Compassion satisfaction, compassion fatigue, burnout, and self-care among South African clinical and counselling psychologists : a cross-sectional mixed methods study

Abstract

Psychologists are a scarce resource in South Africa, making a high rate of retention to the profession vital. In addition, psychologists carry the ethical responsibility to provide a high standard of mental health care to their clients, some of whom may be traumatised as a result of the high local crime rates. Exposure to client trauma, distress, and suffering may impact psychologists’ own wellbeing and their functioning as therapists. The concept of professional quality of life contrasts the positive (compassion satisfaction) and negative (compassion fatigue and burnout) outcomes experienced from doing therapeutic work. Self-care may play a role in mitigating the negative and enhancing the positive outcomes. This study aimed to compare levels of compassion satisfaction, compassion fatigue, burnout, and self-care among South African clinical and counselling psychologists with varying years of experience. Furthermore, it aimed to investigate relationships among these variables and to attain a better understanding of the interrelations through qualitative data. This sequential explanatory mixed methods study assessed compassion satisfaction, compassion fatigue, burnout, and the frequency of applying self-care practices among clinical and counselling psychologists who practice in South Africa. The instruments used in the quantitative assessment were the ProQOL-21, the Copenhagen Burnout Inventory, and the Self-care Assessment for Psychologists. Relationships between the assessed constructs and biographical aspects were explored and compared for early, mid and late career groups. Compassion satisfaction was negatively associated with compassion fatigue and burnout (p < .01). Significant inverse relationships were found between self-care and the negative outcomes, while compassion satisfaction was positively correlated with self-care (p < .01). MANOVA results indicated that significant differences exist between the late and early career group in terms of compassion fatigue, compassion satisfaction, and burnout (p < .05). Significant differences were also evident between the mid and late career groups for compassion fatigue, personal burnout and work-related burnout (p < .05). Results from standard multiple regression analyses indicated that overall burnout, personal, work-related, and client-related burnout can significantly predict compassion fatigue. The subsequent qualitative phase explored the experiences of two psychologists from each career stage to enhance the interpretation of the quantitative data. The three themes identified by using thematic analysis were challenges of being a psychologist, rewards of being a psychologist, and self-care facets. Participants explained facing both regulatory issues and occupational challenges such as seasonal fluctuations and administrative tasks. Other challenges related to their clients and the experience of the negative effects from their work. The rewards of being a psychologist was found to flow from therapy outcomes and their attitude towards the profession. Participants reported applying self-care within time constraints both proactively and reactively. Details of work-related self-care and personal self-care depended on individual preferences. The professional quality of life of South African psychologists was found to be significantly influenced by a complex interaction of career stage, self-care, challenges, and rewards. Training programmes for psychologists should include awareness of the work-related and client-related challenges, recognising the experience of the negative effects, implementing self-care practices, and introductory trauma therapy training. Psychologists should also be motivated to maintain career-long self-care and support from colleagues to enable them to provide ethical care to their clients.