JOURNAL OF SOCIAL ISSUES

VOLUME 34, NUMBER 4, 1978

The Client Role in Staff Burn-Out

Christina Maslach
University of California, Berkeley

The intense involvement with clients required of professional staff

in various human service institutions includes a great deal of emotional
stress, and failure to cope successfully with such stress can result in
the emotional exhaustion syndrome of burn-out, in which staff lose
all feeling and concern for their clients and treat them in detached
or even dehumanized ways. This paper focuses on the role that clients
themselves play in staff burn-out. Important client factors include
the type and severity of the clients' problems, the prognosis of change
or cure, the degree of personal relevance for the staff member of
the clients' problems, the rules governing staff-client interaction, and
the clients' reactions to the staff themselves. Changes in the structure
of the staff-client interaction and changes in client expectations about
staff can alleviate staff burn-out. It should be recognized that clients
can dehumanize staff just as staff can dehumanize them, and that
steps to humanize the staff-client relationship must focus on both
participants in this interaction.

In recent years our society has witnessed a tremendous growth

in the human services industry. More than ever, people are turning
to strangers for care and help with their personal problems rather
than relying exclusively on family and friends. These strangers
are often trained professionals who are qualified to provide a
selected service and who usually do so in the context of a formal
institutional setting. As the range of services and the size of the
clientele have increased, so has the criticism that many of these
services have become impersonal, demeaning, and even dehu-
manizing experiences. Clients complain of being pushed around,
ignored, mistreated, and/or deceived. They often feel ignorant
about what is going on, frustrated and angry at not getting what

This article is based on research supported by Biomedical Sciences

Support Grant 5-S07-RR07006-12.
Correspondence regarding this article may be addressed to C. Maslach,
Department of Psychology, University of California, Berkeley, CA 94720.

Ill
112 CHRISTINA MASLACH

they want, and powerless to effect any positive change in this

situation.
These complaints are often directed at the bureaucratic
structure surrounding the delivery of human services. The various
forms and procedures that are required by the institution, as
well as its policies with regard to service, are perceived by the
clients as the source of the red tape, long lines, and bureaucratic
run-around that they are forced to undergo. However, in many
cases clients see the cause of their problems as the individual
people who staff the institutions, since their experience with
institutions actually translates into their experience dealing with
particular staff people. Clients often accuse staff of being cold,
unfeeling, incompetent, and even cruel. At times, they are more
likely to view staff as adversaries than as aides, and feel that
staff are only putting more stumbling blocks in their path. Or
they may accuse staff people of selling out to an oppressive system
by becoming a part of it. Whatever form these complaints take,
they all serve to identify the professional staff as the source of
the client's difficulties in dealing with the service bureaucracy.
And if bad people are the problem, then the commonly proposed
solution is to get better (i.e., more caring, more humane) people
to staff these institutions.
There is no question that clients have many legitimate reasons
to protest the quality of the treatment they receive. However,
to approach the problem by pointing a damning finger at char-
acter defects in the staff personnel fails to take into account the
effect of the severe emotional stresses that are inherent in their
work. The providers of human services are usually required to
work intensely and intimately with people on a large-scale, con-
tinuous basis. They learn about these people's psychological,
social, and/or physical problems and are expected to provide
aid or treatment of some kind. The staff-client interaction can
be very emotionally stressful for the staff person as well as for
the client, both because of its content—e.g., embarrassing in-
formation about the client, hostility directed at the staff person—
and because of its structure—e.g., regulations requiring the staff
member to ask certain personal questions of the client, or the
staff member not being authorized to give the client what he
or she wants. In order to perform well in such stressful situations,
the staff person may defend against the strong emotions through
techniques of detachment. By establishing some psychological
distance from the client, while still maintaining a concern for
his or her well-being—a process known as "detached concern"
 CLIENTS AND BURN-OUT 113

(Lief & Fox, 1963)—it becomes easier to perform the necessary

interviews, tests, or operations without suffering strong psycholo-
gical discomfort. However, it is rare that staff ever get explicit
guidance and training in such techniques. Because of this lack
of preparation for coping with the chronic emotional stress of
their work, many staff people in human service institutions are
unable to maintain the caring and the commitment that they
initially brought to the job, and then the process of burn-out
begins.
Burn-out involves loss of concern for the people with whom
one is working. It is characterized by an emotional exhaustion
in which the staff person no longer has any positive feelings,
sympathy, or respect for clients. A cynical and dehumanized
perception of clients develops, in which they are labeled in
derogatory ways. As a result of this dehumanizing process, clients
are viewed as somehow deserving of their problems and are often
blamed for their own victimization (Ryan, 1971). Consequently,
there appears to be a deterioration in the quality of care or service
that they receive. The staff person who burns out is unable to
deal successfully with the chronic emotional stress of the job,
and this failure to cope can be manifested in a number of ways,
including low morale, impaired performance, absenteeism, and
high turnover. A common response to burn-out is to get out,
by changing jobs, moving into administrative work, or even leaving
the profession entirely.
Furthermore, burn-out is correlated with various indices of
personal stress. The emotional exhaustion is often accompanied
by physical exhaustion, illness, and psychosomatic symptoms.
People experiencing burn-out sometimes increase their use (and
abuse) of alcohol and drugs as a way of reducing tension and
blotting out strong emotional feelings. They report more mental
illness, saying that they have become "bad people" who are cold
and callous; some of them seek counseling or psychiatric treatment
for what they believe to be their personal failings. If emotional
stress cannot be resolved while on the job, it is often resurrected
at home. People experiencing burn-out often report increased
marital and family conflict. After an emotionally trying day with
clients, the staff member may simply want to get away from all
people for awhile, but this desire for solitude usually comes at
the expense of family and friends.
For the past few years, my colleagues and I have been studying
the social and psychological dimensions of the burn-out syndrome
(Maslach, 1976, 1978, Note 1, in press; Maslach & Jackson, 1978,
114 CHRISTINA MASLACH

Note 2; Maslach & Pines, 1977; Pines & Maslach, 1978). We

have observed and interviewed several hundred helping profes-
sionals of various types, including social workers, physicians,
psychiatrists, clinical psychologists, legal aid attorneys, day-care
staff, police officers, prison personnel, psychiatric nurses, teachers,
counselors, and ministers. The findings of this research, as well
as the observations of Freudenberger (1974, Note 3), have eluci-
dated some situational and personal factors in the development
of the burn-out syndrome and have led to suggestions for coping
with this problem. From my own research vantage point, I have
concluded that burn-out is best understood (and modified) in
terms of the social and situational sources of job-related stresses.
Although personality variables are certainly relevant in the overall
analysis, the prevalence of the phenomenon and the range of
seemingly disparate staff people who are affected by it suggest
that the search for causes is better directed away from identifying
the bad people and toward uncovering the characteristics of the
bad situations where many good people function.

CLIENT FACTORS
One crucial aspect of the staff-client interaction that can have
a major determining influence on the level of emotional stress
is the particular role played by the client. The type of problems
facing the client, the nature of the staff member's relationship
to the client, the rules governing that relationship, and the client
stance and reactions to staff are all elements of the client role
that can affect staff burn-out.
Type of Client Problems
By definition, most clients are people with problems. Whether
they are sick, in trouble, unable to care for themselves, or
experiencing some other kind of difficulty, this negative part
of themselves and their life is what the staff member sees. TThis
focus on negative information is further enhanced by the staff
member's tendency to pay less attention to, or even ignore, what
is good and healthy about the clients, since that is often not
immediately relevant to the problem under consideration. In some
instances such positive information is even deliberately withheld
by the clients, since it could reduce the amount of funds or services
which they could receive. As a consequence of this negative focus,
the interaction between client and staff person is often charged
with strong emotions, such as embarrassment, fear, frustration.
 CLIENTS AND BURN-OUT 115

or anger. Such feelings can be experienced by both participants

in the interaction, as when, for example, the client feels upset
and humiliated about having to respond to very personal questions
and the staff member feels awkward about having to ask such
questions and frustrated at the difficulties involved in getting
complete answers. When the staff member is faced with a large
number of such potentially stressful interactions on a regular,
continuous basis, it is not surprising that he or she may begin
to experience the emotional exhaustion and cynical attitudes of
burn-out.
Some clients may have problems that are far more emotionally
stressful for staff than others. If the contact with clients is
particularly upsetting, depressing, or difficult in some way, then
staff burn-out may be more severe and/or occur more quickly.
An example of highly stressful client contact would be work with
people who are dying, especially when these people are young
children. Work with psychotic patients can also be very emotionally
demanding. Although there is probably some general agreement
about what types of client contact are more stressful than others,
there is also a wide range of individual differences. What is most
emotionally painful for one staff person may not pose any special
problems for the next. For example, some social workers report
great emotional trauma when dealing with cases involving incest;
some, on the other hand, are not particularly upset by such cases
but do find situations involving child neglect to be emotionally
shattering.
Most staff people can identify for themselves those client
problems that are especially stressful. In addition, they can usually
identify client types whom they personally like or dislike very
much. Some clients may be interesting to know and fun to talk
with while others can be obnoxious (e.g., a client who is very
belligerent or who is always trying to con the staff member or
who is excessively clinging and weepy). In institutions where the
staff member has no choice about which of the available clients
he or she will work with, the occasions for less than pleasant
staff-client interactions increase.
Related to the stressfulness of the client's problem is the
probability of successful change or cure. It is particularly difficult
for staff people to put in long hours of work with clients and
not see many, if any, tangible results. The lack of change may
be due to the nature of the client's problem (e.g., mental retarda-
tion, schizophrenia) or it may reflect a significant discrepancy
between the staff member's expectations and reality (e.g., obtaining
116 CHRISTINA MASLACH

a divorce for a client may not appear to the legal aid attorney
as much progress toward a better life for that person). In some
cases, the lack of successful change is viewed as evidence of the
staff member's failure to do a good job. This is especially true
when the same client keeps coming back with the same (or similar)
problems. Staff people often feel that their successes go away
but their failures keep coming back to haunt them and provide
constant visible proof that they are incompetent or make mistakes.
To ward off these feelings of failure and ineffectiveness, staff
may shift the blame for lack of positive change from themselves
to the clients and view them as inherently defective, unmotivated,
bad, or weak: "If they can't change after all I've done for them,
then let's face it—there's something basically wrong with them."
One other aspect of client problems that has relevance for
staff burn-out is whether the problem is chronic or acute. In
many situations that we have observed, it is the "chronics" that
cause more emotional stress for the staff. An acute problem may
be more severe, but it is often less frequent, more clearly linked
to an identifiable cause (or set of causes), and therefore more
amenable to some sort of staff intervention. Furthermore, staff
are often well trained to handle acute, crisis situations. Not only
are they more capable of doing a good job in these cases, but
they have an opportunity to demonstrate how successfully they
can apply their skills and meet the challenge. In contrast, staff
often feel less equipped to handle repeatedly the more mundane
problems of clients who won't go away and never seem to show
signs of improvement. As an example, staff of suicide prevention
centers often find that they are more emotionally drained by
the chronic telephone callers who call one or more times each
day, than by the occasional caller who is seriously considering
suicide at that moment.
Personal Relevance of Client Problems
There will be greater emotional stress in the staff-client
interaction whenever the staff member looks at the client's situation
and thinks "that could be me." If the client's plight resembles
a past experience of the staff member, it may bring back unpleasant
memories or unresolved feelings. Or the client could be undergo-
ing something that is certain to happen to the staff person in
the future (e.g., death), and this may arouse strong fears and
anxieties. The staff person may overidentify with the client and
share in his or her feelings and frustrations.
Getting close to the client's problems can have the advantage
 CLIENTS AND BURN-OUT 117

of giving the staff member more insight into and understanding

of the client's situation. He or she is then more likely to see
things from the client's point of view and to develop a sense
of empathy for the client. However, such emotional closeness
can also have serious drawbacks. It may bias the staff member's
perceptions and influence his or her judgment in ways that are
more detrimental than helpful. Furthermore, in these situations
any difficulties in the treatment of the client or any type of
unsuccessful termination of the staff-client relationship (e.g., the
treatment is a failure, the client breaks off the relationship) can
be especially devastating for the staff person.
In some instances, when the client's problems seem too close
for psychological comfort, the staff member will respond by
attempting to underscore and exaggerate the differences between
"me" and "them." As a result, clients come to be seen as less
good, less capable, and more blameworthy than oneself: "If I
were in that position, I certainly wouldn't act that way." This
process of "moral evaluation" (Roth, 1972) can mesh with the
cynical attitudes toward clients so characteristic of burn-out, as
well as enhance any personal prejudices held by the staff member.
Rules Governing the Staff-Client Relationship
Burn-out can also be affected by the sorts of rules, both
explicit and implicit, that structure the interaction between staff
person and client. These rules can introduce new sources of
emotional stress into the staff-client contact or can enhance those
stresses that are already present. For example, the institution
may require the staff member to ask a series of questions about
the client's financial status (in order to establish the client's
eligibility for services) before trying to deal with the client's
problems. The client may feel both embarrassed and angry about
these questions, and thus the staff-client relationship will be
charged with negative feelings even before any service or treatment
is initiated. In addition to rules which explicitly direct the staff
member to act in certain ways toward the client, the institution
may also have rules which limit or forbid certain staff behaviors.
Thus, staff may be restricted from providing certain services or
granting certain funds. This often leads to situations where the
staff feel trapped in the very uncomfortable position of having
to turn clients away for reasons that are not always easy to argue
convincingly.
While the existence of such rules can promote emotional
stress for the staff, they can also be used to avoid such stress.
118 CHRISTINA MASLACH

Rules can protect staff from personal involvement with clients

by allowing them to apply a formula to the clients' problems
(rather than develop a unique, personalized solution). Further-
more, rules can be used to avoid taking responsibility for unpopular
or painful decisions: "I'm sorry, but it's not my fault—those are
the rules around here, and I have to follow them." For many
of the helping professionals we interviewed, one of the major
signs of burn-out was the transformation of a person with creativity
and commitment into a mechanical, petty bureaucrat who goes
by the book.
Other types of explicit rules which make the staff-client
interaction more stressful are those which limit the amount of
time a staff member can devote to a client's case (and thus make
an incomplete resolution of the problem more likely) and those
which require that the staff member take clients on a "first come,
first served" basis with no possibility of referring difficult or
unpleasant clients to someone who might work more effectively
with them. In the latter instance, staff will feel a lack of control
over their work and will end up feeling trapped in situations
that are going from bad to worse. This sense of being trapped
is also likely to occur when the institutional rules force clients
to meet with the staff (e.g., prisoners who are required to attend
therapy sessions in order to be paroled).
In addition to explicit rules, there are often implicit rules
operating in the staff-client relationship. For example, "etiquette"
for clients requires that they be passive, dependent, and quiet
individuals who only speak when spoken to and who don't cause
trouble. Similarly, the staff people are expected always to be kind,
caring, calm, patient, and respectful toward clients. In many cases,
such implicit rules are so constraining that both staff and clients
are upset and dissatisfied with the relationship. Clients feel
demeaned and powerless, while staff feel artificial in their saintlike
pose and complain about bottling up their true emotions.
Furthermore, much of the tension and friction that occurs
in staff-client interactions can be attributed to the failure of clients'
expectations to match those of the staff. In many cases, clients
and staff do not agree on the goals of their relationship or what
they expect from each other. This lack of agreement often goes
unrecognized, since neither staff member nor client make explicit
their operating assumptions. For example, the client may feel
entitled to far more services than the staff member either can
or wants to provide. The likely outcome is that the client will
feel cheated and frustrated at only getting a bare minimum of
 CLIENTS AND BURN-OUT 119

aid, while the staff member will feel overburdened and helpless
in the face of continuous client demands that never seem to
be satisfied.
Client Stance
In their contacts with professional staff over the years, people
become socialized to behave in a passive and dependent way as
clients. They learn to follow directions, speak only when spoken
to, answer questions, and call upon someone else for help and
guidance with their own problems. The model that is operating
here is one of an authority figure who has knowledge, resources,
and power and a client who has not. The staff person gives,
the client receives.
On the one hand, this passive-dependent stance of clients
has several advantages for the professional staff person. It makes
clients far more manageable, since they are unlikely to question,
interrupt, or resist the actions taken by the staff member. Passive
clients are more easily seen as objects than as people, and can
more easily be categorized as a particular client type. By employing
a client typology (Mennerick, 1974), the staff member can minimize
emotional involvement with clients. Furthermore, client depen-
dence on staff serves to validate the staff person's sense of
importance and competence, since it demonstrates how much
he or she is needed by other people.
However, this typical passive-dependent client stance can be
a double-edged sword for staff. Just as it can ease the staff's
contact with clients, so can it make it more stressful. Most
significantly, it places a tremendous burden of responsibility on
the staff person. The client's fate is in the staff member's hands,
and so the latter's decisions are fraught with anxiety. The staff
member is more likely to feel emotionally overwhelmed by the
client's problems in these circumstances, particularly when some
of them can be attributed to action taken by the staff member
(e.g., a treatment for one medical problem leads to the develop-
ment of another). In addition, the dependent client often clings
to the staff member for constant guidance and in some cases
never seems to go away. When staff complain about clients who
"cannot stand on their own two feet," who call regularly about
any problem no matter how trivial and who cannot seem to do
anything without specific directions from the staff person, they
often fail to recognize that the source of these difficulties is the
clients' passivity and dependence which the staff themselves have
done much to encourage.
120 CHRISTINA MASLACH

Client Reactions to Staff

For many staff, the opportunity to work with people and
help them in some way was their primary reason for entering
their profession and is often the primary source of satisfaction
in their job. Positive personal feedback from clients not only
validates their work but provides a sense of self-worth and high
self-esteem. However, to the extent that client feedback can be
an important source of personal satisfaction, it also has the potential
to be a major source of dissatisfaction, disillusionment, and
psychological pain. Clients have as much power to hurt staff with
their comments as they do to reward them.
In many human service institutions, the nature of the staff-
client interaction is such that negative feedback from clients is
far more prevalent than positive. Staff hear complaints and
criticisms about the job they are doing, and in some instances
they are the targets of hostile remarks or even threatening actions.
Some of this negative feedback occurs because clients are upset
(and justifiably so) over poor service and errors that have been
made. At other times, the client is angry and frustrated at the
institution (which is viewed as making the client's life more difficult,
rather than less), but may direct these feelings toward an in-
dividual staff member who is an immediate and visible symbol
of that institution. Although the staff member may realize, at
some level, that the client is attacking the general institution,
it is often hard not to take the client's remarks personally.
Negative feedback can also be a deliberate strategy by the
client to speed up the delivery of care or service. There is some
truth to the notion that "the squeaky wheel gets the grease,"
and clients who take the offensive when meeting with staff, who
create a lot of fuss and commotion, and who behave in belligerent
or even obnoxious ways are sometimes dealt with more quickly
by staff who are made anxious to get rid of them. Although
this strategy may be an effective one for the client, it also results
in more tense and unpleasant encounters between clients and
staff.
In addition to these forms of negative feedback, clients rarely
give positive feedback, however minimal, for things that the staff
person does well. The primary reason for this appears to be
that the staff member's work is taken for granted by the clients
("that's what you're being paid to do"), and so there is no need
to provide feedback except when things fall short of their expecta-
tions. As a result, staff people are often in a no-win situation:
They hear nothing when things go right, but they hear plenty
when things go wrong. For those whbse major motivation to
 CLIENTS AND BURN-OUT 121

enter the helping professions was to make people's lives happier

and healthier, the lack of positive feedback or "strokes" from
clients for one's accomplishments is a particularly bitter pill to
swallow.

POSSIBLE A LLEVIA TIONS OF STAFF-CLIENT CONFLICT

There are no quick and easy solutions to the problems posed
by staff burn-out. It is a complex process which develops gradually
over time and which appears to be influenced by social and personal
variables. Much more research needs to be done to understand
the dynaniics of the burn-out syndrome, but it seems clear so
far that any attempts to combat burn-out must involve changes
at many levels, including the institution, the immediate work
situation, and the individual staff. Here I will consider only
contributions toward the alleviation of staff burn-out that come
from clients themselves.
One implication of the earlier analysis of the client's dependent
stance is that any efforts to make clients more self-reliant would
have beneficial consequences for both clients and staff alike. For
one thing, if clients took a more active and initiating role in
their interactions with staff, the relationship could come closer
to being one between equals. Staff and clients could function
more as partners in the resolution of a problem and share in
the responsibility for the decisions made. Clients would find their
role less demeaning, and staff would find theirs less of an emotional
burden. To the extent that clients are encouraged to be more
independent and take responsibility for various aspects of the
intervention, the frequently overworked staff would be relieved
of some of their duties. Although such a change might be an
enormous undertaking, involving as it does a resocialization of
both clients and staff, it would do much to ease the emotional
stresses that are currently a common part of staff-client contact.
Secondly, a great deal of misunderstanding and upset arises
from the mismatch between client and staff expectations. Much
of this conflict could be avoided if both staff and clients were
to make explicit their expectations at the outset, to clarify the
possibilities and limitations of the relationship, and to consider
the other's perspective as well as their own. If steps were taken
to ensure that the client understood the reasons for the actions
taken by the staff, and the staff recognized the psychological
and social dimensions of the client's plight, there might be
considerably less ill-feeling between them. As an example, clients
in legal aid offices are often subjected to highly personal and
122 CHRISTINA MASLACH

probing questions before any attention is given to their particular

problem. It may never occur to the staff member that the client
does not know the reason for such questions—namely, to establish
eligibility for legal services—and the upshot is that the client
enters the staff-client relationship feeling bewildered, embar-
rassed, and angry at being treated in a humiliating way. An example
of a better procedure is the policy of nurses at one hospital who
explain to their newly pregnant patients just what the doctor
will do during the routine check-ups, why these brief (and almost
impersonal) encounters are necessary, and how to break into this
routine to get their questions answered. Once the patient knows
that the check-ups rarely turn up any problems for the doctor
to be concerned with, the doctor's seemingly casual approach
to such a significant event in her life is less likely to be interpreted
as callous indifference.
Clients may sometimes have unrealistic ideas about the extent
of personal warmth and caring that they can legitimately expect
from professional staff. The help that one receives from family
and friends is usually imbued with a great deal of emotional
feeling because the people involved have had extensive relation-
ships and are committed to each other in various ways. No such
history of personal caring exists with strangers to whom one turns
for aid and treatment. It may be inappropriate to expect them
to provide a high level of emotional concern for clients, not only
because clients are strangers, but because clients appear in great
numbers and they do not have the emotional resources for all
of them. Also, clients will often not grant professionals the range
of feelings that they allow in others; it is legitimate for a parent
or friend to get upset, but not for a professional staff member
to do so. A recognition by clients of the limits to the comfort
that they can legitimately receive from staff, in addition to their
services, might ease the misunderstandings that currently exist.
Staff-client contact could also be improved by socializing both
participants to provide positive feedback to each other when
justified, rather than taking accomplishments for granted. Staff
need to know explicitly from clients when things have gone well,
as well as when they have not. An occasional word of praise,
a smile, or a pat on the back can be enough to take most staff
people through many hours of stressful interactions, ambiguous
outcomes, and frustrating red tape. Such feedback can be provided
directly by clients in their face-to-face encounters with staff, but
it could also be done via some regular client ratings of staff
performance. Not only would such a mechanism give staff
 CLIENTS AND BURN-OUT 123

members some insight into how to improve the way they do

their job, but it would begin to give the clients a greater sense
of input into, and possible control of, the institutions which are
supposedly serving them.

CONCLUSION
When considering the dynamics of the staff-client relationship,
it is important to keep in mind that there are two participants
who shape and direct the interaction and the thoughts and feelings
that arise from it. Just as staff can dehumanize clients by processing
them in a standardized way, ignoring their pleas and demands,
and judging them as somehow less capable and worthy than
themselves, so clients can dehumanize staff by failing to acknowl-
edge their presence, failing to follow their advice or guidance,
and failing to provide positive (instead of exclusively negative)
feedback. These dehumanization processes are interrelated ones
which can gradually escalate in intensity and frequency. If we
hope to improve the quality of staff-client contacts, we need to
focus on changes on both sides of the exchange. The institutional
system ultimately translates into people, and it is the way each
of these people interacts with others that can either promote
human values or destroy them.
REFERENCE NOTES
1. Maslach, C. Burn-out: A social psychological analysis. Paper presented at
the meeting of the American Psychological Association, San Francisco,
August 1977.
2. Maslach, C , & Jackson, S. E. A scale measure to assess experienced burn-out:
The Maslach Burn-Out Inventory. Paper presented at the meeting of the
Western Psychological Association, San Francisco, April 1978.
3. Freudenberger, H. J. The staff burn-out syndrome. Washington, D.C: Drug
Abuse Council, 1975.

REFERENCES
Freudenberger, H. J. Staff burn-out. Journal of Social Issues, 1974, 30(1),
159-165.
Lief, H. I., & Fox, R. C. Training for "detached concern" in medical students.
In H. I. Lief, V. F. Lief, & N. R. Lief (Eds.), The psychological basis
of medical practice. New York: Harper & Row, 1963.
Maslach, C. Burned-out. Human Behavior, September 1976, pp. 16-22.
Maslach, C. Job burnout: How people cope. Public Welfare, 1978, 36, 56-58.
Maslach,-C. The burn-out syndrome and patient care. In C. Garfield (Ed.),
Stress and survival. St. Louis: Mosby, in press.
Maslach, C , & Jackson, S. E. Lawyer burnout. Barrister, Spring 1978, pp.
8; 52-54.
124 CHRISTINA MASLACH

Maslach, C, & Pines, A. The burn-out syndrome in the day care setting.
Child Care Quarterly, \911, 6, 100-113.
Mennerick, L. A. Client typologies: A method of coping with conflict in
the service worker-client relationship. Sociology of Work and Occupations,
1974, 1, 396-418.
Pines, A., & Maslach, C. Characteristics of staff burnout in mental health
settings. Hospital and Community Psychiatry, 1978, 29, 233-237.
Roth, J. A. Some contingencies of the moral evaluation and control of clientele:
The case of the hospital emergency service. American Journal of Sociology
1972, 77, 839-856.
Ryan, W. Blaming the victim. New York: Pantheon Books, 1971.