THE INDIAN JOURNAL OF SOCIAL WORK Tata Institute of Volume 74,...
THE INDIAN JOURNAL
OF
SOCIAL WORK
Tata Institute
of
Volume 74, Issue 2
Social Sciences
April 2013
Understanding Burnout amongst Counsellors
Working in HIV Testing and Treatment Settings
mary aLPhonSe, meghna jethva, yamini Suvarna, Sunita PaiS, Sony
thomaS, Xyna PraSaD anD raBia ahmeD
Few studies have focused on understanding the issue of burnout and coping strate-
gies used by the counsellors working in the HIV settings. The broad aim of this study
was to focus on factors resulting in burnout among counsellors and to understand how
they deal with such issues. The study was conducted in two phases, where Phase 1
employed the qualitative research approach and Phase 2 involved a quantitative ap-
proach. In Phase 1 of the study, a semi structured interview guide was administered
to 10 key informants and in Phase 2, an interview schedule was administered to 113
counsellors. The findings iterate the need for helping counsellors identify the symptoms
of burnout and recommends mechanisms that the counsellor can implement to deal
with burnout.
Mary Alphonse was the former Principal, College of Social Work, Nirmala Niketan
(CSWNN), Mumbai. Meghana Jethva is Research Officer and Sony Thomas is Zonal
Programme Manager, Saksham, GFATM Round 7, CSWNN, Mumbai. Yamini Suvarna
and Sunita Pais are Research Counsultants; and Xyna Prasad and Rabia Ahmed are
Counsultants with CSWNN, Mumbai.
INTRODUCTION
The interventions in HIV/AIDS have gained a great deal of importance
in the last decade. Although the infection has passed three decades of
existence, there has been no reduction of new infections. The growing
magnitude of cases for HIV testing and treatment has placed a heavy
burden on health care workers working directly with People Living with
HIV and AIDS (PLHA). The NACP-3 State Fact Sheet (March 2012)
states that Maharashtra is the second most affected state in the country,
with an estimated 40,060 people infected with HIV. It also mentions that
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272 Mary Alphonse and others
the number of persons accessing public health systems for HIV testing
and treatment needs has increased to a great extent—due to the relaxation
provided in the costs of the same. The counsellors also report of the
increasing number of clients seeking their services every year. Mumbai
is a commercial centre and continues to draw a large number of migrants,
who are among the users of HIV services. Thus there is tremendous
pressure on the counsellors to address the needs of every client within the
time frame available with the clients. In addition, they have to spend a
considerable amount of time in reporting and documentation. As a result,
the counsellors could be stressed and thus the process of counselling could
be adversely affected.
The overall goal of the National AIDS Control Programme (NACP)
III (2006-2011) is to halt and reverse the epidemic in India over the next
five years by integrating programmes for prevention, care and support and
treatment (MDACS Talks, July 2012). With the widening circle of people
affected by HIV/AIDS, the advancements in HIV/AIDS care and treatment
has also multiplied (Meirleir, 1992). Besides the large number of persons
who come in for testing due to their perceived high risk behaviours, there
are more people living with HIV/AIDS needing lifelong extended care
and psychosocial support (Thejus, Jeeja and Jayakrishnan, 2009). The
National Aids Control Organisation (NACO) module on ‘Identification
and Management of Burn-out in Caregivers and Counselors’ (NACO,
2006) not only recognises the importance of dealing with the stress faced
by counsellors, but also focuses on providing support for the counsellors.
Counsel ors are often required to spend considerable time as they are
intensively involved with people infected and affected by HIV. Their interaction
is centered on the clients’ current psychological, social or physical problems,
which is charged with feelings of anger, embarrassment, fear or despair. It is
possible that the ambiguity and unresolved conditions of the client’s problems
would be emotional y draining for the counsel or and when such a stressful
syndrome remains unaddressed, it may lead to burnout.
Counselling people with HIV and AIDS (PLHA) and their families
(both infected and affected) is an integral aspect of HIV interventions, as
they face a plethora of problems related to health (especially Opportunistic
Infections and Sexually Transmitted Infections), social, interpersonal,
emotional and financial issues of the family (Motihar, 2006). The Global
Fund to fight AIDS, Tuberculosis and Malaria Round 7 (GFATM) through
its Saksham programme provides training to and helps in the capacity
building of HIV counsellors. College of Social Work, Nirmala Niketan
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Understanding Burnout amongst Counsellors Working... 273
(CSWNN) as one of its sub-recipient, handles the ICTC counsellors’
induction and annual refresher training load of counsellors from Mumbai.
This paper aims to examine the different issues related to HIV counselling,
and specifically the issue of burnout, among HIV counsellors in Mumbai.
LITERATURE REVIEW
The literature review showed only few research studies in India that have
explored the issue of burnout among counsellors working with PLHA
in India. Research studies conducted with health care workers show a
positive relation between physical activity and reducing burnout, and this
can be used as one of the strategies to prevent burnout (Meirleir, 1992).
Additionally, there is dearth of research in India focusing on HIV
counsellors’ perspectives, their perception of the issue of burnout and
strategies used by them to deal with and prevent burnout. A review of
literature shows that there is a need for research on the role of hospital
based supervisors in managing burnout as they are supposed to provide
direct support to the counsellors.
In order to fill in some of these gaps, this paper seeks to provide empirical
evidence from the field of HIV/AIDS counselling in Mumbai on the
perception of counsellors regarding the issue of burnout. This paper seeks
to examine some of the key areas which affect the counselling services
such as stress and burnout, coping strategies of the counsellors and their
perception, and their expectations from the hospital based supervisors.
It is envisaged that this research would further strengthen the existing
NACO module, would lead to the development of a more comprehensive
module. The ultimate objective of this analysis is to help strengthen
the counselling component in the field of HIV/AIDS and increase the
efficiency of counsellors as they reach out to PLHA. The Mumbai District
AIDS Control Society (MDACS) has also expressed its need to have data
to strengthen its counselling component.
Understanding Burnout
Freudenberger was the first to use the concept of burnout in 1974 in a
human service setting (Aiken and Solane, 1997). Burnout has been
defined by Gold and Roth (1993) as: “ a syndrome that included symptom
of exhaustion, a pattern of neglecting one’s own needs, being committed
to and dedicated to a cause, working too long and too intensely, feeling
pressures coming from within oneself, being pressured from harried staff
administrators, and from giving too much to needy clients.”
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274 Mary Alphonse and others
Kulkarni (2006), further described ‘Staff Burnout’ as a syndrome of
exhaustion, disil usionment and withdrawal experienced by voluntary
health workers. There is no general accepted definition of burnout, though
most researchers (Dierendonck, Schaufeli and Buunk, 1998; Kulkarni, 2006;
Enzmann and others, 1998) agree that it includes three dimensions: emotional,
exhaustion which focuses on the depletion or draining of emotional resources;
depersonalisation, which centers on negative, cal ous and cynical at itude
toward the recipients of one’s care; and reduced personal accomplishments,
which refers to the tendency to evaluate oneself negatively with regard to one’s
accomplishments at work among individuals who do ‘people work’ of some
kind. It is a response to the chronic emotional strain of dealing extensively with
other human beings, particularly when they are troubled or having problems.
The term ‘burnout’ is usually used to describe the feelings associated
with long-term job-related stress. Burnout refers to a progressive loss
of idealism, energy and purpose experienced by people in the helping
professions as a result of the conditions of their work. These conditions
may include insufficient training, client overload at work, bureaucratic or
political constraints, gap between aspirations and accomplishments, and
so on. Burnout has also been related to work overload; role ambiguity;
role conflict; time and staffing limitations; lack of advancement; poor
work relations; lack of peer support; increased demands by patients and
families; and frequent exposure to hopeless situations, and to death and
dying (Soderfeldt, Soderfeldt and Warg, 1995).
According to Raija (1999), burnout is a three dimensional phenomenon
which includes exhaustion cynicism and lack of self efficacy (see Fig 1).
FIgURE 1: Burnout as a 3-Dimensional Syndrome
Exhaustion
Lack of
Burnout
Self-efficacy
Cynicism
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Understanding Burnout amongst Counsellors Working... 275
Causes of Burnout among Counsellors
In helping professions, there is no single source of burnout. It is a result
of interaction between different factors (Shamasundar, 2008). The reasons
for burnout as detailed in the NACO handout include patient behaviour,
working conditions, emotional depletion, physical and/or psychological
isolation, counsellor–client relationship (leading to counter-transference
and vicarious trauma) and personal disruptions. Other factors that contribute
to burnout include lifestyle and certain personality traits. Burnout causes
can be categorised as follows (Smith, Jaffe-Gill, Segal, and Segal, 2008):
Work-related causes of burnout include lack of control over work; high
job expectations or confusing job expectations; little acknowledgement
or rewards for good work; sudden increase in the knowledge-intensity
of work; excessive demand, monotonous or less challenging job; high
pressure work environment/ chaotic one; and work insecurity/ instability.
Lifestyle causes of burnout are taking on too much work and not
allotting sufficient time for relaxing and socialising; having to live up
to high expectations of other people resulting in doing too much work;
multi-tasking with excessive responsibilities and inadequate help from
others; inadequate rest and sleep; and not having adequate nurturing and
supportive family and social relationships.
Personality traits that contribute to burnout include aiming to be a
perfectionist; viewing the world and self in a pessimistic manner; feeling
a need to do everything on one’s own and be in control; displaying an
unwillingness to delegate work to others; and being a high-achiever.
Despite a huge body of research on burnout and its causes, there is
no consensus on what factors contribute to burnout in human service
workers (Aiken and Solane, 1997). One of the problems is that the number
of variables that have been studied has produced a universe of factors.
Enzmann and others (1998) have listed more than 100 factors which also
cover demographic characteristics of workers such as sex, age, education,
length of time in their current jobs and workers’ personality characteristics
including their expectations, motivations and coping strategies. The
factors studied in relation to burnout have included a large number of
workplace characteristics such as role ambiguity and conflict, workload,
social support, lack of control, lack of reward, lack of community, lack of
fairness and value conflict. A number of researchers attribute workplace
characteristics for development of stress and burnout (Sabo, 2008; Aiken
and Solane, 1997).
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276 Mary Alphonse and others
Burnout may be the result of unrelenting stress, but it is not the same
as too much stress. Stress is a result of too much pressure that demands a
lot of physical and psychological energy of a person. However, stressed
people feel that they will feel better if they manage to control the situation
(Smith and others, 2008). Burnout can be defined as the end result of stress
experienced, but not properly coped with, resulting in exhaustion, irritation,
ineffectiveness, inaction, discounting of self and others and problems of
health (Pestonjee and Pareek, 1997). Burnout results when a person feels
empty, lacks motivation and becomes indifferent to the situation at hand.
People experiencing burnout frequently lose hope of positive change
in their circumstances (Smith and others, 2008). If excessive stress is
like drowning in responsibilities, burnout is being all dried up. Another
difference between stress and burnout is that though usually one is aware
of being under a lot of stress, he/she does not always notice burnout
when it happens. Freudenberger (1974) explains that a characteristic of a
burned-out individual is that they fail to acknowledge their problems and
their own situation (Dierendonck, Schaufeli and Buunk, 1998).
In summation, NACO has classified all the above mentioned signs and
symptoms of burnout into physical, emotional and behavioural indicators
(NACO, 2006).
Physical Indicators
• Frequently feeling drained and exhausted
• Often feeling sick or ill
• Lowered levels of immunity
• Developing headaches, muscle aches and back pain on a regular basis
• Noticing changes in eating or sleeping patterns
Emotional Indicators
• Doubting one’s self and one’s capacity
• Feeling of failure
• A sense of being trapped, helpless and defeated
• A growing sense of being alone in the world and feeling detached from
everything
• Lowered levels of motivation
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Understanding Burnout amongst Counsellors Working... 277
• Developing an increasingly cynical and negative outlook to life and/or
work
• Low levels of satisfaction and
• Feeling a lack of accomplishment with regard to work
Behavioural indicators
• Not wanting to take on new responsibilities and an unwillingness to
complete existing ones
• Alienating self from others
• Resorting to procrastination, requiring more time to accomplish tasks
• Increased dependence on food, alcohol or drugs as a crutch for coping
• Venting frustrations on others
• Irregular attendance at work
RESEARCH METHODOLOGY
Statement of the Problem
With large numbers of PLHA and the increasing circle of people affected
with HIV, counsellors working in many of the testing centres seem to be
over loaded with cases and faced emotional fatigue in addressing problems
of PLHA.
Study Objectives
The objectives of this research were as follows:
i. Develop an understanding of the indicators of burnout as perceived by
the counsellors and experts working in the field of HIV/AIDS.
ii. Study and describe the prevalence and levels of burnout in counsellors
working in the field of HIV/AIDS.
iii. Identify strategies used by the counsellors to cope with burnout.
iv. Understand the role of the hospital based supervisor in helping coun-
sellors deal with burnout.
Research Design
The researchers focused on understanding the issue from the perspectives
of the counsellors in the city of Mumbaiand hence followed an Exploratory
design. Viewed in this perspective, the study explores the issue of burnout
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278 Mary Alphonse and others
among counsellors working in the HIV testing and counselling centres,
namely, ICTC and ART, employing certain tools to obtain both qualitative
and quantitative data. A mixed study enriches evaluation; the open ended
comments provide a way to elaborate and contextualise statistical ‘facts’
(Patton, 2002).
Sampling
This research was a census study as the entire population of counsellors
working in the various centres of MDACS was covered. Initially, the data
was collected from 10 key informants working in HIV testing centres.
These 10 key informants were chosen by the non-probability purposive
sampling method. The key informants were medical officers (n=3),
assistant professors (n=1), the in-charge of the centre (n=1) and senior
counsellors (n=5) having more than three years of experience in the field
of HIV/AIDS. Out of these key informants, six were males and four
were females. The data gathered from key informants provided a base to
formulate the quantitative tool for the second stage of the study. A total of
113 counsellors were covered for the quantitative study. One of the ART
centers with five counsellors was not covered due to difficulty in obtaining
permission. The data was collected from 66 centres including health posts,
maternity homes and major government hospitals located in Mumbai,
which are categorised into six zones with a total of 113 counsellors working
in ICTC and ART. Herein, the ICTC counselling centres were categorised
as ‘maternity homes’, ‘urban health posts’ and ‘hospital based’.
Maternity home centres provide a wide range of services and care
for women during pregnancy and childbirth and for newborn infants.
‘Urban Health Posts’ are those centres located in the communities where
immunisation, DOT services, HIV testing and other facilities are provided.
The rest of the ICTCs were included in the hospital based ICTCs as they
are located in the peripheral or medical colleges. ART centres are those
where Anti Retroviral Treatment is provided to PLHA.
DATA COLLECTION AND ANALYSIS
The data collection was done in two phases:
Phase one included interviewing 10 key informants using the semi
structured interview guide. The interview method was chosen to explore
the respondents’ perceptions and expectations in depth (Boyce and Neale,
2006).
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Understanding Burnout amongst Counsellors Working... 279
Phase two included administering of the interview schedule. It consisted
of closed and open ended questions, focusing on personal profile, work
profile, perception of the counsellors about the concept of burnout,
assessment of their levels of burnout, its causes and its effects, coping
strategies used by counsellors, role of person-in-charge of the centre
(hospital based supervisors) in this issue, suggestions of the counsellors
with regard to help that they would require from the authorities of the
centres to deal with the burnout syndrome among them.
The following inventories were part of the interview schedule.
Maslach Burnout Inventory-Human Services Survey (MBI-
HSS)
To assess the level of burnout, MBI-HSS inventory was used. It is a
standardised inventory to assess the level of burnout. Three versions of
this inventory have been published: the Human Service Survey (HSS),
Educator’s Survey (ES) and General Survey (GS) (Soderfeldt , Soderfeldt
and Warg, 1995). As the respondents for the study were counsellors working
in the field of HIV/AIDS and were continuously dealing with clients and
their related problems, the HSS was considered for use. This contains 22
job related statements which counsellors had to rate on a six point rating
scale, that is, frequency of the feelings. The scoring keys for this inventory
along with its cut off points and related interpretation were obtained with
the inventory from the concerned author. This test assessed the level of
burnout in three aspects—emotional exhaustion, depersonalisation and
personal accomplishment. The reliability coefficients for these three scales
were 0.86, 0.79 and 0.80, respectively (Kim Wan, 1991).
Brief COPE
Carver’s (1997) coping inventory was used to assess the coping strategies
used by the counsellors. This inventory has 14 items: active coping,
planning, self-distraction, denial, substance use, emotional support,
instrumental support, behavioural disengagement, venting, positive
reframing, humor, acceptance, religion, and self-blame.
Most of the qualitative data was collected through electronic recordings
of the interviews with the key informants, and field notes made during the
interactions with them. Two of such interviews were sent to one expert to
check for consistency of the data exploration. The remaining interviews
were carried out after receiving the expert’s approval. Once the recordings
were made into transcripts, the analysis process began. The researchers first
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280 Mary Alphonse and others
practiced open coding of the field notes and later transcribed than to find
the themes. The data was then analysed around six broad themes, namely,
understanding the concept, signs and symptoms, causes, effects, coping
strategies of burnout and supervisory support. No electronic software was
used to analyse this data.
The quantitative data from 113 schedules were keyed into the SPSS for
analysis. It also enabled to identify measures of tendencies, and tested the
significance with correlation and Chi Square tests.
SCOPE AND LIMITATIONS OF THE STUDY
The qualitative data collected by in-depth interviews is limited to the
key informants opinions and experiences. The quantitative study covers
the universe of counsellors employed by MDACS and the findings can
be generalised to the entire population of the counsellors employed by
MDACS in Mumbai.
The nature and quality of the data shared by the counsellors may have
certain limitations as some of the respondents were highly pressed for time
to give interviews. The translation of the technical themes in the tools
from English to Hindi and back again to English might have affected the
quality of data, as respondents’ interpretation of them could have been
different despite the researchers’ explanations. The stipulated period of
study also restricted the possibility of a deeper exploration.
MAJOR FINDINGS
Key Informants Indepth Interviews
The key informants acknowledge that most of the counsellors were
aware of the burnout syndrome and its effects. They felt that most of
the counsellors may not be really conscious of their vulnerability to
the burnout syndrome due to personal and social factors. The common
symptoms of burnout observed were anger, irritation, fatigue, disinterest
and feeling of hopelessness. It was felt that the counsellors experienced
low self esteem, depression, isolation and lived with the constant fear
of contracting diseases. The causes of burnout identified were heavy
workload, lack of adequate and comfortable infrastructure, low salary
and its non availability in time, non recognition of counselling jobs
among the medical fraternity and lack of team spirit. This has resulted
in absenteeism from work, job related stigma, impact on counsellors’
physical and mental health and absence of effective team coordination.
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Understanding Burnout amongst Counsellors Working... 281
Only few counsellors would identify coping techniques such as
meditation, reading, taking a break from work and hobbies. A strong
need was felt for coordination between the MDACS counsellors and
medical team in terms of tasks related to counselling and the work
with individuals and groups. They expressed that the medical team at
the hospitals should also undergo training with MDACS counsellors to
understand their concerns and work processes.
Counsellors Interview
Personal Profile
The profile of the counsellors show that most counsellors (56 percent)
engaged in the counselling job were males, with only a marginal difference
in the mean ages of male (30.7 years) and female counsellors (29.7 years).
Most counsellors (85.8 percent) had a Social Work education background
and hailed from rural areas with permanent residences in rural Maharashtra,
while the female counsellors hailed from urban areas.
Work Conditions
Majority of the counsellors were from hospital based ICTCs and most of
them (62 percent) counselled 11-20 patients every day. About 9 percent
of them counselled—more than 40 clients in a day. The ART centre
counsellors received 50–60 persons every day and they rated the workload
as ‘manageable with great difficulty’. The maternity homes employed more
male counsellors than female counsellors. The average work experience
for the counsellors in the HIV field was three years.
Counsellors in hospital-based ICTCs or ART centres showed higher
level of emotional exhaustion and de-personalisation, though not highly
significant. Nearly 30 percent of the counsellors, mostly male, lacked
adequate interest in the job. The dissatisfaction of salary was very high
among most of the counsellors irrespective of their age and gender.
Overtime work was less common in the centres despite large client load.
Those who did overtime work ‘always’, mostly belonged to hospital based
ICTCs and ART centres. Nearly 55 percent of the counsellors found the
work manageable in spite of higher client loads. The difficulty in managing
the work load was expressed mostly by counsellors from ‘hospital
based’ ICTCs and ART centres. Dissatisfaction with regard to available
infrastructure was expressed mostly by the counsellors from Urban Health
Centres and the hospital based centres.
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282 Mary Alphonse and others
Burnout Syndrome
The term ‘burnout’ was familiar to almost all of the counsellors as they
had learned about the termduring training. On the MBI-HSS scale, most
counsellors scored ‘high burnout’ in emotional exhaustion (61.1 percent) and
de-personalisation (38.9 percent) and majority were at ‘low level of burnout’
in personal accomplishment (89.4 percent). Statistical analysis did not show
any associations of burnout with the ‘age’ or ‘gender’ of the counsellor.
However, emotional exhaustion was noticed more among male counsellors,
while female counsellors suffered more from de-personalisation. Female
counsellors were higher in ‘personal achievement’ than male ones. Also
emotional exhaustion was observed to be more among the counsellors in the
hospital based ICTCs and ART centres. Factors like extent of time given for
hobbies, job interest and salary satisfaction had significant relationship with
‘high burnout’ in emotional exhaustion.
Coping Strategies
The strategies of coping commonly used by the counsellors to reduce their
stress includes ‘active coping’ (75.2 percent), emotional support (57.5
percent), planning (76.1 percent), instrumental support (71.7 percent),
acceptance (66.4 percent), religion (64.6 percent) and positive reframing
(81.4 percent). Male counsellors used ‘planning’ as a strategy more than
female counsellors. Even though very few indulged in substance use,
almost all of them were men (p=0.000, df=1). Use of venting as a technique
was prevalent more among the female counsellors as compared to males
(p=0.031, df=1). Only eight percent of the counsellors felt that ‘humor’ was a
‘very effective’ strategy. Negative strategies like ‘denial’, ‘self blaming’ and
‘behavioural disengagement’ were used by a lesser number of counsellors.
The effective coping strategies that could be considered by counsellors in
future for coping include ‘active coping’ (67.3 percent), self distraction
(85.9 percent), positive reframing (79.6 percent) and religion (73.4 percent).
Support of Centre Based Supervisors
Almost all the counsellors found their centre based seniors who supervised
them to be very helpful and supportive. They expressed that their
supervisors were closer to them and understood their concerns better.
However, they were also helpless at times, as they did not come under the
MDACS administration.
An overwhelming majority (93.8 percent) of the counsellors welcomed
the idea of a ‘counselling mentor’ in the enhancement of their performance,
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Understanding Burnout amongst Counsellors Working... 283
and they expressed the need for increasing the frequency of their visits
from ‘once a month’ to ‘once a week’. The major expectation from these
mentors was to learn micro skills in counselling.
CONCLUSION
This study presents various factors such as the counsellors’ educational
background, age, gender, type of centre and clients handled which
influence the effective functioning of the counsellors. It is important for
the counsellors to identify the symptoms of emotional exhaustion and
not allow them to come in the way of their work. It is found that more
counsellors are getting de-personalised with their clients, which will be
a serious threat in empathising with the clients. The counsellors seem
to be happy with their personal accomplishments, which helps them
move out of burnout. It is thus important for intervening agencies to
also create further platforms that would help acknowledge their personal
accomplishments.
With regard to strategies used by counsellors in coping, there were
a few who used negative strategies like ‘self-blame’, ‘behavioural
disengagement’, ‘denial’, ‘substance use’ and ‘self-distraction’. It is
important to help the counsellors replace these coping strategies with
positive ones such as ‘active coping’, ‘emotional and instrumental support’,
‘venting’, ‘positive reframing’, ‘humour’, ‘planning’ and ‘religion’.
The proactive role of centre based supervisors and counselling mentors
in helping the counsellors need to be considered both by the programme
and at policy levels.
RECOMMENDATIONS
Recommendations for Counsellors
The counsellors who are social work graduates need to further develop
their knowledge and skills related to the psychological needs of the PLHA.
Even though the social work training curriculum does cover the basis
in human behaviour, mental health and therapeutic counselling, these
counsellors also need advanced knowledge on these subjects. Moreover,
the knowledge level of counsellors on these subjects may not be at a
comparable level as they come from different universities and institutions
where there is lack of adequate standardisation and updating of social
work curriculum. The hobby of reading professional literature is not very
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284 Mary Alphonse and others
prevalent among counsellors and has to be inculcated. Special orientation
courses on counselling can also be organised. All this will also help
mitigate ‘de-personalisation’ of the counsellor to some extent.
Since physical activity like sports, gym, nature trails/walks and other
such experiences reduce the chances of burnout, the counsellors are
encouraged to take up such hobbies regularly. The counsellors can take an
active role in organising case conferences along with their peer team, which
can enhance their knowledge and reduce stress levels. Such team activities
can also increase their ‘personal achievement’ through recognition gained
in the hospital settings.
Recommendations on Trainings planned for Counsellors
On the basis of causes of burnout explored in the study, special attention
can be given to refresher trainings, which cover topics related to time
management, team work, skills of negotiation and dialogue with the
administration for a win-win situation, self-healing methods and personal
crisis management. Sessions on increasing the sensitivity of counsellors
towards PLHA can enhance attitudes to empathise with PLHAs and thus,
reduce their ‘emotional exhaustion’ and ‘de-personalisation’. Success
stories and good practices of counsellors in micro skills, workload
management, problem solving approach and team functioning can be
documented and discussed during the trainings. This could help increase
their ‘personal achievement’. More time needs to be allotted during
trainings, especially refreshers, to address burnout syndrome. The training
institutes should provide a comprehensive understanding of burnout.
Aspects related to depersonalisation must be dealt with more intensely so
that the counsellors will develop an attitude of empathy while dealing with
their clients’ problems. Input on functional coping strategies should be
further intensified and their use at the field can be monitored by supportive
supervisors of Saksham.
Recommendations to NACO and SACS1
It has been observed that unhealthy working conditions can reduce burnout
among the employees. The following recommendations are proposed:
1. Formulate or review policies that can bring reasonable changes in the
working conditions of the counsellors such as manageable workload
per counsellor, job stability, career advancement and adequate infra-
structural facilities.
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Understanding Burnout amongst Counsellors Working... 285
2. Offer a competitive salary to attract more skilled counsellors living in
the urban area itself.
3. Design programmes for counsellors and the hospital staff which can
converge with their interests, for example, interactive sessions can en-
hance the team functioning and personal accomplishment levels.
4. Provide more attractive incentives for counsellors such as free medi-
cal check up, travel and medical allowances and leave.
5. Since the counsellors show a high level of interest in personal accom-
plishment, there is a need to identify innovative techniques to help
channelise their potential by allowing them to participate in operation-
al research studies, present papers in conferences, conduct sessions as
trainers, and so on.
ENDNoTE
1. National AIDS Control Organisation (NACO), State AIDS Control
Organisation (SACS)
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