Discussion postings must be timely but cannot reflect a one and done approach. You should be reviewing the discussion section at least twice for each assignment.
RESILIENCY IN THE PRACTICING MARRIAGE AND FAMILY THERAPIST
Pamela Clark Converse College
Although burnout in the helping professions is well documented, few studies have examined the phenomenon of the resilient therapist. This study used a grounded theory methodology to construct a theory of therapist resilience. The participants were eight licensed marital and family therapists: five females, three males, all Caucasian, with an average age of 58.9 and an average of 22.6 years of experience who reported feeling energized by the practice of therapy. The theory that was constructed included a central category (Integration of Self with Practice), a paradigm (Trust in Self), and two main categories (Career Development and Practice of Therapy). The process involved an initial calling, a positive agency experience, career corrections, the influence of relationships, and a move to a more flexible environment.
Practitioner burnout in the helping professions has been the focus of numerous articles and studies since the phenomenon was first noted by Freudenberger in the late 1960s and early 1970s (Maslach & Schaufeli, 1993a). Drawing on the terminology in use by drug users of the era, the term referred to a job-related emotional and physical depletion (Skovholt, 2001). Maslach and Jackson (1982) later operationalized the concept into a three-part construct that included emotional exhaustion, depersonalization, and a reduced sense of personal accomplish- ment. Although exact figures are unknown, it is estimated that approximately 10–15% of prac- ticing mental health professionals will succumb to burnout during the course of their careers (Kahill, 1986). Burnout is problematic for therapists in that it contributes to lower morale, reduced self-esteem, a tendency to dehumanize clients, and, ultimately, to leaving the field completely (Baird & Jenkins, 2003).
Many factors have been found to be associated with the development of practitioner burn- out in the field of therapy. These factors include work environments in which clinicians experi- ence a lack of control (Grosch & Olsen, 1994; Lee & Ashforth, 1996; Leiter & Harvie, 1996), task ambiguity, and a lack of evaluation and ⁄ or feedback on performance (Leiter & Harvie, 1996; Maslach & Jackson, 1982); an absence of meaning or sense of purpose in the work (Cherniss & Krantz, 1983; Leiter & Harvie, 1996; Skovholt, 2001); dissatisfaction with supervi- sor (Davis, Savicki, Cooley, & Firth, 1989; Evans & Hohenshi, 1997; Grosch & Olsen, 1994); and working long hours and ⁄ or working in agency settings (Raquepaw & Miller, 1989; Rosen- berg & Pace, 2006). In addition, working with clients who experience more severe problems or chronic mental illness (Leiter & Harvie, 1996; Raquepaw & Miller, 1989) or clients who report being burned out with the therapy process (Linehan, Chochran, Mar, Levensky, & Comtois, 2000) have been found to be associated with higher levels of reported clinician burnout. Thera- pist factors found to affect occurrences of burnout include having an unrealistic expectation of what can be accomplished (Grosch & Olsen, 1994; Kestnbaum, 1984; Maslach & Jackson, 1982); unresolved family of origin issues (Grosch & Olsen, 1994); the need to be liked and admired by the client (Grosch & Olsen, 1994); blurred boundaries, over-involvement, or feeling personally responsible for change (Ackerley, Burnell, Holder, & Kurdek, 1988); the absence of
Pamela Clark, PhD, Marriage and Family Therapy Program, Converse College.
Address correspondence to Pamela Clark, School of Education and Graduate Studies, Converse College, 580 E.
Main Street, Spartanburg, South Carolina 29302; E-mail: pam.clark@converse.edu.
Journal of Marital and Family Therapy April 2009, Vol. 35, No. 2, 231–247
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY 231
meaningful social support (Leiter & Harvie, 1996; Pines, 1983); and the perception of having too many clients (Raquepaw & Miller, 1989).
One of the more problematic issues associated with practitioner burnout is that little is known about the duration, frequency, course, or recovery process once the condition develops (Maslach & Schaufeli, 1993b). Although much literature exists concerning the prevention and treatment of burnout, there is virtually no empirical evidence that any of these interventions are effective (Maslach & Schaufeli, 1993b). There does exist some literature, albeit scarce, that examines the phenomenon of resilient therapists, or those therapists who have not succumbed to burnout but continue to remain energized by the practice of their career. Resilient therapists tend to be older and more experienced (Rosenberg & Pace, 2006) and have the ability to create a positive work environment, manage work stressors, and nurture self (Mullenbach, 2000; Skovholt, 2001). They have resolved or actively continue to work on family of origin issues (Grosch & Olsen, 1994) and have developed a sense of coherence about their profession (Gustinella, 1995). They have affected a synthesis of their personal and professional selves and report a careful monitoring of boundaries (Protinsky & Coward, 2001). Skovholt’s (2001) extensive research with helping professionals in general found that resilient practitioners have the ability to establish and maintain clear boundaries, rely on the use of self as opposed to techniques, have enriching peer relationships, and proactively resolve personal issues. However, the overall information on resiliency in the field of psychotherapy in general and marriage and family therapy, in particular, remains sparse.
In response to the paucity of research on resilient therapists, this study focused on thera- pists who have continued to practice psychotherapy for an extended period of time and report resiliency. For purposes of this study, resiliency is defined as remaining engaged and energized by the process of practicing therapy. The purpose of the study was to develop a grounded the- ory of resilient therapists. The goals were (a) to identify the process by which marriage and family therapists remain resilient, (b) to identify factors that contribute to therapist longevity and enjoyment of the profession, and (c) to explore implications for newer therapists.
METHODOLOGY
Participants The participants comprised a purposeful sample of licensed marriage and family therapists
in a southeastern state. To participate in the study, the participants were required to (a) be licensed marriage and family therapists, (b) have the practice of therapy as their primary career focus and source of income, (c) have practiced for at least 15 years, and (d) report that they continued to feel engaged and energized by the practice of therapy. The final sample consisted of eight participants: five women and three men. Their ages ranged from 50 to 73 years old with an average age of 58.9 years. The actual length of time the participants had practiced therapy ended up ranging from 18 to 26 years with an average of 22.6 years. Four had master’s degrees, one had an educational specialist degree, and three had doctoral degrees. Five were married, three were single or divorced, and all were Caucasian. The number of clients they saw per week ranged from 20 to 40 with an average of 26.4. All of the clinicians described their approach as systemic but eclectic. All but one of the participants were either in private practice or worked in an agency as therapists. The one exception had just recently accepted a promotion to an administrative position.
Initially, I recruited participants by personally inviting clinicians within the state division of American Association of Marriage and Family Therapy (AAMFT) who I knew met the stated criteria. The participants then provided names of other clinicians who they believed met the study’s criteria, a technique known as snowballing (Cresswell, 1998). As I began data analy- sis and identifying categories in the data, I selected participants from my list intentionally to explore more fully specific aspects of the developing theory. This process is called discriminate
232 JOURNAL OF MARITAL AND FAMILY THERAPY April 2009
sampling (Strauss & Corbin, 1998), and I elaborate on it further in the analysis section. During data collection, I noted that females were overrepresented in the sample. At this point, I sent out a letter to male members of the state division of AAMFT describing the criteria of the study and inviting participation. Two of the male participants were recruited in this manner. I continued this sampling process until analysis of new data yielded little or no new information to the developing theory.
Research Design This study employed a grounded theory approach following the procedure outlined by
Strauss and Corbin (1998). Grounded theory is a qualitative design recommended to researchers who want to generate a theory inductively from data that are systematically collected through in-depth interviews and analyzed in a constant comparative method (Rafuls & Moon, 1996). The following is a discussion of the data collection and analysis process employed in this study.
Data Collection and Analysis I interviewed seven of the participants in his or her office and one participant in his home.
The interviews were audiotaped and took approximately 2 hr each. All participants signed an informed consent and filled out a brief demographics questionnaire. I followed a semi- structured interview format that included questions such as ‘‘Tell me about your experience as a therapist,’’ ‘‘Tell about a time, if ever, when you felt depleted, burned out, or considered leaving the profession,’’ etc. I maintained an open, curious style and followed the lead of the participant’s narrative. Following each interview, I created a field observation note that included a detailed description of the interview environment and the researcher’s impressions, observations, and reactions to the interview experience.
Strauss and Corbin (1998) describe the process of data collection and analysis in grounded theory as intertwined and recursive. The analysis of data from one interview often informs the direction of the next. Therefore, following each interview, I created a verbatim transcription and began initial analysis. Although the description of the data analysis that follows is, of necessity, linear, the actual analysis was not. Table 1 illustrates the process of analysis.
In the initial stage of open coding, the data are closely compared for similarities and differ- ences and given a name. I looked for phenomena with common characteristics to group together. As these concepts accumulated, I began to group them into categories, or more abstract explanatory terms. For example, one participant described becoming angry in relation to a legal action filed against him, fearful after a job interview, and restless after doing agency work for several years. Although the participant was describing three separate incidences, they all shared a common theme in that the participant recognized an emotional state and responded to it. Therefore, I created a tentative category entitled ‘‘emotional attunement.’’ The initial cate- gories are listed in Table 1. At this early stage of analysis, I found the technique of microanaly- sis, a line-by-line analysis of the data (Strauss & Corbin, 1998), to be very useful in both generating categories and finding a relationship among them. This is a process I often returned to throughout analysis whenever I felt ‘‘stuck’’ or confused about how data might be related.
Axial coding is a more complex process in which ‘‘categories are related to their subcatego- ries to form more precise and complete explanations about phenomenon’’ (Strauss & Corbin, 1998, p. 124). Subcategories answer questions such as when, where, why, who, how, and with what consequences. During this process, data are often rearranged and regrouped as the researcher identifies higher abstract categories. For example, I identified ‘‘Emotional Attune- ment,’’ ‘‘Selection of Career,’’ and ‘‘Correction of Career Course’’ as categories during the open coding stage. During the axial coding process, ‘‘Selection of Career’’ and ‘‘Correction of Career Course’’ appeared to fit better as subcategories under the higher category of ‘‘Emotional Attunement.’’ I selected these concepts as subcategories under ‘‘Emotional Attunement’’ because participants tended to report that these phenomena were often informed by their
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY 233
T a b le
1 P ro ce ss
o f R efi n in g C a te g o ri es
a n d S u b ca te g o ri es
in D ev el o p m en t o f G ro u n d ed
T h eo ry
O p e n C o d in g
S ev er a l la rg e,
u n d iff er en ti a te d
ca te g o ri es
A x ia l C o d in g
R efi n ed
in to
su b ca te g o ri es
a n d p a ra d ig m
S e le c ti v e C o d in g
C a te g o ri es
fu rt h er
re fi n ed
a n d co re
ca te g o ry
se le ct ed
F in a l T h e o ry
F il li n g in
ca te g o ri es
a n d
a cc o u n ti n g fo r o u tl y in g ca se s
U se
o f se lf
D iff er en ti a ti o n
R el a ti o n sh ip s
B u il d in g a su p p o rt iv e
en v ir o n m en t
E m o ti o n a l a tt u n em
en t
S el ec ti o n o f ca re er
C o rr ec ti o n o f co u rs e
P ra ct ic e o f th er a p y
P ra ct ic e is su es
Jo y in
th e w o rk
W a tc h in g o th er s g ro w
B ei n g a p a rt
o f
so m et h in g la rg er
D iff er en ti a ti o n o f se lf
‘‘ I’ ’ p o si ti o n
L o w
le v el s o f ch ro n ic
a n x ie ty
In te g ra ti o n o f se lf
w it h p ra ct ic e (c o re
ca te g o ry )
In te g ra ti o n o f se lf a n d
p ra ct ic e (c o re
ca te g o ry )
E m o ti o n a l a tt u n em
en t (p a ra d ig m )
S el ec ti o n o f ca re er
C o rr ec ti o n o f ca re er
co u rs e
In te ra ct io n w it h cl ie n t
T ru st
in se lf (p a ra d ig m )
‘‘ I’ ’ p o si ti o n
E m o ti o n a l a tt u n em
en t
P er so n a l g ro w th
T ru st
in se lf (p a ra d ig m )
‘‘ I’ ’ p o si ti o n
E m o ti o n a l a tt u n em
en t
P er so n a l g ro w th
P ra ct ic e o f th er a p y
S u p p o rt iv e en v ir o n m en t
B el ie fs
a n d v a lu es
E n jo y m en t
P a rt
o f so m et h in g la rg er
C o n fi d en ce
P ra ct ic e o f th er a p y
E n jo y m en t
M a n a g in g ri sk
⁄s tr es s
S u p p o rt iv e
E n v ir o n m en t
M ea n in g
P ra ct ic e o f th er a p y
E n jo y m en t
M a n a g in g ri sk
⁄s tr es s
S u p p o rt iv e en v ir o n m en t
M ea n in g
R el a ti o n sh ip s
P ro fe ss io n a l d ev el o p m en t
P er so n a l g ro w th
S el f- ca re
C a re er
d ev el o p m en t
