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The therapeutic relationship and risk of practitioner burnout in person-centred care

Date: 20-06-2022

Written by Bianca Cashman BHSc (Naturopathy)


Person-centred care

Person-centred care is the cornerstone of complementary healthcare practice, as it aims to foster a deep understanding of the patient and their condition, guiding individualised and lasting change (Santana 2018). Studies show that when patients are given individualised care based upon challenges they are experiencing in their health or life circumstances, the health outcomes greatly improve (Weiner 2013).

The therapeutic relationship

The therapeutic relationship between a patient and practitioner is a critical component of patient-centred care. This relationship reflects an interactive, working alliance between the patient and practitioner, one that is caring, positive and professional (Meert 2013). Developing a therapeutic relationship is fundamental to working well with patients, and involves the patient’s positive emotional connection to the practitioner, and a shared conceptualisation between the patient and practitioner regarding the goals and steps of treatment (Ollendick 1998).

Practitioner burnout

The practitioner’s role in the therapeutic relationship and subsequent focus on person-centred care can increase the risk of practitioner burnout. Without adequate support, the ability of the practitioner to provide person-centred care can be affected, leading to increased emotional exhaustion, depersonalisation and a loss of professional satisfaction.

Some estimates show that the worldwide percentage of practitioner burnout is as high as 76% (Wiederhold 2018). In 2019, the World Health Organisation announced that burnout is now included in the 11th Revision of the International Classification of Disease as an ‘occupational phenomenon’ (WHO 2019), where they identified burnout as feelings of energy depletion or exhaustion, increased mental distance from one’s job or feelings of negativism or cynicism related to one’s job and reduced professional efficacy.

All healthcare practitioners are at risk of burnout, particularly those that focus on person-centred care. While this healthcare framework is seen as an effective approach to patient support, it also requires increased levels of empathy, compassion and emotional investment. This, in conjunction with the pressures of running a business and the tendency to take on too many patients in a short time period, can lead to burnout.

Compassion fatigue and vicarious trauma

There are some commonalities shared between compassion fatigue and burnout. However, compassion fatigue refers more to the prolonged, emotional residue of exposure to patient’s trauma and health concerns. It is the ‘cost of caring’ for others in emotional pain (Figley 1995). The work of helping others requires practitioners to understand and share the feelings of another – unfortunately, this very process of empathy is what can make practitioners vulnerable to compassion fatigue.

The term vicarious trauma was created to describe the profound shift on world view that occurs in practitioners when they work with patients who have experienced trauma (Pearlman 1995). Practitioners can notice that their fundamental beliefs about the world are altered and potentially damaged by repeated exposure to traumatic material. Similar to burnout, this repeated exposure to trauma may impact the practitioner’s ability to care for themselves, and their patients.

An integrative approach to practitioner burnout and compassion fatigue

Fortunately, complementary healthcare practitioners are in a unique position when it comes to reducing the risk of burnout and compassion fatigue. The naturopathic philosophy and tools that are implemented in patient care, can also be applied to oneself. Practitioners can acquire compassionate communication skills and personal resilience tools, such as embodied practices of mindfulness and self-compassion to help prevent burnout and allow them to continue to provide optimal care for their patients.

To learn more on how to build practitioner resilience, particularly in mental health practice, join us at the BioMedica Mental Health Summit.

 

REFERENCES 

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice personā€centred care: A conceptual framework. Health Expectations21(2), 429-440.

Weiner, S. J., Schwartz, A., Sharma, G., Binns-Calvey, A., Ashley, N., Kelly, B., & Harris, I. (2013). Patient-centered decision making and health care outcomes: an observational study. Annals of internal medicine158(8), 573-579.

Meert, K. L., Clark, J., & Eggly, S. (2013). Family-centered care in the pediatric intensive care unit. Pediatric Clinics60(3), 761-772.

Ollendick, T. E. (1998). Comprehensive clinical psychology: Vol. 5: Children & adolescents: Clinical formulation & treatment. Pergamon/Elsevier Science Ltd.

Alexander, A. G., & Ballou, K. A. (2018). Work–life balance, burnout, and the electronic health record. The American Journal of Medicine131(8), 857-858.

Wiederhold, B. K., Cipresso, P., Pizzioli, D., Wiederhold, M., & Riva, G. (2018). Intervention for physician burnout: a systematic review. Open Medicine13(1), 253-263.

World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. https://www.who.int/mental_health/evidence/burn-out/en/. Published May 28, 2019. Accessed July 15, 2019.

Figley, C.R. (Ed). (1995) Compassion Fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W.W. Norton.