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Do Psychologists Demonstrate Bias Based on Female Client

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Do Psychologists Demonstrate Bias Based on Female Client DO PSYCHOLOGISTS DEMONSTRATE BIAS BASED ON FEMALE CLIENT WEIGHT AND ETHNICITY? AN ANALOGUE STUDY. LINDSAY C. VARKULA Bachelor of Arts in Psychology Case Western Reserve University May 2004 Master of Arts in Child Development University of Akron May 2006 submitted in partial fulfillment of requirement for the degree DOCTOR OF PHILOSOPHY IN URBAN EDUCATION, SPECIALIZATION IN COUNSELING PSYCHOLOGY at the CLEVELAND STATE UNIVERSITY APRIL 2013 This dissertation has been approved for the Office of Doctoral Studies, College of Education and the College of Graduate Studies by Elizabeth R. Welfel, Chairperson 04/25/2013 Counseling, Administration, Supervision, and Adult Learning Brian Harper, Member 04/25/2013 Curriculum and Foundations Donna Schultheiss, Member 04/25/2013 Counseling, Administration, Supervision, and Adult Learning Sarah Toman, Member 04/25/2013 Counseling, Administration, Supervision, and Adult Learning Connie Hollinger, Member 04/25/2013 Department of Psychology ACKNOWLEDGEMENTS Many, many thanks to Dr. Welfel for inspiring me to choose CSU’s program, advising me as I moved through it, helping me feel confident in my clinical and academic work, and assisting me with my entire dissertation process. Also, thank you to Dr. Harper for your help, flexibility, and support as my methodologist. I appreciate my committee members, Dr. Toman, Dr. Schultheiss, and Dr. Hollinger, for providing thoughtful feedback. Thank you to my family, friends, and Dr. Curran; without you I could never have written this dissertation. Finally, I need to acknowledge Dr. Irvin Yalom and his willingness to openly share his reactions to a fat client; his writing was the inspiration for this study. DO PSYCHOLOGISTS DEMONSTRATE BIAS BASED ON FEMALE CLIENT WEIGHT AND ETHNICITY? AN ANALOGUE STUDY. LINDSAY C. VARKULA ABSTRACT Although anti-fat bias and discrimination have been widely documented (see Puhl, Andreyeva, & Brownell, 2008), few studies have examined whether psychologists exhibit biases toward clients who are fat. Only one study (Locker, 2011) examined whether client characteristics of ethnicity and weight influenced therapists’ bias; no studies have exclusively examined psychologists. This analogue study investigated psychologists’ biases toward a hypothetical client (vignette adapted from Zadroga, 2009) when the client characteristics of weight (average/obese) and ethnicity (African American/European American) were manipulated. Participants in this study included a national sample of 194 licensed, currently practicing psychologists. A 2 (client weight) x 2 (client ethnicity) randomized experimental design was utilized. Participants’ biases were determined by Global Assessment of Functioning scores, prognosis scores, and scores from an adapted version of the Working Alliance Inventory (see Burkard, 1997) Therapist form (WAI-T- A; Horvath & Greenberg, 1989). A 2 x 2 factorial MANOVA indicated no statistically significant differences according to according to vignette client weight [ F(1, 192) = 1.46, p = 0.23], vignette client ethnicity [ F(1, 192) = 0.77, p = 0.51], or weight by ethnicity interaction [ F(1, 192) = 0.28, p = 0.85]. Results, implications, and limitations were discussed, along with suggestions for further research. iv TABLE OF CONTENTS Page ABSTRACT..................................................................................................................... iv LIST OF TABLES........................................................................................................... vii CHAPTER I. INTRODUCTION............................................................................................ 1 Definition of Terms.................................................................................. 8 Societal Oppression and Stigma.............................................................. 10 Fat in America......................................................................................... 12 Mental Health Professionals and Fat Clients........................................... 22 The Current Study................................................................................... 28 II. REVIEW OF THE LITERATURE................................................................ 29 Anti-fat Bias in the General Population.................................................. 29 Other Professions’ Self-Analysis of Anti-Fat Biases.............................. 54 Anti-Fat Bias in Therapists...................................................................... 63 Need for the Study................................................................................... 78 Purpose of the Study................................................................................ 80 Hypotheses............................................................................................... 82 III. METHOD...................................................................................................... 85 Participant Characteristics....................................................................... 85 Sampling Procedures............................................................................... 85 Sample Size and Power…....................................................................... 87 Measures….............................................................................................. 88 v Research Design....................................................................................... 92 Hypotheses…........................................................................................... 93 Procedure.................................................................................................. 96 Analysis of Data....................................................................................... 97 IV. RESULTS....................................................................................................... 99 Descriptive Statistics............................................................................... 100 Reliability................................................................................................ 101 Multivariate Analysis of Variance.......................................................... 101 V. DISCUSSION................................................................................................ 109 Interpretations......................................................................................... 113 Limitations.............................................................................................. 115 Suggestions for Future Research............................................................ 119 Summary................................................................................................. 121 REFERENCES…........................................................................................................... 124 APPENDICES…............................................................................................................ 167 A. Vignette................................................................................................... 168 B. Author Permissions................................................................................. 169 C. Survey of Diagnostic Severity and Prognosis......................................... 171 D. Adapted Working Alliance Inventory, Therapist Form.......................... 172 E. Demographic Questionnaire................................................................... 176 F. E-Mail to Potential Participants.............................................................. 177 G. Informed Consent Statement................................................................... 178 vi LIST OF TABLES Table Page I. Variables, Measures, and Hypotheses by Vignette Client Characteristics........... 83 II. Correlation Matrix.............................................................................................. 101 III. Factorial MANOVA Results.............................................................................. 103 IV. Hypothesis 1: Vignette Client Weight Status..................................................... 105 V. Hypothesis 2: Vignette Client Ethnicity............................................................. 106 VI. Hypothesis 3: Vignette Client Weight by Ethnicity Interaction…..................... 107 vii CHAPTER I INTRODUCTION In the United States, most people believe that when individuals make bad choices they get what they deserve. For example, most people believe that those who choose to smoke deserve the health problems that they tend to acquire. Research shows that these attitudes are fairly accurate regarding tobacco use; according to the Centers for Disease Control (CDC) in America smoking is directly responsible for one in five deaths each year (CDC, 2008). Weight status, however, works differently. Research shows that the overwhelming majority of people in the United States believe that “choosing to be fat” is bad and that fat people are at fault for their own weight status and health problems (Saguy & Riley, 2005). High body weight is seen as the result of the “risky behavior” of unhealthy lifestyle choices (Saguy & Riley, 2005). From this perspective the use of dieting and other weight loss aids should therefore be encouraged because expunging obesity should be a priority (Saguy & Riley, 2005). In reality, having a high Body Mass Index (BMI) only accounts for about 9% of the variance in health outcomes (Gaesser, 2002). People have far less control over weight status than
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