Therapeutic burnout among borderline personality disordered clients and their therapists: Development and evaluation of two adaptations of the maslach burnout inventory

doi:10.1016/S1077-7229(00)80091-7

Cognitive and Behavioral Practice

Volume 7, Issue 3, Summer 2000, Pages 329-337

https://doi.org/10.1016/S1077-7229(00)80091-7 Get rights and content

Providers of psychotherapy services are likely to become emotionally exhausted, to depersonalize their clients, and to have diminished personal accomplishment as a consequence of treating “difficult” clients. This pattern, termed burnout, has recently received considerable empirical attention. Whereas previous researchers have explored burnout as an occupational phenomenon, we propose that both therapists and clients experience burnout reciprocally; that is, both providers and recipients can become burned out from the therapy process. We administered a modified client version of the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1986) to clients receiving psychosocial treatment for borderline personality disorder (BPD) both prior to therapy and 4 months into treatment and a modified therapist version of the MBI to their therapists. We predicted that client difficulty (depression, anger, and suicidality) would be related to therapist burnout, and that high expectancies of therapy would be related to increased burnout for both clients and therapists at 4 months. Whereas the first prediction was not supported, we did find some support for the relationship between expectancies and burnout. Post hoc analyses also revealed an interesting pattern: The most reliable predictor of therapist burnout at 4 months was client burnout at pretreatment. Implications of this interaction between client burnout and the therapists' responses are discussed.

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Clients with BPD tend to engage in multiple challenging behaviors that interfere with receiving therapy, such as calling the therapist at unreasonable hours outside of session (Dimeff & Linehan, 2001), behaving ineffectively on phone calls (Linehan, 2008), being non-collaborative (e.g., arguing with the therapist), and quitting therapy (Bados, Balaguer, & Saldaña, 2007; Espinosa, Grynberg, & Mendoza, 2009; Farrand, Booth, Gilbert, & Lankshear, 2009; Oumaya et al., 2008). This, paired with emotional and behavioral dyscontrol, including suicidal and non-suicidal self-directed violence (SDV), results in these individuals being difficult-to-treat, BPD being a highly stigmatized disorder, and trepidation by clinicians to provide treatment for clients with BPD (Gunderson et al., 2011; Linehan, Cochran, Mar, Levensky, & Comtois, 2000; Paris, 2005). Dialectical behavior therapy (DBT; Linehan, 1993) is the dominant evidence-based treatment for borderline personality disorder in the community (Koons et al., 2001; Linehan, Armstrong, Suarez, Allmon, & Heard, 1991; Linehan et al., 2002, 2006; Lynch, Morse, Mendelson, & Robins, 2003; Telch, Agras, & Linehan, 2001; Verheul et al., 2003).
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^*: Writing of this manuscript was partially supported by grants MH34486 from the National Institute on Mental Health and DAO8674 from the National Institute on Drug Abuse, Bethesda, MD.

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Special Series: Accentuating The Role Of Therapist Emotion In Behavior Therapy TrainingTherapeutic burnout among borderline personality disordered clients and their therapists: Development and evaluation of two adaptations of the maslach burnout inventory*

Comprehensive Psychiatry

Psychiatric Clinics of North America

Diagnostic and statistical manual of mental disorders

An inventory for measuring depression

Archives of General Psychiatry

Burnout and job expectations of state agency rehabilitation counselors in North Dakota

Journal of Applied Rehabilitation Counseling

The role of professional self-efficacy in the etiology and amelioration of burnout

Prototypic typology and the borderline personality disorder

Journal of Abnormal Psychology

Clinical correlates of self-mutilation in borderline personality disorder

American Journal of Psychiatry

NIMH treatment of depression collaborative research program: I. General effectiveness of treatments

Archives of General Psychiatry

The structured clinical interview for DSM-III-R personality disorders (SCID-II): II. Multi-site test-retest reliability study

Journal of Personality Disorders

Personality and suicide

Annals of the New York Academy of Sciences

Suicide attempts in patients with borderline personality disorder

American Journal of Psychiatry

Perceived control, depressive symptomatology, and professional burnout: A review of the evidence

Psychology and Health

Borderline personality disorder

The therapeutic milieu: Changing themes and theories

Hospital and Community Psychiatry

After-effects of job-related stress: Families as victims

Journal of Occupational Stress

Relationship of burnout among professional psychologists to professional expectations and social support

Psychological Reports

Special Series: Accentuating The Role Of Therapist Emotion In Behavior Therapy Training
Therapeutic burnout among borderline personality disordered clients and their therapists: Development and evaluation of two adaptations of the maslach burnout inventory*