PrychologicalReports, 1990, 67, 107-112. @ Psychological Reports 1990



Psychiatric Center loris, Delft Summary.-The development of a Dutch adaptation of the Maslach Burnout Inventory is described. Preliminary results on burnout for 98 Dutch psychotherapists indicate that (on the average) young therapists and therapists who are employed in regional mental health services are more prone to burnout.

Feelings of burnout and job stress related to professions with high human contact must have occurred long before the term burnout was introduced by Freudenberger (1974). I n psychoanalytic literature, e.g., much has been written about the "dangers of analysis," referring to the potential psychological distress that analytic work could create for the therapist. Since 1974 the concept of burnout has won more and more popularity and attention, as reflected by the large and still growing body of knowledge (Perlman & Hartman, 1982; Beemsterboer & Baum, 1984). Nowadays, burnout is increasingly being recognized as a serious problem, affecting many people in human services (Zastrow, 1984). Burnout has been defined as a response to chronic emotional stress with three components: emotional and/or physical exhaustion, lowered job productivity and overdepersonalisation (Perlman & Hartman, 1982). The term burnout, in contrast to job stress, has been reserved for the effects of chronic and/or severe stress in those professions with high human contact, e.g., among psychotherapists, physicians, nurses, or teachers. The symptoms of burnout can be classified into three dimensions: physical effects, like physical exhaustion, sleep disturbances, headaches, gastrointestinal disturbances and increased susceptibility to various illnesses; psychological effects, e.g., emotional exhaustion, depression, negative attitudinal changes, apathy, and alcohol-, medication-, and drug-abuse; and behavioral effects in respect to the workplace and the quality of work, e.g., lower work productivity, absenteeism, and an assumed deterioration of patient care (Maslach, 1976; Maslach & Pines, 1977; Maslach & Jackson, 1978; Maslach, 1979; Pines, Aronson, & Kafry, 1981; Jones, 1981; Maslach & Jackson, 1981).

'Address correspondence to Henk M. van der Ploeg, Ph.D., Division of Medical Psychology, University of Leiden, P.O. Box 1251, 2340 BG Oegstgeest, The Netherlands.



The antecedents of burnout seem to be related to the nature of the work, especially the characteristic form of emotional involvement, individual characteristics of the worker, organisational and societal characteristics (Maslach, 1976; Edelwitch & Brodsky, 1980; Freudenberger & Richelson, 1980; Cherniss, 1980; Pines, Aronson, & Kafry, 1981). Sometimes it is impossible to distinguish between burnout as an outcome of job stressors (primarily interpersonal) and the stressors themselves. For example, staff turnover and negative attitudes of employers may mutually affect each other (Streepy, 1981). Burnout can be assessed with self-report techniques, e.g., with the widely used Maslach Burnout Inventory (Maslach & Jackson, 1981, 1986). The inventory has 22 items in three subscales and is scored on a frequency dimension. The Emotional Exhaustion subscale (9 items) deals with the development of increased feelings of emotional exhaustion and fatigue and is considered as the key aspect of the burnout syndrome (Maslach & Jackson, 1981). The Depersonalisation subscale (5 items) deals with the tendency to develop negative, cynical, and dehumanizing attitudes towards clients. The Personal Accomplishment subscale (8 items) measures the tendency to evaluate oneself negatively in relation to one's work. The three subscales are regarded separately and no total burnout score can be computed. In the Netherlands several articles on burnout have been published, but no instrument has been available to measure the construct, so an attempt was made to adapt the Maslach Burnout Inventory into Dutch. First, results with the MBI-Dutch are reported and, based on a study of psychotherapists, findings about its cross-cultural validity are given.

METHOD Dutch translations of the Maslach items were made by eight persons, separately. Permission to translate the test into Dutch was granted for this particular research project by the copyright holder and publisher, Consulting Psychologists Press. Next, based upon agreement among these translations, clinical and psychological relevancy, and the meaning of the scale concepts, the two best translations for each item were chosen by the authors. Two translations of each of the original 22 items were applied to allow the use of statistical techniques, instead of personal preferences, in selecting the final set of 22 Dutch items. Thereafter, the "new" scale of 44 items was mailed to 200 randomly selected psychotherapists. These psychotherapists were all licensed members of a Dutch organization for general psychotherapy. From a total of about 1,200 members (mainly psychiatrists and psychologists), a random sample was drawn. The response categories of the questionnaire were changed from the original seven to a five-point scale (never, rarely, sometimes, usually, and always). This resulted in frequency categories mainly corresponding with usual Dutch frequency measurement scales. Along with



these Dutch Maslach items a demographic questionnaire was administered to investigate the relationship of the scores with antecedents of burnout, like age, sex, years spent in profession, work-setting, number of hours per week, kind of work, etc. Because our interest was mainly in adapting the Maslach inventory into Dutch, based upon the literature, onIy a limited number of indvidual and job-related characteristics were investigated. A covering letter and a stamped and addressed envelope were included. The completed questionnaires could be returned anonymously. In total 108 responses were returned. Of these, 98 could be used for statistical analysis.

The Dutch Version of the Maslach Inventory The main purpose was to develop a Dutch adaptation of the Maslach Burnout Inventory. By statistical computation (item-total correlations and Cronbach alphas) and consideration of the psychological relevance of the items from each item-pair the more satisfactory item was chosen. For one item both translations were unsatisfactory, so this item was deleted from the analyses. The mean item-total correlations for the finally selected item-subscales were, respectively, .65 for the Emotional Exhaustion subscale, .47 for the Depersonalisation subscale, and .43 for the Personal Accomplishment subscale. Cronbach alpha coefficients were .89 for the Emotional Exhaustion subscale, .68 for the Depersonalisation subscale, and .72 for the Personal Accomplishment subscale. The corresponding American alpha coefficients are, respectively, .90, .79, and .71 (Maslach & Jackson, 1986). The means, standard deviations and Pearson intercorrelations of scores on the Dutch-Burnout subscales are given in Table 1. Also, the corresponding American means, standard deviations and intercorrelations for mental health workers are included for comparison. These figures show a similar pattern in both cultures. Emotional Exhaustion is positively correlated with Depersonalisation and is negatively correlated with Personal Accomplishment. Personal Accomplishment is also negative correlated with Depersonalisation. Individuals suffering from burnout, then, may show high Emotional Exhaustion and Depersonalisation, and low Personal Accomplishment. Burnout may be inferred from characteristic scores on all three subscales and also from just one or two deviant subscale scores. Antecedents of Burnout Age was negatively related to burnout. The Pearson correlation coefficients were -.25 ( p < .01) for Emotional Exhaustion, -.32 ( P C .001) for Depersonalisation, and .17 ( p < .05) for Personal Accomplishment. The older the respondents, the fewer burnout symptoms were reported. A comparable



trend was observed for the number of years which the psychotherapists had spent in their jobs. The correlation coefficients were -.31 (p

Burnout among Dutch psychotherapists.

The development of a Dutch adaptation of the Maslach Burnout Inventory is described. Preliminary results on burnout for 98 Dutch psychotherapists indi...
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