Clinical judgment in geropsychology practice.

Abstract

An empirical study utilizing an attribution paradigm was performed with 418 clinical psychologists. Therapists were mailed a ' 'clinical judgment" survey containing a standard case history varied according to age (46/72), class (working/middle) and gender; each therapist received only one of these eight possible combinations. Clients were rated along Likert scales on dependent variables tapping attitudinal (e.g., "usefulness of intervention"), symptomatological (e.g., "disorientation") and diagnostic dimensions. MANOVA Analyses demonstrated that the 72 -year-old client elicited significantly more negative perceptions, including more "psychotic" diagnoses than the 46-year-old client. Age interactions with client class and gender, and selected therapist characteristics, were also examined. Results are taken as evidence for ageism in the psychotherapy setting and treatment. Implications for the "reluctant therapist" are discussed.

Race bias, social class bias, and gender bias in clinical judgment.

“…Gender bias was not present for predicting who would be rehospitalized within 2 years (Stack et al, 1983) and for predicting suicide or compliance with treatment (Lewis et al, 1990). Also, in many studies, prognoses for male and female clients were not significantly different (Adams & Betz, 1993; Bernstein & Lecomte, 1982; Billingsley, 1977; Dailey, 1980; Fischer et al, 1976; Foon, 1989; Lewis et al, 1990; Lopez et al, 1993; Rabinowitz & Lukoff, 1995; Schwartz & Abra‐mowitz, 1975; Settin, 1982; Stearns et al, 1980; Wrobel, 1993; Zygmond & Denton, 1988). When the effect of gender was significant, prognostic ratings were more favorable for female clients than male clients, even though clients were described by the same case histories except for the designation of gender (Agell & Rothblum, 1991; Fernbach et al, 1989; Hansen & Reekie, 1990; Teri, 1982).…”

“…However, in most of the studies published in the last 20 years, lower‐class subjects have not been diagnosed as having more severe mental disorders than middle‐class or upper‐class clients. This has been true when clinicians have been given case history information (Bamgbose et al, 1980; Franklin, 1985; Hardy & Johnson, 1992; Settin, 1982; Sutton & Kessler, 1986; Umbenhauer & DeWitte, 1978) and when they have been given case history information and IQ scores (Amira et al, 1977). Studies reporting nonsignificant social class effects have employed larger clinician sample sizes than studies reporting significant social class effects (an average clinician sample size of 266 vs. an average clinician sample size of 49).…”

“…There has been speculation that depression may be overdiagnosed in females (Potts, Burnam, & Wells, 1991). However, the effect of gender was not significant when clinicians made differential diagnoses of adjustment disorder, dysthymic disorder, and anxiety disorder (Agell & Rothblum, 1991; Garfinkle & Morin, 1978), adjustment reaction and depressive neurosis (Settin, 1982), adjustment reaction, dysthymic disorder, cyclothymic disorder, and alcohol abuse (Ford & Widiger, 1989), and adjustment disorder, dysthymic disorder, intermittent explosive disorder, posttraumatic stress disorder, schizophrenia, generalized anxiety disorder, and delusional disorder (Becker & Lamb, 1994). The effect of gender was significant when the task was to make differential diagnoses of major depressive disorder and organic mental disorder (Wrobel, 1993): Males were more likely than females to be diagnosed as having an organic mental disorder while females described as having the same symptomatology as males were more likely to be rated as having a severe depressive disorder.…”

“…Similarly, the effect of gender was generally not significant when clinicians made treatment decisions related to psychotherapy. The effect of gender was not significant when clinicians were to decide if clients could benefit from psychotherapy (Adams & Betz, 1993; Agell & Rothblum, 1991; Bernstein & LeComte, 1982; Hardy & Johnson, 1992; Oyster‐Nelson & Cohen, 1981; Rabi‐nowitz & Lukoff, 1995; Settin, 1982; Stearns et al, 1980). Regarding the type of therapy that was recommended by clinicians (e.g., individual, group, or family therapy; short‐term or long‐term therapy; directive or nondirec‐tive therapy; supportive, behavioral, cognitive‐behavioral, or insight‐oriented therapy), the effect of gender was usually not significant (Agell & Rothblum, 1991; Bernstein & LeComte, 1982; Dailey, 1980; Hansen & Reekie, 1990; Hecker et al, 1995; Lewis et al, 1990; Lowery & Higgins, 1979; Murray & Abramson, 1983; Oyster‐Nelson & Cohen, 1981; Rabinowitz & Lukoff, 1995; Schwartz & Abramowitz, 1975; Stearns et al, 1980; Wrobel, 1993; but see Bowman, 1982; Fernbach et al, 1989; Fischer et al, 1976; Hardy & Johnson, 1992).…”

Adverse factors and the mental health of older people: implications for social policy and professional practice

“…The correlation is especially significant for older age groups in that pervading negative and fatalistic attitudes to deterioration and cognitive impairment may result in less psychological help being offered. Settin (1982) demonstrated this when he showed that a perceived lack of potential for psychological growth led to a denial of therapeutic aid and subsequent deterioration. In the present climate, where all age groups suffering mental distress must compete for services, older people frequently lose out.…”