Journal of Consulting and Clinical Psychology 1977, Vol. 45, No. 1, 101-103
"A Patient by Any Other Name" Revisited: Maladjustment or Attributional Locus of Problem? C. R. Snyder University of Kansas, Lawrence A further analysis of Langer and Abelson's data was performed. Psychodynamically ( w = 1 9 ) and behaviorally (« = 21) trained clinicians observed a taped interview. Half of the clinicians were told the interviewee was a job applicant, and half were told the interviewee was a patient. Judges rated the clinicians' descriptions of the interviewee according to the locus of the problem on a scale from person to situation based. The psychodynamically as compared to behaviorally trained clinicians perceived the problem as significantly more person based when the interviewee was described as a patient. The correlation between Langer and Abelson's interviewee maladjustment and locus of problem as measured in the present study was positive and significant, such that greater maladjustment related to more person-based problems. Langer and Abelson (1974) have presented evidence that a clinician's training may affect his or her assessment of patient maladjustment. In a 2 X 2 factorial design, behaviorally or psychodynamically trained clinicians listened to a videotaped interview of a man who was described as either a job applicant or a patient. No differences emerged between the behavioral and psychodynamic clinicians when the interviewee was described as a job applicant, but the psychodynamic as compared to the behavioral clinicians diagnosed significantly more maladjustment when the interviewee was depicted as a patient. It should be emphasized that the focus of the Langer and Abelson study was diagnosed maladjustment in the interviewee. There is a growing body of research, however, that examines the attributional locus of the problem in diagnostic settings (cf. Batson, 197S; Snyder, Shenkel, & Schmidt, 1976). In this regard, the Langer and Abelson data may proSpecial gratitude is expressed to Ellen Langer for providing the original data from the Langer and Abelson (1974) study and to C. Daniel Batson for helpful comments on earlier versions of this article. This study was presented at the meeting of the Southeastern Psychological Association, New Orleans, March 1976. Requests for reprints should be sent to C. R. Snyder, Graduate Training Program in Clinical Psychology, Department of Psychology, 305 Fraser Hall, University of Kansas, Lawrence, Kansas 66045.
vide a good context to examine (a) theoretical predictions related to attributional locus of problem and (b) the relationship between the maladjustment and attributional locus of problem measures. On the basis of recent attributional research, it appears that training not only has an effect on the perceived maladjustment or intensity of the client problems (e.g., Langer & Abelson, 1974), but it also may influence the perceived locus of the problem. For example, professionals (seminary graduate students) relative to untrained nonprofessionals (undergraduates) have been shown to attribute the client's problem significantly more to person-based rather than situational factors (Batson, 1975). This greater person-based attribution for the professionals occurred in spite of the fact that "their experience was not one that would automatically predispose them to perceive problems as originating from within the individual" (Batson, 1975, p. 458). In another study, subjects listened to a taped interview in which they were instructed to imagine themselves in the role of either the clinician or the client (Snyder et al., 1976). When asked to locate the problem, subjects instructed to take the clinician's rather than the client's role attributed the problem more to the person than the situation. The first purpose of the present study was to reanalyze the Langer and Abelson (1974) data to
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C. R. SNYDER
ascertain whether the two popular training approaches for clinical psychologists—the psychodynamic and behavioral—influence the perceived attributional locus of the problem in clientele. Tt was hypothesized that when both types of clinicians listen to the interview in which the person is labeled a patient, the psychoclynamically trained clinicians would perceive the client problem as being clue to person-based factors while the behaviorally trained clinician would perceive the problem as being due to situation-based factors. The second purpose of the present study was to examine the correlation between maladjustment and attributional locus of the problem. It was hypothesized that greater maladjustment would be positively correlated with more person-based attributions. This prediction follows from the notion that person-based problems are often portrayed as chronic, self-perpetuating, and generally difficult to treat because of the accompanying severity. Method The present study involved a further analysis of the data presented by Langcr and Abelson (1974). In the Langer and Abelson study, psychodynamically (re = 19) or bchaviorally (n = 21) trained clinicians wrote descriptions of an interviewee who was labeled as cither a job applicant or a patient. Judges then rated these written descriptions according to the maladjustment of the interviewee (l = very well adjusted, to 10 = very disturbed). For the present rcanalysis, the clinicians' responses to the following question were utilized: "Do you think that the negative attitudes Mr. Smith holds arc a result of his looking for new work, deep-sealed problems, behavior problems, or what?" The clinicians' written descriptions of the interviewee in response to this question were rated according to the attributional locus of the problem. Three first-year graduate students, blind to the hypotheses and conditions of the experiment, rated each clinician's written description on a 9-point scale with regard to the locus of the interviewee problem (1 — totally in the situation, 5 = equally situational and person based, 9 = totally in the person). The mean interrater correlation over the judgments was .87. The three ratings were then averaged to yield a locus of problem score for each clinician.
Results With regard to the first purpose of the present study, a 2 X 2 analysis of variance
for unequal ns, with the independent variables of interviewee label (job applicant, patient) and clinician training (psychodynamic, behavioral) was performed on the dependent variable of locus of problem. The main effect of interviewee label was not significant, F ( l , 32) = .54, ns. The main effect of clinician training was significant, F ( I , 32) = 4.01, p < .05, such that the psychodynamic clinicians saw the interviewee's problem as being more person based (M — S.90) relative to the behavioral clinicians (M = 4.49). The interaction of interviewee label and clinician training approached significance, F(\, 32) = 3.58, p < .06. As hypothesized, this interaction resulted because there were no differences in the locus of the problem for psychodynamic and behavioral clinicians describing a job applicant (Ms = 5.05, 4.96, respectively), but the psychodynamic clinicians saw the patient's locus of problem as being significantly more person based than behavioral clinicians (Ms •= 6.96, 4.12, respectively, p < .05 by Duncan's multiple-range test for nearly equal MS). The correlation between interviewee maladjustment (the judges' ratings in the Langer and Abelson study) and locus of problem (the judges' ratings in the present study) was positive and statistically significant collapsed across all subjects, r(33) = .64, p < .001. Further, the magnitude of the correlations did not vary significantly across the four cells of t h e 2 X 2 factorial design. Discussion Langer and Abelson (1974) demonstrated that a label applied to an interviewee, as well as the training of the clinician, has an influence upon the perceived maladjustment of the interviewee. The present results indicate that a clinician's training can also have an important effect on where the clinician "sees" the interviewee's problem to lie—especially if that interviewee is labeled a patient. More specifically, the psychodynamically trained clinician "located" the patient problem in the person, and the behaviorally trained clinician "located" the patient problem in the situation. This training "bias" is further amplified by the fact that there is a positive correlation between the perceived attributional locus of the problem and type of
LOCUS OF PROBLEM
therapeutic intervention that is subsequently recommended. For example, Batson (1975) found that clients whose problems are attributed to them personally are more likely to be referred to agencies oriented to changing the person and protecting society; conversely, clients whose problems are attributed to situational factors are more likely to be referred to institutions protecting the person and changing the social situation. As predicted, the correlation between maladjustment and locus of problem was positive, such that greater maladjustment correlated significantly with more person-based attributions. One possible explanation for this relationship is that clinicians have an implicit theory of personality (cf. Schneider, 1973), in which the perception of greater maladjustment is yoked to more person-based attributions and vice versa. Whether maladjustment or attributional locus of the problem takes precedence in the diagnostic impression-formation process is not known. Therefore, considering the question raised in the title of the
103
present article, it appears that both maladjustment and attributional locus of the problem are involved as a clinician forms impressions of a patient. It may be useful, therefore, to use both maladjustment and attributional locus of the problem measures in future studies in the area of diagnostic impression formation. References Katson, C. D. Attribution as a mediator of bias in helping. Journal of Personality and Social Psychology, 191S, 32, 4SS-466. Langer, E. J., & Abclson, R. P. A patient by any other name . . . : Clinician group difference in labeling bias. Journal of Consulting and Clinical Psychology, 1974, 42, 4-9. Schneider, D. Implicit personality theory: A review. Psychological Bulletin, 1973, 79, 294-309. Snyder, C. R., Shenkel, R. J., & Schmidt, A. Effects of role perspective and psychiatric history on diagnostic locus of problem. Journal of Consulting and Clinical Psychology, 1976, 44, 467-472. Received March 29, 1976 •
"A Patient by Any Other Name" Revisited: Maladjustment or Attributional Locus of Problem? C. R. Snyder University of Kansas, Lawrence A further analysis of Langer and Abelson's data was performed. Psychodynamically ( w = 1 9 ) and behaviorally (« = 21) trained clinicians observed a taped interview. Half of the clinicians were told the interviewee was a job applicant, and half were told the interviewee was a patient. Judges rated the clinicians' descriptions of the interviewee according to the locus of the problem on a scale from person to situation based. The psychodynamically as compared to behaviorally trained clinicians perceived the problem as significantly more person based when the interviewee was described as a patient. The correlation between Langer and Abelson's interviewee maladjustment and locus of problem as measured in the present study was positive and significant, such that greater maladjustment related to more person-based problems. Langer and Abelson (1974) have presented evidence that a clinician's training may affect his or her assessment of patient maladjustment. In a 2 X 2 factorial design, behaviorally or psychodynamically trained clinicians listened to a videotaped interview of a man who was described as either a job applicant or a patient. No differences emerged between the behavioral and psychodynamic clinicians when the interviewee was described as a job applicant, but the psychodynamic as compared to the behavioral clinicians diagnosed significantly more maladjustment when the interviewee was depicted as a patient. It should be emphasized that the focus of the Langer and Abelson study was diagnosed maladjustment in the interviewee. There is a growing body of research, however, that examines the attributional locus of the problem in diagnostic settings (cf. Batson, 197S; Snyder, Shenkel, & Schmidt, 1976). In this regard, the Langer and Abelson data may proSpecial gratitude is expressed to Ellen Langer for providing the original data from the Langer and Abelson (1974) study and to C. Daniel Batson for helpful comments on earlier versions of this article. This study was presented at the meeting of the Southeastern Psychological Association, New Orleans, March 1976. Requests for reprints should be sent to C. R. Snyder, Graduate Training Program in Clinical Psychology, Department of Psychology, 305 Fraser Hall, University of Kansas, Lawrence, Kansas 66045.
vide a good context to examine (a) theoretical predictions related to attributional locus of problem and (b) the relationship between the maladjustment and attributional locus of problem measures. On the basis of recent attributional research, it appears that training not only has an effect on the perceived maladjustment or intensity of the client problems (e.g., Langer & Abelson, 1974), but it also may influence the perceived locus of the problem. For example, professionals (seminary graduate students) relative to untrained nonprofessionals (undergraduates) have been shown to attribute the client's problem significantly more to person-based rather than situational factors (Batson, 1975). This greater person-based attribution for the professionals occurred in spite of the fact that "their experience was not one that would automatically predispose them to perceive problems as originating from within the individual" (Batson, 1975, p. 458). In another study, subjects listened to a taped interview in which they were instructed to imagine themselves in the role of either the clinician or the client (Snyder et al., 1976). When asked to locate the problem, subjects instructed to take the clinician's rather than the client's role attributed the problem more to the person than the situation. The first purpose of the present study was to reanalyze the Langer and Abelson (1974) data to
101
102
C. R. SNYDER
ascertain whether the two popular training approaches for clinical psychologists—the psychodynamic and behavioral—influence the perceived attributional locus of the problem in clientele. Tt was hypothesized that when both types of clinicians listen to the interview in which the person is labeled a patient, the psychoclynamically trained clinicians would perceive the client problem as being clue to person-based factors while the behaviorally trained clinician would perceive the problem as being due to situation-based factors. The second purpose of the present study was to examine the correlation between maladjustment and attributional locus of the problem. It was hypothesized that greater maladjustment would be positively correlated with more person-based attributions. This prediction follows from the notion that person-based problems are often portrayed as chronic, self-perpetuating, and generally difficult to treat because of the accompanying severity. Method The present study involved a further analysis of the data presented by Langcr and Abelson (1974). In the Langer and Abelson study, psychodynamically (re = 19) or bchaviorally (n = 21) trained clinicians wrote descriptions of an interviewee who was labeled as cither a job applicant or a patient. Judges then rated these written descriptions according to the maladjustment of the interviewee (l = very well adjusted, to 10 = very disturbed). For the present rcanalysis, the clinicians' responses to the following question were utilized: "Do you think that the negative attitudes Mr. Smith holds arc a result of his looking for new work, deep-sealed problems, behavior problems, or what?" The clinicians' written descriptions of the interviewee in response to this question were rated according to the attributional locus of the problem. Three first-year graduate students, blind to the hypotheses and conditions of the experiment, rated each clinician's written description on a 9-point scale with regard to the locus of the interviewee problem (1 — totally in the situation, 5 = equally situational and person based, 9 = totally in the person). The mean interrater correlation over the judgments was .87. The three ratings were then averaged to yield a locus of problem score for each clinician.
Results With regard to the first purpose of the present study, a 2 X 2 analysis of variance
for unequal ns, with the independent variables of interviewee label (job applicant, patient) and clinician training (psychodynamic, behavioral) was performed on the dependent variable of locus of problem. The main effect of interviewee label was not significant, F ( l , 32) = .54, ns. The main effect of clinician training was significant, F ( I , 32) = 4.01, p < .05, such that the psychodynamic clinicians saw the interviewee's problem as being more person based (M — S.90) relative to the behavioral clinicians (M = 4.49). The interaction of interviewee label and clinician training approached significance, F(\, 32) = 3.58, p < .06. As hypothesized, this interaction resulted because there were no differences in the locus of the problem for psychodynamic and behavioral clinicians describing a job applicant (Ms = 5.05, 4.96, respectively), but the psychodynamic clinicians saw the patient's locus of problem as being significantly more person based than behavioral clinicians (Ms •= 6.96, 4.12, respectively, p < .05 by Duncan's multiple-range test for nearly equal MS). The correlation between interviewee maladjustment (the judges' ratings in the Langer and Abelson study) and locus of problem (the judges' ratings in the present study) was positive and statistically significant collapsed across all subjects, r(33) = .64, p < .001. Further, the magnitude of the correlations did not vary significantly across the four cells of t h e 2 X 2 factorial design. Discussion Langer and Abelson (1974) demonstrated that a label applied to an interviewee, as well as the training of the clinician, has an influence upon the perceived maladjustment of the interviewee. The present results indicate that a clinician's training can also have an important effect on where the clinician "sees" the interviewee's problem to lie—especially if that interviewee is labeled a patient. More specifically, the psychodynamically trained clinician "located" the patient problem in the person, and the behaviorally trained clinician "located" the patient problem in the situation. This training "bias" is further amplified by the fact that there is a positive correlation between the perceived attributional locus of the problem and type of
LOCUS OF PROBLEM
therapeutic intervention that is subsequently recommended. For example, Batson (1975) found that clients whose problems are attributed to them personally are more likely to be referred to agencies oriented to changing the person and protecting society; conversely, clients whose problems are attributed to situational factors are more likely to be referred to institutions protecting the person and changing the social situation. As predicted, the correlation between maladjustment and locus of problem was positive, such that greater maladjustment correlated significantly with more person-based attributions. One possible explanation for this relationship is that clinicians have an implicit theory of personality (cf. Schneider, 1973), in which the perception of greater maladjustment is yoked to more person-based attributions and vice versa. Whether maladjustment or attributional locus of the problem takes precedence in the diagnostic impression-formation process is not known. Therefore, considering the question raised in the title of the
103
present article, it appears that both maladjustment and attributional locus of the problem are involved as a clinician forms impressions of a patient. It may be useful, therefore, to use both maladjustment and attributional locus of the problem measures in future studies in the area of diagnostic impression formation. References Katson, C. D. Attribution as a mediator of bias in helping. Journal of Personality and Social Psychology, 191S, 32, 4SS-466. Langer, E. J., & Abclson, R. P. A patient by any other name . . . : Clinician group difference in labeling bias. Journal of Consulting and Clinical Psychology, 1974, 42, 4-9. Schneider, D. Implicit personality theory: A review. Psychological Bulletin, 1973, 79, 294-309. Snyder, C. R., Shenkel, R. J., & Schmidt, A. Effects of role perspective and psychiatric history on diagnostic locus of problem. Journal of Consulting and Clinical Psychology, 1976, 44, 467-472. Received March 29, 1976 •
