First impressions : a Study of the Relationship Between Presenting Problems and Clinical Perception
Portland State University. Department of Systems Science
Term of Graduation
Date of Publication
Doctor of Philosophy (Ph.D.) in Systems Science: Psychology
Systems Science: Psychology
Drug abuse counselors, Family violence, Qualitative research Social psychology, Substance abuse
1 online resource (2, ix, 339 pages)
Processes involved in clinical perception typically result in tangible outcomes of interest to clients and practitioners (e.g., diagnoses). In developing an overall impression of clients, practitioners integrate information related to target problems clients present. Substance abuse counselors, in particular, are increasingly being asked to assess clients for co-occurring problems. Domestic violence has been identified as a particularly salient co-occurring problem associated with substance abuse.
This dissertation draws on theory by Solomon Asch (1946, 1952) to examine how presenting problems such as domestic violence shape clinical outcomes and processes in substance abuse assessment interviews. Most clinical interactions occur, however, under confidential conditions. Designed as an added component to a study funded by the National Institute on Drug Abuse, the dilemma of confidentiality was circumvented by using a standardized patient. Standardized patients (SPs) are actors trained to simulate a set of symptoms across multiple clinical encounters, allowing researchers to investigate therapeutic interactions.
Eighteen participating substance abuse counselors conducted one mock assessment interview each with a SP who alternated her presenting problem between (a) a problem with violence in a domestic setting and (b) a problem with methamphetamine use. Post interview questionnaires and transcribed videotaped interactions were analyzed using frequency counts, t-tests, content analysis, blind ratings of questionnaires on particular dimensions and narrative analysis.
Results include a serendipitous finding that counselors substantially referenced the SP's maternal role and associated status throughout analyses. However, divergent patterns in impression formation processes and outcomes occurred for the two groups, providing evidence that a dynamic interaction occurred between the SP's maternal status and her presenting problem in perception formation processes for counselors.
Findings support Asch's (1946, 1952) assertions on dynamic processes involved in interpersonal perception, drawing attention to implications of socially salient roles, including associated expectations, in clinical contexts. Social psychological theory as well as practice related to substance abuse counseling and domestic violence intervention benefit from identifying how socially defined information presented initially shape clinical encounters. The dissertation suggests lines of inquiry for future research on impression formation from multiple methodological perspectives using standardized patients, a combination supportive of bridging the gap between research and practice.
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Fussell, Holly Elizabeth, "First impressions : a Study of the Relationship Between Presenting Problems and Clinical Perception" (2006). Dissertations and Theses. Paper 6227.
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