cronin-et-al-2023-therapist-resilience-in-an-ever-changing-world-a-systematic-review

Abstract

• Therapists face increasing demands and require resilience due to changing conditions in the helping professions.

• This systematic review has two primary purposes:

  • Explore internal characteristics that enhance therapist resilience.

  • Investigate commonalities in prior research on therapist resilience and newly identified robust characteristics.

• Analysis of 29 peer-reviewed articles resulted in 10 overarching themes:

  1. Connection to Community

  2. Pursuit of Continual Growth

  3. Emotional Boundaries

  4. Emotional Support

  5. Humor

  6. Integration of Personal and Professional Life

  7. Meaning and Purpose

  8. Positive Sense of Self

  9. Self-awareness

  10. Spirituality

• These themes reinforce four core characteristics defining highly resilient therapists, emphasizing the need to cultivate resilience through these internal attributes.

Professional Hazards

• Psychotherapists are vulnerable to:

  • Burnout (Freudenberger, 1974)

  • Vicarious Trauma (Pearlman & Saakvitne, 1995)

  • Compassion Fatigue and Secondary Traumatic Stress (Figley, 1995, 2002)

• These factors negatively impact therapist effectiveness, making resilience crucial for maintaining high-quality mental health services (Wampold & Imel, 2015).

• The onset of burnout isn't inevitable; resilience, defined as the ability to positively adapt during adversity (Fletcher & Sarkar, 2013), acts as a protective factor.

• External factors that bolster resilience include self-care practices and supportive work environments (Broome et al., 2009; Ducharme et al., 2007).

Internal Characteristics of Resilience

• Research (Hou & Skovholt, 2020) identifies four core resilience characteristics in highly resilient therapists:

  • Drawn to Interpersonal Relationships

  • Active Self-Engagement

  • Core Values and Beliefs Framework

  • Desire for Learning and Growth

• A strong web of connectedness among these characteristics is crucial for fostering resilience.

Systematic Review Methodology

• The systematic literature review included:

  1. Problem identification

  2. Comprehensive literature search using PsycINFO

  3. Data evaluation and analysis

  4. Thematic synthesis

• Inclusion criteria focused on original peer-reviewed research targeting internal resources of therapists and connectedness. Excluded literature emphasized external factors or used non-therapist samples.

• Result: 29 peer-reviewed articles were included for analysis after narrowing from 374 identified studies.

Analysis Process

• Bias consideration was essential as all researchers are counseling psychologists. Themes were derived from article findings through independent coding and consensus around the data.

• The analysis honored the principles of consensual qualitative research, emphasizing collective understanding and ongoing reflection on biases.

Findings: Overarching Themes of Therapist Resilience

1. Connection to Community

• Collective trauma recognition and personal reflection promote therapist well-being. Strategies that therapists use with clients can also buffer their own burnout (Bennet-Levy et al., 2015).

2. Pursuit of Continual Growth

• Ongoing self-growth is essential for therapists, enhancing their enjoyment and motivation in their work.

  • Key elements include maintaining curiosity and a 'beginner's mind' to stimulate learning (Patsiopoulos & Buchanan, 2011).

3. Emotional Boundaries

• Therapists who maintain personal boundaries experience less burnout. Acceptance of personal limits aids in sustaining self-care (Rzeszutek & Schier, 2014).

4. Emotional Support

• Positive relationships can alleviate burnout and enhance job satisfaction (Capner & Caltabiano, 1993; Emery et al., 2009).

5. Humor

• Humor aids in coping with stress and preventing compassion fatigue (De Lange & Chigeza, 2015).

  • Self-defeating humor may lead to burnout, while self-enhancing humor encourages accomplishment (Malinowski, 2013).

6. Integration of Personal and Professional Life

• A holistic perspective fosters resilience. Personal experiences can enrich professional growth and vice versa (Clark, 2009).

7. Meaning and Purpose

• Having a strong sense of purpose in work correlates with lower burnout and greater satisfaction (Lakioti et al., 2020).

8. Positive Sense of Self

• Trusting oneself and acknowledging personal capabilities are protective against vicarious trauma (Clark, 2009).

9. Self-awareness

• Mindfulness and emotional attunement contribute positively to therapist resilience and prevent burnout (Thompson et al., 2014).

10. Spirituality

• A spiritual framework, regardless of religious affiliation, provides support against burnout and can enhance therapeutic relationships (Liou, 2014).

Implications for Practice

• Focus on cultivating internal characteristics over relying solely on external factors for resilience building. Training programs should instill these resilience attributes in aspiring therapists.

• The findings underscore maintaining curiosity and engaging actively with oneself, which are paramount for long-term resilience.

Future Research Directions

• It’s essential to explore the nuances of interconnectedness and meaning/purpose in resilience. Further investigation is necessary to differentiate between lack of purpose versus having a sense of purpose and its impact on burnout.

Limitations

• The study relies on English-language peer-reviewed literature and the PsycINFO database, which may limit the breadth of findings.

Conclusion

• Identifying and reinforcing internal characteristics facilitates therapist resilience, mitigating burnout, and improving service quality in a changing therapeutic landscape.