Clinical Psychologists’ Perceptions of Persons with Mental Illness

Many people have fabulous relationships with their psychologists. They feel supported, understood, well-liked. But there are also those who feel a little uneasy. Research by Lynn Servais and Stephen Saunders of Marquette University in Milwaukee, Wisconsin may have unearthed one of the reasons why.

Some psychologists have a hard time connecting with people with mental illness, especially when they have diagnoses of borderline personality disorder or schizophrenia.

Most psychologists start off by evaluating people — that’s what a diagnosis is. Diagnoses, by their very nature, look at what’s not working. Most would agree that’s a good thing — if you don’t know where the problem is, it’s hard to fix it.

On the other hand, psychologists are people. Like you and me, they have personal likes and dislikes; perhaps they are even not so different from the employer who, research has shown, often decides who to hire within the first few minutes of meeting a prospective employee.

What Servais and Saunders looked at specifically was the concept of “disidentification” which

involves the process of characterizing persons with mental illness as easily recognizable and different from “normal” individuals while characterizing oneself as normal and not susceptible to mental illness (Cumming & Cumming, 1957; Mahatane & Johnston, 1989).

This is similar to the concept of othering you may have heard of and which often comes up when people talk about ethnocentrism (e.g. “I don’t know that I want to live in Surrey; there are so many East Indians there. They are just… different.”)

Disidentification can help boost a person’s self esteem; from my research in chronic pain, I have also formed the hypothesis that it goes even further — there may be a very primitive sense that by distancing oneself from someone who is “afflicted”, one could avoid “catching” an illness. (Of course this goes on at an unconscious level; very few psychologists would consciously hold such an irrational thought.)

The researchers analyzed surveys returned by 306 psychologists. It’s interesting to note that 95% of them were Caucasian; 83% saw mostly mildly or moderately “disturbed” clients.

Psychologists tended to see themselves as quite dissimilar to persons with borderline features and persons with schizophrenia. Borderlines tended to be experienced as quite dangerous and as least desirable of the five classes of people psychologists were asked to rate (themselves, a member of the public, a person with moderate depression, a person with borderline features, and a person with schizophrenia.

What is the effect of such disidentification? The researchers speculate (and find some basis for it in already existing research) that such perceptions detract from the therapist-patient relationship; could dissuade people in need of psychological services from seeking help; make it difficult for the therapist to feel and express empathy and genuine concern; could decrease the therapist’s belief in their clients’ recovery; and may model inappropriate behaviour.

Where does all of this come from? The need to keep up one’s self esteem and a fear of “infection” were already mentioned. Other sources are professional training, especially when it overemphasizes the psychologist as an expert. Personally, I also think that a focus on diagnosis which, as I mentioned earlier on, focuses on what’s wrong, is unhelpful. Additionally, I wonder whether the fact that 95% of those surveyed were Caucasian had something to do with it; conceivably, non-Caucasians may be more sensitive to the detrimental effects of disidentification.

Lastly, and most importantly, how can psychologists be helped to see clients with mental illness as more like themselves, less “other”?

• Psychologists could take a more holistic view of their patients and focus not only on their problems but also on their strengths. Solution focused approaches such as advocated by Scott Miller de-emphasize diagnosis and concentrate on concrete, future-oriented solutions, with great success.
• Universities and other training bodies need to a) specifically address stigmatization and stereotyping; and b) help psychologists form the belief that individuals who have a mental illness can indeed recover.
• Persons with mental illness could be used as trainers for psychologists.

Reference

Servais, L., & Saunders, S. (2007). Clinical psychologists’ perceptions of persons with mental illness. Professional Psychology: Research and Practice, 38 (2), 214-219 DOI: 10.1037/0735-7028.38.2.214