The impact of diagnosing on psychologists’ treatment of, attitude towards, and perception of their clients
Gaies, Samantha Elizabeth
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In the current milieu of health care, diagnoses are often a requirement for receiving mental health services. More specifically, insurance companies require diagnoses for reimbursement, and oftentimes a certain threshold of mental illness needs to be met for the insurance company to approve the treatment. Additionally, newer models of health care, such as care management clinics, also prefer clients to be diagnosed to help indicate which evidence-based practice of care should be employed (Unützer et al., 2006). As a result, psychologists have become accustomed to offering more severe diagnoses than a client may warrant (Pomerantz & Segrist, 2006). Due to cognitive errors and biases that are inherent to cognitive processing, such as the negativity bias (Rozin & Royzman, 2001), labeling clients with pathologies may influence psychologists to hold less accurate and more negative views of their clients. In order to better understand the effects of using diagnoses, an experiment was conducted in which psychologists were either required or not required to assign a diagnosis to a hypothetical client based on written simulated therapy vignettes. It was hypothesized that participants required to diagnose would: 1) be more likely to diagnose that client at the end of the experiment; 2) have less of a desire to work with the client; and 3) hold more negative opinions of the client than psychologists who were not required to diagnose. Multiple regression models were run to test these hypotheses, and the results demonstrated that psychologists who were required to diagnose held a more negative opinion of the client, and the more often psychologists were diagnosing in their own practice, the more likely they were to diagnose the client in the study. Supplemental analyses also revealed that participants with Ph.Ds. from Clinical Psychology programs tended to be more likely to diagnose the hypothetical client and to use CBT techniques. All of these findings advance research and practice by demonstrating that the use of diagnoses has an effect on the therapeutic relationship, treatment, and the psychologist over time, and highlight the need for future research to explore the degree to which diagnosing may detrimentally affect client care.