The Clinical Supervisor

ISSN: 0732-5223 (Print) 1545-231X (Online) Journal homepage: http://www.tandfonline.com/loi/wcsu20

Professional Burnout:

Ernest R. Rogers BA

To cite this article: Ernest R. Rogers BA (1987) Professional Burnout:, The Clinical Supervisor,
5:3, 91-106, DOI: 10.1300/J001v05n03_08

To link to this article: http://dx.doi.org/10.1300/J001v05n03_08

Published online: 18 Oct 2008.

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 Professional Burnout:
A Review of a Concept
Ernest R. Rogers
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ABSTRACT. This paper discusses the relevant trends in the cur-

rent literature with respect to burnout in the helping professions.
After describing the syndrome of burnout, the author reviews the
various causes, diagnosis and evaluation procedures currently in
use. Treatment and prognosis, as well as the effects of burnout,
are also discussed. The overall emphasis is geared towards the
nursing and allied health care professionals. The prevention of
burnout is discussed in practical terms and may he used as a guide
to self-preservation. Conclusions drawn indicate that burnout is
an individual problem and as such, must be treated using unique
methods based on cause, incidence and personal coping skate&%
and resources. Thoueh treatment is oossible. orevention is alwavs
superior. The paper to give the p~acticalc;nsider3tions to thdte
on the front line of the helping professions, as well as thcir super-
visors and administrators.

BURNOUT, WHAT IS IT?

Counseling is an area that involves much contact with other

individuals and their problems. This statement is true for the pro-
fessional as well a s the nonprofessional. T h e professional coun-
sellor (psychiatrist, nurse, psychologist, social worker, etc.) is
one whose main impetus is t o guide while nonprofessionals (po-

Erncst R. Rogcrs, BA, BSc, was Psychiatric Assistanl at the Homcwood Sanitarium
at thc timc this article was submitted. Address rcprint rcqucsts to 2001 Colvcrt St.,
Tuskcgcc. AL 36083. Thc author wishes to acknowlcdgc the support of Dr. C.A.
Culdncr, ThD. Associate Profcssar, Dcpartmcnl of Family Studics. University of
Cuclph, and Dr. M. Vincent, MD. Dircctor. Homcwwd Sanitarium, Cuclph, Ontario.
Thc Clinical Supervisor, Vol. 5(3), Fall 1987
0 1987 hy Thc Haworth Prcss, Inc. All rights rcscrvcd. 91
 92 THE CLINICAL SUPERVISOR

liceman, priestJminister, etc.) use counselling as part of their

necessary "sideskills" in dealing with people. Though these two
types of individuals perform quite different primary functions,
their involvement in the problems of others is often emotionally,
physically and psychologically taxing.
The professional deals with problems day in, day out. These
individuals have had training in the necessary skills so that the
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client is guided through stages to a goal. The therapist has case-

loads, appointment times, and strategies for dealing with the cli-
ent. The cases are long-term as the client learns to approach a
goal.
The nonprofessional has had minimal training. His (her) case-
load is usually nonexistent and tends to be one of crises interven-
tion. The relationships are usually short-term and usually break
off at the time the client sees progress being made.
What do the professional and nonprofessional have in com-
mon? The answer is stress. Stress arises in dealing with emotions
or emotionally charged issues and life crises. Hans Selye states in
many of his publications that some stress is necessary in life.
This statement is generally accepted as truth, though too much
stress may lead to "burnout" (Cook & Mandrillo, 1982).
Burnout is a term first coined by Herbert Freudenberger in the
1960s. This term refers to stress when it reaches an intolerable
level. Burnout is defined in the literature in many ways. It is
important to understand what is meant by tf.',ISterm.
Burnout is generally defined as a decrease in effective func-
tioning or productivity in a committed activity (Brown, 1983).
This definition is very broad and requires explanation of such
ambiguous terms as decrease and functioning. The multiple defi-
nitions of burnout have several common themes.
It should first be noted that burnout is a syndrome, or a group
of signs and symptoms that appear together. This syndrome is a
label for feelings (Brown, 1983) and is defined by its physiologi-
cal, emotional and psychological effects on individuals. These
effects include depletion of energy, both a physical and psycho-
logical wearing out, and an emotional exhaustion (Freeman,
1983; Hagemaster, 1983; Kennedy, 1981; Lavandero, 1981;
Pines el al., 1981; Storlie, 1979).
The common result of these psychological features are exhaus-
 Enrcsr R. Rogers 9.3

tion; cynicism, decreased empathy, negative feelings and de-

crease in self-esteem and self preservation (Pines et al., 1981 &
McConnell, 1982). This may be seen as a general malaise or
depression.
Burnout is a multidimensional syndrome and as such, it also
includes physical symptoms. Many of the physical symptoms
will be recognized by the layman (nonphysician) as being associ-
ated with strcss. These include ulcers, headaches, stomach up-
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sets, physical exhaustion due to lack of sleep, anxiety, negative

and hostile affect and possibly a paranoia due to negative self-
concept (Brown, 1983; Freeman, 1983; Hagemaster, 1983; Ken-
nedy, 1981; Lavandero, 1981; McConnell, 1982; Pines et al.,
1981).
The symptoms of burnout are varied. In all cases some compo-
nents of the symptomology (psychological or physical) exist,
though the helper's ability to cover up in the presence of col-
leagues may disguise the problem (Pines ct al., 1981). This cover
up may in itself be recognized as a symptom of burnout. The
normaily quietperson who becomes gregarious may actually be
seeking the company of colleagues to avoid clients and their
problems. On the other hand, an individual who becomcs very
quiet may in fact be withdrawing from the situation totally
(Lavandero, 1981; McConneil, 1983). These variations may in-
crease the difficulty of diagnosing burnout, making the syndrome
all the more insidious.
Who stands the most risk of burnout? It is common in the
media to refer to high stress jobs and low stress jobs. These rat-
ings result in our popular belief that air traffic controllers, police
and emergency room nurses and physicians are in high stress
professions, while sports instructors, truck drivers and letter car-
riers are in low stress positions. MacBride (1983) has labelled
these ideas as popular misconceptions. In many cases, individ-
uals who work in hectic situations enjoy the challenge and excite-
ment of the job as it stands. The concept of high stress and low
stress jobs is better related to the personljob interaction than the
job per se.
To evaluate the personljob interaction, the Person Environ-
ment Fit Theory was developed (Lofquist & Davis, 1969). This
involves two kinds of fit. The first is to the employee's ability to
 94 THE CLINICAL SUPERVISOR

fit the job; his or her preparation and available skills. The second
fit involves the job and its environment and how these fit the
employee. Poor job fit in either case results in stress which may
in some cases lead to burnout.
What other personal factors are involved, if in only some
cases, stress causes burnout? The factors are as varied as the
people affected. These factors include such things as expecta-
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tions, need for reward and recognition, need for responsibility,

unrealistic ideals (reality shock) and lack of preparation (Lavan-
dero, 1981). The most important factor overriding all other per-
sonal factors is the individual's perception of job fit. An individ-
ual who perceives that the Person Environment Fit is skewed is a
candidate for burnout.
The concept of perceived lack of fit is so important to the
burnout phenomenon that it is worth repeating. Individuals who
do not have a problem in job fit may never show the signs of the
syndrome.
The burnout syndrome itself is a special case of a larger prob-
lem; occupational tedium (Pines et al., 1981). The uniqueness to
the helping profession is the continual giving relationship in
which a helper must be involved.
Diagnosis, consequences, treatment, prognosis and prevention
will be discussed in the following sections. These areas will fur-
ther elucidate the concept of burnout.

CAUSES, DL4GNOSIS AND EVAL LIA TION

The difference in burnout amongst various occupational types
has been studied in terms of causes and diagnosis (Ford et al.,
1983; Cook & Mandrillo, 1982) but not in terms of the features
of the burnout syndrome. Studies are necessary to elucidate the
salient common final features of burnout over occupations. This
type of information would ultimately lead to better diagnosis and
treatment. It has been noted that those individuals in the people-
oriented helping occupations are subject to a different type of
stress than those individuals of the corporate sector (Kennedy,
1981).
The causative agents associated with the health and helping
professionals have been studied (Cook & Mandrillo, 1982; Free-
 Emesl R. Rogers 95

man, 1983; Macbride, 1983; Haack & Jones, 1983; Hagemaster,

1983; Wimbush, 1983; Kennedy, 1981). These factors have been
found to be consistent throughout the literature.
Precursors to stress have been categorized in several ways.
THe first two part categorization involves personal causes and
environmental causes (Lavandero, 1981). Personal causes such
as perception of lack of support, decrease in interpersonal trust
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and associations, decrease in perception of job satisfaction or

accomplishment and role ambiguity all serve to increase stress
and so lead to burnout in some helping professionals (Cook &
Mandillo, 1982; McConnell, 1981; Haack, 1983; Hagemaster,
1983; Pines & Kanner, 1982). Smith and Steindler (1983) have
offered another item which may be classed as an individual cause
of burnout. Reality shock, or treater zeal, refers to the high per-
sonal expectation helpers have on entering their chosen field only
to realize that these expectations cannot be maintained in the
practical (real) situation. The impact of difficult patients upon
treaters is also a source of burnout and stress (Smith & Steindler,
1983).
Organizational causes of burnout are all related to the work
environment. There exist two opinions of the role of this factor in
the precipitation of burnout. Cook and Mandrillo (1982) state
that work area dynamics are not of importance in burnout. This
finding was confirmed by Yasko in 1983. In contrast, MacBride
(1983), Freeman (1983), Pines et al. (1981), Hagemaster (1983)
have found environmental factors to be important. The differ-
ences in findings may be related to a difference in definition of
organizational factors. The definition to be used in this paper
identified the environment as; the surroundings in which an indi-
vidual must work. This is to include inanimate objects, such as
equipment and furniture, as well as the atmosphere created by
co-workers, supervisors, and administrators. The definition is
admittedly broad and even overlaps some territory of the per-
sonal causes but is necessary to avoid confusion. It is obvious,
therefore, that under this definition, the environment does have
significant impact on the individual and stress. Cook and Man-
dillo (1982) described job satisfaction (challenges, opportunity
for advancement and power) as a pertinent factor in burnout;
clearly, this is an environmental factor by the above definition.
Holt (1983) discusses the role of the supervisor in precipitating
 96 THE CLINICAL SUPERVISOR

stress and burnout. Supervisors who depend on the same individ-

uals are "riding a good horse to death." This form of environ-
mental exploitation is another causative agent of burnout (Holt,
1983; Pines & Kanner, 1982).
Pines and Kanner (1982) have classified causative agents into
two categories of unequal importance. The first recognizes the
lack of positive conditions (thought to be more critical in burn-
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out), and the second is the presence of negative conditions as

sources of stress.
Lack of positive conditions are those such as lack of demon-
stration of appreciation; lack of positive professional feedback
and interaction; and doubtful peer reinforcement.
Presence of negative conditions were cited as role ambiguity,
role conflict and status incongruence. The need to deal contin-
ually with crises, injury and death were also considered negative
conditions.
Lack of positive antecedents above seems to fit in well with
Maslow's theory of a hierarchy of needs (Schultz, 1981). The
needs most affected by lack of positive conditions are those of
need for esteem and need for self-actualization. While these
needs are not necessary for suwival, they are of utmost impor-
tance in growth. Ignoring these needs would therefore be a block
to personal attainment. This may lead to frustration and stress
(Cook & Mandrillo, 1982).
There have been many diagnostic tests constructed to establish
burnout. These include Maslach Burnout Inventory (M.B.I.)
(Maslach &Jackson, 1981); Staff Burnout Scale for Health Pro-
fessionals (S.B.S.-H.P.) (Jones, 1980); and projective drawing
(Haack & Jones, 1983). The tests of Maslack and Jackson (1981)
and Jones (1980) have been used and found to be valid. The
projective drawing diagnostic test (Haack & Jones, 1983) was
created to be more sensitive to early burnout. It was found to
correlate well with the M.B.I. and the S.B.S.-H.P. My reserva-
tions of this test as a useful measure of burnout stems from the
failure of the authors to use a double blind study in the test's
evaluation. This test may well have application as a prospective
and diagnostic tool in evaluating burnout, but further study is
necessary.
Diagnosis is of prime concern due to burnout's insidious na-
 Ernest R Rogers 97

ture. Yasko (1983) has suggested diagnosis through evaluation of

prediction variables. This study revealed the following character-
istics in female nursing specialists to be related to a higher sus-
ceptibility to burnout: (1) younger with fewer children; (2) re-
ceiving inadequate psychological support; (3) experiencing high
occupational stress levels; and (4) experiencing role dissatisfac-
tion, apathy and withdrawal. This study correlated well with the
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M.B.I. and the S.B.S.-H.P. The predicted variables could ac-

count for 51.3% of the variance (Yasko, 1982). Further study is
necessary to identify other predictor variables of significance.
This promises to be a powerful evaluative tool as it will allow the
preventative treatment of those individuals shown to be predis-
posed to burnout.
Maslach (1978) has also offered some demographic predictor
variables. These are: (1) females demonstrate greater exhaustion
than males; (2) younger people are more susceptible than older
people to stress.
Diagnosis is somewhat akin to the discovery of an iceberg.
Once seen, the question still remains: How large is the iceberg?
Evaluation of the extent of burnout is of importance both in the
treatment of the syndrome and the prognosis of the individual
afflicted.
Evaluation may be accomplished on the basis of signs and
symptoms that the individual shows. These include: increasing
interpersonal distance, withdrawal, decrease in concentration, ri-
gidity of thought, and decrease in work efficiency in the early
stages. The latter stages may show confusion, deprcssion and
signs of severe exhaustion (McConnell, 1981; Wimbush, 1983;
Haack, 1983).
Two classifications of severity of symptoms have been devcl-
oped. Spaniol and Cuperto (McConnell, 1982) have divided
burnout into three stages. These stages are based on the frc-
quency and duration of signs and symptoms. These arc:

Stage 1 -Mild transient signs of stress.

Stage 2-Regular signs that last longer.
-These signs are increasingly difficult to eradicate.
Stage 3-Continuous physical and psychological problems.
-At this level, these problems cannot be overcome.
 98 THE CLINICAL SUPERVISOR

The second classification by Maslach (1978) is based on the

presence of exact signs and symptoms.

Phase 1-Emotional and physical exhaustion.

Phase 2-a) Increase in negative and dehumanizing attitudes
toward co-staff, clients and self.
b) Avoidance behavior.
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c) Withdrawal with decrease in work accomplish-

ments.
Phase 3 -Terminal burnout -no recovery.

These two classification schemes will have great impact in the

prognosis of recovery from burnout.

TREATMENT AND PROGNOSIS

Once burnout has been diagnosed, treatment should begin im-
mediately. The treatment should address the causes of burnout.
The specific causes may vaIy from individual to individual (Free-
man, 1983) or from environment to environment (Freeman,
1983; Hagemaster, 1983; McBride, 1983; Pines et al., 1981).
McConnell (1982) suggests that if one suspects a colleague is
afflicted by burnout, approach the person with caution and car-
ing. The best approach uses understanding, comfort, avoids con-
frontation or accusations.
The symptoms of burnout in themselves make this syndrome
difficult to treat. The patient will be withdrawing from col-
leagues, family and clients. The choice of the individual to ap-
proach the patient is critical. The person should be trusted and
respected by the afflicted individual. The patient may well lash
out with anger and suspicion. This should be expected (Pines et
al, 1981). We must realize that any therapy is stressful, therc-
fore, in the case of the burnout victim, initial contact and therapy
must be gentle and with minimum stress.
Burnout, precipitated by difficult clinical patients may be par-
tially reduced by a redistribution of work. The reduced workload
will allow the afflicted individual to spend time regrouping his or
 Enlest R. Rogers 99

her emotions. Scheduling particularly difficult clients at well

spaced intervals will give time-outs and allow for a winddown
after stressful sessions.
Physical exhaustion of burnout is best handled by time away
from work (McConnell, 1982). While giving time off may be
difficult for the employer. it is probably less difficult than trying
to find and orient a new therapist.
Burnout precipitated by reality shock or treater zeal (Smith &
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Steindler, 1983) may be treated by implementation of realistic

goals. Individuals who perceive loss of control must be oriented
to goals within the limits of their control. These individuals must
be counselled as to what objective they do have control over.
Dillon (1983) suggests gaining control by understanding one's
susceptibility to stress. In the same vein, Smyth (1982) and Ive-
son (1983) suggest one recognize that real control lies within
oneself.
Schneider (1982) is of the opinion that changing jobs or even
careers will not be of benefit to the burnout victim. She points
out that while this may slow down burnout, it doesn't deal with
the sources of burnout. This points out one feature of burnout
that is not explicitly stated in the literature reviewed. Burnout is a
pattern of behaviors. The realization of the existence of this pat-
tern and the changing of the antecedents is necessary to changc
the consequences, burnout!
I n the latter parts of the first two phases of burnout (Maslach,
1978), psychotherapy and advanced counselling are required.
Prognosis of recovery from burnout is related to the progression
of the symptoms of this syndrome. The literature suggests that
recovery is possible in all but terminal cases (Maslach, 1978;
McConnell, 1982; Dillon, 1983). Though recovery has been sug-
gested, no indication of the quality of post-burnout functioning
has been given. Prognosis in every case is individual and depen-
dent on the person's capacity for recovery. In general, the earlier
burnout is caught, the better the chances of recovery to full func-
tioning (Maslach, 1978).
Clearly, the importance of prevention and early detection of
sources of burnout cannot be overemphasized. These will be dis-
cussed in following sections.
 THE CLINICAL SUPERVISOR

EFFECTS OF BURNOUT
Burnout has its effects on the individual. In the helping profes-
sion, where the relationship between therapist and client is open,
burnout can have devastating effects. The effects on the individ-
ual, environment and clients will be reviewed here.
Burnout in the individual has been studied by many authors.
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Initially exhaustion, both physical and psychological, enters into

the picture. The person may be inattentive, tardy and forgetful.
These initial signs result in an overall decreased efficiency and
poor job competence (Haack & Jones, 1983; Hagemaster, 1983;
Kennedy, 1981; Lavandero, 1981; McConnell, 1982, and oth-
ers). Holt (1983) describes this result as an attempt by the person
to conserve energy while giving minimally acceptable care. Ive-
son (1983) describes this level of functioning as having an inop-
erative member of staff, this has environmental consequences.
The interaction with the client in a helping therapeutic rcla-
tionship is more susceptible to counscllor burnout. Initially, the
counsellor is missing client information and may appear to the
client as "not being quite as sharp as usual" (Kennedy, 1981;
Pines et al., 1981; Lavandero, 1981). As burnout continues to
draw the afflicted individual down into its spiral, the helper at-
tempts to use distance increasing maneuvers to protect himself or
herself (Hagemaster, 1983; Kennedy, 1981; Lavander, 1981;
Pines et al., 1981; Smith & Steindler, 1983, and othcrs). These
defence mechanisms serve to reduce the emotional involvement
with clients. Furniture rearrangement to increase distancc (Smith
& Steindler, 1983), and rigidity of thought frccs the therapist
from the need of making decisions as he or she goes strictly by
the book (Lavandero, 1981; Pines et al., 1981). Other signs are
poorly controlled anger, irritability (Hagemaster, 1983; Ivcson,
1983), also decrease in sympathy and empathy (Kennedy, 1981).
Negative feelings toward co-workers and clients increase as docs
negative self-talk (Hagemaster, 1983).
These signs all serve to estrange clients and co-workers, and
are associated with undirected rage and anger resulting in anxiety
in those who must deal with the burnout victim.
It should be noted at this point that a balance is necessary
between detachment and concern in counselling. One who is too
 Ernest R. Rogers 101

detached lacks the necessary sympathy and empathy to be effec-

tive. On the other hand, if concern is overwhelming, a loss of
objectivity decreases the efficacy of therapeutic intervention.
This balance has been referred to as affective neutrality by Par-
sons (Lavandero, 1981). Anything that upsets this balance will
result in poor therapeutic intervention.
A client who has requested help from a therapeutic profes-
sional is sensitive to the progress of the therapy. Burnout that
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results in delayed treatment or even worse, an iatrogenic precipi-

tation of problems increases the helper's anxiety, making the
therapy more difficult for the therapist (Wimbush, 1983; Smith
& Steindler, 1983). The client will show little or no appreciation
of the intervention or even act hostilely towards the treater (Wim-
bush, 1983). This serves to increase the effects of burnout on the
treater.
As the syndrome progresses in the individual, feelings of ali-
enation and paranoia may emerge (Iveson, 1983; Pines et al.,
1981; Pines & Kanncr, 1983). Psychological effects of burnout
vary in individuals with each person's unique psychological
make-up. Substance abuse has been recognized in some cases
(Haack & Jones, 1983; Iveson, 1983). Job hopping seems preva-
lent among those who are afflicted. Psychological symptoms
may culminate in guilt and shame (Lavandero, 1981; Pines et al.,
1981).
Due to the pervasiveness of this syndrome, not only the indi-
vidual suffers but also the work environment and family (Wim-
bush, 1983). Divorce and separation are higher amongst burnout
victims than non-burnout subjects in the same profession (Lavan-
dero, 1981).
Maslach (1978) and Spaniol and Cuputo (McConnell, 1982)
have stated that in the terminal stages, recovery from burnout is
not possible. These later stages may result in a physical depletion
of an individual and the concomitant physiological signs of se-
vere excess stress. These signs include: headache, palpitations,
hypertension, cardiac and respiratory symptoms, cognitive dys-
function, depression and increased susceptibility to illness. The
mechanisms of these physiological symptoms are via the hormo-
nal responses to the stress. The interested reader is referred to a
textbook of physiology for the details of these events.
 102 THE CLINICAL SUPERVISOR

The overall effects of burnout are withdrawal, preventing a

further physiological and psychological drain of energy
(Maslach, 1978; McConnell, 1982). This withdrawal is mani-
fested in use of defence mechanisms. The later stages of burnout
results in continuous physical and psychological symptoms, all
resulting in the afflicted individual being isolated from others. It
is obvious that by withdrawing, the individual can only impair
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his or her functioning. In the helperihelpee relationship where the

helper is affected, these symptoms will result in poor therapeutic
care and possible psychological injury to the client.
It should be noted that burnout may well be contagious in the
work environment (Smyth, 1983). This presents a problem to the
employer/supervisor and has been shown to be of economic sig-
nificance to the workplace (Pines & Kanner, 1982). This will be
further discussed under prevention.

PREVENTION OF BURNOUT
The prevention of burnout is of significance in all helping oc-
cupations. Burnout has a costbenefit factor associated with it
(Cook & Mandrillo, 1982; Hagemaster, 1983: Lavandero, 1981;
Pines et a]., 1978; & Wimbush, 1983). Many supervisors and
administrators neglect to include the cost of burnout or the bene-
fit of prevention in their yearly budgets (Pines et al., 1978).
Prevention may take different forms and be instituted at vari-
ous levels. The academic level may be used to prepare the indi-
vidual for the stresses of hidher chosen profession. These require
development in student counselors, realistic expectations, self-
awareness and a capacity for self-help. This last area has been
sadly ignored in many training programs (Dillon, 1983).
Realistic expectations of the job can reduce stress and fear in
the new counsellor or in an experienced counsellor moving to a
new position. The academic forum is an excellent time to discuss
expectations and results of counselling. In training, the student
has been presented with situations in which the results are often
black or white, good or bad. He or she has come to expect that
hard work and diligence will lead to a positive result. This may
not always be true in the clinical situation. The counsellor must
 develop an objectivity as to his or her responsibility in events and
those that are beyond his or her therapeutic and personal respon-
sibility. This will give a more realistic appraisal of successes and
a differentiation of failures into those within one's control and
those outside of one's control. This realistic expectation will pre-
vent stress from arising as a result of failures beyond the individ-
ual's control.
Kennedy (1981) describes listening to one's feelings as devel-
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oping an observing self. This technique of awareness leads to

accurate identification of the stress important in the prevention of
burnout (Freeman, 1983).
The area of self-help is an area most useful to the individual.
Throughout this paper the concept of one's perception of events
has been demonstrated to be intimately involved in the prccipita-
tion of burnout. Self-help techniques have been well outlined by
Dillon (1983) and are presented below. The individual:

1. Must gain control and take responsibility.

2. Must take mini vacations-it has been suggested that nu-
mcrous short vacations are more advantageous that one long
vacation.
3. Use positive imagery-see positive results, basically be an
optimist.
4. Must expect strcss areas-this personal coping item is of
particular importance. Expectation of stress areas may al-
low role playing with fellow colleagues to allow one to best
develop control of the stress felt in a situation.

Another interpersonal coping scheme includes former support

systems. These include times to vent frustration and feelings
(Haack & Jones, 1983; Brown, 1983; Cook & Mundrillo, 1982)
with colleagues. Positive coping measures include developing
hobbies or space away from work which is satisfying (Iveson,
1983; Pines et al., 1981; Kennedy, 1981).
Other personal coping strategies include re-scheduling ap-
pointments for maximum personal energy efficiency and varying
stresses to allow for limited hours of stressful work. The tech-
nique most likely to be viewed as useful in controlling stress is
that of developing an expertise in an area of interest: This allows
 104 THE CLINICAL SUPERVISOR

one to avoid areas that are particularly stressful. Examples of

specialization are suicideology, financial counselling, marital
dysfunction, or alcoholism (Iveson, 1983; Jones, 1981; Ken-
nedy, 1981; Pines et al., 1981).
Organizational coping strategies have been examined by Pines
et al. (1981). These are strategies employed by the adrninistra-
tion to relieve employee tension. These include:
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(1) Reduced Ratio-the optimum ration of helper to client

varies with the situation and so must be evaluated in each
case in consultation with counsellors.
(2) Scheduling Flexibility- this organizational strategy assists
the employee in developing outside activities and schedul-
ing vacations.
(3) Training-continuing education has been of great value in
stress reduction. Both in house and conference type cduca-
tional time off should be allowed in all employees' sched-
ules. This has been confirmed by Ford (1983).
(4) Feedback and Peer Review- decreases stress of alienation
in the work space.
(5) Positive Work Conditions-these refer to environmental
pressures such as temperature, humidity, window space.
These items are less critical in a hospital situation as thcse
details have usually been thought of for the patient's bene-
fit.
(6) Clear Organizational Objectives and Goals-these are im-
portant to avoid ambiguity and feelings of powerlessness
in staff. Rewards must be instituted to indicate achieve-
ment of the organizational objectives.

Prevention is a broad topic and is an area that has and is receiv-

ing concern. Two basic rules emerge from the literature with
respect to prevention. The first is related to personal coping strat-
egies. We must take responsibility for our actions but be clearly
aware of the limits of this responsibility. The second general rule
relates to organizational efforts in reducing stress. The organiza-
tion, in forming any policies or goals, should be keenly aware of,
and allow for, employee interpretation and evaluation of the con-
sequences of changes.
 CONCLUSIONS

Burnout as a syndrome is a very personal problem. The causes,

signs, symptoms and consequences are all based on the individ-
ual and his or her particular needs. In general, stress is the pre-
cipitator of burnout. It should not be surprising therefore to real-
ize that the treatments must be tailored to the specific sources of
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stress in all of us. Treatments are of benefit, but prevention is the

best treatment. The responsibility for controlling stress is the in-
dividual's and should be seen as such.
There is a hole in thc research with respect to treatment and
specifically in the area of post-burnout return of functioning.
This area is of importance to those who are burned out or who
have employees who have burnt out. 1 trust these concerns will
be addressed in future research.
Burnout has many facets and is an area of much current re-
search. One should remember . . . burnout is not inevitable
(Wimbush, 1983).

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