Clinical Decision Making of Short- Versus Long-Term Treatment

Abstract

Practitioners'decisions of when to use ST (planned short-term) versus LT (long-term) therapy were studied via their responses to vignettes and an open-ended question about their cnteria for choosing. Using a factorial design, the effects of clients' symptoms (adjustment disorder, Dysthymic Disorder, and borderline personality disorder), gender, race (White and Black), and education (high school and college) were tested. The presence of adjustment disorder symptoms alone was able to correctly predict therapist's decision of when to use ST and LT 92% of the time. ST was recommended for adjustment disorder 95% of the time, but only 13% for Dysthymic Disorder and 9% for borderline personality. In the remainder of these cases LT was recommended. Responses to open-ended questions further support these results. Clients'race, gender, and education did not have a general effect on the choice between ST and LT, except in the dysthymia and borderline groups. There were no significant interactions between client variables. Therapist characteristics had only slight relationships to decisions made. Despite preferences to treat adjustment disorder with ST, and that 25 percent of actual respondent's chents were so diagnosed, therapists treated less than 1.5 ST cases annually.

Influence of social class perceptions on attributions among mental health practitioners

“…These findings indicating that practitioners in this sample did not significantly differ in their perceptions of Pat even though they detected social class differences between the two versions of the vignette were somewhat unexpected based upon prior findings regarding differences in psychotherapy utilization rates, referrals, experiences, and outcomes among individuals from non-upper middle class backgrounds (e.g., Falconnier, 2009; Nadeem et al, 2008; Rabinowitz & Lukoff, 1995; Thompson et al, 2012). However, given the relative dearth of quantitative examinations of the impacts of practitioner perceptions of client social class within psychotherapy (Goodman et al, 2012; Stabb & Riemers, 2012) and the presence of some mixed findings in previous research (e.g., Garb, 1997; Smith et al, 2011), directional hypotheses may have been somewhat premature.…”

“…For example, findings have demonstrated that clients from lower class backgrounds are less likely to be referred to therapy that is insight-oriented rather than supportive in comparison to their peers from more middle and upper class backgrounds (e.g., Franklin, 1985; Levy & Kahn, 1970; Neumann, Salganik, Rabinowitz, Bauer, & Kastner, 1990; Rabinowtiz & Lukoff, 1995). Research also has indicated that psychotherapy clients from lower social class backgrounds are less likely to access mental health care given a myriad of barriers (e.g., Nadeem, Lange, & Miranda, 2008) and that they have higher rates of discontinuing therapy (e.g., Miranda, Azocar, Komaromy, & Golding, 1998; Siefert, Heflin, Corcoran, & Williams, 2000) in comparison to clients from more upper class backgrounds.…”

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

“…Similarly, prognostic ratings did not vary as a function of social class when clinicians interviewed actors who portrayed clients (Wright & Hutton, 1977). In other studies, less favorable prognostic ratings were made for lower‐class clients than for middle‐class or upper‐class clients when clinicians were given case histories (Franklin, 1985; Rabinowitz & Lukoff, 1995; Sutton & Kessler, 1986), when they listened to a recording of an intake interview (Lee & Temerlin, 1970), and when they were given Rorschach test results (Haase, 1964; Levy & Kahn, 1970; Trachtman, 1971).…”

“…In all of the studies, different groups of clinicians were given different case histories that were identical except for the designation of race, or they watched videotapes of actors portraying clients and the videotapes were identical except for the race of the actors. When prognostic ratings made by White and Black clinicians were pooled together, prognoses were more favorable for Black clients than for White clients in three studies (Lewis et ah, 1990; Schwartz & Abramow‐itz, 1975; Strickland et al, 1988) and equally favorable for Black clients and White clients in one study (Rabi‐nowitz & Lukoff, 1995). When ratings were analyzed separately for White and Black clinicians, prognoses made by White clinicians were unaffected by client race (Bloch et al, 1980; Franklin, 1985), but Black clinicians tended to make prognoses that were more favorable for Black clients than White clients (Benefee et al, 1976; Franklin, 1985).…”

“…In a third study (Lindsey et al, 1989), when level of psychopathology and level of dangerous behavior were controlled for, socio‐economic status did not help to predict whether a patient would be committed or admitted voluntarily to a psychiatric hospital. In a fourth study (Rabinowitz, Massad, & Fennig, 1995), psychiatrists and psychiatric residents made recommendations regarding hospitalization in the course of their work at a psychiatric hospital in Israel. Ratings of level of psychopathology were made by members of the research team.…”