Journal of Research and Applications in Clinical Psychology 2000, vol. Ill (i&ii), 19-27

QUALITY OF LIFE OF PSYCHOTHERAPISTS AND OTHER PROFESSIONALS Deepa Elizabeth Thomas and Immanuel Thomas Department of Psychology, University of Kerala, Thiruvananthapuram, Kerala

7778 study focuses on the differences in the quality of life of professionals belonging to various occupations. In line with WHOQOL, quality of life was measured in terms of six domains, viz., physical, psychological, level of independence, social relationships, environment, belief, and overall quality of life. There was also a total score of quality of life. The sample consisted of 30 psychotherapists, 32 doctors, 30 engineers, 30 teachers drawn from 3 districts in Kerala, viz., Thiruvananthapuram, Kottayam and Ernakulam. Differences in quality of life attributable to covariates such as age, income and personality have been controlled using an ANCOVA design. The relationship of quality of life and other variables like sex, marital status, and life goals is also investigated in the study. The results showed that there exist no significant differences among the professional groups in quality of life. A significant correlation was seen between maladjustment and all the domains of quality of life. Age was also found to be significantly related to a few of the domains. The relationship of other variables like sex, marital status, income, and spiritualism was not found to be significant. The services rendered by psychotherapists are utilized by a greater proportion of people in recent years. This has been attributed to the high amount of stress associated with the fast pace of modern living. All psychotherapeutic work involves the psychotherapist in intimate, emotional and mental contact with other human beings. A psychotherapist is said to be a waste paper basket into which the mental agonies of his clients are dumped. Hence, psychotherapy can be rightly described as a stressful profession. Chessick (1978) and Fine (1980) have noted that listening to problems of others' takes its toll on the very wills and souls of therapists, leading to increased depression'. On the other hand, it may also be pointed out that occupational demands and challenges leading to the development of high stress is present in all professions, though in varying degrees. The toll it takes on the psychological well-being of the professional may depend on the personality characteristics of the particular individual. Several studies have been conducted to view the effects of stress on different professionals. In a study by Wagner et al. (1998), failure to cope with stress in

professional firefighters was indicated by high prevalence of post-traumatic stress disorder and other psychiatric impairments. To Wasoski (1995) and Logan et al. (1997), dentistry is a profession subject to a wide range of stressors, which can lead to professional burnout and occupational dissatisfaction. There has been extensive work on the effects of stress on health workers (Firth, 1986; Margison, 1987), and other professionals. However, no work has been published on the actual morbidity and mortality of stress on psychotherapists, may be because psychotherapy does not exist as a separate occupational category. The present study is conceived in this context. The study intends to make a comparison of the quality of life of psychotherapists and three other professionals, viz., doctors, engineers and teachers. While making this comparison, the study also intends to identify the effects of personality variables on quality of life and to control for such effects in the analysis of professional differences. The personality variables considered as relevant in this context are spiritualism and general maladjustment.

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It may be noted that quality of life is defined as individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns (WHOQOL Group, 1993b). According to Liu (1974), quality of life is the 'output' of the inputs of the physical and spiritual'. To Cella and Cherin (1987), quality of life is 'the degree to which a person accomplishes life goals'. Patterson (1975) has identified general health, performance status, general comfort, emotional status and economic status as characteristics important to any evaluation of quality of life. Logan et al. (1997) in their attempt to identify the contributors to dentists' quality of life and job satisfaction, observed that income, professional time and personal time were the combination of variables that best predicted their quality of life. Spiritualism and religiosity are considered to have a positive effect on the psychological well-being and emotional stability in an individual (Jung, 1938; Allport, 1956; Frankl, 1965). This may be expected to enhance the adjustment and overall quality of life. Frankl (1980), in his work, 'Man's Search for Meaning', has emphasized the role religion plays in mental health. Also, Enter (1977) noticed a significant relationship between religious orientation and five of the mental health variables, viz., trust, empathy, emotional stability, lack of anxiety, and self-concept. At the same time, it is also possible that an individual may seek a defensive escape from insecurity or fear through religion and spiritualism. Thus, is considered worthwhile to explore the interrelationships among all the above study variables. Objectives The present investigation is taken up with the following objectives: i. Assess the quality of life of a sample of professionals belonging to different occupations, viz.,

Quality of Life of Psychotherapists

psychotherapists, doctors, engineers and teachers. ii. Make a comparative analysis of the quality of life in terms of profession, sex and marital status. iii. Investigate the relationship between quality of life and variables like age, income, maladjustment, and spiritualism. iv. Determine whether there are differences among the professional groups in quality of life over and above the differences attributable to the above personality variables. Method The methodology adopted for achieving the above objectives is presented below under suitable titles: Sample The sample for the study consisted of 122 professionals selected from organizations such as mental health and de-addiction centers, hospitals, schools, colleges and industrial concerns spread over three districts in Kerala, viz., Thiruvananthapuram, Kottayam and Ernakulam. The sample covered four professional groups viz., psychotherapists (N=30), doctors (N=32), engineers (N=30) and teachers (N=30). The group designated as psychotherapists consisted of clinical psychologists, counselling psychologists, psychiatrists, psychiatric social workers, community mental health workers and alcoholor-drug abuse counselors. The medical professionals included both the physicians and the dentists. The sample included married as well as single subjects of both sexes belonging to the three religions, viz., Hinduism, Christianity and Islam. The monthly income of the subjects ranged from below Rs. 6000 to above Rs. 12,000, while the age of the subjects ranged from 22 yrs to 69 yrs.

21

Deepa Elizabeth Thomas and Immanuel Thomas

Tools 1. The QOL The QOL (Quality of life) scale developed by Thomas and Thomas, (1999) is an adapted version of WHOQOL-100 developed by the World Health Organization. The adapted scale has 36 items. In addition to the total score on quality of life, the questionnaire gives sub scores on six different dimensions of quality of life, viz., physical, psychological, level of independence, social relationships, environment, and personal beliefs/spirituality/ religion. The split-half reliability of the scale, after correction using the Spearman-Brown prophecy formula is 0.86 (N=122).The Cronbach's Alpha for the questionnaire is 0.90 (N=122). Intercorrelations among the six domains revealed that the coefficients ranged from 0.26 to 0.62. These values are high and significant indicating that the domain scores have rather high internal consistency. The scale has high levels of content validity and face validity. The fact that the scale is an adaptation of the widely used WHOQOL-100 popularized by the WHO lends support for the claim of validity for the scale. 2. The GMQ The GMQ (General Ma ladjustment

Questionnaire) gives an index of the general maladjustment of an individual (Thomas & Thomas, 1999). The questionnaire consists of 30 items that covers five major aspects of maladjustment, viz., anxiety, depression, mania, inferiority and paranoia. The split-half reliability of the scale after correction for attenuation is 0.89 (N=120). The Cronbach's Alpha is 0.89. Care has been taken to represent all the relevant aspects of the construct. Hence, the questionnaire can be said to possess content validity. 3. M-S. Rating Scale The M-S (Materialism-Spiritualism) Rating Scale is a graphical rating scale, which is used to get a global measure of an individual's materialism-spiritualism orientation (Thomas & Thomas, 1999). The retest reliability for the scale is 0.69 (N=30). The concurrent validity of the M-S Rating Scale has been found out using Mathew Materialism-Spiritualism scale -short form (Mathew, 1973). The Pearson correlation thus obtained is 0.72. 4. Personal Data Schedule A personal data schedule was used to collect information regarding the sociodemographic variables such as age, gender, marital status, religion, education, occupation and on-the-job pay of the respondents.

Table 1 Mean, SD and F ratio of the scores on maladjustment and spiritualism obtained by subjects belonging to the different professions SI. Variables No.

Psychotherapists (N=30) Mean SD

1. General MaladjustMent

35.60

2. Spiritualism

6.60

*p<0.05

**p
Doctors (N=32)

Engineers (N = 3 0 )

Teachers (N=30)

Mean

Mean

Total (N=122)

Mean

SD

5.70

37.63

8.87

42.77

11.57

40.73

8.09

39.16

9.13

6.95**

2.45

7.84

1.80

6.37

2.78

7.18

2.34

7.01

2.40

2.42*

SD

SD

Mean

tvalue SD

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Procedure After finalizing the tools and the sample for the study, a programme for testing was arranged. Appointments were obtained from the subjects for personally meeting them and administering h t e various questionnaires. Necessary rapport was established before administering the tests. Results The data obtained from the sample were subjected to various statistical procedures in pursuit of the objectives formulated for the study. These procedures included one-way analysis of variance, multivariate analysis of variance (covariance procedure), t-test, correlation and multiple correlations. One-way ANOVA was conducted to study the differences among the professional groups in the selected personality variables (Table 1). The results reveal that the professional groups differ significantly in spiritualism and maladjustment. The finding that the professional groups differed significantly from each other in general maladjustment and spiritualism assumes fu rther significance in the light of the finding that these variables are correlated with each other and with the domains of quality of life. This leads to the possibility that differences among the professional groups in the domains of quality of life may be contaminated by differences in the above covariates. This calls for an analysis of covariance procedure to partial out the effects due to the covariates and to isolated the main effects (differences attributable to the professional groups). Accordingly, a multivariate ANCOVA of the quality of life variables with professional groups as the independent variable and maladjustment, spiritualism and age as the covariates was conducted. The results thus obtained are presented in Table 2. The table shows that the main effects (group differences) are not

Quality of Life of Psychotherapists

statistically significant (F=1.251; P>0.05) while the effect due to the covariate maladjustment is significant at 0.01 level (F=9.188). Table 2 Results of MANOVA of the scores on quality of life domains obtained by the different professional groups Effect MAIN EFFECT

Statistics

Value

F

Profession

Pillai's

trace

0.250

1.251

Pillai's Pillai's

trace trace

0.086 0.127

1.266 1.960

Pillai's

trace

0.405

9.188**

COVARIATES Age Spiritualism General Maladjustment **P<0.01

Detailed exploration of the group differences using univariate ANCOVA showed that significant group differences exist in the three variables of quality of life, viz., psychological domain, overall quality of life and mean score on quality of life (vide Table 3). The effect due to the covariate maladjustment was found to be significant in all the variables of quality of life. In order to ascertain whether three exist significant differences due to sex and marital status, t-tests were conducted on the mean values (Table 4). The results show no significant gender differences in any of the variables except for the variable general maladjustment. The mean scores show that women are more maladjusted than men. Again, no significant differences in terms of marital status were noticed, except in the social relationships domain of quality of life, where married subjects were found to score higher than the unmarried subjects. Intercorrelations among the domains of quality of life and variables of personal characteristics (general maladjustment, spiritualism, age, sex, marital status and income) were computed using Pearson r, the details of which are presented in table 5. It may be noted

Deepa Elizabeth Thomas and Immanuel Thomas

23

Table 3

Results of analysis of covariance across professional groups for the different domains of quality of life

SI. Variables

Psycho- Doctors Therapists (N=30) (N=32)

No .

Engineers

Teachers

Total

(N=30)

(N=30)

(N=122)

F for main effects

F

Mean

Mean

Mean

Mean

Mean

F

F

(SD)

(SD)

(SD)

(SD)

(SD)

(Prof)

(Age)

for covariates

F

F

(Spirit) (Maladj)

DOMAINS OF QUALITY OF LIFE 1. Physical 2. Psychological 3. Level of Independence 4. Social relationships 5. Environment 6. Belief 7. Overall Quality of Life 8. Quality of Life (Total) *P<0.05

5.26 (0.66) 5.51 (0.67) 5.83 (0.54) 5.49 (1.12) 5.17 (0.75) 5.92 (0.79) 5.45 (0.86) 196.17 (22.28)

5.04 (0.78) 5.04 (0.93) 5.60 (1.01) 5.48 (0.78) 5.37 (0.94) 5.56 (1.27) 5.44 (0.97) 190.84 (27.53)

5.2 (0.86) 5.23 (0.75) 5.39 (0.90) 5.49 (1.07) 5.32 (0.80) 5.44 (1.27) 5.63 (0.89) 194.4 (28.04)

5.06 (0.91) 5.10 (0.77) 5.61 (0.66) 5.51 (0.81) 5.27 (0.98) 5.83 (1.10) 5.57 (0.99) 191.17 (24.38)

5.14 (0.80) 5.22 (0.80) 5.61

0.56

0.24

1.30

7.79"

3.19*

0.41

3.82*

60.83**

0.42

0.07

0.63

42.64"

0.95

0.79

2.94

15.73**

1.46

0.02

3.98*

18.77"

1.72

2.69

6.73**

24.6**

3.16*

1.46

1.71

29.8**

2.82*

0.00

6.22*

62.17"

(081) 5.49 (0.94) 5.28 (0.87) 5.69 (1.13) 5.52 193.11 (25.48)

**P<0.01

that sex was coded 1 for males and 2 for females, and marital status was coded 1 for married and 2 for single for the purpose of correlational analysis. The results of correlational analysis show that there exist significant negative correlations between general maladjustment and all the domains of quality of life. Age showed significant positive correlations with social relationships (r=0.20; P<0.05), level of independence (r=0.i7; P<0.05 and belief (r=0.29; P<0.01). Income had a positive correlation with overall quality of life (r=0.20; P<0.05). The variable spiritualism showed a significant correlation with the belief domain (r=0.20; P<0.05). A significant correlation (r=-0.26; P<0.01) was also seen between marital status and the social relationships domain. In addition to the bivariate reported above multiple correlational analysis using the stepwise

method of regression was conducted with a view to identify those characteristics of the individual which are the bes t predictors of each of the domains of quality of life. All the variables for which bivariate correlation were computed were considered in the multivariate analysis. The details of the results are presented in the last column in Table 5. The variables retained in the final equation in each case are reported as notes along with the table. It is evident from the table that general maladjustment entered into all the equations for predicting various dimensions of quality of life. In addition, spiritualism was found to be important in predicting the belief and environmental domains, while marital status turned out to be important in predicting social relationships. The other independent variables were not found to contribute significantly to the regression equation.

24

Quality of Life of Psychotherapists

Table 4 Mean, SD and t-value obtained by the subjects on the different variables when classified based on sex and marital status Sex SI. N o.

1. 2.

4. 5. 6. 7. 8. 9.

Marital status t-value

Variables DOMAINS OF QUALITY OF LIFE Physical Psychological Level of Independence Social relationships Environment Belief Overall Quality of Life Quality of Life (Total) General Maladjustment Spiritualism

10 . *P<0.05

Male Mean

SD

5.22 5.33

0.81 0.79

5.65

Female Mean SD

•

t-value Married Mean

Single SD * M e a n SD

5.04 5.06

0.79 0.79

1.22 1.85

5.21 5.23

0.79 0.83

4.95 5.1.9

0.83 0.72

1.54 0.27

0.88

5.55

0.70

0.71

5.66

0.82

5.46

0.75

1.25

5.59 5.27 5.78

0.99 0.85 1.19

5.36 5.30 5.55

0.87 0.89 1.04

1.37 -0.17 1.13

5.64 5.29 5.79

0.96 0.93 1.14

5.08 5.28 5.38

0.77 0.66 1.06

3.28" 0.05 1.85

5.66

1.02

5.32

0.91

1.93

5.60

1.04

5.27

0.77

1.87

196.20

26.51

188.80

23.54

1.62

194.21

25.90

189.87

24.31

0.84

37.54 6.72

9.14 2.66

41.41 7.42

8.71 1.94

-2.38* -1.69

38.41 7.22

9.52 2.29

41.35 6.42

7.57 2.65

-1.75 1.49

**P<0.01

Discussion The results obtained in this study have enabled a better understanding and description of the variables and subgroups involved. The non-significant F obtained in the MANOVA for professional groups indicates that differences in quality of life in general cannot be explained in terms of the professions the subjects engage in. Even though the results obtained do not permit generalization based on the professions, an examination of the pattern of mean scores obtained by the different professional groups on the various dimensions of quality of life may prove useful in bringing out the differences in the specific domains. The results of one-way ANOVA for specific variables (vide Table 3) may be useful in this context. An examination of the mean scores given along with Table 3 indicate that the psychotherapists topped in the physical, psychological, level of independence and belief domains as well as in

the total score on quality of life. Based on this finding, it may be presumed that even though psychotherapy as a profession is very stressful, psychotherapists enjoy a better quality of life when compared to other professionals. It has also been observed that this group is the least maladjusted when compared to the other professionals (vide Table 1). It is possible that their professional experience and better knowledge of the human personality dynamics enable them to overcome the negative impacts of stress. The finding that the engineers obtained the highest mean score on maladjustment calls for an explanation. It may be noted that compared to the other three professions, the engineers are not required to make intimate human relationships and interactions with their clients. Probably this restricts them from getting the beneficial effects of such interaction. In contrast, the other three groups have to interact closely with people from all lifestyles as part of their

Deepa Elizabeth Thomas and Immanuel Thomas

25

Table 5 Correlation and multiple correlation between domains of quality of life and the other study variables

S

Variables N o. 1. Physical

Marital status

Sex

-0.143

2 Psychological

-0.023

3.

5. 6. 7. 8.

Level of Independence Social Relationships Environment Belief Overall Quality of Life Quality of Life (mean)

Spiritualism

Age

Income

-0.111

General Maladjustment -0.27**

Multiple R

-0.12

0.08

0.11

0.271 #

-0.166

-0.58**

-0.12

0.08

0.16

0.581 #

-0.109

-0.062

-0.55**

0.06

0.17*

0.15

0.555#

-0.259** -0.004 -0.161

-0.121 0.016 -0.101

-0.36** -0.36** -0.47**

0.15 0.17 0.20*

0.20* 0.15 0.29**

-0.01 0.19 0.15

0.42$ 0.397 @ 0.505@

-0.146

-0.170

-0.45

0.10

0.23"

0.20*

0.448#

-0.074

-0 144

-0.58**

0.15

0.17

0.17

0.58#

*P<0.05 "P<0.01 # Only general maladjustment retained in the final equation $ General maladjustment and marital status retained in the final equation @ General maladjustment and spiritualism retained in the final equation

profession, and this helps them gain insight into their own professional lives and thus adjust better each day. It has been seen that doctors are more spiritualistic than the other three groups. Daily encounters with human miseries and the knowledge that many a life depends on them may be factors that make them increasingly spiritually oriented. Like the psychotherapists, their scores on maladjustment were also found to be relatively low. However, their performance on the various domains of quality of life was lower compared to the psychotherapists. The differences between these two helping and healing professionals in quality of life is interesting especially in the light of the fact that the doctors typically harbor with them a medical model of the mental health, whereas psychotherapists generally have a social/ psychological model. The present finding calls for further exploration of the differences in the personality of these two professionals. Sex differences noted in the analysis, viz., significantly greater maladjustment in females, may be explained as due to the greater demands

on their skills of adjustment resulting from the multifarious roles they have to play in their daily life. They are required to play the role of a mother, a wife and a career woman, all at the same time. The cultural restrictions placed on the freedom of the woman and the perfection and appropriateness with which she is required to play all these roles are additional sources of stress not found in men. It has also been observed that males have higher mean scores in the various domains of quality of life and total score on quality of life. The present finding is consistent with the result of a study by George (1987) on college students in Kerala where females were found to be more maladjusted than males. Analysis of the differences based on the marital status indicate that married subjects generally tend to score higher in all the domains of quality of life even though differences reach an acceptable level of significance only in the case of social relationships. It is possible that being married improves one's social relationships, as one will be required to interact and adjust within a variety of social situations including

26

those involving not only one's own parental family but also the family of the spouse. Based on the results obtained in the present study, it seems reasonable to conclude that maladjustment is an important determinant of one's quality of life. Results of ANOVA (multivariate as well as univariate) have underlined the fact that maladjustment is a significant covariate when considering the group differences. Further, the negative Pearson r's obtained betw een general maladjustment and all the domains of quality of life point to the obvious truth that a good quality of life or a 'quality life' is that which is free from problems like anxiety, depression, etc., which are selfdefeating. Spiritualism, age and income have also been found to influence the various dimensions of quality of life. On the basis of the correlational analysis, it may be inferred that growing older increases one's level of independence. Also, the personal and spiritual beliefs grow stronger with age. Similarly, the positive correlation between income and total scores on quality of life indicates that a general improvement in quality of life may be expected with improvement in income level. The results of the multiple regression analysis indicate that among the different predictors of quality of life considered in the study (viz., age, sex, marital status, income, spiritualism and maladjustment), general maladjustment is retained as a significant predictor for the various dimensions as well as the total score on quality of life. Summarizing the results obtained in the present study, it may be concluded that one's profession is not a major determinant of one's quality of. life. At the same time, personal characteristics of the individual, especially the level of one's psychological adjustment (freedom from inferiority, anxiety, depression, paranoia, etc.), is the most important factor which determines one's quality of life.

Quality of Life of Psychotherapists

References Allport, G.W. (1956). The Individual and His Religion. New York: McMillan. Anderson, D.A. and Worthen, D. (1997). Exploring a fourth dimension: Spirituality as a resource for the couple therapist. Journal of Marital Family Therapy , Jan; 23(1): 3-12. Cella, D.F. and Cherin, E.A. (1987). Measuring quality of lif e in patients with cancer. In Proceedings of the Fifth National Conference on Human values and Cancer. A Service and Rehabilitation Education Publication. New York: American Cancer Society. Chessick, R.D. (1978). 'The sad soul of the psychiat rist'. Bulletin of the Meninger Clinic, 42:19. Cited in V.P. Varma (Ed). Stress in Psychotherapists. London: Routledge. Entner, P.D. (1977). Religious orientation and mental health. Dissertation Abstracts International, 38(4): 173- 180. F i n e , H . J . ( 1 9 8 0 ) . D e s p a i r and Depletion in the Therapist, Psychotherapy: Theory, Research and Practice, 17: 392-5. Cited in V.P. Varma (Ed.). Stress in Psychotherapists. London: Routledge. Firth, J. (1986). Levels of Stress in Medical Students. British Medical Journal, 292: 1177- 80. Frankl, V.E. (1965). The doctor and the soul (Eng trans.). Cited in R.H. Thouless (1971). An Introduction to the Psychology of Religion (3 ed.). Cambridge: Cambridge University Press. Frankl. V.E. (1980). Man's Search for Meaning: An Introduction to Logo therapy. New York: Simon and Schusters. George A.P. (1987). Relationship of Religiosity to Spiritualism and Adjustment. Unpublished doctoral thesis. University of Kerala. Thiruvananthapuram. Jung, C.G. (1938). Psychology and Religion. London: Yale University Press. Liu, B.C. (1974). Quality of life indicators. A preliminary investigation. Social Indicators Research, 1:187208. Logan, H.L., Muller, P.J., Berst, M.R. and Yeaney, D.W. (1997 ). Contributors to dentists' job satisfaction and quality of life. Journal of American College of Dentistry, Winter, 64(4): 39 - 43. Margison, F.R. (1987). Stress in Psychiatrists. In R.L. Payne and J. Firth-Cozens (Eds.). Stress in Health Professionals. New York: John Wiley. Mathew, V.G. (1973). Manual to Mathew MaterialismSpiritualism Scale. Department of Psychology, University of Kerala. Thiruvananthapuram. Patterson, W. (1975). The quality of survival in response to treatment. Journal of the American Medical Association, 233: 280 -1. Thomas, D.E. and Thomas, I. (1999). The QOL Scale. In D.E. Thomas (1999). Quality of Life of

Deepa Elizabeth Thomas and Immanuel Thomas

Psychotherapists and Other Professionals in relation to Spiritual ism and Adjustment. Unpublished dissertation. Department of Psychology, University of Kerala. Thiruvananthapuram. Wagner, D., Heinrichs, M. and Ehlert, U. (1998). Prevalence of symptoms, of posttraumatic stress disorder in German professional firefight ers. American Journal of Psychiatry, Dec. 155(12): 1727-32. Wasoski, R.L. (1995). Stress, professional burnout and

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dentistry. Journal of Oklahoma Dental Association, Fall. 86(2): 28-30. WHOQOL Group (1993 b). Measuring Quality of Life: The Development of the World health Organisation Quality of Life Instrument (WHOQOL). Geneva: WHO: Cited in A. Bowling (1995). Measuring Disease: A Review of Disease—Specific Quality of Life Measurement Scales. Buckingham: Open University Press.

Requests for reprints may be made to Deepa Elizabeth Thomas, Department of Psychology, University of Kerala, Thiruvananthapuram, Kerala.