, 1988). However, because this instrument was develop ed for the specific working conditions that teachers encounter, it was not suitable to assess the unique working contexts of mental health counselors. Th e Occupational Stress Inventory Revised which assesses general work related stress and personal reso urces, was examined for possible use in this study (Layne et al., 2004). The researcher determined that the items were too general to provide a meaningful picture of the counselor working co nditions Because the Counselor Perceived Working Conditions Scal e was designed for the purpose of this study, efforts have been made to establish its reliability and validity The development of each item was intentional. The researcher engaged in numerous
90 dialogues with counseling colleagues in the development of the items. To determine its internal reliability, an internal consistency estimate for the instrument was calculated. Content validity for this instrument was established through a process of vetting by a n expert panel to determine whether the scale items repr esent relevant working conditions that counselors may experience. The researcher presented a pool of items to a panel of three experts who were asked to evaluate the representativeness of the five domains, the representativeness of the items and suggest ad ditional domains or items that may capture an el ement of counselor working conditions that the researcher had not identified. The expert panel was also invited to edit existing items. The expert panel assessed an in i tial item pool of 57 items. There were seven original items in the domain Characteristics of Clientele. One of the original seven items was replaced with a engaging i An eig hth item suggested by an expert reviewer with their clients was added : I have concerns for my safety in working with many of my clients In addition, t he wording of three of the original seven items in this domain was re vised based on expert feedback to increase clarity Two were revised to a positive valence from ne gative valence based on reviewer feedback that this domain lacked positive statements. In addition, the creator of the instrument added two positive valence item s to thi s domain based on this feedback for a total of ten items with an equal number of positi ve and negative items
91 Preparedness One of the original items was replaced with an item suggested by an replaced by: I feel that it is next to impossible to h One item was removed due to redundancy, replaced by a different item suggested by a reviewer. Three of the original items were revised based on expert fee dback. Three additional items were suggested by an expert reviewer. One item was then later removed due to redundancy. The review resulted in seven total items There were originally ten items in Two items we re combined based on expert feedback Three items were removed due to redundancy. One additional item was recommended by an expert reviewer and added to the items The wording of one item was revised based on expert feedback. The review resulte d in seven t otal items for this domain There were originally seven items in the overall Expert reviewers suggested an additional eight items for potential inclusion. Two of the suggested items were used in place of two original items. Th ree item s was deleted. Two more items were added to increase the number of positive items. Another item was revised according t o expert feedback. There were five items in the final version There were originally seven items in the private practice subsect The version used in the survey included four items, with two positive and two negative items. There were originally seven items in the organizations domain. The wording of f o ur original items was
92 revised based on expert feedback. The version used in survey included seven items in this domain and Overall Two of the original items wer e replaced by two of four items suggested by expert reviewers. The wording of one item was revised based on expert feedback Two items were changed from positive to negative items to equalize this domain. One additional item was included in the final vers ion, so that it t he instrument included in the survey had eleven items in this section. Original subscale scoring The researcher originally divided th e items so that 25 were included on a positive subs cale and 25 were included on a negative subscale. Thr ee positive valence items were reverse scored for inclusion on the negative perception subscale. The Counselor Perceived Working Conditions Scale was originally conceptualized as consisting of two subscales with two distinct scores. One subscale was int ended to measure positive perceptions of working conditions while the other was meant to measure counselor perceptions of negative working conditions A higher score on the positive sub scale was originally intended to indicate greater levels of positive p erceptions while a higher score o n the negative scale was intended indic ate greater levels of negative perceptions. There were 5 0 total items in the instrument that survey participants completed with an equal number of items on each subscale. The subsca le score s were determined by summing the scores of participant s responses to each item. The original range was 1 1 2 5 for each of the subscales.
93 Instrument Validation After the survey data were obtained, a confirmatory factor analysis was conducted on thi s instrument. The research er d ownloaded the data set and t he 213 participants who met criteria for inclusion in this study were included in the factor analysis. Confirmatory factory analysis (n=213) was conducted on the summed scored for the two conceptual ized subscales positive perception subscale and negative perception subscale. A scree plot was used to determine that there was one primary factor which accounted for 27.95 % percent of the variance A scr ee plot is considered an accepted means of determ ining factors (Costello & Osborne, 2005). After reviewing the items that comprised the primary factor indicated by the scree plot it was determined perception of working conditions formed a continuum from positive to negative on one primary underlying fac tor. The negative perception items that loaded on this factor were reverse scored so higher scores indicate more positive perceptions, lower scores indicate less positive perceptions. After eliminating items wi th a loading of less than .4, 46 items remaine d. The .4 cut off point for factor loadings is considered a robust measure for factor loading in instrument development (Costello & Osborne, 2005). The remaining 46 items were summed to form one over all score for counselor perceptions of the work environme nt. The sum score for this scale was then loaded it into SPSS for all subsequent data analysis s Alpha was .94 for the Counselor Perceived Working Conditions S cale consisting of 46 items (See Appendix H ). The development and initial validatio n of this instrument was inte grated with overall goal of this study Greater understanding of counselor perceptions of specific working conditions was sought through the development of this instrument and the initial validation of the instrument on the stu dy sample
94 Professional Quality of Life Scale The Professional Quality of Life Scale 5 (ProQOL; Stamm, 2010) is an instrument designed to assess compassion satisfaction, burnout, and compassion fatigue/secondary traumatic stress among professionals in a variety of helping professions (Stamm, 2010 ). This instrument was used to measure the operationalized variables of c ompassion satisfaction, burnout, and compassion fatigue each of which has a distinct subscale on the ProQOL One subscale measures compassi on satisfaction, which for the purposes of this study was analyzed as a predictor variable. A second subscale measures burnout, which was analyzed as an outcome variable. The third subscale m easures compassion fatigue, which was also analyzed as an outcome variable. This instrument does not provide a composite score rather, each subscale is scored distinctly (Stamm, 2010) The burnout subscale assesses feelings of exhaustion, depletion and hopelessness associated with professional work. Compassion f atigue is conceptualized as the negative consequence of the stress of secondary exposure to traumatic information, inclu ding conversations and therapeutic interactions with clients (Stamm, 2010). Burnout and compassion fatigue both represent the negative cons equ ences of stress and will be used as outcome variables in this study. These outcome variables are consistent with the theoretical framework of the transactional theory of stress and coping. The ProQOL consists of 30 item s which respond e nts rate on a 5 po int L ikert scale. Each subscale consists of 10 items. Sample items for the compassion satisfaction fter working with those I counsel feel ove rwhelmed because my case because of
95 my work as a counselor to tap the experience of secondary traumatic stress related to exposure to client tr auma, me of the frightening ex periences of the people I counsel at work because I am losing sleep over the traumatic experiences of a person I help While the three subscales have been demonstrated to measure independent constructs, there is a shared variance of 34% (r =.58) between the burnout subscale and compassion fatigue/ secondary traumatic stress subsc ale which has been attributed to the distress common to both constructs (Stamm, 2010). The reliability of the ProQOL subscales has been reported as follows: compassion satisfaction with an alpha of .87, burnout with an alpha .90 and compassi on fatigue with an alpha of .87 ( Hooper, Cra ig, Ja nvrin, Wetsel, & Reimels, 2010). The ProQOL has a long track record of u se with a wide variety of helping professionals and it is intended for use with this population (Stamm, 2010). There is an extensive body of literature that uses the ProQOL, whic h is evidence of both its validity and reliability (Stamm, 2010). Brief COPE The Brief COPE instrument was The Brief COPE was developed and first administe red to a sample of 168 people from a community sever ely impacted by a hurricane 3 6 months earlier (Carver, 1997). There were two subsequent administrations aft er another six months and then one year later (Carver, 1997). The Brief COPE was created from the original 60 item COPE inventory to give research ers the opportunity to use a briefer inventory in conjunction with other relevant instruments so that coping could be measured without putting undue burden on participants (Carver, 1997).
96 The B rief COPE n getting to rate how frequently they use the coping strategy described each stat ement on a 4 The B rief COPE c an be used to assess dispositional or situation al coping (Carver, 1997) The B rief COPE has been used as an assessment of situational coping in re s ponse to particular stressors or triggers. For example, there is a precedent for using it to assess how patie nts are cop ing with stress since they found out they needed a surgical procedure ( http://www.psy.miami.edu/faculty/ccarver/sclBrCOPE.html ). For the purposes of this study, responde nts were asked to recall a spec ific work challenge and then to describe it i n writing. Below is the statement used to introduce this section of the survey: Research has indicated that certain working conditions may pose challenges for counselors (e.g. excessive caseload, traumatic issues of clients, lack of organizational support, and lack of needed supervision). In this section we would like to learn about a specific challenge that you experience in your work setting and h ow you typically cope with it. In the space below please describe a specific condition in your work environmen t that you have found challenging during the past 30 days. After writing their own description of a specific working conditions, r espondents were asked to respond to the B rief COPE items according to how they are coping wit h the specific challenge they des cribed The instruction for the Brief COPE instrument was intended to elicit specific workplace challenges f rom survey respondents and have them respond to the B rief COPE based on how they are coping with this specific
97 challenge. The heading for the sectio n was How you are dealing with this challenging work condition s for the B rief COPE used in this survey is quoted below: While different people may deal with challenges in different ways; we're interested in how you've dealt wit h a challenging work condition, such as the condition that you described above. Keep the challenge described above in mind as you respond to the items below. Please indicate how you are currently responding to your above example. Only keep in mind the chal lenge and how you are responding to it, there is no need to evaluate if your response is working or not. Using the choices below, rate how frequently you've been responding this way. Rate each item separately from every other item. Make your ans wers as tru e FOR YOU as you can. 1 = I haven't been doing this at all 2 = I've been doing this a little bit 3 = I've been doing this a medium amount 4 = I've been doing this a lot The original 60 item COPE was reported to have strong reliability and validity (Carve r et al., 1989). Carver reported that confirmatory factor analysis yielded nine ). The Brief COPE has acceptable internal reliability for all subscales (Carver, 1997). The Brief COPE was origi nally conceptualized as consisting of 14 subscales, consisting of two items per subscale: active coping, planning, positive reframing, acceptance, humor, religion, using emotional support, using instrumental support, self distraction, denial, venting, subs tance use, behavioral disengagement, and self blame (Carver, 1997). There is a precedent in the research literature for grouping some of these subscales together into broader subgroups: Brief COPE can be grouped into adaptive versus mala daptive as well as emotion focused versus problem The B rief COPE can be administered as a situational or dispositional inventory (Carver, 1997). In the current study, the B rief COPE was administered as a situational inventory to assess three types of coping strategies: problem focused, emotion focused, and
98 maladaptive. Research related to the grouping of the subscales into these three types of coping is detailed below. In a longitudi nal study of coping among caregivers of peop le with dementia, researchers group ed the original 14 subscales into three composite subscales: dysfunctional, problem focused or emotion focused (Cooper, Katona, & Livingston, 2008 p. 839 ). There were 92 participants at time 1 and 74 particip ants at time 2 two years later. They reported that the internal consistency was good for these composite subscales alpha of 0.72 for the emotion focused, alpha of 0.84 for the problem focused, and 0.75 for the dysfunctional (Cooper et al., 2008). These researchers grouped the original 14 B rief COPE subscales as follows: e motion focused strategies acceptance, emotional suppor t, humor, positive reframing, and religion ; p roblem focused strategies acti ve coping, instrumental support, and planning ; dysfu nctional strategies behavioral disengagement denial, self distraction, self blame, substance use, and venting (Cooper et al., 2008). These researchers also reported adequate test retest reliability as well as good convergent and concurrent validity (Coo per et al., 2008). For the purposes of the current study, the term maladaptive was used instead of dysfunctional. T he groupings that Cooper et al. (2008) used were examined for the problem focused, emotion focused and maladaptive coping subscales used in t he current study The authors of the original COPE identified several types of coping strategies as representing problem focused or emotion focused coping strategies. These efforts have guided the current effort to group the 14 subscales of the B rief COP E (Carver, Scheier, & Weintraub, 1989) into three general categories. Further, these authors argue that
99 there can be forms of adaptive coping encompassed within the broad categories of problem focused or emotion focused cop ing Therefore, the following B r ief COPE subscales were groupe d under the category of problem focused coping: active coping, use of instrumental support, and planning. The following B rief COPE subscales will be grouped under the category of emotion focused coping: use of emotional suppo rt, positive reframing, humor, acceptance, and religion. There is a precedent in the research literature for the term avoidance coping which refers to coping strategies in which individuals avoid dealing directly with the problem at hand, such as minimiz ing or denying (Holahan, Moos, Holahan, Brennan, & Schutte, 2005). Further, there is also a research precedent for grouping some scales of the B rief COPE as maladaptive (Meyer, the negative outcomes that certain types of coping strategies may have. Therefore, the following B rief COPE subscales were grouped in the category of maladaptive coping: self distraction, denial, substance use, behavioral disengagement, venting and self bl ame. Mindful Attention Awareness Scale Mindfulness was assessed using the 15 item Mindful Attention Awareness Scale, trait version (MAAS; Brown & Ryan, 2003). This instrument assesses mindfulness as a personal characteristic or tra it (Brown & Ryan, 2003) Brown and Ryan (2003) open or receptive p. 822). This definition of mindfulness is consistent with numerous contemporary definitions of mindfulness, including Kabat definition of mindfulness as paying complete attention in the present moment, with moment to moment non judgment al awareness (1994). The MAAS trait version is
100 lness. Responde nts rate the frequenc y with which they experience what is described by each item on a 6 point The MAAS uses an indirect item approach to get at various aspects of mindfu lness (Brown & Rya n, 2003) including I tend not to notice feelings of physical tension or discomfort unti l they really grab my of what The single factor structure of the MAAS has been demonstrated in a college student sample of 327 people and in a national adult sample of 239 people (Brown & Ryan, 2003). Researchers reported internal consistency to be acceptable with alphas ranging from .80 to .90 (Brown & Ryan, 2003). Fur ther, in a study examining the construct and criterion validity of the MAAS among a sample of cancer patients with he single factor structure of the MAAS was invariant across the grou p. 29 ). These researchers also reported that igher MAAS scores were associated with lower mood disturbance and stress symptoms in cancer patients, and the structure of these relati an, 2005 p. 29 ). The test retest reliability of the MAAS has also been demonstrated (Brown & Ryan, 2003). The MAAS has been used with a general population to assess mindfulness characteristics that are not dependent on particular mindfulness training (Bro wn & Ryan, 2003). The MAAS has also been used successfully to distinguish between individuals who have received training in meditation and those who have not, indicating that it does differentiate between mindfulness characteristics that are consistent wit h mindfulness
101 training (Brown & Ryan, 2003). For the purposes of this study, the MAAS was used to Demographic Questionnaire A demographic questionnaire was developed for this study to gather information characteristics: gender (categorical), age in years (continuous), race/ethnicity (categorical) They were asked about their marital status (categorical) if they are parents (categorica l) and if they are a caregiver for an elderly person (categorical). If they answer ed yes to any of these questions, they were asked to indicate on a scale of one to five how stressful that role is for them. Par t icipants were then asked number of children ( continuous), whether their children live at home (categorical) level of education (categor ical) and city and state of residence (categorical). The questionnaire also include d questions about history and work context: total number of graduate credit hours completed (continuous), total number of hours worked per week (continuous), number of hours of direct client contact per week (continuous) total number of clients on caseload (continuous), number of total years in the counseling field (continuous), number of years at current position (continuous), the nature of t heir work setting (categorical), licensure status (categorical) additional licenses held (categorical) membership status in the American Mental Health Counselors Associ ation (categorical), whether or not they receive supervision (categorical). I f they receive supervision they were asked what type of supervision they receive from among the following options individual clinical, group clinical, group administrative, and group clinical (categorical) Participants were also asked to indicate their income from their counseling job (categorical). Participants were also in vited to write in any other information related to their wor k as a counselor that
102 they thought would be im portant for the researcher to know. This data was not analyzed for this research study. Hypotheses H1 There is a significant association between perceived working conditions and reported level of burnout H2 There is a significant association between per ceived working conditions and reported level of compassion fatigue. H3 There is a significant contribution of counselor gender in predicting the relationship between counselor perceived working conditions and reported level of burnout H4 There is a sig nificant contribution of counselor gender in predicting the relationship between counselor perceived working conditions and reported level of compassion fatigue. H5 There is a significant contribution of counselor length of time in field in predicting the relationship between counselor working conditions and reported level of burnout. H6 There is a significant contribution of counselor length of time in field in predicting the relationship between counselor working conditions and reported level of burnout H7 There is a significant contribution of perceived working conditions, length of time in field, gender and extent of reported mindfulness, compassion satisfaction, and type of coping strategy to the prediction of reported level of burnout H8 There i s a significant contribution of perceived working conditions length of time in field, gender and extent of reported mindfulness, compassion satisfaction, and type of coping strategy to the prediction of reported level of compassion fatigue. Summary The pu rpose of this study was to examine the effect of perceived working conditions type of coping strategy, mindfulness, counselor gender, length of time in the field, and compassion satisfaction on counselor compassion fatigue and burnout levels. A national sample of mental health counselors was sought through recruitment efforts
103 involving the American Mental Health Counselors Association national email list, local and state chapters of this organization, and professional contacts locally, regionally, and nat ionally. Study p articipants completed an online survey consi sting of the Perceived Working Conditions Scale the Professional Quality of Life Scale, the Brief COPE, the Mindful Attention Awareness Scale, and a demographic questionnaire Data was analyzed u sing multiple linear regression analysis. The results of the data analysis are provided in Chapter 4 and the discussion of these results and their implications are included in Chapter 5.
104 Table 3 1 Participant age range Participant Age Range Number of Participants Percentage 25 & younger 8 3.76 26 35 60 28.17 36 45 36 16.90 46 55 41 19.25 56 65 54 25.35 66 & older 14 6.57 Grand Total 213 100.00 Table 3 2 Participant race/ethnicity Race/Ethnicity Number of Participants Perc entage Asian 1 0.47 Black/African American 19 8.92 Latino(a) 9 4.23 White/Caucasian 179 84.04 Multiethnic 2 0.94 Multiple categories 2 0.94 No selection 1 0.47 Grand Total 213 100.00 Table 3 3 Relationship status of resultant sample Relationsh ip Status Number of Participants Percentage Single 27 12.68 In a Relationship 14 6.57 Committed Partnership 16 7.51 Married 131 61.50 Divorced 18 8.45 Widowed 5 2.35 Other 2 0.94 Grand Total 213 100.00
105 Table 3 4 Hours worked per week as a cou nselor Ho urs Worked Weekly Number of Participants Percentage 20 25 25 11.74 26 30 20 9.39 31 35 20 9.39 36 40 87 40.85 41 45 30 14.08 46 50 15 7.04 51 55 8 3.76 56 60 4 1.88 61 65 1 0.47 66 70 1 0.47 71+ 2 .94 Grand Total 213 100.00 Table 3 5 Work setting Work Setting Number of Participants Percentage Private Practice 68 31.93 Community Mental Health Agency 65 30.52 College Counseling Center 13 6.10 Hospital 6 2.82 Crisis Stabilization Unit 3 1.41 Substance Abuse Treatment Center 11 5. 16 Career Counseling Center 3 1.41 Other 44 20.66 Grand Total 213 100.00
106 Table 3 6 Geographic distribution of resultant sample State Number of Participants Percentage Alabama 28 13.15 Alaska 1 0.47 Arizona 1 0.47 Arkansas 1 0.47 California 1 0.47 Colorado 3 1.41 Connecticut 3 1.41 D. of Columbi a 2 0.94 Florida 45 21.13 Georgia 7 3.29 Hawaii 1 0.47 Idaho 1 0.47 Illinois 6 2.82 Indiana 2 0.94 Lou isian a 4 1.88 Maine 2 0.94 Maryland 2 0.94 Massachusetts 5 2.35 Michigan 1 0.47 Minne sota 1 0.47 Mississi p pi 1 0.47 Missouri 6 2.82 Montana 1 0.47 Nebraska 1 0.47 New Hampshire 1 0.47 New Jersey 2 0.94 New Mexico 2 0.94 New York 5 2.35 North Carolina 7 3.29 Ohio 20 9.39 Oklahoma 1 0.47 Oregon 3 1.41 Pennsylva nia 3 1.41 Puerto Rico 1 0.47 Rhode Island 2 0.94 South Carolina 2 0.94 Tennessee 8 3.76 Texas 10 4.69 Vermont 2 0.94 Virginia 6 2.82 Washington 2 0.94 West Virginia 7 3.29 Wisconsin 2 0.94 Wyoming 1 0.47 Grand Total 213 100.00
107 CHAPTER 4 DATA ANALYSIS AND RE SULTS working conditions and personal resources predict their level of reported well being. Specifically, this study examined the impact of the following eight predictor variable s on conditions, 2) counselor gender, 3) counselor length of time in the field, 4) mindfulness, 5) compassion satisfaction, 6) problem focused coping 7) emotion focused coping and 8) maladaptive coping. Two hundred thirteen mental health counselo rs participated in the study The data an alytic procedures used in this study are described. Then, the descriptive statistics for the variables of interest in this study are provided. The reliability statistics for the scales and subscales used in this study are also presented. T he results of each of the eight study hypotheses are presented. Data Analytic Procedures The data analytic procedures began with the calculation of descriptive stati stics such as the mean, range and standard deviation to describe the demographic features of the sample and the study variables. The descriptive statistics for gender and length of time in field were calculated and then used in the subsequent analysis alpha coefficients were then computed for the instruments and subscales relevant to the study: the Perceived Working Conditions Scale the compassion fatigue, burnout, and compassion satisfaction subscales of the Professional Quality of Life S cale the three coping subscales from the Brief COPE, and the Mindful Attention Awareness Scale. A f actor analysis was then conducted on the participa nt responses to the Perceived Working Conditions Scale to further establish its construct validity. The re sults of this
108 analysis were presented in Chapter 3. After the internal consistencies of t he scales and subscales were established, the summed or mean scores for each scale or subscale of in terest in this study were then computed A corr elation matrix was created to assess the interrelationships among each of the variables of interest Once this was completed, two separate hierarchical multiple linear regressions were performed to predict the two outcome variables of burnout and compassion fatigue. Descrip tive Statistics for the Study Variables The survey completed by participants in this study was comprised of three existing instruments that had been previously validated one instrument designed by the researcher to assess a variable of interest in this st udy, and a demographic questionnaire that was designed for this study. The descriptive statistics for the variables of interest in this study are presented in T able 4 1. T he mean score for the maladaptive coping sub scale obtained from the study sample was 1.72, with participant responses ranging from a low of 1 to a high of 2.92, and standard deviation of .41. The mean score for the emotion focused coping subscale obtained from the study sample was 2.57, with a range of 1 3.7, and a standard deviation of 54. The mean score for the problem focused coping subscale obtained from this sample was 2.75, with a range of 1 to 4, and a standard deviation of .71. The mean score on the Mindful Attention Awareness Scale ( MAAS ) obtained from this sample was 4.58, with a range of 2.27 6, and standard deviation of .84. The mean c ompassion satisfaction score obtained from this sample was 49.95, with a low score 18.04 and a high score of 63.9, and a standard devi ation of 10.02. The mean burnout score from this sample was 4 9.92, with a range of a low score of 32.62 to
109 a high score of 81.95, with a standard deviation of 10.01. The m ean compassion fatigue score obtained from this sample was 50.04, with a range with a low score of 36.97 to a high score of 85.28, and a standard deviation of 10.06. The mean score on the Counselor Perceived Working Conditions Scale was 172.29, with participant responses ranging from of a low score of 89 to a high score of 229, with a standard deviation of 24.83 The mean number of years of experi ence reported by participants in this study was 12.58, with the least amount of experience reported as half a year and the highest number of years as 53, and a standard deviation of 10.38. Reliability Statistics The reliability statistics for the scales an d subscales of interest in this study are reported below. The reliability statistics for the 12 item maladaptive coping subscale was good with a for this sample The reliability for the 10 item emotion foc used coping scale was goo d, with a Cronb for this sample The reliability statistics for the 6 item problem focused subscale were good, with a Cronbach for this sample The compassion satisfaction subsca le consists of 10 items and has good reliab ility with a coefficient of .906 for this sample The burnout subscale i s comprised of 10 items and has good reliability with a The compassion fatigue sub scale is comprised of 10 items and has a reported Cronbac A lpha of .833. The MAAS trait version consists of 15 items and had of .922 for this sample The Counselo r Perceived Working Conditions S cale consists of 46 items and ha d indicat ing good internal consistency
110 Relationships a mong the Variables Table 4 2 contains a correlation matrix reporting relationships that were calculated among the variables of interest i n this study Significant correlations were found between several variables of interest. Counselor per ception of working conditions was inversely correlated with maladaptive coping ( r = .413 ), burnout ( r = .643), and compassion fatigue scores ( r = .361 ) at a level of significance of .01. Counselor perception of working conditions was positively correlat ed to years as a counselor in field ( r = 28), mindfulness ( r = .34) and compassion satisfaction scores ( r = .542) at a level of significance of .01. The relationships between counselor perception of working conditions and the following variables were not significant: gender, problem focused coping, and emotional focused coping. Gender and years as counselor in field were inversely correlated ( r = .319 ) at a level of significance of .01. Gender was not significantly related to counselor perception of work ing conditions. Years working as counselor in the field was positively correlated to counselor perception of working conditions ( r = 28) and mindfulness ( r =.243 ) at a significance level of .01. Neither gender nor y ears as a counselor in the field were si gnificantly associated with the three types of coping: emotion focused, problem focused or maladaptive coping Gender was not significantly related to compassion satisfaction or burnout score Gender was significantly relate d to compassion fatigue score ( r = .223) at a level of significance of .01. Gender was also inversely correlated with mindfulness ( r = .202 ) at a significance level of .01. Mindfulness was positively correlated with counselor perception of working conditions ( r = .343) years as a couns elor in field ( r =.243), and c ompassion satisfaction t score ( r = .42) at a level of significance of .01. Mindfulness was inversely
111 related to gender ( r = .202), maladaptive coping ( r = .418) burnout score ( r = .546 ), and compassion fatigue score ( r = .448) at a level of significance of .01. Mindfulness scores were not significantly related to emotion focused or problem focused coping scores Compassion Satisfaction was positively correlated with c ounselor perception of working conditions ( r = .54) mindfulness ( r = .423) at a level of significance of .01. It was also positively correlated with years as a counselor in field ( r = .183 ) at a significance level of .01. Compassion satisfaction was inver sely associated with maladaptive coping ( r = .210) burnout score ( r = .679) and compassion fatigue score ( r = .205) at a significance level of .01. Hypothesi s Testing The fi rst two hypotheses were tested using results from the correlation matrix. The remain ing six hypotheses were tested using results f rom hierarchical regression analyse s. Before the regression analyses were conducted, the study data was examined to ensure that the assumptions of regression were satisfied. H 1 There is a significant association between perceived positive working conditi ons and reported level of burnout A correlation matrix summarizing the relationships between the variables of interest in this study was completed to determine whether this hypothesis could be accepted. T here was a significant association between perceive d positive working conditions and reported level of burnout, with inverse relationship ( r = .643) between perceived positive working conditions and reported levels of burnout at a significance level of .01 Hence, t he first hypothesis was accepted. H 2 Th ere is a significant association between perceived working conditions and reported level of compassion fatigue.
112 The correlation matrix demonstrated a significant association between perceived positive working conditio ns and reported level of compassion fa tigue There is an inverse relationship ( r = .361 ) between perceived positive working conditions and reported levels of compassion fatigue at a level of significance of .01 Hence, t he second hypothesis was accepted. H 3 There is a significant contributi on of counselor gender in predicting the relationship between counselor perceived working conditions and reported level of burnout The third hypothesis was examined using multiple regression analysis. The predictor variables were counselor perception of w orking conditions and gender. The dependent variable was burnout t score. There was no significant association by gender and reported level of burnout in the regression analysis, therefore the third hypothesis was not accepted. H4 There is a significant contribution of counselor gender in predicting the relationship between counselor perceived working conditions and reported level of compassion fatigue. The fourth hypothesis was evaluated through multiple regression analysis. The model summary is shown in T able 4 5 and the regression coefficients in T able 4 6. Gender was not found to be a significant predictor of compassion fatigue in this model, therefore the fourth hypothesis was not accepted. H5 There is a significant contribution of counselor length of time in field in predicting the relationship between counselor working conditions and reported level of burnout. Hy pothesis five was tested using the results of multiple linear regression analysis. The regressio n model summary can be seen in T able 4 7 a nd the model coefficients in T able 4 8. Years as a counselor in the field was not found to be a significant predictor of burnout in this model, therefore the fifth hypothesis was not accepted.
113 H6 There is a significant contribution of counselor length of time in field in predicting the relationship between counselor working conditions and reported level of compassion fatigue. Hypothesis six was also examined through multiple linear regression analysis. The regression model summary is found in table 4 9 a nd the mo del coefficients in table 4 10. No significant association between years as a counselor in field and reported level of compassion fatigue was found in this sample. Hence, hypothesis six was not accepted. H7 There is a significant contribution of perceived working conditions, length of time in field, gender and extent of reported mindfulness, compassion satisfaction, and type of coping strategy to the prediction of reported level of burnout. Hypothesis seven was examined thro ugh hierarchical regr ession analysis. The regression mode l summary is found in Table 4 11 and the model coeffi cients are found in Table 4 12 This regression equation used eight predictor variables to predict th e outcome variable of burnout. This analysis revealed an R = .818, R 2 = .669, and adjusted R 2 = .656 at a significance level of <.001 T here is a significant contribution o f perceived working conditions, extent of reported mindfulness, compassion satisfact ion, emotion focused coping, and maladaptive coping to the predict ion of reported level of burnout among mental health counselors. Perception of working conditions was a significant predictor of burnout, inversely related to burnout ( B = .109 t = 5.084 p = <.001) Mindfulness was a significant predictor of burnout, i nversely related ( B = 2.698 t = 4.580 p = <.001). Compassion satisfaction was also a significant predictor, inversely related to burnout with ( B = .386 t = 7.550 p = <.001). Maladaptive coping was a significant predictor, positively related to burn out ( B = 4.907 t = 4.004 p = <.001). Emotion focused coping was a significant predictor at the .002 level, inversely related to burnout ( B = 2.998 t =
114 3.176 p = .002 ). Years working as a cou nselor in the field, gender and problem focused coping were not signif icantly predictive of burnout score in this model. However, the overall model accounted for 66.9 % of the variance of burnout t scores reported by mental health counselors in the study sample. Hence, hypothesis seven was accepted. H8 There is a significant contribution o f perceived working conditions, length of time in field, gender and extent of reported mindfulness, compassion satisfaction, and type of coping strategy to the prediction of reported level of compassion fatigue. The final hypoth esis in this study was examined through hierarchical multiple linear regression analysis. The regres sion mod el summary is found in Table 4 13 and the model coef ficients are found in Table 4 14 This regression equation used eight predictor variables to pre dict the outcome variable of burnout. This analysis revealed an R = .558 R 2 = .311 and adjusted R 2 = .284, at a level of significance of <.001. The data analysis supports the final hypothesis examined in the current study. T here is a significant contribu tion of perceived working condi tions, gender, e xtent of reported mindfulness, and maladaptive coping to the predict ion of reported level of compassion fatigue among mental health counselors. Mindfulness was a significant predictor of compassion fatigue, wi th an inverse relationship to compassion fatigue ( B = 3.576, t = 4.185, p = <.001). Maladaptive coping was a predictor of compassion fatigue at the .005 level ( B = 5.386 t = 3.030 p = .003). Gender, compassion satisfaction, emotion focused coping, and p roblem focused coping were not significant predictors of compassion fatigue in this prediction model. The factors in this model when examined together accounted for 31.1 % of the variance of compassion fatigue scores reported by
115 mental health counselors in the study sample. Therefore, hypothesis eight was accepted. Summary Hypothesis one which stated that there i s a significant associated between perceptions of working conditions and level of burnout, was accepted Hypothesis two, which stated that there i s significant association between perception of working conditions and level of com passion fatigue, was accepted. Hypothesis three, which stated that there is a significant contribution of counselor gender in predicting the relationship between counselor p erceived working conditions and reported level of burnout, was not accepted. Hypothesis four, which stated there is a significant contribution of counselor gender in predicting the relationship between counselor perceived working conditions and reported le vel of compassion fatigue, was not accepted. Hypothesis five, which stated that there is a significant contribution of counselor length of time in field in predicting the relationship between counselor working conditions and reported level of burnout, was not accepted. Hypothesis six, which stated that there is a significant contribution of counselor length of time in field in predicting the relationship between counselor working conditions and reported level of burnout, was not accepted. Hypothesis seven, which stated that there is a significant contribution of perceived working conditions, length of time in field, gender, and extent of reported mindfulness, compassion satisfaction, and type of coping strategy to the predicti o n of reported level of burnout, was accepted. Hypothesis eight, which stated that that there is a significant contribution of perceived working conditions, length of time in field, gender and extent of reported mindfulness, compassion satisfaction, and type of coping strategy to the pre diction of reported level of compassion fatigue was accepted.
116 Table 4 15 provides a summary of the results of the hypothesis testing conducted for this study.
117 Table 4 1. Descriptive Variable Mean Possible Rang e Range Low Score Range High Score SD Maladaptive 1.7 2 1 4 1 2.92 .4 1 Emotion Focused 2.57 1 4 1 3.7 .54 Problem Focused 2.75 1 4 1 4 .71 Mindfulness 4.58 1 6 2.27 6 .84 C S score 49.9 5 18.04 63.9 10.02 Burnout score 49.92 32. 62 81.95 10.0 1 CF score 50.04 36.97 85.28 10.0 6 PWC 172.29 46 230 89 229 24.8 3 Years as a Counselor 12.58 .5 53 .5 53 10.38 Note: CS=compassion satisfaction, CF=compassion fatigue, PWC=counselor perceived working conditions Table 4 2 Correlations 1 2 3 4 5 6 7 8 9 10 1 PWC 2 GDR .099 3 YI F .283 ** .319 ** 4 MD .343 ** .202 ** .243 ** 5 CS .542 ** .044 .183 ** .423 ** 6 EF .023 .000 .034 .131 .092 7 PF .019 .047 .068 .050 .037 .565 ** 8 MC .413 ** .041 .097 .418 ** .210 ** .300 ** .212 ** 9 BO .643 ** .076 .219 ** .546 ** .679 ** .037 .087 .466 ** 10 CF .361 ** .223 ** .186 ** .448 ** .205 ** .097 .110 .411 ** .499 ** Note: PWC=counselor perceived working conditions, GDR=counselor gender, YIF=counselor years in field, MD =mindfulness, CS=compassion satisfaction, EF=emotion focused coping, PF=problem focused coping, MC=maladaptive coping, BO=burnout, CF=compassion fatigue Table 4 3 Gender and burnout regression model summary Model Sum of Squares Mean Square F chg P df1 d f2 1 8793.375 4396.188 74.227 <.001 2 210
118 Table 4 4 Gender and burnout regression coefficients Model 1 B Std. Error T Significance (Constant) 94.288 3.930 23.994 <.001 Counselor Perception of Working Conditions .259 .021 .642 12.099 <.001 Gender .293 1.242 .013 .236 .814 Table 4 5 Gender and compassion fatigue regression model summary Model R R 2 R 2 adj Std. Error R 2 chg F chg P df1 df 2 1 .542 .294 .287 8.464 .294 43.702 .000 2 210 Table 4 6 Gender and compassion fatigue regression c oefficients Model 1 B Std. Error t Significance (Constant) 11.992 4.322 2.7759 .006 Counselor Perception of Working Conditions .219 .024 .543 9.319 .000 Gender .236 1.366 .010 .172 .863 Table 4 7 Burnout predicted by years in field regression model summary Model R R 2 R 2 a dj Std. Error R 2 chg F chg p df1 df2 1 .645 .416 .410 7.687 .416 74.645 .000 2 210 Table 4 8 Burnout predicted by years in field regression Model 1 B Std. Error t Significance (Constant) 94.291 3.724 25.318 <.001 Counselor Perception of Working Co nditions .255 .022 .632 11.489 <.001 Years as Counselor in Field .039 .053 .041 .739 .461
119 Table 4 9 Compassion fatigue predicted by years in field regression model summary Model R R 2 R 2 adj Std. Error R 2 chg F chg P df1 df2 1 .371 .138 .130 9.38 2 .138 16.803 <.001 2 210 Table 4 10 Compassion fatigue by years in field regression model coefficients Model 1 B Std. Error t Significance (Constant) 74.551 4.545 16.401 <.001 Counselor Perception of Working Conditions .136 .027 .335 5.022 <.001 Years as Counselor in Field .088 .065 .091 1.358 .176 Table 4 11 Burnout regression model summary Model R R 2 R 2 ad j Std. Error R 2 chg F chg p df1 df2 1 .818 .669 .656 5.867 .669 51.584 <.001 8 204 Table 4 12 Burnout regression model coefficients Model 1 B Std. Error t Significance (Constant) 94.814 5.250 18.060 <.001 Counselor Perception of Working Conditi ons .109 .021 .270 5.084 <.001 Years as Counselor in Field .004 .043 .004 .082 .935 Gender .682 1.009 .029 .676 .500 Mindfulness 2.698 .589 .227 4.580 <.001 Compassion Satisfaction .386 .051 .386 7.550 <.001 Emotion focused coping 2.9 98 .944 .162 3.176 .002 Problem focused coping 1.913 .690 .136 2.775 .006 Maladaptive Coping 4.907 1.226 .199 4.004 <.001
120 Table 4 13 Compassion fatigue regression model summary Model R R 2 R 2 adj Std. Error R 2 chg F chg P df1 df2 1 .558 .311 .284 8.51 1 .311 11.503 <.001 8 204 Table 4 14 Compassion fatigue regression model coefficients Variable B Std. Error t Significance Constant 64.195 7.615 8.430 <.001 Counselor Perception of Working Conditions .079 .031 .196 2.561 .011 Years as Counsel or in Field 3.139 1.464 .134 2.145 .033 Gender .006 .062 .006 .095 .925 Mindfulness 3.576 .855 .299 4.185 <.001 Compassion Satisfactio n .082 .074 .082 1.113 .267 Emotion focused coping .857 1.369 .046 .626 .532 Problem focused coping .871 1.0 00 .062 .871 .385 Maladaptive Coping 5.386 1.778 .217 3.030 .003
121 Table 4 15 Summary of hypothesis testing results Hypothesis Result H1 There is a significant association between perceived positive working conditions and reported level of bur nout. Accepted H2 There is a significant association between perceived working conditions and reported level of compassion fatigue. Accepted H3 There is a significant contribution of counselor gender in predicting the relationship between counselor per ceived working conditions and reported level of burnout. Not Accepted H4 There is a significant contribution of counselor gender in predicting the relationship between counselor perceived working conditions and reported level of compassion fatigue. Not A ccepted H5 There is a significant contribution of counselor length of time in field in predicting the relationship between co unselor working conditions and reported level of burnout. Not Accepted H6 There is a significant contribution of counselor len gth of time in field in predicting the relationship between counselor working conditions and reported level of compassion fatigue Not Accepted H7 There is a significant contribution of perceived working conditions, length of time in field, gender, and extent of reported mindfulness, compassion satisfaction, and type of coping strategy to the prediction of reported level of burnout. Accepted H8 There is a significant contribution of perceived working conditions, length of time in field, gender and e xtent of reported mindfulness, compassion satisfaction, and type of coping strategy to the prediction of reported level of compassion fatigue. Accepted
122 CHAPTER 5 DISCUSSION While work stress is often considered a normal occurrence in the day to day liv es of many, the experiences of burnout and compassion fatigue go above and beyond the everyday hassles most workers experience. Burnout is characteri zed by emotional exhaustion, depersonalization and lack of personal accomplishment (Maslach et al., 2001) Compassion fatigue is characterized by emotional fatigue brought on by caring for traumatized clients and It and may involve symptoms such as hyper vigilance and re traumatic content (Figley, 1995). As such, a secondary traumatic stress process is considered an important component of compassion fatigue (Stamm, 2010). Burnout is evaluated by a distinct scale on the ProQOL that includes items such as number 10 feel trapped by my job as a I feel worn out because of my work as a with the work context that is characteristic of burnout. The secondary traumatic stress subscale (formerly called the compassion fatigue scale) includes items such as number I am preoccupied with more than one person I counsel certain activ ities or situations because they remind me of frightening experiences of the people I counsel The items capture the sense of fear and preoccupation related to stres s process associated with compassion fatigue. These examples of the items provide a window into the differences in the conceptualization of these phenomena.
123 Mental health counselors may experience particular types of stressful working conditions and respon sibilities to clients that non helping professionals may never encounter (e.g. assessing a client diagnosed with depression for suicidal intent ). The responsibility t o foster clients well being create opportunities for burnout and compassion fatigue to arise. In addition, even professionals from related fields such as psychology and social work may experience different working conditions than mental health counselors The purpose of the current study was to examine specific contextual and personal determinants that might contribute to mental health counselor burnout and compassion fatigue. This study examined the influence of counselor perceptions of their working con ditions, counselor gender, length of time in the counseling field, compassion satisfaction, mindfulness, emotion focused coping, problem focused coping, and maladaptive coping in predicting levels of burnout and compassion fatigue reported in a sample of 2 13 mental health counselors. This chapter will present a brief description of the research sample, discussion of the research results, limitations of the study, implications for theory, practice, and future research, and conclusions. Research Sample A nati onal sample of mental health counselors in the United States was obtained for this study. The final research sample consisted of 213 mental health or licensed professional counselors. The sample was approximately 25% male and 75% female. Approximately 62% of participants self reported their relationship status as married; 13% as s ingle ; 7% i n a relationship ; 8% in a c ommitted Partnership ; 8% divorce d ; 2%
124 widowed and 1% selected other. Participants reported living in 43 out of 50 states and Puerto Rico. Pa rticipants were at all stages of their career and represented a variety of ages, with a ra nge of 24 years old to 78 years old Approximately 4 % of the sample reported their age as 25 and younger, 28% were between ages 26 35, 17% were between 36 45, 19% we re between ages 46 55, 25% were between ages 56 65, were 7% were 66 and older. Mental health counselors in this sample reported working in a variety of settings: 31.93% in private practice settings, 30.52% in community mental health agencies, 6.10% in C ollege Counseling Centers, 2.82% in hospital settings, 1.41% in Crisis Stabilization Units, 5.16% in substance abuse treatment centers, 1.41% in Career setting. Discussion of Results Burnout and Compassion Fatigue The mean level s of burnout and compassion fatigue reported by this sample was comparable to the mean score reported in the ProQOL manual. The mean burnout score for this sample was 49.92, with a range from a low s core of 32.62 to a high score of 81.95 and a standard deviation of 10.01. The mean burnout score in the ProQOL manual is 50, with a standard deviation of 10, and a reported subscale reliability of .75 (Stamm, 2010). The mean score for the compassion fatigu e subscale (know n as the secondary traumatic stress subscale ) reported in this sam ple was 50.04, with a range from a low score of 36.97 to a high score of 85.28, and a standard deviation of 10.06. Th is was comparable to the mean score reported in the ProQO L manual f or secondary
125 traumatic stress of 50, with a standard deviation of 10 and a reported scale reliability of .81 (Stamm, 2010). The mean score on the compassion satisfaction subscale for this study sample was comparable to the means reported in th e ProQOL manual. The sample score mean f or the compassion satisfaction was 49.95, with a low score of 18.04 and a high score of 63.9, and a standard deviation of 10.02. The score mean reported in the ProQOL manual for the compassion satisfaction is 50, wit h a standard deviation of 10, and a reported scale reliability of .88 (Stamm, 2010). Counselor Working Conditions, Burnout, and Compassion Fatigue conditions on their level s of burnout and compassion fatigue Specific aspects of administration fairness in administrative decision making financial compensation, flexibility of hours worked, quality of supervis ion, coworker r elationships, clinical preparedness to serve the types of clients on their caseload and eptions of the overall climate ( including whether there was a competitive atmosphere at their work setting ) The Counselor Perceived Working Conditions Scale was developed for this study to address the need for further understanding of how these contextual factors influence and compassion fatigue. Specific aspects of the counselor work environment have been studied in previous resear ch. For example, Linley and Joseph (2007) reported that receiving clinical supervision was associated with greater personal growth in therapists surveyed. Linley and Joseph conducted their research in England with a population of clinical and counseling p sychologists. Ducharme et al. (2008) found that perception of coworker support was associated with lower levels of emotional exhaustion among
126 substance abuse counselors. While the research findings above support the importance of contextual fac tors, the cu rrent study provided evidence that there were various workplace factors predicting mental health counselor stress outcomes in addition to coworker social support and supervision The first hypothesis tested in this study was whether there was significant a ssociation between perceived working conditions and reported level of burnout. This hypothesis was accepted because t he re was a significant inverse relationship between perceived working conditions and reported level of burnout demonstrated by the results of correlation matrix ( r = .643, p =.01). Those counse lors who reported more positive perceptions of their workin g conditions reported lower levels of burnout than counselors reporting more negative working conditions The second hypothesis was that there is a significant association between perceived working conditions and reported level of compassion fatigue. This hypothesis was also accepted because t he re was a significant inverse association between perceived positive working conditions and reported le vel of compassion fatigue. Those counselors who reported more positive perceptions of their workin g conditions also reported lower level s of compassion fatigue than counselors who reported more negative working conditions ( r = .361, p =.01) This finding supports the need to recognize the contextual and perceptual factors associated with counselor compassion fatigue. Gender Effect on Working Conditions, Burnout and Compassion Fatigue Gender has been explored in the counselor burnout and compassion fatigue literature with equivocal results. For example, Sprang et al. (2007) found gender differences in levels of burnout and compassion fatigue reported by a diverse sample of
127 professionals including psychiatrists, social workers, marriage and family therapis ts, and counselors. Th e third hypothesis proposed that there would be a significant contribution of counselor gender in predicting the relationship between counselor perceived working conditions and reported level of burnout. This hypothesis was not accept ed as the re was no significant association between gender perceived working conditions, and level of repo rted burnout found in the regression analysis The correlation matrix also revealed no significant relationship between gender and burnout in this sam ple. These results differ from the results of Sprang et al. (2007), in which being female was associat ed with higher levels of burnout. Gender effects in the current sample may have been less relevant because all participants in the current sample were me ntal health counselors, meaning that potential status differences by gender were not applicable The fourth hypothesis proposed a significant contribution of counselor gender in addition to perception of working conditions to the prediction of compassion fatigue. This hypothesis was not accepted as gender was not found to make a significant contribution in addition to perceived working conditions in predicting compassion fatigue in the regression analysis. However, the correlation matrix rev ealed that g end er was significantly associated with c ompassion fatigue ( r = .223, p = .01). Because men were coded as 0 and women as 1, the results of the correlation matrix indicate that females in this sample were more likely to experience compassion fatigue than males in this sample. Sprang et al. (2007) reported gender associations with both burnout and compassion fatigue with being female between associated with higher risk for both
128 However, i n the current study, the results of the regression analyses showed no ass ociation between gender and levels of burnout and compassion fatigue. Effects of Counselor Length of Time in Field The fifth hypothesis proposed that counselor length of t ime in field would be a significant contributor in addition to perceived working con ditions in predicting burnout in the regression analysis This hypothesis was not accepted. However, the correlation matrix revealed a significant association between length of time in counseling field and burnout ( r = .219, p = .01). There was an inverse relationsh ip between counselor length of tim e in field and reported burnout with m ore reported years working in the counseling field was associated with lower levels of reported burnout. This could be a function of tenure, as more experienced counse lors ma y have moved up in the work org anization and therefore the nature of their working conditions may have improve d, resulting lower levels of reported burnout. For example, more experienced counselors with a longer tenure in a work organization may engage in more supervisory, training, and/or administrative activities as compared to newer hires who may have the bulk of their time taken up in providing direct services and documenting those services. Hypothesis six proposed that there would be a significant co ntribution of counselor length of time in field in addition to counselor perceived working conditions in predicting counselor compassion fatigue. This hypothesis was not accepted because the regression analysis demonstrated no significant contribution of c ounselor length of time in field in addition to perceived working conditions in predicting reported level of compassion fatigue However, t he correlation matrix demonstrated that there was an inverse relationship between years a counselor in the f ield and compassion fat igue ( r = .186, p = .01) Greater length of time in field was associated with less reported
129 compassion fatigue. These results are in contrast to the reported results of Linley and ( 2007 ) study, in which more years of clinical experi ence reported more negative psychological changes and compassion fatigue than those with fewer years of experience Linley and s sample was comprised of clinical and counseling psychologists in England, so different cultural and career factors could have accounted for the increase in psychological changes and compassion fatigue in their sample. In the current research sample, all participants were mental health counselors living and working in the United States. It is possible that the psychologist s sampled in England dealt with a more severe populat ion and became more fatigued over time as they dealt with this severe population More information about the nature of the clientele served and the climate of the work organization is needed to determine w hat factors are really responsible for these types of differences. Counselor length of time in field may not account for the underlying factors that are more meaningful, such as nature of work responsibilities and specific types of client contact that prof essionals engage in with their clients. Influence of Working Conditions and Personal Resources on Burnout A major objective of the current study was to examine the combined contribution of working conditions and personal resources in predicting level of b urnout reported by mental health counselors. Hy pothesis seven was that there would be a significant contribution of perceived working conditions, length of time in field, counselor gender, and extent of reported mindfulness, compassion satisfaction, and ty pe of coping strategy to the prediction of reported level of burnout. The regression model had an R 2 = .669 at a significance level of <.001, which indicates that these predictor variables accounted for 66.9% of the variance in the outcome variable of burn out. This result
130 indicates that four predictor variables in this model account ed for the majority of th e variance in levels of burnout reported by this sample Compassion satisfaction, mindfulness, maladaptive coping, and perception of working conditions w ere each significant predictors of burnout, at a level of significance of <.001; a fifth variable, e motion focused coping was significant at a level of .002 Compassion satisfaction the strongest predictor in this model was inversely related to reported burnout ( B = .386 t = 7.550 p = <.001). This suggests that c ounselors who reported experiencing the most satisfaction in their role as counselors also report ed the lowest levels of burnout. Compassion satisfact ion has been linked to reduced risk of bu rnout (Kraus, 2005) and also has also been reported to buff er counselors from the negative effects of exposure to traumatic client material (Collins & Long, 2003). The results of the current study are in alignment with this previous research and suggest t hat compassion satisfaction can be a powerful resource to help counselors buffer the stress of their work settings. Compassion satisfaction may allow counselors to tolerate the aspects of their job that are less fulfilling because they gain such a sense o f meaning and fulfillment from their contact with clients. Understanding how compassion satisfaction operates and what factors increase compassion satisfaction could be a fruitful area of future research. For example, exploring whether there are connection s between altruistic motivations to be in the counseling profession and resulting compassion satisfaction could be a beneficial area of future research. Mindfulness was a strong and significant predictor of burnout, inversely related ( B = 2.698 t = 4.5 80 p = <.001). Higher reported level s of mindfulness were associated with lower reported levels of burnout in this sample of mental health counselors. In
131 previous studies examining mental health counselor mindfulness, associations between mindfulness and self care and well being have been reported (Richards et al., 2010). Mindfulness was shown to be a significant predictor of burnout among substance abuse counselors (Vilardaga et al., 2011). The results of the current study provide further evidence of the significance of mindfulness attitudes in reducing mental health acceptance of the present moment, so perhaps counselors who endorse higher levels of mindfulness are le ss likely to judge themselves or their work setting negatively. Maladaptive coping was a strong and significant predictor, positively related to burnout ( B = 4.907 t = 4.004 p = <.001). The maladaptive coping subscale used in this study included items i ntended to capture respondents endorsement of substance use, distraction, denial, and self blame as coping strategies. This connection between maladaptive coping and burnout suggests that some of the ways counselors cope with their stressors may have unint ended negative consequences, and actually lead to the risk of more severe consequences of stress such as burnout. Perception of working conditions was also a significant predictor of burnout ( B = .109 t = 5.084 p = <.001) It was inversely related t o burnout, in that positive perceptions of working conditions were associated with lower levels of reported burnout. Counseling working conditions examined in this study included various aspects of the work environment. This outcome provides evidence for w hy counselor working conditions matter and should be addressed in efforts to ameliorate burnout. Emotion focused coping was a significant predictor of burnout at the .002 level, inversely related to burnout ( B = 2.998 t = 3.176 p = .002). Thus, the mo re
132 counselors endorsed the use of emotion focused techniques was associated with lower levels of reported burnout. This outcome suggests that counselors who sought ways to manage their emotional reactions to stressful situations were less likely to experie nce counseling process. For this reason, perhaps emotion focused coping strategies help counselors effectively manage the stress of the uncertainty and lack of control t hat is inherent in the counseling relationship. Years as a counselor in the field, gender, and problem focused coping were not significantly predictive of burnout t score in this model. It is possible that examining years as a counselor in the field was to o general a predictor to be significant when included in this regression model. Counselor gender was not significant in this model either. Gender effects may have been minimized due to the professional homogeneity of this sample. Problem focused coping was not significant in this model either. It is possible that the problem focused coping subscale used in this study included too many different types of coping strategies and therefore results were not clear For example, the problem focused subscale include d items such as : I've been thinking hard about what steps to take I've been taking action to try to make the situation better and These items tap different aspects of p rob lem focused coping, such as thinking and planning, taking action, and seeking instrumental support. Further, perhaps problem focused coping strategies are effective in handling many types of job stress, but are perhaps not as helpful in addressing stressor s associated with relating to autonomous clients in a helping role.
133 Influence of Working Conditions and Personal Resources on Compassion Fatigue The eighth and final hypothesis tested was that there would be a significant contribution of perceived working conditions, length of time in field, counselor gender and extent of reported mindfulness, compassion satisfaction, and type of coping strategy to the prediction of reported level of compassion fatigue. This hypothesis was accepted. T hese factors accounted for 31.1% of the variance in compassion fatigue scores, as compared to 66.9% of the variance in burnout scores. Mindfulness was a significant predictor of compassion fatigue, with an inverse relationship to compassion fatigue ( B = 3.576, t = 4.185, p = < .001). Maladaptive coping was a predictor o f compassion fatigue at the .003 level ( B = 5.386 t = 3.030 p = .003). Gender, compassion satisfaction, emotion focused coping, and problem focused coping were not significant predictors of compassion fatigue in this prediction model. The variables predicting burnout explained almost dou ble the amount of variance as the variables predicting compassion fatigue. This result indicates that these eight predictor variables when examined together account ed fo r a subst antial amount of the variance in burnout scores, but not in compassion fatigue scores. While some of these variables were significantly predictive of compassion fatigue, they were predictive of less of the variance. While gender was significantly correlat ed to compassion fatigue when examined alone, g ender, compassion satisfaction, emotion focused coping, and problem focused coping were not significant predictors of compa ssion fatigue in this model. One might interpret this finding to mean that there are o ther factors not addressed in this study that might better explain counselor compassion fatigue. For example, therapist personal
134 trauma history was not examined in this study and was not included as a variable in this study Although Leonard (2008) report ed no significant associations between co mpassion fatigue and personal trauma history significant associations between therapist personal trauma history and compassion satisfaction were reported Since the relationship between compassion fatigue and compa ssion satisfaction is still being studied (Stamm, 2010), the inclusion of personal trauma history as a predicti ve variable could be useful in future models. T here is also supportive evidenc personal trauma history can impact their well being, with Linley and Joseph (2007) reporting that therapists with a reported personal trauma history showed greater levels of personal growth. Implications for Practice These study findings indicate that the nature of counselor working conditions matter in the occurrence of both counselor burnout and compassion fatigue. The more positively participants in th is study viewed their working conditions; the less likely they were to report burnout or compassion fatigue. This finding has implications for adminis trators and clinicians For example, the Counselor Perceived Working atmosphere at their work setting such as : I receive the administrative support that I need to care for clients Exploring ways to improve counselor working conditions could have powerful ramifications for counselor well being. Moreover, these findings could have implication s for administrators who are charged with maintaining a cohesive staff and reducing turno ver rates. The findings of this study suggest that c ounselor compassion satisfaction matters and that finding ways to increase compassion satisfaction among clinicians may reduce
135 the likelihood that clinicians will experience burnout and compa ssion fati gue. C ompassio n satisfaction involves the satisfaction that professionals experience in th eir helping roles (Stamm, 2010). P erhaps counselors who report more compassion satisfaction are getting rewards from their helping role that may mitigate the negative eff ects of stressors that they encounter in their job settings. The findings of the current study are consistent with previous research findings. Collins and Long (2003) reported that compassion satisfaction seemed to buffer counselors from the negative i mpact of material Lawson and Myers (2011) also reported that counselor wellness is associated with compassion satisfaction. Moreover, these findings indicate that c ounselor dispositional mindfulness attitudes matter Mindful ness was inversely related to both burnout and compassion fatigue in this study. Further exploration of applications of mindfulness in clinical practice and supervision as a way to reduce risk of counselor burnout and compassion fatigue is needed. In a qua litative study of counselor mindfulness practices, counselors who reported that they practiced mindfulness also reported experiencing connectedness and abundant gratitude. Although mindfulness was practiced in different ways, each participant emphasized aw areness of breath and body in their mindfulness practice (Rothaupt & Morgan, 2007). Hence, the f urther exploration of how cultivation of counselor mindfulness practice s may compassion fatigue and burnout is nee ded. Associations between counselor mindfulness and self care and well being have also been reported (Richards et al., 2010). Researchers reported a positive relationship between self care and mindfulness and also suggested that mindfulness may mediate
136 the relationship between counselor self care and well being (Richard et al., 2010) The results of the current study contribute to the literature of the impact of mindfulness for counselor well being, as mindfulness attitudes were associated with lower levels of both burnout and compassion fatigue The types of c oping strategies that counselors use have an impact on counselor stress outcomes such as burnout Maladaptive coping strategies such as denial, distraction, self blame and substance use were associat ed with higher levels of reported burnout in this study. These results suggest that further examination of the associations between maladaptive coping and counselo r burnout and compassion fatigue could be beneficial. In addition, exploration of how assessm ent of coping strategies is related to self care assessments would be beneficial, as self care is frequently discussed in the counseli ng literature (e.g. Richards et al., 2010; Skovholt, 2001) Further exploration of coping in the counselor literature coul d provide a richer picture of the many ways that counselors respond to the stresses they encounter, not solely the positive or beneficial ways. In the counseling literature, self care and career sustaining behaviors have been the main constructs used. For example, Lawson and Myers (2011) included career sustaining behaviors in their study examining counselor wellness. Including a coping assessment in addition to self care and/or career sustaining behavior assessments could provide a richer picture of the ra nge of counselor coping behaviors. Implications for Counselor Preparation Counselors in training are vulnerable to f eeling overwhelmed by the volume of new knowledge that they are learning in addition to the new prof essional identity they are developing Contextual aspects of a counselor education program may impact how
137 counselors in t raining develop prof essionally. Likewise, counselor work contexts m a y impact their professional functioning. Coun selor educators could use findings from the current study to build a rationale for preparing counselors in training for the risks of compassion fatigue and burnout. Exploring compassion satisfaction in group and individual supervision and examining the inverse relationship between compassion satisfaction and burnout would also be a beneficial area to discuss. In addition, exploration of the possible role of gender and societal gender role socialization in the experience of compassion fatigue could be a beneficial subject for supervisory discussion. The need for f urth er assessment of counselors in training s for risk factors associated with the development of burnout and compassion fatigue is another implication of this study. By taking a proactive approach and examining how counselors in training are coping with the de mands of their training, perhaps prevention of burnout can begin even before graduation For example, maladaptive coping strategies were associated with burnout in this sample of mental health counselors. While further research is needed to determine whet h er this correlation is found among counselors in training s the current results provide evidence that maladaptive coping and burnout are linked. Counselor educators could help counselors in training to self asses s their coping strategies according to this typology and develop healthy coping strategies Addressing Work Contextual Factors Counselor well responsibility t o maintain through self care practices. This individualized model of stress management neglects the power of community action to cultivate new norms and create
138 a more supportive context. Supporting counselor well being within a framework that recognizes t hat counselor stress, distress, and impairment can happen to anyone is one approach to encourage ongoing self assessment and prevention (Lawson et al., 2007). Counselor educators can help counselors in training prepare for the risks and demands of the coun seling profession and the types of work contexts that they may experience. Research on counselors in students are exposed to many of the concepts of wellness, the means for effectively implementing strategies to educate and evaluate student progress in this area remains p. 39 ). There is also a need for counselor educators to provide direct instructio n to prevent burnout through the use of effective coping str a tegies Enhancing Personal Resources Coping strategies, mindfulness attitudes, and compassion satisfaction were all studied as personal resources in this study. The results indicated that the use of ma ladaptive coping strategies was correlated with hig her levels of reported burnout. Maladaptive coping strategie s include denial, substance use, and self blame and were assessed on the brief COPE by items including the following: I've been refusing to I've been using alcoh ol or other drugs to help me get and These items provide an overview of the prevailing commonality among maladaptive coping strategies using strategies that meet an immediate need, yet fai l to provide emotional or instrumental resolution to any aspect of the stressor. A benefit of assessing coping strategies versus solely assessing self care is that this approach allows for a picture of both positive and negative strategies counselors may e mploy to cope with their
139 stressors. Thus, use of coping strategies provides a richer picture of the range of coping behaviors counselors use and how these may be predictive of their stress outcomes. Emotion focused coping strategies were inversely related to burnout in the current study Emotion focused coping strategies include seeking emotional support and thinking about a situation differently: These findings suggest that counselors who employ emotion focused coping strategies are more able to handle the demands of their jobs without experiencing burnout. An implication of these findings is that there is a need to explo re effecti ve coping practices and avoid maladaptive coping strategies with counselors in training One mode of implementation could be a training program consisting of several modules intended to explore these topics as well as educate counselors in train ing about effective means of coping. Such a program could be integrated into existing group supervision classes for practicum and internship students. Rather than being an outside observer, the professor/facilitator could be a participant observer and shar e stress management challenges as well as effective coping strategies they have used. This program could be an experiential form of emotion focused coping for the counselors in training to both experience and learn to use similar strategies when facing f uture stressors. In addition to the need for training in specific strategies to manage stress, it has been asserted that there is a need for counselors and counselors in training to evaluate their self care practices and their status along the continuum of well, stressed, distressed and impaired (Cummins et al., 2007). By gaining awareness of their own
140 status on this continuum, counselors can recognize their own vulnerability and take actions to address it (Cummins et al., 2007). It might be beneficial to include approach es to enhance self awareness when designing interventions to prevent burnout and compassion fatigue. Counselors in training could be encou raged to explore their own coping process through j ournaling and other creative practices. Journaling could assist counselors in train ing as journaling has been reported to be instrumental in easing emotional distress (Pennebaker, 1990). Reflective assignments regarding coping practices could be used to promote a proactive ongoing assessment process. Jou rnal writing could be inco rporated throughout the graduate training to increase self awa reness and assist counselors in training to reflect on their level of stress and well being. Mindfulness has also been explored in the counselor preparation literature (Schure et al., 2008). Mindfulness has also been studied in relation to counselor self efficacy, attention, and empathy (Greason & Cashwell, 2009). Mindfulness interventions for counselors in training could be further studied to determine their efficacy i n preventing future burnout. Implications for Theory The findings of this study provide evidence for the relevance of examining counselor coping strategies in addition to self care behaviors. This study explored counselor c oping using a typology comprised of three types of coping emotion focused, problem focused, and maladaptive coping. The exploration of coping is new in the research on counselor well being burnout and compassion fatigue, despite links between coping and stress outcomes in other populat ions such as recent immigrant populations ( Belizaire & Fuertes, 2011 ) and college students adjusting to a family
141 ( Schmidt & Welsh, 2010) While counselor self care (Richards et al., 2010) and career sustaining behav iors (Myers & Lawson, 20 11) have been explored by counseling res earchers coping strategies have not been previou sly studied in this population. Given the unique demands of the counseling work environment, the exploration of coping in this population seems long overdue. Whereas c omparisons between various research explorations of s elf care have been hampered by inconsistent definitions ( Richards et al., 2010) the use of a coping construct could allow for a more consistent operationalization. The exploration of coping strategies allowed for a theoretically grounded and nuanced examination of both the positive and negative ways that counselors strive to manage the demands and stressors that they encounter. From the transactional perspective, psychological stress cannot be viewed separately from appraisal or coping (Lazarus & Folkman, 1984). Appraisal and coping are influenced by both individual and contextual factors in a recursive process. The use of this theoretic al lens and the theoretically r obust construct of coping allows fo r examination of the recursive nature of the counselor stress experience. In addition, w hereas self care is focused on positive activities, coping includes a broad range of activities that are intended to reduce stress, bu t may or may not have a positiv e effect on the individual. For example, the use of this coping typology allowed for the exploration of maladaptive coping strategies that counselors may employ to cope with stress, such as self blame and substance use, which are not accounted for in the s elf care literature. Further, the finding in this study that maladaptive strategies were associated with burnout supports the further exploration of coping in the mental health
142 counselor population, as well as a theoretical shift from focusing solely of po sitive counselor behaviors to manage stress, to including a wide range of counselor attempts to manage stress, both negative and positive. The use of coping in the counselor well being literature in addition to the constructs of self care and career sustai ning behavior could add to our understanding of how maladaptive attempts to cope with stress that have unintended negative consequences may hamper efforts to reduce incidence of counselor burnout. In this study, compassion satisfaction was examined as a p redictor variable, rather than an outcome variable. This approach adds to the literature on counselor compassion satisfaction in which compassion satisfaction is conceptualized a positive outcome that may result from counseling work (Stamm, 2010) By exam ining compassion satisfaction as an input rather than an output, compassion satisfaction is conceptualized as something within the individual counselor that they can choose to cultivate. This conceptualization of compassion satisfaction is consistent with the transactional model of stress and coping, and represents a new conceptualization of compassion satisfaction as a personal resource rather th an an outcome. This highlights the active role that counselors can play in cultivating their own level of compas sion satisfaction, even as they encounter the stresses and demands of their work environment. The results of the current study suggest that compassion satisfaction may be an important buffer in redu cing counselor risk of burnout, given the significant inv erse correlation found between reported levels of compassion satisfaction and burnout in this sample. While further research examination is needed, the current finding suggests that
143 compassion satisfaction may serve a preventative function in the etiology of burnout. In contrast compassion satisfaction and compassion fatigue were not correlated in this study. This suggests that a counselor could be experiencing both compassion satisfaction and compassion fatigue simultaneously w hich provides a window int o the differences between burnout and compassion fatigue and the need for greater understanding of the predictors and buffers of counselor compassion fatigue. Implications for Research T he results of this study suggest the need for further understanding of how counselors perceive their working conditions. The instrument created for this study to assess counselor s perceptions of their working conditions could be used in futu re research studies to explore counselors perceptions of their working conditions i n connection with counselor well being and turnover. C ounselor turnover in substance abuse settings is related to counselor emotional exhaustion and has negative impact for clients (Ducharme et al., 2008). It has also been reported that higher occupational stress is associated with turnover intention among rehabilitation counselors ( Layne et al. turnover rates and turnover intention is needed. Moreover further understandin g of how work context can in turn impact turnover and how interventions to improve counselors work context impact retention rates would be beneficial to the counseling profession. One of the implications of the research on the development of the MAAS is that dispo sitional mindfulness levels are related to state mindfulness levels. Therefore, an area for additional research exploration is to examine if dispositional mindfulness among counselors can be in creased by mindfulness training. There is a need for research w hich examines the relationship between mindfulness trainin g and
144 dispositional mindfulness in this population, due to the correlation between increased levels of mindfulness and lower levels of reported burnout and compassion fatigue in this study. Existin g research has explored the impact of mindfulness on substance abuse counselors (Vilardaga et al. 2011). While workplace factors were found to be predictive of burnout, substance abuse counselor mindfulness attitudes were even better predictors These fin dings suggest that mindfulness is a powerful predictor of burnout. Further, examining how counselor mindfulness attitudes and practices that may reduce burnout and compassion fatigue and how this may in turn benefit clients is also needed. The current fin dings suggest a potential connection between mindfulne ss and compassion satisfaction, however there is in a need for further research in this area to see if these findings are replicated by other studies. Moreover, f uture studies could be conducted to exam ine whether there is a causal relationship between mindfulness and compassion satisfaction among mental health counselors. Moreover, research examining whether clinicians who practice mindfulness are less likely to use maladaptive coping strategies concurr ently is needed. In addition, e xploring whether g ender role socialization impact s the relationship between being a female counselor and experiencing compassion fatigue is a research area that needs further attention based on the findings of this study a s well as previous research fin dings. Sprang et al. (2007) advocated for further research to examine the impact of gender role socialization on various aspects of compassion fatigue and burnout, including clinician disclosure of symptomology and actual diffe rences in occurrence rates by gender. The findings of the current study suggest that there may be
145 differences between the phenomena of burnout and compassion fatigue such that females are more likely than men to experience compassion fatigue but no corresp onding gender effect in occurrences of burnout. Further research exploration into the construct differences between burnout and compassion fatigue is needed to understand the risks and protective factors that clinicians may experience due to gender role so cialization. A nother area ripe for further research is how cultural and gender identity intersect in the experience of counselor compassion fatigue and burnout. Moreover, r esearch exploration of cross cultural understandings of well being, burnout and co mpassion fatigue is needed. C ounseling researchers have advocated for research exploration of the impact of racism and other forms of discrimination on counse lor wellness levels (Day V ines & Holcomb McCoy, 2007). The current study did not address the impac t of discrimination or counselor cultural factors in the development of counselor burnout and compassion fatigue, due to the relatively homogenous sample. Future studies could recruit a more diverse sample of counselors to address this area of needed resea rch exploration. The current study addressed counselor burnout and compassion fatigue. Another related area of research is to study positive counselor stress outcomes such as counselor well being. Research examining whether counselor well being is correla ted with client treatment outcomes is also needed While there are ethical mandates that counselors take care of themselves and self monitor to prevent impairment (ACA Code of Ethics, 2005) there is a dearth of empirical research connecting counselor str ess outcomes to client treatment outcomes
146 One factor impacting the dearth of research linking counselor stress outcomes to client treatment outcomes could be the practical difficulties and confidentiality concerns involved in research that links clinician and client. However, with careful research design, such concerns could be addressed and the results of research in this domain could add to our understanding of clinician factors that are associated with client treatment outcomes. Moreover, research evide nce that counselor well being matters to client treatment outcomes could provide an empirical foundation supporting the counselor wellness movement and the impetus to further integrate issues related to counselor well being in counselor preparation program s and continuing education and counselor accountability initiatives. If this type of research demonstrates a connection between counselor well being and positive client treatment outcomes, the professional impetus to improve factors that impact counselor well being or lack thereof would increase. Factors such as those addressed in this study, including counselor working conditions, compassion satisfaction, mindfulness attitudes, and coping practices merit further research. Study Limitations There were l i mitations related to the generalizability, self report survey research design and the instrumentation used in the study. Although this study was designed to be generalizable to the population of interest, the author acknowledges certain limitations of the study design. While efforts were made to recruit mental health counselors from a variety of backgrounds who are not members of the American Mental Health Counselors Association ( AMHCA ) one means of recruiting participants was through the email lists of AMHCA membership. Listserv announcements were posted to professional association listservs including the Association for Spiritual, Ethical, and
147 Religious Values in Counseling. This may have le d to a sample consisting of counselors who are active in profes sional associations. Therefore, the data gathered from this sample may not accurately reflect the entire population of mental health counselors in the United States many of whom may not be active in professional associations In addition, participants in this study were voluntar y and self selected. R esearchers have reported that research volunteer s tend to have different characteristics than non volunteers. For example, volunteers tend to seek social approval, be arousal seeking, and be more intelligent t han non volunteers (Gall et al., 2007). Therefore the sample of research participants could have skew ed the results in ways that describe research volunteers but do not necessarily generalize to the population of interest. Further, a s a self report survey method, a limitation of this study is the social desirability bias p articipants may try to present themselves in the best possible light, rather than answering honestly (Gall et al., 2007) Another limitation of the study design wa s that counselors who we re most stressed might not have take n the time to complete the survey, due to their level of stress. Hence, the sample may not i nclude some participants experiencing maximum amounts of stress thereby limiting the generalizability of the results Moreove r potential participants who were experiencing stress may not have want ed to complete the survey due to the nature of the topic itself. T he instrumentation while carefull y selected or developed to measure the variables of interest in this study, may als o have posed a limitation T he researcher developed the Counselor Perceived Working Conditions Scale which does not have a previous track record of use While the scale had strong reliability and demonstrated
148 effectiveness, only initial reliability and val idity information is available, based on factor analysis conducted on the results of the research sample in this study The instrument used to measure counselor coping, t he B rief COPE was normed on a non counselor population (Carver, 1997). T he current s tudy used this instrument on a different population than the one on which it was originally normed In addition, the researcher utilized a method of grouping the 14 subscales of the B rief COPE into three broader subscales of emotion focused, problem focuse d, and maladaptive coping. While this grouping was based on the previous r esearch findings (Meyer, 2001), the organization ( 1997). In addition to these methodological li mitations, there are also c onceptual limita tions inherent in a study of this nature; for example, it is possible that this research design was missing a key personal resource that may have also impacted the outcome variables that were explored. The results demonstrated that the specific contextual factors and personal resources hypothesized as predictors of burnout were predictive of burnout and compassion fatigue. However, the amount of variance of compassion fatigue scores accounted for by these predictor s was not as great as that for burnout scores Therefore, there may be other personal resources or contextual factors that are important predictors of compassion fatigue among mental health counselors that were not accounted for in this study. For example, Sprang et al. ( 2007 ), reported results that specialized training in working with traumatized clientele was associated with greater levels of compassion satisfaction.
149 Further, while an exploration of work related contextual factors was deliberately detai led in this study, family related contextual factors were not as well addressed in this study design and were not included as predictor variables Future research addressing family related contextual factors in prediction models for burnout and compassion fatigue is needed. While coping was examined in this study, a more situation specific approach to analyzing coping responses might have yielded more meaningful results. Respondents were asked to provide a written description of a recent stressful experienc e at work and then were ask ed to respond to the B rief COPE based on how they had responded to the specified stressful experience ( 1997 ) specifications that this inventory could be used a dispositional or situational invent ory. Although participants were asked to think of specific stressors and write about them, it was beyond the scope of this study to analyze their qualitative responses and then connect them to their coping responses on the B rief COPE inventory. Conclusio n This study addressed the phenomena of counselor burnout and compassion fatigue using the theoretical framework of the transactional theory of stress and coping. The use of this theory represents a conceptual innovation in the counselor burnout and compas sion fatigue literature, in that it acknowledges the transactional nature of mental per ceptions, and ways of coping and the constellation of environmental factors that they experience are understood to concurrently and synergistically impact individu al
150 their working conditions and their length of time in the field and their gender were considered as specific contextual factors that were hypothesized to predict the outcomes of counselor burnout and compassion fatigue. The specific personal resourc es that are p roposed to mediate these contextual factors were counselor mindfulness attitudes, compassion satisfaction, and emotion focused, problem focused, and maladaptive coping strategies. These variables accounted for 66.9% of the amount of variance in reported bu rnout among the 213 mental health counselors in this sample. However, t hese same factors were predictive of only 33.1% of the variance in the level of compassion fatigue reported. Th e difference in outcome for burnout and compassion fatigue provides furt her evidence for the difference between these two phenomena. Moreover, this model was strongly predictive of variance in burnout scores, which indicates that counselor working conditions mindfulness, compassion satisfaction, and coping strategies warrant further attention in the field.
151 APPENDIX A INFORMED CONSENT DOC UMENT ONLINE VERSION Dear Participant, My name is Isabel Thompson and I am doctoral candidate in Mental Health Counseling at the University of Florida. You are invited to participate in a research study which is part of my doctoral dissertation. The purpose of this study is to explore professional counselors' working conditions, their ways of coping with these conditions, and the impact of these conditions on their well being. I serv e as the principal investigator of this research study. This study has been approved by my faculty adviser, doctoral dissertation committee, and by the University of Florida Institutional Review Board (IRB). To participate in this study, it will be necess higher degree) in mental health counseling, community counseling, or a closely related field and work at least 20 hours per week as a paid counselor providing clinical services to clients. Further, in ord er to participate in this study you need to have worked in your current setting for at least 6 months. As a participant in this study, you will be asked to complete an online survey. The survey will take approximately 20 minutes to complete. Your identit y and individual responses will remain confidential to the extent provided by law. Your name will not be collected nor used in any report. Results will be combined for data analysis and reported in the form of group data. All aspects of the data collectio n and transmission process are protected by security technology. There is a minimal risk that security of any online data may be breached, but since (1) no individually identifying information will be collected, (2) the online host uses several layers of e ncryption and (3) all data will be kept in a secure electronic database and removed upon completion of the study, it is highly unlikely that a security breach of the online data will result in any adverse consequence for you. For further information on th e security of your data please visit http://www.psychdata.com/content/security.asp. There are no known risks or benefits of participating in this study. No monetary or other form of compensation will be provided for participation in this study. Your parti cipation in this study is completely voluntary. You may withdraw from this study at any time without penalty. Your responses will not be included in the study data if you choose to discontinue the survey. If you have questions about this study, please con tact me at (352) 273 4334 or firstname.lastname@example.org Or you may contact my supervisor, Dr. Ellen S. Amatea at the University of Florida, School of Human Development and Organizational Studies in Education, 1202 Norman Hall, P.O. Box 117046, Gainesville, FL 326 11 7046, phone (352) 273 4322 or via email at
152 email@example.com. Questions or concerns about your rights as a research participant can be directed to the IRB02 office, PO Box 112250, University of Florida, Gainesville, FL 32611 2250; phone (352) 392 0433
153 APPENDIX B I NFORMED CONSENT DOCUMENT PAPER AND PENCIL VERSION Dear Participant, My name is Isabel Thompson and I am doctoral candidate in Mental Health Coun seling at the University of Florida. You are invited to participate in a research study which is part of my doctoral dissertation. The purpose of this study is to explore professional counselors' working conditions, their ways of coping with these conditio ns, and the impact of these conditions on their well being. I serve as the principal investigator of this research study. This study has been approved by my faculty advisor, doctoral dissertation committee, and by the University of Florida Institutional Review Board (IRB). higher degree) in mental health counseling, community counseling, or a closely related field and work at least 20 hours per week as a pa id counselor providing clinical services to clients. Further, in order to participate in this study you need to have worked in your current setting for at least 6 months. As a participant in this study, you will be asked to complete a survey. The survey w ill take approximately 20 minutes to complete. Your individual responses will remain confidential. Results will be combined for data analysis and reported in the form of group data. There are no known risks or benefits of participating in this study. No monetary or other form of compensation will be provided for participation in this study. Your participation in this study is completely voluntary. You may withdraw from this study at any time without penalty. Your responses will not be included in the stu dy data if you choose to discontinue the survey. If you have questions about this study, please contact me at (352 ) 273 4334 or firstname.lastname@example.org Or you may contact my supervisor, Dr. Ellen S. Amatea at the University of Florida, School of Human Developm ent and Organizational Studies in Education, 1202 Norman Hall, P.O. Box 117046, Gainesville, FL 32611 7046 phone (352) 273 4322 or via email at email@example.com. Questions or concerns about your rights as a research participant can be directed to the IR B02 office, PO Box 112250, University of Florida, Gainesville, FL 32611 2250; phone (352) 392 0433. By signing and dating below you are consenting to participate in this study. ______________________ ______________________ Signature Date
154 APPE NDIX C COUNSELOR PERCE IVED WORKING CONDITIONS how you respond to your day to day experience ask you to tell us a little bit more about yourself and your work and educational history. Part 1 This part of the survey asks you to share your thoughts and feelings about the specific working conditions that you are experiencing. Please rate the frequency with which you experience each of the working conditions described below in the past 30 days. (If you never e xperience this working condition in your current work setting, select never). 1=never 2=rarely 3=occasionally 4=often 5=almost always 1. My interactions with my clients a re very rewarding emotional ly. 1 2 3 4 5 2. The atmosphere at my work setting is collegial 1 2 3 4 5 3. I receive the administrative support that I need to care f or clients. 1 2 3 4 5 knowledge or experiences. 1 2 3 4 5 5. The amount of paperwork I hav e to complete is overwhelming. 1 2 3 4 5 6. Billing and insurance concerns take up too much of my time. 1 2 3 4 5 7. Colleagues take the time to consult with me regarding clinical issues when I need it. 1 2 3 4 5 8. My caseload includes many c lients who are actively suicidal or self injurious. 1 2 3 4 5 9. I have the freedom to choose how I conduct clinical interventions with clients. 1 2 3 4 5 10. My boss is reasonable in her/his demands. 1 2 3 4 5 11. My coworkers seem discouraged and overwhelmed. 1 2 3 4 5 12. The clients I work with face such overwhelming problems, I wonder how anybody can help them. 1 2 3 4 5 13. I receive an adequate salary and health care benefits. 1 2 3 4 5 14 I have the ability to set my own work schedule at my work setting. 1 2 3 4 5 15 I feel that it is next to impossible to help the clients on my caseload. 1 2 3 4 5
155 16 I am able to take time off from work when I need to. 1 2 3 4 5 17 It seems too difficult to help the c lients I work with make changes 1 2 3 4 5 18 I believe th well being. 1 2 3 4 5 19 I have the skills to help my c lients make progress with their problems/issues. 1 2 3 4 5 20 I feel cut off from my colleagues at my work setting. 1 2 3 4 5 21 The size of my caseload is reasona ble given the other commitments that I have at my work setting. 1 2 3 4 5 2 2 I have the training I need to work effectiv ely with each of the clients on my caseload. 1 2 3 4 5 23 Counselors at my work setting cooperate to ensure that clients receive the best care possible. 1 2 3 4 5 24 My caseload includes a balance of different types of cases and levels of severity of cl ient issues. 1 2 3 4 5 25 Profit is the top priority in this work orga nization. 1 2 3 4 5 26 I seem to take more responsibility for helping my clients make changes than they do. 1 2 3 4 5 27. The supervision I receive provides me what I need to be effect ive as a counselor. 1 2 3 4 5 28 Counselors at my work setting have to compete with one another to get a head in their careers. 1 2 3 4 5 29 My clients have so many problems that it is hard to even know where to start. 1 2 3 4 5 30 My cultur al background is respe cted at my work setting. 1 2 3 4 5 31 The people I counsel are motivated to make positive changes in their lives. 1 2 3 4 5 32 I spend too much time completing paperwork and not enough time providing therapeutic services. 1 2 3 4 5 33 I feel empowered to speak out about how clients are treated at my work setting. 1 2 3 4 5 34 My supervisor wants me to excel and hel ps me build on existing skills. 1 2 3 4 5
156 35 Effective client treatment is a top priority in this work organization. 1 2 3 4 5 36 I feel as though my clients are engaged i n the treatment process. 1 2 3 4 5 37 It is difficult for me to predict the kind of income I am going to have from week to week. 1 2 3 4 5 38 Decisions that impact me in my work setting are made in a fair and ope n way. 1 2 3 4 5 39 Because we are so understaffed at my work setting, I cannot take ti me off when I need to. 1 2 3 4 5 40 I have concerns for my safety in working with many of my clients. 1 2 3 4 5 41 I believe that there is an unfair distribution of cases at my work setting. 1 2 3 4 5 42 The clients I work with m ake too many demands on me. 1 2 3 4 5 43 I see the clients I work with making pos itive changes in their lives. 1 2 3 4 5 44 My work setting provides me with ongoing education to further develop my skills. 1 2 3 4 5 45. Staff in my work setting are open to trying new innovative co unseling approaches. 1 2 3 4 5 46 The pace of my work creates little time for me to reflect on how to work with my clients. 1 2 3 4 5 47 The clients I work with tell me they are benefiting from our counseling work. 1 2 3 4 5 48 I am comfortable approaching my colleagues about consultation or support. 1 2 3 4 5 49 In my work setting, we are expected to do more with fewer resources. 1 2 3 4 5 50 I enjoy the types of work that I complete throughout the day at my work setting. 1 2 3 4 5
157 APPENDIX D SURVEY PART II The following section deals with possible working conditions you experience as a counselor and how you cope with them. Research has indicated that certain working conditions may be stressful for counselors (e.g. excessive caseload, traumatic issues of clients, lack of organizational support, and lack of needed supervision). We are interested in finding out about a specific stressful working condition that you experience in your work setting an d what helps you cope with it. In the space below please describe a condition in your work environment that you have found stressful during the past 30 days. ____________________________________________________________________________ ____________________ ________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ________________________________________________ ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ _______________________________________________________________ While differ ent people may deal with stress in different ways; we're interested in how you've dealt with a stressful/challenging work condition, such as the one that you described above. Keep the situation described above in mind as you respond to the items below. Ple ase indicate how you are currently responding to your above example. There is no need to evaluate if your response is working or not. Using the choices below, rate how frequently you've been responding this way. Rate each item separately from every other i tem. Make your answers as true FOR YOU as you can. 1 = I haven't been doing this at all 2 = I've been doing this a little bit 3 = I've been doing this a medium amount 4 = I've been doing this a lot 1. I've been turning to other activities to take my mind off things. 1 2 3 4 2. I've been concentrating my efforts on doing something about the situation I'm in. 1 2 3 4 3. I've been saying to myself "this isn't real." 1 2 3 4 4. I've bee n using alcohol or other drugs to make myself feel better. 1 2 3 4 5. I've been getting emotional support from others. 1 2 3 4 6. I've been giving up trying to deal with the situation. 1 2 3 4
158 7. I've been taking action to try to make the situation better. 1 2 3 4 1 = I haven't been doing this at all 2 = I've been doing this a little bit 3 = I've been doing this a medium amount 4 = I've been doing this a lot 8. I've been refusing to believe that it has happened. 1 2 3 4 9. I've been saying things to let my unpleasant feelings escape. 1 2 3 4 10. 1 2 3 4 11. I've been using alcohol or other drugs to help me get through this situation. 1 2 3 4 12. I've been trying to see it in a different light, to make it seem more positive 1 2 3 4 13. 1 2 3 4 14. I've been trying to come up with a strategy a bout what to do. 1 2 3 4 15. I've been getting comfort and understanding from someone. 1 2 3 4 16. I've been giving up the attempt to cope with the situation. 1 2 3 4 17. I've been looking for something good in what is happening. 1 2 3 4 18. I've been making jokes about this situation. 1 2 3 4 19. I've been doing something to think about it less, such as going to movies, 1 2 3 4 watching TV, reading, daydreaming, sleeping, or sho pping. 20. I've been accepting the reality of the fact that it has happened. 1 2 3 4 21. I've been expressing my negative feelings. 1 2 3 4 22. I've been trying to find comfort in my religion or spiritual beliefs. 1 2 3 4 23. 1 2 3 4 24. I've been learning to live with the situation. 1 2 3 4 25. I've been thinking hard about what steps to take. 1 2 3 4 26. e been blaming myself for things that happened. 1 2 3 4 27. I've been praying or meditating. 1 2 3 4 28. I've been making fun of the situation. 1 2 3 4
159 APPENDIX E PROFESSIONAL QUALITY OF LIFE Counselor Exp eriences When you counsel people you have direct contact with their lives. As you may have found, your compassion for those you help can affect you in positive and negative ways. Below are some questions about your experiences, both positive and negative, as a counselor. Consider each of the following questions about you and your current work situation. Select the number that honestly reflects how frequently you experienced these things in the last 30 days 1=Never 2=Rarely 3=Sometimes 4=Often 5=Very Of ten ______1. I am happy. ______2. I am preoccupied with more than one person I counsel. ______3. I get satisfaction from being able to help people. ______4. I feel connected to others. ______5. I jump or am startled by unexpected sounds. ______6. I feel i nvigorated after working with those I help. ______7. I find it difficult to separate my personal life from my life as a counselor. ______8. I am not as productive at work because I am losing sleep over traumatic experiences of a person I help. ______9 I think that I might have been affected by the traumatic stress of those I help. ______10. I feel trapped by my job as a counselor. ______11. Because of my counseling, I have felt "on edge" about various things. ______12. I like my work as a counselor. _____13. I feel depressed because of the traumatic experiences of the people I counsel. ______14. I feel as though I am experiencing the trauma of someone I have helped. ______15. I have beliefs that sustain me. ______16. I am pleased with how I am able to keep up with counseling techniques and protocols. ______17. I am the person I always wanted to be. ______18. My work makes me feel satisfied. ______19. I feel worn out because of my work as a counselor ______20. I have happy thoughts and feelings about those I counselor and how I could help them. ______21. I feel overwhelmed because my caseload seems endless. ______22. I believe I can make a difference through my work. ______23. I avoid certain activities or situations because they remind me of frightening experiences of the people I counsel. ______24. I am proud of what I can do to help. ______25. As a result of my counseling, I have intrusive, frightening thoughts. ______26. I feel "bogged down" by the system. ______27. I have thoughts that I am a "success" as a counselor. ______28. I can't recall important parts of my work with trauma victims. ______29. I am a very caring person. ______30. I am happy that I chose to do this work.
160 APPENDIX F MINDFUL ATTENTION AW ARENESS SCALE Instructi ons: Below is a collection of statements about your everyday experience. Using the 1 6 scale below, please indicate how frequently or infrequently you currently have each experience. Please answer according to what really reflects your experience rather th an what you think your experience should be. Please treat each item separately from every other item. 1 2 3 4 5 6 Almost Very Somewhat Somewhat Very Almost Never Infrequently Infrequently Frequently Frequently Always I could be experiencing some emotion and not be conscious of it until so me time later. 1 2 3 4 5 6 I break or spill things because of carelessness, not paying attention, or thinking of something else. 1 2 3 4 5 6 I find it diff present. 1 2 3 4 5 6 attention to what I experience along the way. 1 2 3 4 5 6 I tend not to notice feelings of physical tension or discomfort until they really grab my attention. 1 2 3 4 5 6 d it for the first time. 1 2 3 4 5 6 1 2 3 4 5 6 I rush through ac tivities without being really attentive to them. 1 2 3 4 5 6 I get so focused on the goal I want to achieve that I lose touch 1 2 3 4 5 6 I do jobs or tasks automatically, without being aware of what I'm doing. 1 2 3 4 5 6 I find myself listening to someone with one ear, doing something else at the same time. 1 2 3 4 5 6
161 1 2 3 4 5 6 Almost Very S omewhat Somewhat Very Almost Never Infrequently Infrequently Frequently Frequently Always there. 1 2 3 4 5 6 I find myself preoccupied with the future or the past. 1 2 3 4 5 6 I find myself doing things without paying attention. 1 2 3 4 5 6 1 2 3 4 5 6
162 APPENDIX G DEMOGRAPHIC QUESTION NAIRE Gender (please circle): Male/ Female Please write in your age in years. ___________ Race/Ethnicity (please check which apply): ___Native American/Alaskan Native ___Asian ___Black/African American ___Latino/a ___White/Caucasian American ___Native Hawaiian or other Pacific Islander __ _Multiethnic Other (please specify)____________________ Relationship Status: percentages ___Single ____In a relationship ___Committed Partnership ___Married ___Divorced ___Widowed Other (please specify)____________________ If you are in a relationship, how stressful is it for you to manage the demands of your relationship? Please circle the number that applies to you: 1=Not stressful, 2=Somewhat Stressful, 3=Fairly Stressful, 5=Very Stressful Not Stressful 1 2 3 4 Very Stressful If you are a caregiving for an elderly or disabled relative, how stressful is it for you to manage the demands of caregiving? Please circle the number that applies to you: 1=Not stressful, 2=Some what Stressful, 3=Fairly Stressful, 5=Very Stressful
163 Not Stressful 1 2 3 4 Very Stressful Do you have children? Yes / No If you indicated that you have children, how many do you have? If you indicated that you have children, do they currently live with you? If you are a parent, how stressful is it for you to manage the demands of parenting? Please circle the number that applies to you: 1=Not stressful, 2=Somewhat Stress ful, 3=Fairly Stressful, 5=Very Stressful Not Stressful 1 2 3 4 Very Stressful Please indicate the cit y and state in which you live: Educational Background. Please check the degrees that you have completed. B.A. __ _______ M.A. _____ ____ M.Ed. ________ Ed.S._________ Ph.D. /EdD ___________ Other (please specify)__________ How many graduate credit hours have your earned in total? Please include graduate credits from all degrees, including post master's degrees _________________________ Current Work Involvement Please indicate the total number of hours you work per week. _____ Please indicate the number of hours you spend providing direct services to clients. ____ Ple ase indicate the total number of clients on your caseload. ____ Please indicate the total number of years you have worked in the counseling field.____
164 Please indicate the number of months or years you have worked at your current job setting. Minimum of 6 months at current job for inclusion in this study. _______________ What is your salary/yearly income from your counseling work? Please include only income from your counseling work. __ _Less than 10,000 __ __10,000 24,999 __ __25,000 34,999 _____35,000 44,999 __ __45,000 54,999 ___ _55,000 64,999 ___65,000 74,999 _____75,000 84,999 ___85,000 94,999 ___95,000 or more ___ _Other (please specify):_______________________ How would you describe your work setting? __ Individual Private Practice ___ _Group Private Practice ___ __Community Mental Health Agency __ __College Counseling Center ___ Hospital _____ Crisis Stabilization Unit ___ Substance Abuse Treatment Center _____Career Co unseling Center ___ _Other (please specify):___________________________ If you work in a private practice setting, how many clinicians work in your practice? Please write in number._________________________
165 What is your current licensure status? Please ch eck all that apply. ____Fully licensed in your state ____Registered Intern Status ____National Certified Counselor ____Other (please specific):____________________ None specified ______ What licenses do you hold? Since many states have different licensu re titles for professional mental health counselors, please write in your licensure here. If you are dually licensed in another profession, please indicate that here. ____________________________________________________________________________ ___________ _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________ Do es your workplace promote a particular theoretical orientation? Yes/No If you answered yes to the question above, which theoretical orientation does your workplace promote/endorse? (Please briefly describe the theory that your workplace promotes).________ ___________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ __________________________________ Do you cur rently receive supervision? Yes/No If you currently receive supervisor, please describe the nature of the supervision you currently receive below. ____________________________________________ _______________________________ _______________________________ _____________________________________________ ____________________________________________________________________________ _________________________________________________________ ___________________ Are you a member of the American Counseling Association (A CA)? Yes/No Are you a member of the American Mental Health Counselors Association (AMHCA)?
166 Yes/No Are you a member of any of the following professional associations? Please check all that apply and/or write in another association. ____American Associatio n of Marriage and Family Therapists (AAMFT) ____Association for Assessment in Counseling and Education (AACE) ____Association for Adult Development and Aging (AADA) ____Association for Child and Adolescent Counseling (ACAC) ____Association for Creativity i n Counseling (ACC) ____American College Counseling Association (ACCA) ____Association for Counselors and Educators in Government (ACEG) ____Association for Counselor Education and Supervision (ACES) ____Association for Humanistic Counseling (AHC) ____Assoc iation for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC) ____Association for Multicultural Counseling and Development (AMCD) ____American Rehabilitation Counseling Association (ARCA) ____American School Counselor Association (ASCA) ____Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) ____Association for Specialists in Group Work (ASGW) ____Counselors for Social Justice (CSJ) ____International Association of Addictions and Offender Counselors (IAAOC) __ __International Association of Marriage and Family Counselors (IAMFC) ____National Career Development Association (NCDA) ____National Employment Counseling Association (NECA) ____Other (please specify):___________________________________ How easy is it for you to let go of difficult emotions after an intense session with a client? Please circle the number that applies to you: 1=very hard to let go, 2=somewhat hard to let go, 3=Neither hard nor easy to let go, 4=somewhat easy to let go, 5=Easy to let
167 Very hard to let go 1 2 3 4 5 E asy to let go Is there any other information related to your work as a counselor that you think that it would be important for us to know? ____________________________________________________________________________ ____________________________________________________________________________ ________________ ____________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________ ________________________________ ______________________________________________________ Thank you!
168 APPENDIX H COUNSELOR PERCEIVED WORKING CONDITION S SCALE Please rate the frequency with which you experience each of the working conditions described below in the past 30 days. (If you never experience this working condition in your current work setting, select never). 1=never 2=rarely 3=occasionally 4=often 5=almost always 1 The atmosphere at my w ork setting is collegial. 1 2 3 4 5 2 I receive the administrative support that I need to care for clients. 1 2 3 4 5 3 The amount of paperwork I have to complete is overwhelming. 1 2 3 4 5 4 Colleagues take the time to consult with me regarding clinical issues when I need it. 1 2 3 4 5 5 I have the freedom to choose how I conduct clinical interventions with clients 1 2 3 4 5 6 My boss is reasonable in her/his demands. 1 2 3 4 5 7 My coworker s seem discouraged and overwhelmed. 1 2 3 4 5 8 The clients I work with face such overwhelming problems, I wonder how anybody can help them. 1 2 3 4 5 9 I receive an adequate sala ry and healthcare benefits 1 2 3 4 5 10 I have the ability to set my own work schedule at my work setting. 1 2 3 4 5 11 I feel that it is next to impossible to help the clients o n my caseload. 1 2 3 4 5 12 I am able to take time off from work when I need to. 1 2 3 4 5 13 It seems too difficult to help the clients I work with make changes. 1 2 3 4 5 14 my well being. 1 2 3 4 5 15 I have the skills to help my clients make progress with their problems/issues 1 2 3 4 5 16 I feel cut off from my colleagues at my work setting. 1 2 3 4 5
169 17 The size of my caseload is reasonable given the other commitments that I have at my work setting. 1 2 3 4 5 18 I have the training I need to work effectively with each of the clients on my caseload. 1 2 3 4 5 19 Counselors at my work setting cooperate to ensure that clients receive the best care possible. 1 2 3 4 5 20 My caseload includes a balance of different types of cases and levels of severity of client issues. 1 2 3 4 5 21 Profit is the top priority in this work organization. 1 2 3 4 5 22 I seem to take more responsibility for helping my clients make changes than they do. 1 2 3 4 5 23 The supervision I receive provides me what I need to be effective as a counselor. 1 2 3 4 5 24 Counselors at my work setting have to compete with one another to get ahead in their caree rs 1 2 3 4 5 25 My clients have so many problems that it is hard to even know where to start. 1 2 3 4 5 26 My cultural background is respected at my work setting. 1 2 3 4 5 27 The people I counsel are motivated to make positive changes in their lives. 1 2 3 4 5 28 I spend too much time complet ing paperwork and not enough time providing therapeutic services. 1 2 3 4 5 29 I feel empowered to speak out about how clients are treated at my work setting 1 2 3 4 5 30 My supervisor wants me to excel and helps me build
170 on existing skills. 1 2 3 4 5 31 Effective client treatment is a top priority in this work organization 1 2 3 4 5 32 I feel as though my clients are eng aged in the treatment process. 1 2 3 4 5 33 It is difficult for me to predict the kind of income I am going to have from week to week. 1 2 3 4 5 34 Decisions that impact me in my work setting are made in a fair and open way. 1 2 3 4 5 35 Because we are so understaffed at my work setting, I cann ot take time off when I need to. 1 2 3 4 5 36 I have concerns for my safety in working with many of my clients. 1 2 3 4 5 37 I believe that there is an unfair distribution of cases at my w ork setting. 1 2 3 4 5 38 The clients I work with make too many demands on me. 1 2 3 4 5 39 I see the clients I work with making positive changes in their lives. 1 2 3 4 5 40 My work setting provides me with ongoing education to further develop my skills. 1 2 3 4 5 41 Staff in my work setting are open to trying new innovative counseling approaches. 1 2 3 4 5 42 The pace of my work creates little time for me to reflect on how to work with my clients. 1 2 3 4 5 43 The clients I work with tell me they are benefiting from our counseling work. 1 2 3 4 5 44 I am comfortable approaching my colleagues about consultation or support. 1 2 3 4 5 45 In my work setting, we are expected to do more with fewer resour ces. 1 2 3 4 5
171 46 I enjoy the types of work that I complete throughout the day at my work setting. 1 2 3 4 5
172 LIST OF REFERENCES American Counseling Association (2005). Code of Ethics. Alexandria, VA: Author. Baer, R. A., Smith, G.T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self report assessment methods t o explore facets of mindfulness. Assessment 13 27 44. Baird, K., & Kracen, A.C. (2006). V icarious traumatization and secondary traumatic stress: A research synthesis. Counselling Psychology Quarterly 19 (2), 181 188. Baker, E.K. (2003). professional well being Washington, D.C.: Ameri can Psychological Association Bell, H. (2003). Strengths and secondary trauma in family violence work. Social Work 513 522. Belizaire, L.S., & Fuertes, J.N. (2011). Attachment, coping, acculturative stress, and quality of life among Haitian immigrants. Jo urnal of Counseling & Development, 89 (1), 89 97. Bishop, S., Lau. M., Shapiro. S., C arlson. L., Anderson. N., & Carmody, J. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11 230 241. Broome, K. M. Fly nn, P. M. Knight, D. K., & Simpson, D. D. (2007). Program structure, staff perceptions, and client engagement in treatment Journal of Substance Abuse Treatment 33 149 158 Brown, K. W., & Ryan, R. M. (2003). The benefits of being p resent: Mindfulnes s and its role in psychological well b eing Journal of Personality and Social Psychology 84 ( 4 ) 822 848 Cashwell, C. S., Bentley, D. P., & Bigbee, A. (2007). Spirituality and counselor wellness. Journal of Humanistic Counseling, Education & Development, 46 (1), 66 81. Carlson L. E., & Garland S. N. (2005). Impact of Mindfulness Based Stress Reduction (MBSR) on s leep, mood, stress and fatigue symptoms in cancer o utpatients International Journal of Behavioral Medicine 12 ( 4 ) 278 285 Carlson, L. E., & Br own, K. W. (2005). Validation of the Mindful Attention Awareness Scale in a cancer population. Journal of Psy c hosomatic Research 58 29 33. Carver, C. S. (1997) You want to measure coping but your protocol is too long. International Journal of Behavioral Medicine 4 (1), 92 100.
173 Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267 283 Carver, C. S., & Connor Smith, J. (2010). Personalit y and coping. Annual Review of Psychology, 61, 679 704 Cohen, J. S. & Miller, L. J. (2009). Interpersonal mindfulness training for well being: A pilot study with psychology graduate students. Teachers College Record 111 (12), 2760 2774. Collard, P., Avn y, N., & Boniwell, I. (2008). Teaching mindfulness based cognitive therapy (MBCT) to students: The effect of MBCT on the levels of mindfulness and subjective well being. Counselling Psychology Quarterly 21 (4), 323 336. Collins, S., & Long, A. (2003). Wor king with the psychological effects of trauma: Consequences for mental health care workers A literature review. Journal of Psychiatric and Mental Health Nursing, 10 417 424 Cooper, C., Katona, C., & Livingston, G. (2008). Validity and reliability of the brief COPE in carers of people with dementia. Journal of Nervous and Mental Disease 196 (11), 838 843. Costello, A. B., & Osborne, J. (2005). Best practices in exploratory factor a nalysis: Four r ecommendations for getting the most from your a nalysis Pract ical Assessment, Research & Evaluation 10 (7), 1 9. Retr i eved from http://graduate.tuiu.edu/res620sum08/Modules/Module03/FactorAnalysis.pdf Cummins, P., Massey, L, & J ones, A. (2007). Keeping ourselves well: Strategies for promoting and maintaining counselor wellness. The Journal of Humanistic Counseling, Education and Development, 46 (1), 35 49. Cunningham, M. (2003). Impact of trauma work on social work clinicians: E mpirical findings. Social Work 451 459. Dillman, Don A. 2000. Mail and internet surveys: The t ailor ed design m ethod. New York, NY: Wiley. Drouet Pistorius, K. D., Feinauer, L. L., Harper, J. M., Stahmann, R. F., Miller, R. B. (2008). Working with sexual ly abused children. The American Journal of Family Therapy 36 181 195 Ducharme, L. J., Knudsen, H. K., Roman, P. M. (2008 ). Emotional exhaustion and turnover intention in human service occupations: The protective role of coworker support. Sociological Sp ectrum, 28 (1), 81 104. Figley, C. R. (2002). Compassion Fatigue: Therapists chronic lack of self care. JCLP/In Session: Psychotherapy in Practice 58 (11), 1433 1441.
174 Figley C. R. (1995) Compassion fatigue as secondary traumatic stress disorder: an overvi ew. In: Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized (ed. Figley, C.R.), pp. 1 20. Brunner/Mazel: New York. Gall, M. D., Gall, J. P., & Borg, W. R. (2007). Educational research: An introduction (8 th ed.) New York, NY: Pearson. Grafanaki, S., Pearson, D., Cini, F., Godula, D., McKenzie, B., Nason, S., & Anderegg, M. (2005). Sources of renewal: A qualitative study on the experience and role of leisure in the life of counsellors and psychologists. Cou nselling Psychology Quarterly 18 (1), 31 40. Greason, P. B., & Cashwell, C. S. (2009). Mindfulness and counselor self efficacy: The mediating role of attention and empathy. Counselor Education & Supervision 49 2 19. Hatcher, R ., & Noakes, S. (2010). Wo rking with sex offenders: the impact on Australian t reatment providers Psychology, Crime & Law 16 ( 1 2 ) 145 167 Holahan C. J. Moos R. H., Holahan C. K., Brennan P. L. & Schutte K. K. (2005). S tress generation, avoidance coping, and depressive s ymp toms: A 10 Year m odel Journal of Consulting and Clinical Psychology 73 ( 4 ), 658 666 doi : 10.1037/0022 006X.73.4.658 Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change New Y ork: Guilford. Hooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E., (2010). Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing 36 420 42 7. doi: 10.1016/j.jen.2009.11.027 Kabat Zinn, J. (1990). Full Catastrophe Living New York: Delta. Kabat Zinn, J. (1994). Wherever you go there you are : Mindfulness meditation in everyday life. New York: Hyperion. Kaplowitz, M.D., Hadloc k, T.D., Levine, R. (2004). A comparison of web and mail survey response rates. Public Opinion Quarterly 68 (1), 94 101. Kraus, V.I. (2005). Relationship between self care, compassion satisfaction, compassion fatigue, and burnout among mental health profes sionals working with adolescent sex offenders. Counseling and Clinical Psychology Journal 2 (1), 81 88.
175 Lamb, D. H., Presser, N. R., Pfost, K. S., Baum, M. C., Jackson, V. R., & Jarvis, P. A (1987). Confr onting professional impairment during the i nternsh ip: Identification, due process, and r emediation. Professional Psychology: Research and Practice 18 ( 6 ) 597 603 Lambie, G. (2007). The contribution of ego development level to burnout in school counselors: Implications for professional school counseling Journal of Counseling & Development 85, 82 88 Lau, M. A., Bishop. S. R., Segal, Z. V., Buis, T., Anderson, N. D., Carlson, L., Shapiro, S., & Carmody, J. (2006). The Toronto mindfulness scale: Development and validation. Journal of Clinical Psychology 62 (12), 1445 1467. Lawson, G. (2007). Coun selor wellness and impairment: A national survey. Journal of Humanistic Counseling, Education and Development, 46 (1), 20 33. Lawson, G. Venart, E Hazler, R., & Kottler, J. (2007). Toward a culture of counsel or wellness. The Journal of Humanistic Counseling, Education and Development, 46 (1), 5 19. Lawson G. & Myers J. E. (2011). Wellness, professional q u ality of l ife, and career sustaining b ehaviors: What keeps us w ell? Journal of Counseling & Development 89, 163 171. Layne, C. M., Hohenshil, T. H., & Singh, K (2004). The relationship of occupational stress, psychological strain, and coping resources to the turnover intentions of rehabilitation counselors. Rehabilitation Counseling Bulletin 48 (1) 19 30 Lazarus, R. S. & Folkman, S. (1984). Stress, appraisal, and coping New York: Springer. Lazarus, R. S., & Folkman, S. (1987). Transactional theory and research on emotions and coping. European Journal of Personality 1 141 169. Lee, S. M., Baker, C. R. Cho, S. H., Heckathorn D. E., Holland, M. H., Newgent, R. A., Yu, K (2007). Development and initial p sychometrics of the Counselor Burnout Inventory Measurement and Evaluation in Counseling and Development, 40 142 154. Lee, S. M., Seong, H. C ., Kissinger, D., & Ogle, N. T. (2010). A typology of burnout in professional counselors. Journal of Counseling & Development 88, 131 138. Leonard, L. (2008). workplace factors on compassion fatigue and compassion satisfaction. (Doctoral dissertation). Retrieved from http://etd.fcla.edu.lp.hscl.ufl.edu/UF/UFE0021907/leonard_l.pdf
176 Linley, P. A., & J oseph, S. well being. Journal of Social and Clinical Psychology 26 (3), 385 403. Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology 52 397 422. McCa rthy, L. A. (2006). Influences of couple conflict type, division of labor, and violated expectations on first being. (Doctoral dissertation). McCollum, E. E., & Gehart, D. R. (2010). Using mindfulness meditation t o teach beginning therapists therapeutic presence: A qualitative study. Journal of Marital and Family Therapy, 36 (3), 347 360. Meyer, B. (2001). Coping with severe mental illness: Relations of the b rief COPE with s ympt oms, functioning, and well being. Jou rnal of Psychopathology and Behavioral Asses sment, 23 ( 4 ), 265 276. Newsome, S., Christopher, J. C., Dahlen, P., Christopher, S. (2006). Teaching counselors self care through mindfulness practices. Teachers College Record 108 (9), 1881 1900. F. (2001). On the etiology and effective management of professional distress and impairment among psychologists. Professional Psychology: Research and Practice, 32 (4), 345 350. Ogle, N. T., Powell, M. L., Quinn, J. J., Wallace, S. L., and Yu, K. (2007). Development and initial p sychometrics of the Counselor Burnout Invento ry. Measurement and Evaluation in Counseling and Development 40, 142 154. M., & Linton, J. M. (2000). Stress on the job: Self care resources for counselors. Journal of Mental Health Counseling, 22 354 364. Osburn, C. J. (2004). Seven salutary suggestions for counselor stamina Journal of Counseling & Development 82 319 328. Ostertag, P. A., & McNamara, J. sex rati o and its implications for the profession. The Psychology of Women Quaterl y, 15, 349 369 Purvanova, R. K., & Muros, J. P. (2010). Gender differences in burnout: A meta analysis Journal of Vocational Behavior 77 168 185 Richards, K. C., Campenni, C. E ., & Muse Burke, J. L. (2010). Self care and well being of mental health professionals: The mediating role of self awareness and mindfulness. Jour nal of Mental Health Counseling, 32 (3), 247 264.
177 Roach, L. F., & Young, M. E. (2007). Do counselor education programs promote wellness in their students? Counselor Education & Supervision, 47 29 45. Rothaupt, J. W., & Morgan, M. practice of mindfulness: A qualitative inquiry. Counseling and Values, 52 40 54. Sch auben, & Frazier (1995). Vicarious trauma: Effects on female counselors of working with sexual violence survivors. Psychology of Women Quarterly 19 49 64. Schmidt, C. K., & Welsh, A. C. (2010). College adjustment and subjective well being when coping wit Jour nal of Counseling & Development, 88 (4), 397 406. Schure, M. B., Christopher, J., & Christopher S. (2008). Mind body medicine and the art of self care: Teaching mindfulness to counseling students through yoga, meditation, and Qigong. Journal of Counseling & Development, 86 47 56. Segal, Z. V., Williams, I. M.G., & Teasdale, J. D. (2002). Mindfulness based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press. Schutz, R. W. & Lo ng, B. C. (1988). Confirmatory factor analysis, validation and revision of a Teacher Stress Inventory. Educational and Psychological Measurement, 48 497 Skinner, K. & Louw, J. (2009). The feminization of psychology: Data from South Africa. Internation al Journal of Psychology 44 (2), 81 92. Skovholt, T. (2001). The resilient practitioner: Burnout prevention and self care Strategies for counselors, therapists, teachers, and health care professionals. Boston, MA: Allyn & Bacon. Smith, J. E., Richard son, J., Hoffman, C., & Pilkington, K. (2005). Mindfulness based stress reduction as supportive therapy in cancer care: Systemic review. Journal of Advanced Nursing 52 (3), 315 327. Sprang, G., Clark, J. J., & Whitt Woosley, A. (2007). Compassion fatigue compassion Journal of Loss and Trauma 12 259 280. Stamm, B. (2002). Measuring compassion satisfaction as well as fatigue: Developmental history of compassion fatigue and sati sfaction test. In C.R. Figley (Ed.), Treating Compassion Fatigue pp.1 20. London: Taylor & Francis. Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org.
178 Stev anovic, P., & Rupert, P.A. (2004). Career sustaining behaviors, satis factions, and stresses of professional psychologists. Psychotherapy: Theory, Research, Practice, Training, 41, 301 309. doi: 10.1037/0033 322.214.171.1241 Tannen, C. (2009). Choosing to be present as counselors in training: A grounded theory. (Doctoral disse rtation). Retrieved from : http://purl.fcla.edu.lp.hscl.ufl.edu/fcla/etd/UFE0024132 Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9 (3), 455 472. Tehrani, N. (2007). The cost of caring the impact of secondary trauma on assumptions, values, and beli efs. Counselling Psychology Quarterly 20 (4), 325 339. Trippany, R. L., White Kress, V. E., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling and Development, 82 (1 ), 31 37. Venart, E., Vassos, S., & Pritcher Heft, H. (2007). What individual counselors can do to sustain wellness. The Journal of Humanistic Counseling, Education and Development 46, 50 65. Vilardaga, R., Luoma, J. B., Hayes, S. C., Pistorello, J., Lev in, M. E., Hildebrandt, M. J., Bond, F. (2011). Burnout among the addiction counseling workforce: The differential roles of mindfulness and values based processes and work site factors Journal of Substance Abuse Treatment 40 323 335 Wallace, B. A. (2006). The attention revolution: Unlocking the power of the focused mind Somerville, MA: Wisdom Publications, Inc Wilkerson K. (2006). Impaired students: Applying the therapeutic process model to graduate training programs. Counselor Education & Supervision 45 207 217. Winship, G. (Ed) (2007). Research in brief. Journal of Psychiatric and Mental Health Nursing 14 603 608. Young, M. E. & Lambie, G. W. (2007). Wellness in school and mental health systems: Organizational influences The Journal of Humanistic Counseling, Education and Development, 46 98 113.
179 BIOGRAPICAL SKETCH Isabel A. Thompson was born in Abidjan, Ivory Coast and spent her early childhood in Dhaka, Bangladesh and New Delhi, India. Her family then moved to Bet hesda, Maryland where they lived for four years. In 1994, she moved to St. Petersburg, Florida. Before pursuing graduate stud ies, she completed her B.A. in l i terature/Hispanic language and c ulture at New College of Florida. She met her future husband Eric S. Thompson at New College of Florida in 2000. Isabel Thompson grad uated in 2006 with her M.A. in mental health counseling and certificate in marriage and family t herapy from the University of Central Florida. She is currently a registered mental health c ounselor i ntern working toward licensure in the state of Florida, with counseling experience in school, private practice, and community settings. In August 2012, Isabel will graduate with her Ph.D. in Counselor Education and Supervision from the Universi ty of Florida. Isabel actively researches, publishes, and presents on counselor well being and family school partnerships for students at risk. She also leads workshops on creativity and mindfulness. Isabel has studied Spanish in Spain and Ecuador. She is also a certified yoga instructor and certified in contemplative approaches to managing emotions. Her transcultural experiences inform her integrative approach to research, teaching, supervision, and counseling. Isabel currently lives with her husband Er ic in Gainesville, Florida. When not working on their doctoral studies, they enjoy bike rides on nature trails, traveling, and meditation retreats.