Client Gender Research Articles

Does Client-Therapist Gender Matching Influence Therapy Course or Outcome in Psychotherapy?

The present study examined the impact of therapist and client gender, and gender matching on therapy outcome and attendance variables. Analysis was based on a database of over 17,000 students treated in a university counseling center by over 200 therapists. Results indicated that gender of clients (but not the gender of therapist, or the match between therapists and clients) was associated with greater improvement in female clients. Clinical significance analysis indicates that female clients were more likely to start treatment in the clinical range and also end treatment in the “improved” category. Significant associations were found between client gender, therapist gender, and gender match on the total number of sessions attended by clients with females receiving more sessions.

Interest and preferences for contingency management design among addiction treatment clientele

ABSTRACTBackground: Despite strong support for its efficacy, debates persist about how dissemination of contingency management is most effectively undertaken. Currently-promoted contingency management methods are empirically-validated, yet their congruence with interests and preferences of addiction treatment clientele is unknown. Such client input is a foundational support for evidence-based clinical practice. Objective: This study documented interest in incentives and preferences for fixed-ratio vs. variable-ratio and immediate vs. distal distribution of earned incentives among clients enrolled at three community programs affiliated with the National Institute on Drug Abuse Clinical Trials Network. Methods: This multi-site study included anonymous survey completion by an aggregate sample of 358 treatment enrollees. Analyses first ruled out site differences in survey responses, and then tested age and gender as influences on client interest in financial incentives, and preferences for fixed-ratio vs. variable-ratio reinforcement and immediate vs. distal incentive distribution. Results: Interest in different types of $50 incentives (i.e. retail vouchers, transportation vouchers, cash) was highly inter-correlated, with a mean sample rating of 3.49 (0.83) on a five-point scale. While consistent across client gender, age was an inverse predictor of client interest in incentives. A majority of clients stated preference for fixed-ratio incentive magnitude and distal incentive distribution (67% and 63%, respectively), with these preferences voiced by a larger proportion of females. Conclusion: Sample preferences contradict currently-promoted contingency management design features. Future efforts to disseminate contingency management may be more successful if flexibly undertaken in a manner that incorporates the interests and preferences of local client populations.

Going-concern opinions, executive tenure and gender

Regulators in the USA and elsewhere have shown renewed interest in auditors’ judgments related to going-concern modified (GC) audit reports. Such judgments involve evaluating management’s plans, and prior research suggests that executive turnover is associated with significant organizational changes. Further, some recent studies posit that gender is associated with accounting and audit judgments. We examine audit opinions for two different samples: 2,089 financially stressed firms and 642 manufacturing firms that filed for bankruptcy. In both samples, we find that GC opinions are more likely for firms with a new CFO; however, we find no significant association between GC opinions and executives’ gender. The CFO tenure related result may arise from auditors’ professional skepticism related to a new executive. Our gender-related results differ from those of Gold et al. (2009) and suggest the need for additional research related to the role of client gender in auditing settings.

The Utility of Social Class, Race, and Gender in Clinical Practice: A Case Study Involving Intraracial Dyads

This article focuses on clinical work involving a male Black practitioner and a male Black client in which issues of social class, race, and gender were prominent in the treatment process. Three questions raised by the client early in the therapeutic encounter informed assessment, treatment, and the clinician's countertransference. Tenets from self-psychology, relational theory, intersubjectivity, and sociocultural factors relative to Black men are used to ground the discussion. Finally, the article illustrates why intraracial therapy should be understood in the context of the delivery of culturally competent services, highlighting how the intersection of a client's psychological issues, social class, race, and gender can emerge as functional features in psychotherapeutic work.

Youth care workers' views on the challenges of working with girls: An analysis of the mediating influence of practitioner gender and prior experience with girls

Abstract Research on helping agents' preferences regarding the gender of justice-involved clients has shown that practitioners are reluctant to work with girls, which they perceive as particularly difficult and demanding. Recognizing the potentially detrimental impact of this reluctance on the quality of interventions delivered to girls, this paper investigates preferences for client gender among a sample of 131 practitioners working with juveniles mandated into residential care. We also explore the perceived level of difficulty that these practitioners associate with intervention with both genders. These perceptions are contextualized by controlling for practitioners' gender, level of education, as well as current and previous work experience with both clienteles. Findings show that practitioners significantly prefer working with boys. This preference, however, is only found among male practitioners. Furthermore, practitioners with experience with both boys and girls have no significant preference for the gender of the clientele and feel they possess sufficient knowledge of both clienteles, in contrast to those who only worked with boys. Yet, actual work experience with both boys and girls does not eliminate the impression that working with girls is more difficult than with boys. Our findings reaffirm the need to improve training and supervision of practitioners and highlight the importance of encouraging and facilitating work experience with both genders. But above all, our results suggest that the professional preferences, affinities, and abilities of practitioners should be recognized and valued in order to create gender-responsive contexts of intervention.

Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis.

Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male-female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6-9:1). We hypothesized that this occurs because therapists do not adhere to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and International Classification of Diseases (10th rev.; ICD-10) criteria. Instead, we hypothesized that, in accordance with the representativeness heuristic, therapists might diagnose attention-deficit/hyperactivity disorder (ADHD) if a patient resembles their concept of a prototypical ADHD child, leading therapists to overlook certain exclusion criteria. This may result in overdiagnosis. Furthermore, as ADHD is more frequent in males, a boy might be seen as a more prototypical ADHD child and might therefore receive an ADHD diagnosis more readily than a girl would. We sent a case vignette to 1,000 child psychologists, psychiatrists, and social workers and asked them to give a diagnosis. Four versions of the vignette existed: Vignette 1 (ADHD) fulfilled all DSM-IV/ICD-10 criteria of ADHD. Vignettes 2-4 (non-ADHD) included several ADHD symptoms but stated other ADHD criteria were nonfulfilled. Therefore, an ADHD diagnosis could not be given. Furthermore, boy and girl versions of each vignette were created. In Vignettes 2-4 (non-ADHD), 16.7% of therapists diagnosed ADHD. In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes. Therapists do not adhere strictly to diagnostic manuals. Our study suggests that overdiagnosis of ADHD occurs in clinical routine and that the patient's gender influences diagnosis considerably. Thorough diagnostic training might help therapists to avoid these biases.

Supplemental Material for Is ADHD Diagnosed in Accord With Diagnostic Criteria? Overdiagnosis and Influence of Client Gender on Diagnosis

Supplemental Material for Is ADHD Diagnosed in Accord With Diagnostic Criteria? Overdiagnosis and Influence of Client Gender on Diagnosis

P1-11-14: Gender and Sexual Orientation of Clients Who Were Linked to Breast Cancer Screening Services through Outreach and Education Supported by the Avon Breast Health Outreach Program.

Abstract Background: Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health disparities in breast cancer screening related to multiple socioeconomic factors, including stigma and discrimination. Since 2001, the Avon Breast Health Outreach Program (Avon BHOP) has granted almost $60 million to 240+ organizations to promote breast cancer screening. Avon BHOP beneficiaries collect a standardized set of de-identified, self-reported client level health and demographic data to ensure that programs reach their target population. Prior to 2011, no data on client gender or sexual orientation were collected. Methods: From 2009–2010, the Avon BHOP conducted a review of the standard confidential client intake form (CIF), last revised in 2006. Based on stakeholder input, including the Avon Foundation for Women and Avon BHOP beneficiaries, the CIF was updated in 2011 to incorporate variables for gender and sexual orientation. Proposed revisions were presented to current beneficiaries in June 2010 for feedback. Although the CIF has historically included many sensitive elements such as race/ethnicity and income, several programs expressed concern that clients or program staff would be uncomfortable addressing questions on gender and sexual orientation in particular. In response, the Avon BHOP Coordinating Center provided standard language that programs could use to help ease the concerns of staff and clients that incorporated three key messages: 1) the same form is used for all clients and programs funded by the Avon BHOP to help ensure funds are reaching clients in need; 2) all responses are kept confidential; and 3) clients may skip any question they are not comfortable answering. Results: Preliminary CIF data for January-March 2011 were analyzed for 20,672 clients from 109 programs. Overall, 96.6% (n=19,966) indicated female gender; 0.5% (n=101) self-reported gender as follows: 75 male, 8 transgender, 12 “other”, and 6 “unknown”; and 2.9% (n=605) did not respond to this question. For sexual orientation, 77.7% (n=16,067) of clients selected “heterosexual”. Of the remaining 22.3% (n=4,606), 175 (0.8%) selected “lesbian, gay or bisexual”, 431 (2.1%) selected “other”, 1045 (5.1%) selected “unknown”, and 2,954 (14.3%) did not respond to this question. By program, the non-response rate ranged from 0% to 40.2% for gender, and from 0% to 81.9% for sexual orientation. Discussion: Avon BHOP programs were able to collect sensitive information on client gender and sexual orientation during the first three months during which this information was requested. Despite concerns expressed among staff, overall response rates were high and rates of “unknown” (which may indicate that a staff person did not ask a client to complete the question) were low. Beneficiaries receive a quarterly summary of their own CIF data, which allows program staff to review client responses and ensure that client needs are met in a culturally sensitive manner. The Avon BHOP is committed to supporting diversity among funded programs; requesting data on client gender and sexual orientation may help improve services for LGBT clients by giving them a voice and reducing stigma. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-14.

The Impact Of Gender And Dress On Choice Of CPAs

The study investigated the impact of client gender, CPA gender, and CPA dress on the likelihood of hiring a CPA for professional services. Subjects perceptions of CPAs in regard to nine variables, such as expertise, credibility, and professionalism, were collected and analyzed. The results indicate that perceptions of friendliness were significantly affected by both client and CPA gender, while professionalism was significantly affected by the dress. Moreover, interactions of the three main effects were significant.

The U.S. Domestic Workforce Use of Employee Assistance Support Services: An Analysis of Ten Years of Calls

Archival data from 1999 to 2010 (excluding 2001) related to 90,000 cases presented to an external Employee Assistance Program provider were analyzed with respect to frequency of presenting problems. The authors examined differences in frequencies across gender, sector, and relationship of client with sponsoring organization. Significant differences were found between women and men. In addition, the authors provide demographic breakdowns to substantiate use by demographics. It is argued that given the noteworthy sample size and longitudinal nature of the data archive, commensurate value of the employee assistance service can be inferred. Implications for the future of the employee assistance profession are addressed.

Impact of Gender, Race, And Dress On Choice of CPAs

<span>The study investigated the effect of client gender, CPA ethnic origin, CPA gender and CPA dress on the likelihood of hiring a CPA. Subjects perceptions of CPAs for important determinants of the hiring decision were collected and analyzed. Results indicate that Caucasian CPAs were rated highest on most dimensions including likelihood-of-hiring and African-American CPAs were rated lowest. While the dress of Caucasian CPAs did not seem to matter, casually dressed minority CPAs were rated significantly lower than formally dressed minority CPAs.</span>

Substance abuse professionals’ attitudes regarding harm reduction versus traditional interventions for injecting drug users

Investigations of attitudes regarding harm reduction have usually assessed the acceptance of specific interventions, but investigators have rarely compared the ratings of harm reduction interventions to the ratings of traditional interventions or tested whether the perceived value of harm reduction interventions varies as a function of client characteristics. Therefore, using a vignette describing an injecting drug user, we tested whether clinical administrators of substance abuse treatment agencies and licensed chemical dependency counselors rated the beneficence (on a 7-point scale from “Extremely Harmful” to “Extremely Beneficial”) of injection-related harm reduction interventions (e.g., cleaning needles with bleach, muscling, non-injecting routes of administration) differently from the beneficence of traditional treatment interventions (e.g., self-help group, individual and group counseling), and whether client gender and human immunodeficiency virus (HIV) status impacted such ratings. In Study One, a set of traditional interventions was rated as more beneficial than a set of harm reduction interventions. Study Two showed that a subset of harm reduction interventions designed to prevent transmission of blood-borne diseases was seen as more beneficial than a subset designed to prevent overdose fatalities. Clinical administrators rated harm reduction as more beneficial for HIV-negative clients than for those whose HIV status was described as unknown (Study One), but there was no impact of HIV status on perceived beneficence of harm reduction among licensed chemical dependency counselors (Study Two). Gender of the vignette client did not influence the beneficence ratings in either sample.

Issues in using interpreters in therapeutic work with refugees. What is not being expressed?

‘Interpreting’ could be thought about as a legal equal opportunities or human rights issue. Whereas interpreters are likely to focus on the linguistic issues, and will be aware of the technical complexities of their work. Clinicians may worry about the impact on the therapeutic relationship of the interpreter's presence, how this will be managed and how it may depend on the match or mismatch of such factors as the client's gender, age and first or other language. This paper considers the issue on each of these levels to reveal the complexities and dilemmas of effective clinical work with interpreters, but also what can be achieved: the multiple layers of meaning concerning the client's experience and communication which can be elicited through effective working between interpreter and clinician.

Recovery Among Youths Referred to Outpatient Psychotherapy: Reliable Change, Clinical Significance, and Predictors of Outcome

Although psychotherapy for children and adolescents is efficacious when administered in university-based research settings, relatively little data support its effectiveness in the community. This study examined the outcomes of 35,429 youths (5–17 years of age) referred to public outpatient psychotherapy programs in Ohio. All youths showed statistical elevations in symptom severity and were assigned at least one DSM-IV diagnosis at intake. Parents, therapists, and adolescents completed the same norm-referenced symptom severity measure at intake and at 3 month intervals until termination. One year after intake, approximately 55% of youths showed statistically reliable symptom reduction whereas 8% showed reliable symptom exacerbation. Approximately one-third of the sample showed both reliable and clinically significant improvement. Outcomes varied significantly by informant, client age, and client gender. Results indicate that many youths improve during the course of therapy but most remain symptomatic 1 year after intake.

Family intervention for co-occurring substance use and severe psychiatric disorders: Participant characteristics and correlates of initial engagement and more extended exposure in a randomized controlled trial

Clients with severe mental illness and substance use disorder (i.e., dual disorders) frequently have contact with family members, who may provide valuable emotional and material support, but have limited skills and knowledge to promote recovery. Furthermore, high levels of family conflict and stress are related to higher rates of relapse. The present study was a two-site randomized controlled trial comparing a comprehensive, behaviorally-based family intervention for dual disorders program (FIDD) to a shorter-term family psychoeducational program (FPE). The modal family was a single male son in his early 30s diagnosed with both alcohol and drug problems and a schizophrenia-spectrum disorder participating with his middle-aged mother, with whom he lived. Initial engagement rates following consent to participate in the study and the family intervention programs were moderately high for both programs (88% and 84%, respectively), but rates of longer term retention and exposure to the core elements of each treatment model were lower (61% and 55%, respectively). Characteristics of the relatives were the strongest predictors of successful initial engagement in the family programs with the most important predictor being relatives who reported higher levels of benefit related to the relationship with the client. Subsequent successful exposure to the family treatment models was more strongly associated with client factors, including less severity of drug abuse and male client gender. The results suggest that attention to issues of motivating relatives to participate in family intervention, and more focused efforts to address the disruptive effects of drug abuse on the family could improve rates of engagement and retention in family programs for dual disorders.

The Impact of Client and Auditor Gender on Auditors’ Judgments (Retracted)

SYNOPSIS: This study assesses the influence of client gender and auditor gender on auditors’ judgments. In an experimental task, a client offers unverified explanations as to why the auditor’s initial proposed adjusting journal entry (AJE) to lower the inventory value should not be recorded. The design includes one randomly manipulated variable (client gender: male or female) and one measured variable (auditor gender: male or female). The dependent variable assesses the influence of the client’s explanations on the auditor’s final proposed AJE recommendation. The results indicate that both male and female auditors exhibited a male favorability; that is, they were persuaded more by a male than female client to change their initial AJE recommendation. Furthermore, female auditors were more influenced by a male client and less influenced by a female client than male auditors. Using an expert panel’s consensus opinion as a benchmark for the “best” solution, the male auditors were more accurate than female auditors, irrespective of client gender. Additional research will aid in substantiating, determining the limits, and generalizing the findings.

Therapists’ Assessment and Treatment of Internet Infidelity Cases

In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists' age, therapists' gender, how religious therapists reported they were, and the extent of therapists' personal experience with infidelity.

Religiosity as a Predictor of Successful Post-Treatment Abstinence for African-American Clients

ABSTRACT The purpose of this study was to examine the role of religiosity as a predictor of post-treatment abstinence. A sample of 96 African-American clients receiving community-based outpatient alcoholism treatment were interviewed at treatment entry and three months later. Achieving complete abstinence was predicted from client gender and 17 other predictors, including 6 substance-related factors, 7 psychosocial and health variables, and 4 religiosity/spirituality measures. Bivariate analyses showed that abstainers drank less prior to treatment, had more prior formal treatment and AA involvement, practiced their religion more regularly, and scored higher on measures of both spirituality and extrinsic religiosity. In addition, women were more likely to achieve abstinence. Forward entry binary logistic regression revealed that, controlling for client gender and pre-treatment consumption, only regular practice of one's religion/faith significantly predicted abstinence. Recommendations include (1) the need for research to evaluate if the current findings can be generalized across race/ethnicity and religious affiliation and (2) directing more attention to clients' religiosity in alcoholism treatment.

The Application of Cognitive-Behavioral Therapy for Psychosis in Clinical and Research Settings

This study compared the practice of cognitive-behavioral therapy (CBT) for psychosis across research and routine clinical settings. An observer-rated adherence measure was used to compare the content of 40 therapy sessions of clients with positive psychotic symptoms. Twenty therapist-client dyads came from a research setting in the United Kingdom and 20 from three clinical settings, two in the United Kingdom and one in the United States. In the research setting CBT was provided by research clinical psychologists and trained local therapists. In the clinical settings CBT was part of a case management service by trained therapists. Therapist adherence to CBT for psychosis did not differ between the research and clinical settings. However, clinicians in the research settings scored significantly higher on items for schema work (z=-1.98, p<.05), relapse prevention interventions (z=-2.08, p<.05), and formulating a model of relapse (z=-2.61, p<.01). CBT for psychosis conducted in clinical settings was more strongly characterized by assessment of symptoms and work on coping strategies and less so by relapse prevention and schema-level work. Relapse prevention interventions and schema work could be considered more challenging for therapists to undertake. The findings suggest that therapists working in routine clinical settings are able to establish good therapeutic relationships with people with psychosis and to work on assessing and coping with their psychotic symptoms. However, some therapeutic approaches may be more challenging in this context.

Primary alcohol versus primary drug use among adolescents: An examination of differences

Examination of differences between primary alcohol and drug abusing adolescents can provide valuable direction to intervention efforts, though little research in this area has been conducted. The current study compared primary alcohol and primary drug abusing runaway adolescents who were randomly assigned to family therapy or treatment as usual. Baseline differences, as well as response to treatment, were examined separately for alcohol and drug use and by gender. Although few baseline differences were found, hierarchical linear modeling indicated that alcohol and drug abusing male and female adolescents responded differently to therapy. Primary drug using males showed poorer alcohol use outcomes than did primary alcohol abusers. Specifically, alcohol use increased for primary drug using males receiving family therapy, while drug use decreased in all groups. Findings suggest that alcohol and drug use outcomes might be improved at treatment planning through consideration of client's gender and primary alcohol versus drug use.