Therapeutic Reactivity to Confidentiality With HIV Positive Clients: Bias or Epidemiology?

Abstract

Therapeutic reactivity among psychology trainees (N=68) was ascertained by their response to 10 clinical vignettes depicting clients with HIV who are sexually active with uninformed partners. This construct accounts for the relative change in decisions to maintain the confidentiality of clients who acknowledge safe versus unsafe sexual behavior. As anticipated, an analysis of variance revealed a significant main effect for safety and a significant 3-way interaction (Sexual Orientation X Safety X Gender). Subsequent analyses revealed that trainees exhibit the highest level of therapeutic reactivity toward heterosexual male clients, and the lowest reactive stance toward heterosexual female clients. Although the decisional pattern evidenced toward heterosexuals seems congruent with epidemiological estimates of risk, the decisions toward lesbians and gay males appear more likely a function of bias. The ethical implications of these findings are discussed.

The role of perceived risk in general practitioners' decisions to inform partners of HIV-infected patients

“…In this study, we hypothesized that risk behaviours and biasing factors would have a substantial influence on decision making. We replicated the finding that the decision to breach confidentiality is sensitive to whether or not a patient is taking measures to protect their partner (Palma & Iannelli, 2002).…”

“…When a HIV patient did not use protection, the GP was more likely to contact the partner and this was partially because GPs perceived the risk to the partner to be higher. However, whilst male to male intercourse has been associated with a higher rate of HIV transmission than male to female intercourse, GPs did not perceive the risk to the partner to be different, and the partner was more likely to be contacted when the relationship was heterosexual rather than homosexual (Palma & Iannelli, 2002). This distinction was not based on risk perceptions and may reflect biasing factors in decision making.…”

“…Using a vignette methodology in a small sample of trainee psychologists, Palma and Iannelli examined the impact of experimentally manipulating a hypothetical client's risk behaviour on decision making. Confidentiality was more likely to be broken when hypothetical clients did not use protection during intercourse, than when protection was used (Palma & Iannelli, 2002). However, as this study did not measure risk perceptions, it is not clear if the patient's behaviour is influencing decision making because the risk to the partner is judged to be elevated or because of other judgment biases relating to a HIV patient not using protection during intercourse (e.g., negative attitudes, stereotypes of carelessness, perceived lack of consideration).…”

Breaching confidentiality with HIV-positive clients: the effects of client gender, client dangerousness, clinician HIV-related knowledge and stigmatization

“…(2) Clinicians assigned vignettes depicting male clients will have higher IBC scores as compared to clinicians assigned vignettes depicting female clients. This finding is predicted based on the research of Palma and Iannelli (2002), who concluded from their study that psychology trainees showed the greatest therapeutic reactivity toward heterosexual males and the least therapeutic reactivity toward heterosexual females. This reactivity was measured by looking at the change in willingness to breach confidentiality between "safe" and "unsafe" client scenarios for each client type.…”

“…Client Gender. It was hypothesized that clinicians would have higher IBC scores when presented with a vignette depicting an HIV-positive male as compared to an HIVpositive female, based on the findings in a study by Palma and Iannelli (2002). These researchers concluded that psychology trainees showed the greatest therapeutic reactivity toward heterosexual males and the least therapeutic reactivity toward heterosexual females.…”