Students: Dissertation: Holly Fussell

ABSTRACT

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 must 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 overlay to a study funded by the National Institute of 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 the maternal status of the standardized patient substantially informed interpretations of subsequent clinical interactions. 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. 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.

May 5, 2006
DISSERTATION COMMITTEE
Janice Haaken, Chair
Todd Bodner
Kerth O'Brien
Wayne W. Wakeland
Richard Hunter, Graduate Studies Representative