Examining differential effects of internal and external resources on counselor burnout symptoms in South Korea.
Keywords: counselor burnout, environmental/external resources, countertransference management ability, internal resources
Counseling is one of the professions with high levels of emotional engagement (S. M. Lee, Cho, Kissinger, & Ogle, 2010). Some clients present counselors with distressful stories about violence, addiction, death of a close person, or attempted suicide. Because counselors need to focus on being compassionate and empathic to clients' distressful stories, counselors who work with traumatized clients are more at risk for developing vicarious or secondary traumatic stress symptoms (Burke, Carruth, & Prichard, 2006). According to Kirchberg and Neimeyer (1991), counselors have reported feeling uncomfortable handling problems of death or loss in counseling sessions. Terry, Bivens, and Neimeyer (1995) observed that the aversion and discomfort concerning death-related issues in counseling occur more frequently among novice counselors. These uncomfortable and stressful experiences may lead to secondary trauma or burnout (Wallace, Lee, & Lee, 2010). Maslach (1978) argued that the more counselors are exposed to such stressful cases, the more they experience burnout symptoms. Several researchers (e.g., Naring, Briet, & Brouwers, 2006) have also reported that high levels of emotional engagement are directly related to high levels of burnout symptoms.
Burnout implies a generalized state of physical, emotional, and mental exhaustion caused by long-term involvement in demanding situations (Shin, Lee, Kim, & Lee, 2012). Victims of burnout report loss of idealism, energy, and purpose (J. Lee, Lim, Yang, & Lee, 2011). Early burnout research (Caldwell, 1984; Savicki & Cooley, 2011) dealt with the helping professions far more frequently than other occupations. For counselors, burnout means the failure to perform clinical tasks appropriately because of personal discouragement, apathy, and emotional and physical drain (S. M. Lee et al., 2007). Counselor burnout may induce negative self-concept, negative job attitudes, and loss of concern and positive feelings for clients (Yu, Lee, & Lee, 2007). Unless counselors, as change agents, have concern and positive feelings for their clients, the quality of therapeutic services they provide to clients will decline. Therefore, the protective factors that prevent counselors from being burned out should be explored and examined. In the present study, protective factors are separated into two categories: internal resources and external resources. Internal factors include individual competencies such as cognitive and behavior patterns, and external factors include environmental conditions such as autonomy and social support (Richter & Hacker, 1998).
Regarding internal factors, various types of counselors' psychological resources can be considered. For example, internal management resources such as self-awareness, stress coping skill, and cognitive emotion regulation can help prevent counselor burnout (J. Park & Joo, 2012; Yoon & Chung, 2009). Because of the critical importance of the therapeutic relationship, counselors need to be cautious about the issue of countertransference. From a subjective perspective, countertransference refers to counselors' internal or external responses to their clients that are evoked by real events during counseling sessions or in the counselors' personal life. Some researchers (e.g., Yeow, 2005) even consider countertransference as one of the burnout symptoms counselors can experience. Burke et al. (2006) suggested that countertransference not only limits the potential for healing but also depletes counselors' emotional and professional resources. Countertransference can be helpful or harmful to clients in counseling sessions. Regardless, countertransference is an inevitable phenomenon of the therapeutic process and should be carefully managed. To this end, Van Wagoner, Gelso, Hayes, and Diemer (1991) suggested the notion of countertransference management ability, which consists of five constructs: self-insight, self-integration, empathy ability, anxiety management, and conceptualizing skills. In this study, we consider countertransference management ability as the primary internal resource that prevents or buffers counselors' burnout symptoms.
External factors such as environmental or organizational resources also have relevance in buffering counselors' burnout. Many researchers (e.g., Demerouti, Bakker, De Jonge, Janssen, & Schaufeli, 2001; Salanova, Agut, & Peir6, 2005; Taris & Feij, 2004) have contended that external job resources like autonomy, social support, and positive performance feedback may prompt work engagement. Furthermore, these external resources have been proven to buffer burnout (J. Lee, Puig, & Lee, 2012). According to Bakker, Sixma, and Bosveld (2001), autonomy, social support, and positive feedback moderated the relationships between emotional demands (e.g., complaints, impoliteness, and intimidation) and burnout symptoms. That is, the combination of high demand and low resources results in burnout, whereas the combination of high demand and high resources results in high motivation and positive growth (De Jonge, Bosma, Peter, & Siegrist, 2000; Van der Doef & Maes, 1998). Given previous findings, we examined the effects of environmental/external resources such as autonomy and social support in the relationship between job demands and counselor burnout.
Historically, the main factor influencing counselor burnout is the type of clients with whom the counselors are working (Bohart, 2000; Tallman & Bohart, 1999). According to Wallace et al. (2010), counselors working with traumatized or bereaved clients (e.g., clients who experienced the traumatic death of a significant other or complicated grief; suicidal clients) are more vulnerable to burnout symptoms than a criterion reference group of general counselors. For example, several previous studies (e.g., Kirchberg & Neimeyer, 1991; Terry et al., 1995) found that death-related stories in counseling sessions resulted in more severe emotional distress to psychotherapists than other life stories. Other studies (e.g., Jones, 2007; Stebnicki, 2007; Thomas, 1998) reported that the relationships among job demands, resources, and burnout symptoms were quite different depending on the workers' occupations. For example, job demands were directly related to burnout symptoms in a sample of blue-collar industrial workers but indirectly related to burnout symptoms (via external resources such as autonomy) in a sample of white-collar workers. In this context, it is important to investigate the relationships among job demands, resources, and burnout symptoms in a sample of counselors with bereaved or traumatized clients (i.e., abuse or death-related problems) versus a sample of counselors with clients with personal growth issues (e.g., adjustment disorders).
Conservation of resources (COR) theory (Hobfoll, 1988) has been widely supported in the burnout literature (Halbesleben & Buckley, 2004; Shirom, 2003). This theory assumes that individuals flourish when they protect, gain, maintain, and conserve resources (Hobfoll, 2001). However, stress will arise when an individual's resources are lost or at risk of being lost. Finally, burnout can occur when an individual fails to gain other resources through investments (Hobfoll, 1988, 2001). In COR theory, resources refer to the key to survival and well-being (e.g., shelter, attachment to significant others, and self-esteem) or resources that are linked to the process of creating and maintaining tangible energy (e.g., money or insurance). In COR theory, each resource has differential effects on the dimensions of burnout (Hobfoll, 1988, 2001). For example, Wallace et al.'s (2010) research showed that various coping strategies (e.g., distraction and humor) differentially influenced the relationship between job demands and burnout symptoms.
In tandem with previous studies, we can infer that counselor burnout may be related to two types of resources: internal resources and external resources. Moreover, the type of resources seems to differentially influence burnout depending on the counselor's experience and skills. Additionally, given that counselors working with traumatized or bereaved clients (e.g., clients who experienced the traumatic death of a significant other or complicated grief; suicidal clients; abuse survivors) are more vulnerable to burnout, we hypothesized that the experience of clients with these issues would moderate the relationship between resources and burnout. Therefore, we hypothesized that internal and external resources differentially influence the relationship between job demands and burnout. We expected that counselors of traumatized or bereaved clients would be more affected by internal resources, whereas counselors of clients with personal growth issues would be affected by external resources in the relationship between job demands and burnout.
Procedure and Participants
Our survey was given to counselors who attended the monthly conference of the Korean Counseling Association. The survey included some background information about the aims of the study and an invitation to participate in a study on counselor burnout. We distributed a total of 753 questionnaires, and 183 questionnaires were returned. Excluding unreliable responses, missing responses, and respondents who never performed counseling, 165 questionnaires were retained for a response rate of 21.9%.
All participants were counselors in South Korea who graduated from a counseling program and were practicing psychotherapy or counseling in their respective fields. Of the 165 participants included in the study, 143 were women (87%) and 22 were men (13%). Ten participants (6.0%) held a bachelor's degree, 60 (36.4%) were in master's courses, 58 (35.2%) held a master's degree, 17 (10.3%) were in doctoral courses, and 20 (12.1%) held a doctoral degree. Participants ranged between 20 and 70 years of age; 40 participants were ages 20-30 years (24.2%), 45 were 31-40 years (27.3%), 52 were 41-50 years (31.5%), and 27 were over 51 years of age (16.4%). One participant was a missing case (0.6%).
Counselor burnout. The Korean version of the Counselor Burnout Inventory (K-CBI; Yu, Lee, & Nesbit, 2008) was used. S. M. Lee et al. (2007) developed the original CBI to assess American counselors' burnout levels. Yu et al. (2008) developed and established the CBI's initial psychometric properties for Korean counselors by using translation, back translation, and pilot and validation studies. The K-CBI is a 20-item questionnaire with each item scored on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). High levels of all subscales are indicative of burnout. Yu et al. (2008) examined the reliability and validity of the K-CBI with counselors and concluded that its use with counselors was appropriate. The reliability (Cronbach's a) of the total score of K-CBI was .90.
Countertransference. To measure countertransference management ability, we used the Korean version of the Countertransference Factors Inventory (K-CFI; Choi, 2002). The original CFI (Van Wagoner et al., 1991) was developed with a sample of American counselors. The CFI is a 36-item questionnaire that uses a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Choi (2002) examined the reliability and validity of the K-CFI by factor analysis and concluded that it had good psychometric properties. The factor loadings of each construct were higher than .50, which means the inventory procured evidence for convergent validity (Matsunaga, 2010). Cronbach's alpha of subscales ranged from .69 to .96, indicating that the reliability was acceptable. High levels of all subscales are indicative of a high level of countertransference management ability. The reliability of the total score of the K-CFI in this study was .94.
Job demand and environmental resources. To measure job demands and environmental resources, we used the Korean versions of the Job Demand Scale (K-JDS; L. H. Park, 2007) and the Job Resources Scale (K-JRS; Chang, 2011). Karasek and Theorell (1990) developed the original JDS and JRS using American workers. The JDS is a 15-item questionnaire with a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). In the present study, the items of the JDS were modified slightly to make it suitable for the work of counselors because the original scales were developed for general workers. Most sentences were retained, but professional terms in the field of counseling such as clients and case were substituted in place of more general expressions. Sample items include "Enough time for clients is not given to me" and "I feel the pressure of responsibility for my clients." The JRS is a 23-item questionnaire with a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The reliability of the K-JDS total score in this study was .84, and the reliability of the K-JRS total score was .93.
Experience of counseling on trauma or death issues. To draw a comparison between counselors who have had experience counseling clients with trauma or death-related problems and those who have not, we presented two yes/no scenarios to participants: Have you ever experienced counseling dealing with the following problems? (a) client's suicide attempt (yes/no) and (b) traumatic death of someone close to the client (yes/no). If participants answered yes to either of the two questions, they were assigned to the group of counselors with traumatized/bereaved clients. The other participants were assigned to the group of counselors with personal growth/adjustment issues clients. Personal growth/adjustment issues include, among other things, self-exploration, emotional and personality issues, work-related concerns, family, and/or interpersonal relationships. Of the participants, 79 (47.9%) responded that they had experience with counseling clients with trauma, suicide, or death-related issues; 86 (52.1%) responded that they did not have experience with such clients.
To examine the relationships among job demands, internal/external resources, and burnout symptoms in counselors with and without traumatized/bereaved clients separately, we conducted a moderated mediation analysis using the SPSS MODMED macro (Preacher, Rucker, & Hayes, 2007). Moderated mediation effects mean that the mediator and the moderator have an interaction effect. That is, the effect of an independent variable A on a dependent variable C via a mediator variable B differs depending on the levels of a moderator variable D. One of the advantages of moderated mediation analysis is that it provides the indirect effects such as the Sobel test and accelerated bootstrap confidence intervals. Through this analysis, the indirect effects of internal/external resources and statistical significance of the indirect effect can be analyzed and the interaction effects between the counselors with different types of clients and internal/external resources on burnout can be verified.
Before verifying a moderated mediation model, we performed an independent sample t test to compare the group difference of the measured variables between counselors with traumatized/bereaved clients and counselors without these clients. As shown in Table 1, the two groups were considered equivalent, and there were no significant differences between the groups on job demands and environmental resources (i.e., autonomy and social support). However, there was a significant difference between counselors with traumatized/bereaved clients and counselors without these clients on internal resources, that is, countertransference management ability (t = -2.39, p < .05). The mean of the countertransference management ability score is much higher for counselors with traumatized/bereaved clients (M = 3.64, SD = 0.43) than counselors without traumatized/bereaved clients (M = 3.49, SD = 0.39). As shown in Table 1, all correlation coefficients of the counselors of traumatized/bereaved clients were statistically significant (p < .01). However, in the group of counselors without these clients, correlation coefficients were not statistically significant in countertransference management ability with job demand and environmental resources. This indicates the importance of separately analyzing the data of the group of counselors with traumatized/bereaved clients from the data of counselors without these clients.
We posited that the internal resources (i.e., countertransference management ability) and external resources (i.e., environment resources) function differently in the relationship between job demands and burnout depending on counselor groups with and without traumatized/bereaved clients (see Figure 1). As shown in Table 2, the results indicated that the Countertransference Management Ability x Counselor Groups interaction was significant (B = -0.29, t = -2.13, p < .05). This means that the effect of countertransference management ability on counselor burnout would be different depending on the type of clients (traumatized/bereaved vs. personal growth issues). Accordingly, plotting slopes were drawn as conventional procedures. As shown in Figure 2, the relationship between countertransference management ability and counselor burnout was much steeper in the counselor group with traumatized/bereaved clients than in the counselor group with clients with personal growth issues. On the other hand, the External Resources x Counselor Groups interaction was not significant (B = -0.02, t = 0.19). This indicates that the effect of environmental resources on counselor burnout does not differ depending on the type of clients they serve.
Table 2 also illustrates that there were two significant indirect effects on the study's models. One significant indirect effect was detected in the path from job demands to counselor burnout through the countertransference management ability of counselors with traumatized/bereaved clients (B = .12, Sobel z = 3.09, p < .01). The results of bootstrapping also confirmed the significant indirect effect (95% confidence interval [.04, .23]) because the coefficient range does not contain zero. Another significant indirect effect was detected in the path from job demands to counselor burnout through environmental resources of the counselor group without traumatized/bereaved clients (B = .08, Sobel z = 2.01, p < .05). In summary, in the group of counselors with traumatized/bereaved clients, countertransference management ability (internal resources) mediated the relationship between job demands and counselor burnout, whereas in the group of counselors with personal growth or adjustment clients, job demands indirectly influenced counselor burnout via environmental resources.
The purpose of this study was to explore the relationships among job demands, environmental resources, countertransference management ability, and counselor burnout for counselors with and without traumatized/bereaved clients using moderated mediation analysis. In the group of counselors with traumatized/bereaved clients, countertransference management ability (i.e., internal resources) mediated the relationship between job demands and counselor burnout. Conversely, in the group of counselors without these clients, job demands indirectly influenced counselor burnout via environmental resources (i.e., external resources).
The results of the present study can be partly interpreted by COR theory. The basic rule of COR theory is that "people have an innate as well as a learned drive to create, foster, conserve, and protect the quality and quantity of their resources" (Gorgievski & Hobfoll, 2008, p. 2). On the basis of the COR theoretical framework, Gehmeyr (1993) confirmed that stressors faced by helping professionals such as role conflict, role ambiguity, and role overload can reduce their resources, which in turn can lead to burnout. This is in line with the present study's results that both internal and external resources negatively mediated the influence of job demand on counselor burnout.
In addition to the main idea of COR theory (i.e., lack of resources can cause counselor burnout), our results suggest that internal and external resources can lead to different pathways of counselor burnout across types of clients. That is, counselors with traumatized or bereaved clients were more likely to be burned out because of the absence of internal resources (e.g., countertransference management ability), whereas counselors without traumatized or bereaved clients were more likely to be burned out because of the absence of external resources (e.g., autonomy and social support).
The results of our study suggest that countertransference management ability would reduce burnout in counselors with traumatized/bereaved clients; conversely, counselors without these types of clients would not experience burnout in the same way. A number of empirical studies have shown that managing countertransference problems is a good internal skill to avoid burnout (Figley, 1995a, 1995b; Gehmeyr, 1993; Halperin, 1981; Homer, 1993; Jones, 2007; Sabin-Farrell & Turpin, 2003; Skovholt & Trotter-Mathison, 2011; Stebnicki, 2000, 2007; Thomas, 1998; Watkins, 1983; Worden, 1991; Yeow, 2005). In addition, previous studies (Figley, 1995a; Halperin 1981; Horner, 1993; Kirchberg, Neimeyer, & James, 1998; Skovhoh & Trotter-Mathison, 2011) have suggested the important role of countertransference management ability to buffer counselor burnout by handling negative feelings induced by clients' death-related issues. Therefore, several things should be taken into consideration. First, counselors need to be aware of their anxiety in counseling sessions. Next, counselors should continually assess their objectivity with clients' presenting issues in order to maintain appropriate professional boundaries. Objective understanding of the client means a counselor's ability to provide empathic and objective responses. When the client's presenting problems evoke a counselor's unresolved conflicts or a specific countertransference response, this may interfere with the counselor's work performance. The counselor may then feel incompetent or may experience vicarious trauma by engaging with the client's feelings (Figley, 1995b). The difficulties caused by the lack of countertransference management ability lead to a gradual erosion of the counselor's enthusiasm and energy (Homer, 1993). Thus, counselors' loss of internal resources such as competency and motivation can be interpreted from the perspective of COR theory. In other words, counselors serving clients with trauma and death-related issues experience loss of internal, not external, resources. This is in line with the results of the present study that only internal resources predict counselor burnout in counselors with traumatized/bereaved clients.
This study contributes to the burnout literature by demonstrating the distinct roles of internal and external resources on counselor burnout depending on the type of clients (traumatized/bereaved clients vs. clients with personal growth/adjustment issues). The results of this study can be applied to practitioners as well as researchers in the field of counseling in South Korea. According to the results of this study, increasing both external and internal resources is effective in reducing burnout symptoms of Korean counselors. However, differentiated interventions should be provided. The counselors with traumatized/bereaved clients need interventions to enhance countertransference management ability (internal resource), whereas the counselors without traumatized/bereaved clients need interventions related to workplace conditions. For counselors with traumatized/bereaved clients, supervision could be helpful to deal with their own internal conflict and to enhance countertransference management ability, whereas counselors without traumatized/bereaved clients need to seek environmental resources such as autonomy and social support.
From these results, some implications for counseling training programs can be suggested. First, counselor training programs should emphasize the importance of countertransference management ability as a protective factor from counselor burnout. Previously, countertransference was considered to influence the effectiveness of counseling; however, we need to recognize the importance of countertransference management ability in the context of counselors' psychological well-being. Second, an open atmosphere to discuss countertransference should be considered. For most counselors, countertransference may be an uncomfortable experience. Talking to a trusted colleague, supervisor, counselor, or other supportive person can be helpful for counselors to deal effectively with countertransference. Third, empirical studies to explore the development and implementation of optimal working environments should be conducted. Although poor working conditions are believed to trigger burnout, little is known about practical measures to improve working conditions and alleviate burnout. A systematic approach for enhancing environmental resources will contribute to the establishment of role models of counselors' self-care.
Despite the various contributions of this study, there are some limitations. First, there is a problem with generalizability. Although enough to perform analyses, the number of participants was small. Additionally, the sample gathered at the monthly conference of the Korean Counseling Association was not a random sample. Also, because all counselors were Korean, there might be cultural effects in the results. Further research needs to be conducted by using a bigger random sample and data gathered from counselors worldwide, thereby allowing for multicultural exploration. Second, the cross-sectional measures of the variables do not allow for interpretation of cause-and-effect relations. In future research, longitudinal studies could measure internal and external resources on counselor burnout over time. Third, because the study used self-report questionnaire measurements, report bias may exist; therefore, future research could use multiple assessments to measure specific variables. Despite these limitations, this research is meaningful in terms of identifying the role of both internal and external resources on counselor burnout symptoms between counselors with traumatized/bereaved clients and counselors without these clients. These results may indirectly enhance counselors' well-being by providing useful information to apply to those counselors experiencing burnout.
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Hyunju Choi, Keunhwa Kim, Seongchan Lee, and Sang Min Lee, Department of Education, Korea University, Seoul, Korea; Ana Puig, Office of Educational Research and Department of Counselor Education, University of Florida, Gainesville. Correspondence concerning this article should be addressed to Sang Min Lee, Department of Education, Korea University, Anam-Dong, Seongbuk-Gu, Seoul, South Korea (e-mail: email@example.com).
TABLE 1 Intercorrelations, Descriptive Statistics, and t-Test Results Intercorrelations Variable 1 2 3 4 1. JD -- -.40 *** -.31 ** .67 *** 2. CMA -.19 -- .29 ** -40 *** 3. ER -.52 *** .20 -- -.39 *** 4. CB .68 *** -.46 *** -.44 *** -- TB Group PG Group (n = 79) (n = 86) Variable M SD M SD f 1. JD 2.59 0.50 2.72 0.46 1.74 2. CMA 3.64 0.43 3.49 0.39 -2.39 * 3. ER 3.69 0.49 3.57 0.50 -1.51 4. CB 2.30 0.55 2.32 0.46 0.19 Note. Intercorrelations for counselors with traumatized or bereaved clients (TB group; n = 79) are presented above the diagonal, and intercorrelations for counselors with personal growth issues clients (PG group; n = 86) are presented below the diagonal. JD = job demand; CMA = countertransference management ability; ER = environmental resources; CB = counselor burnout. * p < .05. ** p < .01. *** p < .001. TABLE 2 Regression Results for Conditional Indirect Effect Counselor Burnout Constant and Group B SE t P Countertransference Management Ability (CMA) Constant 4.27 .18 24.40 .000 Job demand -0.27 .06 -4.10 .000 Counselor burnout Constant 1.13 .43 2.61 .010 Job demand -0.65 .06 10.68 .000 CMA -0.16 .10 -1.60 .113 Counselor groups 1.14 .48 -2.36 .020 Interaction (CMA x -0.29 .13 -2.13 .035 Counselor Groups) Traumatized/bereaved group Personal growth group Environmental Resources (ER) Constant 4.78 .20 24.09 .000 Job demand -0.43 .07 -5.88 .000 Counselor burnout Constant 1.21 .38 3.17 .002 Job demand 0.64 .07 9.54 .000 ER -0.18 .08 -2.17 .032 Counselor groups 0.00 .44 0.01 .992 Interaction (ER x 0.02 .12 0.19 .846 Counselor Groups) Traumatized/bereaved group Personal growth group Conditional Indirect Effect Across Groups Constant and Group IE SE z P Countertransference Management Ability (CMA) Constant Job demand Counselor burnout Constant Job demand CMA Counselor groups Interaction (CMA x Counselor Groups) Traumatized/bereaved .12 .04 3.09 .002 group Personal growth group .04 .03 1.45 .147 Environmental Resources (ER) Constant Job demand Counselor burnout Constant Job demand ER Counselor groups Interaction (ER x Counselor Groups) Traumatized/bereaved .07 .04 1.57 .116 group Personal growth group .08 .04 2.01 .045 Conditional Indirect Effect Across Groups Bootstrap 95% CI Constant and Group Percentile BC BCa Countertransference Management Ability (CMA) Constant Job demand Counselor burnout Constant Job demand CMA Counselor groups Interaction (CMA x [.04, .28] [.04, .23] Counselor Groups) Traumatized/bereaved [.04, .23] group Personal growth group [-02, .11] [.01, .12] [-01, .12] Environmental Resources (ER) Constant Job demand Counselor burnout Constant Job demand ER Counselor groups Interaction (ER x Counselor Groups) Traumatized/bereaved [.02, .16] [-.02, .17] [-.02, .17] group Personal growth group [.02, .14] [.02, .14] [-02, .14] Note. Unstandardized regression coefficients are reported. Bootstrap sample size = 10,000. CI = confidence interval; IE = indirect effect; BC = bias corrected; BCa = bias corrected and accelerated.
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|Author:||Choi, Hyunju; Puig, Ana; Kim, Keunhwa; Lee, Seongchan; Lee, Sang Min|
|Publication:||Journal of Employment Counseling|
|Date:||Mar 1, 2014|
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