A mixed methods approach to investigating self-care, attachment awareness, and burnout in marriage and family therapists



Journal Title

Journal ISSN

Volume Title



The purpose of this convergent mixed methods study was to investigate and expand our knowledge of the experience of burnout among marriage and family therapists in terms of attachment experiences, self-care, and clinical practice during the first year of a global health crisis. This study is significant as the voices of marriage and family therapists are underrepresented in the mental health literature concerning burnout and work-life balance. A major goal of this study was to bring increased awareness of the experience of burnout to the mental health field. This study was funded by the Hogg Foundation for Mental Health with grant money from the Frances Fowler Wallace Memorial Award. Participants were predominantly fully licensed LMFTs (n = 67) and licensed LMFT associates (n = 27). The quantitative analyses compared participant burnout scores on the three subscales of the Maslach Burnout Inventory – Human Services Survey (MBI-HSS) and participant global adult attachment scores on the Experiences in Close Relationships-Relationship Structures (ECR-RS). Multiple linear regression analyses revealed that therapists with an avoidant attachment style scored higher on the emotional exhaustion and depersonalization subscales, and lower on the personal accomplishment subscale of burnout when compared to therapists with an anxious attachment style. Other variables included therapists’ awareness of their own attachment style, frequency of self-care practices, average number of clients per week, and population of clients. A correlation analysis found the strongest significant association between therapists’ frequency of self-care practices and all three subscales of burnout. Responses to the four qualitative open-ended questions explored participant experiences with personal and work-related challenges during COVID-19, self-care practices, and attachment knowledge and its impact on clinical work. A total of 32 participants (16 males and 16 females) shared data that were coded into themes such as Diminished emotional functioning, Disengaged and detached, Professional discontent, and Work-life imbalance. These themes call attention to the challenges MFTs face as they juggle managing their personal and professional lives during an ongoing global pandemic. Strategies and interventions can be developed to support therapists’ ability to cope with the experience of burnout, maintain overall wellness, and ensure quality therapeutic care in clinical practice.



Burnout, Self-care, Attachment theory, Attachment style, Marriage and family therapist, Work-life balance