This study assessed how therapist liking moderates observer ratings of a clinician with mild burnout. Participants viewed segments of three videotaped therapy sessions depicting a therapist with fatigue and inattention, then rated the therapist on several dimensions. Those indicating liking for the therapist yielded significantly higher ratings on other variables, regardless of the presence or absence of burnout. Burned out or not, observers are unlikely to alter their impressions of a therapist they like.

Psychotherapist burnout is often accompanied by symptoms such as fatigue, inattention, and irritability. Such overt behavior may be detected by co-workers and clients (Kilburg, Kaslow & VandenBos, 1988). However, no research to date has explored the effect of moderate psychotherapist burnout on clients and other observers. This neglect of a third-party perspective is somewhat surprising, as previous studies have demonstrated that therapist behaviors influence clients’ judgements about the therapeutic process (Horvath & Luborsky, 1993). In particular, clients and observers have emphasized their liking of the therapist when evaluating the quality of the alliance (Coady & Marziali, 1994), their degree of satisfaction with treatment (Bent, Putnam, Kiesler & Nowicki, 1976; Conte, Buckley, Picard & Karusu, 1994). No studies have utilized liking as a variable when measuring therapist burnout, and only one study has directly assessed how severe therapist burnout affects third-party observers (Renjilian, Baum, and Landry, 1998).

The current study attempted to understand how more moderate levels of therapist stress (i.e., "mild burnout") influenced observer perceptions over the course of several psychotherapy sessions. It was predicted that participants exposed to a therapist with mild burnout (via video-taped vignettes) would give significantly lower ratings on several dimensions compared with those subjects who observed the same therapist without burnout. It was also predicted that those participants who observed therapist burnout earlier in therapy (i.e., the second vs. the third session) would yield lower ratings of the therapist overall. An additional hypothesis was that observers who expressed a high level of liking for the therapist would produce significantly higher ratings of the therapist on other dimensions.

Participants

A total of 94 participants (77 female, 17 male) were solicited from undergraduate classes at Marywood University. The age of subjects ranged from 18 to 27 (M = 19.57, SD = 2.02). Participants were enrolled in 33 different fields of study.

Procedure

Small groups of participants viewed a twenty-minute video depicting a series of three psychotherapy sessions during which the therapist displayed mild symptoms of burnout (e.g., fatigue, clock watching, brief inattention) in the second session only, the third session only, or in none of the sessions. Participants rated their impressions of the psychotherapist using a seven-point Likert scale (one = low anchor, seven = high anchor) on the following dimensions: Liking, attentiveness, empathy toward the client, comfort in seeing the therapist or referring a family member to him, and their recommendation that the client continue to work with the therapist. Participants also recorded demographic information such as age, sex, major, year of study and number of psychology courses they had taken.

A median split was performed on the ratings of therapist liking to separate participants who provided high versus low scores on this variable (Mdn = 4.60). A 2 (high versus low liking) X 3 (burnout absent in all sessions, burnout present in session two only, burnout present in session three only) factorial design was utilized to explore main effects and interactions between conditions. An Analysis of Variance (ANOVA) was performed on the total score (minus ratings of liking) of the Psychotherapy Questionnaire. Results of this ANOVA yielded a significant main effect for level of therapist liking (F (1, 88) = 60.71, p < .05), indicating that subjects who offered high ratings of therapist liking produced significantly higher overall ratings on the instrument (M=23.50, SD = 2.35) than those who offered low ratings of therapist liking (M = 7.63, SD = 4.46). There were no other significant main effects or interactions.

To explore the main effect for level of therapist liking on the total score on the Psychotherapy Questionnaire, unpaired t-tests were performed on the mean ratings of individual items. Significant differences were found for ratings on each of these items. Participants whose ratings of therapist liking fell above the median perceived the therapist as significantly more attentive (t (92) = 5.12, p < .05), more empathetic (t (92) = 6.36, p < .05), more suitable as a target for referral (t (92) = 9.34, p < .05), and recommended more highly that the client continue with the therapist (t (92) = 4.98, p < .05) than those who had low scores on therapist liking. Table 1 shows means and standard deviations on the Psychotherapy Questionnaire items by median-split.

The hypothesis that observers would evaluate a therapist with mild burnout more negatively than a clinician without burnout was not supported. The prediction that the presence of episodic therapist burnout in early versus later sessions of therapy would produce lower observer ratings was also not upheld. However, the hypothesis that level of liking for the therapist would lead to more positive impressions of him overall, regardless of burnout, was supported.

The results of the current study confirm that "nonspecific factors" play a significant role in the judgements third parties make of therapists. Liking proved to be related to the development of positive impressions on other dimensions, even in the presence of mild burnout. This may be due to the anchoring and adjustment heuristic (Tversky & Kahneman, 1974), which asserts that once raters have formed an impression, they will tend to anchor later judgements to this initial judgement. The findings suggest that liking is responsible for the development of other positive impressions of the therapist, rather than the presence or absence of therapist burnout.

Bent, R. J., Putnam, D. G., Kiesler, D. J., & Nowicki, S. (1976). Correlates of successful and unsuccessful psychotherapy. Journal of Consulting and Clinical Psychology, 44, 1, 149.

Coady, N. F., and Marziali, E. (1994). The association between global and specific measures of the therapeutic relationship. Psychotherapy, 31, 1, 17-26.

Conte, H. R., Buckley, P., Picard, S. & Karusu, T. B. (1994). Relations between satisfaction with therapists and psychotherapy outcome. Journal of Psychotherapy: Practice and Research, 3, 215-221.

Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61, 561-573.

Kilburg, R. R., Kaslow, F. W. & VandenBos, G. R. (1988). Professionals in distress. Hospital and Community Psychiatry, 39, 723-725.

Renjilian, D. A., Baum., R. E., & Landry, S. L. (1998). Psychotherapist burnout: Can college students see the signs? Journal of College Student Psychotherapy, 13 (1), 39 &emdash; 48.

Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: Heuristics and biases. Science, 185, 1124-1131.

Table 1.

Means and Standard Deviations on Psychotherapy Questionnaire Items By Median-Split (High-Low Liking of Therapist)

	Liking of Therapist
Item	High (N = 46)	Low (N = 48)
"How attentive do you think this therapist was to the client?" M (SD)	6.28 (.69)	5.15 (1.32)
"Was the therapist empathetic toward the client (in-tune with her feelings)?" M (SD)	6.22 (.81)	4.81 (1.12)
"How comfortable would you be seeing this therapist (or referring a friend or family member to him)?" M (SD)	5.17 (.90)	3.04 (1.24)
"Would you recommend that the client continue therapy with this therapist?" M (SD)	5.96 (.79)	4.71 (1.51)