Clinicians' Judgments of the Need for Psychological Treatment

Northeastern University, Boston MA

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Abstract

DESCRIPTION (provided by applicant): Expert and novice mental health clinicians have previously been shown to demonstrate an understanding-normality effect (Meehl, 1973), wherein having a plausible explanation for a client's bizarre behaviors results in perceiving those behaviors as being more "normal" or acceptable (Ahn, Novick, &Kim, 2003). We propose to test whether this understanding-normality effect influences clinicians'judgments of clients'need for mental health treatment, and if so, what types of explanations trigger the effect. (1) First, we propose to test whether knowing an explanation for a client's behaviors leads clinicians to see clients as being less in need of psychological treatment. A hypothesis consistent with the understanding-normality effect is that clinical psychologists and psychiatrists will perceive hypothetical clients as being less in need of treatment when provided with a plausible explanation for their behaviors. If true, such findings would challenge the standard clinical assumption that understanding a client's problems is necessarily beneficial for the client or, at the very least, cannot harm the client. (2) Second, we will examine what types of explanations for behaviors are most likely to trigger the effect in treatment decisions. In particular, we will test the degree to which activation of the effect depends on whether clients are seen as having been in control of the precipitating events that lead to their current behaviors. (3) Third, we will also ask primary care physicians to judge the likelihood that they would refer the same clients to a mental health professional. By examining the differential impacts of explanations reasonably likely to be generated by clinicians, we can better identify the potential scope of the effect and specify its systematic triggers. We will actively seek to publicize our results to raise clinicians'awareness of the possibility that more understanding could lead to less treatment. PUBLIC HEALTH RELEVANCE: People suffering from mental disorders are in distress regardless of what explanations a clinician is able to mentally generate and bestow upon their behaviors and other symptoms. This proposal describes translational research testing the hypothesis that clinicians will perceive a client as being less in need of professional psychological treatment when the client's symptoms can be plausibly explained. After we document the effect and its triggers in the proposed research, we will have a solid foundation for a larger NIH proposal, in which we will examine the same process in clients and its effect on treatment seeking, study the influence of the effect on decisions to terminate treatment, and develop an intervention to increase clinicians'and clients'awareness of the effect.