Burnout Among Sexual Minority Mental Health Practitioners

Burnout Among Sexual Minority Mental Health Practitioners: Investigating Correlates and Predictors

Cory Viehl Life University

Franco Dispenza Georgia State University

Rafe McCullough Lewis and Clark College

Kan Guvensel Life University

Burnout is a significant concern that results in negative outcomes for both mental health practitioners (MHPs; e.g. counselors, psychologists, social workers) and their clients. Viehl and Dispenza (2015) found that sexual-minority-identified MHPs reported higher rates of burnout when compared to heterosexual-identified MHPs. To continue understanding what factors contribute to burnout among sexual-minority-identified MHPs, we used Internet survey procedures to explore possible correlates and predictors of burnout among 84 sexual- minority-identified MHPs. MHPs were recruited and sampled from across the U.S. Perceptions of reasonable workload, perceptions of workplace heterosexism, perceptions of workplace support, and identity concealment were all explored in this study as specific factors that could lead to burnout. All of the aforementioned factors correlated with burnout, and to some degree, uniquely predicted burnout among the MHPs sampled for this study. Perceptions of workplace support also mediated the relationship between workplace heterosexism and burnout. The data supports the need for MHPs, MHP educators, and clinical supervisors to address the stigma related to sexual minority identity as a potential contributor to burnout, as well as ways to navigate this marginalized identity within the mental health field.

Keywords: minority stress, burnout, sexual minority, LGBQ, mental health practitioner

Burnout is a significant concern that results in negative out- comes for both mental health practitioners (MHPs) and their clients (Thompson, Amatea, & Thompson, 2014). As a construct, burnout consists of three components: emotional exhaustion, dep- ersonalization, and feelings of ineffectiveness or lack of personal accomplishment (Maslach, Jackson, & Lieter, 1997). Emotional exhaustion involves a perceived inability to feel compassion for one’s clients, being overextended, and a perceived inability to meet the demands of the work environment (Lent & Schwartz, 2012). Depersonalization is a process in which a practitioner distances themselves from the client as a means to protect against empathy fatigue (Lent & Schwartz, 2012). Lastly, feelings of ineffectiveness or lack of personal accomplishment occurs when the practitioner experiences a negative sense of personal and career worth (Oser, Biebel, Pullen, & Harp, 2013).

Various correlates of burnout among MHPs have also been explored. For instance, perceptions of the workplace climate (Thompson et al., 2014), caseload size (Craig & Sprang, 2010; Salyers & Bond, 2001), and type of workplace settings (Lent & Schwartz, 2012) have been associated with burnout. In a sample of 213 mental health counselors, Thompson et al. (2014) reported that counselors who reported more positive perceptions of their work environment reported less burnout. Additionally, Oser et al. (2013) noted that higher caseloads, and the subsequent paperwork asso- ciated with high caseloads, correlated with higher reported burnout among practitioners. Furthermore, Lent and Schwartz (2012) sug- gest that counselors in independent practice report less burnout symptomology, and may be at less of a risk for burnout because of the autonomy and flexibility of independent practice compared with community mental health.

Researchers have also examined protective factors that aid in the prevention of burnout symptoms, including both coworker (Oser et al., 2013) and social support (Galek, Flannelly, Greene, & Kudler, 2011). Oser and colleagues (2013) reported that a protective factor existed within coworker support, as coworkers could easily rec- ognize burnout symptoms and could offer suggestions based on the workplace environment. Galek et al. (2011) discussed the impor- tance of social support, which included both supervisory and family support, in the prevention of burnout and secondary trau- matic stress in a sample of 311 chaplains.

Moreover, personal demographic variables have also been ex- plored in relation to burnout. In particular, gender has been exam-

This article was published Online First July 17, 2017. Cory Viehl, Department of Positive Human Development & Social

Change, Life University; Franco Dispenza, Department of Counseling and Psychological Services, Georgia State University; Rafe McCullough, Graduate School of Education and Counseling, Lewis and Clark College; Kan Guvensel, Department of Positive Human Development & Social Change, Life University.

Correspondence concerning this article should be addressed to Cory Viehl, Department of Positive Human Development & Social Change, Life University, 1269 Barclay Circle, Marietta, GA 30062. E-mail: cory.viehl@life.edu

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Psychology of Sexual Orientation and Gender Diversity © 2017 American Psychological Association 2017, Vol. 4, No. 3, 354–361 2329-0382/17/$12.00 http://dx.doi.org/10.1037/sgd0000236

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ined as a contributing factor in experiences of burnout within the mental health field. Dupree and Day (1995) found that male- identified MHPs experienced higher rates of burnout when com- pared with female-identified MHPs, whereas Lent and Schwartz (2012) found that female counselors reported higher levels of emotional exhaustion when compared with male counselors with the same years of experience. Although these findings do not provide any definitive conclusions as to why gender may have an effect on burnout, they suggest that gender identity, and possibly socialization mechanisms, might influence the manner in which MHPs experience burnout in the mental health field. More re- search is necessary to see how gender, gender identity, or gender expression might influence burnout among MHPs.

Age has also been explored in relation to burnout. Vredenburgh, Carlozzi, and Stein (1999) found that reported age significantly predicted depersonalization and emotional exhaustion. They sug- gested that older MHPs were less likely to report experiencing symptoms of burnout because they possibly developed certain characteristics, such as more effective coping, as they matured in age. Similarly, Craig and Sprang (2010) examined a group of trauma counseling practitioners and found that therapists younger in reported age experienced higher rates of burnout because of lower perceived self-efficacy in their work with trauma clients as well as feeling ill-equipped to handle the stressful demands of trauma work.

Relatedly, sexual orientation is one demographic variable that has been recently examined in relation to burnout but warrants further exploration. Viehl and Dispenza (2015) found that sexual minority men (e.g., gay, bisexual, queer) experienced higher rates of burnout within the mental health field when compared with both male- and female-identified heterosexual MHPs as well as sexual- minority-female-identified MHPs. They also reported that sexual minority MHPs, including both sexual minority men and women, engaged in less emotion-focused coping than heterosexual MHPs. Although the cross-sectional study did not explore what accounted for these findings, Viehl and Dispenza suggested that sexual mi- nority MHPs may possibly be managing the stigma of a sexual minority identity as well as the stressors associated with non- normative gender role expectations. It is also possible that the sexual minority MHPs in the study were encountering workplace discrimination as a result of their sexual orientation.

Sexual minority individuals have an increased risk of encoun- tering a host of adverse experiences within the workplace, includ- ing homophobic-related prejudices, harassment, and discrimina- tion (Chung, Williams, & Dispenza, 2009). Heterosexual-related privileges in the workplace (e.g., having a picture of your opposite- sex partner or bringing your opposite-sex spouse to the holiday office party) have been associated with negative psychological and physical health as well as lower rates of job satisfaction for sexual minorities (Lyons, Brenner, & Fassinger, 2005; Ragins, 2008; Waldo, 1999). Relatedly, the stigma of identifying as a sexual minority individual has been associated with higher ratings of job burnout (Rabelo & Cortina, 2014) as well as greater psychological distress in the workplace (Velez, Moradi, & Brewster, 2013). Furthermore, Waldo (1999) specifically examined the influence of workplace heterosexism, a series of prejudicial events that take place in the workplace as result of one’s sexual orientation. His study focused on instances of prejudicial events experienced by sexual minority individuals in the workplace and the subsequent

development of psychological distress, health concerns, and lower job satisfaction reported by participants. Similarly, Smith and Ingram (2004) found that sexual minority individuals’ experiences of workplace heterosexism positively correlated with depressive and other psychological symptoms. Lyons et al. (2005) found that sexual minority employees who experienced instances of work- place heterosexism reported lower levels of job satisfaction.

Identity concealment, or the avoidance of having to disclose one’s sexual minority identity, is also of great importance when considering the workplace experiences of sexual minority individ- uals (Chung et al., 2009). Concealment has been considered det- rimental to the overall identity development and well-being of sexual minority individuals (Meyer, 2003). Pachankis (2007) as- serted that concealment resulted in negative psychological effects for sexual minority individuals, because of the fact that sexual minority individuals were forced to regulate their identity expres- sion with others. Concealment of sexual orientation has also been associated with higher reported incidences of mental health con- cerns among sexual minority individuals (Hatzenbuehler, 2009; Meyer, 2003). Velez et al. (2013) examined the tenets of minority stress in workplace contexts, and found that perceptions of work- place heterosexism and identity concealment within the workplace resulted in lower rates of job satisfaction and higher rates of psychological distress.

Among sexual minority persons, heteronormative environments (i.e., contexts that promote heterosexuality as the preferred sexual orientation) have the propensity to increase reported attributions of perceived prejudices (Burns, Kamen, Lehman, & Beach, 2012). Sexual minority persons may have higher expectations that they will encounter heterosexist discrimination and stigma, and there- fore are likely to experience increased anxiety (Burns et al., 2012) and other psychological and behavioral outcomes (Hatzenbuehler, 2009; Meyer, 2003). The literature has established the connection between heterosexist expectations and concealment within the workplace (Meyer, 2003; Pachankis, 2007; Velez et al., 2013), and as such, it is possible that these experiences could be related to counselor burnout among sexual minority MHPs. However, no known research has specifically explored workplace heterosexism and concealment among sexual minority MHPs.

The Present Study

By integrating both the vocational (Chung et al., 2009; Eliason, Dibble, & Robertson, 2011; Velez et al., 2013) and the minority stress literature (Alessi, 2014; Burns et al., 2012; Hatzenbuehler, 2009; Meyer, 2003), the present study sought to examine both correlates and predictors of burnout among sexual-minority- identified MHPs. The present study analyzed existing quantitative data from a larger data set in which participants responded to questionnaires related to burnout, experiences of minority stress, and perceived workplace support. For the purposes of this study, we proposed two sets of hypotheses. Our first set of hypotheses examined the correlational and predictive potential of age, percep- tions of reasonable workload, workplace heterosexism, conceal- ment, perceptions of workplace support, and burnout. Specifically, we tested the following:

• Given that age and perceptions of workload reasonability have been previously shown to have negative associations with burnout (Craig & Sprang, 2010; Devilly, Wright, &

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Varker, 2009; Vredenburgh et al., 1999), we predicted that age and perceptions of workload reasonability would also have a negative association with burnout among sexual minority MHPs.

• We predicted that workplace heterosexism and conceal- ment would have a positive association with burnout. In other words, the more a sexual minority MHP was ex- pected to conceal or was subjected to a heterosexist work- place environment, the more likely they would be to report higher symptoms of burnout.

• Lastly, perceptions of workplace support has been shown to buffer the relationship between negative work experi- ences and burnout (Galek et al., 2011; Oser et al., 2013). We predicted that higher perceptions of workplace support (i.e., coworker support, supervisor support) would have a negative association with burnout.

We further predicted that perceptions of workplace support could function as a potential mediating variable in the context of burnout, and these served as our second set of hypotheses. Hat- zenbuehler (2009) initially suggested that psychosocial processes, such as interpersonal support, could mediate the relationship be- tween heterosexist events and negatively laden outcomes (i.e., psychological distress, substance use, etc.). Thus, we extended this theory to be applicable with MHPs’ experiences of burnout, and predicted that (a) workplace support would mediate the relation- ship between workplace heterosexism and burnout; alternatively, seeking support could also be a means of mitigating the effects of concealment on burnout, and thus we additionally predicted that (b) workplace support would mediate the relationship between concealment and burnout.

Method

Data

Data for the present study came from a larger data set that included both sexual-minority-identified and heterosexual- identified MHPs. Only sexual-minority-identified MHPs were ex- tracted from the larger data set for this study. Consistent with other published studies that used subsequent data from larger data sets (e.g., Brewster, Velez, Mennicke, & Tebbe, 2014; Velez et al., 2013), most of the variables explored in this study were not used in the previously published study. Only measures of burnout and workload reasonability with this sample were used in the previous published study (Viehl & Dispenza, 2015).

Participants

From the original data set, a total of 119 participants reported identifying as a sexual minority. Of these 119 participants, 35 were excluded from final data analysis because of missing data in their responses, resulting in a final sample size of 84 participants. Participants ranged in age from 24 to 68 (M � 38.54, SD � 10.58) years old. The sample reported an average of 7.28 years of clinical experience in the field (SD � 7.74; range � 1–39 years). Partic- ipants reported working in the indicated primary work setting for an average of 4.55 years (SD � 6.24; range � 1–37 years). Participants reported working an average of 32.13 hr per week (SD � 14.60; range � 1–60 hours) as a mental health professional

and seeing an average of 20.85 clients per week (SD � 36.49; range from 1 to 343 clients per week, with school counselors having the largest caseload). Participants reported receiving an average of 1.60 h of supervision/consultation per week (SD � 1.35; range � 0 � 0–7 hr per week). Remaining demographic information (e.g., gender, sexual orientation, race/ethnicity) is presented in Table 1.

Measures

Personal and professional demographic form. Information including age, race, ethnicity, sex/gender, region, sexual orienta- tion, highest degree held, allied field of mental health practice, primary work setting, number of years in primary work setting, number of years of experience within the field, average number of clients seen per week, average number of hours of supervision/ consultation received per week, average number of sick days taken per year, and average number of personal/vacation days taken per year was collected.

Table 1 Frequencies and Percentages of Participant Demographics

Variable N %

Identified gender Men 51 42.86 Women 58 48.74 Transgender/gender queer 10 8.4

Sexual orientation Bisexual 14 11.76 Queer 9 7.56 Gay/lesbian 96 80.67

Racial/ethnic identity White/European American 102 85.71 Black/African American 2 1.68 Hispanic/Latin 6 5.04 Asian/Asian American 2 1.68 Biracial/multiracial 7 5.88

Geographic region (U.S.) Southeast 44 36.97 West 36 30.25 Midwest 28 23.53 Northeast 14 11.76

Highest degree earned Master’s/educational specialists 74 62.18 Doctorate 45 37.82

Degree discipline Mental health counseling 32 26.89 Counselor education 16 13.45 Counseling psychology 16 13.45 Clinical psychology 33 27.73 School counseling 1 .84 Marriage and family therapy 2 1.68 Rehabilitation counseling 2 1.68 Social work 4 3.36 School psychology 1 .84

Primary work setting Private outpatient clinic 20 16.81 Community mental health center 26 21.85 Private practice/other 22 18.49 University 28 23.53 School district 7 5.88 Hospital 12 10.08 Child/adolescent psychiatric or pediatric center 2 1.68 Prison/correctional facility 1 .84

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Perception of reasonable workload. This variable was mea- sured utilizing a single item from a measure originally developed by Devilly et al. (2009). Participants responded to a 5-point Likert scale (1 � strongly agree, 5 � strongly disagree) asking them, “Please indicate the degree to which you agree or disagree with the following: My workload is reasonable.”

Burnout. The Counselor Burnout Inventory (CBI; Lee et al., 2007) measures the unique feelings and behaviors associated with burnout in mental health professionals. The CBI consists of 20 items that are divided into five subscales: Exhaustion (e.g., “I feel exhausted due to my job as a counselor”), Incompetence (e.g., “I do not feel like I am making a change in my clients”), Negative Work Environment (e.g., “I feel frustrated with the system in my workplace”), Devaluing the Client (e.g., “I am not interested in my clients and their prob- lems”), and Deterioration in Personal Life (e.g., “Due to my job as a counselor, I feel overstressed”). Lee et al. (2007) reported coefficients of internal consistency reliability ranging from .73 to .85. Convergent validity has been investigated with CBI data examining correlations between the CBI and the Maslach Burnout Inventory—Human Ser- vices Survey (MBI-HSS; Maslach, Jackson, & Lieter, 1997). The CBI showed significant positive correlations with the Emotional Exhaus- tion and Depersonalization subscales and significant negative corre- lations with the Personal Accomplishment subscale of the MBI-HSS (Lee et al., 2007). Yu et al., 2008 The inventory has been cross- culturally validated with counselors in the U.S. and with counselors in various southeast Asian countries (Shin, Yuen, Lee, & Lee, 2013; Yagi, Lee, Puig, & Lee, 2011; Yu, Lee, & Nesbit, 2008). Cronbach’s alpha for this sample was .78.

Workplace heterosexist experiences. The Workplace Hetero- sexist Experiences Questionnaire (WHEQ; Waldo, 1999) is a 22-item measure that assesses participants’ experiences of sexual-orientation- based harassment and discrimination. All items are presented with the stem “During the past 12 months in your workplace, have you ever been in a situation where any of your coworkers or supervisors . . .,” and a response scale ranging from never (0) to most of the time (4) is used to rate sample items such as “made you feel it was necessary to ‘act straight’” (e.g., “monitor your speech, dress, or mannerisms;” Waldo, 1999, p. 223). Waldo (1999) and Smith and Ingram (2004) found Cronbach’s alphas of .93 and .92 on WHEQ items in their sample of LGB individuals. WHEQ scores have been shown to positively correlate with perceived organizational tolerance for work- place heterosexism (Waldo, 1999). Cronbach’s alpha for the WHEQ for this sample was .70.

Concealment. The Concealment Subscale of the Lesbian, Gay, Bisexual Identity Scale (LGBIS; Mohr & Kendra, 2011) was used in this study. The concealment subscale consists of three questions that measure potential concealment of one’s sexual orientation (i.e., “I keep careful control over who knows about my same-sex romantic relationships”). The LGBIS (Mohr & Kendra, 2011) yielded strong exploratory factor analysis and confirmatory factor analysis as well as strong test–retest reliability (Mohr & Kendra, 2011). Mohr and Ken- dra (2011) reported coefficients of internal consistency reliability on the Concealment subscale ranging from .67 to .82. Six-week test– retest correlation coefficients for the LGBIS subscales ranged from .70 to .92, indicating a moderate to high degree of stability. Cron- bach’s alpha for this sample was .83.

Workplace support. Perceptions of workplace support was measured using the Sources of Social Support Questionnaire (SSSQ; Haddad, 1998). The scale consists of 18 items that evaluate three

different aspects of support in the workplace, including advice and guidance (five items), acceptance and belonging (seven items), and feedback (six items). The SSSQ requires participants to answer each of the 18 items on a 5-point Likert-type scale ranging from no support (1) to very much support (5). On the original SSSQ, participants are asked to answer each of the 18 questions across five following groups: supervisors, colleagues, friends, spouse, and family. An average total score is then calculated, with higher scores indicating more positive perceptions of social support in the workplace.

For the purposes of this study, we modified the measure slightly to only include two groups instead of five: work supports and family/friends supports. Participants were specifically instructed to consider work supports as including clinical supervisors, admin- istrative supervisors, work colleagues, other MHPs, or even super- visees. Participants were then instructed to consider family/friends supports as including spouse, family-of-choice members, family- of-origin members, and friends. The measure was modified for purposes of brevity and to further account for the work-related experiences of MHPs across different work settings. In particular, we considered the fact that MHPs may be in independent practice and therefore may not have a clinical supervisor to whom they directly report, or that the participant may be the clinical supervi- sor. Furthermore, we wanted to ensure that the family/friends category was broadly defined to include family of choice as well as family of origin for sexual minority persons in the study. The modified measure was initially evaluated for face validity by six doctoral students who already possessed master’s degrees in clin- ical mental health counseling. Furthermore, we sent it to five sexual-minority-identified MHPs, who independently reviewed the modified measure for appropriateness, relevance, and clarity. Consistent feedback was that the modified measure was appropri- ate and applicable with sexual-minority-identified MHPs. Cron- bach’s alpha for the modified measure with this sample was .82.

Procedures

Participants were recruited via the Internet utilizing an en- crypted survey engine (i.e., Qualtrics). The call to participate in the survey was posted on various professional counseling and MHP listservs as well as social media sites geared toward mental health professionals. In order to be eligible for participation in the study, participants must have met the following criteria: (a) over the age of 18; (b) an MHP (e.g., professional mental health counselor, counselor educator, psychologist); and (c) currently providing professional services (e.g., individual psychotherapy, appraisal, group counseling) on a consistent basis. If the participant met these criteria, and was interested in volunteering, the participant was directed to a survey link in which the informed consent for the study was presented. The informed consent outlined the purpose of the study as well as the time commitment involved for participants. Participants were also offered an incentive for agreeing to partic- ipate in the study that included entry into a raffle for one of five $20.00 Amazon gift certificates. Participants then proceeded to complete a series of questionnaires. Participants who were inter- ested in enrolling in the raffle were asked to click a link that directed them to an external survey for the raffle to ensure the confidentiality of their data.

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Results

Data were first transferred from Qualtrics to IBM SPSS 22.0 in order to complete all statistical analyses. Means, standard devia- tions, and intercorrelations among all continuous predictor and criterion variables are shown in Table 2. We screened the data and found no significant outliers in the data set. Additionally, all variables of interest were in the acceptable range of skewness and kurtosis (e.g., skewness |3 | and kurtosis |10 | ; Weston & Gore, 2006). A series of nonparametric tests revealed no statistically significant differences on the CBI Total as a function of gender, �2(2) 2.43, p � .29, race or ethnicity, �2(4) 6.23, p � .18, degree type, �2(2) 4.44, p � .11, licensure, �2(5) 2.16, p � .83, and work setting, �2(15) 22.36, p � .09.

Variables were then sequentially entered in three blocks in a hierarchical regression analysis. Given that there was a correlation between age and CBI Total (r � �.18, p � .015), it was added in the first block along with workload reasonability. We then entered workplace heterosexism and concealment in the second block, and perceptions of workplace support in the third block. Prior to any interpretations, we assessed for potential violations of assumptions

of independence, multicollinearity, bias, linearity, and homosce- dasticity. The Durbin-Watson test statistic was 2.05, suggesting that residual terms were independent of one another. Next, we examined the absolute values of predictor variables and variance inflation factors, which revealed that multicollinearity was not an issue. Case-wise diagnostics were consulted to check the residuals for evidence of bias. None of the cases in this sample had a Cook’s distance greater than 1, and the Mahalonobis distance revealed that none of our cases were close to our criterion of 15.09 (�2 critical value for 5 degrees of freedom, p � .01). Following Field’s (2013) recommendations, scatterplot analyses were then consulted, and assumptions of linearity and homoscedasticity were met.

Next we examined model parameters. The results of the hierar- chical regression analysis are found in Table 3. A significant model resulted in Step 1, F(2, 81) � 4.78, p � .01, with approx- imately 10.6% of the variance accounted for in counselor burnout. Only perceptions of workload reasonability were statistically sig- nificant in the model (� � �.33, p � .003), whereas age was not. A significant model also resulted in Step 2, F(2, 79) � 5.40, p � .001, with workplace heterosexism (� � .25, p � .019) and concealment (� � .22, p � .029) both emerging as significant predictors of burnout symptoms. Introducing workplace heterosex- ism and concealment in Step 2 explained an additional 10.9% and the change in R2 was significant, F(4, 79) � 5.49, p � .006. Lastly, a significant model resulted in Step 3, F(5, 78) � 6.49, p � .001, and perceptions of workplace support (� � �.31, p � .004) emerged as significant predictor of burnout. The addition of this variable explained approximately 7.9% of additional variance, and the change in R2 was significant, F(1, 78) � 8.73, p � .004. When all five predictors were included in Step 3, age remained nonsig- nificant and workplace heterosexism was no longer significant. Together, all five predictor variables accounted for a total of 29.4% of the variance in burnout.

To evaluate our second set of hypotheses regarding mediation, we used Hayes’s PROCESS macro for SPSS. We used a bootstrap procedure to create 1,000 bootstrap samples from the original data set, and we set the macro to compute 95% confidence intervals to

Table 2 Means, Standard Deviations, and Bivariate Correlations for Counselor Burnout Inventory (CBI), Workload Reasonability, Workplace Heterosexist Expectations Questionnaire (WHEQ), Concealment, and Sources of Social Support

Variable 1 2 3 4 5

1. CBI — 2. Workload reasonability �.33�� — 3. WHEQ .27�� �.11 — 4. Concealment .21� .05 .06 — 5. Workplace support �.42��� .28�� �.34�� .03 — M 48.62 14.58 27.08 9.81 58.54 SD 10.44 2.78 6.43 4.14 14.43

� p � .05. �� p � .01. ��� p � .001.

Table 3 Multiple Linear Regression, With Counselor Burnout Inventory as the Outcome Variable

Variable B SE � t p

Step 1: F(2, 81) � 4.78, p � .05, R2 � .11 Age �.02 .11 �.02 �.15 .88 Workload reasonability �1.22 .40 �.33 �3.09 .00�

Step 2: F(2, 79) � 5.40, p � .01, R2 � .22 Age .08 .11 .08 .77 .45 Workload reasonability �1.14 .38 �.30 �3.01 .00�

WHEQ .41 .17 .25 2.40 .02�

Concealment .56 .25 .22 2.22 .03�

Step 3: F(1, 79) � 6.49, p � .001, R2 � .29 Age .05 .10 .05 .53 .60 Workload reasonability �.87 .37 �.23 �2.33 .02�

WHEQ .23 .17 .14 1.36 .18 Concealment .58 .24 .23 2.39 .02�

Workplace support �.23 .08 �.31 �2.96 .00�

Note. WHEQ � Workplace Heterosexist Expectations Questionnaire. � p � .05.

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evaluate the indirect relationships among pathways. Statistically significant correlations were already observed between the predic- tor and criterion variables prior to running these analyses (see Table 2), and all assumptions of normality, independence, multi- collinearity, bias, linearity, and homoscedasticity were determined in the previous analyses. We found that there was a significant indirect effect of workplace heterosexism on burnout through perceptions of workplace support (b � 0.212, BCa CI [.026, .472]). Perceptions of workplace support fully mediated the rela- tionship between workplace heterosexism and burnout among MHPs. Preacher and Kelley’s (2011) kappa-squared coefficient was equal to .128, 95% BCa CI [.019, .273], revealing a medium effect size in the indirect effect. Workplace heterosexism was associated with a .21-point increase on burnout symptoms as mediated by reduced perceptions of workplace support. The indi- rect effect of concealment on burnout through perceptions of workplace support was not statistically significant (b � �.006, BCa CI [�.268, .205]). Thus, perceptions of workplace support did not mediate the relationship between concealment and burnout symptoms.

Discussion

Findings from this study help advance the research on burnout by specifically examining correlates and predictors of burnout among a small sample of sexual-minority-identified MHPs. First, perceptions of reasonable workload, workplace heterosexism, per- ceptions of workplace support, and identity concealment all cor- related and uniquely predicted burnout among sexual minority MHPs. Although reported age was not a significant predictor of burnout in the regression analysis, there was an inverse correlation between age and burnout with this sample. Like other studies that found that MHPs younger in age were more likely to report burnout (e.g., Craig & Sprang, 2010; Vredenburgh et al., 1999), we suspected that the younger sexual minority MHPs in this sample may have indicated higher rates of burnout as a result of not having developed the necessary characteristics to cope or the self-efficacy to manage minority stress in the workplace. Again, these are only speculations, and further research would be necessary.

Not surprisingly, sexual minority MHPs who reported higher rates of reasonable workloads also indicated lower rates of burn- out. This finding is consistent with other reports that less paper- work, smaller caseloads, and more flexibility around task-oriented matters at work were all associated with lower rates of burnout among MHPs (Lent & Schwartz, 2012; Oser et al., 2013). Con- sistent with the notion that concealing one’s sexual minority iden- tity has negative psychological and behavioral health conse- quences (Pachankis, 2007; Velez et al., 2013), we found that sexual minority MHPs who reported higher concealment rates subsequently reported higher levels of burnout. Similar to studies that reported that concealment was associated with higher ratings of job burnout (Rabelo & Cortina, 2014) and psychological dis- tress in the workplace (Velez et al., 2013), these findings imply that not disclosing one’s sexual orientation in the mental health workplace is associated with emotional exhaustion, depersonaliza- tion, and feelings of ineffectiveness for MHPs.

Findings from this study further support the notion that percep- tions of the workplace environment are associated with burnout rates among sexual minority MHPs. Just as environments that

promote heterosexuality as the preferred sexual orientation are associated with lower levels of job satisfaction (Lyons et al., 2005; Waldo, 1999), we found that higher instances of workplace het- erosexist experiences were also related to increased rates of burn- out (i.e., exhaustion, depersonalization, and feelings of ineffective- ness) among sexual minority MHPs. However, with the addition of perceptions of workplace support in the regression model, work- place heterosexist experiences no longer predicted burnout. This indicated that perceptions of workplace support functioned as mediator, thus supporting one of our two hypotheses regarding the mediating effects of workplace support.

Whereas our results indicated that workplace heterosexism could have a direct negative impact on burnout, the mediation analysis revealed that perceptions of workplace support influence the manner in which workplace heterosexism effects burnout among sexual minority MHPs. In the presence of workplace het- erosexism, reduced perceptions of workplace support could in- crease burnout levels among sexual minority MHPs. The inverse order could also be true, in that increased perceptions of workplace support could help reduce burnout levels. This validates findings that have indicated that lesbian and gay persons are likely to utilize social support as a means of managing and reducing stress asso- ciated with workplace heterosexism and discrimination (Chung et al., 2009). Additionally, as initially hypothesized, these findings further support tenets of minority stress theory (Hatzenbuehler, 2009; Meyer, 2003). Specifically, psychosocial processes, such as social supports, can help mitigate the deleterious effects of work- place heterosexist experiences on burnout for sexual minority MHPs.

Our second mediation hypothesis revealed that perceptions of workplace support did not mediate the effects of concealment on burnout. This may indicate that perceptions of workplace support do little to reduce burnout in relation to concealment for sexual minority MHPs. Although this finding precludes us from making any definitive conclusions, this finding further suggests the com- plex contextual nature of identity concealment. For instance, one may have to disclose their identity in order to receive adequate social support in the workplace, but this potentially increases one’s vulnerability to encountering heterosexist discrimination or preju- dice. However, not disclosing one’s identity in the workplace could lead to further prejudices that could interfere or prevent a sexual minority MHP from seeking social support at work.

Implications

Clinical supervisors and administrators need to be aware that sexual minority MHPs experience unique stressors in the work- place context as a result of their sexual minority identity. For instance, sexual minority MHPs may feel compelled to conceal their identity in heteronormative workplace environments. Sexual minority stigma could also contribute some effect on burnout, placing a sexual minority MHP at risk for considerable stress. Clinical supervisors would be well advised to discuss and process how their supervisee’s sexual orientation may contribute to nega- tive workplace experiences and how these could further contribute to burnout. The supervisee may feel forced to conceal or to develop identity management strategies as a result of heterosexist expectations. As a result, the supervisor has an ethical responsi-

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bility to ensure that the supervisee is taking steps to manage these symptoms and help mitigate burnout.

Clinical supervisors should also note the importance of work- place support and its relation to burnout. Consistent with Oser and colleagues (2013), supervisor and colleague support helps prevent symptoms of burnout. This is particularly salient with regard to sexual minority individuals, as they may feel unsafe disclosing their sexual identity and thus feel disconnected or discriminated against within the workplace. Clinical supervisors could assist the supervisee in identifying a potential workplace ally or colleague within the field to provide some degree of workplace support. Hebl, Tonidandel, and Ruggs (2012) noted that identification of a gay or lesbian mentor can be especially influential, as sexual- minority-identified mentors were associated with increased job satisfaction in their study.

Practitioner educators (e.g., psychologists, counselor educators, social workers) should take steps to raise awareness of heterosex- ism and its adverse effects on sexual minority MHPs. MHPs-in- training can be taught ways to reduce workplace heterosexism, such as using affirming language, and creating caring, supportive relationships with sexual minority and ally coworkers. As allies, heterosexual MHPs can advocate with and on behalf of sexual minority colleagues for positive and affirming workplace climates. This additional support may reduce the pressure for sexual minor- ity MHPs to conceal aspects of their identities, further decreasing symptoms of burnout. Additionally, MHPs-in-training may even- tually become future supervisors and may have significant influ- ence on workplace structures and environments.

Limitations and Future Directions

There are several limitations to consider. One limitation is the diversity of the sample. Over 85% of the participants reported their racial/ethnic identity as White/European American. Similarly, al- though this study focuses on burnout within sexual minority pop- ulations, approximately 3% of participants identified as transgen- der, and approximately 6% identified as queer. Because this is the case, we have not captured representative experiences from gender and queer minority groups within the sexual-minority-identity spectrum, and therefore the results cannot be generalized to those groups. Another limitation is that participants opted into the study and so the sample may not reflect the full range of experiences of burnout in sexual minority MHPs. The sample may include a higher number of individuals who were interested in participating in the study because they did encounter more negative experiences with burnout.

Despite having an adequate sample size to analyze our data, our sample was still small. Future studies should recruit larger samples in order to analyze other potential factors that could influence burnout among MHPs. For instance, because there were few participants who identified as transgender or queer, future studies should examine differences between how transgender and gender nonconforming (TGNC) and queer MHPs experience burnout dif- ferently than sexual minority MHPs. Specifically, studies could explore how concealment might be different for TGNC and queer MHPs. One would assume that TGNC and queer individuals may experience a higher level of stigma about their identities than sexual minority individuals, and so therefore might feel a greater need to conceal their identities in the workplace. Similarly, exam-

ining how TGNC and queer MHPs access social support in the workplace may further contribute to our understanding of what type of social support decreases burnout for these populations.

Future studies should also explore the intersectionality of mul- tiple marginalized identities and how this affects experiences of burnout (i.e., racial/ethnic identity, sexual minority identity). As individuals who experience multiple layers of marginalization, it is important to explore how individuals navigate these identities in the workplace. Sexual minority and TGNC MHPs of color may experience both heterosexism and racism in the workplace, com- pounding the stress that can lead to burnout. Moreover, similar to Craig and Sprang (2010), future studies should consider examining the effects of self-efficacy as a correlate to burnout with this population. As a result, sexual minority MHPs of color may feel an increased pressure to conceal aspects of their identities, and feel less equipped to meet the demands of their work. On the other hand, perhaps sexual minority MHPs of color have unique ways of accessing social supports that may bolster resiliency and decrease symptoms of burnout.

Conclusion

This study extends the examination of demographic and con- textual variables that contribute to burnout among sexual minority MHPs. There are unique correlates and predictors that account for burnout among sexual minority identified MHPs, including con- cealment, workplace heterosexism, and social supports. Clinical supervisors and MHP educators are encouraged to consider the importance of sexual identity within the workplace and how this affects workplace experiences for their sexual minority supervis- ees and trainees in the mental health field.

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Received February 9, 2017 Revision received June 8, 2017

Accepted June 10, 2017 �

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361BURNOUT AMONG SEXUAL MINORITY MHPS

 

  • Burnout Among Sexual Minority Mental Health Practitioners: Investigating Correlates and Predictors
    • The Present Study
    • Method
      • Data
      • Participants
      • Measures
        • Personal and professional demographic form
        • Perception of reasonable workload
        • Burnout
        • Workplace heterosexist experiences
        • Concealment
        • Workplace support
      • Procedures
    • Results
    • Discussion
      • Implications
      • Limitations and Future Directions
    • Conclusion
    • References

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