Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
DSpace
UBCV
Digeso, Jacqueline Annette
Master of Arts - MA
University of British Columbia
This thesis explores work and family-life stresses among a sample of family therapists. Previous research had not studied burnout among family therapists nor the effects of both spheres, work and family, on a therapist's work performance. This study addresses these two shortcomings by exclusively researching family therapists and their work and family lives. A cross-sectional survey design was used to explore the relationship between independent variables — the therapist's family life events and changes, family/work concerns, family functioning, and coping strategies - and the dependent variables of burnout and therapeutic functioning. One hundred and forty-two family therapists completed a survey consisting of a Maslach Burnout Inventory; a Family/Work Concerns checklist; a Family Inventory of Life Events and Changes; a Family Relationship Index, along with a Family Functioning Grid; a Stress- Management checklist; and questions on therapeutic functioning, including. Work Activities list and a Therapeutic Functioning Grid. Three preliminary hypotheses were examined, using t-test comparisons for gender differences with respect to burnout and therapeutic functioning. Significant gender differences were found between males and females for emotional exhaustion and depersonalization. Overall, family therapists were experiencing low to moderate levels of burnout, and compared to the normative sample, were experiencing significantly less depersonalization and reduced personal accomplishment. Seven primary hypotheses were examined using t-test comparisons or one-way analyses of variance. Stressful life events and changes were significantly related to burnout, while moderately correlated with therapeutic functioning. As well, significant correlations were observed for stressful life events and therapeutic functioning. Analyses found that family therapists' dissatisfaction in their ability to handle work and family stresses significantly relates to burnout, measured by emotional exhaustion and depersonalization, and is negatively associated with therapeutic functioning, measured by the Therapeutic Functioning Grid, and the Work Activities list. No s ignificant correlations were found for therapist's satisfaction in handling work and family stress and burnout, or for in-session functioning, except for reduction in work activities. This latter finding contradicts expected results. Increased levels of family functioning were found to be negatively associated with burnout. Specifically, modest correlations were reported for reduced personal accomplishment, while a trend was noted for emotional exhaustion and depersonalization. No significant relationships were observed between increased levels of family functioning and positive in-session therapeutic functioning, except for a slight but positive correlation with in-session therapeutic stability. Finally, a significant difference was reported for family therapists who engage in many stress-managing behaviours versus therapists who engage in few stress-managing behaviours on emotional exhaustion and depersonalization. No significant differences were found for level of engaging in stress-managing behaviours and the three aspects of therapeutic functioning. The findings form a foundation for understanding the relationship between work and family-life stresses and the professional effectiveness of family therapists. Implications for counselling and future research are discussed.
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IMPACT OF WORK AND FAMILY ON THE FAMILY THERAPIST' PROFESSIONAL EFFECTIVENESS by JACQUELINE ANNETTE DIGESO B.A., The Uni v e r s i t y of B r i t i s h Columbia, 1985 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August 1995 © Jacqueline Annette DiGeso, 1995 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of CflldSfclUrJ^ ftVCttolOkl) The University of British Columbia Vancouver, Canada Date StPT.%, m$ ABSTRACT This thesis explores work and f a m i l y - l i f e stresses among a sample of family t h e r a p i s t s . Previous research had not studied burnout among family therapists nor the e f f e c t s of both spheres, work and family, on a therapist's work performance. This study addresses these two shortcomings by e x c l u s i v e l y researching family therapists and t h e i r work and family l i v e s . A c r o s s - s e c t i o n a l survey design was used to explore the r e l a t i o n s h i p between independent variables — the therapist's family l i f e events and changes, family/work concerns, family functioning, and coping strategies -and the dependent variables of burnout and therapeutic functioning. One hundred and forty-two family therapists completed a survey consisting of a Maslach Burnout Inventory; a Family/Work Concerns c h e c k l i s t ; a Family Inventory of L i f e Events and Changes; a Family Relationship Index, along with a Family Functioning Grid; a Stress-Management c h e c k l i s t ; and questions on therapeutic functioning, including . Work A c t i v i t i e s l i s t and a Therapeutic Functioning Grid. Three preliminary hypotheses were examined, using t - t e s t comparisons for gender differences with respect to burnout and therapeutic functioning S i g n i f i c a n t gender differences were found between males and females for emotional exhaustion and depersonalization. Overall, family therapists were experiencing low to moderate l e v e l s of burnout, and compared to the normative sample, were experiencing s i g n i f i c a n t l y less depersonalization and reduced personal accomplishment. Seven primary hypotheses were examined using t - t e s t comparisons or one-way analyses of variance. S t r e s s f u l l i f e events and changes were s i g n i f i c a n t l y r e l a t e d to burnout, while moderately correlated with therapeutic functioning. As well, s i g n i f i c a n t c o rrelations were observed for s t r e s s f u l l i f e events and therapeutic functioning. Analyses found that family therapists' d i s s a t i s f a c t i o n i n t h e i r a b i l i t y to handle work and family stresses s i g n i f i c a n t l y relates to burnout, measured by emotional exhaustion and depersonalization, and i s negatively associated with therapeutic functioning, measured by the Therapeutic Functioning Grid, and the Work A c t i v i t i e s l i s t . No s i g n i f i c a n t c o r r e l a t i o n s were found for therapist's s a t i s f a c t i o n i n handling work and family stress and burnout, or for in-session functioning, except for reduction i n work a c t i v i t i e s . This l a t t e r f i n d i n g contradicts expected r e s u l t s . Increased l e v e l s of family functioning were found to be negatively associated with burnout. S p e c i f i c a l l y , modest cor r e l a t i o n s were reported for reduced personal accomplishment, while a trend was noted for emotional exhaustion and depersonalization. No s i g n i f i c a n t r e l a t i o n s h i p s were observed between increased l e v e l s of family functioning and p o s i t i v e i n -session therapeutic functioning, except f o r a s l i g h t but p o s i t i v e c o r r e l a t i o n with in-session therapeutic s t a b i l i t y . F i n a l l y , a s i g n i f i c a n t difference was reported for family therapists who engage i n many stress-managing behaviours versus therapists who engage i n few stress-managing behaviours on emotional exhaustion and depersonalization. No s i g n i f i c a n t differences were found f o r l e v e l of engaging i n stress-managing behaviours and the three aspects of therapeutic functioning. The findings form a foundation for understanding the r e l a t i o n s h i p between work and f a m i l y - l i f e stresses and the professional effectiveness of family t h e r a p i s t s . Implications for counselling and future research are discussed. i v TABLE OF CONTENTS ABSTRACT i i TABLE OF CONTENTS i v LIST OF TABLES v i LIST OF FIGURES v i i ACKNOWLEDGMENTS v i i i CHAPTER I INTRODUCTION 1 Background to The Problem 3 Statement of The Problem 6 D e f i n i t i o n of Terms ...7 Purpose of the Study 10 CHAPTER II LITERATURE REVIEW 11 Background on Burnout Theory... 11 Dynamics of Burnout 13 Burnout Syndrome 15 Stress and Burnout Among Psychotherapists 17 Work 17 Family 22 Work and Family Stress and Therapeutic Functioning 25 Factors Predi c t i n g Burnout and Therapeutic Functioning 28 S t r e s s f u l L i f e Events 29 S t r e s s f u l L i f e Events within the Context of Family Theory....30 Variables of Work and Family 32 Work 32 Family 35 Work and Family Stresses and the Family Therapist 38 Factors Mediating Burnout and Therapeutic Functioning 40 Coping within the Family Context 41 Family Functioning 42 Unanswered Questions 44 CHAPTER III METHODOLOGY , ...46 Research Design and Variables 46 Research Hypotheses ; 46 Preliminary Hypotheses 47 Primary Hypotheses 47 Parti c i p a n t s 48 Data C o l l e c t i o n Procedures 54 Instruments 58 Standardized Measures 59 Non-standardized Measures 66 Demographic Data 74 Summary of the Instruments 74 S t a t i s t i c a l Analyses 75 Methodological Assumptions 76 V CHAPTER IV R ESULTS 77 Preliminary Hypotheses 77 Hypothesis 1 and l a 77 Hypothesis 2 80 Demographic Variables 81 Primary Hypotheses 89 Hypothesis 3 89 Hypothesis 4 and 4a 91 Hypothesis 5 94 Hypothesis 6 and 6a 96 Hypothesis 7 99 Hypothesis 8 100 Hypothesis 9 101 Hypothesis 10 105 Post-hoc Analyses 107 CHAPTER V DISCUSSION, LIMITATIONS, FUTURE RESEARCH 109 Discussion of the Findings 109 Preliminary Hypotheses 109 Demographic Variables 112 Hypotheses 3 and 5 116 Hypotheses 4, 4a, 6, and 6a 118 Hypotheses 7 and 8 122 Hypotheses 9 and 10 124 Limitations 126 P o s s i b i l i t i e s f o r Future Research 130 Implications f or Counselling 133 Conclusion 137 REFERENCES 138 APPENDICES 147 Appendix A: Preliminary or Screening Questions 147 Appendix B: Work Attitude Inventory 148 Appendix C: Family/Work Concerns 149 Appendix D: Family Changes Inventory 151 Appendix E: Family Environment Inventory 154 Appendix F: Family Functioning Grid 155 Appendix G: Stress-Management Checklist 156 Appendix H: Work A c t i v i t i e s 157 Appendix I: Therapeutic Functioning Grid 158 Appendix J : Demographic Information 159 Appendix K: Endorsement Letter 162 Appendix L: Covering Letter 163 Appendix M: Follow-Up Letters 164 Appendix N: Sample of Lottery Ticket 166 Appendix O: Co r r e l a t i o n between Demographic and Dependent Variables 167 Appendix P: Summary S t a t i s t i c s f o r Independent and Dependent Variables 168 v i LIST OF TABLES Table 1: Response Rate and Demographic C h a r a c t e r i s t i c s of Sample (N = 142) 51 Table 2: t - t e s t s for Non-Practising and Pr a c t i s i n g Family Therapists.... 57 Table 3: t - t e s t s for Males and Females on Maslach Burnout Inventory 79 Table 4: t - t e s t s for Present and Normative Sample on Burnout 80 Table 5: t - t e s t s for Males and Females on Therapeutic Functioning 81 Table 6: Correlations between Demographic Variables and Burnout 82 Table 7: ANOVA and t- t e s t s for Demographic and Dependent Variables 87 Table 8: Correlations between Family L i f e Events and Burnout 91 Table 9: t - t e s t s for Present and Normative Sample on Family L i f e - C y c l e Stages 91 Table 10: Correlations between Family/Work Concerns and Burnout 94 Table 11: Correlations between Family L i f e Events and Therapeutic Functioning 96 Table 12: Correlations between Family/Work Concerns and Therapeutic Functioning 99 Table 13: Correlations between Family Functioning and Burnout 100 Table 14: Correlations between Family Functioning and Therapeutic Functioning 101 Table 15: ANOVA and t-t e s t s for Stress-Management Strategies and Burnout 104 Table 16: ANOVA & t- t e s t s for Stress-Management Strategies & Therapeutic Functioning 106 Table 17: t - t e s t for Post-hoc Analyses 108 LIST OF FIGURES Figure 1: Family Functioning Grid V l l l ACKNOWLEDGMENTS I would l i k e to express my deepest appreciation to Dr. Beth Haverkamp, my advisor, for her tremendous patience, constant encouragement, and invaluable guidance throughout the evolution of t h i s t h e s i s . A very s p e c i a l thanks goes to Drs. John Batmen and Jacquelyn Baker-Sennett, my other committee members, whose keen i n t e r e s t , wealth of ideas, and support have helped me reach my goal. For my husband, Klaus Stresing, who helped i n every way he could and who kept me on track, I have a deep gratitude. To my family, for t h e i r values of hard work and persistence, I wish also to express my gratitude. I would l i k e to thank my colleagues. Dr. Bea MacKay, G l o r i a McArter, and Pat Dubberley, for eagerly p i l o t i n g my questionnaire and o f f e r i n g many i n s i g h t f u l comments and suggestions. A s p e c i a l thanks goes to my proofreader, Neall Calvert, for his attention to d e t a i l and to Jonathan Berkowitz for his s t a t i s t i c a l advice. I would l i k e to thank a number of my friends but e s p e c i a l l y my close friends, Odette Goncalves and S h i r l Kinsman, for t h e i r emotional support and sense of humour during the d i f f i c u l t times. F i n a l l y , I would l i k e to extend my appreciation to those family therapists who w i l l i n g l y p a r t i c i p a t e d and i n so doing made t h i s thesis possible. IN MEMORY OF NOEMI (EMMA) CANZIAN 1 CHAPTER I INTRODUCTION The mental health of psychotherapists i s instrumental to t h e i r work. This idea has long been asserted by many p r a c t i t i o n e r s from a wide range of t h e o r e t i c a l orientations, who regard a therapist's mental and emotional well-being as the cornerstone of his or her work (Freud, 1937/1964; Rogers, 1957; Sandler, Holder, & Dare, 1970; W h i t f i e l d , 1980). As James Guy (1987) explains, " i t i s the emotional s t a b i l i t y and maturity of the therapist that provides an e s s e n t i a l foundation for the r e l a t i o n s h i p and point of reference for the treatment" (p. 197). The b e l i e f i s that clear perceptions and uncontaminated reactions are associated with good mental health and that they form the therapist's t o o l s . However, when the therapist does experience.an excessive emotional reaction and/or reactions that are clouded due to personal c o n f l i c t or stress, (s)he i s then expected both to be aware of these occurrences and to deal with them apart from the time with c l i e n t s . In fact, many theor i s t s agree that the therapist's emotional and mental i l l health, regardless of degree of severity, w i l l have some negative impact on the c l i e n t , making therapy le s s e f f e c t i v e (Bergin, 1966; Bergin & Jasper, 1969; Knutsen, 1977; P a r l o f f , Waskow, & Wolfe, 1978) . Do therapists maintain p o s i t i v e mental health? The research l i t e r a t u r e suggests that the interpersonal functioning of the psychotherapist i s s i g n i f i c a n t l y impacted by the p r a c t i c e of psychotherapy (Guy & Liaboe, 1986). The consequences appear to be both p o s i t i v e and negative. On the p o s i t i v e side, the p r a c t i c e of psychotherapy i s both i n t e l l e c t u a l l y and emotionally stimulating, r e s u l t i n g i n the therapist's subjective experience of growth and development, increased l e v e l s of 2 assertiveness, self-assurance, s e l f - r e l i a n c e , s e l f - r e f l e c t i o n , and s e n s i t i v i t y (Burton, 1975; Farber, 1983) . A growing body of research suggests that many therapists experience negative consequences as well. There i s accumulating evidence of harmful e f f e c t s upon the psychotherapist's family l i f e . In the area of family r e l a t i o n s , therapists report becoming "distant, aloof, and withdrawn" from family members (Cray & Cray, 1977) as a r e s u l t of conducting psychotherapy. Others report decreased emotional investment i n t h e i r own family and an i n a b i l i t y to be "genuine, spontaneous, and comfortable with f r i e n d s " (Farber, 1983) . The negative consequences of a psychotherapy career are also evident i n the prevalence of alcoholism (Knutsen, 1977; Thoreson, Nathan, Skorina, & Kilburg, 1983), psychosomatic and mental disorders (Will, 1979), sexual misconduct (Hare-Mustin & H a l l , 1981; Saunders & Keith-Spiegel, 1980), and in the higher-than-average rates of suicide (Guy & Liaboe, 1985). Such findings have l e d to speculation that psychotherapists are negatively impacted by factors inherent i n the p r a c t i c e of psychotherapy, factors that may include physical and psychic i s o l a t i o n (Will, 1979), repeated feelings of loss as a r e s u l t of planned and unplanned termination (Greben, 1975), and increased interpersonal distance from family and friends due to the development of a "therapeutic" or " i n t e r p r e t i v e " stance (Farber, 1983) . However, i t may also be that the pr a c t i c e of psychotherapy a c t u a l l y exacerbates emotional and interpersonal problems already present i n the l i f e of the therapist (Henry, Sims, & Spray, 1973). Anecdotal accounts written by therapists reveal how t h e i r f a m i l i e s , marriages, i l l n e s s e s , and friends' deaths have aff e c t e d t h e i r professional work (Barnes & Berke, 1971; Chernin, 1976; Cray & Cray 1977, Lewis, 1982). In short, these therapists unanimously concede that t h e i r behaviour at work i s somehow alt e r e d during times of personal d i s t r e s s . 3 Theoreticians, c l i n i c i a n s , and researchers a l i k e agree that therapists are under a great deal of stress (Faber, 1983; Freudenberger & Robbins, 1979; Guy, 1987; Guy & Liaboe, 1986; Guy, Poelstra & Stark, 1989) . The very nature of the work places therapists i n a p o s i t i o n where they are confronted d a i l y by intense emotions and problematic c o n f l i c t s of others i n c l u d i n g s u i c i d e threats, aggression, h o s t i l i t y , and even c r i m i n a l i t y . The term "burnout" has been coined to refer to the occupational-stress syndrome that occurs among those caregivers who work i n the helping professions (Cherniss, 1982; Freudenberger, 1974, 1990; Freudenberger & Richelson, 1980; Maslach, 1976, 1978). Indeed, one would expect job stress and burnout to be p a r t i c u l a r l y pronounced among psychotherapists, whose d a i l y work consists of dealing with others' problems as well as with t h e i r own. Although the occupational-stress l i t e r a t u r e i s vast, there are only a few studies of stress among psychotherapists (Cherniss, 1982; Deutsch, 1984; Faber & Heifetz, 1982; Raquepaw & M i l l e r , 1989; Udovch, 1983). The focus has tended to be on symptoms and on-the-job or organizational causes of burnout among a number of helping professionals (see Schaufeli, Maslach, & Marek, 1993 for review). However, empirical contributions to the understanding of interpersonal sources of stress and burnout among psychotherapists i s l i m i t e d . Regrettably, researchers have not investigated the extent to which therapists' experience of personal d i s t r e s s i n work and, e s p e c i a l l y i n family l i f e , impacts on t h e i r p r o f e s s i o n a l effectiveness. Background to The Problem Burnout has severe psychological, s o c i a l , and p h y s i c a l consequences for the helping professional and the r e c i p i e n t of his or her care. Maslach (1976) found that "burned out" professionals "lose a l l concern, a l l emotional fee l i n g s for the persons they work with and come to t r e a t them i n 4 detached or even de-humanized ways" (p. 16). The psychological consequences of burnout can include depression, negative self-concept, and cynicism; the s o c i a l consequences can be withdrawal from others, loss of concern and caring for others, and a negative a t t i t u d e towards others. The ph y s i c a l consequences are many, including ulcers, hypertension, backaches, and chest pains (Golembiewski, Munzenrider, & Stevenson, 1986; Maslach, 1976; Selye, 1993). The implications of burnout are serious: absenteeism, loss of pro d u c t i v i t y , decreased c l i e n t care, and poor family l i f e . Unfortunately, those most a f f e c t e d are the people who are the most committed and who are the highest achievers (Freudenberger & Richelson, 1980; Pines & Aronson, 1988). These are the very therapists the profession can l e a s t a f f o r d to lose. The few studies performed among psychotherapists have indicated the presence of burnout (Cherniss, 1982; Deutsch, 1984; Faber & Heifetz, 1982; Raquepaw & M i l l e r , 1989; Udovch, 1983). Most of the aforementioned research has been c o r r e l a t i o n a l i n nature, where work-related stressors have been correlated with degree of burnout at one point i n time. Such studies, although presuming a causal l i n k , have not permitted a te s t of causal hypotheses. Heterogeneous populations of therapists have been sampled i n various work settings. These populations have been predominantly p s y c h i a t r i s t s (Bermak, 1977; Freudenberger & Robbins, 1979; Kline, 1972; McCarley, 1975), although more recent studies include psychologists, s o c i a l workers, and p o l i c e o f f i c e r s (Maslach, 1993). To date, no study has focused e x c l u s i v e l y on a population of family th e r a p i s t s . F i n a l l y , the previous studies have focused on within-session sources of str e s s ; few explore stresses inherent i n the therapist's family l i f e . Thus, many questions s t i l l remain regarding the process of psychotherapist burnout, i n p a r t i c u l a r , the experience of stress i n the 5 work and family l i f e of the family therapist and i t s impact on professional effectiveness. The family-therapy movement emerged as a f i e l d of therapy i n the 1950s. Its approach to therapy i s systemic; that i s , one i n which not only the c l i e n t ' s system but the therapist's, as well, are taken into account. The therapist's system consists of interpersonal connections that influence his or her conduct of therapy. This system can include peers, other professionals, and even agency p o l i c i e s . More importantly, the therapist's system also possesses elements of his or her personal l i f e (e.g., r e l a t i o n s h i p s with s i g n i f i c a n t others l i k e spouses, children, and even extended family members). These relationships contribute to the therapist's r o l e and conduct i n family therapy. According to Charny (1982), the pr a c t i c e of family therapy, i n contrast to i n d i v i d u a l therapy, i s one i n which the therapist experiences him- or h e r s e l f as far more human, "more of a kindred s o u l " (p. 42). The physic a l structure of family therapy i n v i t e s the therapist out from "behind the desk to s i t among other fellow human beings" (p. 42). The very content of family therapy — the universal problems of re l a t i o n s h i p s and intimacy -- draws family therapists into " s e l f - d i s c l o s u r e of some of t h e i r own d a i l y experiences and struggles" (p. 42). Pinsof (1986) concurs by s t a t i n g that family therapists tend to be "more s e l f - r e v e a l i n g , active, and d i r e c t i v e than i n d i v i d u a l t h e r a p i s t s " (p. 201); consequently, the influence of family therapists' personal l i v e s i s more v i s i b l e i n t h e i r therapy. In fact, some schools of family therapy assert that one of the goals of becoming a well-trained, responsible family therapist involves an e f f o r t i n "knowing oneself i n the context of one's family" (Titelman, 1987; p. 4). What i s known about the family l i v e s of family therapists? There i s a growing concern among p r a c t i t i o n e r s concerning the p o t e n t i a l "emotional hazards" that may e x i s t i n the f i e l d of family therapy; however, very l i t t l e i s written on the matter (Wetchler & Piercy, 1986). According to 6 Kaslow (1984), there seems to e x i s t a "taboo" against family professionals admitting to problems i n t h e i r own marriages and f a m i l i e s . Whatever the reason, the issue remains p a r t i c u l a r l y important, considering the evidence that psychotherapists' emotional problems can " s p i l l over" i n t o t h e i r therapy and can have a negative impact on c l i e n t s (Bergin, 1966; Bergin & Jasper, 1969; Knutsen, 1977; P a r l o f f , Waskow, & Wolfe, 1978). Most have taken the p o s i t i o n that the "therapist's psychological health ... i s the most c r u c i a l a t t r i b u t e i n the therapist .... he must be at ease with himself, able to enjoy himself, r e l a t i v e l y s a t i s f i e d with his l i f e , his marriage, his s e x u a l i t y and his family" (Gurman, 1987, p. 115). Beutler, Crago, and Arizmendi (1986) concur that healthy therapists bring about greater c l i e n t change than do unhealthy therapists. Thus, there i s a need for family therapists to be studied, so that they can become aware of and understand the impact that t h e i r family and work stresses may have on the p r a c t i c e of family therapy. Statement of The Problem The p r o f e s s i o n a l duties of psychotherapists may i n v i t e burnout due to high l e v e l s of stress inherent i n t h e i r work, which involves confronting people's problems on a d a i l y basis (Maslach, 1978) . Research has also shown that the longer one practices i n the mental-health f i e l d (Pines & Maslach, 1978) and the more "excessive" one's caseload (Hellman, Morrison, & Abramowitz, 1987), the more l i k e l y burnout w i l l occur. Burnout has also been p r e d i c t i v e of psychotherapists' reported intentions to leave the profession of psychotherapy for other professions (Raquepaw & M i l l e r , 1989). Raquepaw and M i l l e r found that those psychotherapists who l e f t the profession, i n general, tended to be the most committed and the most e f f e c t i v e i n working with t h e i r c l i e n t s . C l e a r l y , there i s a need to study the stresses that lead to burnout and r e s u l t i n therapists leaving the profession for other kinds of employment. 7 Stresses within the therapy session have been explored and i d e n t i f i e d . However, as of yet no study has been performed that focuses s o l e l y on the family therapist, his or her work and family l i f e stresses, and t h e i r impact on burnout. There i s a need to em p i r i c a l l y demonstrate the r e l a t i o n s h i p between work and family l i f e stresses and burnout for a population of family t h e r a p i s t s . Furthermore, there i s a. need to demonstrate an empirical r e l a t i o n s h i p between the family therapist's work and family l i f e stresses, and therapeutic functioning. We must also i d e n t i f y factors that may buffer the process of burnout or therapeutic functioning i n family therapists, factors such as family functioning and/or coping s t r a t e g i e s . F i n a l l y , the issue of gender differences i n burnout requires further study. Several researchers (Etzion & Pines, 1986; Pines, Aronson & Kafry, 1981) assert that women are at greater r i s k for burnout than men and one study says that "across every profession, women tend to be more burned out than men" ( I z r a e l i , 1988 p. 330). However, the empirical data i s l i m i t e d and inconsistent. The studies have often confounded gender with type of occupation and/or with the l e v e l of education (Maslach & Jackson, 1985) . Thus, by studying gender differences within the same, sin g l e occupation and l e v e l of .therapy t r a i n i n g , many of these gender confounds can be avoided. D e f i n i t i o n of Terms The following d e f i n i t i o n s are offered of terms frequently used i n th i s study. Burnout: The author accepts the d e f i n i t i o n given by C h r i s t i n a Maslach (1982a), that burnout i s "a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among in d i v i d u a l s who do 'people work' of some kind" (p. 3) which "can lead to a de t e r i o r a t i o n i n the q u a l i t y of care or service provided" (Maslach & Schaufeli, 1993 p. 14). The main c h a r a c t e r i s t i c s are: (a) emotional 8 exhaustion; (b) depersonalization that e n t a i l s negative, c y n i c a l attitudes and feelings about one's c l i e n t s ; and (c) lack of feelings of personal accomplishment r e s u l t i n g from negative s e l f - e v a l u a t i o n . While d e f i n i t i o n s may vary s l i g h t l y , , they a l l describe the end r e s u l t of a process i n which highly motivated and committed i n d i v i d u a l s lose t h e i r s p i r i t . Emotional exhaustion: The f i r s t aspect of the burnout syndrome comprises the- feelings of being emotionally overextended and exhausted by one's work (Maslach & Jackson, 1981, 1986). As emotional resources are depleted, workers f e e l they can no longer give of themselves. Depersonalization: An unfeeling and impersonal response towards r e c i p i e n t s of one's care, service, treatment or i n s t r u c t i o n forms the second aspect of the burnout syndrome (Maslach & Jackson, 1981, 1986). This aspect of burnout involves negative, cy n i c a l attitudes and feelings about one's c l i e n t s . Personal accomplishment: Feelings of reduced competence and achievement i n one's work with people forms the t h i r d aspect of the burnout syndrome. This includes unhappy feelings about oneself, negative s e l f -evaluation, and d i s s a t i s f a c t i o n with regard to accomplishments with c l i e n t s and work (Maslach & Jackson, 1981, 1986). Stress: Psychological stress i s defined as "a r e l a t i o n s h i p between the person and the environment that i s appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being" (Lazarus & Folkman, 1984, p. 19). There can also be a p h y s i o l o g i c a l component that i s experienced as a "nonspecific response of the body to any demand made upon i t " (Selye, 1974, p. 14). Stressor: A stressor i s a l i f e event (e.g., death, marriage, parenthood) impacting upon the family unit which produces, or has the p o t e n t i a l to produce, changes i n the family s o c i a l system. These change may a f f e c t the family's "boundaries, goals, patterns of i n t e r a c t i o n , or values" (McCubbin & Patterson, 1983). 9 F a m i l y - l i f e events and changes: This i s defined as the accumulation or "pile-up" of demands associated with normative and nonnormative s t r e s s f u l events and changes (McCubbin and Patterson, 1991). The concept of " p i l e -up" provides an explanation for why some families may be more vulnerable to a s i n g l e stressor or lack regenerative power to recover from a c r i s i s . That i s , i f a family's resource's to cope with stressors are already overtaxed i n dealing with other l i f e changes (both normative and s i t u a t i o n a l ) , family members confronted with a d d i t i o n a l s o c i a l stressors may be unable to make further adjustments. Thus, f a m i l y - l i f e changes are additive and at some point the l i m i t i s reached of a family's a b i l i t y to adjust and i t i s at t h i s point one would an t i c i p a t e some negative consequences i n the family system (McCubbin & Patterson, 1991) . Family functioning: Three dimensions of family behaviour capture the concept of family functioning: (a) cohesion, (b) expressiveness, and (c) contention or c o n f l i c t . These fundamental dimensions have been selected because they generalize across d i f f e r i n g t h e o r e t i c a l models of family therapy. According to Burr and K l e i n (1994, p. 96): (a) cohesion or togetherness represents the family's a b i l i t y to " p u l l together, to be connected, l o y a l , caring, and united"; (b) communication or expressiveness within the family i s the "willingness to talk, share ideas and seek others' ideas, a c t i v e l y l i s t e n , tap into others' true emotions, and empathize"; and contention or c o n f l i c t i s the amount of disruption a family experiences due to " f i g h t i n g , y e l l i n g , animosity and resentment." Therapeutic functioning: According to Tomm and Wright (1979), therapeutic functioning, for family therapists, consists of four major " i n - s e s s i o n " functions: engagement, problem i d e n t i f i c a t i o n , change f a c i l i t a t i o n , and termination. S p e c i f i c a l l y , engagement involves " e s t a b l i s h i n g and maintaining a meaningful working r e l a t i o n s h i p " with the c l i e n t family; problem i d e n t i f i c a t i o n i s the process of "ongoing assessment"; change f a c i l i t a t i o n i s the " a l t e r a t i o n of interpersonal patterns of i n t e r a c t i o n 10 and i n d i v i d u a l family members' behaviour, thinking, and experience"; and termination involves " r e l i n q u i s h i n g the r e l a t i o n s h i p with the c l i e n t family i n a manner that encourages them to maintain constructive changes and allows family members to solve t h e i r own problems" (Tomm & Wright, 1979 p. 228). This d e f i n i t i o n for therapeutic functioning has been selected on the basis of Tomm and Wright's (1979) research i n working towards a "broad-based" model of family therapy. Purpose of the Study The primary purpose of t h i s study was to e m p i r i c a l l y demonstrate that personal d i s t r e s s , consisting of family and work concerns and s t r e s s f u l family l i f e events or changes, has an impact on the s e l f - r e p o r t e d p r o f e s s i o n a l effectiveness of family therapists, as r e f l e c t e d i n t h e i r l e v e l s of burnout and therapeutic functioning. I t was a n t i c i p a t e d that t h i s would be accomplished by i n v e s t i g a t i n g the following three basic research questions: 1. Did exposure to high l e v e l s of stress i n the work and family l i f e of family therapists r e l a t e to burnout? 2. Did high l e v e l s of stress i n the work and family l i f e of family therapists r e l a t e to reduced therapeutic functioning? 3. Was burnout mitigated and was therapeutic functioning enhanced by high l e v e l s of family functioning?. The findings of t h i s study demonstrate the presence of work and family stress i n the l i v e s of family therapists. Through t h i s study we gain a better understanding of the degree to which these stresses are associated with burnout and/or impact on therapeutic functioning. I t follows that appropriate intervention strategies could be developed and implemented to reduce the rate of stress and enhance therapeutic functioning. 11 CHAPTER II LITERATURE REVIEW This chapter contains a review of the l i t e r a t u r e r e l a t e d to burnout theory, the dynamics of burnout, and the e f f e c t s of stress and burnout on family t h e r a p i s t s . Normative and nonnormative l i f e events and changes and d a i l y family and work stress are explored as predictors of burnout and therapeutic functioning. F i n a l l y , family functioning and coping strategies are considered as mediating factors i n burnout and therapeutic functioning. Background on Burnout Theory The concept of burnout f i r s t emerged as a s o c i a l problem and not an academic concern. Rather than being grounded i n s c h o l a r l y constructs, the notion was shaped by pragmatics. A p s y c h i a t r i s t , Freudenberger (1974), i s credited with f i r s t using the term "burned out" i n the 1960s. He coined the term to describe a process he observed i n volunteers i n a health-care agency. Time a f t e r time, he witnessed them experience gradual emotional depletion and a loss of motivation and commitment. Generally, the process took one year and was accompanied by numerous mental and phy s i c a l symptoms. Freudenberger and Richelson (1980) l a t e r r e f i n e d the term to mean a "state of fatigue or f r u s t r a t i o n brought about by a devotion to a cause, way of l i f e , or r e l a t i o n s h i p that f a i l e d to produce the expected reward" (p. 13). At about the same time, Maslach, a s o c i a l psychology researcher, was studying the ways i n which people coped with emotional arousal on the job. She discovered that concepts l i k e "detached concern" and "dehumanization i n self-defense" were best understood by the interviewees as burnout. Maslach (1982) was the f i r s t to develop a d e f i n i t i o n of burnout that was appropriate to the helping professionals: "a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that occurred among i n d i v i d u a l s who d i d ^people-work'" (p. 32). 12 Although burnout has been defined i n numerous ways, the general consensus i n the l i t e r a t u r e i s that burnout i s re l a t e d to prolonged job stress (Maslach, 1982) and i t i s a process that occurs when workers perceive a discrepancy between the rewards they expect to receive for t h e i r work e f f o r t s and the rewards they a c t u a l l y receive (Farber, 1983; Raquepaw & M i l l e r , 1989) . Perlman and Hartman (1982) reviewed 48 a r t i c l e s published between 1974 and 1981, a l l o f f e r i n g ideas about what causes burnout and proposals about what should be done about i t . Only f i v e provided any empirical data beyond the anecdotal notes and personal case h i s t o r i e s . Furthermore, there was no conceptual framework for i n t e g r a t i n g and evaluating the various findings and proposed recommendations. In the 1980s, the research on burnout entered a more empirical phase. There continued to be an outpouring of books and a r t i c l e s about burnout but i n addition to the ideas and interventions, survey and questionnaire data appeared. There was the development of standardized measures of burnout, i n p a r t i c u l a r , the Maslach Burnout Inventory (Maslach & Jackson, 1986). A general review of the recent l i t e r a t u r e on burnout indicates several trends. F i r s t , much of the research continues to be done within people-oriented occupations, although the v a r i e t y of these occupations has expanded (e.g., p o l i c e o f f i c e r s and prison guards). Second, the concept has been extended to the non-occupational spheres of l i f e . For example, there i s some discussion of burnout within the family, as evidenced i n "marriage burnout" (Pines & Aronson, 1988). The l a t e s t empirical research tends to focus on job factors s p e c i f i c to t h e r a p i s t s : job s a t i s f a c t i o n , job stress, job withdrawal, caseload, r e l a t i o n s with co-workers and supervisors, and agency p o l i c y . Some personal factors are studied, including demographics: age, sex, and marital status. In addition, some attention i s now being d i r e c t e d towards variables such as personal health, personal values and commitment, and 13 r e l a t i o n s with family and friends (Maslach & Schaufeli, 1993, p. 7). In short, the burnout theory i s f i r m l y embedded i n the stress l i t e r a t u r e and i s conceptualized as a s p e c i f i c type of job stress. I t has the same harmful e f f e c t s as other stress responses. Dynamics of Burnout The l i t e r a t u r e reveals that not only has there been d i f f i c u l t y i n defining burnout, there has been d i f f i c u l t y i n conceptualizing the process. A number of d i f f e r e n t theories have been put f o r t h regarding the causes; the three currently accepted approaches to the study of burnout include: a focus on i n t e r n a l factors, l i k e personality, age, coping s k i l l s ; a focus on external or s i t u a t i o n a l factors; and more recently, a focus on the i n t e r a c t i o n of external and i n t e r n a l factors (Berkowitz, 1987). Early research into burnout looked for the causes of burnout within the person; that i s , intrapsychic dynamics that made a person vulnerable to burnout. Maslach (1982) coined the term "burnout-prone i n d i v i d u a l " to r e f e r to the i n d i v i d u a l with s p e c i f i c p e r sonality factors that make him or her vulnerable to burnout. According to Maslach the burnout-prone i n d i v i d u a l i s one who i s weak and unassertive i n dealing with people. This person i s submissive, anxious, and has d i f f i c u l t y i n s e t t i n g l i m i t s . As a r e s u l t , the i n d i v i d u a l i s e a s i l y overburdened and runs a high r i s k of emotional exhaustion. The burnout-prone i n d i v i d u a l lacks self-confidence, has l i t t l e ambition, and has neither a c l e a r l y defined set of goals nor the determination and self-assurance needed to achieve them (Maslach, 1982). Personal values may also be contributing factors; i t has been argued that a loss of commitment and moral purpose i n the work can lead to burnout (Cherniss & Krantz, 1983). Freudenberger posited a d i f f e r e n t p e rsonality p r o f i l e of burnout. The person most l i k e l y to burn out i s one who i s committed, i d e a l i s t i c and overachieving (Freudenberger & Richelson, 1980) . The two researchers 14 believe those who f a l l prey to burnout are, for the most part, those who have s t r i v e n hard to reach t h e i r goals. They are usually the leaders among us who s t a r t out with great expectations and refuse to compromise t h e i r goals along the way. However, contradictions develop within such i n d i v i d u a l s when a discrepancy exists between expected and achieved goals; t h i s can be part of the problem ultimately leading to burnout. Most discussions, however, emphasize contact with people and the factors that make contact emotionally s t r e s s f u l and a major source of burnout. With a focus on s i t u a t i o n a l factors, two general sources of stress have been i d e n t i f i e d : i n t e r n a l and external stress (Pines & Kafry, 1978). Internal stress includes properties i n t r i n s i c to work, such as challenge, i n t e r e s t , feedback'and a sense of success, while external sources of stress revolve around work r e l a t i o n s with colleagues, supervisors, and c l i e n t s . The research shows that external sources of stress c o r r e l a t e more strongly with burnout than i n t e r n a l c h a r a c t e r i s t i c s . In general, burnout i s conceived as a gradual process. In fact, the process may be "so gradual that the worker may not be aware of what i s happening and w i l l refuse to believe that anything i s wrong" (Daley, 1979 p. 443). Maslach and Jackson (1981) conceptualize burnout as a continuous variable, ranging from low to high degrees of experience. The most congruence i n the l i t e r a t u r e on the process of burnout exists i n the i d e n t i f i c a t i o n of physical symptoms. The p h y s i c a l signs include feelings of exhaustion and fatigue, frequent headaches and g a s t r o i n t e s t i n a l disturbances, sleeplessness, and shortness of breath. Behavioural signs of burnout include quickness to anger; i r r i t a t i o n and f r u s t r a t i o n ; suspicion and paranoia; r i g i d , i n f l e x i b l e thinking; and verbalized negative a t t i t u d e s . The p h y s i c a l exhaustion i s characterized by low energy, chronic fatigue, and a general weariness. The burned-out person reports greater proneness to accidents, greater s u s c e p t i b i l i t y to i l l n e s s , muscle tension, 15 back ache, ul c e r s , and changes i n weight, as well as chronic i l l n e s s e s . Emotional exhaustion involves feelings of depression, hopelessness, and i n extreme cases mental i l l n e s s and thoughts of suicide. F i n a l l y , mental exhaustion i s characterized by negative attitudes towards one's s e l f , work, and l i f e (Maslach, 1982). C o n f l i c t exists i n the l i t e r a t u r e as to whether burnout i s a r e s u l t of personality, the s i t u a t i o n , or an i n t e r a c t i o n of both p e r s o n a l i t y and the s i t u a t i o n . There i s however, general agreement among most researchers that burnout can occur at both the i n d i v i d u a l l e v e l (Daley, 1979; Farber, 1983; Freudenberger & Richelson, 1980; Maslach, 1982) and on an organizational l e v e l (Paine, 1982). There i s also agreement that burnout i s an i n t e r n a l psychological experience in v o l v i n g f e e l i n g s , attitudes, and expectations and that burnout i s a negative experience for the i n d i v i d u a l that involves d i s t r e s s , discomfort, and other negative consequences (Paine, 1982) . Burnout Syndrome Maslach's conceptualization of the burnout syndrome i s used as the primary t h e o r e t i c a l model i n t h i s study. Maslach (1982) posited a multifaceted, three-component model of the burnout syndrome in v o l v i n g emotional exhaustion, depersonalization, and reduced personal accomplishment. She stated that a person who becomes overly involved emotionally, gets overextended, and feels overwhelmed by emotional demands imposed by other people i s emotionally exhausted. The i n d i v i d u a l feels drained and used up, lacks enough energy to face the day, emotional resources are depleted, and there i s no source of replenishment. This component of the burnout syndrome comes close to the t r a d i t i o n a l d e f i n i t i o n of s t r e s s . The factors believed to re l a t e to emotional exhaustion are s i m i l a r to those found i n the general stress l i t e r a t u r e . 16 However, burnout i s more than simply an i n d i v i d u a l ' s stress experience or emotional exhaustion. It i s "an i n d i v i d u a l stress experience embedded i n a context of s o c i a l r e l a t i o n s , that involves the person's conception of both s e l f and others" (Maslach, 1993, p. 28). She (1982) stated that one way people attempt to r e l i e v e t h e i r emotional burden i s to cut back t h e i r involvement with others; they detach themselves p s y c h o l o g i c a l l y from meaningful involvements i n an attempt to put emotional distance between themselves and the people whose needs and demands seem overwhelming. The increasing detachment develops into an a t t i t u d e of cold i n d i f f e r e n c e to others' needs and a callous disregard for t h e i r f e e l i n g s . This detached, callous, and sometimes dehumanized response signals the second aspect of the burnout syndrome: depersonalization. Maslach (1982) described t h i s aspect of burnout as the i n d i v i d u a l developing a poor opinion of other people, expecting the worst from them, and even d i s l i k i n g them. This negative reaction to people manifests i t s e l f i n various ways. The caregiver may subtly put other people down, ignore t h e i r pleas and demands, or f a i l to provide help, care, or service. This component of the burnout syndrome captures the dimension of interpersonal r e l a t i o n s between caregiver and r e c i p i e n t of care. Feeling negatively about others can progress u n t i l i t encompasses being down on oneself. Burned-out caregivers often f e e l g u i l t about the manner i n which they have mistreated others. At t h i s point, the t h i r d aspect of burnout appears: a f e e l i n g of reduced personal accomplishment. Providers develop a gnawing sense of inadequacy about t h e i r a b i l i t y to r e l a t e with c l i e n t s that may r e s u l t i n feelings of f a i l u r e . This t h i r d component of the model represents the dimension of s e l f - e v a l u a t i o n . The feelings of inadequacy can lead to depression. This usually t r i g g e r s the onset of the burnout syndrome. The above approach, proposed by Maslach, postulates a sequential progression over time, i n which the occurrence of one component of burnout 17 p r e c i p i t a t e s the development of the next. However, there i s no firm evidence i n the l i t e r a t u r e for a sequential progression of the burnout syndrome. In fact, some components may develop i n p a r a l l e l because they are reactions to d i f f e r e n t factors i n the work environment (Maslach & Schaufeli, 1993). Regardless of the s p e c i f i c sequence involved, burnout i s accepted as having multiple dimensions. To sum up, burnout i s a type of job stress manifested i n emotional exhaustion, depersonalization, and reduced personal accomplishment. What i s unique about the concept of burnout i s that i t appears to be a response to sources of emotional and interpersonal stress on the job. In the three-component model of burnout, reduced personal accomplishment r e f l e c t s a dimension of s e l f - e v a l u a t i o n , and depersonalization captures a dimension of interpersonal r e l a t i o n s . Both of these components add meaning over and above the general notion of stress. Stress and Burnout Among Psychotherapists Work The e a r l i e s t l i t e r a t u r e on the issue of therapist stress consists p r i m a r i l y of c l i n i c a l accounts of the d i f f i c u l t i e s of therapeutic work. These discussions of profession-related stress l a r g e l y come from p s y c h i a t r i c p r a c t i t i o n e r s or observers of p s y c h i a t r i s t s (Kubie, 1971; Sc h l i c h t , 1968; Whitfield, 1980). These professionals believe that psychotherapy i s a hazardous profession and that the hazards, or "stress sources," stem from the professional role and s o c i e t a l expectations associated with psychotherapy as well as from the very nature of c l i e n t work. Furthermore, some writers describe many p a i n f u l symptoms among those who engage i n the p r a c t i c e of psychotherapy. For instance, "depression, l o n e l i n e s s , the i n a b i l i t y to r e l a t e to patients, family, friends; feelings of emptiness, cynicism, paranoia, callousness, loss of a u t h e n t i c i t y , of 18 v i t a l i t y ; and a tendency to carry over the psychoanalytic process into one's personal l i f e , to make analysis the whole of one's existence, r e s u l t i n g i n a loss of r e l a t i n g to mate, f r i e n d — even p a t i e n t " (Freudenberger & Robbins, 1979, p. 275). Only a handful of studies could be i d e n t i f i e d from t h i s e a r l i e r time frame which deal d i r e c t l y with therapist stress, two of which are descriptions of therapy groups composed of th e r a p i s t s . Kline (1972) reported h i s observations of a group of eight psychoanalysts who met once a week for two hours for a period of one year and f i v e months. These men a l l rel a t e d concerns of professional i s o l a t i o n , l o n e l i n e s s , and a general sense of d i s s a t i s f a c t i o n with t h e i r work and l i v e s . In McCarley's (1975) observations of several small groups of both p s y c h i a t r i c residents and f u l l - f l e d g e d p s y c h i a t r i s t s over a two-year span, she found a pronounced depressive theme i n the older members which was matched by s i m i l a r dynamics i n the younger residents. Furthermore, the experienced therapists f e l t an oppressive and overwhelming r e s p o n s i b i l i t y , p a r t i c u l a r l y i n m i d - l i f e , when working with p s y c h i a t r i c patients. They reported having a resistance to entering therapy because of feelings of embarrassment and humiliation at i d e n t i f y i n g oneself as a "patient" and the reluctance of assuming a dependent r o l e . Instead, they e i t h e r "camouflaged" t h e i r inner fe e l i n g s , or shared t h e i r private thoughts and feelings with t h e i r c l i e n t s . A p r a c t i c e not considered appropriate i n therapy. Research of a more experimental nature includes Bermak's (1977) study of the s p e c i f i c stresses experienced by therapists. His q u a l i t a t i v e survey of 75 San Francisco-area p s y c h i a t r i s t s found that s p e c i a l d i f f i c u l t i e s did e x i s t f o r the sample. The major stressors included problems of pr o f e s s i o n a l i s o l a t i o n , having to control one's emotions i n sessions with c l i e n t s , omnipotent wishes and subsequent f r u s t r a t i o n s , ambiguity of progress, emotional drain of being constantly empathic, and confusion and c o n f l i c t s of professional i d e n t i t y . 19 S i m i l a r l y , Farber and Heifetz (1982), a f t e r interviewing 95 psychotherapists, i n c l u d i n g p s y c h i a t r i s t s , psychologists, and s o c i a l workers regarding j o b - s a t i s f a c t i o n , reported that 73.7% c i t e d "lack of therapeutic success"(p. 297) as' t h e i r primary stressor, and 57.4% blamed "non-reciprocated attentiveness, giving, and r e s p o n s i b i l i t y demanded by the therapeutic r e l a t i o n s h i p " (p. 295) as major causes of burnout. Excessive workload, d i f f i c u l t y with patients, organizational p o l i t i c s , emotional depletion, r e s p o n s i b i l i t y for patients' l i v e s , constant attentiveness, c l i e n t s u i c i d a l ideation, expressions of aggression and h o s t i l i t y by the c l i e n t s , and premature termination were rated as moderate stre s s o r s . Of p a r t i c u l a r importance, some 63.6% of the therapists f e l t they were e s p e c i a l l y prone to "transient feelings of burnout when stresses at home lowered t h e i r threshold for coping with d a i l y therapeutic f r u s t r a t i o n and impaired t h e i r a b i l i t y to attend e f f e c t i v e l y to the needs of t h e i r p a t i e n t s " (p. 297). From t h i s e arly l i t e r a t u r e , the hazards of stress i n the p r a c t i c e of psychotherapy are evident. Furthermore, i t i s also apparent that family stresses may impact on burnout and on the therapist's a b i l i t y to perform work e f f e c t i v e l y . A number of v a l i d c r i t i c i s m s can be made regarding the r e l i a b i l i t y and v a l i d i t y of the above-mentioned studies. F i r s t , sample sizes are small to modest, ranging from eight to 95 p a r t i c i p a n t s . Second, the sole p a r t i c i p a n t s i n most studies are male p s y c h i a t r i s t s ; consideration i s given neither to female gender nor to therapeutic s p e c i a l t i e s , thus l i m i t i n g the g e n e r a l i z a b i l i t y of the research. Third, i n one study p a r t i c i p a n t s were personally known to the researcher (Bermack, 1977). Fourth, i n the participant-observer studies (Kline, 1972; McCarley, 1975; W h i t f i e l d , 1980), the mere presence of the observer could have s i g n i f i c a n t l y influenced the group's behaviour such that the external v a l i d i t y of these findings may be compromised. F i n a l l y , the survey study's 20 use of open-ended, vaguely worded stimulus items (Bermack, 1977; Farber & Heifetz, 1982) may have resulted i n reporter bias and misinterpretation. Deutsch (1984) attempted to overcome the early l i t e r a t u r e ' s shortcomings by launching an extensive survey of therapists' s e l f - r e p o r t e d sources of str e s s . A sample of 264 therapists from the U.S. Midwest working i n the f i e l d of psychology, s o c i a l work, counselling, education, pastoral counselling, and c h i l d development was selected for the study. Her findings proved amazingly s i m i l a r to Farber and Heifetz's (1982) research. Sixty-one percent of therapists considered c l i e n t ' s s u i c i d a l statements as the most s t r e s s f u l work-related occurrence. Other items of moderate or greater stress included c l i e n t expression of anger (58%), lack of observable progress (50%), severely depressed c l i e n t (52%), and apathy or lack of motivation i n c l i e n t (51%). Women therapists on the whole reported greater stress than d i d men on the same stress f a c t o r s . As well, seasoned therapists were less l i k e l y to report stress than younger ther a p i s t s . Despite the s e l f - r e p o r t nature of the study, and possible reporting biases, the findings expanded upon the previous speculations of occupational stress i n the pr a c t i c e of psychotherapy. From data c o l l e c t e d i n the her 1984 study, Deutsch (1985) expanded on the occupational concerns relevant to t h i s profession. The res u l t s i n d i c a t e that the vast majority of therapists, 82%, reported having experienced r e l a t i o n s h i p d i f f i c u l t i e s ; 57% reported the occurrence of depression. Men and women reported equal rates of personal-problem occurrence, although the women reported higher frequencies of undertaking therapy and medication programs. Again, the re s u l t s are subject to the c r i t i c i s m s of s e l f - r e p o r t studies: s e l e c t i v e responding; terms needing clearer d e f i n i t i o n s ; p a r t i c i p a n t s l e f t to define for themselves the degree of t h e i r disorders; the v e r a c i t y of the s e l f - r e p o r t experience and i t s r e l a t i o n s h i p to 21 observable behaviour being unknown; and the competing causal explanations of the c o r r e l a t i o n a l approach. More recently, three studies can be c i t e d as making a s i g n i f i c a n t contribution to the l i t e r a t u r e on burnout among psychotherapists. However, these studies continue to be c o r r e l a t i o n a l i n nature, thus they do not e s t a b l i s h c a u s a l i t y . F i r s t , Raquepaw and M i l l e r (1989) conducted a study of burnout i n psychotherapists, psychologists and s o c i a l workers from Texas working i n a v a r i e t y of sett i n g s . A random sample of 68 therapists was surveyed using the Maslach Burnout Inventory, (MBI'; Maslach & Jackson, 1981) . A d d i t i o n a l questions assessing the respondents' intent to leave the profession and perceived i d e a l caseload were also obtained. The authors found that symptoms of burnout were more evident i n therapists i n agency settings than i n p r i v a t e p r a c t i c e . Furthermore, si z e of caseload was not associated with burnout, while both s a t i s f a c t i o n with caseload and i n t e n t i o n to leave the profession were. Thus, i t appears that the therapist's perception of caseload and his or her future career intentions are more strongly associated with burnout. Second, a study by Snibbe, R a d c l i f f e , Weisberger, Richards, and K e l l y (198 9) examined burnout, using the MBI, among physicians and mental-health professionals i n an i n s t i t u t i o n a l s e t t i n g . The mental-health respondents consisted of 51 p s y c h i a t r i s t s , psychologists, and s o c i a l workers. Snibbe et a l . (1989) found that the p s y c h i a t r i s t s scored higher on a l l three areas of burnout ( i . e . , emotional exhaustion, depersonalization, and reduced personal achievement) than the physicians. P s y c h i a t r i s t s and s o c i a l workers had s i g n i f i c a n t l y higher scores on depersonalization than psychologists. Other i n t e r - p r o f e s s i o n a l differences could be found with the s o c i a l workers, who scored s i g n i f i c a n t l y higher on emotional exhaustion than e i t h e r p s y c h i a t r i s t s or psychologists. A l l professionals scored the same on reduced personal achievement. The authors state that the high 22 l e v e l s of burnout could be a t t r i b u t a b l e to the large number of c l i e n t s i n the i n s t i t u t i o n and the short-term treatment goals of the s e t t i n g being i n c o n f l i c t with the psychotherapists' t r a i n i n g , which emphasizes long-term treatment. The t h i r d study, a mail survey by Johnson and Stone (1986), explored d i f f e r e n t types of job stressors among a sample of 46 s o c i a l workers using the MBI, Work Environment Scale (WES), Jenkins A c t i v i t y Scale, and the Hassles Scales. Their c o r r e l a t i o n a l methodology indicates that the respondents were experiencing "moderate l e v e l s of job stress as measured by the MBI" (p. 73). The authors found-that burnout was r e l a t e d to the hassles of d a i l y l i v i n g ; these hassles accounted for 25% of the variance i n burnout, while the WES accounted for 3% of the variance i n burnout. With a higher proportion of the variance being accounted for by the hassles of d a i l y l i v i n g i t becomes important to focus on the d a i l y stresses or concerns and environments other than work as p r e d i c t i v e factors i n burnout. Limitations to the above study are that the concepts of burnout and job stress were used interchangeably. Family The l i t e r a t u r e suggests that psychotherapeutic p r a c t i c e has the p o t e n t i a l for e i t h e r a p o s i t i v e or negative impact not only on work l i f e but on family l i f e as well. Farber (1983) found that psychotherapists experience important personal growth as a r e s u l t of c l i n i c a l p r a c t i c e . For example, they suggest that doing psychotherapeutic work greatly enhances interpersonal r e l a t i o n s , "adding, depth, subtlety, nuance, and irony to the understanding and appreciation of others" (p. 174). Indeed, such behavioural changes should improve the therapist's a b i l i t y to r e l a t e to his or her spouse i n a meaningful way. In an autobiographical a r t i c l e by Cray and Cray (1977), the authors report that psychotherapeutic p r a c t i c e allows the therapist to 23 become more tolerant, accepting, understanding, and patient i n r e l a t i o n s h i p to his or her partner. (S)he i s better able to enter into a l o v i n g r e l a t i o n s h i p with spontaneity, v u l n e r a b i l i t y , and openness. In short, according to the Crays, the p r a c t i c e of psychotherapy makes one a better person and thereby a better spouse. Wetchler and Piercy's (1986) survey of 110 family therapists from the Indiana A s s o c i a t i o n for Marriage and Family Therapy found family-therapy work to be an "enhancer" i n t h e i r l i v e s , with 87% reporting that t h e i r work gave them a greater acceptance of t h e i r part i n family/marital problems. Ei g h t y - f i v e percent saw t h e i r work as helping them develop better communication s k i l l s within t h e i r f a m i l i e s , and 85% also believed that t h e i r work gave them an opportunity to appreciate t h e i r family strengths. Although t h i s research provides a picture of the p o s i t i v e impact of psychotherapeutic p r a c t i c e , the s e l f - r e p o r t nature of the study, the s e l f -selected nature of the sample, and the lack of c o n f i d e n t i a l i t y i n the research findings obtained a l l r e s u l t i n data that i s subject to a positive-response bias. The view that psychotherapeutic p r a c t i c e brings many p o s i t i v e benefits to the therapist's interpersonal r e l a t i o n s i s tempered by the findings on marital and family discord. Research i n t h i s area suggests that psychotherapists experience marital f a i l u r e at a rate equal to or greater than the general population (Looney, Harding, Blotcky, Branhart, 1980; Schofield, 1964). Surveys l i k e Deutsch's study (1985) of 264 psychotherapists found that an overwhelming 82% were experiencing r e l a t i o n s h i p d i f f i c u l t i e s with spouses and children, and that 47% of these had sought therapy for these problems. As well, a nationwide survey by Guy, Poelstra, and Stark (1989) of 318 p r a c t i s i n g psychotherapists from d i f f e r i n g orientations found 75% had experienced personal d i s t r e s s i n the past three years and that 43.6% of the d i s t r e s s could be a t t r i b u t e d to marital and family problems. 24 Norcross and Prochaska's (1986a, 1986b) focus on 171 female psychologists and counsellors found that t h e i r interpersonal problems, such as "dysfunctional marriages, troubled r e l a t i o n s h i p s , and impending divorces" accounted for nearly one-third of the t r i g g e r s for d i s t r e s s . Wahl (1986) found that of some 241 therapists, 40% had been divorced at l e a s t once. These rates of marital discord and f a i l u r e are equal to or greater than the general population. These findings support Charney's (1982) e a r l i e r observations that the majority of senior leaders of family therapy had been divorced at l e a s t once. I t i s i r o n i c that being i n a profession dedicated to helping others with personal and r e l a t i o n s h i p problems does not render one less vulnerable to such d i f f i c u l t i e s i n one's own personal r e l a t i o n s . Furthermore, one wonders what impact marital and family discord has on the therapist's mental health, and i n turn, on his or her work. The r e s u l t s of these findings are perhaps not that s u r p r i s i n g since the l i t e r a t u r e describes a number of factors associated with psychotherapeutic p r a c t i c e that impacts on marital and family l i f e (Guy, 1987). Psychotherapists report that t h e i r work i s often demanding, emotionally draining, and personally depleting (Burton, 1975; Tryon, 1983). A f t e r spending a day with d i s t r e s s e d c l i e n t s , many therapists f e e l exhausted and "used up" when they a r r i v e home (Farber, 1983). These i n d i v i d u a l s need to be u n i l a t e r a l l y replenished by t h e i r partner. They do not f e e l l i k e entering into a mutually supportive i n t e r a c t i o n (Bermak, 1977). Others tend to withdraw and wish to be l e f t alone to replenish personal resources (Henry, Sims, & Spray, 1973). Regardless of the pattern the therapists use, few of them a r r i v e home w i l l i n g to meet the emotional needs of t h e i r family (Farber, 1983). This pattern can impact the marital r e l a t i o n s h i p i n several ways. For example, i t may be d i f f i c u l t for the therapist to l i s t e n to personal concerns and needs of t h e i r partner. The therapist's a b i l i t y to be 25 empathic i s gone. Cray and Cray (1977) describe i t as follows: "when the [therapist] does get home ... the very s k i l l e d l i s t e n e r i s no longer i n the mood to l i s t e n . He would l i k e to t a l k for a change. He has been suppressing his t a l k i n g a l l day. Moreover, the problems of the family seem very t r i t e compared to the problems (s)he has been focusing on. His s e n s i t i v i t y i s d u l l e d " (p. 33). The emotional depletion coupled with a decreased desire to l i s t e n reduces the therapist's a b i l i t y to be intimate" and genuine with his or her partner. Instead, t h i s interpersonal distance promotes stress, tension, and distance i n the family. In sum, the l i t e r a t u r e establishes that the hazards of stress and burnout do e x i s t i n the pr a c t i c e of psychotherapy. However, the question s t i l l remains i f these hazards also e x i s t i n the p r a c t i c e of family therapy. I f indeed they do then one must ask i f a family therapist's experience of these stresses, e s p e c i a l l y stresses from family, adds to the tensions and pressures above and beyond c l i e n t work. Work and Family Stress and Therapeutic Functioning Many researchers have t r i e d to assess the e f f e c t s of job stress on the helping professional's health, both physical and mental. In terms of physic a l health, the focus has been on coronary heart disease and ulc e r s . The r e s u l t s i n d i c a t e job stress i s consistently r e l a t e d to heart disease while i n c o n s i s t e n t l y r e l a t e d to ulcers (Maslach & Schaufeli, 1993). Job stress has also been linked to impairments i n psychological w e l l -being, as r e f l e c t e d i n the above-mentioned reports of depression, anxiety, and tension. In the recent l i t e r a t u r e , there i s mention of job stress and i t s r e l a t i o n s h i p to increased alcohol and drug usage (Thoreson, 1986) and to incidents of t h e r a p i s t / c l i e n t sexual misconduct (Scruggs, 1986). Although much of the evidence i s based on s e l f - r e p o r t and not behavioural observations, i t i s i n t e r e s t i n g to note that, i n the cases of sexual 26 misconduct, most therapists admitting to sexual misconduct say that they do i t to meet needs not f u l f i l l e d i n t h e i r personal l i f e (Scruggs, 1986). Given that job stress i s l i n k e d to impairments i n one's well-being, the common-sense assumption i s that job stress and burnout lead to impairments i n job performance and a d e t e r i o r a t i o n i n the q u a l i t y of service provided to c l i e n t s . However, there has been l i t t l e research on the issue (Maslach, 1986). Job s a t i s f a c t i o n has received the most research attention. In general, high l e v e l s of job stress are re l a t e d to lower l e v e l s of s a t i s f a c t i o n (Golembiewski, Munzenrider, & Stevenson, 1986; Jones, 1981; Maslach & Jackson, 1981/1984) and more complaints about the job (Maslach & Jackson, 1981). People experiencing higher l e v e l s of burnout express a desire to spend less time working d i r e c t l y with c l i e n t s (Maslach & Jackson, 1984), t r y to avoid being with people (Jackson & Maslach, 1982), are more l i k e l y to be absent from work or take extended work breaks (Jones, 1981; Maslach & Jackson, 1981), and have a greater i n t e n t i o n of q u i t t i n g t h e i r jobs (Maslach & Jackson, 1981/1982/1984). There i s some evidence to t i e job stress to "counterproductive behaviours," such as damaging equipment, s t e a l i n g from the employer, d e l i b e r a t e l y doing i n f e r i o r work, and spreading rumours (Manigone & Quinn, 1975), but research of t h i s nature i s not generally found i n association with people i n the helping professions. The research i s l i m i t e d to one study by Jones (1981), who found that burnout was associated with more on-the-job mistakes, more "inhumanistic" counselling p r a c t i c e s , more aggressive behaviour toward c l i e n t s , and more d i s c i p l i n a r y action by supervisors. As well, one survey, by Guy, Poelstra, and Stark (1989), found 62.2% of therapists admitting to "working when too d i s t r e s s e d to be e f f e c t i v e , " but contradicting themselves by s t a t i n g i n response to another question that personal d i s t r e s s had no impact on q u a l i t y of c l i e n t care. It i s s u r p r i s i n g that therapists undergoing job stress report no difference i n job performance; even more troubling i n the survey are the reports from 27 substance abusers who were the most l i k e l y to report no differences i n c l i e n t care. Perhaps denial plays a major role i n t h i s perception, which would be consistent with Kilburg, Nathan, and Thoreson's (1986) research. One of the l e a s t understood dynamics i n the occupational-stress l i t e r a t u r e i s the concept that family can be a source of stress that a f f e c t s the i n d i v i d u a l at work. The l i t e r a t u r e indicates that low l i f e s tress, as measured by the Holmes and Rahe Soc i a l Readjustment Scale, i s s i g n i f i c a n t l y correlated with managerial success and the degree of task challenge (Vicino & Bass, 1978). Life-change scores have been rel a t e d negatively with behavioural outcomes l i k e indices of academic performance (Harris, 1972) and with measures of teaching effectiveness (Carranza, 1972). U n i v e r s i t y f a c u l t y provide further examples of negative family-to-job s p i l l o v e r with a moderate c o r r e l a t i o n (r = 0.43, p < .01) on negative job performance (Schultz, Chung and Henderson, 1989). Thus, a smattering of research e x i s t s which supports the notion that family stress i s l i n k e d to one's work performance; however, those studied have not been therapists nor people working i n helping professions. Only one paper was found (Bhagat, McQuaid, Lindholm, & Segovis, 1985) that attempts systematically to develop a model l i n k i n g the e f f e c t s of s t r e s s f u l l i f e events (e.g., stresses pertaining to health, family, marriage, work, finances and l e g a l matters) to i n d i v i d u a l performance and work adjustment within an organizational s e t t i n g . The authors studied a heterogeneous sample of 282 f u l l - t i m e , white-collar administrative and health c a r e - s t a f f i n a large c i t y i n southwestern Texas. The study proposed linkages between the experience of negative s t r e s s f u l l i f e events and e f f e c t s on an i n d i v i d u a l ' s work behaviour (e.g., job involvement, performance effectiveness, and turnover i n t e n t i o n s ) . Moderate correlations (r = 0.20 to 0.38, p_ < .01) were found. Variables such as coping, s o c i a l support, and organizational control systems were proposed as factors which mediate the l i n k between an i n d i v i d u a l ' s l i f e events and the work outcomes. 28 According to the authors, there are " c l e a r relationships between negative personal l i f e stress and the organizational outcomes; ... there i s a s p i l l o v e r of the e f f e c t s of nonwork stress on organizational outcomes" (p. 211). Furthermore, the heterogeneous sample enables them to be "reasonably confident about the external g e n e r a l i z a b i l i t y of the f i n d i n g s " (p. 212). By and large, l i t e r a t u r e has not explored family l i f e stresses or changes and work effectiveness for therapists. In fact, not one study explores the therapist's job functioning over a period of time. The research that exists tends to be based on s e l f - r e p o r t , c o r r e l a t i o n a l data with problems of positive-response bias and g e n e r a l i z a b i l i t y from the male gender. Therapist job performance i s usually mentioned i n discussions of therapist d i s t r e s s and issues of impairment (Guy & Liaboe, 1986; Guy, Poelstra, & Stark, 1989; Norcross & Prochaska, 1986a,b) and not i n terms of assessment of work effectiveness. Furthermore, the concept of therapeutic functioning, for therapists, i s not e x p l i c i t l y developed i n the l i t e r a t u r e , except i n the work of Tomm and Wright (1979) on therapist s k i l l s . Evaluating one's own job performance i s inherently subject to response bias and even more so i f i t i s linked with the q u a l i t y of c l i e n t care (Guy, Poelstra, & Stark, 1989). Thus, ways need to be found to assess family therapist job effectiveness without the r i s k of response bias or threat to t h e r a p i s t . In the study undertaken for t h i s t h e s i s , i t i s hoped that questions assessing changes i n one's job a c t i v i t y w i l l be less threatening for the t h e r a p i s t . Furthermore, asking one to r e c a l l his or her l e v e l of therapeutic functioning based on behavioural s k i l l s i s less subjective than asking one to r e c a l l performance l e v e l i n general. Factors Predicting Burnout and Therapeutic Functioning In the l i t e r a t u r e , s t r e s s f u l l i f e events and work-environment stressors have been the focus of study. Those researchers that have 29 attempted to e s t a b l i s h l i n k s between stress and health outcomes have explored stressors that e x i s t i n l i f e i n general and/or the work environment. Recently, socia l - s c i e n c e researchers have also considered family environment stressors and t h e i r influence on work. S t r e s s f u l L i f e Events Cannon (cited i n Selye, 1993) i s credited with e a r l y experimental work showing that s t i m u l i (e.g., l i f e events) associated with emotional arousal cause changes i n p h y s i o l o g i c a l processes. Meyer (c i t e d i n Sandler & Guenther, 1985), using a l i f e chart i n medical diagnosis, demonstrated the r e l a t i o n s h i p between ordinary l i f e events and i l l n e s s . In explaining t h i s r e l a t i o n s h i p , i t has been noted that the human body attempts to maintain homeostasis. Any l i f e change which upsets the body's steady state c a l l s for readjustment. Excessive changes tax the body's capacity for readjustment and r e s u l t i n stress. Thus, l i f e events are conceived of as experiences that cause the i n d i v i d u a l to s u b s t a n t i a l l y readjust his or her behaviour (Dohrenwend & Dohrenwend, 1974; Holmes & Rahe, 1967). The focus on the assessment of l i f e events has evolved from the work of Holmes and Rahe (1967). They have developed a measure that focuses on major l i f e events of a f a m i l i a l , personal, occupational, or f i n a n c i a l nature that necessitate some change or readjustment. L i f e events include death of a loved one, divorce, b i r t h of a c h i l d , job loss or promotion, that have accumulated over a b r i e f period of time (six months to two years). Proportional weights are assigned to each event based on the r e l a t i v e amount of readjustment required by the i n d i v i d u a l experiencing each event. An i n d i v i d u a l ' s score i s the sum of weights associated with each event experienced. This approach to the study of stress has dominated the research l i t e r a t u r e . Many prospective and retrospective studies have taken place over the past f i f t e e n years (McCubbin & Patterson, 1991). P o s i t i v e 30 re l a t i o n s h i p s have been found between the magnitude of l i f e changes and c r i t e r i o n variables for heart disease, b i r t h complications, tuberculosis, poor teacher performance, fractures, c o l l e g e - f o o t b a l l i n j u r i e s and numerous other mental and phy s i c a l i l l n e s s e s (Dohrenwend, Dohrenwend, Dodson, & Shrout, 1984; Holmes & Masuda, 1974). S t r e s s f u l L i f e Events within the Context of Family Theory The focus of l i f e - s t r e s s l i t e r a t u r e has been on the i n d i v i d u a l and his or her adaptive reaction to s o c i a l stressors; e f f o r t s have been made to document the impact of family l i f e events and changes on the family system and i t s i n d i v i d u a l members (Lavee, McCubbin, & Olson, 1987; McCubbin & Patterson, 1983). The i n i t i a l conception of family stress began i n the 1930s with Angell's work (cited i n Burr & Klein, 1994). But i t was H i l l who systematically b u i l t on the i n i t i a l ideas by studying m i l i t a r y families experiencing stressors of war separation and reunion (cited i n Burr & Klein, 1994). In his e f f o r t s to understand why families faced with a single stressor event varied i n t h e i r a b i l i t y to adjust, H i l l advanced the ABCX f a m i l y - c r i s i s model: A (the stressor event) i n t e r a c t i n g with B (the family's crisis-meeting resources) i n t e r a c t i n g with C (the d e f i n i t i o n the family makes of the event) produces X (the c r i s i s ) . H i l l defined a stressor as a " s i t u a t i o n for which the family has had l i t t l e or no p r i o r preparation" and a c r i s i s as "any sharp or decisive change for which old patterns are inadequate" (McCubbin & Patterson, 1991, p. 82). These d e f i n i t i o n s are analogous to those used i n the l i f e - e v e n t s research. Furthermore, H i l l described stressors i n terms of t h e i r "hardships," which were operationalized as "the number of changes that were required by the stressor event." According to McCubbin and Patterson (1991), t h i s concept of hardships corresponds to the life-change weights assigned to l i f e events i n the psychobiological stress research. Although H i l l ' s work i s important 31 to understanding a family's c a p a b i l i t y to deal with a stressor event, his work was l i m i t i n g ; i t only focused upon a single stressor event and was dir e c t e d at differences i n how families respond to that same stressor event. McCubbin and his colleagues (1983), t r y i n g to better understand a family's response to stress expanded upon H i l l ' s work to develop the now current double ABCX model. The demands or needs of the i n d i v i d u a l , family, and society are not s t a t i c but change over time. For example, normative growth and development of adult family members, b i r t h and development of children, changes i n society (e.g., changing roles of women) are a l l events that c a l l upon family adaptation and hence are sources of a d d i t i o n a l demands on the family. Because family c r i s e s evolve and are resolved over a period of time, the family i s seldom dealing with one sing l e stressor. Instead, the l i t e r a t u r e supports the notion that f a m i l i e s experience a "pile-up" of demands (McCubbin & Figley, 1983; McCubbin & Patterson, 1991). There are at l e a s t four broad types of stressors that can contribute to a pile-up of demands i n the family system at a time of c r i s i s : the i n i t i a l stressor and i t s hardship; developmental t r a n s i t i o n s ; p r i o r s t r a i n s ; and ambiguity, both i n t r a f a m i l y and s o c i a l . B r i e f l y , inherent i n the occurrence of a s t r e s s f u l event (e.g\, b i r t h of a baby, or a member re-entering the work force) are s p e c i f i c hardships which l i k e l y increase the d i f f i c u l t i e s a family may face. There are also stresses a family experiences as i t faces a major t r a n s i t i o n . For example, f a m i l i e s can experience changes i n the f a m i l y - l i f e - c y c l e stages — the normative stresses — (e.g., children entering school or becoming an adolescent). In addition, there are the nonnormative stressors (e.g., divorce, i l l n e s s ) . These t r a n s i t i o n s can occur at the same time, and are often independent of the i n i t i a l stressor. It would appear that most family systems carry some residue of stress, which may be the r e s u l t of unresolved hardships from e a r l i e r stressors or t r a n s i t i o n s . Unfortunately, these p r i o r s t r a i n s are 32 not d i s c r e t e events; rather, they emerge i n an i n s i d i o u s fashion to contribute to the pile-up of demands a family contends with i n a c r i s i s s i t u a t i o n . F i n a l l y , a c e r t a i n amount of ambiguity i s inherent i n every stressor, since change produces uncertainty about the future. L i f e events, both normative and nonnormative, which are experienced by the family as a whole or by any one member, add together to determine the magnitude of l i f e changes (Lavee, McCubbin and Olson, 1987). Furthermore, the greater the cumulative family l i f e changes the more l i k e l y there w i l l be a decline i n family functioning. Thus, important to t h i s study i s the a b i l i t y to assess the "pile-up" of l i f e events experienced by a person. This i s achieved with the Family L i f e Events and Change Inventory, an index of family stress (McCubbin & Patterson, 1991). Variables of Work and Family Work Maslach (1982) observed that when burnout begins, the tendency i s to a t t r i b u t e the cause to the person. The blame i s placed on e i t h e r the caregiver or the r e c i p i e n t of care. Maslach believes that i t i s easier for humans to look for and a t t r i b u t e causes to f a u l t y people than to the si t u a t i o n s i n which people f i n d themselves. A focus on the s i t u a t i o n a l factors allows for the p o s s i b i l i t y that burnout i s p r e c i p i t a t e d by the nature of the job and/or family l i f e and not the nature of the person. Maslach (1982) believes that researchers should focus on t r y i n g to i d e n t i f y the c r i t i c a l components of bad sit u a t i o n s i n which good people function. As well, Freudenberger and Richelson (1980) believe that those who are ambitious and maintain high goals are at a greater r i s k for burnout as a r e s u l t of t h e i r work environments. In the l i t e r a t u r e on work environments, extensive studies suggest a number of variables that play an important role i n promoting or preventing 33 burnout. These variables can be grouped into four d i f f e r e n t dimensions. The f i r s t i s the psychological dimension, which includes aspects that a f f e c t both the person's emotional well-being (such as the opportunity for personal growth) and cognitive well-being (such as work va r i e t y , overload, and autonomy). The second dimension i s the physi c a l environment, which includes f i x e d aspects of the work (such as space, crowding, and noise). The t h i r d aspect of the work environment i s the s o c i a l dimension, which includes a l l people coming i n d i r e c t contact with the i n d i v i d u a l , including service r e c i p i e n t s (their number and the seve r i t y of t h e i r problems); co-workers (the q u a l i t y of re l a t i o n s with them and t h e i r capacity to provide support); and supervision (the nature of t h e i r feedback). F i n a l l y , there i s the organizational dimension, which includes bureaucratic hassles (such as paperwork, rules and regulations) (Pines, 1982). This review i s l i m i t e d only to those variables which w i l l be used i n the current assessment of the Family/Work Concerns. These are described below. A major psychological variable that i s apparent i n many of the studies on burnout i s work overload. For many psychotherapists, overload c o g n i t i v e l y t ranslates into too many people to serve and too l i t t l e time to serve t h e i r needs adequately. Work overload i s considered an antecedent of stress and has repeatedly been found to p o s i t i v e l y c o r r e l a t e with burnout among human-service workers regardless of gender or culture (Pines, 1982; Pines, 1993). In addition, Pines, Aronson, and Kafry (1981) found that lack of autonomy and control were major antecedents of burnout for health-care professionals working i n i n s t i t u t i o n a l settings. A sense of control mediates against stress and can prevent burnout because i t i s associated with one's a b i l i t y to cope e f f e c t i v e l y and predict outcomes. In several studies autonomy has been found to be p o s i t i v e l y correlated with job s a t i s f a c t i o n and negatively correlated to burnout (Golembiewski, Munzenrider, & Stevenson, .1986; Pines, 1982). 34 Lack of p o s i t i v e feedback about one's job performance i s another factor p r e d i c t i v e of burnout (Maslach & Jackson, 1982; Pines, 1982) . Feedback i s c r u c i a l for one's sense of meaningfulness and achievement at work. The degree to which people receive information about t h e i r success and performance l e v e l was found, to be s i g n i f i c a n t l y and negatively correlated with burnout (r = -.36, p_ < .05) for a sample of 129 s o c i a l workers (Pines, 1982) . Several factors i n the s o c i a l dimension of the work environment can be a source of stress. This dimension includes a l l people that come i n d i r e c t contact with the i n d i v i d u a l as part of h i s or her work. For therapists, the s o c i a l environment of the workplace includes contact with c l i e n t s , co-workers, supervisors, and possibly d i r e c t o r s . When re l a t i o n s h i p s , e s p e c i a l l y those with co-workers or supervisors, are unpleasant or nonsupportive, the r i s k of burnout i s greater (Jackson & Maslach, 1982; Maslach & Jackson, 1984; Pines, 1982). There i s evidence to suggest that poor r e l a t i o n s with one's boss, colleagues, or subordinates may be l i n k e d to negative assessments of the job (Maslach, 1986). Pines and Maslach (1978) found the following regarding the nature of work re l a t i o n s h i p s : the better the work r e l a t i o n s , the more professionals l i k e d t h e i r work (r = .38, p = .001); the more they f e l t free to express themselves (r = .41, p = .001), the more they were l i k e l y to stay i n the profession for s e l f - f u l f i l l m e n t (r = .41, p = .040); the more successful they f e l t on the job (r = .31, p = .008), the more l i k e l y they were to confer with others (r = .27, p = .025). Moreover, burnout i s greater when the nature of c l i e n t contact i s upsetting, f r u s t r a t i n g or d i f f i c u l t (Maslach & Jackson, 1984; Pines, 1982). Each person i n the work environment can p o t e n t i a l l y impose c e r t a i n demands on the the r a p i s t and provide c e r t a i n rewards. I t i s the r a t i o of the demands to the rewards that i s an important determinant of burnout (French, Rogers & Cobb, 1974). 35 The q u a l i t y of i n t e r a c t i o n s i n many human services i s af f e c t e d by the number of people for whom the professional i s caring, ( i . e . , s i z e of the caseload). As amount of c l i e n t contact increases, e i t h e r i n terms of a higher caseload or a greater percentage of d i r e c t c l i e n t contact, burnout i s more l i k e l y to occur (Jackson & Maslach, 1982). S p e c i f i c a l l y , i n a mental-health study by Pines and Maslach (1978), the authors found that the larger the r a t i o of patients to s t a f f , the more l i k e l y s t a f f members wanted to quit (r = .46, p = .001) . C l e a r l y , a number of work variables play an important r o l e i n p r e d i c t i n g burnout. For t h i s study the variables of caseload s i z e , feedback, and work r e l a t i o n s , to mention a few, w i l l be explored as possible factors leading to burnout and reduced therapeutic functioning. Family Family and work are considered the two most central i n s t i t u t i o n s that impinge on the l i f e of an i n d i v i d u a l (Mortimer, Lorence, & Kumka, 1986). T r a d i t i o n a l l y , researchers have focused on only one of these spheres, to the general exclusion of the other. Several forces have come together to h i g h l i g h t the work/family i n t e r f a c e : the i n f l u x of women into the workforce; the new l i f e s t y l e s which integrate work, family, and l e i s u r e ; and, the number of dual-career and single-parent f a m i l i e s . Furthermore, i f one adopts a systemic view, then the "myth of separate worlds" surrounding work and family must be d i s p e l l e d , for families are open systems involved i n a two-directional interchange with the larger environment. The empirical research on the work/family i n t e r f a c e has been documented to show the impact of work variables on an i n d i v i d u a l ' s home and family l i f e (see Burke & Bradshaw, 1981, for review). Job demands and job stress, for example, can negatively impact on marital and l i f e s a t i s f a c t i o n (Burke, Weir, & Duwors, 1980a,b; Jayaratne, Chess, & Kunkel, 1986), family experiences (Burke, Shearer, & Deszca, 1984), and even spousal well-being 36 (Burke, Weir, & Duwors, 1980a,b). Nieva (cited i n Burke & Bradshaw, 1981) found that the following were a l l s i g n i f i c a n t l y and negatively correlated to measures of job s a t i s f a c t i o n , job involvement, and i n t e n t i o n to re-e n l i s t among m i l i t a r y personnel: work-family c o n f l i c t s (interferences of work on family), family-work c o n f l i c t (interferences of family on work), general family demands (the family's need for time and energy), and b i d i r e c t i o n a l c o n f l i c t s (pulled i n opposite d i r e c t i o n s by work and family). However, the g e n e r a l i z a b i l i t y of the above-mentioned findings i s l i m i t e d to l a r g e l y male m i l i t a r y personnel, p o l i c e o f f i c e r s , c o r r e c t i o n a l i n s t i t u t i o n administrators, and a few s o c i a l workers. The l i n k between a f f e c t i v e reactions to work and the impairment of aspects of family l i f e has also been studied. Although the sources of burnout may be l a r g e l y work-related, the e f f e c t s may be f e l t i n the non-work areas of l i f e . The r e l a t i o n s h i p between job-induced emotional exhaustion and disruption of family l i f e was studied by Jackson and Maslach (1982) with a sample of 142 male p o l i c e o f f i c e r s and t h e i r f a m i l i e s . The findings suggest that the p o l i c e o f f i c e r s who by nature have a s t r e s s f u l occupation were more l i k e l y to display anger, spend time away from the family, be uninvolved i n family matters, and to have unsatisfactory marriages. Independently, the spouses of the more burned-out p o l i c e o f f i c e r s described the q u a l i t y of t h e i r family l i f e i n more negative terms. Other studies support these findings, where p o l i c e o f f i c e r s with high l e v e l s of burnout report a greater negative impact on t h e i r family l i f e (Burke, Shearer, & Deszca, 1984). One study with mental-health workers ( i . e . , s o c i a l workers) found high burnout to be l i n k e d to a greater d i s s a t i s f a c t i o n with one's marriage. Other data that speak to the l i n k between burnout and family l i f e are analyses of demographic va r i a b l e s , which i n d i c a t e that workers who are married or who have chi l d r e n experience les s burnout (Maslach & Jackson, 1985). 37 In the most recent study, Zedeck, Maslach, Moiser, and Skitka (1988) explored the r e l a t i o n s h i p between employees' a f f e c t i v e reaction to work and family l i f e . S p e c i f i c a l l y , female-employee job s a t i s f a c t i o n and burnout and male-spouse perceptions of t h e i r wives' work and impact on family l i f e were measured. The findings suggest moderate to strong c o r r e l a t i o n s between burnout and job s a t i s f a c t i o n (r ranged from .22 to .60). S a t i s f a c t i o n with e x t r i n s i c aspects of work (e.g., job security) was more highly r e l a t e d to the husband's perceptions of the work's impact on family l i f e than was the wife's i n t r i n s i c s a t i s f a c t i o n (e.g., feelings of competency and pleasure from being c r e a t i v e ) . These studies c l e a r l y i n d i c a t e that experiences i n one l i f e sphere (work) have a d i r e c t influence or " s p i l l o v e r " onto the other l i f e sphere (family). The bulk of research on the e f f e c t s of work on family rests on r e l a t i o n s h i p s between s t r u c t u r a l c h a r a c t e r i s t i c s of jobs, such as timing and s p a t i a l l o c a t i o n of work, and work/family c o n f l i c t and the q u a l i t y of family l i f e (review by Voydanoff, 1988) . B r i e f l y , working long hours i s associated with work/family c o n f l i c t and s t r a i n , while r e g u l a r l y scheduled work hours i s not s i g n i f i c a n t l y r e l a t e d to marital or family s a t i s f a c t i o n . Those working weekends and n i g h t - s h i f t hours experience higher l e v e l s of work/family c o n f l i c t and less m a r i t a l or family s a t i s f a c t i o n . The e f f e c t s of geographic m o b i l i t y and t r a v e l vary s i g n i f i c a n t l y depending on the frequency, and the a v a i l a b i l i t y and use of, s o c i a l supports i n the family (Voydanoff, 1988). Voydanoff (1988) also reviewed research on the psychological aspects of work roles, work/family c o n f l i c t , and the q u a l i t y of family l i f e . Here the studies show that job demands create job stress which i n turn influences family relationships and physical health among male managers. S p e c i f i c a l l y , the following job demands were s i g n i f i c a n t l y r e l a t e d to work/family c o n f l i c t : r o l e ambiguity, r o l e c o n f l i c t , i n t e l l e c t u a l and physical e f f o r t , rapid change, pressures for q u a l i t y work, pressure to work 38 hard and f a s t , and a heavy work load. As well, job involvement was r e l a t e d to work/family c o n f l i c t and lower marital s a t i s f a c t i o n among male "corporates." Research supports the notion that a number of job-related variables impact family l i f e and marital well-being. Moreover, s t r u c t u r a l and psychological c h a r a c t e r i s t i c s of work, l i k e long hours with few vacations, rapid change and fast pace of work, and role c o n f l i c t a l l influence a worker's family. The findings are l a r g e l y derived from samples of o f f i c e managers, corporate executives, and people i n the business world. One wonders i f there are work and family stresses s p e c i f i c i n the l i v e s of family t h e r a p i s t s . Work and Family Stresses and the Family Therapist Two a r t i c l e s address t h i s issue of d a i l y stresses for the family therapist. The f i r s t i s I s r a e l Charny's (1982) p o s i t i o n paper on the mental health of family therapists. He l i s t s a number of problems that a family t h e r a p i s t i s l i k e l y to experience. F i r s t , there are the concerns of having "enough energy, time, and tolerance for the staying-with-itness of family l i f e " (p. 46). There are the f r u s t r a t i o n s that family therapists experience i n having to be good l i s t e n e r s both at work and at home. As well, family therapists express concern with making u n r e a l i s t i c demands on t h e i r f a m i l i e s by s e t t i n g the same "high standards for marital and family functioning as they often expect from t h e i r c l i e n t s " (p. 47). Some therapists are disappointed i n t h e i r mishandling of t h e i r own family b a t t l e s around the very c e n t r a l values of family therapy; "communication, emotional support, and commitment" (p. 49). F i n a l l y , the therapist may f i n d d i s s a t i s f a c t i o n with home l i f e , where he or she "may not f e e l appreciated for the accomplishments and v i c t o r i e s achieved at work" (p. 48). Although these concerns appear as p o t e n t i a l l y v a l i d stresses for the family therapist, no empirical evidence i s presented by Charny. 39 In the second a r t i c l e , Wetchler and Piercy (1986) surveyed 110 family therapists from the State of Indiana and found four major concerns: not enough time for family (45%), not enough energy for family commitments (44%), d i f f i c u l t y i n changing roles from therapist to family member when away from the o f f i c e (37%), and the constant attentiveness needed by family (32%). The s e l f - r e p o r t nature of the study, the s e l f - s e l e c t e d nature of the sample, and e s p e c i a l l y the lack of c o n f i d e n t i a l i t y i n the research responses obtained a l l r e s u l t i n data that i s subject to a p o s i t i v e -response bias. Indeed, further study which explores s p e c i f i c work and family concerns for the family therapist, l i k e time and energy for family and friends, standards for the therapist's own marriage, attentiveness to family needs, and ro l e c o n f l i c t i s warranted. One of the concerns that develops out of reviewing t h i s l i t e r a t u r e i s the question of causal r e l a t i o n s h i p , that i s , do work stresses and burnout a f f e c t the family or do personal and family stresses influence burnout? The author prefers the point of view put for t h by Paradine, Higgins, Beres, Szeglin, and Kravitz (1981), that job stress and off-the-job stress combine i n a " m u l t i p l i c a t i v e fashion" to cause s t r a i n on the worker. Both a high l e v e l of off-the-job stress and a high l e v e l of stress on the job must be present to produce worker s t r a i n . This s t i l l respects the notion that there i s b i d i r e c t i o n a l " s p i l l o v e r " between the two l i f e spheres, work and family. This thesis w i l l address both major s t r e s s f u l l i f e events and d a i l y l i f e concerns for a sample of family therapists. Major l i f e stresses w i l l be assessed using a measure of family l i f e events and changes (McCubbin & Patterson, 1991), while d a i l y concerns with be explored v i a statements pertaining to the work and family concerns of family therapists (Charny, 1982; Wetchler & Piercy, 1986). 40 Factors Mediating Burnout and Therapeutic Functioning Researchers recognize that stress i s a part of the human condition, and, i n looking for variables that might moderate the s t r e s s - i l l n e s s r e l a t i o n s h i p , have i d e n t i f i e d coping as one prominent mediating variable ( B i l l i n g s & Moos, 1981). I t i s believed that i f one can cope e f f e c t i v e l y with the problems at hand, one may be better able to reduce the harmful consequences of stress, such as burnout and reduced work effectiveness. According to Lazarus and Folkman (1984), coping refers to cognitive and behavioural e f f o r t s to "master, reduce, or t o l e r a t e " i n t e r n a l and/or external demands that are created by stressors. Coping "must include e f f o r t s to manage s t r e s s f u l demands, regardless of outcome" (p. 134). This means that no one strategy i s inherently better than any other and that not coping does not imply f a i l u r e . The functions of coping are conceptualized as being emotion-focused or the regulations of emotions or d i s t r e s s and as problem-focused, or the management of the problem that i s causing the d i s t r e s s (Folkman & Lazarus, 1980/1984). Emotion-focused coping i s used to control d i s t r e s s i n g emotions, sometimes by a l t e r i n g the meaning of an outcome, whereas problem-focused coping i s used to control the troublesome person-environment r e l a t i o n s h i p through problem-solving, decision-making and d i r e c t action. Folkman and Lazarus (1980) have shown that both forms of coping are used i n most s t r e s s f u l s i t u a t i o n s . They studied 100 men and women ages 45 to 64 regarding how they coped with a wide v a r i e t y of r e a l - l i f e events over the course of seven months. The events reported by the p a r t i c i p a n t s ranged from minor problems, l i k e car trouble, to major problems, such as job loss or l i f e - t h r e a t e n i n g i l l n e s s . More than 1,200 s t r e s s f u l episodes were analysed and findings show that both emotion-focused coping and problem-focused coping were used i n over 98% of the episodes. Moreover, problem-focused forms of coping increased i n situations that were appraised as 41 changeable and emotion-focused forms of coping increased i n s i t u a t i o n s that were appraised as not amenable to change. Many of the discussions i n the l i t e r a t u r e on coping tend to focus on the i n d i v i d u a l ' s e f f o r t s at coping with stress. However, the l i t e r a t u r e has not e m p i r i c a l l y established the effectiveness of the i n d i v i d u a l ' s e f f o r t s at coping with burnout-. Maslach and Schaufeli (1993) propose studying coping from a comprehensive perspective, one that focuses not only on the i n d i v i d u a l but on the organizational and s o c i a l l e v e l s as well. In t h i s paper, coping w i l l be addressed only i n so far as an i n d i v i d u a l ' s actions, i n dealing with normative and nonnormative l i f e events and work and family stress, mitigate burnout and enhance therapeutic functioning. By and large the focus w i l l be on the s o c i a l l e v e l . The study w i l l explore the therapist's l e v e l of family functioning, s p e c i f i c a l l y cohesion, communication, and c o n f l i c t and the r e l a t i o n to burnout and therapeutic functioning. Coping within the Family Context Families i n c r i s i s facing excessive demands and depleted resources come to r e a l i z e that i n order to restore some functional s t a b i l i t y they may need to restructure, to make changes i n t h e i r e x i s t i n g roles, rules, and/or patterns of i n t e r a c t i o n . A d d i t i o n a l l y , a f t e r families have made i n i t i a l changes, they may be c a l l e d upon to make subsequent changes i n an e f f o r t to consolidate, to bring the family together into a coherent unit working together. According to McCubbin and F i g l e y (1983), these processes of " r e s t r u c t u r i n g " and "consolidating" evolve over time as families work towards "adaptation." The family's e f f o r t s at r e s t r u c t u r i n g and consolidating are f a c i l i t a t e d by the adaptive strategies of "synergizing, i n t e r f a c i n g , and compromising" (p. 23). Research indicates that family coping i s not created i n a single instant and i s not d i r e c t e d at a single stressor (Boss, 1987; Burr & Klein, 42 1994; McCubbin & Figley, 1983). Instead, families make many d i f f e r e n t kinds of responses i n order to achieve a better f i t between environmental and family demands. The conclusions are that a family i s a system and coping s t r a t e g i e s involve the management of various dimensions of family l i f e simultaneously: (a) maintenance of family bonds of coherence; (b) maintenance of conditions for communication and organization; (c) maintenance and development of s o c i a l support; and (d) promotion of member self-esteem. Thus, coping within the family context does not simply mean the removal of a c o n f l i c t nor the return to status quo, but rather involves a process of achieving balance i n the family to f a c i l i t a t e organization and unity and promote growth and development. The current family-science l i t e r a t u r e i d e n t i f i e s several d i f f e r e n t categories of coping s t r a t e g i e s . This study concerns i t s e l f with the most recent conceptual framework proposed by Burr and K l e i n (1994). In i t there are seven general areas of family-coping s t r a t e g i e s : cognition, emotion, re l a t i o n s h i p s , communication, community, and s p i r i t u a l i t y ; the seventh factor refers to the process of t r y i n g to enhance one's i n d i v i d u a l development. As Boss (1987) has emphasized, managing stress i n families i s often a combination of both f a m i l i a l and i n d i v i d u a l processes. Individual actions w i l l be measured with the Stress Management Checklist, and family functioning with the Family Relationship Index. Family Functioning According to McCubbin and Figley (1983) the resources, c h a r a c t e r i s t i c s or strengths a family has at i t s disposal w i l l help them achieve a better f i t between environmental demands and family demands. There are four basic components to personal resources: (1) f i n a n c i a l or economic secu r i t y , (2) education or problem-solving s k i l l s , (3) health, and (4) psychological resources. However, income, occupation, and well-being 43 do not always enable one to predict the coping patterns of a family under str e s s . More importantly, the l i t e r a t u r e i d e n t i f i e s several family-system resources that highly correlate with a family' a b i l i t y to deal with stress. Family i n t e g r a t i o n , an aspect of family functioning, was f i r s t proposed by Angell i n the 1930s (cited by Burr & Klein, 1994) a f t e r a study of 50 fam i l i e s ' reaction to the Depression. He found that bonds of "coherence, common i n t e r e s t s , a f f e c t i o n , and a sense of economic interdependence" helped f a m i l i e s adjust more e f f e c t i v e l y to the Depression (p. 141). S i m i l a r l y , H i l l ( c i t e d by Burr & Klein, 1994) stated that family i n t e g r a t i o n , consisted of "strong a f f e c t i o n a l t i e s , ... pride i n family t r a d i t i o n s , and high p a r t i c i p a t i o n as a family i n j o i n t a c t i v i t i e s " (p. 142), was important to how well a family adjusted to c r i s i s . Recent researchers concur that families competent i n meeting c r i s e s have been found to be.cohesive and adaptable (McCubbin & Figley, 1983; Olson, Russell, & Sprenkel, 1983). S p e c i f i c a l l y , families functioning moderately along the dimensions of cohesion and a d a p t a b i l i t y are more l i k e l y to su c c e s s f u l l y adapt to c r i s e s (Olson, McCubbin, Barnes, Larsen, Muxem, & Wilson, 1982). Communication i s another aspect of family functioning. H i l l was the f i r s t to consider open communication an important strategy i n dealing with stress. He states that " c r i s e s of separation and reunion may be cushioned ... and even strengthened ... i f the processes of communication are adequate and the avenues kept open" (cited by Burr & Klein, 1994, p. 144). Talking about the s i t u a t i o n was reported as being h e l p f u l by Boss (1987), who studied routine absences of corporate executive husbands and fathers and patterns of coping among t h e i r f a m i l i e s . The exchange of information among family i s e s p e c i a l l y important at times when a chronic or l i f e -threatening i l l n e s s e x i s t s . The process of honest, open discussion enables family members to plan and face the i n e v i t a b l e outcome(s) (Kaplan, Smith, 44 Grobstein, & Fischman, 1973). McCubbin and Fi g l e y (1983) noted that e f f e c t i v e f a m i l i e s "tend to have few sanctions against when and what to t a l k about and, indeed enjoy l i s t e n i n g to each other discuss a wide range of t o p i c s " (p. 28) . Another form of communication i s nonverbal. G i l b e r t (1989) found that when couples found i t d i f f i c u l t to express t h e i r thoughts and emotions to one another verbally, then nonverbal means of communicating were used instead. The family-therapy l i t e r a t u r e has placed a great deal of value on communication i n maintaining stable family functioning. A vast amount of research has focused on pathological communication patterns l i k e "double-bind messages," "exaggerated forms of communication," and "disguised communication" which are a l l believed to lead to serious disruptions i n family functioning (Goldenberg & Goldenberg, 1985). According to Lyman Wynne (cited i n Goldenberg & Goldenberg, 1985), families with patterns of communicating based on f i g h t i n g , arguing, and y e l l i n g struggle and experience greater d i f f i c u l t y i n d i s s i p a t i n g s t r e s s f u l s i t u a t i o n s . Instead, he emphasizes the importance of e s t a b l i s h i n g and maintaining " c l e a r and healthy" communication channels. Furthermore, i n many cases stress can increase c o n f l i c t within a family (Burr & Klein, 1994). Thus, families competent at meeting cri s e s have been found to be cohesive, f l e x i b l e , open to communication from within and outside the family, and capable of dealing with tensions i n a calm and n o n c r i t i c a l manner. These three components of family functioning — cohesion, communication, and c o n f l i c t -- w i l l be assessed with the Family Relationship Index. Unanswered Questions The f i e l d ' s i n i t i a l approach to burnout was exploratory and d e s c r i p t i v e . Anecdotal reports, open-ended questions, and on-site observations were the method of data c o l l e c t i o n . With the development of standardized questionnaires came s e l f - r e p o r t surveys of large samples and a 45 body of empirical data. Research now focuses on more i n t e g r a t i v e studies i n which both p e r s o n a l i t y and s i t u a t i o n a l factors i n burnout are being assessed (Berkowitz, 1987; Raquepaw & M i l l e r , 1989; Udovch, 1983) . The l i t e r a t u r e u n i v e r s a l l y establishes the hazards of stress and burnout i n the p r a c t i c e of i n d i v i d u a l psychotherapy. However, questions remain i f these hazards also e x i s t i n the p r a c t i c e of family therapy. Do major l i f e events and d a i l y stresses at home add to the tensions and pressures above and beyond c l i e n t work? This i s p a r t i c u l a r l y important since the family therapist's personal l i f e may be more v i s i b l e i n therapy (Pinsof, 1986). I t i s believed that " s p i l l o v e r " between the two l i f e spheres of work and family occurs and that family and work stress combine i n a m u l t i p l i c a t i v e fashion to cause stress, burnout, and reduced therapeutic functioning (Paradine, Higgins, Beres, Szeglin, & Kravitz, 1981). I t i s imperative to determine i f the impact of t h i s s p i l l o v e r hampers the q u a l i t y of therapy provided to c l i e n t s . F i n a l l y , the l i t e r a t u r e establishes the s i g n i f i c a n c e of family functioning and i n d i v i d u a l coping strategies i n handling s t r e s s , however, questions s t i l l remain regarding t h e i r effectiveness i n dealing with burnout. One wonders i f family therapists, by the very nature of t h e i r work and t r a i n i n g , are better able to deal with stress such that p o s i t i v e therapeutic functioning i s promoted. 46 CHAPTER III METHODOLOGY This chapter sets f o r t h the design, hypotheses, procedures, and s t a t i s t i c a l analyses used for i n v e s t i g a t i n g the impact of work and family on the family therapist's pro fe ss io na l effectiveness. The s p e c i f i c subsections covered include the research design and variable s , hypotheses, s e l e c t i o n of the p a r t i c i p a n t s , instruments, data c o l l e c t i o n procedures, s t a t i s t i c a l analyses, and methodological assumptions. Research Design and Variables The study employed a cross-sectional survey design that was de s c r i p t i v e and c o r r e l a t i o n a l i n nature. The o v e r a l l objective was to examine the re l a t i o n s h i p s among variables r e l a t e d to work and family, and the degree to which these variables were rel a t e d to burnout and therapeutic functioning. The independent or predictor variables included measures of the t h e r a p i s t s ' f a m i l y - l i f e events and changes; family/work concerns; family functioning i n c l u d i n g cohesion, expressiveness, and c o n f l i c t ; and coping s t r a t e g i e s . Therapist gender was also considered an independent va r i a b l e . The dependent or c r i t e r i o n variables were the three subscales of burnout ( i . e . , emotional exhaustion, depersonalization, and personal accomplishment) plus the therapeutic functioning of the family therapist ( i . e . , work a c t i v i t i e s and in-session functioning). Research Hypotheses It was an t i c i p a t e d that the following research hypotheses would c l a r i f y the r e l a t i o n s h i p between family and work stresses, family functioning, burnout, and therapeutic functioning i n a sample of family t h e r a p i s t s . 47 Preliminary Hypotheses Hypothesis 1. Male and female family therapists would s i g n i f i c a n t l y d i f f e r on l e v e l s of burnout as measured by the Maslach Burnout Inventory. Hypothesis l a : The present sample of family therapists would not s i g n i f i c a n t l y d i f f e r from the normative sample of therapists on the Maslach Burnout Inventory. Hypothesis 2. Male and female family therapists would s i g n i f i c a n t l y d i f f e r on l e v e l s of therapeutic functioning. Primary Hypotheses Hypothesis 3. An increase i n the l e v e l of s t r e s s f u l normative and nonnormative l i f e events during the past year, as measured by the Family Inventory of L i f e Events and Changes, would be p o s i t i v e l y associated with burnout as measured by emotional exhaustion, depersonalization, and reduced personal accomplishment i n family therapists. Hypothesis 4. D i s s a t i s f a c t i o n i n handling work and family stress would be p o s i t i v e l y associated with burnout, where work and family stress were measured by a Family/Work Concerns c h e c k l i s t and burnout was measured by emotional exhaustion, depersonalization, and reduced personal accomplishment. Hypothesis 4a. S a t i s f a c t i o n i n handling work and family stress would be negatively associated with burnout, where work and family stress were measured by a Family/Work Concerns c h e c k l i s t and burnout was measured by emotional exhaustion, depersonalization, and reduced personal accomplishment. Hypothesis 5. An increase i n the l e v e l of s t r e s s f u l normative and nonnormative l i f e events during the past year, as measured by the Family Inventory of L i f e Events and Changes, would be negatively associated with therapeutic functioning i n family therapists. 48 Hypothesis 6. D i s s a t i s f a c t i o n i n handling work and family stress would be negatively associated with therapeutic functioning, where work and family stress were measured by a Family/Work Concerns c h e c k l i s t and therapeutic functioning was measured by the Work A c t i v i t i e s l i s t and Therapeutic Functioning Grid. Hypothesis 6a. S a t i s f a c t i o n i n handling work and family stress would be p o s i t i v e l y associated with therapeutic functioning. Work and family stress was measured by a Family/Work Concerns c h e c k l i s t and therapeutic functioning was measured by the Work A c t i v i t i e s l i s t and Therapeutic Functioning Grid. Hypothesis 7. An increase i n family functioning, as measured by the Family Relationship Index, would be negatively r e l a t e d to l e v e l s of burnout as measured by emotional exhaustion, depersonalization, and reduced personal accomplishment i n family therapists. Hypothesis 8. An increase i n family functioning, as measured by the Family Relationship Index, would be p o s i t i v e l y associated with therapeutic functioning i n family therapists. Hypothesis 9. There would be a s i g n i f i c a n t difference i n the mean score of burnout between family therapists who engaged i n stress-managing behaviours and who d i d not engage i n stress-managing behaviours with respect to family and work stress, as measured by the Stress-Management Strategies c h e c k l i s t . Hypothesis 10. There would be a s i g n i f i c a n t d i f f e r e n c e i n the mean score of therapeutic functioning between family therapists who engaged i n s t r e s s -managing behaviours and who d i d not engage i n stress-managing behaviours with respect to family and work stress, as measured by the Stress-Management S t r a t e g i e s . c h e c k l i s t . Participants The research sample consisted of 142 family therapists, randomly selected and s t r a t i f i e d from a population of 839; a l l were current members 49 of the Canadian D i v i s i o n (Zone 5) of the American Ass o c i a t i o n of Marriage and Family Therapy (AAMFT). The research sample represents a l l e l i g i b l e returns from a mailing to 250 p o t e n t i a l candidates. Of the 250 questionnaires mailed, 175 were returned, f o r a response rate of 70%. Of the 175 surveys returned, two were not in t e r e s t e d i n taking part i n the study, two were no longer l i v i n g i n Canada, three were r e t i r e d , four were l i v i n g alone, two had changed profession, and one was deceased. As a r e s u l t , these 14 respondents were i n e l i g i b l e as subjects for the study. Furthermore, 20 respondents described themselves as not currently p r a c t i s i n g family therapy and were excluded; thus, the f i n a l number of e l i g i b l e p a r t i c i p a n t s was 142, or 56.8% of the 250 p o t e n t i a l respondents. There were somewhat more women (n = 81 or 57%) than men (n = 61 or 43%) i n the sample; however, there was no s i g n i f i c a n t difference i n gender breakdown from the i n i t i a l 250 therapists sampled, where 137 (54.8%) were female and 113 (45.2%) were male. The P r a i r i e provinces and A t l a n t i c Canada yielded the highest return rates -- 71% and 100%, resp e c t i v e l y (see Table 1). Respondents were p r i m a r i l y married or i n a committed r e l a t i o n s h i p (90.8%), with an age range of 26 to 72 (M = 46.6, SD = 8.9). Some 83.1% of the therapists were l i v i n g i n an urban centre, one-third of these i n a large metropolitan area. Approximately one-quarter of the therapists were l i v i n g with c h i l d r e n i n the "young adult" f a m i l y - l i f e stage; an add i t i o n a l one-third were experiencing t h e i r children leaving home or were i n the empty-nest stage of family l i f e . O verall, these family therapists r a r e l y experienced health concerns (M = 1.96, SD = .56). The majority d i d not smoke (91.5%), experience ulcers (93%), or experience hypertension (74.6%). On the other hand, one-third of the therapists reported health concerns rel a t e d to sleep disturbances, neck and back aches, and lack of physical exercise. Most of the therapists were not currently i n personal therapy (79.6%). 50 P r o f e s s i o n a l l y , the majority (76.1%) hold " c l i n i c a l " membership status with AAMFT. One-third hold M.S.W. degrees, and another t h i r d hold other master's degrees; the remaining t h i r d hold a mixture of degrees, mostly at the doctorate l e v e l . The majority of the family therapists were i n the middle stage of t h e i r careers (72.5%). The primary place of employment for respondents was private p r a c t i c e (42.3%), followed by family agencies (18.3%) . S l i g h t l y over one-third reported no secondary place of employment; another one-third worked i n private p r a c t i c e as a second career. Over h a l f of the therapists considered themselves to be p r a c t i s i n g a systemic form of therapy. Forms of therapy most commonly mentioned i n the "other" category were narrative, solution-focused, and feminist (a t o t a l of 20.4%). For 23% of the therapists, s t r u c t u r a l therapy was reported as the second i n f l u e n t i a l school of theory. According to caseload numbers, the family therapists provided counselling on average to 8.80 i n d i v i d u a l s and 4.19 couples per week, and 50% reported no desire to change t h e i r present caseload. Family therapists were seen "as working f u l l - t i m e , on average 34.54 hours per week. F i n a l l y , most family therapists (64.8%) indicated no i n t e n t i o n of leaving the profession i n the next f i v e years. A complete d e s c r i p t i o n of the sample i s presented i n Table 1. 51 Table 1: ' Response Rate and Demographic C h a r a c t e r i s t i c s of Sample (N = 142) Ch a r a c t e r i s t i c s M SD Mdn Range P r o v i n c i a l response rate B r i t i s h Columbia Alberta P r a i r i e s Ontario Maritimes 54.8 59.1 71.4 53.2 100. 0 Personal C h a r a c t e r i s t i c s Gender Male (n = 61) Female (n = 81) Age (n = 13 9) M a r i t a l Status Single Married or Committed Separated Divorced Widowed Community Rural Small Town Urban Centre Large Metropolitan 2.8 90. 8 2.1 4.2 0.0 3.5 14.1 57.0 25.4 46.6 8.9 46.0 26-72 Family L i f e - C y c l e Stage Couple Preschoolers School age Young adults Launching Middle years Retirement Other 10. 9. 16. 21. 11. 19. 2. Overall Health Concerns In Therapy No Yes 79.6 20.4 1. 96 0.56 1.13-4.25 (table continues) 52 C h a r a c t e r i s t i c s M SD Mdn Range Professional Variables AAMFT A f f i l i a t i o n C l i n i c a l 76.1 Associate i7.6 Student 6.3 Professional Degree Ph.D. 16.2 Ed.D. 2.8 M.D. 5.6 M.A./M.Sc./M.Ed. 30.3 M.S.W. 31.0 Th.D. 2.1 M.Th. 3.5 M.Div 2.8 Other 5.6 Primary T h e o r e t i c a l Orientation Behavioural 0.7 Bowenian 4.2 Cognitive/Behavioural 5.6 Communications 2.8 Integrative 4.9 Ex p e r i e n t i a l 8.5 Psychoanalytic 7.7 Stra t e g i c 3.5 Str u c t u r a l 4.9 Systemic 36.6 Other 20.4 Secondary Theoretical Orientation (n = 139) Behavioural 2 1 Bowenian 6 3 Cognitive/Behavioural 9 2 Communications 9 2 Integrative 7 7 Ex p e r i e n t i a l 6 3 Psychoanalytic 4 2 Stra t e g i c 9 9 Str u c t u r a l 11 3 Systemic 22 5 Other 9 2 (table continues) 53 C h a r a c t e r i s t i c s % M SD Mdn Range Professional Variables Primary Employment Setting Private Practice 42.3 U n i v e r s i t y Counselling 0.7 Pastoral Counselling 3.5 U n i v e r s i t y Faculty 2.8 Community Mental Health 9.2 Family Agency 18.3 Hospital 11.3 Other 12.0 Secondary Employment Setting Private Practice 31.7 U n i v e r s i t y Counselling 1.4 Pastoral Counselling 2.8 U n i v e r s i t y Faculty 7.7 Community Mental Health 2.8 Family Agency 4.2 Hospital 3.5 Other 7.0 Not Applicable 38.7 Career Stage Beginning 19.0 Mid 72.5 Late 8.5 Caseload (# of clients/week) Individual 8.80 6.76 Couple 4.19 3.52 Family 2.99 3.58 Group .83 2.19 Total Hours of Work 34.54 12.32 Ideal Caseload (n = 141), Smaller 26.8 No change 50.0 Larger 22.5 Intention of Leaving Profession-Not at a l l 64.8 S l i g h t 21.8 Moderate 7.7 Strong 4.2 Very strong 1.4 Note. D i f f e r e n t n's r e s u l t from missing data. 54 Data C o l l e c t i o n Procedures A m a i l i n g - l a b e l l i s t of a l l AAMFT members from the Canadian D i v i s i o n (Zone 5) and who resided i n predominantly English-speaking provinces had been obtained from Washington, D.C. This l i s t included members with c l i n i c a l , associate, and student status. An anonymous survey package was d i s t r i b u t e d to a sample of family th e r a p i s t s . The sampling was s t r a t i f i e d such that 31 members represented B r i t i s h Columbia, 44 members Alberta, 14 members Saskatchewan and Manitoba (these two provinces were collapsed to form the P r a i r i e provinces), 154 members Ontario, and f i n a l l y 7 members Nova Scotia, New Brunswick, Newfoundland, and Prince Edward Island (these provinces were collapsed to form A t l a n t i c Canada). I t was necessary to combine the above-mentioned provinces because the actual number of members i n these populations was very small and, i f considered separately, they may not have been adequately represented i n the return rates. Every province except Quebec was represented i n the mailing. (The sample excluded members from Quebec because the measures had not been developed nor s u f f i c i e n t l y v a l i d a t e d i n the French language). The questionnaire package included the following items, l i s t e d i n order: a l e t t e r of endorsement, a covering l e t t e r , a questionnaire booklet, a stamped and addressed return envelope, and a l o t t e r y t i c k e t with envelope. The l e t t e r of endorsement was provided from Dr. John Banmen, an i n t e r n a t i o n a l l y recognized family therapist and past board member of the AAMFT. Both the l e t t e r of endorsement and the covering l e t t e r were pr i n t e d on appropriate stationery to e s t a b l i s h c r e d i b i l i t y of the study and to encourage family therapists to p a r t i c i p a t e . (See Appendix K for l e t t e r of endorsement). The questionnaire was reduced i n si z e and p r o f e s s i o n a l l y printed i n booklet form. This follows Dillman's (1978) procedures for 55 s u c c e s s f u l l y constructing an " a t t r a c t i v e , well organized questionnaire that looks easy to complete," and presents a professional appearance, thus enhancing "the importance of the survey i n the respondent's eyes" (p. 121-122). An incentive was offered: those who p a r t i c i p a t e d i n the study were e l i g i b l e to win one of two, one-year free memberships to the AAMFT drawn i n a l o t t e r y (see Appendix N). The questionnaires were coded so that a record of respondents was maintained for the purpose of determining whether or not a d d i t i o n a l follow-up reminders were needed. To ensure complete anonymity, the p a r t i c i p a n t s ' names di d not appear anywhere on the questionnaire. The family therapists were i n s t r u c t e d to f i l l out the l o t t e r y t i c k e t and place i t i n the separate envelope provided. Both'the completed questionnaire and sealed l o t t e r y t i c k e t were then to be put into the stamped, addressed return envelope. Upon a r r i v a l of the completed questionnaire, the questionnaire and l o t t e r y t i c k e t were separated so that c o n f i d e n t i a l i t y of respondents was maintained. The l o t t e r y draw took place at the end of the data c o l l e c t i o n period (end of July) and the two winners were n o t i f i e d by mail. They received, i n the form of a bank draf t i n US funds, the amount that covered one year's membership dues. As per Dillman's (1978) procedure for mailing surveys, the questionnaire packets were mailed early i n the week ( i . e . , a Tuesday) to avoid weekend mail delays and to ensure the highest possible return rate. Exactly two weeks l a t e r , a reminder card was sent to each AAMFT member who had not yet responded. Then, at four weeks from the date of the f i r s t mailing, a second and f i n a l follow-up l e t t e r was sent to non-respondents, along with a replacement questionnaire package (see Appendix M for follow-up l e t t e r s ) . The d i s t r i b u t i o n of the questionnaires took place between May 1995 and June 1995; approximately f i v e weeks was allowed for c o l l e c t i o n of the data. Within the f i r s t two weeks of data c o l l e c t i o n , 18 (7.2%) survey 56 packets were returned "address unknown." A f t e r an unsuccessful attempt at l o c a t i n g the therapists'•new addresses, replacement p a r t i c i p a n t s were selected v i a s t r a t i f i e d random sampling. As previously mentioned, 20 family therapists responded that they were not c u r r e n t l y p r a c t i s i n g family therapy, ind i c a t e d i n the pre-screening section of the questionnaire. Comparison tests were used to examine p o s s i b l e demographic differences between the two groups of family therapists those p r a c t i s i n g and those not p r a c t i s i n g family therapy. As expected, the r e s u l t s of the t - t e s t s i n d i c a t e that the t o t a l number of c l i e n t s (in p a r t i c u l a r , couples and families) c a r r i e d by the non-p r a c t i s i n g family therapists was s i g n i f i c a n t l y l e s s (t = -12.72, p_ < .01 and t = -8.14, p < .01, r e s p e c t i v e l y ) , than by the p r a c t i s i n g family t h e r a p i s t s . There was also a s i g n i f i c a n t difference between the two groups i n the t o t a l work hours per week. Non-practising family therapists were less l i k e l y to spend t h e i r time counselling c l i e n t s or supervising and teaching (t = -4.55, p < .01 and t = -2.07, p_ < .05, respectively) than the p r a c t i s i n g therapists (see Table 2). Other pr o f e s s i o n a l demographic variables were compared using a c h i -square t e s t . The r e s u l t s i n d i c a t e that non-practising therapists (40% of them) were more l i k e l y to be i n t h e i r l a t e career stage % 2 (2) = 16.21, p < .001, as compared to the p r a c t i s i n g family therapists (8.5%). As well, more of the non-practising therapists (also 40% of them) sa i d they were l i k e l y to leave the profession i n the next f i v e years % 2 (4) = 12.39, p < .01, as compared to the p r a c t i s i n g family therapists (11.9%). (Some caution i s warranted i n i n t e r p r e t i n g these findings as the sample siz e for the non-practising therapists i s small). No other p r o f e s s i o n a l differences were found to be s i g n i f i c a n t . F i n a l l y , there were no s i g n i f i c a n t differences between non-practising and p r a c t i s i n g family therapists on personal demographics. Table 2: t- t e s t s for Non-Practising and Pr a c t i s i n g Family Therapists 57 Variable N M SD t Value Number C l i e n t s : Individuals/Week Group 1 19 Group 2 142 Number C l i e n t s : Couples/Week Group 1 19 Group 2 142 Number C l i e n t s : Families/Week Group 1 19 Group 2 142 Number C l i e n t s : Groups/Week Group 1 19 Group 2 142 Total Number of Clients/Week Group 1 19 Group 2 142 Hours/Week Seeing C l i e n t s Group 1 20 Group 2 142 Hours/Week Supervising/Teaching Group 1 20 Group 2 142 Hours/Week Office/Paperwork Group 1 20 Group 2 142 Total Work Hours/Week Group 1 Group 2 20 142 5.79 8. 80 . 16 4.19 .21 2.99 6. 84 16.81 8.95 19.21 2.05 3. 94 7. 60 9. 87 18 . 6 33. 02 8.22 6.76 . 50 3.52 .71 3.58 8.53 8.58 10.76 9.25 3.46 5.81 10.56 7.52 14.75 12.14 -1.77 -12.72 -8.14 68 2.11 -.28 83 2.19 -4.76 -4.55 -2.07 93 -4 . 84 Note. Group 1 represents non-practising family ther a p i s t s ; Group 2 represents p r a c t i s i n g family th e r a p i s t s . D i f f e r e n t n's r e s u l t from missing data. * E < .05 ** p_ < .001 58 Instruments Each family therapist completed an anonymous questionnaire. The study was introduced as a survey on the work and family experiences of family t h e r a p i s t s . (See Appendix L for covering l e t t e r ) . The Preliminary Section was established for screening purposes at two l e v e l s . The f i r s t determined the current work status of the family therapist; only those p r a c t i s i n g family therapy were included i n the research sample. The second determined marital status, perception and composition of the family unit (see Appendix A) . Those therapists who d i d not have immediate family or who were s i n g l e and l i v i n g alone were excluded from the study. The survey contained the following three standardized s e l f - r e p o r t measures: (1) Maslach Burnout Inventory, (2) Family Inventory of L i f e Events and Changes, and (3) Family Relationship Index. I t also contained the following non-standardized sets of questions and/or c h e c k l i s t s : (1) Family/Work Concerns, (2) Stress-Management Checklist, and (3) Therapist Work A c t i v i t i e s L i s t . The sets of non-standardized questions and/or ch e c k l i s t s were developed for the study since no standardized measures were found i n the l i t e r a t u r e s p e c i f i c to exploring both the family and work concerns, coping strategies, and work performance of family therapists. As well, two grids, the Family Functioning Grid and the Therapeutic Functioning Grid (in-session functioning), were used to obtain a long-term measure of functioning both at home and at work for the family therapist. These standardized measures and non-standardized questions are discussed i n d e t a i l below. F i n a l l y , a demographic section (see Appendix J) requested general information on gender, age, and geographic l o c a t i o n . The demographic section also s o l i c i t e d information s p e c i f i c to the therapist's p r o f e s s i o n a l status, t r a i n i n g , career stage, t h e o r e t i c a l o r i e n t a t i o n , l o c a t i o n of employment, work hours, caseload, i d e a l caseload and i n t e n t i o n 59 of leaving the profession. Personal information sought included family l i f e - c y c l e stage, health, and involvement i n personal therapy. Standardized Measures Maslach Burnout Inventory (MBI). The Maslach Burnout Inventory was used to measure burnout; s p e c i f i c a l l y , i t measured the family therapists' a t t i t u d e s , f e e l i n g s , and perceptions of themselves and t h e i r c l i e n t e l e (see Appendix B). The MBI consists of 22 statements designed to assess the three aspects of the burnout syndrome: (1) Emotional Exhaustion, (2) Depersonalization, and (3) Personal Accomplishment. The Emotional Exhaustion subscale i s concerned with f e e l i n g s of being emotionally overextended and drained by one's work. The Depersonalization subscale i s concerned with the development of negative and c y n i c a l attitudes towards re c i p i e n t s of one's care. The Personal Accomplishment subscale i s concerned with feelings of competence and success i n working with people. Burnout i s conceptualized as a continuous variable, ranging from low to moderate to high degrees of experienced f e e l i n g . High scores on the Emotional Exhaustion and Depersonalization subscales and low scores on the Personal Accomplishment subscale r e f l e c t s a high l e v e l of burnout. A moderate degree of burnout i s r e f l e c t e d i n moderate scores on a l l three subscales, while a low degree of burnout i s r e f l e c t e d i n low scores on the Emotional Exhaustion and Depersonalization subscales and i n high scores on the Personal Accomplishment subscale. Scores were considered high i f they were i n the upper t h i r d of the normative d i s t r i b u t i o n , moderate i f they were i n the middle t h i r d , and low i f they were i n the lower t h i r d . The numerical cutoff points, or norms, were provided by Maslach and Jackson (1986); these norms are well suited for research purposes. The scores for each subscale were considered separately and were not combined in t o a t o t a l score. 60 The preliminary form of the MBI consisted of 47 items i n a two-scale format (frequency and"intensity) which was administered to a sample of 605 health-services people (56% male and 44% female). Secondarily, a series of factor analyses on a broad range of human-service people re s u l t e d i n the construction of a four-factor scale with 25 questions. These questions covered the following: Emotional Exhaustion (nine items), Depersonalization (five items). Personal Accomplishment (eight items), and Involvement (three items). The Involvement scale i s no longer considered i n the l a t e s t manual; neither i s the i n t e n s i t y r a t i n g . The subscales of Emotional Exhaustion and Depersonalization are moderately co r r e l a t e d at 0.52. The Personal Accomplishment subscale i s independent of the other two subscales. Emotional Exhaustion and Personal Accomplishment are weakly correlated at 0.22 and Depersonalization and Personal Accomplishment are weakly correlated at 0.26. The r e l i a b i l i t y c o e f f i c i e n t s reported are based on samples not used i n item s e l e c t i o n , to avoid improper i n f l a t i o n of the r e l i a b i l i t y estimates. Using Cronbach's c o e f f i c i e n t alpha, the r e l i a b i l i t y estimates are 0.90 for Emotional Exhaustion, 0.79 for Depersonalization, and 0.71 for Personal Accomplishment. In t h i s study, the standardized c o e f f i c i e n t alpha for each subscale i s 0.91 for Emotional Exhaustion, 0.67 for Depersonalization, and 0.74 for Personal Accomplishment. Test-retest r e l i a b i l i t y f o r a 2-4 week i n t e r v a l i s 0.82 for Emotional Exhaustion, 0.60 for Depersonalization, and 0.80 for Personal Accomplishment (Maslach & Jackson, 1986). A l l c o e f f i c i e n t s are s i g n i f i c a n t beyond the 0.001 l e v e l . S t a b i l i t y c o e f f i c i e n t s suggest that Emotional Exhaustion i s the most stable dimension, whereas Depersonalization i s the l e a s t stable dimension. Convergent v a l i d i t y has been s u b s t a n t i a l l y demonstrated i n several ways. F i r s t , i n d i v i d u a l s ' MBI scores have been compared with independent behavioural ratings made by persons well-known to the i n d i v i d u a l , such as co-workers or spouses. People rated by co-workers as being emotionally 61 drained d i d score higher on Emotional Exhaustion and Depersonalization, as expected. Spousal ratings of p o l i c e o f f i c e r s confirmed p r e d i c t i o n s that o f f i c e r s scoring high on Emotional Exhaustion were seen as coming home upset, angry, p h y s i c a l l y exhausted, and complaining about work (Maslach & Jackson, 1982). Further evidence of convergent v a l i d i t y comes from studies c o r r e l a t i n g MBI scores with various job c h a r a c t e r i s t i c s (e.g., caseload, task s i g n i f i c a n c e , feedback from the job) that were expected to contribute to the experience of burnout (Maslach & Jackson, 1982). F i n a l l y , MBI scores have been shown to be correlated with personal outcome and reactions. MBI scores have been associated with i n t e n t i o n to leave one's job (Maslach & Jackson, 1982), as well as increased use of alcohol and drugs (Jackson & Maslach, 1982). Discriminant v a l i d i t y of the MBI has been provided by Meier (1984). Single scores of the MBI correlated s i g n i f i c a n t l y with Meier Burnout Assessment (r = 0.61). Furthermore, discriminant v a l i d i t y has also been obtained by d i s t i n g u i s h i n g the MBI from other constructs ( l i k e job s a t i s f a c t i o n and depression). A comparison of MBI scores and the Job Diagnostic Survey (JDS) (Maslach, 1976) finds that l e s s than 6% of the variance i s accounted for by any one of the subscale c o r r e l a t i o n s . Thus, burnout i s not simply a synonym for job d i s s a t i s f a c t i o n . However, Emotional Exhaustion was found to be s u b s t a n t i a l l y r e l a t e d to depression as measured by Beck's Depression Inventory ( F i r t h , 1986). F i n a l l y , the MBI subscale scores were compared by Maslach and Jackson (1981) with scores on the Crowne-Marlowe Soc i a l D e s i r a b i l i t y Scale for 40 graduate students i n s o c i a l welfare. None of the MBI subscales were s i g n i f i c a n t l y correlated with s o c i a l - d e s i r a b i l i t y scores. Currently, the MBI i s the most widely used index of burnout i n studies with i n d i v i d u a l s who do "people work" (Pines, 1993). I t "shows adequate evidence of both r e l i a b i l i t y and v a l i d i t y ... and may be used for 62 a wide v a r i e t y of occupations ... requiring extensive contact with others" (Offermann, 1985, p. 424). Family Inventory of L i f e Events and Changes (FILE). The Family Inventory of L i f e Events and Changes was used to assess the cumulative stressors and l i f e changes (positive and negative) experienced by the family t h e r a p i s t and his or her family members over a 12-month period (McCubbin & Patterson, 1983, 1991) (see Appendix D). Based on psychobiological stress research and family-stress theory, a pool of 171 items was developed. McCubbin and Patterson (1983) incorporated the concept of "pile-up" (multiple l i f e changes within a short period of time) into H i l l ' s (1958) ABCX f a m i l y - c r i s i s model. The r e s u l t was the "double-ABCX model," which suggests that cumulative stressors experienced by members of a family during the past year should be considered because cumulative stress may increase a family's v u l n e r a b i l i t y to a sin g l e s t r e s s f u l event. The f i r s t version of FILE, developed by McCubbin, Wilson, and Patterson i n 1979 (cited i n McCubbin & Patterson, 1991), used families l i v i n g i n a r u r a l l o c a l e experiencing chronic i l l n e s s among one family member. The 171 items were chosen to r e f l e c t substantive changes (either p o s i t i v e or negative) within families that would require adjustment i n t y p i c a l family i n t e r a c t i o n s . The authors' c l i n i c a l experience and research with f a m i l i e s and i n d i v i d u a l life-change inventories ( l i k e Holmes and Rahe's S o c i a l Readjustment Scale, 1967) provided d i r e c t i o n for the se l e c t i o n of the items. Also included were items that r e f l e c t e d l i f e events t y p i c a l l y experienced by families at d i f f e r e n t stages i n the family l i f e cycle. Using factor analysis, FILE was reduced to produce a 71-item inventory with nine subscales: Intra-Family Strains, M a r i t a l Strains, Pregnancy and Childbearing Strains, Finance and Business Strains, Work-Family Transitions and Strains, I l l n e s s and Family Care Strains, Family 63 Losses, Family Transitions In and Out, and Family Legal Strains (McCubbin & Patterson, 1991). The respondent determines which of the 71 events l i s t e d has occurred to any one family member or the family as a whole during the l a s t year and responds with a "Yes" or "No". Although several methods of scoring are possible with t h i s inventory, the t e s t authors recommend using weighted standardized scores to account for the r e l a t i v e importance and i n t e n s i t y of the l i f e events. Furthermore, the t e s t authors believe that the degree of family stress should be evaluated only on the basis of a comparable stage of the l i f e cycle. Thus, a question on family l i f e - c y c l e stage has been included i n the study. Normative data were c o l l e c t e d from 2,280 married subjects across the seven stages of the family l i f e cycle (Olson, McCubbin, Barnes, Larsen, Muxem, & Wilson, 1982). Thus, the score i s compared with the normative data for f a m i l i e s i n the same stage of the family l i f e c ycle. The normative data locate the family i n a high-stress, moderate-stress, or low-stress category. I t i s important to note that the measure seems best suited to the t r a d i t i o n a l nuclear family and the types of stresses that impinge on i t . In t h i s t h e s i s , 91.5% of family therapists responded as belonging to one of the seven stages of the f a m i l y - l i f e cycle. The remaining 8.5%, which comprised the "other" category, were t y p i c a l l y those l i v i n g i n homosexual partnership or blended f a m i l i e s . Very l i t t l e r e l i a b i l i t y and v a l i d i t y information i s a v a i l a b l e for FILE. A sample of 322 families with a c h r o n i c a l l y i l l c h i l d yielded an i n t e r n a l consistency estimate of 0.72 (Cronbach's Alpha) for the Total Family Pile-Up Score (McCubbin & Patterson, 1991). A d d i t i o n a l analyses with another sample (2,740 individuals) resulted i n an o v e r a l l r e l i a b i l i t y c o e f f i c i e n t of 0.81 (McCubbin & Patterson, 1991). However, the i n t e r n a l consistency estimates for the subscales were lower, ranging from 0.16 to 64 0.72. In t h i s study, the Total Pile-Up Score was used as opposed to subscale scores and the r e l i a b i l i t y c o e f f i c i e n t was 0.78. Test-retest r e l i a b i l i t i e s were obtained from 150 (predominantly single) i n d i v i d u a l s a f t e r a five-week period. The c o r r e l a t i o n s suggest r e l a t i v e l y stable responses for the Total Family Pile-Up Score (r = 0.80) and the subscales (0.64 to 0.84) (Olson, McCubbin, Barnes, Larsen, Muxem, & Wilson, 1982) . Evidence of v a l i d i t y i s provided by several studies. McCubbin and Patterson (1983) reported that the Total Family Pile-Up Score of the o r i g i n a l measure correlated s i g n i f i c a n t l y and i n v e r s e l y with a decline i n the health status of children with c y s t i c f i b r o s i s . The t e s t authors also correlated the nine subscales and the Total Family Pile-Up Score with the Family Environment Scale (FES). The t o t a l score of the FILE r e l a t e d s i g n i f i c a n t l y and i n v e r s e l y with several of the FES scales, i n c l u d i n g Family Cohesion, Independence of Family Members, and Family Organization. A p o s i t i v e c o r r e l a t i o n was found between Total Family Pile-Up Score and family c o n f l i c t as measured by FES. Other investigators have also found that the t o t a l score of the FILE related negatively to variables of family cohesion, a d a p t a b i l i t y , and p o s i t i v e a f f e c t toward ch i l d r e n with a sample of f i r s t - m a r r i e d (N = 106) and remarried (N = 108) families (Waldren, B e l l , Peek & S o r e l l , 1990). According to the review by O'Brien and Brown (1990), FILE has good face v a l i d i t y and has been " c a r e f u l l y designed from a clea r and consistent t h e o r e t i c a l model of family stress ... and provides a useful d e s c r i p t i v e i n d i c a t o r of family s t r e s s " (p. 264 & 266). But, because FILE i s a r e l a t i v e l y new instrument some caution has been exercised i n i n t e r p r e t i n g l e v e l s of family s t r e s s . Family Relationship Index (FRI). The Family Relationship Index assessed the q u a l i t y of s o c i a l r e l a t i o n ships within the family therapist's family (see Appendix E). This measure has been derived from the Family 65 Environment Scale (Holahan & Moos, 1983). I t consists of a 27-item, forced choice (true-false) inventory and i s based on the three subscales that comprise the r e l a t i o n s h i p domain of the Family Environment Scale (Moos & Moos, 1986). The three subscales of the FRI are Cohesion, Expressiveness, and C o n f l i c t . Cohesion assesses the "degree to which family members are h e l p f u l and supportive of one another"; Expressiveness assesses the "extent to which family members act openly and express f e e l i n g s " with one another; and C o n f l i c t assesses the "extent to which there i s open expression of anger and aggression" (Holahan & Moos, 1983, p. 158). (The authors have reversed the scoring on the subscale of C o n f l i c t , so that a l l three subscales are scored i n the same d i r e c t i o n ; scores range from 0 to 27). This measure, the FRI, was selected for i t s a b i l i t y to match s i m i l a r areas of family functioning studied by Burr and Klein (1994) and reported as being "meaningful aspects of the family system i n response to s t r e s s " (p. 126). The Family Environment Scale i s a multidimensional measure and t e s t development has focused on each of the 10 subscales within the measure. However, the Family Relationship Index i s a unidimensional measure and scale development has focused on three subscales combined together to form a si n g l e conceptual dimension. In the o r i g i n a l development of the FES, each item selected had to i d e n t i f y an aspect of family environment and r e f l e c t an emphasis on interpersonal r e l a t i o n s h i p s . Items c h a r a c t e r i s t i c of extreme fam i l i e s were avoided, while an equal number of items with true and f a l s e responses were included to control for response set. The norms for the FES were based on a sample of 1,125 normal and 500 d i s t r e s s e d families from " a l l areas of the United States, single-parent and multigenerational f a m i l i e s , and families from d i f f e r i n g ethnic groups of a l l ages" (Moos & Moos, 1986, p. 5). The FRI was administered to a random sample of 267 male and 267 female San Francisco Bay area residents. A f u l l 66 demographic breakdown of the norm group and the t e s t group for the FRI was not provided; thus, the p o s s i b i l i t y of sampling bias may e x i s t . Using Cronbach's Alpha, the FES subscales demonstrate moderate to high i n t e r n a l consistency, ranging from 0.61 to 0.78. S i m i l a r l y , the FRI has high i n t e r n a l consistency (Cronbach's Alpha = 0.89), with a median i n t e r c o r r e l a t i o n among the three subscales of 0.43 (Holahan & Moos, 1983). In t h i s t h e s i s , i n t e r n a l consistency for the FRI was 0.66. Test-retest r e l i a b i l i t i e s have been computed for an eight-week period; they are acceptable, ranging from 0.73 for Expressiveness to 0.86 for Cohesion. The measure i s considered to have considerable s t a b i l i t y . Support for the construct v a l i d i t y of the FES has been established through numerous studies (for a review see Caldwell, 1985), while the construct v a l i d i t y of the FRI has been assessed by examining i t s r e l a t i o n s h i p to the indices of physical and psychological symptoms ( l i k e depression, psychosomatic i l l n e s s , and negative l i f e events). The findings suggest that the FRI has a s i g n i f i c a n t negative r e l a t i o n s h i p to both i l l n e s s measures for the following: employed men, and employed and unemployed women. It also has a s i g n i f i c a n t negative r e l a t i o n s h i p to depression for unemployed men (Holahan & Moos, 1983). Holahan and Moos further believe that the FRI can make an important contribution to understanding whether family support moderates the e f f e c t s of stress. In sum, the FRI appears to have good face v a l i d i t y . Generally, each item i s c l e a r l y expressed and seems to have relevance to the r e l a t i o n s h i p domain of family functioning. Non-standardized Measures Family/Work Concerns. The Family/Work Concerns c h e c k l i s t , developed for t h i s study, consists of 32 statements r e l a t i n g to d a i l y occurrences that a family therapist may experience as s t r e s s f u l both at home and at work (see Appendix C). The f i r s t part was designed to determine the actual 67 occurrence of a p a r t i c u l a r concern. The second part explored the therapist's perception of work and family stresses which i n t e r f e r e with his or her work as a t h e r a p i s t . The t h i r d and f i n a l section assessed the therapist's l e v e l of s a t i s f a c t i o n i n handling the s p e c i f i c stresses. For example, therapists were asked to decide i f "family l i f e s p i l l s over into work" (question 21). I f t h i s event had occurred, they then needed to decide i f the event i n t e r f e r e d with t h e i r work. F i n a l l y , i f work interference had taken place, the therapist needed to respond regarding his or her l e v e l of s a t i s f a c t i o n i n handling family s p i l l o v e r i n t o work. The statements used i n the construction of the Family/Work Concerns were derived from three areas i n the l i t e r a t u r e : Charney's (1982) p o s i t i o n paper on the mental health of family therapists; Faber and Heifetz's (1982) research on stresses s p e c i f i c to psychotherapeutic work; and Wetchler and Piercy's (1986) more recent study of stressors s p e c i f i c to the l i v e s of family t h e r a p i s t s . The work and personal stresses i d e n t i f i e d i n the l i t e r a t u r e have been grouped into four areas: r e l a t i o n s h i p , scheduling, overinvolvement, and doubts. The categories have been adapted from Faber and Heifetz's (1982) research and, for the purposes of t h i s study, have been expanded to include items r e l a t e d to family stress. The f i r s t section of the scale, i n which the therapist was asked to rate the occurrence of the p a r t i c u l a r work or family concern, provides for a "Yes" or "No" answer. The second section of the scale, an i n d i r e c t look at therapeutic functioning, asked the therapist to i d e n t i f y whether c e r t a i n stresses i n t e r f e r e d with family therapy work; again possible answers were "Yes" and "No". F i n a l l y , the therapist rated his or her l e v e l of s a t i s f a c t i o n i n handling work and family stresses; possible responses were "Yes", "?" for undecided, and "No". From t h i s set of questions three scores were obtained. F i r s t , a t o t a l score was derived from the work and family stresses; i t was a simple 68 addition of the number of "Yes" items endorsed i n the section on Occurrence (scores range from 0 to 32). Second, Interference was indexed with a frequency score of 1 for those items endorsed "Yes", as i n d i c a t i n g they i n t e r f e r e d with family-therapy work, and of 0 for items answered with a "No". Third, S a t i s f a c t i o n was indexed by assigning a frequency r a t i n g of 2 for items answered "Yes" as i n d i c a t i n g s a t i s f a c t i o n i n handling work and family concerns, of 1 for items endorsed with a "?" (undecided), and of 0 for those items answered "No". F i n a l l y , the v a l i d i t y and r e l i a b i l i t y of the Family/Work Concerns c h e c k l i s t was not established. An attempt was made to measure the i n t e r n a l consistency of each of the three subsections of the c h e c k l i s t . The i n t e r n a l consistency for items i n the Occurrence subsection was c a l c u l a t e d (standardized item alpha = .86). However, a standardized item alpha could not be computed for e i t h e r the Interference or S a t i s f a c t i o n subsections because items considered "not a p p l i c a b l e " were coded as blank. This "skip pattern" precludes r e l i a b i l i t y c a l c u l a t i o n s i n t h i s type of format. Family Functioning Grid. The Family Functioning Grid was administered but i s not relevant to the hypotheses tested i n t h i s thesis; i t remains as part of future study. The Grid developed by Wesley Burr (1994) provides a graphic de s c r i p t i o n of an i n d i v i d u a l ' s perception of how his or her family functions, i n one or more areas of family l i f e , under s t r e s s f u l s i t u a t i o n s . The Family Functioning Grid was used to g r a p h i c a l l y depict the family therapist's perception of stress and i t s impact on o v e r a l l family functioning over a one-year period (see Appendix F). The therapist was asked to r e c a l l both p o s i t i v e and negative family experiences over the past year. Prior survey questions, from the Family Changes Inventory and the Family Environment Scale, should have primed the p a r t i c i p a n t for r e c o l l e c t i o n of events that impacted his or her l e v e l of family functioning. Therapists then p l o t t e d on the g r i d t h e i r l e v e l of family functioning (see Figure 1 below). 69 Substantially Better Much Better Better Slightly Better Usual for us Slightly Disrupted Moderately Disrupted Severely Disrupted Paralysed 4 3 2 1 0 -1 -2 -3 -4 ft u fe fe a a O > 4) O U O 4= a ? ^ 0) M 3 0) 3 £ Figure 1: Family Functioning Grid The "X" marked on the g r i d indicates a sample response. In t h i s case, a therapist was experiencing "better" than usual family functioning f o r the month of A p r i l 1995. (Adapted from W. Burr and S. Klein, 1994, Reexamining Family Stress, p. 69.) The x-axis of the g r i d i s the measure of time; each of the 12 c e l l s represents one month (A p r i l 1995 to May 1994). The y-axis of the g r i d i s the measure of family functioning and consists of eight c e l l s . In th i s case, the y-axis i s the measure of the therapist's l e v e l of o v e r a l l family functioning. A baseline divides the g r i d i n ha l f ; four c e l l s are above, and four c e l l s below, the baseline. The baseline i s numerically represented with a zero and i s considered the therapist's l e v e l of usual functioning. Above-the-baseline functioning was allowed to become " s l i g h t l y b e t t e r , " "better," "much better," and " s u b s t a n t i a l l y better"; below-the-baseline functioning could become " s l i g h t l y disrupted," "moderately disrupted," "severely disrupted," and "paralysed" (Burr & Klein, 1994, p. 69). A scale from +4 to -4 captured the numerical range 70 for the descriptors for family functioning (Burr, 1994, p. 69). As suggested by Burr and K l e i n (1994), family functioning could be either p o s i t i v e or negative during times of stress. The family-functioning score was derived i n the following way. F i r s t , an average family-functioning score was computed by taking the t o t a l score for p o s i t i v e functioning (scores above the baseline) and subtracting t o t a l score for negative functioning (scores below the b a s e l i n e ) . Second, a s t a b i l i t y score for family functioning was derived by counting the number of times that the family-functioning score crossed the baseline from p o s i t i v e to negative and/or vice versa (range of scores, 0 to 11). Stress-Management Strategies. The Stress-Management Strategies c h e c k l i s t , a forced-choice, 20-item l i s t i n "Yes or No" response format, was developed for t h i s study to explore the coping strategies used by the family t h e r a p i s t (see Appendix G). The coping statements were adapted from two sources: Lazarus and Folkman's (1984) "emotion-focused and problem-focused coping s t r a t e g i e s , " and Burr and Klein's (1994) framework for "family coping s t r a t e g i e s . " Both frameworks are based on a process approach to coping. The frameworks focus on what the person a c t u a l l y thinks or does rather than what the person usually does or thinks they should do. Furthermore, coping i s seen as i n v o l v i n g a combination of both f a m i l i a l and i n d i v i d u a l processes i n the managing of stress (Boss, 1987). The Stress-Management Strategies c h e c k l i s t was based on four categories of coping s t r a t e g i e s : cognitive, emotional, r e l a t i o n s h i p , and community. These categories have been adapted from Burr and Klein's (1994) l i s t of seven family-coping s t r a t e g i e s . The items are grounded i n the concept that there are coping strategies which are "universal and transcend a l l types and categories of s t r e s s o r " (McCubbin & Figley, 1983, p. 18). The 20 strategy statements i n the Stress-Management Strategies c h e c k l i s t were developed from an overlap with t h e o r e t i c a l frameworks, as proposed by both Burr and K l e i n (1994) and Lazarus and Folkman (1984). The 71 20 strategies have been endorsed as being h e l p f u l i n coping with family stress (Burr & Klein, 1994, p. 159), emphasize both family and i n d i v i d u a l strategies of coping with stress, and have s p e c i f i c relevance to a family therapist's strategy choices. The v a l i d i t y and r e l i a b i l i t y of t h i s c h e c k l i s t have not been established; however, i n t e r n a l consistencies based on the sample data obtained from t h i s study were calculated (standardized item alpha = .60). . Thus, t h i s c h e c k l i s t appears to be r e l a t i v e l y stable. Scoring of the c h e c k l i s t was as follows. A frequency score of 1 was given to each of the coping strategies answered "Yes"; a "No" item was given a frequency score of 0. Therapeutic Functioning. To explore the family therapist's work performance, the concept of therapeutic functioning was developed. Although t h i s concept i s not e x p l i c i t l y defined i n the l i t e r a t u r e , for the purposes of t h i s study i t pertains to s p e c i f i c work a c t i v i t i e s and/or functions that a family t h e r a p i s t performs i n the everyday p r a c t i c e of family counselling. S p e c i f i c a l l y , therapeutic functioning was measured by assessing the family therapist's perception i n two areas r e l a t i n g to family-therapy work. The f i r s t area pertained to everyday therapist work a c t i v i t i e s . For example, therapists were asked to determine i f they "performed co-therapy work" (question 16). If they ro u t i n e l y d i d co-therapy work, they were then to decide i f over the past year they had given up performing t h i s type of task due to work or family stress. (Items for the "Work A c t i v i t i e s " l i s t were adapted from the Dictionary of Occupational T i t l e s (1991), Employment and Immigration Canada, Canada Communications Group (1992), and from personal communications with p r a c t i s i n g t h e r a p i s t s ) . The questions from the "Work A c t i v i t i e s " l i s t provided a measure of the family therapist's perception of changes i n work a c t i v i t y that may have resulted from work and family s t r e s s . 72 P a r t i c i p a n t s responded to a l i s t of 29 "Work A c t i v i t i e s . " The scoring of the "Work A c t i v i t i e s " was a simple count of those tasks that the therapist usually performed as part of t h e i r job (description), but were relinquished due to work and family stress. The v a l i d i t y and r e l i a b i l i t y of t h i s c h e c k l i s t has not been established, so, using the data obtained i n t h i s research, measures of i n t e r n a l consistency were computed. The standardized item alphas are as follows: number of work a c t i v i t y items performed (.70), number of work a c t i v i t y items relinquished (.77). Thus, the s t a b i l i t y of these items appears good. The second area of therapeutic functioning pertained to in-session functioning with c l i e n t s . Four therapist functions ( i . e . , engagement, problem i d e n t i f i c a t i o n , change f a c i l i t a t i o n , and termination) formed the basis for completing the Therapeutic Functioning Grid that provided a measure of therapist counselling effectiveness. The Therapeutic Functioning Grid had been modified from Wesley Burr's (1994) work on the Family Functioning Grid. In the current study, the Therapeutic Functioning Grid was used to g r a p h i c a l l y depict the family therapist's perception of stress and i t s impact on his or her l e v e l of in-session functioning over a one-year period. The therapist focused on each of the four s p e c i f i c therapy functions and determined i f his or her l e v e l of functioning had changed as a r e s u l t of the work and family stresses experienced during the past year. These functions are part of an integrated, systems framework for family-therapist functioning developed by Tomm and Wright (1979). Their model has evolved through a s s i m i l a t i n g many theories and techniques from d i f f e r i n g schools of family therapy. It has been organized at three l e v e l s of t h e r a p i s t a c t i v i t y : functions, competencies, and s k i l l s . (Only "functions", the f i r s t l e v e l of therapist a c t i v i t y , was assessed here). According to the authors, these functions tend to follow i n a l i n e a r fashion but over the course of therapy a therapist moves back and f o r t h 73 among the four functions. Also, the four functions are presented as d i s c r e t e u n i t s ; however, i n the process of therapy, a therapist may use these functions together, simultaneously. S p e c i f i c a l l y , engagement refers to the "process of e s t a b l i s h i n g a meaningful working r e l a t i o n s h i p " with c l i e n t s . Problem i d e n t i f i c a t i o n i s an "ongoing assessment process." Change f a c i l i t a t i o n i s the core of the therapeutic process; " i t includes interventions aimed at a l t e r i n g interpersonal patterns of i n t e r a c t i o n and i n d i v i d u a l family member's behaviour, thinking, and experience." Termination i s the process of " r e l i n q u i s h i n g the r e l a t i o n s h i p between the therapist and family" i n a manner that encourages the family to maintain constructive changes and solve future problems (Tomm & Wright, 1979, p. 228) . As noted, these four functions were used as the basis for respondents' s e l f - r e p o r t of t h e i r therapeutic functioning. The x-axis of the g r i d measures time; each of the 12 c e l l s represents one month ( A p r i l 1995 to May 1994). The y-axis measures in-session therapist functioning and consists of eight c e l l s . A baseline divides the g r i d i n h a l f ; four c e l l s are above, and four c e l l s below, the baseline. The baseline i s numerically represented with a zero and i s considered the therapist's l e v e l of usual t h e r a p i s t functioning. Above-the-baseline functioning was allowed to become " s l i g h t l y b e t t e r , " "better," "much bet t e r , " and " s u b s t a n t i a l l y b e t t e r , " while below-the-baseline functioning could become " s l i g h t l y disrupted," "moderately disrupted," "severely disrupted," and "paralysed" (Burr, 1994, p. 69). A scale from +4 to -4 captured the numerical range for the descriptors (Burr & Klein, 1994, p. 69). The therapeutic-functioning scores were derived i n the following two ways. F i r s t , an average therapeutic-functioning score was computed by taking the t o t a l score for p o s i t i v e functioning (scores above the baseline) and subtracting i t from the t o t a l score for negative functioning (scores 74 below the b a s e l i n e ) . Second, a s t a b i l i t y score for therapeutic functioning was derived by counting the number of times that the therapeutic functioning score crossed the baseline from p o s i t i v e to negative and/or vice versa (range of scores, 0 to 11) . Demographic Data. Participants were asked to provide information on a number of demographic variabl e s , including t h e i r age, gender, marital status, geographic l o c a t i o n , educational t r a i n i n g , p r o f e s s i o nal standing, career stage, work se t t i n g , work hours, caseload, t h e o r e t i c a l o r i e n t a t i o n , health, i n t e n t i o n to leave profession, and involvement i n personal therapy. Summary of the Instruments The order of administration within the questionnaire was structured such that screening items were presented f i r s t . Second came items pertaining to burnout,' family and work concerns, and family l i f e events and changes. With these items at the beginning of the survey, family therapists would see that the questionnaire had good face v a l i d i t y . Items on family r e l a t i o n s and family functioning followed. I t was important to have these questions follow items pertaining to work and family stress, since i t was assumed that thinking about work and family stress would f i n e -tune the p a r t i c i p a n t ' s a b i l i t y for s e l f - r e f l e c t i o n and help with the r e c a l l of functioning over a one-year time frame. The items on coping strategies were presented next, since a l l items r e l a t i n g to work and family stress had been asked. The items on therapeutic functioning, which may have appeared more threatening, were reserved for a l a t e r section of the questionnaire; because they asked the therapist to evaluate his or her own job functioning. At t h i s point i n the questionnaire, the therapist should have f e l t l e s s reluctant to answer such questions. The f i n a l section dealt with demographic questions and the most personal items were presented l a s t . 75 again to reduce any r i s k of possible threat to the therapist and to avoid bias i n the responses. S t a t i s t i c a l Analyses F i r s t , to answer the three preliminary hypotheses, a se r i e s of t -tests was computed to explore s i g n i f i c a n t differences between gender and the dependent va r i a b l e s . Normative data on burnout among mental health professionals was a v a i l a b l e to permit a comparison with our present sample of family therapists (Maslach & Jackson, 1986). To explore the relationship s between the demographic and dependent variable s , a complete c o r r e l a t i o n matrix was computed for age, number of c l i e n t s , hours of work, and health. For the remaining demographic variables such as marital status, family l i f e - c y c l e stage, career stage, and i n t e n t i o n of leaving the profession, a series of one-way analyses of variance and t - t e s t s were computed. Second, to answer the seven primary hypotheses of the t h e s i s , either c o r r e l a t i o n a l or comparison analyses were performed. For questions pertaining to the l e v e l s of s t r e s s f u l normative and nonnormative l i f e events and t h e i r r e l a t i o n s h i p to burnout (Hypothesis 3), or therapeutic functioning (Hypothesis 5), Pearson product-moment co r r e l a t i o n s were computed. Hypotheses concerned with the r e l a t i o n s h i p between the family therapist's degree of s a t i s f a c t i o n or d i s s a t i s f a c t i o n i n handling work and family stress and burnout (Hypothesis 4 and 4a), or therapeutic functioning (Hypothesis 6 and 6a), were also explored using Pearson product-moment co r r e l a t i o n s . Again, c o r r e l a t i o n a l analyses were performed to detect r e l a t i o n s h i p s between family functioning and burnout (Hypothesis 7), or therapeutic functioning (Hypothesis 8). F i n a l l y , to determine possible s i g n i f i c a n t differences i n burnout (Hypothesis 9), or therapeutic functioning (Hypothesis 10) among family therapists who engage or do not 76 engage i n stress-managing behaviours, a series of one-way analyses of variance and t - t e s t s were calculated. F i n a l l y , i n addition to the above analyses, a series of scattergrams was p l o t t e d for variables studied v i a c o r r e l a t i o n a l analyses. This was done to ensure that any unusual findings, such as nonlinear relationships or o u t l i e r s would, be detected. As well, a series of histograms was produced to examine the skewness of the d i s t r i b u t i o n for each of the variables under study. Methodological Assumptions The following assumptions were maintained i n t h i s study: 1. The standardized measures used were s u f f i c i e n t l y r e l i a b l e and v a l i d . A l l non-standardized measures used appeared reasonably sound and appropriate for the purposes of t h i s i n v e s t i g a t i o n . 2. The p a r t i c i p a n t s of the study were s u f f i c i e n t l y representative of the population studied to permit some generalizations of the findings. 3. The data was accurately scored by the author. 4. The.data was accurately recorded and analyzed by the author. 77 CHAPTER IV RESULTS This chapter investigates whether personal stress, c o n s i s t i n g of family and work concerns and s t r e s s f u l f a m i l y - l i f e events or changes, i s associated with burnout and reduced therapeutic functioning. A secondary, but simultaneous, i n v e s t i g a t i o n considers whether a p o s i t i v e l e v e l of family functioning and the use of stress-managing strategies are l i n k e d to pr o f e s s i o n a l effectiveness. The r e s u l t s of the data analyses are presented below. A summary of d e s c r i p t i v e s t a t i s t i c s for a l l independent and dependent variables i s provided i n Appendix P. Preliminary Hypotheses Hypothesis 1 and l a . I t was hypothesized that male and female family therapists would s i g n i f i c a n t l y d i f f e r on l e v e l s of burnout as measured by the Maslach Burnout Inventory (MBI). Investigation of gender differences, using t -tests, revealed that both male and female family therapists experienced moderate to low l e v e l s of emotional exhaustion, with male therapists scoring s l i g h t l y higher than female therapists on t h i s subscale. The differ e n c e was s i g n i f i c a n t at the alpha l e v e l £ < .10. Gender comparisons are presented i n Table 3. T y p i c a l l y , the l i t e r a t u r e suggests that women experience more emotional exhaustion than men (Maslach & Jackson, 1985; Pines, 1988); however, i n t h i s study a number of male therapists reported that t h e i r workload was impacted by administrative tasks i n addition to t h e i r counselling duties. Furthermore, i t i s important to note that the amount of v a r i a b i l i t y , or deviation from the mean score, for males and females on emotional exhaustion i s high i n the current study. Therefore, i n c l i n i c a l p r a c t i c e , one would not expect to f i n d much dif f e r e n c e between 78 male and female family therapists on the expression of emotional exhaustion. Both genders experienced low l e v e l s of reduced personal accomplishment. No s i g n i f i c a n t difference was found for gender on reduced personal accomplishment. These low scores on reduced personal accomplishment i n d i c a t e that family therapists generally experience p o s i t i v e feelings of success and personal accomplishment from t h e i r work. F i n a l l y , both groups reported low l e v e l s of depersonalization, with male therapists scoring s i g n i f i c a n t l y higher than female th e r a p i s t s . The dif f e r e n c e was s i g n i f i c a n t at the alpha l e v e l p < .05. This f i n d i n g i s consistent with the l i t e r a t u r e , which suggests that men, i n general, hold a negative view of t h e i r c l i e n t s compared to female health-care professionals (Maslach & Jackson, 1985; Pines, 1988). Again, the standard deviation scores i n d i c a t e a large amount of v a r i a b i l i t y among both genders. Therefore, i t i s expected, at the c l i n i c a l l e v e l , that one would f i n d male and female family therapists sharing s i m i l a r views regarding t h e i r c l i e n t s . In short, male and female family therapists do s i g n i f i c a n t l y d i f f e r on l e v e l s of burnout, i n p a r t i c u l a r emotional exhaustion and depersonalization. Thus, t h i s hypothesis was accepted. However, on a p r a c t i c a l l e v e l , the difference between male and female family therapists i n t h i s sample do not appear to be large. Hypothesis l a . It was hypothesized that the present sample of male and female family therapists would not s i g n i f i c a n t l y d i f f e r from the l e v e l s of burnout reported for the normative MBI sample. Using a t - t e s t to compare the present sample with the normative sample of health professionals, the findings suggest that burnout scores for the present sample di d s i g n i f i c a n t l y d i f f e r from the normative sample. The t - t e s t values between the present sample and normative mental health sample are presented i n Table 4. The normative sample included psychologists. 79 psychotherapists, counsellors, h o s p i t a l medical s t a f f , and p s y c h i a t r i s t s (Maslach & Jackson, 1986). Both the present and normative samples scored moderate to low on the subscale of emotional exhaustion, but s t a t i s t i c a l l y no s i g n i f i c a n t d i f f e r e n c e was evident for the two groups on emotional exhaustion. However, the present sample d i d s i g n i f i c a n t l y d i f f e r from the normative sample on both subscales of depersonalization and personal accomplishment (p < .001). The lower mean score on depersonalization indicates that the present sample shares more p o s i t i v e feelings towards t h e i r c l i e n t s than the normative health professionals. In addition, the higher mean score on reduced personal accomplishment suggests that the present sample f e e l more personal success i n t h e i r therapy work than the normative group. Overa l l , the present sample of family therapists d i f f e r e d s i g n i f i c a n t l y from the normative sample on l e v e l s of burnout, i n p a r t i c u l a r on depersonalization and reduced personal accomplishment. In t h i s case, the hypothesis was rejected. Table 3: t- t e s t s for Males and Females on Maslach Burnout Inventory Males Females (n = 60) (n = 78) M SD M SD t Values Emotional Exhaustion 17 . 97 10.89 14 .86 9.15 1.82t Depersonalizat ion 4 . 17 3.83 2 . 95 2 .68 2.10* Personal Accomplishment 3 42 .73 4 .27 43.38 4.06 - .91 Note. a Personal Accomplishment i s interpreted i n the opposite d i r e c t i o n . tp_ < .10 *p_ < .05 80 Table 4: t - t e s t s for Present and Normative Sample on Burnout Present Normative (n = 138) (n = 730) M SD M SD t Values Emotional Exhaustion 16 .21 10.02 16 .89 8 . 90 - .80 Depersonalization 3.48 3 .27 5.72 6 .42 * * * -8.04 Personal Accomplishment 3 43.10 4.15 30.87 6 .37 * * * 32.63 Note. a Personal Accomplishment i s * * * E < .001 interpreted i n the opposite d i r e c t i o n . Hypothesis 2. It was hypothesized that male and female family therapists would s i g n i f i c a n t l y d i f f e r on l e v e l s of therapeutic functioning. Therapeutic functioning was measured i n three ways: 1) work a c t i v i t i e s performed and relinquished; 2) o v e r a l l in-session functioning as reported on the g r i d ; and 3) s t a b i l i t y measuring the number of times the therapist's functioning crossed the baseline from p o s i t i v e to negative and/or vice versa, also reported on the g r i d . t - t e s t s were used to examine whether there was a gender di f f e r e n c e in.the above three measures of therapeutic functioning (see Table 5). The r e s u l t s showed that males and females d i d not s i g n i f i c a n t l y d i f f e r with respect to therapeutic functioning, as measured by e i t h e r work a c t i v i t i e s performed and relinquished or by in-session functioning (the g r i d or s t a b i l i t y score). Therefore, the hypothesis that gender differences would e x i s t for therapeutic functioning was rejected. 81 Table 5: t - t e s t s for Males and Females on Therapeutic Functioning Variable N M SD t Value TF A c t i v i t i e s Male 71 1 97 2 72 .32 Female 91 1 84 2 65 Overall TF Grid Male 68 1 82 6 35 .27 Female 87 1 53 6 91 TF S t a b i l i t y -Male 68 75 98 1.00 Female 87 60 91 Note. TF A c t i v i t i e s i s the number of work a c t i v i t i e s performed and relinquished due to work and family stress; Overall TF Grid i s in-session functioning with c l i e n t s ; TF S t a b i l i t y i s the number of times the therapist's l e v e l of therapeutic functioning crossed the baseline l e v e l of functioning. Demographic Variables To i d e n t i f y a l l possible relationships between the i n t e r v a l demographic and the dependent variables, a complete c o r r e l a t i o n matrix was computed for age, number of c l i e n t s , hours of work, and health. For the remaining, c a t e g o r i c a l , demographic variables such as marital status, family l i f e - c y c l e stage, and career stage, a series of one-way analyses of variance and t - t e s t s were performed. Only the s i g n i f i c a n t r e s u l t s are discussed below. F i r s t , Pearson product-moment correlations were used to investigate the r e l a t i o n s h i p between demographic variables and the subscales of burnout. Selected correlations that are s i g n i f i c a n t are reported i n Table 6; the complete c o r r e l a t i o n matrix i s reported i n Appendix O. 82 A s i g n i f i c a n t but modest negative c o r r e l a t i o n was found for age and emotional exhaustion (r = -.26, £ < .01). This fi n d i n g suggests that older family therapists are less prone to emotionally exhaustion than are t h e i r younger counterparts. However, age was not s i g n i f i c a n t l y r e l a t e d to depersonalization or to reduced personal accomplishment. A s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n of modest siz e was observed for o v e r a l l health concerns and emotional exhaustion (r = .38, p < .01), and depersonalization (r = .21, £ < .05). From t h i s f i n d i n g , i t appears that family therapists who experience a number of health concerns are also l i k e l y to f e e l t i r e d at work and to hold a negative, c y n i c a l view of t h e i r c l i e n t s . As well, a s i g n i f i c a n t but moderate negative c o r r e l a t i o n was obtained for o v e r a l l health concerns and reduced personal accomplishment (r = -.20, p < .05). Interestingly, t h i s says that family therapists with health worries p o s s i b l y see themselves as being " s u c c e s s f u l " at work. A s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p was reported for the number of hours spent per week seeing c l i e n t s and reduced personal accomplishment (r = .20, p < .05). This unexpected r e s u l t suggests that family therapists who spend many hours per week seeing c l i e n t s may f e e l l e s s personal success i n t h e i r work. Table 6: Correlations between Demographic Variables and Burnout Demographic Emotional Depersonalization Personal Variables Exhaustion Accomplishment Age -.26** -.15 .00 Overall Health Concerns .38** .21* -.20* # Hours Seeing C l i e n t s .00 .00 .20* *p_ < .05 * * 2 < .01 83 Next, Pearson product-moment correlations were used to investigate the r e l a t i o n s h i p between demographic variables and therapeutic functioning. Only one s i g n i f i c a n t r e l a t i o n s h i p was observed (see Appendix 0). A s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n of moderate s i z e was obtained for health concerns and in-session therapeutic functioning, s p e c i f i c a l l y therapeutic s t a b i l i t y (number of times that therapeutic functioning crosses the baseline) (r = .25, p < .01). I t suggests that family therapists who experience health concerns may also experience greater v a r i a b i l i t y i n the counselling they perform. F i n a l l y , a series of one-way analyses of variance and t - t e s t s were computed to explore possible differences between the demographic and the dependent variables (see Table 7). The analyses of variance were performed on groups where a reasonable sample siz e could be established; otherwise, t- t e s t s were calculated for the extreme response choices. The findings are discussed i n the following four sections: 1) p ro fe ss io na l demographics and burnout, 2) p r o f e s s i o n a l demographics and therapeutic functioning, 3) personal demographics and burnout, and 4) personal demographics and therapeutic functioning. F i r s t , a one-way analysis of variance (ANOVA) was conducted on the responses family therapists reported with respect to preference i n caseload and l e v e l s of burnout. They marked one of three choices: 1) a smaller, 2) no change, or 3) a larger caseload. A s i g n i f i c a n t d i f f e r e n c e was found among family therapists with respect to t h e i r perception of i d e a l caseload and emotional exhaustion (F (2,134) = 6.60, p_ < .001). A Student-Newman-Keuls follow-up t e s t indicated that those therapists who hoped for a smaller caseload had a s i g n i f i c a n t l y higher mean score on emotional exhaustion than therapists wanting no change or a larger caseload. A t - t e s t was also performed between smaller and larger i d e a l caseload, to overcome the unequal sample sizes observed among the three categories. The r e s u l t s suggest that therapists who hoped for a smaller 84 caseload had a s i g n i f i c a n t l y higher mean score on emotional exhaustion than therapists hoping for a larger caseload (t = 2.70, p_ < .01). Another one-way ANOVA was performed on the three stages of career ( i . e . , beginning, mid, and late) and l e v e l s of burnout. A s i g n i f i c a n t d i f f e r e n c e was found among family therapists with respect to t h e i r career stage and reduced personal accomplishment (F (2,135) = 3.70, p_ < .05). A Student-Newman-Keuls t e s t found that family therapists who were i n the mid-career stage had a s i g n i f i c a n t l y higher mean score on reduced personal accomplishment than therapists at the s t a r t or end of t h e i r careers. Some caution i s warranted i n i n t e r p r e t i n g t h i s r e s u l t , since the number of cases for both the beginning and l a t e career stages was small (n = 25 and n = 11, respectively) compared to the mid-career stage (n = 102). An a d d i t i o n a l t - t e s t was performed between therapists i n the beginning and l a t e career stage. However, no s i g n i f i c a n t differences were observed between these two groups on reduced personal accomplishment (t = .28, p_ = .783) . Second, a t - t e s t was computed for in t e n t i o n to leave the profession and therapeutic functioning. To overcome the small sample sizes i n the strong and very strong categories (n = 7 and n = 2, r e s p e c t i v e l y ) , a t - t e s t was computed between the "not at a l l " and a grouping of the remaining categories ( i . e . , s l i g h t , moderate, strong, and very strong p o s s i b i l i t y ) on o v e r a l l therapeutic functioning. The res u l t s suggest that family therapists who reported no desire to leave the profession had a s i g n i f i c a n t l y higher mean score on o v e r a l l in-session functioning than therapists who reported varying degrees of wanting to leave profession (t = 2.45, £ < .05). Third, a t - t e s t or one-way analysis of variance was conducted on the family therapist's degree of concern regarding health and l e v e l s of burnout. S p e c i f i c a l l y , a t - t e s t was performed between the following two categories of d i s i n t e r e s t i n exercise: 1) therapists who were "not at a l l " 85 and " r a r e l y " i n t e r e s t e d i n exercise, and 2) therapists who were "sometimes," "often," and "very often" i n t e r e s t e d i n exercise. The t - t e s t analysis indicates that family therapists who are the l e a s t or r a r e l y active experienced s i g n i f i c a n t l y higher l e v e l s of emotional exhaustion than those therapists who were sometimes, often or very often active (t = -2.42, p < .05) . A second health factor was also examined using an ANOVA. The degree of sleep disturbance ( i . e . , not at a l l , r a rely, sometimes, and often plus very often — the l a t t e r two were combined due to small sample size) was compared with emotional exhaustion. A s i g n i f i c a n t d i f f e r e n c e was found among family therapists with respect to greater degree of experienced sleep disturbance and emotional exhaustion (F (3,134) = 5.24, p < .01). There also existed a s i g n i f i c a n t difference among family therapists with respect to greater degree of experienced sleep disturbance and depersonalization (F (3,134) = 3.36, p < .05). And t h i r d , a s i g n i f i c a n t d i f f e r e n c e was found for family therapists with respect to greater degree of experienced sleep disturbance and reduced personal accomplishment (F (3,134) = 3.15, p < .05). Student-Newman-Keuls tests found that family therapists who experienced i r r e g u l a r sleeping i n the "often plus very often" category had s i g n i f i c a n t l y higher mean scores on emotional exhaustion and depersonalization than therapists who reported no or fewer sleep disturbances. This follow-up t e s t also found that family therapists who did not experience sleeping problems "not at a l l " had s i g n i f i c a n t l y higher mean scores on personal accomplishment than therapists who reported on a l l other categories of sleep disturbance. F i n a l l y , an ANOVA was performed to compare the differences among family therapists with respect to the degree of sleep disturbance ( i . e . , not at a l l , r a r e l y , sometimes, often plus very often) and therapeutic functioning. A s i g n i f i c a n t difference was found among family therapists with respect to sleep disturbance and in-session therapeutic functioning 86 (F (3,151) = 3.80, p = .01). A Student-Newman-Keuls te s t found that family therapists who experienced no sleep problems "not at a l l " had s i g n i f i c a n t l y higher mean scores on in-session therapeutic functioning than therapists who reported on a l l other categories of sleep disturbance. 87 Table 7: ANOVA and t - t e s t s f o r Demographic and Dependent Variables C r i t e r i o n V a r i a b l e : Burnout -- Emotional Exhaustion Ideal Caseload: Smaller No change Larger (n = 38) (n = 69) (n = 30) M = 21.11 M = 14.61 M = 14.10 SD = 11.15 SD = 8.50 SD = 9.95 df(2,134) F = 6.60, £ < .001*** t = 2.70, E = .009** Note. t - t e s t between Smaller and Larger Ideal Caseload. C r i t e r i o n V a r i a b l e : Burnout -- Reduced Personal Accomplishment Career Stage Beginning Mid Late (n = 25) (n = 102) (n = 11) M = 41.68 M = 43.66 M = 41.18 SD = 4.32 SD = 3.72 SD = 6.24 df(2,135) F = 3.70, p = .027* t = .28, £ = .873 Note. t - t e s t between Beginning and Late Career Stage. C r i t e r i o n V a r i a b l e : Therapeutic Functioning -- Grid Intention of leaving Profession Not at a l l S l i g h t Moderate Strong Very Strong (n = 96) (n = 33) (n = 12) (n = 7) (n = 2) M = 2.71 M = .00 M = 2.75 M = -5.14 M = .00 SD = 6.30 SD = 5.52 SD = 11.03 SD = 5.43 SD = .00 t = 2.45, E = -016* Note. t - t e s t between Group 1 = Not at a l l and S l i g h t ; Group 2 = Moderate, Strong, and Very Strong. C r i t e r i o n V a r i a b l e : Burnout -- Emotional Exhaustion Health ( d i s i n t e r e s t i n ph y s i c a l a c t i v i t y or exercise) Not at a l l Rarely Sometimes Often Very Often (n = 22) (n = 40) (n = 48) (n = 18) (n = 10) M = 13.36 M = 14.30 M = 17.04 M = 17.33 M = 24.10 SD = 9.44 SD = 8.38 SD = 9.65 SD = 11.07 SD = 13.68 t = -2.42, E = -017* Note. t - t e s t between Group 1 = Not at a l l and Rarely; Group 2 = Sometimes, Often, and Very Often. (table continues) C r i t e r i o n V a r i a b l e : Burnout - - Emotional Exhaustion Sleep disturbance Not at a l l (n = 36) M = 13.08 SD = 10.21 Rarely (n = 35) M = 15.00 SD = 9.21 df(3,134) F = 5.24, p Sometimes (n = 40) M = 15.90 SD = 6.57 Often (n = 20) M = 21.15 SD = 11.40 Very Often (n = 7) M = 26.00 SD = 15.87 .002 C r i t e r i o n V a r i a b l e : Burnout Sleep disturbance Depersonalization Not at a l l (n = 36) M = 2.47 SD = 3.08 df(3,134) F = 3.36, C r i t e r i o n V a r i a b l e : Sleep disturbance Not at a l l (n = 36) M = 44.50 SD = 3.98 df(3,134) F = 3.15, C r i t e r i o n V a r i a b l e : Sleep disturbance Not at a l l (n = 42) M = 3.69 SD = 6.06 Rarely (n = 35) M = 3.34 SD = 2.45 p = .021* Burnout -Rarely (n = 35) M = 43.40 SD = 3.83 Sometimes (n = 40) M = 3.45 SD = 2.94 Often , (n = 20) M = 4.95 SD = 4.43 Very Often (n = 7) M = 5.29 SD = 4.4 6 Reduced Personal Accomplishment Sometimes (n = 40) M = 41.68 SD = 4.43 p = .027 Therapeutic Functioning Rarely (n = 37) M = 2.95 SD = 7.82 Sometimes (n = 48) M = -.38 SD = 4.77 Often (n = 20) M = 42.60 SD = 3.83 Grid Often (n = 20) M = 1.00 SD = 8.83 Very Often (n = 7) M = 44.00 SD = 3.96 Very Often (n = 8) M = -1.13 SD = 2.47 df (3,151) F = 3.80, p = .011 Note. The Often and Very Often category were combined for the an a l y s i s . * Differences between means were s i g n i f i c a n t at the rj < .05 l e v e l . * * Differences between means were s i g n i f i c a n t at the rj < .01 l e v e l . * * * Differences between means were s i g n i f i c a n t at the p_ < .001 l e v e l . 89 Primary Hypotheses Hypothesis 3. S t r e s s f u l l i f e events, both normative and nonnormative, were hypothesized to be p o s i t i v e l y associated with burnout. To investigate the hypothesis, Pearson product-moment correlations were used to examine the r e l a t i o n s h i p between s t r e s s f u l l i f e events and changes, as measured by the Family Inventory of L i f e Events and Changes, and l e v e l s of burnout among family therapists (see Table 8). The r e s u l t s i n d i c a t e that family therapists were experiencing moderate l e v e l s of normative and nonnormative stress (M = 406.82, SD = 246.07), and that a s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n was present for f a m i l y - l i f e events and changes and emotional exhaustion (r = .35, p_ < .01). The findings i n d i c a t e that an increase i n s t r e s s f u l l i f e events i s modestly associated with a family therapist's l e v e l of exhaustion at work. As well, a s i g n i f i c a n t but moderate p o s i t i v e c o r r e l a t i o n was found for f a m i l y - l i f e events and changes and depersonalization (r = .23, £ < .01). Here, an increase i n s t r e s s f u l l i f e events i s only moderately r e l a t e d to the family therapist's negative perception of his or her c l i e n t s . Furthermore, a s i g n i f i c a n t negative r e l a t i o n s h i p was found for s t r e s s f u l l i f e events and reduced personal accomplishment (r = -.18, £ < .05). Although the c o r r e l a t i o n i s small, the r e s u l t s s t i l l i n d i c a t e that a trend e x i s t s : as s t r e s s f u l f a m i l y - l i f e events increase, the therapist's perception of his or her success decreases. Thus, a s i g n i f i c a n t r e l a t i o n s h i p between the family therapist's f a m i l y - l i f e stresses and the three l e v e l s of burnout was maintained and i n t h i s case, the hypothesis was accepted. A d d i t i o n a l analyses were performed to determine i f a s i g n i f i c a n t d i f f e r e n c e on s t r e s s f u l l i f e events existed between t h i s sample of family therapists and a normative sample of families across the seven f a m i l y - l i f e 90 stages. A series of seven t - t e s t comparisons was computed (see Table 9). By and large, no s i g n i f i c a n t differences were found between family therapists, regardless of family l i f e - c y c l e stage, and the normative families (McCubbin & Patterson, 1991, p. 92). (The normative sample represents a group of 1140 American families from the general population selected across a l l seven family l i f e - c y c l e stages). However, the res u l t s suggest that family therapists i n the "school age" and "young adult" stage of family l i f e s i g n i f i c a n t l y d i f f e r from the normative sample (M = 373. 17, SD = 207.34 and M = 427.90, SD = 265.84, r e s p e c t i v e l y ) . Here we f i n d that family therapists experience s i g n i f i c a n t l y less f a m i l y - l i f e stress than the normative population. Unfortunately, 8.5% of family therapists d i d not belong to one of the seven family l i f e - s t a g e categories and could not be accounted f o r using the norms provided. F i n a l l y , the three most frequently c i t e d f a m i l y - l i f e events and changes were: 1) f i n a n c i a l s t r a i n on family for food, clothing, and home care (15.7%); 2) i l l n e s s and family care, where a parent or spouse had become s e r i o u s l y i l l or injured (12.1%); and 3) work s t r a i n , where a family member had experienced d i f f i c u l t y with co-workers (10.7%). 91 Table 8: Correlations between Family L i f e Events and Burnout Variable (n = 138) Emotional Exhaustion Depersonalization Personal Accomplishment FILE ** .35 ** .23 * - .18 Note. FILE i s the independent v a r i a b l e family l i f e events and changes. *E < .05 * * E < -01 Table 9: t- t e s t s f or Present and Normative Sample on Family L i f e - C y c l e Stages Present Normative (N = 1140 couples) M SD M SD t Values New Couple(n = 15) 407 07 129 80 478 00 241. 00 -1 12 Preschoolers(n = 13) 427 54 271 42 530 00 309. 00 -1 36 School age(n = 24) 373 17 207 34 500 00 234 . 00 -3 00** Young adults(n = 30) 427 90 265 84 545 00 304 . 00 -2 41* Launching(n = 16) 452 75 263 00 635 00 314 . 00 -1 77 Middle years(n = 28) 362 82 294 91 425 00 264 . 00 -1 12 Retirement(n = 4) 500 25 273 83 395 00 304 . 00 -0 77 *E < -05 * * E < -01 Hypothesis' 4 and 4a. It was hypothesized that d i s s a t i s f a c t i o n i n handling work and family stress would be p o s i t i v e l y associated with the three components of burnout. D i s s a t i s f a c t i o n i n handling work and family stress was derived by the number of items, on the Family/Work Concerns c h e c k l i s t , endorsed as having 92 occurred during the past year which i n t e r f e r e d with family-therapy work, and were inadequately handled by the family t h e r a p i s t . Pearson product-moment co r r e l a t i o n s were used to examine the r e l a t i o n s h i p between d i s s a t i s f a c t i o n i n handling work and family stress, and the three subscales of burnout among family therapists (see Table 10). The r e s u l t s i n d i c a t e that a s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p exists between a family therapist's d i s s a t i s f a c t i o n i n handling work and family stress and emotional exhaustion (r = .51, £ < .01). This f i n d i n g indicates that a therapist's disappointment i n how well (s)he handles everyday work and family matters i s strongly r e l a t e d to an increased l e v e l of emotional exhaustion at work. As well, a s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n was found for d i s s a t i s f a c t i o n i n handling work and family stress and depersonalization (r = .43, £ < .01). Again, a strong r e l a t i o n s h i p exists between the therapist's d i s s a t i s f a c t i o n with themselves, i n t h e i r a b i l i t y to manage d a i l y stresses at work and at home and an increased negative attitud e towards others. F i n a l l y , the c o r r e l a t i o n between d i s s a t i s f a c t i o n i n handling work and family stress and reduced personal accomplishment was negative, but d i d not reach s i g n i f i c a n c e . O v e r a l l , the findings support the hypothesis that a p o s i t i v e r e l a t i o n s h i p e x i s t s between family therapists who are d i s s a t i s f i e d with the way they handle work and family stress and emotional exhaustion and depersonalization. Although no s i g n i f i c a n c e was found with respect to reduced personal accomplishment, a trend was noted. Thus, t h i s hypothesis was accepted for emotional exhaustion and depersonalization, but the hypothesis was not accepted for reduced personal accomplishment. Hypothesis 4a. S a t i s f a c t i o n i n handling work and family stress was hypothesized to be negatively associated with l e v e l s of burnout. S a t i s f a c t i o n i n handling work and family stress was derived by the number of items, on the Family/Work Concerns c h e c k l i s t , endorsed as having occurred during the past year which i n t e r f e r e d with family-therapy work. 93 but were perceived by the family therapist as being handled i n a s a t i s f a c t o r y manner. Again, Pearson product-moment cor r e l a t i o n s were computed to examine the r e l a t i o n s h i p between s a t i s f a c t i o n i n handling work and family stress and the subscales of burnout among family therapists (see Table 10). The r e s u l t s of the analyses found no s i g n i f i c a n t c o r r e l a t i o n s between s a t i s f a c t i o n i n handling work and family stress and the three l e v e l s of burnout i n t h i s sample of family therapists. Thus, t h i s hypothesis was rejected. Of i n t e r e s t , the variable " i n d e c i s i o n regarding one's s a t i s f a c t i o n i n handling work and family s t r e s s " was included i n the analyses (see Table 10). Indecision i n handling work and family stress was derived by the number of items, on the Family/Work Concerns c h e c k l i s t , endorsed as having occurred during the past year which i n t e r f e r e d with family-therapy work, but that were considered neither adequately nor inadequately handled by the family t h e r a p i s t . The r e s u l t s of a Pearson product-moment c o r r e l a t i o n found s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n s between ind e c i s i o n i n handling work and family stress, and emotional exhaustion (r = .33, £ < .01) and depersonalization (r = .34, £ < .01). This f i n d i n g suggests that as a family therapist's degree of uncertainty, i n his or her a b i l i t y to handle d a i l y stresses, increases so does his or her l e v e l of work exhaustion, and negative view of others. F i n a l l y , a s i g n i f i c a n t but negative c o r r e l a t i o n of moderate siz e was obtained between i n d e c i s i o n i n handling work and family stress, and reduced personal accomplishment (r = -.25, £ < .01). This unexpected f i n d i n g suggests that as a family therapist's doubts regarding his or her a b i l i t y to handle d a i l y stresses increases, he or she feels more successful at work. 94 Table 10: Correlations between Family/Work Concerns and Burnout Variables Emotional Depersonalization Personal Exhaustion Accomplishment ** ** D i s s a t i s f a c t i o n .51 .43 -.13 Undecided .33** .34** -.25** S a t i s f a c t i o n .10 .13 .00 Note. a Personal Accomplishment i s interpreted i n the opposite d i r e c t i o n . * * E < -01 Hypothesis 5. An increase i n the stresses of normative and nonnormative l i f e events, as measured by the Family Inventory of L i f e Events and Changes, was hypothesized to be negatively associated with therapeutic functioning i n family t h e r a p i s t s . Pearson product-moment correlations were used to examine the r e l a t i o n s h i p between s t r e s s f u l l i f e events and changes, and therapeutic functioning among family therapists (see Table 11). A s i g n i f i c a n t but weak, negative c o r r e l a t i o n was observed for family-l i f e events and in-session functioning (r = -.18, p_ < .05) . In t h i s case, in-session functioning was the average score of work performance derived from the therapeutic functioning g r i d . Although the r e s u l t s i n d i c a t e a weak c o r r e l a t i o n , they suggest that an increase i n s t r e s s f u l l i f e events i s r e l a t e d to lowered in-session functioning with c l i e n t s . Next, a s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n was observed for f a m i l y - l i f e events and s t a b i l i t y of therapeutic functioning, measured by the number of times the therapist's work functioning crossed the baseline (r = .26, p < .01). (It i s important to note that an increase i n the number of times the therapist's functioning crosses the baseline, the less stable the therapist's perception of work ef f e c t i v e n e s s ) . Although a p o s i t i v e 95 re l a t i o n s h i p was observed between the stresses of normative and nonnormative l i f e events and s t a b i l i t y of therapeutic functioning, the findings suggest that family therapists who experience an increase i n s t r e s s f u l l i f e events also experience an increase i n the i n s t a b i l i t y of t h e i r l e v e l of therapeutic functioning. Hence, these findings, as measured by both the therapeutic functioning g r i d for o v e r a l l functioning and i n s t a b i l i t y of therapeutic functioning, support the hypothesized negative r e l a t i o n s h i p between the family therapist's f a m i l y - l i f e events and changes and therapeutic functioning. The hypothesis was accepted for both aspects of in-session functioning. A s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n was obtained between f a m i l y - l i f e events and changes and a reduction i n work a c t i v i t i e s , as measured by the Work A c t i v i t i e s c h e c k l i s t , (r = .46, p_ < .01). Hence, a strong r e l a t i o n s h i p exists between an increase i n normative and nonnormative l i f e stresses and the number of work a c t i v i t i e s relinquished or cut back by the r a p i s t s . (It i s important to note that an increase i n the number of a c t i v i t i e s relinquished implies a decrease i n number of work tasks performed). Thus, t h i s f i n d i n g also supports the hypothesis that a negative r e l a t i o n s h i p occurs between f a m i l y - l i f e events and changes and therapeutic functioning, as measured by work a c t i v i t i e s relinquished. Again, the hypothesis was accepted f o r t h i s aspect of therapeutic functioning. 96 Table 11: Correlations between Family L i f e Events and Therapeutic Functioning Variable (n = 141) TF A c t i v i t i e s Overall TF Grid TF S t a b i l i t y Family l i f e events ** .46 * - .18 ** .26 Note. TF A c t i v i t i e s i s the number of work a c t i v i t i e s performed and relinquished due to work and family stress; Overall TF Grid i s in-session functioning with c l i e n t s ; TF S t a b i l i t y i s the number of times the therapist's l e v e l of therapeutic functioning crossed the baseline l e v e l of functioning. *p_ < .05 ** E < .01 Hypothesis 6 and 6a. It was hypothesized that therapists' d i s s a t i s f a c t i o n i n handling work and family stress would be negatively associated with therapeutic functioning. D i s s a t i s f a c t i o n i n handling work and family stress was derived by the number of items, on the Family/Work Concerns c h e c k l i s t , endorsed as having occurred during the past year which i n t e r f e r e d with family-therapy work, and were inadequately handled by the family therapist. To t e s t the hypothesis, Pearson product-moment cor r e l a t i o n s were used to examine the r e l a t i o n s h i p between d i s s a t i s f a c t i o n i n handling work and family stress and therapeutic functioning among family therapists (see Table 12). F i r s t , a s i g n i f i c a n t but weak, negative c o r r e l a t i o n was found for d i s s a t i s f a c t i o n i n handling work and family stress and in-session functioning, as measured by the therapeutic functioning g r i d (r = -.17, p < .05). Although a weak c o r r e l a t i o n was found, the r e s u l t s s t i l l i n d i c a t e that family therapists who are unhappy with how well they handle 97 d a i l y stresses also report lower l e v e l s of therapy functioning with c l i e n t s . Hence, a trend was noted and the hypothesis was accepted. A nonsignificant c o r r e l a t i o n was observed for d i s s a t i s f a c t i o n i n handling work and family stress and in-session functioning, as measured by s t a b i l i t y of therapeutic functioning. Here, the hypothesis was rejected. The r e s u l t s found a s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p between a family therapist's d i s s a t i s f a c t i o n i n handling work and family stress and a reduction i n work a c t i v i t i e s , as measured by the Work A c t i v i t i e s c h e c k l i s t (r = .34, p < .01). A moderate r e l a t i o n s h i p indicates that those therapists who are disappointed with t h e i r a b i l i t y to handle everyday work and family matters are also more l i k e l y to cut back on the number of work a c t i v i t i e s . Given t h i s finding, the hypothesis was accepted. In summary, a p o s i t i v e r e l a t i o n s h i p between family therapists' d i s s a t i s f a c t i o n i n handling work and family, and therapeutic functioning, was supported with respect to in-session functioning, as measured by the therapeutic functioning g r i d , and a reduction i n work a c t i v i t i e s . However, the hypothesis was not supported with respect to in-session functioning, as measured by therapeutic s t a b i l i t y . Hypothesis 6a. I t was hypothesized that a s a t i s f a c t i o n i n handling work and family stress would be p o s i t i v e l y associated with therapeutic functioning. S a t i s f a c t i o n i n handling work and family stress was derived by the number of items, on the Family/Work Concerns c h e c k l i s t , as having occurred during the past year which i n t e r f e r e d with family-therapy work, but were adequately handled by the family therapist. When a Pearson product-moment c o r r e l a t i o n was computed, a nonsignificant r e l a t i o n s h i p was found for s a t i s f a c t i o n i n handling work/family stress and in-session therapeutic functioning, as measured by both o v e r a l l therapeutic functioning g r i d and s t a b i l i t y of therapeutic functioning. Therefore, no support was found for the hypothesis and i t was rejected. 98 However, a s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n was found between s a t i s f a c t i o n i n handling work and family stress and a reduction i n work a c t i v i t i e s , measured by the Work A c t i v i t i e s c h e c k l i s t (r = .29, p < .01) (see Table 12). The moderate r e l a t i o n s h i p indicates that family therapists who are s a t i s f i e d with the way they handle everyday work and family concerns are also more l i k e l y to cut back on t h e i r work a c t i v i t i e s . (An increase i n the number of a c t i v i t i e s relinquished implies a decrease i n the amount of work performed). Consequently, the hypothesis was also rejected for therapeutic functioning, as measured by reduction i n work a c t i v i t i e s . As i n Hypothesis 4a, the variable " i n d e c i s i o n regarding one's s a t i s f a c t i o n i n handling work and family s t r e s s " was included i n the analyses (see Table 12). The res u l t s of a Pearson product-moment c o r r e l a t i o n found one s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n of modest siz e between i n d e c i s i o n i n handling work and family stress and a reduction i n work a c t i v i t i e s (r = .34, p_ < .01) . This r e s u l t suggests that as a family therapist's doubts increase regarding his or her a b i l i t y to handle d a i l y stresses, so does the number of work a c t i v i t i e s relinquished. 99 Table 12: Correlations between Family/Work Concerns and Therapeutic Functioning Variables TF A c t i v i t i e s Overall TF Grid TF S t a b i l i t y D i s s a t i s f a c t i o n .34 -.17 .08 Undecided .34** -.09 .14 * * S a t i s f a c t i o n .29 -.08 .05 Note. TF A c t i v i t i e s i s the number of work a c t i v i t i e s performed and relinquished due to work and family stress; Overall TF Grid i s in-session functioning with clients,- TF S t a b i l i t y i s the number of times the therapist's l e v e l of therapeutic functioning crossed the baseline l e v e l of functioning. *p_ < .05 * * p_ < .01 Hypothesis 7. An increase i n family functioning was hypothesized to be negatively r e l a t e d to l e v e l s of burnout. Family functioning was measured by the Family Relationship Index. A Pearson product-moment c o r r e l a t i o n was used to i n v e s t i g a t e the r e l a t i o n s h i p between the family therapist's family functioning and l e v e l of burnout (see Table 13). A moderate to high l e v e l of family functioning was reported among the family therapists (M = 17.65, SD = 3.25), with scores ranging from 7 to 24. A negative but s i g n i f i c a n t c o r r e l a t i o n was obtained for family functioning and emotional exhaustion (r = -.23, p < .01), i n d i c a t i n g that family therapists who report high l e v e l s of family functioning also report lower l e v e l s of emotional exhaustion. Again, a s i g n i f i c a n t negative c o r r e l a t i o n , but of weak magnitude, was observed for family functioning and depersonalization (r = -.19, p < .05). Although a weak c o r r e l a t i o n was obtained, the f i n d i n g suggests that 100 therapists who report high l e v e l s of family functioning are l i k e l y to report lower l e v e l s of depersonalization. F i n a l l y , a s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n of moderate s i z e was found for family functioning and .reduced personal accomplishment (r = .31, p < .01), implying that family therapists who report high l e v e l s of family functioning also report feelings of greater success i n t h e i r work accomplishments. Ov e r a l l , the findings provide support for the hypothesis that strong or increased l e v e l s of family.functioning are r e l a t e d to reduced l e v e l s of burnout for family t h e r a p i s t s . The hypothesis was accepted. Table 13: Correlations between Family Functioning and Burnout Variable Emotional Depersonalization Personal (n = 138) Exhaustion Accomplishment Family Functioning * * - .23 * - .19 * * .31 *E < .05 * * E < -01 Hypothesis 8. It was hypothesized that family functioning, as measured by the Family Relationship Index, would be p o s i t i v e l y associated with therapeutic functioning among family therapists. A Pearson product-moment c o r r e l a t i o n was used to i n v e s t i g a t e the r e l a t i o n s h i p between the family therapist's family functioning and therapeutic functioning (see Table 14). The r e s u l t s obtained found a s i g n i f i c a n t negative c o r r e l a t i o n of moderate s i z e between family functioning and in-session therapeutic functioning, measured by s t a b i l i t y of therapeutic functioning (the number of times a therapist's l e v e l of therapeutic functioning crosses the baseline l e v e l of functioning) (r = -.23, £ < .01). The f i n d i n g indicates 101 that family therapists who display high l e v e l s of family functioning also display greater s t a b i l i t y i n t h e i r therapeutic functioning. Given t h i s finding, the hypothesis was accepted for s t a b i l i t y of therapeutic functioning. However, no s i g n i f i c a n t r e l a t i o n s h i p was observed between family functioning and in-session functioning, as measured by the Overall Therapeutic Functioning Grid, or by a reduction i n work a c t i v i t i e s . Thus, the hypothesis was rejected based on the inconsistent findings for the gri d , and work a c t i v i t i e s . Table 14: Correlations between Family Functioning and Therapeutic Functioning Variable (n = 141) TF A c t i v i t i e s Overall TF Grid TF S t a b i l i t y Family Functioning - .04 . 11 * * - .23 Note. TF A c t i v i t i e s i s the number of work a c t i v i t i e s performed and relinquished due to work and family stress; Overall TF Grid i s in-session functioning with c l i e n t s ; TF S t a b i l i t y i s the number of times the therapist's l e v e l of therapeutic functioning crossed the baseline l e v e l of functioning. * * p_ < .01 Hypothesis 9. I t was hypothesized that there would be a s i g n i f i c a n t difference i n the mean score of burnout between family therapists who engaged i n s t r e s s -managing behaviours and who d i d not engage i n stress-managing behaviours with respect to family and work stress, as measured by the Stress-Management Strategies c h e c k l i s t . A one-way analysis of variance was computed for three d i f f e r e n t stages of stress-managing behaviour and the components of burnout (see 102 Table 15). Therapists employing 14 or more strategies were c l a s s i f i e d as hig h - l e v e l engagers, those using 9 to 13 strategies were c l a s s i f i e d as medium-level engagers, and therapists using 1 to 8 strategies were placed i n the low-level engager category. A s i g n i f i c a n t difference was found for family therapists engaging i n stress-managing behaviours and emotional exhaustion (F (2,135) = 3.55, p < .05). A Student-Newman-Keuls follow-up t e s t reported that family therapists who a c t i v e l y engaged i n a high number of stress-managing behaviours had a s i g n i f i c a n t l y higher mean score on emotional exhaustion than those therapists who engaged i n fewer stress-managing behaviours. A s i g n i f i c a n t difference was also found for family therapists engaging i n stress-managing behaviours and depersonalization (F (2,135) = 3.71, p < .05). A Student-Newman-Keuls te s t reported that family therapists who a c t i v e l y engaged i n a high number of stress-managing behaviours had a s i g n i f i c a n t l y higher mean score on depersonalization than those therapists who engaged i n fewer stress-managing behaviours. No s i g n i f i c a n t difference was reported for family therapists' l e v e l of engaging i n stress-managing behaviours and reduced personal accomplishment. To overcome problems with the unequal sample sizes between the three groups of engagers i n stress-managing behaviours, a t - t e s t was computed between only the low and high groups. The re s u l t s suggest that family therapists who engaged i n a high number of stress-managing behaviours experienced s i g n i f i c a n t l y higher l e v e l s of both emotional exhaustion and depersonalization than those therapists who engaged i n few stress-managing behaviours (t = -2.43, p_ < .05, and t = -1.97, p_ < .05, r e s p e c t i v e l y ) . As well, a median s p l i t t - t e s t was computed for the en t i r e sample. In t h i s case, the r e s u l t s suggest that family therapists who engaged i n a high number of stress-managing behaviours experienced s i g n i f i c a n t l y higher 103 l e v e l s of depersonalization (t = -2.14, £ < .05). No s i g n i f i c a n t d i f f e r e n c e was observed for the other two subscales of burnout. In summary, the hypothesis that family therapists who engage i n stress-managing behaviours would s i g n i f i c a n t l y d i f f e r from therapists who do not engage i n stress-managing behaviours on l e v e l s of burnout was supported for emotional exhaustion and depersonalization, but was not supported for reduced personal accomplishment. 104 Table 15: ANOVA and t - t e s t s for Stress-Management Strategies and Burnout C r i t e r i o n V a r i a b l e : Burnout -- Emotional Exhaustion Stress-managing Behaviours: Low Medium Hiqh (n = 21) (n = 90) (n = 27) M = 11.29 M = 16.62 M = 18.67 SD = 8 .89 SD = 9.53 SD = 11.46 df (2,135) F = 3.55, p = .031* t = -2.43, p. = .019* C r i t e r i o n V a r i a b l e : Burnout -- Depersonalization Stress-managing Behaviours: Low Medium Hiqh (n = 21) (n = 90) (n = 27) M = 2.81 M = 3.19 M = 4.96 SD = 2.73 SD = 2.89 SD = 4.37 * * df (2,135) F = 3.71, p = .027 t = -1.97, £ = -054 C r i t e r i o n V a r i a b l e : Burnout -- Reduced Personal Accomplishment Stress-managing Behaviours: Low Medium Hiqh (n = 21) (n = 90) (n = 27) M = 43.43 M = 43.11 M = 42.81 SD = 5.09 SD = 3.93 SD = 4.21 df (2,135) F = .13, p = .880 t = .46, E = -649 Note. t - t e s t comparisons computed between Low and High Groups. * Differences between means were s i g n i f i c a n t at the E < -05 l e v e l . 105 Hypothesis 10. I t was hypothesized that there would be a s i g n i f i c a n t d i f f e r e n c e i n the mean score of therapeutic functioning between family therapists who engaged i n stress-managing behaviours and who did not engage i n s t r e s s -managing behaviours, with respect to family and work stress as measured by the Stress-Management Strategies c h e c k l i s t . An ANOVA was computed for three d i f f e r e n t stages of stress-managing behaviour and therapeutic functioning (see Table 16). (Again the same c l a s s i f i c a t i o n into high, medium, and low engagers was used, as discussed i n the above hypothesis). No s i g n i f i c a n t difference was reported for family t h e r a p i s t s ' l e v e l of engaging i n stress-managing behaviours, and i n -session therapeutic functioning or reduction i n work a c t i v i t i e s . As well, a t - t e s t was computed between only the low and high groups. The r e s u l t s found no s i g n i f i c a n t differences for family therapists' l e v e l of engaging i n stress-managing behaviours and o v e r a l l therapeutic functioning, s t a b i l i t y of therapeutic functioning, and reduction of work a c t i v i t i e s (t = -.89, £ = .379; t = .64 £ = .525; and t = -.63, £ = .534 r e s p e c t i v e l y ) . A median s p l i t t - t e s t was also computed for the entire sample. Again, the res u l t s found no s i g n i f i c a n t differences on a l l three aspects of therapeutic functioning: o v e r a l l therapeutic functioning (t = -1.08, £ = .283), therapeutic s t a b i l i t y (t = -.52, £ = .602), and reduction of work a c t i v i t i e s (t = .75, £ = .456). Therefore, the hypothesis was not supported f o r any of the three components of therapeutic functioning and was rejected. 106 Table 16: ANOVA & t - t e s t s for Stress-Management Strategies & Therapeutic Functioning C r i t e r i o n Variable : Therapeutic Functioning -- Work A c t i v i t i e s Stress-managing Behaviours: Low Medium Hiqh (n = 21) (n = 93) (n = 27) M = 1.90 M = 2.09 M = 2.70 SD = 3.32 SD = 2.58 SD = 2.91 df(2,138) F = .64, p = .527 t = - .89, E = .379 C r i t e r i o n Variable Therapeutic Functioning -- Grid Stress-managing Behaviours: Low Medium Hiqh (n = 21) (n = 93) (n = 27) M = 2.24 M = 2.00 M = .89 SD = 6.76 SD = 6.86 SD = 7.60 df(2,138) F = .31, p = .735 t = .64, E = -525 C r i t e r i o n Variable Therapeutic Functioning -- S t a b i l i t y Stress-managing Behaviours: Low Medium Hiqh (n = 21) (n = 93) (n = 27) M = .62 M = .73 M = .81 SD = 1.24 SD = .91 SD = .92 df(2,138) F = .24, p = .786 t = - .63, E = -534 Note, t - t e s t comparisons computed between Low and High Groups. 107 Post-hoc Analyses. A d d i t i o n a l analyses were conducted to investigate the confounded findings obtained i n Hypothesis 9. A median s p l i t t - t e s t was performed to determine i f a s i g n i f i c a n t difference existed between l e v e l s of s t r e s s -managing behaviour ( i . e . , high engagers with a score over 11 and low engagers with a score up to 11) and the following: 1) family functioning, and 2) t o t a l number of work hours per week. As well, a chi-square was computed for the three stages of stress-managing behaviour and i d e a l caseload ( i . e . , smaller, no change, or larger caseload). I t was an t i c i p a t e d that work-demand variables and/or family-functioning variables would account for the unexpected findings among low and high engagers with respect to burnout. The r e s u l t s of the median s p l i t t - t e s t found no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s f or l e v e l of stress-managing behaviour and family functioning, or t o t a l work hours per week (see Table 17). As well, no s i g n i f i c a n t differences were found using the chi-square analysis for i d e a l caseload and stress-managing behaviours % 2 (4) = 5.35, p = .25. 108 Table 17: t - t e s t for Post-hoc Analyses C r i t e r i o n V a r i a b l e : Family Functioning Stress-managing Behaviours: Low Hiqh (n = 78) (n = 63) M = 17.50 M = 17.84 SD = 3.37 SD = 3.11 t = - .62, p = .537 C r i t e r i o n V a r i a b l e : Total Work Hours/Week Stress-managing Behaviours: Low (n = 78) M = 33.95 SD = 12.97 t = - .55, p = .580 Hiqh (n = 63) M = 35.11 SD = 11.57 109 CHAPTER V DISCUSSION, LIMITATIONS, FUTURE RESEARCH This chapter summarizes the s t a t i s t i c a l findings and considers t h e i r implications for counselling. It discusses the research l i m i t a t i o n s of the study, and provides recommendations for further research concerning burnout and therapeutic functioning among family therapists. This was a nonexperimental, cross-sectional survey, d e s c r i p t i v e and c o r r e l a t i o n a l i n nature. The o v e r a l l objective of t h i s research was to examine family and work stress i n the l i v e s of family therapists and the r e l a t i o n s h i p to p r o f e s sional effectiveness. The data regarding family and work concerns, normative and nonnormative l i f e events and changes, family functioning, and coping behaviours were c o l l e c t e d i n an e f f o r t to gain an understanding of these variables and t h e i r r e l a t i o n s h i p to the subscales of burnout and the dimensions of therapeutic functioning. Discussion of the Findings Ten hypotheses, both preliminary and primary, were tested i n an attempt to understand the r e l a t i o n s h i p between work and family stress, and burnout and therapeutic functioning, among a sample of Canadian family t h e r a p i s t s . The hypotheses have been combined for discussion i n t h i s section. The three subscales of burnout are discussed under the rubric of burnout. However, each subscale i s addressed separately within each grouping. This method of presentation i s also followed for the discussion of the dependent variables of therapeutic functioning. Preliminary Hypotheses. The preliminary hypotheses were concerned with s i g n i f i c a n t d ifferences between male and female family therapists on the dependent measures of burnout and therapeutic functioning. As well, family 110 therapists i n t h i s study were compared to a group of mental-health professionals studied by Maslach and Jackson (1986). The normative sample consisted of middle-aged, American mental-health p r a c t i t i o n e r s . By and large, females were working as counsellors, s o c i a l workers, and psychologists; whereas males were highly represented i n the f i e l d of psychiatry and medicine i n i n s t i t u t i o n a l settings. Analyses of the data indicated that male and female family therapists experienced a low to moderate degree of burnout as measured by the emotional exhaustion subscale. Males experienced s i g n i f i c a n t l y greater l e v e l s of emotional exhaustion than female family therapists (p_ < .10). This f i n d i n g may be a t t r i b u t e d to a dual role that some male therapists reported: family counsellor and administrator. In general, the wide v a r i a b i l i t y observed on emotional exhaustion scores for male and female family therapists suggests that i n d i v i d u a l s of both genders experienced being overextended and exhausted by t h e i r work. Furthermore, both males and females i n t h i s sample were found to experience s i m i l a r l e v e l s of emotional exhaustion compared to the normative sample. Apparently, the primary source of burnout for t h i s sample i s the experience of emotional exhaustion. These therapists were also experiencing a low degree of burnout as measured by reduced personal accomplishment. This appears well supported since the present sample's scores s i g n i f i c a n t l y d i f f e r e d from the normative sample on reduced personal accomplishment (p < .001). This suggests that p o s i t i v e f e e l i n g s of competence and achievement were experienced by those i n family therapy work. As well, male and female family therapists reported a low l e v e l of burnout as measured by the depersonalization subscale. This suggests that family t h e r a p i s t s , when compared to the normative group, experienced fewer responses towards c l i e n t s of a negative or cyni c a l nature. A s i g n i f i c a n t l y lower experience of depersonalization was reported for the present sample I l l compared to the normative sample (p_ < .001). Both genders scored well within the low range of depersonalization. However, male therapists experienced s i g n i f i c a n t l y more depersonalization than female therapists (p_ < .05). This f i n d i n g has been obtained i n other studies on burnout (Maslach, 1982a). Raquepaw and M i l l e r (1989) found that men i n t h e i r sample experienced more depersonalization than women. They a t t r i b u t e t h i s higher l e v e l of depersonalization found i n men to the intense emotional encounters i n therapeutic work — encounters that may be les s taxing for women since they are s o c i a l i z e d from early childhood to assume a more empathic and r e l a t i o n a l r o l e . O v e r a l l , male and female family therapists were f a i r l y s i m i l a r i n t h e i r experiences of burnout. The differences observed are rather small and the findings are consistent with the occupational-stress l i t e r a t u r e which claims there are no gender differences (see review, Martocchio & O'Leary, 1989) . Furthermore, the current sample of family therapists displayed l e s s burnout, i n a l l three subscales, than a group of physicians, p s y c h i a t r i s t s , psychologists, and s o c i a l workers working i n an i n s t i t u t i o n a l s e t t i n g , studied by Snibbe, R a d c l i f f e , Weisberger, Richards, and K e l l y (1989). I t i s important to note, that differences observed between family therapists studied here and the normative or comparison group of " i n d i v i d u a l " mental-health professionals may be a t t r i b u t e d to the nature of working i n private p r a c t i c e , (e.g., where one can exert more control over caseload s i z e and work demands) versus an i n s t i t u t i o n a l s e t t i n g (e.g., where work demands are t y p i c a l l y set by the agency) and not to the nature of performing systemic versus i n d i v i d u a l therapy. The findings i n the study at hand revealed no gender differences with respect to therapeutic functioning. One explanation may be that s e l e c t i n g family therapists who are members of the AAMFT ensured, to some extent, homogeneity i n the r a p i s t t r a i n i n g . By and large, therapists shared s i m i l a r t h e o r e t i c a l backgrounds (systemic 59.1%, narrative, solution-focused or 112 feminist 29.6%, and s t r u c t u r a l 16.2%). The s k i l l l e v e l or functions performed by both male and female therapists could thus be considered s i m i l a r , and as a r e s u l t one would not expect to f i n d gender differences with respect to in-session functioning with c l i e n t s . Demographic Variables F i r s t , Pearson product-moment correlations were used to investigate two areas of r e l a t i o n s h i p : demographic variables and the components of burnout; and demographic variables and therapeutic functioning. Second, to determine s i g n i f i c a n t differences among family therapists, one-way analyses of variance were performed i n two areas: on the remaining demographic variables and burnout; and on the remaining demographic variables and therapeutic functioning. Analyses of the r e s u l t s i n d i c a t e a s l i g h t negative r e l a t i o n s h i p between emotional exhaustion and age. Age was not s i g n i f i c a n t l y correlated with any other burnout subscale or with therapeutic functioning. The trend suggests that younger family therapists were more emotionally exhausted than the older family therapists, a finding consistent with other research (Maslach & Jackson, 1986). Beck (1987) found age to be s i g n i f i c a n t l y c orrelated with burnout i n her study of counsellor burnout i n family agencies. This greater degree of emotional exhaustion associated with age may be a t t r i b u t e d to the idealism that younger therapists often bring to the workplace. Inexperienced therapists may have u n r e a l i s t i c expectations of what they can accomplish. This can lead to feelings of f r u s t r a t i o n when t h e i r i d e a l i s t i c expectations c o n f l i c t with real-world s i t u a t i o n s . Cherniss (1980) observed s i m i l a r findings with respect to work experience. He noted that a "professional mystique" contributes to burnout by creating u n r e a l i s t i c expectations among new workers. Older therapists, on the other hand, tend to have more r e a l i s t i c expectations and tend to have better i n s i g h t into t h e i r personal l i m i t a t i o n s . They may be better able to 113 i d e n t i f y what can be changed and the energy that needs to be invested i n order to accomplish the desired change. Older therapists may also make more e f f e c t i v e and e f f i c i e n t use of t h e i r time, energy, and e f f o r t s . In general, older therapists may have more r e a l i s t i c expectations of t h e i r c l i e n t s than younger therapists, which may minimize the stresses and f r u s t r a t i o n s that they experience which can ulti m a t e l y lead to burnout. A s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n was found for o v e r a l l health concerns and emotional exhaustion. As well, a s i g n i f i c a n t but s l i g h t c o r r e l a t i o n was found for health concerns and depersonalization. In general, the findings suggest that family therapists are i n good health, expressing few somatic concerns. However, those who do experience health problems are also more l i k e l y to experience work exhaustion (accounting for 14% of the variance), and to see t h e i r c l i e n t s i n a poor l i g h t . An unexpected f i n d i n g was reported for o v e r a l l health concerns and reduced personal accomplishment. That i s , therapists with more health worries were also l i k e l y to see themselves as being successful at work. Upon closer examination of the o v e r a l l health variable, one would be l i k e l y to f i n d these therapists reporting a .disinterest i n physical a c t i v i t y , engaging i n smoking, and eating a poor d i e t . Perhaps these behaviours can also be found i n workaholics, who do not f i n d the time to care for themselves, v i a die t and exercise, but instead s t r i v e for work excellence and f i n d s a t i s f a c t i o n i n t h e i r work accomplishments. Among the health concerns, family therapists who experienced sleep disturbances on an often plus very often basis (n = 27) had s i g n i f i c a n t l y higher mean scores on emotional exhaustion and depersonalization. Those family therapists who d i d not experience any sleeping problems had s i g n i f i c a n t l y higher mean scores on reduced personal accomplishment. Perhaps the sleeplessness leaves some family therapists f e e l i n g t i r e d at work and i r r i t a b l e towards t h e i r c l i e n t s . On the other hand, those who 114 sleep well and f e e l rested may be more s a t i s f i e d with t h e i r work accomplishments. Another health-concern variable with s i g n i f i c a n t findings i s d i s i n t e r e s t i n physical a c t i v i t y or exercise. Family therapists who were the l e a s t i n t e r e s t e d i n physical a c t i v i t y also reported higher scores on emotional exhaustion. This f i n d i n g supports the commonly accepted concept that exercise i s h e a l t h f u l , and helps i n reducing stress (this was reported by many of the respondents), and i n v i g o r a t i n g oneself. The r e l a t i o n s h i p between health problems and occupational stress i s well-documented i n the l i t e r a t u r e (Holt, 1993). A considerable v a r i e t y of pathologies are s a i d to be caused or exacerbated by occupational stress i n c l u d i n g cardiovascular diseases, migraines, r e s p i r a t o r y i l l n e s s e s , and diabetes (Holt, 1993, p. 353). A moderate, p o s i t i v e c o r r e l a t i o n was also found for therapists experiencing health concerns and in-session therapeutic functioning ( i . e . , therapeutic s t a b i l i t y ) . This c o r r e l a t i o n hints at a possible r e l a t i o n s h i p between therapist well-being and a b i l i t y to maintain a consistent l e v e l of counselling s k i l l . Furthermore, family therapists "who experienced no sleep disturbances (n = 42) had s i g n i f i c a n t l y higher mean scores on in-session therapeutic functioning. Perhaps a well-rested family therapist i s better able to focus on counselling s k i l l s and perform at a consistent l e v e l with c l i e n t s . F i n a l l y , no other s i g n i f i c a n t r e l a t i o n s h i p s were found for health concerns and other aspects of therapeutic functioning. Turning to professional demographics, therapists whose i d e a l caseload was smaller than t h e i r current caseload were found to be s i g n i f i c a n t l y more burned out, on the emotional exhaustion subscale. O v e r a l l , respondents i n t h i s sample had r e l a t i v e l y small caseload s i z e s . Thus, the perception of having too many c l i e n t s was associated with burnout, rather than the actual caseload s i z e . Higher l e v e l s of burnout have been associated with extremely high caseloads that were perceived as unmanageable. However, a 115 number of family therapists i n t h i s sample work i n pri v a t e p r a c t i c e , and the very nature of t h i s work s e t t i n g provides some external control on the size of the caseload. Other studies i n v e s t i g a t i n g caseload and burnout have obtained s i m i l a r r e s u l t s ( i . e . , the more excessive the perceived caseload, the more l i k e l y burnout was present, Beck, 1987; Hellman, Morrison, & Abramowitz, 1986; Raquepaw & M i l l e r , 1989). As well, the more hours per week spent seeing c l i e n t s , the more l i k e l y family therapists were to experience reduced personal accomplishment. Int e r e s t i n g l y , t h i s suggests that the more c l i e n t s a therapist sees i n a week, the more l i k e l y (s)he i s to f e e l unsuccessful i n his or her accomplishments. However, these findings are consistent with Maslach's research (1976/1982/1993), where time spent i n continuous, d i r e c t contact with c l i e n t s d i r e c t l y correlated with stress and negative attitudes regarding one's work. F i n a l l y , those therapists who reported no i n t e n t i o n of leaving the profession had s i g n i f i c a n t l y higher mean scores on in-session therapeutic functioning, while no s i g n i f i c a n t differences were found for in t e n t i o n of leaving the profession and burnout. Overall, family therapists appear to be content i n t h e i r career choice (86.6%) and seem to focus t h e i r energies on providing family therapy, rather than looking to other avenues for work. The lack of s i g n i f i c a n t findings with respect to i n t e n t i o n of leaving the profession and burnout i s s u r p r i s i n g . This f i n d i n g i s inconsistent with Raquepaw and M i l l e r ' s study (1989), which stated that the l i k e l i h o o d of leaving the profession i s related to feelings of burnout, e s p e c i a l l y emotional exhaustion and depersonalization. However, the unexpected find i n g i n the current study may be accounted for by the small number of cases (n = 9) which responded to a strong or very strong i n t e n t i o n of leaving family therapy work i n the next f i v e years. 116 Hypotheses 3 and 5. It was hypothesized that s t r e s s f u l l i f e events, both normative and nonnormative, would be p o s i t i v e l y associated with burnout or negatively associated with therapeutic functioning for family th e r a p i s t s . S t r e s s f u l l i f e events, measured by the Family Inventory of L i f e Events and Changes, were s i g n i f i c a n t l y correlated with emotional exhaustion and depersonalization, but only weakly correlated with reduced personal accomplishment. Moderate l e v e l s of stress were reported for family therapists, regardless of family l i f e - c y c l e stage. Those family therapists reporting greater personal stresses, during the past year, were more l i k e l y to experience emotional exhaustion and experience a negative s h i f t i n a t t i t u d e towards t h e i r c l i e n t s . Although a weak, p o s i t i v e c o r r e l a t i o n was found between an increase i n s t r e s s f u l l i f e events and reduced personal accomplishment, a trend i s noted. Similar r e s u l t s were obtained by Farber and Heifetz (1982), who found that therapists were more prone to " t r a n s i e n t " feelings of burnout when stresses at home lowered t h e i r threshold for coping with d a i l y therapeutic f r u s t r a t i o n s . Their study focused on within-session sources of stress for psychotherapists; however, the findings also suggest that stresses i n other areas of l i f e can combine with work stresses to correlate with burnout. In the current sample of therapists, s t r e s s f u l l i f e events accounted for 11.9% of the variance with respect to emotional exhaustion, and for 5.46% of the variance with respect to depersonalization. A l i t e r a t u r e review on stress-disorder correlations suggests that t h i s i s a meaningful r e s u l t , e s p e c i a l l y with respect to emotional exhaustion, since s t r e s s f u l l i f e events t y p i c a l l y account for only 10% or less of the variance ( M i l l e r , 1993). S t r e s s f u l l i f e events were also found to s i g n i f i c a n t l y correlate with in-session•therapeutic functioning, measured by the g r i d and by work 117 a c t i v i t i e s performed and relinquished. The r e s u l t s suggest a trend exists with respect to the family, therapist's experience of s t r e s s f u l events and work performance. A moderate association was found between s t r e s s f u l l i f e events and the therapist's a b i l i t y to maintain a consistent l e v e l of therapeutic s k i l l over the one-year period. Thus, therapists who were experiencing greater normative and'nonnormative l i f e changes were also more l i k e l y to experience a greater f l u c t u a t i o n i n counselling s k i l l s provided to t h e i r c l i e n t s . It i s important to note that the findings for in-session functioning are t e n t a t i v e ; only a very small amount of the variance, 3% to 6%, i s accounted for by s t r e s s f u l l i f e events i n in-session functioning. There i s , however, a stronger, p o s i t i v e r e l a t i o n s h i p between s t r e s s f u l l i f e events and the number of work a c t i v i t i e s performed and relinquished (accounting for 21% of the variance). This indicates that the greater the therapist's experience of s t r e s s f u l l i f e events, the more l i k e l y (s)he i s to l e t go of r o u t i n e l y performed work tasks due to personal stresses. There are no s p e c i f i c studies that investigate the r e l a t i o n s h i p between s t r e s s f u l l i f e events and therapeutic functioning among family t h e r a p i s t s . However, the findings reported here to some extent concur with studies i n v e s t i g a t i n g the r e l a t i o n s h i p between l i f e stress and organizational outcomes (Bhagat, McQuaid, Lindholm, & Segovis, 1985; Schultz, Chung and Henderson, 1989). That i s , negative, personal l i f e stress (e.g., stresses pertaining to health, family, marriage, work, finances and l e g a l matters) moderately correlates with negative job involvement, performance effectiveness, and turnover intentions. Thus, negative l i f e stress can negatively impact on work, and s p i l l o v e r e f f e c t s from nonwork stress can a f f e c t organizational outcomes. F i n a l l y , no s i g n i f i c a n t differences were found for s t r e s s f u l l i f e events between family therapists, regardless of family l i f e - c y c l e stage, and the normative families (McCubbin & Patterson, 1991, p. 92), except for 118 family therapists i n the "school age" and "young adult" stage of family l i f e . Here, we f i n d that family therapists experience s i g n i f i c a n t l y less f a m i l y - l i f e stress than the normative population (p_ < .01 and p < .05, re s p e c t i v e l y ) . One would expect that family therapists, by the nature of t h e i r t r a i n i n g and professional status, are better able to deal with, or f i n d the resources to help them with, parenting issues compared to parents i n the general population. Not a l l respondents could be compared to the norms. Some 8.5% of family therapists did not belong to one of the family l i f e - s t a g e categories and could not be accounted for using the norms provided. Family therapists c i t e d f i n a n c i a l hardship, the burden of caring for e l d e r l y parents and i l l spouses, and r e l a t i o n s h i p d i f f i c u l t i e s among co-workers as the most s t r e s s f u l l i f e events experienced over the past year. I t appears that negative p e r s o n a l - l i f e events, for t h i s sample of therapists, were not l i m i t e d to the stresses of work; they included the stresses of home and family l i f e . C learly, therapists do not separate t h e i r p e r s o n a l - l i f e stresses from t h e i r work l i v e s . In t h i s case, family-l i f e stresses appear to be rela t e d to burnout and therapeutic functioning. Hypotheses 4, 4a, 6, and 6a. It was assumed that a d i s s a t i s f a c t i o n i n handling work and family stress would be p o s i t i v e l y r e l a t e d with burnout, while i t was assumed that a s a t i s f a c t i o n i n handling work and family stress would be negatively r e l a t e d with burnout. Analyses found that family therapists' perception of t h e i r a b i l i t y to handle d a i l y s tress, both work and family, was s i g n i f i c a n t l y r e l a t e d to burnout as measured by emotional exhaustion and depersonalization. S p e c i f i c a l l y , the greater the therapist's sense of d i s s a t i s f a c t i o n i n handling work and family stresses, the more emotional exhaustion and depersonalization was experienced. In fact, therapists' d i s s a t i s f a c t i o n i n 119 handling work and family stress accounted for the l a r g e s t proportion of the variance i n t h i s study — a t o t a l of 44%. Work and family concerns most commonly reported by the therapist as leading to a greater perception of d i s s a t i s f a c t i o n included: excessive workload, lack of peer or supervisor feedback, and being p u l l e d i n two di r e c t i o n s (work and family). Other studies i n v e s t i g a t i n g caseload and burnout have obtained s i m i l a r r e s u l t s to those found here. The more excessive one perceives t h e i r caseload, the more l i k e l y burnout w i l l be present (Beck, 1987; Hellman, Morrison, & Abramowitz, 1986; Raquepaw & M i l l e r , 1989). The l i t e r a t u r e also shows that contacts with co-workers and/or supervisors i s an important aspect of therapy work. Feedback i s c r u c i a l for one's sense of meaningfulness and achievement at work; when the r e l a t i o n s h i p s are lacking, nonsupportive, or unpleasant, then the r i s k of burnout i s greater (Cherniss & Krantz, 1983; Golembiewski, Munzenrider, & Stevenson, 1986; Pines & Maslach, 1978). Further, c o n f l i c t between family role and work role has been found to s i g n i f i c a n t l y correlate to work and i n d i v i d u a l health outcomes and i s a greater problem for women than men (Burke, 1988). The current study also concurs with occupational-stress theory i n several respects. F i r s t , burnout tends to represent an imbalance between people's perceptions of the demands placed on them and t h e i r a b i l i t y to cope with the demands (C a r r o l l & White, 1982). Second, a high proportion of variance was accounted for by work and family stresses reported from the Family/Work Concerns c h e c k l i s t , as opposed to the normative and nonnormative l i f e events, reported from the Family Inventory of L i f e Events and Changes. This f i n d i n g suggests that d a i l y , ongoing stresses may be more f r u s t r a t i n g and d i s t r e s s i n g to a family therapist, and may serve as a better p r e d i c t o r of burnout compared to major normative and nonnormative l i f e events (Johnson & Stone, 1986; Kanner, Coyne, Schaefer, Lazarus, 1981). Moreover, the findings support the idea that a therapist's concerns i n both spheres — work and family — can combine i n a " m u l t i p l i c a t i v e 120 fashion" and s i g n i f i c a n t l y r e l a t e to burnout (Paradine, Higgins, Beres, Szeglin, & Kravitz, 1981). Turning to a therapist's s a t i s f a c t i o n i n handling work and family stress and the three l e v e l s of burno'ut, no s i g n i f i c a n t c o r r e l a t i o n s were found (for Hypothesis 4a). Although a d i s s a t i s f a c t i o n i n handling work and family stress appears to contribute to an increase i n burnout, one's l e v e l of s a t i s f a c t i o n does not.appear to contribute to or reduce burnout. This findings i s inconsistent with related research which that suggests family-l i f e s a t i s f a c t i o n i s s i g n i f i c a n t l y correlated with contentment with one's job (Pahl & Pahl, 1971). The unfounded r e l a t i o n s h i p between s a t i s f a c t i o n i n handling work and family stress and burnout may be explained by the notion that family therapists can experience high l e v e l s of stress and not perceive i t as such, because they may be s a t i s f i e d that they are handling the stress well. Or i t may be what the l i t e r a t u r e refers to as an "unwillingness" or " d e n i a l " on the part of the therapist to dis c l o s e p r o f e s s i o n a l d i f f i c u l t i e s (Kilburg, Nathan, & Thoreson, 1986). On the other hand, therapists that are d i s s a t i s f i e d with t h e i r handling of stress may be more apt to see t h e i r world i n a negative l i g h t ; thus, perceiving higher l e v e l s of stress and burnout. F i n a l l y , i n d e c i s i o n regarding one's s a t i s f a c t i o n i n handling work and family stress was s i g n i f i c a n t l y correlated with emotional exhaustion and depersonalization. The findings are s i m i l a r to those reported by the " d i s s a t i s f i e d " family therapists. Interestingly, t h i s " i n d e c i s i o n " accounted for approximately 25% of the variance i n burnout. Thus, i t appears that a family therapist's self-doubt also tends to colour t h e i r world i n a negative manner. It was also hypothesized (in Hypothesis 6) that a d i s s a t i s f a c t i o n i n handling work and family stress would be negatively associated with therapeutic functioning. The findings support the hypothesis with respect 121 to o v e r a l l functioning, as measured by the grid , and work a c t i v i t i e s relinquished. Thus, family therapists who are disappointed i n t h e i r a b i l i t y to handle d a i l y stresses also show lower l e v e l s of therapy functioning with c l i e n t s . However, they are also more l i k e l y to cut back on work a c t i v i t i e s performed. D i s s a t i s f a c t i o n i n handling work and family stress accounted for 12% of the variance i n work a c t i v i t i e s , and only 3% of the variance i n o v e r a l l functioning. Perhaps disengaging from work a c t i v i t i e s may be an adaptive mechanism, a form of active coping for a therapist who i s unhappy with the e f f e c t s of work and family stresses. The nonsignificant r e l a t i o n s h i p between d i s s a t i s f a c t i o n i n handling work and family stress and in-session functioning, measured by s t a b i l i t y of therapeutic functioning, may be accounted for by the few number of times (a maximum of 4) the therapist's l e v e l of functioning crossed the baseline. As well, therapeutic s t a b i l i t y as presented here only measured how often the therapist's l e v e l of functioning crossed the baseline, without taking into account the extent of the fl u c t u a t i o n s . Conversely, i t was hypothesized that a s a t i s f a c t i o n i n handling work and family stress would be p o s i t i v e l y associated with therapeutic functioning (Hypothesis 6a). In t h i s case, no s i g n i f i c a n t r e l a t i o n s h i p was found between s a t i s f a c t i o n i n handling work and family stress and i n -session functioning as measured by either the g r i d or by therapeutic s t a b i l i t y . Given the subjective, retrospective nature of measuring therapeutic functioning, family therapists may have experienced gaps i n r e c a l l i n g past information. A l t e r n a t i v e l y , they may have found the four therapist functions ( i . e . , engagement, problem i d e n t i f i c a t i o n , change f a c i l i t a t i o n , and termination) too global a concept to p r e c i s e l y capture t h e i r counselling s k i l l s . Perhaps a more objective, observational measure of a therapist's counselling s k i l l s would y i e l d d i f f e r e n t r e s u l t s . Although a s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n was found between s a t i s f a c t i o n i n handling work and family stress, and a reduction i n work 122 a c t i v i t i e s , the r e s u l t was confounded. That i s , family therapists who are generally s a t i s f i e d with the way they handle everyday work and family concerns are also more l i k e l y to cut back on t h e i r work a c t i v i t i e s . This unexpected f i n d i n g may be influenced by the i n a b i l i t y of the therapist to assign a r e l a t i v e measure of importance to each question i n the Family/Work Concerns c h e c k l i s t . For example, a therapist reporting d i s s a t i s f a c t i o n with "not having enough energy for marriage and family l i f e (question #19), perhaps an item of highly personal concern to them, may r e l i n q u i s h a number of work a c t i v i t i e s even though (s)he i s s a t i s f i e d i n handling most or a l l other work and family stresses. This lack of weighted response may have skewed the s t a t i s t i c a l outcome. In order to obtain a s t a t i s t i c a l l y meaningful r e s u l t , the therapist should be able to assign a l e v e l of r e l a t i v e importance or weight to each question, which would produce an o v e r a l l weighted average measure of s a t i s f a c t i o n to be compared against a reduction i n work a c t i v i t y . Again, i n d e c i s i o n regarding one's s a t i s f a c t i o n i n handling work and family stress was found to be related to work a c t i v i t i e s relinquished, accounting for approximately 12% of the variance. This r e s u l t suggests that as a family therapist's doubts increase regarding his or her a b i l i t y to handle d a i l y stresses, so does the number of work a c t i v i t i e s relinquished. Perhaps a family therapist's degree of self-doubt negatively colours t h e i r perception of handling work and family s t r e s s . Hypotheses 7 and 8 It was hypothesized that increased l e v e l s of family functioning would be negatively associated with burnout or p o s i t i v e l y associated with therapeutic functioning for family therapists. Family functioning was measured by the Family Relationship Index which consisted of the following dimensions: cohesion, expressiveness and reduced c o n f l i c t . 123 A moderate to high l e v e l of family functioning was reported among family t h e r a p i s t s . This sample of family therapists reported few separated or divorced marriages, which may explain t h i s moderate to high rate of family functioning. In other research studies, psychotherapist p r a c t i t i o n e r s reported overwhelming r e l a t i o n s h i p d i f f i c u l t i e s with spouses and children, high rates of dysfunctional marriages, and marital f a i l u r e (Deutsch, 1985; Guy, Poelstra, & Stark, 1989; Norcross & Prochaska, 1986a, 1986b) . Although no study s p e c i f i c a l l y examines family functioning among family t h e r a p i s t s , research exists on the pr a c t i c e of family therapy and i t s impact on th e r a p i s t family l i f e . Wetchler and Piercy's survey (1986) found the p r a c t i c e of family therapy to be an "enhancer" i n the l i v e s of family t h e r a p i s t s , with 85% reporting improved communication within t h e i r f a m i l i e s , 85% reporting an appreciation of family strengths, and 87% reporting a greater acceptance of t h e i r part i n family/marital problems. Thus, one suspects that t r a i n i n g and pr a c t i c e i n family therapy prepare the the r a p i s t to be a p o s i t i v e change agent within h i s or her family, promoting improved family functioning s k i l l s . Family functioning was s i g n i f i c a n t l y related to a l l three components of burnout. Family therapists who reported increased l e v e l s of family functioning also reported greater feelings of success i n t h e i r work accomplishments. This subscale accounted for the highest proportion of the explained variance, approximately 10%. Moderate and weak c o r r e l a t i o n s were found between family functioning, and emotional exhaustion (accounting for 5.16% of the variance) and depersonalization (accounting for 3.49% of the variance), r e s p e c t i v e l y . However, the fi n d i n g s t i l l suggests a trend exists among therapists reporting increased l e v e l s of family functioning and lower l e v e l s of both emotional exhaustion and depersonalization. These r e s u l t s concur with e a r l i e r studies that state that families competent i n meeting with cr i s e s are cohesive, f l e x i b l e , open to 124 communication both within and outside the family, and are capable of dealing with stress i n a n o n c r i t i c a l manner (McCubbin & Figley, 1983; Olson, Russell, & Sprenkel, 1983; Wynne, 1985). Thus, the l e v e l s of family functioning, i n t h i s sample, suggest that a family therapist's family system employs mediating strategies based on coherence, open communication, and c o n f l i c t r e s o l u t i o n . It was also hypothesized that family functioning would be p o s i t i v e l y associated with therapeutic functioning among family therapists (Hypothesis 8). The findings were inconsistent. F i r s t , no s i g n i f i c a n t r e l a t i o n s h i p was observed between family functioning and in-session therapeutic functioning, as measured by eit h e r the Therapeutic Functioning Grid, or by the reduction i n work a c t i v i t i e s . Again, the lack of s i g n i f i c a n t findings may be due to the s e l f - r e p o r t , retrospective nature of measuring therapeutic functioning. Despite moderate l e v e l s of stress, family therapists o v e r a l l relinquished very few work a c t i v i t i e s . A histogram d i s t r i b u t i o n displayed a highly p o s i t i v e , skewed d i s t r i b u t i o n for the vari a b l e reduction i n work a c t i v i t i e s . Perhaps family therapists f e e l a sense of commitment towards t h e i r work which does not permit them to e a s i l y l e t go of work tasks. Second, although family therapists who reported increased l e v e l s of family functioning also reported greater s t a b i l i t y (or consistency) i n the counselling s k i l l s provided to c l i e n t s , only about 5% of the variance was accounted f o r by family functioning with respect to therapeutic s t a b i l i t y . Hypotheses 9 and 10 Although a s i g n i f i c a n t difference was reported for family therapists who engage i n stress-managing behaviours versus therapists who do not engage i n stress-managing behaviours on l e v e l s of emotional exhaustion and depersonalization, the findings are confounded. That i s , one i n t u i t i v e l y expects family therapists who are high-level engagers of stress-managing 125 strategies to also report low l e v e l s of emotional exhaustion and depersonalization. This would be consistent with the l i t e r a t u r e , for example, Pines and Aronson's (1988) study of coping and burnout. In a sample of human-service professionals, these authors found that the more frequently the active strategies ( i . e . , attempting to change or do something about the source of stress) were used, the less burnout was reported. The unanticipated findings, i n t h i s t h e s i s , l e d to post-hoc analyses i n an e f f o r t to f i n d support for a t h i r d v ariable p r e d i c t i n g a r e l a t i o n s h i p between burnout and the engagers of high- and low-level stress-managing behaviours. Three variables were studied i n the post-hoc analyses: family functioning; and two work variables — t o t a l number of hours worked per week, and perception of i d e a l caseload. The assumption was that high l e v e l s of family functioning would encourage family therapists to engage i n more stress-managing behaviours at work to achieve a balanced home and work l i f e . For the work variables, i t was assumed that family therapists who worked long hours would need to engage i n more stress-managing strategies i n an e f f o r t to deal with a strenuous workload. S i m i l a r l y , i t was presumed that therapists who hoped for a smaller caseload would employ more s t r e s s -managing strategies as a means of dealing with t h e i r heavy workload. However, no s i g n i f i c a n t difference was found for l e v e l of s t r e s s -managing behaviours and family functioning. In fact, moderate l e v e l s of family functioning were indicated for a l l three groups of stress-managing engagers. Although therapists i n the low-engager category of s t r e s s -managing behaviours reported a greater number of work hours per week, no s i g n i f i c a n t differences were found. F i n a l l y , no s i g n i f i c a n t differences were reported for i d e a l caseload and l e v e l of engaging i n stress-managing behaviour. This lack of s i g n i f i c a n c e may be a t t r i b u t e d to the small number of cases observed. That i s , n = 3 for smaller caseload and low-level engager and n = 11 for smaller caseload and high-level engager. 126 It was also hypothesized that family therapists who engage i n s t r e s s -managing behaviours versus therapists who do not engage i n stress-managing behaviours would s i g n i f i c a n t l y d i f f e r with respect to t h e i r therapeutic functioning (Hypothesis 10). The results show that l e v e l of engaging i n stress-managing behaviours d i d not vary s i g n i f i c a n t l y with the three aspects of therapeutic functioning. Again, the lack of s i g n i f i c a n t findings may be accounted for by the nature of measuring therapeutic functioning. Moreover, although therapists o v e r a l l reported using a moderate number of stress-engaging strategies, no s p e c i f i c i n d i c a t i o n was given whether the strategies employed were directed towards work stresses, family stresses, or a combination of both. Another possible explanation for the lack of findings i n the study i s that coping i s an ongoing process that changes over time, s i t u a t i o n s , and demands. This i s well substantiated i n the research by Lazarus and Folkman (1984). Thus, i t i s very l i k e l y that coping cannot be accurately captured i n a c r o s s - s e c t i o n a l survey study such as t h i s one. Overall, the l i t e r a t u r e does not provide much empirical research on the e f f e c t s of coping i n the workplace. Limitations In t h i s t h e s i s , a good methodological design was used, a r e l i a b l e measure of burnout, s t r e s s f u l l i f e events, and family functioning were u t i l i z e d , and a relevant sample was obtained. However, the g e n e r a l i z a b i l i t y of these findings i s l i m i t e d to English-speaking Canadian family t h e r a p i s t s . As well, since only family therapists from AAMFT were selected, perhaps the more competent or f i n a n c i a l l y secure members of the profession are represented. Thus, threats to i n t e r n a l v a l i d i t y may have resulted i n a sampling bias due to the voluntary p a r t i c i p a t i o n of a s e l e c t few family t h e r a p i s t s . A s e l f - s e l e c t i o n bias may also be l i k e l y as some therapists 127 (30%) d i d not respond; perhaps these therapists were the most burned out and found t h i s survey an added stressor. Given the moderate return rate, the demographics indi c a t e that the sample consisted p r i m a r i l y of married or committed family therapists who were middle-aged, established, working i n p r i v a t e p r a c t i c e , and l i v i n g i n an urban or metropolitan centre. This i n i t i a l research reports on a general sample of family t h e r a p i s t s . However, young therapists beginning to p r a c t i c e family therapy, those separated or divorced, working i n agencies or i n s t i t u t i o n a l settings, or those l i v i n g i n a small town or r u r a l area may have been underrepresented. As well, i t i s possible that subgroups of family therapists e x i s t which l i m i t the findings on l e v e l s of burnout. For instance, those therapists who are associate or student members, not i n personal therapy, counselling mostly " i n d i v i d u a l " c l i e n t s , and not p r a c t i c i n g a systemic form of therapy may be the more l i k e l y candidates for burnout. Another l i m i t a t i o n of the study may have existed i n the d e l i v e r y of the survey. For instance, threats to i n t e r n a l v a l i d i t y may be present i n that, although a l l questionnaires were mailed out at the same time, there was no way to control mail d e l i v e r y . Therefore, the time of day or day of the week i n which the mail was received by the therapists varied. As well, some therapists completed the questionnaire following receipt of the i n i t i a l mail-out, but the majority (69.8%) completed the survey following the second reminder. Because of the i n a b i l i t y to control for t h i s variance, maturation may have presented a small threat to the i n t e r n a l v a l i d i t y of the study. More importantly, i f the family t h e r a p i s t had just returned from a holiday or recently attended a workshop on burnout, his or her a t t i t u d e may have been influenced by such extraneous events, thus causing a h i s t o r i c a l threat to i n t e r n a l v a l i d i t y . In fact, several therapists d i d apologize for t h e i r tardiness i n responding; they had j u s t returned from a holiday. 128 This study was l i m i t e d to three predictor v a r i a b l e s : family l i f e events and change; work and family stress; and family functioning, c o n s i s t i n g of cohesion, expressiveness, and c o n f l i c t . These variables were believed to eit h e r mitigate burnout or enhance therapeutic functioning. Cl e a r l y , no one factor i s s u f f i c i e n t to cause therapist burnout or reduced work performance. As Cherniss and Krantz (1983) point out, burnout i s most l i k e l y the r e s u l t of a complex i n t e r a c t i o n among i n d i v i d u a l , organizational, and s o c i e t a l factors. Thus, i t i s appropriate to study the i n t e r a c t i o n among personality t r a i t s of the therapist, c l i e n t c h a r a c t e r i s t i c s , work-related factors, and f a m i l i a l variables i n order to develop a conceptual framework i n which to understand the process of burnout and i t s outcomes (Burr & Klein, 1994; Maslach, 1986; 1993). Furthermore, although 91.5% of the sample belonged to a t r a d i t i o n a l nuclear family, research also needs to address stressors s p e c i f i c to therapists who do not l i v e a nuclear-family l i f e arrangement. Weakness may also l i e i n the research items developed by the author or the nonstandardized measures used; these include: Family/Work Concerns, Stress-Management Strategies c h e c k l i s t , and Therapeutic Functioning. Although they a l l appear to have good face v a l i d i t y , the v a l i d i t y and r e l i a b i l i t y of these items have not been established. Although measures of i n t e r n a l consistency were obtained for the Stress-Management Strategies c h e c k l i s t and Work A c t i v i t i e s l i s t and they appear to have moderate s t a b i l i t y , caution i s warranted i n i n t e r p r e t i n g the r e s u l t s . Furthermore, there may have been a lack of construct v a l i d i t y for in-session functioning, as measured by the Therapeutic Functioning Grid. Some therapists mentioned having d i f f i c u l t i e s i n assessing t h e i r therapy functioning over the past year. A l l data was based on s e l f - r e p o r t measures. In some cases, respondents may have f e l t too embarrassed, threatened, or t i r e d ; t h i s could account f o r the incomplete surveys (approximately 4%). Several family 129 therapists indicated, i n the comments section, that r e c a l l for retrospective information pertaining to the Therapeutic Functioning Grid was a challenging task. One would expect " f a l l o f f i n r e c a l l of l i f e events at about 5 percent per month" (Sandler & Guenther, 1985 p. 566). Overall, the majority of therapists were able to focus on s p e c i f i c events, over the one-year period, enabling them to s u c c e s s f u l l y respond. There i s some evidence that the s t r e s s f u l impact of a l i f e event i s manifested within four to s i x months; however, without looking back over time, the f u l l e f f e c t s of the event would not be apparent to the r e c a l l e r (Andrews, 1981). A problem with fatigue may also have existed with regard to the in-session functioning g r i d , which was located towards the end of the questionnaire, e s p e c i a l l y since no therapist commented on the d i f f i c u l t y of completing the Family Functioning Grid which was located e a r l i e r on. It should also be recognized that l i m i t a t i o n s e x i s t because of the exclusive focus on the i n d i v i d u a l family therapist and his or her responses to work and family stress. This thesis did not focus on the perceptions of others, such as co-workers, supervisors, spouses, and other family members. F i n a l l y , the research design posed a l i m i t a t i o n to the study. Because of the c o r r e l a t i o n a l nature of the data and lack of experimental control, a causal r e l a t i o n s h i p between independent and dependent variables cannot be drawn. Thus, no firm conclusions can be made with respect to the nature of c a u s a l i t y , only tentative suppositions. For example, the author cannot say with c e r t a i n t y that a family therapist's experience of work and family stresses e l i c i t s burnout or reduces therapeutic functioning. Nor i s i t known whether an increased l e v e l of family functioning causes a reduction i n burnout and enhances therapeutic functioning. I t i s possible that the c o r r e l a t i o n s observed between work and family stresses and burnout, and work and family stresses and therapeutic functioning may be due to a t h i r d or myriad of uncontrolled v a r i a b l e s . This i s e s p e c i a l l y evident i n understanding the r e l a t i o n s h i p between the use of i n d i v i d u a l 130 coping strategies and burnout. Possible variables discussed i n the l i t e r a t u r e that may mediate one's experience of burnout include personality factors (Maslach, 1993), l i f e s a t i s f a c t i o n variables (Burke & Bradshaw, 1981), s o c i a l support systems (Freudenberger, 1980; Pines & Aronson, 1988; Pines & Kafry, 1981), marital s a t i s f a c t i o n , and family a d a p t a b i l i t y (Burr & Klein, 1994) . P o s s i b i l i t i e s for Future Research The findings of the study point the way for several d i f f e r e n t avenues of i n v e s t i g a t i o n . F i r s t , because t h i s i s an i n i t i a l i n v e s t i g a t i o n into the work and family stresses of the family therapist, i t would be important to r e p l i c a t e the study using a larger sample of family t h e r a p i s t s . Such an approach would hopefully r e p l i c a t e s i m i l a r r e l a t i o n s h i p s , c l a r i f y some trends, and increase the representativeness of the data. For example, i t may prove important to sample therapists from r u r a l areas or smaller towns who may not have resources r e a d i l y a v a i l a b l e to help them deal with burnout; or to study younger family therapists who may have u n r e a l i s t i c expectations for providing family counselling. Furthermore, family therapists i n t h i s study were experiencing low to moderate l e v e l s of burnout. I t may be necessary to pre-screen and f i n d therapists who are at the highend of the burnout continuum as a comparison. Second, as mentioned, the amount of burnout reported i n t h i s study i s much less than that experienced by other groups of helping professionals. This may be due to several f a c t o r s . Family therapists by the nature of t h e i r t r a i n i n g (in a systemic perspective) may be better able to manage and e f f e c t i v e l y deal with chronic stress. By and large, t h i s group has experienced extensive t r a i n i n g i n intrapersonal and interpersonal processes. They have an awareness of t h e i r own dynamics and an understanding of the importance of relationships and i n t e r a c t i o n s with others i n t h e i r l i v e s . This may allow them to more accurately i d e n t i f y 131 stresses e a r l y on and implement the necessary interventions before the stress progresses to burnout. Cle a r l y , we need to study the ways i n which family therapists function within t h e i r families and implement coping strategies to help them through d i f f i c u l t times. As well, many of the therapists i n t h i s study were employed i n private p r a c t i c e . Family therapists working i n private p r a c t i c e may d i f f e r from t h e i r counterparts i n i n s t i t u t i o n a l settings. Those i n p r i v a t e p r a c t i c e may have more control over t h e i r caseloads, vacation time, and monetary gains, while therapists i n i n s t i t u t i o n a l settings work under the conditions set f o r t h by funding agencies that can d i c t a t e caseload, length of therapy, leaves of absence, and f i n a n c i a l rewards. Thus, we need to further explore possible differences, i n stress and burnout, that may e x i s t i n d i f f e r e n t health-care settings. Furthermore, data was c o l l e c t e d i n the spring ( i . e . , May-June); some pa r t i c i p a n t s had j u s t returned from a vacation. Thus, a d i f f e r e n t time of year may produce d i f f e r e n t findings. As Farber and Heifetz's (1982) study shows, therapists found they were p a r t i c u l a r l y prone to burnout during winter months (40.8%); smaller proportions f e l t most vulnerable to burnout i n the spring (16.3%) and summer (14.3%). Another d i r e c t i o n i n which research could move i s to r e f i n e the items on the Family/Work Concerns l i s t . Although the items presented have good face v a l i d i t y , with increased feedback from family therapists the items could be t a i l o r e d even further to capture underlying work and family stresses. .For example, questions addressing' administrative and economic concerns, or issues of health care for extended family members and continued' f i n a n c i a l a i d to adult c h i l d r e n could be added to the l i s t . (These were the concerns that therapists mentioned as having been a source of stress for them over the past year). As well, scoring of these items needs to allow for a wider range of responses, and thus r i c h e r data analysis. For instance, by developing a response r a t i n g scale from 1 to 5, 132 for degree of s a t i s f a c t i o n i n handling work and family concerns, one can more e a s i l y study differences among s a t i s f i e d and d i s s a t i s f i e d t herapists. Furthermore, i f therapists could also assign a l e v e l of importance or weight to each item of concern, then degree of s a t i s f a c t i o n could be compared to therapeutic functioning. In addition, the measure of therapeutic functioning for family therapists requires further development. Problems with the global nature of the Therapeutic Functioning Grid could be overcome by measuring s p e c i f i c counselling tasks performed by therapists. For example, the therapist could be asked to report on a series of d e t a i l e d therapeutic actions, referred to by Tomm and Wright (1979) as "executive s k i l l s . " These overt actions could be self-monitored or observed by others, and reported on a regular b a s i s . I d e a l l y , a l o n g i t u d i n a l or panel design would be advantageous i n t h i s type of research. An i n v e s t i g a t o r can study the same therapists at several points i n time, noting changes i n t h e i r l e v e l s of stress, coping st r a t e g i e s , and therapeutic functioning. One can then use the patterns of r e l a t i o n s h i p between l e v e l s of stress, coping' s t r a t e g i e s , and therapeutic functioning over time to i n f e r c a u s a l i t y . Although i t i s not a true experimental design, our confidence i n a causal r e l a t i o n s h i p between work and family stresses, burnout and therapeutic functioning, would be strengthened. Furthermore, t h i s method c l e a r l y avoids problems associated with retrospective r e c o l l e c t i o n of information. Fourth, a better measure of burnout and therapeutic functioning can be obtained i f the therapist's spouse gives ratings on family s t r e s s . S i m i l a r l y , supervisors or co-workers can be i n v i t e d to provide observational ratings of work stress and l e v e l s of therapeutic functioning for the p a r t i c i p a n t . Even c l i e n t s may be i n v i t e d to report on t h e i r perception of therapist functioning and in-session outcome. In t h i s way, data i s not s o l e l y based on s e l f - r e p o r t by the p a r t i c i p a n t . 133 F i n a l l y , i t may be b e n e f i c i a l to gather ratings on work and family stresses and therapeutic functioning from those therapists who are currently i n the process of leaving the family-therapy profession. From such a study, one can e a s i l y assess whether work and family stresses and therapeutic functioning are more strongly r e l a t e d i n t h i s p a r t i c u l a r sample. Implications for Counselling O v e r a l l , the findings i n d i c a t e that s t r e s s f u l l i f e events, work and family concerns, and family functioning are rel a t e d to burnout, and to a le s s e r extent to therapeutic functioning. Given t h i s outcome, the study has several implications for professionals who work with family therapists at both the t r a i n i n g and therapy l e v e l s . A l l too often mental-health workers are given s i m p l i s t i c formulas or advice on preventing burnout (e.g., relax more, take more vacations, develop outside hobbies). Unfortunately, these common-sense ideas o f f e r only temporary r e l i e f . This study provides a s t a r t i n g point for planning e f f e c t i v e interventions for family therapists that involves r e a l i s t i c s e l f -assessment, implementation of counselling strategies, and u t i l i z a t i o n of support groups to promote balance i n one's l i f e . Decreasing an i n d i v i d u a l ' s v u l n e r a b i l i t y to stress -- and ultimately burnout — involves r a i s i n g the l e v e l of self-awareness. During the f i r s t years of counsellor t r a i n i n g , family therapists can be taught to detect the early signs of st r e s s . Two such signs may include sleep disturbances and a d i s i n t e r e s t i n phys i c a l a c t i v i t y . In the study, those therapists reporting problems with sleep and a d i s i n t e r e s t i n exercise also reported experiencing higher l e v e l s of burnout. In addition, awareness programs designed f o r the partners or spouses of the student therapists could be implemented. This involvement with a t r a i n i n g program might s e n s i t i z e a spouse to the problems associated with being i n a marriage or r e l a t i o n s h i p 134 with a family counsellor, and help them f e e l more a part of t h e i r spouse's l i f e . As well, the partner or spouse would be i n a better p o s i t i o n to observe the f i r s t outward signs of d i s t r e s s and be better able to a i d t h e i r t h e r a p i s t spouse. P r a c t i c i n g family therapists can also be taught the importance of r e a l i s t i c a l l y assessing how they are doing i n t h e i r l i v e s . This involves questioning how much s a t i s f a c t i o n they are getting from handling the d a i l y concerns of a working family therapist. Therapists experiencing greater l e v e l s of d i s s a t i s f a c t i o n i n t h e i r a b i l i t y to handle work and family concerns were more l i k e l y to report higher l e v e l s of stress and a reduction i n work a c t i v i t i e s . Given the findings that stresses from both work and family spheres influence the therapist, i t also becomes important to assess the balance i n a therapist's a c t i v i t i e s . This means to f i n d out whether they are becoming one-dimensional — that i s , thinking, reading, or studying only what i s relevant to the family-therapy profession, while neglecting d i f f e r e n t i n t e r e s t s , people, or ideas. Ultimately, i t means honestly assessing family l i f e : how are one's spouse and c h i l d r e n doing, and how do they f i t into the d a i l y family system? At the next l e v e l of burnout prevention, both student and p r a c t i c i n g therapist can be taught s p e c i f i c strategies for dealing with burnout. Supervisors of t r a i n i n g programs would be responsible for providing i n s t r u c t i o n on educational topics such as boundary development or " r e s p o n s i b i l i t y s e t t i n g " (Friedman, 1985) and assertiveness t r a i n i n g . These discussions may be of p a r t i c u l a r benefit to younger therapists whose enthusiasm and i d e a l i s t i c goals for therapy may place them i n a p o s i t i o n most at r i s k for burnout. As well, the assertiveness t r a i n i n g would be b e n e f i c i a l f o r therapists who struggle with issues of boundary s e t t i n g and " i n d e c i s i o n " i n t h e i r a b i l i t y to handle work and family issues. B u i l t into the t r a i n i n g or supervision program could be a resource system that allows for voluntary therapy, where pos s i b l y free counselling 135 for both the student and spouse i s provided, with an emphasis on privacy and anonymity. Informal interventions could be provided through group discussion i n which students and spouses explore couple-communication s k i l l s , parenting s k i l l s , issues around family t r a n s i t i o n s i n an e f f o r t to promote p o s i t i v e family functioning. Although low to moderate l e v e l s of burnout were found for t h i s sample of family t h e r a p i s t s , the " a s s o c i a t i o n " could s t i l l o f f e r programs, workshops, or counselling sessions to a s s i s t those i n need. C l e a r l y , the findings suggest that consideration should be given to counselling that focuses on both work and family stress issues as they a f f e c t the therapist. M a r i t a l therapy could address problematic r e l a t i o n s h i p issues that may generate maladaptive coping patterns to stress. There should be a focus on the dynamics of family functioning, with p a r t i c u l a r emphasis on developing open l i n e s of communication between spouses, and on strategies for c o n f l i c t r e s o l u t i o n both of which are related to lower l e v e l s of burnout. Interventions could include "homework assignments" to structure p o s i t i v e family time together, i n an e f f o r t to help reduce therapist work/family role c o n f l i c t , which emerged as one of the greatest stressors for therapists i n the study. As well, given that there i s some i n d i c a t i o n that a therapist's negative perception of handling work and family stress i s r e l a t e d to burnout, i t may be important to provide cognitive therapy strategies that would increase the therapist's sense of s e l f - e f f i c a c y . Other interventions could include broadening the therapist's coping r e p e r t o i r e by teaching the value i n cutting back or dropping a c t i v i t i e s that are optional or no longer thought rewarding. Those family therapists who relinquished work a c t i v i t i e s , i n t h i s study, may have found i t an e f f e c t i v e way of dealing with burnout. At a p r a c t i c a l l e v e l , t h i s study was seen by some therapists as a needs assessment. The comments accompanying the returned questionnaires i n d i c a t e that therapists would benefit from having financial-management 136 s k i l l s that a i d them i n dealing with economic d i f f i c u l t i e s , costs of caring for a i l i n g and aging parents, and demands from unemployed adult children. At the t h i r d l e v e l of burnout prevention, p r o f e s s i o n a l support groups could be established. This support may take many d i f f e r e n t forms. For family therapists i n p r i v a t e p r a c t i c e experiencing lack of peer feedback, case consultation with colleagues sharing s i m i l a r i n t e r e s t s or problems would be a s o l u t i o n . For those therapists i n family agencies or i n s t i t u t i o n a l settings the discussion may be extended from problems with c l i e n t s to include bureaucracy and administrative concerns as well. Regular "gri p e " sessions with co-workers could be established to help r e l i e v e the stresses faced by those therapists who have problems with o f f i c e demands. As well, outreach support networks could be developed where therapists with high l e v e l s of family functioning and e f f e c t i v e use of coping strategies (who have survived family c r i s e s l i k e death of a spouse or c h i l d , divorce, f i n a n c i a l losses) can help others i n s i m i l a r s i t u a t i o n s through a sharing of personal experiences. A f i n a l aspect of burnout prevention involves helping therapists f i n d a balance i n t h e i r l i v e s . This includes not only family and marriage counselling r e l a t e d to the "care and feeding" of primary r e l a t i o n s h i p s , but helping therapists f i n d the time for the "care and feeding" of t h e i r own ph y s i c a l , emotional, and s p i r i t u a l selves. This may mean taking an occasional.afternoon to just s i t and l i s t e n to music, taking someone to a play, f i n d i n g a place that encourages contemplation such as an art g a l l e r y or church, taking a s t r o l l i n the country, or being p h y s i c a l l y active on a regular b a s i s . In short, i f we are going to be e f f e c t i v e family therapists, we have to remain healthy and that means learning to f i n d ways to balance love, work, and play. 137 Conclusion This thesis was an i n i t i a l attempt to study stressors unique to the l i v e s of family t h e r a p i s t s . The findings i n d i c a t e that family therapists, compared to other mental-health p r a c t i t i o n e r s experience l e s s severe l e v e l s of burnout. The low to moderate l e v e l s of burnout that they experience appears to be r e l a t e d to the d a i l y concerns of work and family l i f e rather than the impact of major l i f e events and changes. C l e a r l y , the research on the j o i n t e f f e c t s of stresses from work and family dispels the myth that work and nonwork are separate, and gives credence to the idea that family stresses can add to work-related stress, and ulti m a t e l y can lead to burnout. The impact of personal, work and family stresses on reduced therapeutic functioning s t i l l remains weak. Therapists who a c t i v e l y relinquished work a c t i v i t i e s , due to the burden of work and family stress, may have done so i n an e f f o r t to continue providing q u a l i t y care to t h e i r c l i e n t s . However, i t seems warranted to further explore the r e l a t i o n s h i p between work and family stresses, burnout and therapy functioning i n the hopes of maintaining high professional standards. 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The American Journal of Family Therapy, 14, 99-108. Whitfield, M. (1980). Emotional stresses on the psychotherapist. Canadian Journal of Psychiatry. 25, 292-296. W i l l , O.A. (1979) . Comments on the professional l i f e of the psychotherapist. Contemporary Psychoanalysis. 15, 560-575. Zedeck, S., Maslach, C , Mosier, K., & Skitka, L. (1988). A f f e c t i v e response and q u a l i t y of family l i f e : Employee and spouse perspectives. Journal of Soc i a l Behaviour and Personality. 3., 135-157. 147 APPENDICES Appendix A: Preliminary or Screening Questions Please answer the following questions to determine which part of the survey you need to complete. 1. Your marital status: ( c i r c l e one number) 1 Single 4 Divorced 2 Married or Committed 5 Widowed 3 Separated 2. Whom do you consider to be your immediate family? ( c i r c l e a l l that apply) 1 Spouse or Partner 4 In-laws 2 Child(ren) 5 Siblings 3 Parents 6 Close friends 7 Other: 3. Who has l i v e d with you for the better part of the past year? ( c i r c l e a l l that apply) 1 Spouse or Partner 4 In-laws 2 Child(ren) 5 Siblings 3 Parents 6 Close friends 7 Other: 4. Are you currently p r a c t i s i n g family therapy? ( c i r c l e one number) 0 No I f NO, proceed to page 17, Section G. Demographics 1 Yes I f YES, please complete the remaining survey. 148 Appendix B: Work Attitude Inventory The purpose of the following inventory i s to discover how people i n the helping professions view t h e i r job and the people with whom they work cl o s e l y . Below are 22 statements of work-related f e e l i n g s . Please read each statement and then decide i f you f e e l t h i s way about your work. I f you never have t h i s f e e l i n g , write a "0" (zero) on the l i n e before the statement. I f you indeed have t h i s f e e l i n g , i n d i c a t e how often you f e e l i t by w r i t i n g the number "1 to 6" that best describes how frequently you f e e l t h i s way. HOW OFTEN: .0 . Never 1 A few times a year or less 2 Once a month or le s s 3 A few times a month 4 Once a week 5 A few times a week 6 Every day 0 - 6 1. I f e e l emotionally drained from my work. 2. I f e e l used up at the end of the work day. 3. I f e e l fatigued when I get up i n the morning and have to face another day at work. 4. I can e a s i l y understand how my c l i e n t s f e e l about things. 5. I f e e l that I t r e a t some c l i e n t s as i f they were impersonal obj ects. 6. Working with people a l l day i s r e a l l y a s t r a i n for me. 7. I deal very e f f e c t i v e l y with the problems of my c l i e n t s . 8. I f e e l burned out from my work. 9. I f e e l I'm p o s i t i v e l y i n f l u e n c i n g other people's l i v e s through my work. 10. I've become more callous toward people since I took t h i s job. 11. I worry that t h i s job i s hardening me emotionally. 12. I f e e l very energetic. 13. I f e e l f r u s t r a t e d by my job. 14. I f e e l I'm working too hard on my job. 15. I r e a l l y don't care what happens to some c l i e n t s . 16. Working with people d i r e c t l y puts too much stress on me. 17. I can e a s i l y create a relaxed atmosphere with my c l i e n t s . 18. I f e e l exhilarated a f t e r working c l o s e l y with my c l i e n t s . 19. I have accomplished many worthwhile things i n t h i s job. 20. I f e e l l i k e I'm at the end of my rope. 21. In my work, I deal with emotional problems calmly. 22. I f e e l c l i e n t s blame me for some of t h e i r problems. 149 Appendix C: Family/Work Concerns The 32 statements below are events or experiences that family therapists have i d e n t i f i e d as causes of pro f e s s i o n a l and personal concern. Think about your experiences over the past year, and for each statement i n d i c a t e i n the left-most column whether i t OCCURRED (place a check mark i n the Yes or No box). If the experience occurred, then decide whether (a) i t INTERFERED with your work as a family therapist and (b) how SATISFIED you were i n handling the p a r t i c u l a r concern (place a check mark i n the Yes, No, or ?(unsure) box where appropriate). & Yes No Yes No Yes ? No • • • • • • • 1. Professional c o n f l i c t with colleagues • • • • • • • 2. Slow and e r r a t i c pace of work • • • • • • • 3. Excessive workload • • • • • • • 4 . S i l e n t l y c r i t i q u i n g own work while conducting therapy • • • • • • • 5. Lack of peer or supervisor feedback • • • • • • • 6. I n s u f f i c i e n t vacation time (time away from work) • • • • • • • 7. Est a b l i s h i n g rapport with new c l i e n t s • • • • • • • 8. Taking c l i e n t problems home • • • • • • • 9. Frustrations with i n s u f f i c i e n t c l i e n t success • • • • • • • 10. Needing c l i e n t expression of gratitude/appreciation • • • • • • • 11. Managing s e l f - d i s c l o s u r e with c l i e n t s • • • • • • • 12. C o n t r o l l i n g emotional r e a c t i v i t y • • • • • • • 13. Career-advancement pressures from supervisors or organization • • • • • • • 14. Negative evaluation of own therapeutic contributions • • • • • • • 15. C l i e n t work r a i s i n g personal issues • • • • • • • 16. Organizing the work day • • • • • • • 17. Being p u l l e d i n two d i f f e r e n t d i r e c t i o n s (wor and family) • • • • • • • 18. D i f f i c u l t y switching from therapist role to family member • • • • • • • 19. L i t t l e energy l e f t for marriage/family • • • • • • • 20. Parenting own child(ren) • • • • • • • 21. Family l i f e " s p i l l i n g over" into work 150 & Yes No Yes No Yes 7 No • • • • • • • 22. Creating intimate couple/partner time • • • • • • • 23. Creating personal time • • • • • • • 24. Missing out on c h i l d ( r e n ) ' s a c t i v i t i e s • • • • • • • 25. Limited time for s o c i a l i z i n g with extended family & friends • • • • • • • 26. Listening to own family & marital concerns • • • • • • • 27. Mishandling unforeseen family & marital situ a t i o n s • • • • n • • 28 . Setting u n r e a l i s t i c standards for own marriage/family • • • • • • • 29. Lack of family support for career r e s p o n s i b i l i t i e s • • • • • • • 30. D i f f i c u l t y with s o c i a l r e l a t i o n s h i p s out s i work • • • • • • • 31. E s t a b l i s h i n g p r i o r i t i e s • • • • • • • 32. Handling d a i l y household tasks 151 Appendix D: Family Changes Inventory Below i s a l i s t of statements about f a m i l y - l i f e changes that can happen i n a family at any time. Because family members are connected to each other i n some way, a l i f e change for one member af f e c t s a l l the other persons i n the family to some degree. A family i s defined as a group of two or more persons l i v i n g together who are r e l a t e d by blood, marriage, or adoption. This includes persons who l i v e with you and to whom you have a long-term commitment. Please read each f a m i l y - l i f e change and decide whether i t happened to any member of your family — including you. Decide i f i t happened any time during the l a s t 12 months and check Yes or No. Please be sure to answer each statement. 4f • • 1. Increase of husband/father's time away from family • • 2. Increase of wife/mother's time away from family • • 3. A member appears to have emotional problems • • 4 . A members appears to depend on alcohol or drugs • • 5. Increase i n c o n f l i c t between husband and wife • • 6. Increase i n arguments between parent(s) and child(ren) • • 7 . Increase i n c o n f l i c t among children i n the family • • 8 .. Increased d i f f i c u l t y i n managing teenage child(ren) • • 9. Increased d i f f i c u l t y i n managing school-age children (6-12 yrs) • • 10. Increased d i f f i c u l t y i n managing preschool ch i l d r e n (2'/j-6 yrs) • • 11. Increased d i f f i c u l t y i n managing toddler (s) (l-2'/j yrs) • • 12. Increased d i f f i c u l t y i n managing infants (0-1 yr) • • 13. Increase i n the amount of "outside a c t i v i t i e s " which the child(ren) are involved i n • • 14. Increased disagreement about a member's friends or a c t i v i t i e s • • 15. Increase i n the number of problems or issues which don't resolved get • • 16. Increase i n the number of tasks or chores which don't get done • • 17. Increased c o n f l i c t with in-laws or r e l a t i v e s • • 18. Spouse/parent was separated or divorced • • 19. Spouse/parent had an " a f f a i r " • • 20. Increased d i f f i c u l t y i n resolving issues with a "former" separated spouse or • • 21. Increased d i f f i c u l t y with sexual r e l a t i o n s h i p between husband and wife • • 22. Spouse had an unwanted or d i f f i c u l t pregnancy 152 4^ • • 23. An unmarried member became pregnant • • 24. A member had an abortion • • 25. A member gave b i r t h to or adopted a c h i l d • • 26. Took out a loan or refinanced a loan to cover increased expenses • • 27. Went on welfare • • 28 . Change i n conditions (economic, p o l i t i c a l , environmental) whicl hurts the family • • 29. Change i n Stock Market, Land Values, or A g r i c u l t u r e Market which hurts family investments and/or income • • 30. A member started a new business • • 31. Purchased or b u i l t a home • • 32. A member purchased a car or other major item • • 33. Increasing f i n a n c i a l debts due to over-use of c r e d i t cards • • 34 . Increased s t r a i n on family "money" for medical/dental expenses • • 35. Increased s t r a i n on family "money" for food, clothing, energy, home care • • 36. Increased s t r a i n on family "money" for ch i l d ( r e n ) ' s education • • 37 . Delay i n receiving c h i l d support or alimony payments • • 38. A member changed to a new job/career • • 39. A member l o s t or quit a job • • 40. A member r e t i r e d from work • • 41. A member started or returned to work • • 42. A member stopped working for an extended period (e.g., l a i d o f f , leave of absence from work) • • 43. Decrease i n s a t i s f a c t i o n with job/career • • 44. A member had increased d i f f i c u l t y with people at work • • 45 A member was promoted at work or given more r e s p o n s i b i l i t i e s • • 46. Family moved to a new home/condo/apartment • • 47. A child/adolescent member changed to a new school • • 48. Parent/spouse became se r i o u s l y i l l or in j u r e d • • 49. C h i l d became s e r i o u s l y i l l or injured • • 50. Close r e l a t i v e or f r i e n d became se r i o u s l y i l l or in j u r e d • • 51. A member became p h y s i c a l l y disabled or c h r o n i c a l l y i l l • • 52 . Increased d i f f i c u l t y i n managing a c h r o n i c a l l y i l l or disabled member • • 53. Member or close r e l a t i v e was committed to an i n s t i t u t i o n • • 54. Increased r e s p o n s i b i l i t y to provide d i r e c t care or f i n a n c i a l help to husband's and/or wife's parent(s) 153 4^ • • 55. Experienced d i f f i c u l t y i n arranging for s a t i s f a c t o r y c h i l d care • • 56. A parent/spouse died • • 57 . A c h i l d member died • • 58 . Death of husband's or wife's parent or close r e l a t i v e • • 59. Close f r i e n d of the family died • • 60. Married son or daughter was separated or divorced • • 61. A member "broke up" a re l a t i o n s h i p with close f r i e n d • • 62 . A member was married • • 63. Young adult member l e f t home • • 64. A young adult member began college or post-high-school t r a i n i n g • • 65. A member moved back home or a new person moved in t o the household • • 66. A parent/spouse started school (or t r a i n i n g program) a f t e r being away from school for a long time • • 67. A member went to j a i l or juvenile detention • • 68. A member was picked up by p o l i c e or arrested • • 69. Physical or sexual abuse i n the home • • 70. A member ran away from home • • 71. A member dropped out of school or was suspended. From the above l i s t of f a m i l y - l i f e changes, please rank order the f i v e most s t r e s s f u l l i f e events you experienced t h i s past year. (Please p r i n t the number that corresponds to the above phrase). (MOST STRESSFUL) 1. 2. 3. 4. 5. (LEAST STRESSFUL) 154 Appendix E: Family Environment Inventory The following i s a l i s t of 27 statements about one's immediate family environment. You are to decide which of these statements are true of your family and which are f a l s e . C i r c l e T for true i f you think the statement i s TRUE or mostly TRUE, and F for FALSE i f you think the statement i s FALSE or mostly FALSE. Please be sure to answer each question. Family members r e a l l y help and support one another. Family members often keep t h e i r feelings to themselves. We f i g h t a l o t i n our family. We often seem to be k i l l i n g time at home. We say anything we want to around the house. Family members r a r e l y become openly angry. We put a l o t of energy i n t o what we do at home. It's hard to "blow o f f steam" at home without upsetting somebody. Family members sometimes get so angry they throw things. There i s a f e e l i n g of togetherness i n our family. We t e l l each other about our personal problems. Family members hardly ever lose t h e i r tempers. We r a r e l y volunteer when something has to be done at home. I f we f e e l l i k e doing something on the spur of the moment we often j u s t pick up and go. Family members often c r i t i c i z e each other. Family members r e a l l y back each other up. Someone usually gets upset i f you complain i n our family. Family members sometimes h i t each other. There i s very l i t t l e group s p i r i t i n our family. Money and paying b i l l s i s openly talked about i n our family. I f there's a disagreement i n our family, we t r y to smooth things over and keep the peace. We r e a l l y get along well with each other. We are usually c a r e f u l about what we say to each other. Family members often t r y to one-up or out-do each other. There i s plenty of time and attention for everyone i n our family. There i s a l o t of spontaneous discussion i n our family. In our family, we believe you don't ever get anywhere by r a i s i n g your voice. T F 1. T F 2. T F 3. T F 4. T F 5. T F 6. T F 7 . T F 8. T F 9. T F 10 T F 11 T F 12 T F 13 T F 14 T F 15 T F 16 T F 17 T F 18 T F 19 T F 20 T F 21 T F 22 T F 23 T F 24 T F 25 T F 26 T F 27 155 Appendix F: Family Functioning Grid Think about your p o s i t i v e and negative family experiences t h i s past year. Use the above-mentioned statements i n the Family Environment Inventory and Family Changes Inventory as a guide to help you describe your family functioning. Your family functioning experiences w i l l be p l o t t e d on the g r i d below. Rating Scale for Grid: 0 your usual l e v e l of family functioning 1 to 4 s l i g h t l y better to s u b s t a n t i a l l y better family functioning -1 to -4 s l i g h t l y disrupted to paralysed family functioning Place an " X " on the g r i d where the l i n e s i n t e r s e c t to r e f l e c t your l e v e l of family functioning for each month during the past year. Substantially Better Much Better .2 Better cs . O Slightly •+j Better CI 3 Usual for us Slightly 7^ 3 Disrupted Ci Moderately £ Disrupted Severely Disrupted Paralysed 4 3 2 1 0 -1 -2 -3 as as a, < X i o CO cd a a >-3 CD X I s CD U CD a CD CD > O CD X I O O o u CD X I s CD -4J ft CD 3 CD G >-3 156 Appendix G: Stress-Management Checklist Which of the following stress-management strategies d i d you use t h i s past year: (place a check mark i n the Yes or No box to as many strategies as apply to you) • • 1. Reframed the stress i n a p o s i t i v e way • • 2. Separated stress into manageable parts • • 3. Confronted the s i t u a t i o n on my own • • 4. Sought to forget e n t i r e matter • • 5. Viewed stress as family-centred concern, not i n d i v i d u a l • • 6. Reduced anxiety by taking time away from work • • 7. Kept feelings i n s i d e • • 8. Tr i e d to f e e l better by taking medication, drugs or alcohol • • 9. Became passive • • 10. Openly expressed p o s i t i v e & negative feelings • • 11. Became c r i t i c a l of others • • 12. Shared s i t u a t i o n or experience as a family • • 13. Changed basic values as r e s u l t of s i t u a t i o n • • 14. Increased mutual support among family members • • .15. Avoided being with family, friends, co-workers • • 16. Sought i n d i v i d u a l or family counselling • • 17. Joined a s e l f - h e l p group • • 18. Confided i n r e l a t i v e s or friends • • 19. Sought peer or professional supervision • • 20. Became involved i n s p i r i t u a l a c t i v i t i e s • • 21. Other: Appendix H: Work A c t i v i t i e s This question has two parts: 1. Below i s a l i s t of the a c t i v i t i e s that a family t h e r a p i s t performs. Place a "check mark" insi d e the box beside those a c t i v i t i e s that yo generally perform as part of your work. 2. Of the a c t i v i t i e s that you generally perform, d i d you decide to r e l i n q u i s h or cut back on any of them, due to work or family stress t h i s past year? I f Yes, please c i r c l e Y. • Y 1. Interview c l i e n t ( s ) • Y 2. Assess current c l i e n t / f a m i l y problem(s) • Y 3. Counsel and provide therapy • Y 4. Write up case notes • Y 5. Prepare c l i e n t reports • Y 6. Complete administrative paperwork • Y 7 . Administer and i n t e r p r e t tests • Y 8 . Purchase te s t supplies • Y 9. Develop and implement intervention programs • Y 10. Evaluate the effectiveness of intervention programs • Y 11. Evaluate the effectiveness of c l i e n t progress • Y 12. Case consultation with outsiders (e.g., s o c i a l workers, teachers, doctors) • Y 13. Case consultation as a supervisee • Y 14. Make c l i e n t r e f e r r a l s to other services • Y 15. Supervise and/or teach students • Y 16. Perform co-therapy work • Y 17 . Direct and evaluate an administrative s t a f f • Y 18. Address community groups, provide p u b l i c education • Y 19. Provide consultation to other therapists or professionals • Y 20. Attend professional development courses • Y 21. S i t on a committee or board • Y 22. Practise p u b l i c r e l a t i o n s (e.g., network, advertise) • Y 23. Set and c o l l e c t fees • Y 24. Deal with f i n a n c i a l records • Y 25. Design and conduct research studies • Y 26. Publish research papers or books • Y 27. Keep up with current l i t e r a t u r e • Y 28. Attend AAMFT / association meetings • Y 29. Upkeep of the o f f i c e • Y 30. Other (specify) 158 Appendix I: Therapeutic Functioning Grid The four general " i n - s e s s i o n " f u n c t i o n s / s k i l l s of a family therapist are: • (1) Engagement • (2) Problem i d e n t i f i c a t i o n • (3) Change f a c i l i t a t i o n • (4) Termination. Think about your t h e r a p i s t / c l i e n t in-session experiences over the past year. Use the above-mentioned l i s t of s k i l l s as a guide to help you describe your in-session functioning as a family t h e r a p i s t . Your in-session experiences w i l l be p l o t t e d on the g r i d below. Rating Scale for Grid: 0 your usual l e v e l of therapist functioning 1 to 4 s l i g h t l y better to s u b s t a n t i a l l y better therapist functioning -1 to -4 s l i g h t l y disrupted to paralysed therapist functioning Place an " X " on the g r i d where the l i n e s i n t e r s e c t to r e f l e c t your l e v e l of therapeutic functioning for each month during the past year. o .1-) fe u !=! CD Ph a CD Substantially . Better 4 bO Much Better Better Slightly Better Usual for me Slightly Disrupted Moderately Disrupted Severely Disrupted Paralysed 3 2 1 0 -1 -2 -3 -4 in ft < 43 u 03 2 m 3 43 3 a cd *-3 (-, M co 43 De CO CD 43 -4-> Ul S 6 43 Q 8 CO o CO > O Septe cu 3 De No' O Septe <! 3 CD c 3 ""3 C35 cd 159 Appendix J: Demographic Information 1. Your gender: ( c i r c l e one number) 1 Male 2 Female 2. Your present age: (in years) 3. Your present f a m i l y - l i f e stage: ( c i r c l e one number) 1 Couple stage (newlywed, ch i l d l e s s ) 2 Family with preschool children (0-6 yrs) 3 Family with school children (oldest 6-12 yrs) 4 Family with young adults (oldest 13-20 yrs) 5 Family as a launching centre (leave-taking of children) 6 Family i n middle years (empty nest) 7 Family i n retirement (breadwinner 65 and over) 8 Other: 4. Which of the following best describes the community where you practise? ( c i r c l e one number) 1 Rural 3 Urban Centre 2 Small Town 4 Large Metropolitan 5. Your pr o f e s s i o n a l degree: ( c i r c l e one number) 1 Ph.D. 5 M.S.W. 2 Ed.D. 6 Th.D. 3 M.D. 7 M.Th. 4 M.A./M.Sc./M.Ed 8 M.Div. 9 Other (specify) 6. Your AAMFT membership a f f i l i a t i o n : ( c i r c l e one number) 1 C l i n i c a l 3 Student 2 Associate 7. Your career stage: ( c i r c l e one number) 1 Beginning career development (0 to 5 years). 2 Mid-career development (established i n p r a c t i c e ) . 3 Late career development (gradual retirement from p r a c t i c e ) . 160 8. Your employment: ( c i r c l e one number from each column) Primary Secondary employment employment s e t t i n g s e t t i n g 1 1 Private Practice 2 2 U n i v e r s i t y Counselling Centre 3 3 Pastoral Counselling 4 4 Un i v e r s i t y Faculty 5 5 Community Mental Health 6 6 Family Agency 7 7 Hospital 8 8 Other (specify) 9 Not Applicable 9. Number of c l i e n t s per week you see (doing therapy work) i n each category (family-systems therapy with one c l i e n t i s considered here to be " i n d i v i d u a l " ) : 1 Individuals /week 2 Couples /week 3 Families /week 4 Groups /week 10. Your t o t a l number of hours/week: 1 seeing c l i e n t s hours/week 2 supervision/teaching_ hours/week 3 office/paperwork hours/week Grand Total number of work hours/week 11. Your i d e a l caseload: ( c i r c l e one number) 1 smaller than present caseload 2 no change i n present caseload 3 larger than present caseload 161 12. Consider the following t h e o r e t i c a l orientations or schools of therapy: 1 Behavioural 6 Ex p e r i e n t i a l 2 Bowenian 7 Psychoanalytic 3 Cognitive/Behavioural 8 Strategic 4 Communications 9 Structural 5 Integrative 10 Systemic 11 Other Which of the above therapeutic orientations has been i n f l u e n t i a l on your current p r a c t i c e of therapy? (place number of or i e n t a t i o n on the l i n e ( s ) below) Most I n f l u e n t i a l Second Most I n f l u e n t i a l 13. In the past year, how often have you experienced the following? ( c i r c l e one number for each experience) 1) Not at a l l 2) Rarely 3) Sometimes 4) Often 5) Very Often 1 2 3 4 5 Di s i n t e r e s t i n physical a c t i v i t y / e x e r c i s e 1 2 3 4 5 Poor d i e t and/or n u t r i t i o n 1 2 3 4 5 Smoking cigarettes 1 2 3 4 5 Hypertension 1 2 3 4 5 Ulcers 1 2 3 4 5 Neck or Back aches 1 2 3 4 5 Sexual dysfunction 1 2 3 4 5 Sleep disturbances 14. Are you presently i n therapy? ( c i r c l e one number) 0 No 1 Yes 15. What i s the l i k e l i h o o d of you leaving the family-therapy profession for another i n the next f i v e years? ( c i r c l e one number) 1 Not at a l l 2 S l i g h t p o s s i b i l i t y 3 Moderate p o s s i b i l i t y 4 Strong p o s s i b i l i t y 5 Very strong p o s s i b i l i t y 166 Appendix N: Sample of Lottery Ticket Lottery Ticket (please print) Name: Membership Category: Address: C i t y : Province: Postal Code: ** Approved by AAMFT ** 167 Appendix O: Cor r e l a t i o n between Demographic and Dependent Variables EE DEP PA Overall TF Grid TF Stab Age -.26* -.15 . 02 . 10 -.07 Health .38" .21* -.20* -.09 .25** # Individuals -.07 . 11 . 09 . 02 -.07 # Couples . 13 -.08 . 15 . 05 -.05 # Families . 04 . 04 . 02 .17* . 03 # Groups . 01 . 09 -.01 . 00 -.01 Hrs. with C l i e n t s . 00 . 00 .20* . 17* -.05 Hrs. Supervising -.03 . 10 . 06 . 04 . 00 Hrs. O f f i c e Work . 11 . 07 -.05 -.03 . 01 Total Hours . 09 . 09 . 10 . 09 . 04 Note. EE = Emotional Exhaustion; DEP = Depersonalization; PA = Personal Accomplishment; Overall TF Grid = in-session functioning with c l i e n t s ; TF Stab = therapeutic s t a b i l i t y , number of times the therapist's l e v e l of , therapeutic functioning crossed the baseline l e v e l of functioning. *p_ < .05 * * p_ < .01 168 Appendix P: Summary S t a t i s t i c s for Independent and Dependent Variables Variables M SD Range Independent Family/Work Concerns (n = 142) # of items occurred 16 30 6 54 0-1 # of items i n t e r f e r e d 6 28 5 49 0-26 # of items occurred, i n t e r f e r e d , & d i s s a t i s f i e d 1 98 3 41 0-20 # of items occurred, i n t e r f e r e d , & s a t i s f i e d 2 76 2 93 0-17 Family Inventory of L i f e Events (n = 141) 406 82 246 07 24-1289 Family Relationship Index (n = 141) 17 65 3 25 7-24 Stress-Management Strategies (n = 141) 11 24 2 83 3-19 Dependent Emotional Exhaustion (n = 138) 16 21 10 02 Depersonalization (n = 138) 3 48 3 27 Personal Accomplishment (n = 138) 43 10 4 15 Therapeutic Functioning Grid (n = 141) 1 82 6 95 -16-28 Therapeutic Functioning S t a b i l i t y (n = 141) 73 96 0-4 Work A c t i v i t i e s (n = 142) 2 16 2 75 0-12 Note. D i f f e r e n t n's r e s u l t from missing data.
Thesis/Dissertation
eng
Counselling Psychology
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Graduate
Impact of work and family on the family therapist’s professional effectiveness
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