Burnout and Empathy in High-Stress Correctional Settings

Psychology, Crime and Law | 2024, Vol. 30, No. 1, p. 86-100

Burnout and Empathy in Mental Health Professionals Working in Correctional settings, Community settings, and with sex offenders

Melanie E. Mivshek; Federal Bureau of Prisons, Butner, NC, USA

Jennifer L. Schriver; Indiana State University, Terre Haute, USA

Previous research has found higher rates of burnout among mental health professionals (MHPs) working in correctional settings and among those treating sex offenders, but it is not clear whether the setting or the client type is associated with greater burnout.Burnout has been linked with decreased empathy among healthcare providers, but this relationship has not been explored in MHPs. The present study explored differences in burnout and empathy among 219 MHPs working in correctional or community settings and among those primarily treating sex offenders versus other types of clients in the United States. Those working in correctional settings had higher levels of burnout than those working in community settings, but no differences in burnout were found for those treating sex offenders versus other types of clients, regardless of setting. No differences in empathy were found across the four groups, but self-reported empathy was inversely associated with levels of burnout. This research suggests that correctional settings may be more likely to result in burnout as compared to working with offender populations more generally. Implications for training professionals who desire to work in correctional settings are discussed. Interventions for preventing and reducing burnout are also discussed.

Burnout; empathy; sexoffender; correctional; mental health professional

“Although providing mental health services is often rewarding and uplifting, it can also result in feelings of stress, compassion fatigue, vicarious traumatization, and burnout. Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment in response to job-related stressors has been widely documented among mental health professionals (MHP). Burnout is particularly common among those working in correctional settings and among MHPs who treat sex offenders. Research suggests that burnout is inversely associated with empathy, such that greater burnout is related to decreased empathy, although most of the research in this area has focused on healthcare providers rather than MHPs. Empathy is a core concept in the delivery of mental health services, and both burnout and empathy are related to quality of mental health care and overall client outcomes. This study sought to examine levels of burnout among MHPs working in correctional and community settings and among MHPs specifically treating sex offenders. Additionally, this study examined the relationship between burnout and empathy in these groups” (p. 86 - 87).

“A total of 2,347 email invitations were sent to randomly selected members of the American Psychological Association, American Psychology and Law Society (AP-LS), and Association for the Treatment of Sexual Abusers (ATSA) with a link to access the online study… Two hundred seventy-five MHPs completed the online study, resulting in a response rate of 11.7%... The sample consisted of primarily Caucasian (90.9%) women (54.8%). The age of participants ranged from 25 to 79 years with a mean of 51.31 years (SD = 12.90)... In terms of work setting, 79.3% worked in community-based settings (e.g. community mental health or independent practice) and 20.7% worked in correctional settings” (p. 89). In addition to demographic questions, participants were asked to complete the Barrett-Lennard relationship inventory and Maslach’s burnout inventory. 

“Our results are consistent with past research that found MHPs working in correctional settings to have higher rates of burnout than those working in community settings, but this study did not support past research that has found higher rates of burnout among those providing sex offender treatment, regardless of setting. Thus, it seems that the correctional setting might be more responsible for elevated levels of burnout rather than working with offenders, per se… MHPs working in correctional settings reported higher levels of burnout across all three indices of the MBI-HSS, including Emotional Exhaustion, Depersonalization, and PersonalAccomplishment. Moreover, over 40% of these professionals scored above the cut-off for high burnout on the Emotional Exhaustion and Depersonalization subscales. Given the negative effects of burnout for individuals, organizations, and clients, this high level of overall burnout among correctional professionals is concerning” (p. 92 - 93).

“Burnout was negatively associated with therapist empathy, such that higher burnout was related to lower empathy. Therapist empathy is a critical part of the therapy process, and the negative relation between burnout and empathy illuminates one of the ways that clients might be harmed by therapists who have high levels of burnout. MHPs who are experiencing burnout might put less effort into therapy, have more trouble building therapeutic relationships with clients, and be at greater risk for ethical misconduct. However, this study was correlational, so it is not clear if burnout precedes a drop in empathy or if lower empathy results in burnout” (p. 94).

“Because individuals who work in correctional settings are at an increased risk for experiencing burnout, additional training and interventions should be developed to target this group of MHPs. With increasing numbers of students interested in working with offender populations and completing training experiences in corrections, it is important that graduate programs provide mentorship to students to better prepare them for the unique challenges of working with offenders and in correctional environments. Having conversations during graduate training about the nature of work in correctional environments can help to shape expectations, normalize experiences, and even dissuade some individuals from pursuing a professional path that might not be a good fit. For example, it would be helpful for students to know that skills in crisis intervention and suicide risk assessment are particularly necessary and valued in correctional settings. Similarly, developing an understanding and appreciation for the collaboration with custody staff that is required in corrections is another point of education and mentorship that would be valuable for students in training. Better preparing students for what to expect in correctional settings might be a method of preventing future burnout.

Our results found that older professionals with more clinical experience reported lower levels of burnout, which might suggest that the risk for burnout is greater in new professionals. Another strategy for preventing burnout that would target new professionals is to develop intentional mentorship programs for new professionals. Such programs could provide new professionals with immediate sources of information and support. Although such programs might be good additions to many mental health agencies, they seem particularly well-suited to organizations that have unique clinical demands, such as corrections, or when working with challenging client populations, such as offenders. No research exists on using mentoring to specifically reduce burnout in MHPs, but studies have found mentoring to increase job satisfaction in community MHPs and to reduce burnout in hospital employees and new correctional officers. Prevention efforts, as compared to burnout reduction interventions, might also better reduce staff turnover and other negative outcomes for MHPs and their clients. 

In terms of interventions to reduce burnout, it is not clear whether interventions that target the MHP directly would be most beneficial or whether targeting organizational factors might produce better results. Research with MHPs that work in correctional settings has not examined the root causes for higher rates of burnout in this population, and such research would be helpful in the development of appropriate interventions. For example, a meta-analysis of research on job stress among correctional officers found that the organizational factors of supervisor and peer support had the largest impact on stress. Thus, it would be logical to design interventions for correctional officers that increase supervisor and peer support. In a meta-analysis of intervention studies to reduce burnout among MHPs, [a study] found that interventions focused on the MHP (e.g. coping strategies, CBT approaches) were more effective at reducing emotional exhaustion as compared to interventions that focused on organizational factors (e.g. job training, clinical supervision). Additionally, the most effective organizational intervention was job training/education. These findings are inconsistent with other research that has found greater perceptions of peer support and opportunities to discuss the personal impact of work reduces psychological distress and vicarious trauma in MHPs who work with sex offenders. Further research that helps to clarify intervention strategies that are effective for MHPs who work in correctional settings is needed” (p. 95 - 96).

“The study of therapist empathy overall requires additional consideration. Much of the current research on therapist empathy utilizes semi-structured interviews of the MHP, the viewing of therapy sessions with ratings of the professional’s empathy, or client ratings of therapist empathy. Measuring empathy through self-report, as done in this study, is less common. The face-valid nature of the empathy questionnaire used in this study might have resulted in inflated ratings since clinicians are taught throughout their training that empathy is crucial for the therapeutic relationship. MHPs may be unwilling to acknowledge problems with empathy or unaware that problems exist in this area. An additional limitation to the measurement of empathy by self-report is that the Barrett–Lennard Relationship Inventory was created for the participant to answer with one client in mind, but in this study participants were asked to think of clients in general. Thinking about one’s level of empathy overall might result ininflations of empathy, as it is likely that participants have high levels of empathy toward at least a proportion of their clients. An additional limitation of this study involves the demographic characteristics of participants. Most participants identified as Caucasian, which limited the diversity within the sample. Of note, the demographics of the current sample are similar to those found in a large survey of health service providers completed by the American Psychological Association (2016). Overall, research on burnout among MHPs has often failed to explore the experience of ethnic minorities. Future research that oversamples members of ethnic minority groups is important to better understand the problem of burnout. Finally, this study had a low response rate which could limit the generalizability offindings. There could be many reasons for the low response rate, including that the rate is artificially deflated because many of the individuals who were asked to participate did not meet criteria for participation (e.g. licensed MHP with at least 1 year of practice experience). However, it could also be that levels of burnout were associated with decisions to participate or not participate in this study” (p. 94 - 95).