Adverse Childhood Experiences and Emotional Exhaustion in Therapists: The Mediating Role of Early Maladaptive Schemas

Clin Psychol Psychother. 2025 Jul-Aug;32(4):e70115. doi: 10.1002/cpp.70115.

ABSTRACT

OBJECTIVE: Therapist burnout is prevalent and can negatively impact both therapists and their clients. This study aimed to investigate whether (a) therapists who report more adverse childhood experiences report higher levels of emotional exhaustion and (b) whether this is explained by the extent to which they endorse early maladaptive schemas relating to feeling unlovable or flawed and prioritising achievement and the desires of others over one’s emotions, preferences and needs.

METHOD: A cross-sectional survey was completed by therapists recruited online. Eligible participants were 18 years or older, fluent in English, currently practising as therapists and had been practising for at least 1 year. Hierarchical regression analyses and the PROCESS macro were used to investigate the defectiveness shame, unrelenting standards, self-sacrifice and subjugation schemas as parallel mediators of the relationship between childhood adversity and emotional exhaustion in therapists.

RESULTS: The sample comprised 383 therapists (M_age = 46.0 years, SD_age = 12.79; 89% women). Cumulative adverse childhood experiences scores were positively associated with emotional exhaustion in therapists. The unrelenting standards and subjugation schemas mediated this relationship, whilst the self-sacrifice and defectiveness shame schemas did not.

CONCLUSION: This preliminary research indicates that schemas relating to excessively high personal standards and subjugating one’s emotions and needs to avoid negative consequences may play an important role in the link between childhood adversity and therapist burnout. Future research is necessary to gather longitudinal evidence and examine whether targeting these schemas in self-reflective practice, personal therapy or consultation could reduce emotional exhaustion in therapists.

PMID:40631727 | DOI:10.1002/cpp.70115