Professional burnout in therapists working with LGBTQ+ patients: associations with defenses and reflective functioning

This cross-sectional, questionnaire-based study examined the role of psychological (i.e., defenses and reflective functioning) and contextual variables (i.e., LGBTQ+ identity, clinical experience, and LGBTQ+-specific training) in contributing to professional burnout among 51 Italian psychologists and psychotherapists (mean age 40.12, standard deviation SD=9.86) working with LGBTQ+ patients. Preliminary correlational analyses showed that mature defenses were negatively associated with emotional exhaustion and depersonalization, and positively with personal accomplishment. Conversely, immature defenses correlated positively with emotional exhaustion and depersonalization, and negatively with personal accomplishment. Neurotic defenses were linked specifically to reduced personal accomplishment. Lower certainty about mental states – an indicator of diminished reflective functioning – was also associated with higher burnout. In line with the study’s main hypothesis, regression analyses revealed that lower overall defensive functioning (ODF), reduced certainty about mental states, and fewer years of clinical experience significantly predicted higher burnout levels. These findings underscore the importance of both intrapsychic resources and professional development in protecting therapists from burnout. Adaptive defenses and strong reflective functioning appear particularly protective in LGBTQ+ clinical contexts, where therapists often encounter emotionally complex, identity-related challenges. Therapists who can mentalize effectively and regulate internal responses through mature defenses may be better equipped to sustain therapeutic engagement and mitigate emotional exhaustion. These results suggest that clinical training and supervision should prioritize the enhancement of reflective capacity and adaptive defenses. Supporting these intrapsychic skills may be key to promoting therapist well-being and ensuring affirming, competent care for LGBTQ+ patients.