“It’s real. It’s a thing:” Mental health counselors’ listening exhaustion during COVID-19

Damla Ricks; Grace Ellen Brannon

doi:10.4081/qrmh.2023.11261

Authors

Damla Ricks Department of Communication, College of Liberal Arts, University of Texas at Arlington, Arlington, TX, United States. https://orcid.org/0009-0007-8903-4782
Grace Ellen Brannon
grace.brannon@uta.edu
Department of Communication, College of Liberal Arts, University of Texas at Arlington, Arlington, TX, United States. https://orcid.org/0000-0003-1116-9015

Mental health counselors regularly use active listening skills to be present with each client; however, active listening may cause burnout due to high emotional labor, inadequate staffing, excessive workload, and many other issues, each of which contributes to career exits. COVID-19 exacerbated all of these factors, and—adding to already stressful conditions—most mental health professionals were forced to conduct therapy sessions via telehealth. For this study, twenty licensed mental health counselors at various stages of their careers were interviewed during the height of the pandemic to understand their experiences with the technology and other factors related to their workload during that time. Thematic qualitative analysis was used to explore effects of active listening—including requisite adjustments made for virtual therapy sessions—on counselors’ emotional exhaustion and burnout levels. Results show how back-to-back, daily therapy sessions increased listening exhaustion levels and that counselors experienced both long-term and short-term listening exhaustion when utilizing telehealth due to lack of nonverbal cues and other related factors pertaining to online delivery. Implications for counselors, social workers, and other mental health professionals are discussed.

Altabef, D., Meier, S., Reynolds, A., Delucia, J., & Friedling L. (2017). Therapist response to a distressed client: Differences in active listening and changes in negative affect. Counseling & Psychotherapy Research, 17(3), 234-239. DOI: https://doi.org/10.1002/capr.12124

America’s Health Insurance Plans. Health insurance providers respond to coronavirus (COVID-19). (2021, February 24). Retrieved March 03, 2021, from https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/

American Psychological Association. (2022). Psychologists struggle to meet demand amid mental health crisis: 2022 COVID-19 practitioner impact survey. Available from: https://www.apa.org/pubs/reports/practitioner/2022-covid-psychologist-workload

American Psychological Association. Telepsychiatry and COVID-19. (n.d.). (Updated 5/1) Retrieved January 28, 2021. Available from: https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/blog/apa-resources-on-telepsychiatry-and-covid-19?utm_source=Internal-Link&utm_medium=COVID-HUB&utm_campaign=Covid-19

Awa, W. L., Plaumann, M., & Walter, U. (2010). Burnout prevention: a review of intervention programs. Client Education and Counseling, 78(2), 184-190. DOI: https://doi.org/10.1016/j.pec.2009.04.008

Bletscher, C. G., & Lee, S. (2021). The impact of active empathetic listening on an introductory communication course. College Teaching, 69(3), 161–168. DOI: https://doi.org/10.1080/87567555.2020.1841079

Bodie, G. D., Vickery, A. J., Cannava, K., & Jones, S. M. (2015). The role of "Active listening" in informal helping conversations: Impact on perceptions of listener helpfulness, sensitivity, and supportiveness and discloser emotional improvement. Western Journal of Communication, 79(2), 151-173. DOI: https://doi.org/10.1080/10570314.2014.943429

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Braun, V., & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. SAGE Publications Inc.

Brown, W., Schmitz, T., Scott, D. M., & Friesner, D. (2017). Is telehealth right for your practice and your patients with asthma?. Journal of patient experience, 4(1), 46–49. DOI: https://doi.org/10.1177/2374373516685952

Campbell, L. O., Jones, J. T., & Lambie, G. W. (2020). Online academic incivility among adult learners. Adult Learning, 31(3), 109–119. DOI: https://doi.org/10.1177/1045159520916489

Charoensukmongkol, P., & Phungsoonthorn, T. (2021). The effectiveness of supervisor support in lessening perceived uncertainties and emotional exhaustion of university employees during the COVID-19 crisis: The constraining role of organizational intransigence. Journal of General Psychology, 148(4), 431–450. DOI: https://doi.org/10.1080/00221309.2020.1795613

Colman, D. E., Echon, R., Lemay, M. S., McDonald, J., Smith, K. R., Spencer, J., & Swift, J. K. (2016). The efficacy of self-care for graduate students in professional psychology: A meta-analysis. Training and Education in Professional Psychology, 10(4), 188–197. DOI: https://doi.org/10.1037/tep0000130

Craig, C., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress & Coping, 23(3), 319-339. DOI: https://doi.org/10.1080/10615800903085818

Crayne, M. P. (2020). The traumatic impact of job loss and job search in the aftermath of COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S180–S182. DOI: https://doi.org/10.1037/tra0000852

Creswell, J. W. (2007). Qualitative inquiry & research design: Choosing among five approaches (2nd ed.). Sage.

Delgadillo, J., Saxon, D., & Barkham, M. (2018). Associations between therapists’ occupational burnout and their clients’ depression and treatment outcomes. Depression & Anxiety (1091-4269), 35(9), 844-850. DOI: https://doi.org/10.1002/da.22766

Emery, S., Wade, T. D., & McLean, S. (2009). Associations among therapist beliefs, personal resources and burnout in clinical psychologists. Behaviour Change, 26(2), 83-96. DOI: https://doi.org/10.1375/bech.26.2.83

Farber, B. A. (1990). Burnout in psychotherapists: Incidence, types, and trends. Psychotherapy in Private Practice, 8(1), 35-44. DOI: https://doi.org/10.1300/J294v08n01_07

Fischer, A., Shapiro, J., Nguyen, T., Meckler, G., Lam, T., Mai, U., Fenning, R., De La Cruz, J. P., & Haq, C. (2022). Views from the trenches: California family physicians’ challenges and resilience factors while providing client care during the initial wave of COVID-19. Qualitative Research in Medicine & Healthcare, 6, 10296. DOI: https://doi.org/10.4081/qrmh.2022.10296

Foley, G. N., & Gentile, J. P. (2010). Nonverbal communication in psychotherapy. Psychiatry 7(6), 38–44.

Gold, J. We need to talk about another pandemic mental health crisis: Therapist burnout. (2021, January 19). Available from: https://www.forbes.com/sites/jessicagold/2021/01/19/we-need-to-talk-about-another-pandemic-mental-health-crisis-therapist-burnout/?sh=536a329b4d18

Hawley, C. E., Genovese, N., Owsiany, M. T., Triantafylidis, L. K., Moo, L. R., Linsky, A. M., Sullivan, J. L., & Paik, J. M. (2020). Rapid integration of home telehealth visits amidst COVID 19: What do older adults need to succeed? Journal of the American Geriatrics Society, 68(11), 2431-2439. DOI: https://doi.org/10.1111/jgs.16845

Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 292, 114523. DOI: https://doi.org/10.1016/j.socscimed.2021.114523

Jeftić, A. (2020). “I was close to them”: Re-experiencing war through trauma-based interviews. Social Epistemology, 34(1), 79-85. DOI: https://doi.org/10.1080/02691728.2019.1681555

Johnson, J., Hall, L. H., Berzins, K., Baker, J., Melling, K., & Thompson, C. (2018). Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. International Journal of Mental Health Nursing, 27, 20-32. DOI: https://doi.org/10.1111/inm.12416

Joshi, G., & Sharma, G. (2020). Burnout: A risk factor amongst mental health professionals during COVID-19. Asian Journal of Psychiatry, 54, 102300. DOI: https://doi.org/10.1016/j.ajp.2020.102300

Kaeding, A., Sougleris, C., Reid, C., Vreeswijk, M. F., Hayes, C., Dorrian, J., & Simpson, S. (2017). Professional burnout, early maladaptive schemas, and physical health in clinical and counselling psychology trainees. Journal of Clinical Psychology, 73(12), 1782–1796. DOI: https://doi.org/10.1002/jclp.22485

Kawamichi, H., Yoshihara, K., Sasaki, A. T., Sugawara, S. K., Tanabe, H. C., Shinohara, R., Sugisawa, Y., Totutake, K., Mochizuki, Y., Name, T., & Sadao, N. (2015). Perceiving active listening activates the reward system and improves the impression of relevant experiences. Society for Neuroscience, 10(1), 16-26. DOI: https://doi.org/10.1080/17470919.2014.954732

Kim, J. J., Brookman-Frazee, L., Gellatlly, R., Stadnick, N., Barnett, M. L., & Lau, A. S. (2018). Predictors of burnout among community therapists in the sustainment phase of a system-driven implementation of multiple evidence-based practices in children’s mental health. Professional Psychology: Research & Practice, 49(2), 132-141. DOI: https://doi.org/10.1037/pro0000182

Lee, M. K., Kim, E., Paik, I. S., Chung, J., & Lee, S. M. (2019). Relationship between environmental factors and burnout of psychotherapists: Meta-analytic approach. Counseling and Psychotherapy Research, 20(1), 164-172. DOI: https://doi.org/10.1002/capr.12245

Levitt, H. M., Bamberg, M., Creswell, J. W., Frost, D. M., Josselson, R., & Suárez-Orozco, C. (2018). Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report. American Psychologist, 73(1), 26-46. DOI: https://doi.org/10.1037/amp0000151

McCormack, H. M., Macintyre, T. E., O'shea, D., Herring, M. P., & Campbell, M. J. (2018). The prevalence and cause(s) of burnout among applied psychologists: A systematic review. Frontiers in Psychology, 9, 1897. DOI: https://doi.org/10.3389/fpsyg.2018.01897

Moring, J. C., Dondanville, K. A., Fina, B. A., Hassija, C., Chard, K., Monson, C., LoSavio, S. T., Wells, S. Y., Morland, L. A., Kaysen, D., Galovski, T. E., & Resick, P. A. (2020). Cognitive processing therapy for posttraumatic stress disorder via telehealth: Practical considerations during the COVID-19 pandemic. Journal of Traumatic Stress, 33(4), 371–379. DOI: https://doi.org/10.1002/jts.22544

Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and Its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341-352. DOI: https://doi.org/10.1007/s10488-011-0352-1

Poletti, B., Tagini, S., Brugnera, A., Parolin, L., Pievani, L., Ferrucci, R., Compare, A., & Silani, V. (2021). Telepsychotherapy: A leaflet for psychotherapists in the age of COVID-19. A review of the evidence. Counselling Psychology Quarterly, 34(3-4), 352-367. DOI: https://doi.org/10.1080/09515070.2020.1769557

Rogers, C. R. (1951). Client-centered therapy. Houghton-Mifflin.

Rokach, A., & Boulazreg, S. (2022). The COVID-19 era: How therapists can diminish burnout symptoms through self-care. Current Psychology 41(8), 5660-5677. DOI: https://doi.org/10.1007/s12144-020-01149-6

Rosenberg, T., & Pace, M. (2007). Burnout among mental health professionals: Special considerations for the marriage and family therapist. Journal of Marital and Family Therapy, 32(1), 87-99. DOI: https://doi.org/10.1111/j.1752-0606.2006.tb01590.x

Sklar, M., Reeder, K., Carandang, K. et al. (2021). An observational study of the impact of COVID-19 and the rapid implementation of telehealth on community mental health center providers. Implement Science Communications, 2(29). DOI: https://doi.org/10.1186/s43058-021-00123-y

Sodeke-Gregson, E. A., Holttum, S., & Billings, J. (2013). Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients. European Journal of Psychotraumatology, 4(1), 21869. DOI: https://doi.org/10.3402/ejpt.v4i0.21869

Spradley, J. (1979). The ethnographic interview. Holt, Rinehart and Winston.

Steel, C., Macdonald, J. Schröder, T., & Mellor-Clark, J. (2015). Exhausted but not cynical: burnout in therapists working within improving access to psychological therapy services. Journal of Mental Health, 24(1), 33-37. DOI: https://doi.org/10.3109/09638237.2014.971145

Summers, R. F., Gorrindo, T., Hwang, S., Aggarwal, R., & Guille, C. (2020). Well-being, burnout, and depression among North American psychiatrists: The state of our profession. The American Journal of Psychiatry, 177(10), 955-964. DOI: https://doi.org/10.1176/appi.ajp.2020.19090901

Thompson-de Benoit, A., & Kramer, U. (2021). Work with emotions in remote psychotherapy in the time of COVID-19: A clinical experience. Counselling Psychology Quarterly, 34(3-4), 368-376. DOI: https://doi.org/10.1080/09515070.2020.1770696

U. S. Department of Health and Human Services (2020). FAQs on telehealth and HIPAA during the COVID-19 nationwide public health emergency. HHS-0945--F-4530. https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf

Vindegaard, N., & Eriksen Benros, M. (2020). COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain, Behavior, and Immunity, 89, 531-542. DOI: https://doi.org/10.1016/j.bbi.2020.05.048

Warlick, C. A., Van Gorp, A., Farmer, N. M., Patterson, T., & Armstrong, A. (2021). Comparing burnout between graduate-level and professional clinicians. Training and Education in Professional Psychology, 15(2), 150–158. DOI: https://doi.org/10.1037/tep0000328

Weger, H., Castle Bell, G., Minei, E. M., & Robinson, M. C. (2014). The relative effectiveness of active listening in initial interactions. International Journal of Listening, 28(1), 13-31. DOI: https://doi.org/10.1080/10904018.2013.813234

Zhou, X., Snoswell, C. L., Harding, L. E., Bambling, M., Edirippulige, S., Bai, X., & Smith, A. C. (2020). The role of telehealth in reducing the mental health burden from COVID-19. Telemedicine and e-Health, 26(4), 377-379. DOI: https://doi.org/10.1089/tmj.2020.0068

Ricks, Damla, and Grace Ellen Brannon. 2023. “‘It’s Real. It’s a thing:’ Mental Health counselors’ Listening Exhaustion During COVID-19”. Qualitative Research in Medicine and Healthcare 7 (2). https://doi.org/10.4081/qrmh.2023.11261.