Systematic review
Objectives. This systematic review examined how client characteristics impact upon clinicians’ clinical decision-making, focusing on the characteristics of biological sex, gender identity, and sexual orientation
Method. A systematic literature search of four electronic bibliographic databases (PsycINFO, Scopus, PubMed, Medline, and Web of Science) was conducted. The 47 papers included examined the impact of client biological sex, gender identity, and/or sexual orientation on psychological therapists’ decision-making. The review was pre‐registered [CRD42021215865] and followed PRISMA guidelines.
Results. There was mixed evidence for the impact of client gender and sexual characteristics on clinical decision-making. Clinicians’ diagnostic decisions were indicative of gender bias. Likewise, clinicians were more willing to refer and treat females, and gave them a more favourable prognosis. Client sexual orientation did not influence clinicians’ diagnostic decisions. However, clinicians showed a preference for working with lesbian clients compared to heterosexual clients. Moreover, lesbian, and gay clients were rated as having greater relational functioning, motivation for therapy, and need for medication than heterosexual clients
Conclusions. The findings of this review suggest that clinicians hold social biases that influence important aspects of their clinical decision-making. Further research should examine how diverse client gender and sexual identities influence decision-making, particularly related to treatment.
Research project
Objectives. Exposure-based therapies are underutilised by therapists, despite evidence for their crucial role of exposure in treating anxiety. This experimental study explored the impact of clinician and client characteristics on clinicians’ preference for, and reported use of, imaginal exposure therapy to treat Post-Traumatic Stress Disorder (PTSD).
Method. 127 qualified and trainee therapists were randomised to one of four conditions in which they were required to indicate how they would treat a client with PTSD, detailed within a clinical vignette. The state anxiety and gender of the client varied across conditions. Participants’ intolerance of uncertainty, likelihood of excluding clients from exposure therapy and negative beliefs about exposure therapy were also assessed.
Results. Clinicians with greater intolerance of uncertainty were more likely to hold negative beliefs about exposure therapy, delay the use of imaginal exposure, and exclude clients from exposure therapy. Clinicians were less likely to plan for imaginal exposure with female clients than they were with male clients.
Conclusions. Clinician and client characteristics impact upon use of imaginal exposure for PTSD. Further research should examine how other specific clinician and client characteristics interact, and impact upon clinical decision-making.
