Burnout and Clinical

Supervision in Mental
Health Clinicians

By: Karen Mason

SOWK 693: Research as a Foundation for Leadership

Impacts of Burnout
Individuals experience depression, a sense of failure,
fatigue, and loss of motivation resulting in
organizations experiencing absenteeism, turnover
rates, and lowered productivity (van Dierendonck,
Schaufeli, & Buunk, 1998, p. 392).

Turnover rates can compromise continuity of care and

create organizational instability and financial drain
related to the costs of employee separation and
recruiting and training replacements (Paris & Hoge,
2010, p. 520)

Why Research
given the prevalence and consequences of burnout
among mental health workers, there is a great need for
additional, future development and research of burnout
prevention and intervention programs (Morse, et al.,
2012, p. 349).
Webster and Hacket assert that to combat the inevitable
emotional fatigue associated with this kind of work,
clinicians need supervisors who promote positive
relationships among staff and administration, who help
staff focus on client strengths, and who model appropriate
behavior and values to staff (1999, p. 389)

The need for Interventions at

the Organizational level
Research has found that situational and organizational
factors play a bigger role in burnout than individual
ones (Maslach et al., 2001, p. 418).

Burnout Defined
a psychological syndrome in response to chronic
interpersonal stressors on the job.

The three key dimensions of this response are an

overwhelming exhaustion, feelings of cynicism and
detachment from the job, and a sense of
ineffectiveness and lack of accomplishment (Maslach,
Schaufeli, & Leiter, 2001, p. 399).

Three Factors of Burnout

Emotional exhaustion (EE) - being emotionally
overextended and depleted of ones emotional
resources

Depersonalization (DP) - a negative, callous, or

excessively detached response to other people

Reduced Personal Accomplishment - a decline in

feelings of competence and productivity at work
(Maslach & Goldberg, 1998, p. 64).

Maslach Burnout InventoryTool

The MBI has the strongest psychometric properties

and continues to be used most widely by researchers

(Maslach et al., 2001, p. 401) and has become the
almost universally accepted gold standard to assess
burnout (Paris & Hoge, 2010, p. 521).

The Maslach Burnout Inventory (MBI) which contains

three subscales assessing EE, DP, and PA will be
used. The scale has 22 items that are scored on a
frequency of occurrence basis ranging from 0 = never
to 6 = everyday (Hyrks, 2005, p. 536).

Clinical Supervision Defined

systematic action aimed at developing supervisees
professional knowledge and skills, as well as
supporting, clarifying, and strengthening their
professional identity and practice (Hyrks, 2005, p.
532)

Proctor Model of CS the Normative domain (to

address the promotion of standards and clinical audit
issues), the Restorative domain (to develop the
personal wellbeing of the supervisee), and the
Formative domain (development of knowledge and
skills) (White & Winstanley, 2011, p. p. 82).

Manchester Clinical
Supervision Scale - Tool
Internationally validated instrument (White &
Winstanley, 2001, p. 82)

The Manchester Clinical Supervision Scale (MCSS)

operationalizes the three domains of the Proctor model
of CS through 7 factors; Finding Time,
Importance/Value of CS, Supervisory Advice/Support,
Trust/Rapport, Personal Issues, Improved Care and
Skills, and Reflection (White & Winstanley, 2011, p. 82).

Studies Utilizing MBI and

MSCS
The findings of this study demonstrate that efficient CS is
related to lower burnout (Hyrks, 2005, p. 552).

Edwards et al., 2006 higher scores on the MCSS were

associated with lower levels of measured burnout, with
significant negative correlations between the total MCSS
score and the emotional exhaustion subscale (Edwards et
al., 2006, p. 1013).

Both studies were of nurses one in the UK and one in

Finland.

Need to evaluate in Saskatchewan with Mental Health

Clinicians

Research Aim - Question

Does a correlation
exist between EE,
DP, and PA and the
quality of CS
provided

Are self reported rates of

burnout as measured by
the MBI associated with
quality of CS as measured
by the the MCSS, in
mental health clinicians
providing counseling
services in outpatient
settings in
Saskatchewan?

Operationalized Question and

Hypothesis
Questions

Is EE associated with quality of CS

Is DP associated with quality of CS
Is PA associated with quality of CS

Hypotheses

Lower EE will be associated with

higher ratings on the MCSS
Lower DP will be associated with
higher ratings on the MCSS
Lower PA will be associated with
higher ratings on the MCSS

Conceptual Framework
Research
Question

Independent
Variable

Dependent
Variable

Control
Variables

Will rates of
Burnout be
associated with
the quality of CS
provided?

Quality of CS as
measured by the
Manchester
Scale of Clinical
Supervision

EE, DP, PA as
measured by the
Maslach Burnout
Inventory

Age, Gender,
Marital Status,
Level of
Education, Years
of Experience,
Amount of
Supervision
received

Sample
Definition of Mental Health Clinician
Clinical social workers, psychologists, and psychiatrists
employed full time that provide individual mental health
counseling services to at least60% of their client in an
outpatient setting in Saskatchewan.

Population of interest = Sampling Frame

Recruitment
12 Directors of Mental Health Services in each health
region will be contacted and asked to provide an email
list of employees meeting our definition of Mental
Health Clinicians.

Email will be sent with a link to survey to ensure

anonymity of respondents

Response rate to be 80%, and second and third emails

requesting participants respond will be utilized.

Tools
1. A survey will be created to collect data on control
variables of gender, age, education, marital status, years of
experience providing mental health counseling, and number
of times per year CS is received.

2. The Maslach Burnout Inventory (MBI)The scale has 22

items that are scored on a frequency of occurrence basis
ranging from 0 = never to 6 = everyday

3. The Manchester Clinical Supervision Scale (MCSS),The

instrument is a 36 item questionnaire where respondents
score the CS they have received based on a five-point Likert
Scale from 1 = strongly disagree to 5= strongly agree
(Hyrks, 2005, p. 536).

Data Analysis
Statistical Analysis Software (SPSS)

Mean scores of each variable of burnout (EE, DP, PA)

will be compared to mean total scores of MCSS.
Findings will be compared to control variables to
assess their influence.

A second level of analysis will identify correlations

between three levels of burnout and the 7 subscales of
MSCS to determine which factors may account for any
correlation identified.

Benefits of Research
Better understand the relationship of EE, DP, PA and
the role quality of CS plays.

While this study would not prove causation, at a

practice level it would it would support the value of
organizational policies and procedures that seek to
provide quality CS to address burnout.

Were formalized policies and practices implemented,

the negative impacts of burnout may be reduced.
Multiple positive impacts may be realized for individual
clinicians, organizations, clients, and leaders.

Partnership
Will be required with an established research agency.
Guidance of Senior researcher to ensure soundness of
the methodologies used, to ensure workers are within
their level of competence, and to have enough validity to
gain access to the sample is essential.

Assistance with a Funding Plan

Ethical
Program Design must pass the ethics committee of
partnering agency and each health region approached.
Informed consent will be ensured. Employee Family
Assistance Plan providers will be contacted and will provide
support to participants if necessary.

Dissemination
Summary report will be provided to each director of
Mental Health, SK Health, and a link to the report will
be provided to all potential participants. Copies will be
sent to SASW, CASW, Canadian Psychological
Association and SK Psych association. The partner
agencies pathways for dissemination, including
submitting for publication, speaking engagements, and
posts on web sites will be utilized.

Conclusion
Reducing burnout is not only a matter of personal
health and welfare, but it is an ethical obligation to
maintain the provision of service to the highest
standard possible (Everall & Paulson, 2004, p. 31).
Although mechanisms for providing workplace support
and training to staff may be considered expensive in
todays climate, management needs to assess the costeffectiveness of such tools as workplace support clearly
shows that it reduces job stress (Acker, 2011, P. 487).

References
Acker, G. M. (2011). Burnout among mental health care providers.
Journal of Social Work, 12(5), 475-490.
Edwards, D., Burnard, P., Hannigan, B., Cooper, L., Adams, J., Juggessur, T.,
Fothergil, A., Coyle, D. (2006). Clinical supervision
and burnout: The
influence of clinical supervision for community mental health nurses. Journal
of Clinical Nursing, 15,
1007-1015.
Everall, R. D., & Paulson, B. L. (2004). Burnout and secondary traumatic
stress: Impact on ethical behaviour. Canadian Journal
of
Counselling, 38(1), 25-35.
Hyrks, K. (2005). Clinical supervision, burnout, and job satisfaction
among mental health and psychiatric nurses in Finland. Issues in
Mental Health Nursing, 26(5), 531-556.

Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual
Review of Psychology, 52, 397-422.
Maslach, C., & Goldberg, J. (1998). Prevention of burnout: new
perspectives. Applied and Preventive Psychology, 7(1), 63-74.
van Dierendonck, D., Schaufeli, W. B., & Buunk, B. P. (1998). The
evaluation of an individual burnout intervention program: the role
of inequity and social support. Journal of Applied
Psychology, 83(3),
392-407.
Webster, L., & Hackett, R. K. (1999). Burnout and leadership in
community mental health systems. Administration and Policy in
Mental Health, 26(6), 387-399.
White, E., & Winstanley, J. (2011). Clinical supervision for mental health
professionals: the evidence base. Social Work & Social Sciences
Review, 14(3), 77-94.
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For Your Time and Attention