College students' preferences for therapist attire, gender, and office decor
PREFERENCES FOR THERAPIST APPEARANCES 1 Table of Contents Abstract 3 Introduction 4 Method 30 Results 35 Discussion 42 References 55 Table 1: Participants' Race within the Sample 63 Table 2: Participants' Marital Status within the Sample 64 Table 3: Participants' Family Income within the Sample 65 Table 4: Participants' Current Education Level within the Sample 66 Table 5: Scale Descriptive Statistics for SBQ and CRF 67 Table 6: CRF (Barak & LaCrosse, 1975) Subcategories Pearson Correlations 68 Table 7: Descriptive Statistics for Variables in Multivariate Analyses for Expertness Subcategory of the CRF 69 Table 8: Descriptive Statistics for Variables in Multivariate Analyses for Trustworthiness Subcategory of the CRF 70 Table 9: Descriptive Statistics for Variables in Multivariate Analyses for Attractiveness Subcategory of the CRF 71 Table 10: Multivariate Statistics 72 Appendix A: Female Therapist, Casual Attire, Casual Office - Service Brochure 73 Appendix B: Female Therapist, Casual Attire, Formal Office -Service Brochure 74 Appendix C: Female Therapist, Formal Attire, Casual Office - Service Brochure 75
PREFERENCES FOR THERAPIST APPEARANCES 2 Appendix D: Female Therapist, Formal Attire, Formal Office - Service Brochure 76 Appendix E: Male Therapist, Casual Attire, Casual Office - Service Brochure 77 Appendix F: Male Therapist, Casual Attire, Formal Office - Service Brochure 78 Appendix G: Male Therapist, Formal Attire, Causal Office - Service Brochure 79 Appendix H: Male Therapist, Formal Attire, Formal Office - Service Brochure 80 Appendix I: Counselor Rating Form (Barak & LaCrosse, 1975) 81 Appendix J: Service Brochure Questionnaire (SBQ) 82 Appendix K: Demographics Questions 83 Appendix L: Informed Consent 84 Appendix M: Debriefing Form 85
PREFERENCES FOR THERAPIST APPEARANCES 3 Abstract Previous research has explored factors of professional image that may influence potential clients' perceptions of and preferences for clinicians, such as therapist attire, gender, and office decor (e.g., Amira & Abramowitz, 1979; Stillman & Resnick, 1972); however, this research is limited and outdated. It was predicted that both main effects and interactions of therapist attire, gender, and office decor would be found based on ratings of the counselors. It was also hypothesized that participants who had considered seeking counseling would provide higher ratings of the counselors as compared to those individuals who had not considered counseling. Surveying undergraduate and graduate students (N = 169), results suggest that female therapists in casual attire and male therapists in formal attire (as depicted in a series of service brochures) were found to be more expert and trustworthy. Female therapists were also found to be more attractive than male therapists, and therapists in formal attire were found to be more expert than therapists in casual attire. No significant differences were found for office decor. Lastly, results indicate that no significant differences of overall perceptions of therapists were found between those individuals who had considered seeking counseling and those individuals who had not. Consequently, clinicians are encouraged to consider the implications of these results when employing marketing practices and establishing first impressions with clients. Additionally, these results may benefit training programs of clinicians.
PREFERENCES FOR THERAPIST APPEARANCES 4 College Students' Preferences for Therapist Attire, Gender, and Office Decor When the word psychotherapy is mentioned, one may immediately experience a variety of mental images, including a professionally decorated office with a couch and a professionally dressed man holding a clipboard in one hand and his spectacles in the other. However, others may simply visualize an image of Sigmund Freud, an icon in the field of psychology. Although many decades have past since Freud's time, and psychotherapy has gone through drastic changes, these images still appear to be prominent. However, to what extent do mental health professionals continue to contribute to this stereotype? Statement of the Problem Given the paucity of research and availability of academic textbooks providing beginning clinicians with minimal direction regarding developing marketing approaches (e.g., Pearson, 2009), it seems essential that additional attention should be paid to this important aspect that appears to influence one's success as a clinician working in private practice (Pope & Vasquez, 2005). Previous research has found limited consensus regarding preferences for these aspects of professional image, such as attire and office decor (e.g., Amira & Abramowitz, 1979; Stillman & Resnick, 1972; Subich, 1983). Further, this body of literature is dated, making it difficult to apply the findings in present practice settings. Thus, the present study will aid in updating and further developing the previous literature as well as provide professional image implications for clinicians. The current study will explore the perceptions of and preferences for the elements that contribute to clinicians' physical images, including therapist attire, therapist sex, and office decor.
PREFERENCES FOR THERAPIST APPEARANCES 5 Perceptions of the Field As compared to other professions, psychology appears to be misunderstood and misperceived by the public (e.g., Bram, 1997). The mystique of psychotherapy, inaccurate media portrayals, and other factors may affect how the public views psychologists. A review of the literature reveals that perceptions of the fields of psychology and psychiatry and various types of mental health professionals have been created in diverse ways, including through the representations that exist within the media (e.g., Bram; Dacy & Brodsky, 1992; Gaddes, 1960; von Sydow & Reimer, 1998). In addition, it seems that these perceptions of the field may influence whether individuals decide to enter treatment (Tinsley & Harris, 1976), which may be cause for concern for those individuals who may be suffering but fear seeking treatment. The study of exploring the public's perceptions of the field of psychology dates back many decades, and, although it seems that there may be a trend suggesting that the public's perception is becoming more accurate and more positive, there still may be a long way to go. When the public's view of psychology was initially examined, it was found that most individuals were unclear about what psychology is and the roles of psychologists (Guest, 1948; Steer & Cox, 1957). Additionally, during this time, it seems that the public's perception of psychologists may have been neutral, if not somewhat negative, rather than valuing the profession (Steer & Cox). However, it was not soon after when these perceptions became more positive. Further exploring the public's attitudes toward the caring and nurturing professions, Nunnally and Kittross (1958) found that all of the professions appeared to be rated somewhat positively; however, those professions dealing with physical problems (e.g., physician) were rated more positively
PREFERENCES FOR THERAPIST APPEARANCES 6 than those professions working with mental difficulties (e.g., psychologist). In addition, the term "mental patient" was found to be viewed somewhat negatively (Nunnally & Kittross). As time progressed, research revealed that the public's perception appeared to become more positive; however, there still seemed to be a certain amount of skepticism regarding the personal benefits that may be obtained from seeking treatment (Tinsley & Harris, 1976). Further, inaccurate or confused views of the field still seemed to be present (e.g., lack of scientific basis; Webb & Speer, 1986). It was not until the 1990s that the public's perceptions of psychology, psychotherapy, and psychologists appeared to not only be positive but also somewhat accurate (Furnham & Wardley, 1990; Furnhma, Wardley, & Lillie, 1992; Murstein & Fontaine, 1993; Wong, 1994). It seems that the public's perceptions of mental health professionals and the field of psychology may be influenced by a variety of factors. In particular, it appears that differences among the public may impact the way in which individuals view mental health professionals. More specifically, research has shown that older adults appear to be more skeptical about the process and benefits of psychotherapy (Furnham & Wardely, 1990; Wong, 1994); however, von Sydow and Reimer (1998) suggest that this may simply be a cohort effect, rather than actual chronological age. Further, Furnham and Wardley found that individuals who were better educated believed less in the process of psychotherapy. Moreover, there appears to be less consistent results regarding the influence of sex in regard to perceptions of mental health professionals. Some research has suggested that men are more realistic about the possible gains that they could receive from therapy (Wong, 1994), whereas others have indicated that women perceive mental health professionals more negatively (Schneider & Watkins, 1990). However, others
PREFERENCES FOR THERAPIST APPEARANCES 7 have suggested that men and women tend to simply have different views of the roles of mental health professionals and the benefits that can be gained from psychotherapy (von Sydow & Reimer). Furthermore, it seems that individuals who have considered seeking therapy (Richards & Renjilian, 2009) and those who have previous therapy experience (Bram, 1997) may be significantly influenced in their perceptions of mental health professionals. Research suggests that individuals with psychological experience may hold less optimistic views of psychotherapy, but these views may be more realistic (Furnham & Wardley; Wong). Additionally, it appears that the portrayal of mental health professionals in the media may play a significant role in how the public may perceive the field (e.g., Orchowski, Spickard, & McNamara, 2006; von Sydow & Reimer, 1998). Notably, the way in which the media portrays mental health professionals appears negative and inaccurate (e.g., Orchowski, Spickard, & McNamara). For example, these authors discuss some of the common personas that are found in the media, including the odd and eccentric psychotherapist who does not appear to be effective and the psychotherapist who ignores the power differential within the therapeutic relationship and falls in love with his patient (Orchowski, Spickard, & McNamara). Consequently, this negative and inaccurate portrayal in the media may have aided in the public's inaccurate views of mental health professionals that have been observed throughout the last several decades. However, recent research demonstrates some promising results, suggesting that the public may be aware of the inaccuracy of the media's portrayals of mental health professionals (Richards & Renjilian, 2009).
Just as the roles and ethics of mental health professionals are inaccurately portrayed in the media (Cannon, 2008; Orchowski, Spickard, & McNamara, 2006), the physical image and appearance of mental health professionals also appear to be illustrated in stereotypic ways (von Sydow & Reimer, 1998). In their meta-analytic review, von Sydow and Reimer identified four types of mental health professionals based on the media's portrayals: the Freud type, "bearded, gray-haired, middle-aged males with glasses, dressed conservatively, possibly with a balding pate;" the Neurotic type, "unshaven, unkempt, neglected, often has longer tousled hair and unbecoming clothing;" the Ecological type, "longer hair, full beard, Birkenstock sandals, hand-knit pullovers.. .no makeup, casual clothing, long skirt or jeans;" and the Intellectual type, "slim, wears gold- or steel-rimmed spectacles and correct, stylishly elegant suit" (p. 473). They also note that cartoons play a significant role in depicting these images in the media. Von Sydow and Reimer indicate that the majority of mental health professionals illustrated in the media are men, and, when women are depicted in such roles, they tend to been seen as sex objects or unstable. The therapeutic office setting tends to most commonly be illustrated with a couch, tables, chairs, and a hanging diploma (von Sydow & Reimer). Yet, research shows that the public does not believe that most clients lie on a couch during therapy (Furnham & Wardley, 1990). In conclusion, it appears that the public's perceptions of mental health professionals and the field of psychology has dramatically changed over that last 60 years, becoming more positive and accurate; however, it seems that a variety of variables may still be influencing the public's views. Although the public appears to be more
PREFERENCES FOR THERAPIST APPEARANCES 9 comfortable with the field, mental health professionals still have obstacles to face in order to professionally market themselves to the public in positive and accurate ways. Clinician Characteristics Clinician attire. An examination of the literature reveals little consensus regarding the type of counselor attire that is preferred by clients or potential clients. More specifically, researchers have found preferences for professional attire (e.g., Dacy & Brodsky, 1992) and casual attire (e.g., Roll & Roll, 1984). Other researchers have found no difference in preference (e.g., Stillman & Resnick, 1972). Finally, others have found that the preference for a specific type of attire may be dependent on other variables (e.g., Hubble & Gelso, 1978). When exploring the effects of therapist attire, Dacy and Brodsky (1992) examined three styles of attire: informal, casual, and formal. The informal condition was defined by jeans and a shirt for men and women. The casual condition was represented with dress slacks and a sweater for men and dress slacks, a blouse, and a jacket for women. Finally, the formal condition was defined by a dark business suit for both sexes. Dacy and Brodsky presented photographs representing each condition to undergraduate students. These participants were asked to rate the individuals in the photographs on skills-centered traits (i.e., expertise, knowledge, credibility, and organization) and relationship characteristics (i.e., sympathetic attitudes toward clients' problems, trustworthiness, friendliness, and attractiveness; Dacy & Brodsky, p. 487). Overall, these researchers found that the photographs representing the formal condition were rated most positively across all traits and characteristics. It was, therefore, concluded that formal attire is preferred when considering first impressions of therapists on their clients.
PREFERENCES FOR THERAPIST APPEARANCES 10 Schmidt and Strong (1979) investigated qualities that would be considered characteristic of an "expert" or "inexpert" male counselor. Although type of counselor attire was not a direct variable that was measured, it was found that the "expert" counselor was seen as having ".. .a neat appearance but is not 'stuffy'" (Schmidt & Strong, p. 116). Consequently, the results suggest that the "inexpert" counselor ".. .is dressed so casually that the 'student thinks not much help is to be offered'" (Schmidt & Strong, p. 117). Even though minimal discussion regarding counselor attire is provided, it can be suggested that attire appears to play a role in how counselors' "expertness" is viewed. Other research has shown that casual attire appears to be viewed more positively. More specifically, Roll and Roll (1984) examined the influence of counselor attire on college students' perceptions of various counselor characteristics. Unlike Dacy and Brodsky (1992), Roll and Roll had two conditions, formal and informal attire. In the formal attire condition, the counselor wore a beige suit, hose, and dress shoes, whereas the informal attire condition had a counselor wearing jeans and a beige sweater. In both conditions, only female counselors were used (Roll & Roll). In each condition, college students attended a group therapy session in which relaxation techniques were taught, and after the session, the participants rated the counselor on various characteristics (Roll & Roll). Results suggest that although no differences were found for the appropriateness of the counselor's attire, the informally dressed counselor was viewed as significantly more expert, trustworthy, and helpful as compared to the formal attire condition (Roll & Roll). The authors suggest that because the participants were college students, they may have
PREFERENCES FOR THERAPIST APPEARANCES 11 viewed the informally dressed counselor as being more similar to them and, therefore, viewing her more positively. Barak, Patkin, and Dell (1982) also explored the factors that influence ways in which counselors are perceived by potential clients. These researchers had two attire conditions: formal (i.e., dark suit and tie) and casual (i.e., open collar shirt and slacks) attire. Furthermore, a male counselor was used for all conditions. Participants viewed videotaped interview sessions representing one of the two attire conditions (Barak et al.). The results indicate that the counselor in the formal attire condition was rated more positively in regard to expertness; however, the counselor in the casual attire condition was perceived as more attractive (Barak et al.), suggesting that the type of counselor attire may have various impressions on clients. Further, the researchers note that attire was not found to be as influential as compared to other variables (e.g., nonverbal behaviors). Further investigating the influence of counselor attire, Stillman and Resnick (1972) explored the perceived attractiveness of the counselor and the willingness to disclose to the counselor. Two conditions were used: professional (i.e., jacket, tie, and dark slacks) and casual (i.e., sport shirt and casual slacks) attire. Participants were interviewed by a male counselor in one of the two conditions (Stillman & Resnick). Unlike previously reviewed research (e.g., Dacy & Brodsky, 1992; Roll & Roll, 1984), Stillman and Resnick found that there were no differences between professional and casual attire of counselors in regard to perceived attractiveness and client disclosure. These researchers conclude that the interaction of other factors may aid in the influential nature of counselor attire.
PREFERENCES FOR THERAPIST APPEARANCES 12 As Stillman and Resnick (1972) suggested, other research has found that additional variables have been shown to interact with counselor attire to influence the perceptions of counselors. Hubble and Gelso (1978) explored three counselor attire conditions: traditional, casual, and highly casual. The traditional attire condition was represented by a sport coat, tie, and dark slacks. The casual attire condition was defined by an open collar sport shirt and casual pants. Finally, the highly casual attire condition was represented by a sweatshirt and jeans (Hubble & Gelso). Female participants were interviewed by male counselors from one of the three conditions. Although the results suggest that a significant difference in participant anxiety was found between the casual and the highly casual conditions, it seems that these results are moderated by participants' dress preference (Hubble & Gelso). More specifically, it was found that participants prefer counselors who dress "one step or level more formal than the clients' own dress level" (Hubble & Gelso, p. 584). These researchers suggest that this enables the counselor to demonstrate a balance of empathy and expertness. In summary, the literature indicates a lack of developed consensus regarding the perceived preference for counselor attire. It appears that preferences have been found for both professional (e.g., Dacy & Brodsky, 1992) and casual (e.g., Roll & Roll, 1984) attire. Further, researchers have found no differences in preference (e.g., Stillman & Resnick, 1972), while others have suggested that additional variables, besides attire, may influence such preferences (e.g., Hubble & Gelso, 1978). In addition to there being a paucity of literature that examines the preference of counselor attire, the available literature that does explore such preferences is outdated, causing a difficulty in generalizability to current practicing clinicians. Further, significant trends in fashion and
PREFERENCES FOR THERAPIST APPEARANCES 13 the meanings behind this fashion for men and women may also have changed throughout the decades, resulting in other factors to consider when exploring the previous literature regarding preferences for counselor attire. There also appears to be a significant variation in methodology used in the research that is available, which is another potential source for such varied results. Because of this, there appears to be a need to further update the current literature. Clinician gender. A review of the previous literature indicates that, similar to the aforementioned variables, there does not appear to be a consensus regarding the preference for counselor gender. More specifically, it seems that some researchers have found a preference for female counselors (e.g., Carter, 1978), whereas others have suggested that there are no differences in preference for counselor gender (e.g., Subich, 1983). Additionally, other researchers have found that the preference for counselor gender may be dependent on other variables (e.g., Lee, Hallberg, Jones, & Haase, 1980). Lastly, it is important to note that, as the research regarding this topic appears to have expanded, an exploration regarding preferences for counselor sex roles has developed (e.g., Blier, Atkinson, & Geer, 1987). Carter (1978) explored the preferences for counselor gender. Participants listened to audiotape recordings of a man or woman providing an introduction of him- or herself working in a university counseling center (Carter). In addition to listening to the recordings, participants were provided attractive or unattractive pictures to match the person in the recording. Results indicate that female counselors had significantly more positive ratings on a variety of characteristics (e.g., warmth, trustworthiness; Carter). The author suggests that since the female counselors were perceived to possess more
PREFERENCES FOR THERAPIST APPEARANCES 14 positive characteristics then a significant preference for female counselors may exist independently of other variables (e.g., attractiveness). Dacy and Brodsky (1992) found results that appear to be consistent with Carter's (1978) findings. As mentioned previously, Dacy and Brodsky asked participants to view a variety of photographs that depicted both men and women dressed in a variety of attire styles. Further, participants were asked to imagine that the individuals in the photographs were potential therapists with whom they may engage in treatment (Dacy & Brodsky). The results suggest that the female therapists were rated more positively on all characteristics as compared to the male therapists. Additionally, the female therapists were rated significantly better than the male therapists on expertise, knowledge, sympathy, and trustworthiness (Dacy & Brodsky). Further, these authors suggest that because of social beliefs that women are viewed as the more nurturing sex, this may have influenced the results that were found. Contrary results have also been published on this topic. Subich (1983) explored preferences for male and female counselors and found no such significant preferences. More specifically, participants were asked to complete a measure assessing their expectations about an initial counseling interview, and the instructions specified the sex of the counselor on whom the participants would interact (Subich). Results indicate that no significant differences were found for counselor sex among the participants. An important caveat is that a trend, although not significant, was found for participants having more positive expectations about their counseling experience when the sex of the counselor was not specified in the instructions (Subich). The author speculates that because of these findings, the results may be more of a function of methodological
PREFERENCES FOR THERAPIST APPEARANCES 15 limitations rather than actual results. More specifically, she suggests that if the participants were to see or meet the counselors, rather than read about them, a preference for counselor sex may be found to be more significant (Subich). Exploring participants' expectations of male and female counselors, Hardin and Yanico (1983) found similar results as Subich (1983), indicating that no differences between male and female counselors were found. Participants were given a questionnaire, which instructs individuals to imagine an initial counseling session to assess their beliefs about expectations of counseling. The additional directions specified whether the session was being conducted by a male or female counseling psychologist (Hardin & Yanico). The results indicate that, although differences in expectations were found for sex of participant, no significant differences in expectations were found based on sex of counseling psychologist. Hardin and Yanico suggest that the results imply that the expectations about counseling may be more influenced by the potential clients' expectations rather than the sex of the counselor. Additional research has found preferences for counselor gender to be dependent on other variables. Boulware and Holmes (1970) examined these preferences and found that a preference for a male or female therapist was contingent on variables related to the client. More specifically, the researchers presented the participants with four pictures containing two men and two women, and then asked the participants to rate how much they would prefer to talk with one of the individuals pictured about either a personal or vocational problem (Boulware & Holmes). The results initially suggest that male therapists were preferred over female therapists. However, when considering the types of presenting problems, male therapists were preferred for seeking services for vocational
PREFERENCES FOR THERAPIST APPEARANCES 16 problems, and no significant difference in preference was found for seeking services for personal problems (Boulware & Holmes). In addition, when further examining the results, the researchers found that male participants appeared to prefer male therapists for both types of presenting problems, although this was not found to reveal statistically significant results. On the other hand, female participants seemed to prefer male therapists for vocational problems and female therapists for personal problems (Boulware & Holmes). Similar to the Boulware and Holmes (1970) study, Lee et al. (1980) found that preference for counselor gender was dependent on presenting problem of the clients. More specifically, Lee and colleagues presented participants with videotaped sessions involving a client presenting with vocational concerns or a client presenting with child- rearing concerns. Each presenting problem was videotaped once with a male counselor and once with a female counselor (Lee et al.). In addition, the participants were asked to complete an assessment regarding their views of the counselors. The results indicate that there was no overall difference in perceived credibility of the counselors based on counselor sex (Lee et al.). However, the results also suggest that male counselors were preferred for presenting problems regarding vocational concerns, whereas female counselors were preferred for concerns dealing with child-rearing problems (Lee et al.). These authors suggest the significant influence that presenting concerns appear to have on preference for counselor gender, although perceived credibility does not seem to differ among male or female counselors. Just as Boulware and Holmes (1970) and Lee et al. (1980) found that presenting problem appears to be influential in determining sex of counselor preference, Bernstein,
PREFERENCES FOR THERAPIST APPEARANCES 17 Hofmann, and Wade (1987) found a similar trend; however, these authors also found additional variables that may be influential in determining such preferences. Participants were asked to complete measures that assessed their preferences for a variety of counselor characteristics as well as measures regarding their own characteristics (Bernstein et al.). The results suggest a trend to prefer male counselors for vocational/academic (i.e.,".. .career concerns, study habits and skills...;" Bernstein et al., p. 21) and social/interpersonal problems ( i.e.,. .relating to people, meeting new people, racial issues...;" Bernstein et al., p. 21) and to prefer female counselors for personal/intimate problems (i.e.,".. .problem with a spouse or lover, problem with parents, loneliness, and sexual issues...;" Bernstein et al., p. 21). Additionally, the results indicate that those participants who were determined androgynous and had previous experience in counseling appeared to have no preference for sex of counselor (Bernstein et al.). Although there appeared to be a trend to prefer male counselors, these authors suggest the important influential role that the participants' characteristics played on their preferences or lack there of. While some researchers explored preferences for counselor gender, others have investigated the impact of sex roles as influential in potential clients' preferences for counselors. Blier and colleagues (1987) examined potential clients' willingness to seek counseling based on their perceptions of various counselor characteristics. Participants were asked to review descriptions of counselors that identified the counselors' sex (i.e., male or female) and sex role (i.e., feminine, masculine, or androgynous) and then asked to indicate their willingness to seek services from each counselor for a variety of listed problems. Results suggest that there was no difference in preference of counselor sex in
PREFERENCES FOR THERAPIST APPEARANCES 18 regard to participants' willingness to seek counseling. However, results indicate that counselor sex role was significantly influential in participants' preference, but this was dependent on presenting problem (Blier et al.). More specifically, participants indicated that they would prefer to seek services from a feminine counselor for personal problems, a masculine counselor for assertiveness problems, and a masculine or androgynous counselor for academic problems (Blier et al.). Additionally, Banikiotes and Merluzzi (1981) examined the impact that sex roles of counselors had on female participants in regard to their preferences and feelings of comfort in seeking counseling for certain problems. Female participants were asked to review descriptions of four types of counselors: traditional female, traditional male, egalitarian female, and egalitarian male (Banikiotes & Merluzzi). The description of the traditional counselors indicated that they participated in activities that were considered typical for their sex, enjoyed activities with their same-sex child, and met their spouse in an "unequal status situation" (p. 344). On the other hand, the description of the egalitarian counselors stated that they participated in activities that were not considered to be typical for their sex, enjoyed activities with their children of both sexes, and met their spouse in an "equal status situation" (p. 344). Further, the participants were asked to rate their level of comfort in discussing a variety of listed problems with each of the types of counselors described and to complete a measure to assess their perceptions of the counselors described (Banikiotes & Merluzzi). The results indicate that participants felt more comfortable discussing various problems with female counselors and egalitarian counselors. Moreover, participants perceived female egalitarian counselors as expert and viewed female traditional counselors as least expert. Additionally, participants also