Reparative therapy and confirmation bias: Langer & Abelson’s 1974 study of clinical bias

Recently, I have been examining the possible role of confirmation bias in the attributions of reparative therapists.  In this post, I look at a classic study of how theoretical persuasion associates with clinical judgment.

Ellen Langer’s and Robert Abelson’s 1974 study* on clinical judgment is an important caution to clinicians about the role of preconceived ideas on diagnosis and attributions about patients. The abstract for the study is presented here:

The effect of labels on clinicians’ judgments was assessed in a 2 X 2 factorial design. Clinicians representing two different schools of thought, behavioral and analytic, viewed a single videotaped interview between a man who had recently applied for a new job and one of the authors. Half of each group was told that the interviewee was a “job applicant,” while the remaining half was told that he was a “patient.” At the end of the videotape, all clinicians were asked to complete a questionnaire evaluating the interviewee. The interviewee was described as fairly well adjusted by the behavioral therapists regardless of the label supplied. This was not the case, however, for the more traditional therapists. When the interviewee was labeled “patient,” he was described as significantly more disturbed than he was when he was labeled “job applicant.”

In addition to ratings of pathology, the authors recorded some of the descriptions of the interview by therapists who were told the interviewee was a job applicant and those who were told he was a patient. The differences are striking. Behavior therapists did not differ much but the psychoanalytic therapists described the job applicants as well adjusted but the same interviewee, when labeled as a patient, was labeled as disturbed. Note these differences from Langer and Abelson’s discussion of their study.

In the study just described, all of the subjects saw the same videotaped interview. Yet when asked to describe the interviewee, the behavior therapists said he was “realistic”; “unassertive”; “fairly sincere, enthusiastic, attractive appearance”; “pleasant, easy manner of speaking”; “relatively bright, but unable to assert himself”; “appeared responsible in interview.” The analytic therapists who saw a job applicant called him “attractive and conventional looking”; “candid and innovative”; “ordinary, straightforward”; “upstanding, middle-class-citizen type, but more like a hard hat”; “probably of lower or blue-collar class origins”; “middle-class protestant ethic orientation; fairly open-— somewhat ingenious.” The analytic therapists that saw a patient described him as a “tight, defensive person . . . conflict over homosexuality”; “dependent, passive-aggressive”; “frightened of his own aggressive impulses”; “fairly bright, but tries to seem brighter than he is … impulsivity shows through his rigidity”; “passive, dependent type”; “considerable hostility, repressed or channeled.”

Note the dramatic differences in descriptions. The same person who was described as well adjusted by analysts who thought they were watching a person applying for a job was described in pathological terms when they thought they were watching a patient being interviewed. Note that an attribution of homosexuality was made by at least one of the analytic therapists.

When reparative therapists say they are not biased when examining the histories of their same-sex attracted patients, I am highly skeptical.

Langer and Abelson describe the potential problem with making attributions based on patient labeling:

In practical terms, the labeling bias may have unfortunate consequences whatever the specific details of its operation. Once an individual enters a therapist’s office for consultation, he has labeled himself “patient.” From the very start of the session, the orientation of the conversation may be quite negative. The patient discusses all the negative things he said, did, thought, and felt. The therapist then discusses or thinks about what is wrong with the patient’s behavior, cognitions and feelings. The therapist’s negative expectations in turn may affect the patient’s view of his own difficulties, thereby possibly locking the interaction into a self-fulfilling gloomy prophecy.

It is not hard to see how a client presenting with “unwanted same-sex attraction” could end up in the kind of self-fulfilling prophecy described by Langer and Abelson. Since reparative therapists believe homosexuality is invariably caused by “gender wounds” early in life, no small amount of effort will be spent to find evidence of them, whether or not they exist.

*Langer, E.J.; & Abelson, R.P. (1974).A patient by any other name . . . : Clinician group difference in labeling bias.Journal of Consulting and Clinical Psychology.42(1), 4-9.

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  • Lynn David

    Abstract:

    We assessed the attributional style of psychoanalysts, behavior therapists, and nontherapists by using a mail survey. Respondents listed causal explanations for three hypothetical problems experienced by either themselves, their friends, or their clients. Results indicated that [a] psychoanalysts gave more dispositional explanations than situational explanations, whereas the reverse was true for behavior therapists and nontherapists; [b] psychoanalysts gave psychological explanations for problems hypothetically experienced by their friends or clients, but physical explanations for the same problems hypothetically experienced by themselves; and [c] psychoanalysts holding medical degrees gave fewer psychological attributions and more physical attributions than behavior therapists or psychoanalysts with doctorate degrees.

    They summarize:

    The therapist’s orientation and training may exert a bias on the way common problems are explained, on the locus of perceived sources of change, and consequently, on the strategies utilized to effect change. For psychoanalytic therapists, the presence of an attributional bias might be interpreted as a source of concern; because they use different standards to judge themselves and their clients, an undesirable psychoanalytic distance may be created. Since there is some evidence that empathy tends to increase situational attributions and reduce actor/observer differences (cf. Regan & Totten, 1975), attempts to reaffirm empathy as an essential ingredient in the client-therapist relationship might offer the best antidote to undesirable therapeutic biases.

    From: http://www.eliot.smith.socialpsychology.org/pdf/jccp1986.pdf

    Might have to hit reload/refresh to get the PDF.

  • StraightGrandmother

    I am at a disadvantage understanding the article because I do not know what these basic terms mean.

    Behavior therapists

    psychoanalytic therapists

    analytic therapists

    I think I have a pretty good idea what “Reparative” Therapist do though.

  • GayGrandfather

    So we have the sad case of Jennifer Keaton suing Augusta College for requiring her to take diversity sensitivity training regarding gays and lesbians. She states the requirement violates her religious beliefs.

    I’d say she is the poster girl for confirmation bias. I do so hope the defense is aware of the L&A study. Otherwise, to release Ms. Keaton into the wild with a state license in hand is to virtually guarantee emotional damage to potential patients.

    http://emhardegree.hubpages.com/hub/Christian-Counseling-Student-Sues-School-for-Forcing-Gay-Sensitivity-Training

    (Note to StraightGrandmother: What can I say? You’re inspiring. I have a grandson. I like to be reminded of that when I comment online. It keeps me honest and I cuss a whole lot less).

  • Kellen

    Are you going to investigate confirmation bias in gay-affirming research and studies?

  • Michael Bussee

    Kellen: I don’t think that anyone is suggesting that “gay affiriming therapists” are unbiased. Every therapist (being human) is prone to bias. Any therapist who claims to be unbiased is a fool.

    What is different about “reparative therapists” is that they “assume that the existence of same-sex attraction means a person has suffered gender based trauma during a specific period of childhood.”

    Good therapists (gay affirming or not) don’t begin with an assumption that their gay patients had any particular type of parenting. They may have had abusive parents, neglectful parents, inadequate parents, good parents or even excellent parents.

    “Reparative therapists”, on the other hand, have already made up their minds beforehand that homosexuality is somehow pathological, that it is “caused” by something and that this “something” is some sort of gender based trauma inflicted by their parents. Then, they benovolently “help” their patients uncover it.

  • StraightGrandmother

    GayGrandfather, I read the article you linked to. What I don’t understand is why these Ultra Christians don’t go to Private schools? They can join the Christian Counseling Association when they graduate and they probably won’t have rules like the non secular professional associations do. Why don’t they seek out a college or university that has the programs that fit their values?

    Change of topic. I’m reading an article in Rolling Stone that Box Turtle Bulletin recommended about that Minnesota School District who has the “Don’t say Gay rule” and they have had like 9 kids commit suicide, 4 perceived to be a Sexual Minority.

    http://www.rollingstone.com/politics/news/one-towns-war-on-gay-teens-20120202?page=1

    GayGrandfather I have a dream. If I ever win the lottery I am going to go in the middle of the country, maybe St. Louis because a lot of trains go through St. Louis and also it has an airport and is centrally located but a bit warmer climate, and open a residential Middle and High School for children who are gay, lesbian, bi-sexual, transgender or queer (although I don’t know what queer is). I wish there was a nice school for these kids where the could go to and be safe and be HAPPY.

    It would be a safe haven for all the kids whose parents throw them out because of their sexual orientation or sexual identity. I wish there was a school like that, if I ever win the lottery that is what I would do with the money.

  • Jayhuck

    SGM –

    I currently live in St Louis and I’m sure such a school would be welcome by many here ;)

  • Richard Willmer

    ‘ Good therapists (gay affirming or not) don’t begin with an assumption that their gay patients had any particular type of parenting. They may have had abusive parents, neglectful parents, inadequate parents, good parents or even excellent parents.

    ‘ “Reparative therapists”, on the other hand, have already made up their minds beforehand that homosexuality is somehow pathological, that it is “caused” by something and that this “something” is some sort of gender based trauma inflicted by their parents. Then, they benevolently “help” their patients uncover it. ‘

    Yes, Michael Bussee, I think you’ve ‘hit the nail on the head’! Therapists should seek to discover and/or develop ‘answers’, not assume them. And even the most carefully-developed ‘answers’ are relative and proximate, and ripe for on-going ‘improvement’. Life is a journey, after all.

  • GayGrandfather

    How do you check confirmation bias on a therapist who begins with the assumption that there’s nothing pathological about homosexuality? And who would you then draw a conclusion by comparing that approach to a therapists who *does* begin with the assumption that there is pathology in homosexuality?

    One says: You’re getting a backlash from your friends and family, right? (confirming the problem is not the patient)

    The other: You’re repressing the memory of a bad event in childhood between the age of 1.5 and 3 years old that made you homosexual. (confirming the problem is the patient.)

    So, I had therapy from *both* of these kinds of counselors. Suffice to say that my oldest memory was from when I was about 4 years old. I was sitting on the fender of my uncle’s pickup watching my dad and my uncle carry a mattress into our house. I was eating an apple at the time. Period. Full Stop. Oh, the horror!

  • ken

    GayGrandfather# ~ Feb 2, 2012 at 5:55 pm

    “So we have the sad case of Jennifer Keaton suing Augusta College ”

    This sounds pretty similar to the Julea Ward case, which the 6th District Appeals court overturned the lower court and ruled in Ward’s favor. that topic was previously discussed on this blog starting here

  • ken

    Kellen# ~ Feb 2, 2012 at 6:10 pm

    “Are you going to investigate confirmation bias in gay-affirming research and studies?”

    Can you provide some examples of the research and studies you believe should be examined for confirmation bias?

  • http://aebrain.blogspot.com Zoe Brain

    Warren, the classic case of Confirmation Bias is in Autogynephilia theory, as espoused by Blanchard and Bailey.

    To over-simplify, this states that trans women are either

    a) Homosexual men trying to trick straight men into having sex.

    b) Heterosexual men with a misdirected sex target problem

    and also

    c) All Transsexuals habitually lie.

    The theory is unfalsifiable. Any testimony by patients either confirms a) or b) directly, or confirms c) if in contradiction.

    There are a number of difficulties with the theory though.

    1) It doesn’t account for measured neurological anatomical differences;

    2) it doesn’t account for Trans men;

    3) the tests for autogynephilia on Trans women, when applied to the usual kind, give the same results; and finally,

    4) the plethysmograph tests on post-operative women give different results from the tests on the usual kind – but the same as for women who have had genital reconstruction after cancer treatment etc. They screwed up the control group in a blatantly obvious way.

    All of this – the terminology, the testing, the theory itself – is based on the a priori axiom that Trans women are men. If that axiom is discarded, and that treated as a hypothesis to be tested rather than accepted unquestioningly, quite a different picture emerges.

    Fortunately this is becoming known, and AGP theory as a universal explanation for all Transsexuals without exception – rather than for a small proportion – is now no longer flavour-of-the-month.

  • Patrocles

    The idea of Bussee seems to be that therapists ought to be blank slates without any sort of preconceived ideas about the origins of their patient’s troubles.

    Extremely unconvincing. If a person has no preconceived idea why other peoples are troubled – and how to change that -, the person wouldn’t risk to become a therapist at all.

    All we can do is, having preconceived ideas, but leaving room for possible refutations of them.

    Kellen,

    we shouldn’t make things more simple for the opponents by speaking about bias in studies and research (where it is your MAIN obligation to decide if something is true or not).The question was bias in therapy.

    Now I admit that there are therapies which need little theoretical assumptions, like Dr. Throckmorton’s Sexual Identity Therapy. On the other hand, a “gay affirmative” therapist would normally have a preconceived idea why his patient feels troubled. If the patient is an evangelical, maybe the therapist is influenced by the idea that evangelicalism is a psychiatric disorder (there are some books which promote that idea) and may design his therapy along that line. Would be interesting to study the theories behind “gay affirmative therapy” – did anyone do that?

    • http://www.patheos.com/blogs/warrenthrockmorton Warren

      Patrocles – I am with Bussee on this. In my view, therapists have done much harm running ahead of the research in the sexuality area, for sure, but in many other areas as well. Autism was once thought to be due to refrigerator mothers. I recall in grad school being told with great confidence that children with schizophrenia clearly had disruptions during the symbiotic phase of attachment. The children may have shown problems then but it was not the mother’s coldness that did it. We now know that some cases of childhood OCD are caused by reactions to strep throat. Before we knew this, therapists were assuming parents did it.

      Therapists need to be more like scientists and less like gurus. Skepticism and inquiry with empathy and compassion mark good therapists.

      These are not the qualities inherent within the reparative model. These folks plod ahead when their clients say they’re wrong, confident that the client is in denial or cannot possibly know himself as well as the therapist, who with superior gnostic powers can divine the depths of a person’s history and psyche in a session or two, or even fewer, if the client has SSA. Once you know the presenting problem in that case, you know all you need to know.

      Let me add that Bussee is correct, gay affirmative therapists who assume the client’s problems are due to some factor known in advance by therapist are just as guilty as the reparative therapist.

  • Patrocles

    Annotation.

    The books I am referring to promote the idea that evangelicalism is something like alcoholism – even including that the children of evangelical parents may be co-dependent and that all their later troubles (suicides, divorces etc.) are caused by their parents’ evangelicalism-alcoholism.

  • Michael Bussee

    Patrocles remarked: “The idea of Bussee seems to be that therapists ought to be blank slates without any sort of preconceived ideas about the origins of their patient’s troubles.”

    First of all, I don’t consider “homosexuality” to be a “trouble” — unless the client is “troubled” by it in some way. I would not assume that it is “trouble” beforehand — as”reparative therapists” might do. It may trouble some clients and not trouble others.

    I would listen to the client. If the client was “troubled” by it, I would help the client explore in what ways it “troubled” him — and then explore ways to resolve this. Maybe it doesn’t mesh with his religious values or personal beliefs. I would respect that.

    I would also not assume beforehand that his homosexuality was “caused” by anything in particular. I would especially not assume that his parents must be at fault somehow. I would listen to the client.

    If he had “troubled” parents, I would explore how this has affected his life. — and help him determine how he would like to deal with these issues to live a more satisfying and healthy life.

    But yes, otherwise you pretty much you are right. I think the therapist should not assume beforehand that he know what “causes” any client’s “troubles”. Depression, for example, can be caused by many things. So can anxiety. So can marital or sexual problems.

    Preconcieved ideas on the part of the therapist can leave the therapist blind to the complexities of the client’s issues — and the possibilities of what might be helpful to this particular client.

    Patrocles also said: “On the other hand, a “gay affirmative” therapist would normally have a preconceived idea why his patient feels troubled.” I disagree. How can any therapist (“gay affirming” or not) know how or why a client (gay or straight) “feels troubled” — before listening to the client?

    Every client is unique and has his own life story. Maybe the client isn’t troubled by his sexual orientation. Some are. Some aren’t. And if the client does feel “troubled” by it, there are many possibilities as to why this might be so — and how that “trouble” might be resolved.

  • GayGrandfather

    Inasmuch as therapists don’t hang out a shingle declaring the are “[whatever]-affirming”, the blank slate approach does indeed make it the most appealing since my counselors have no idea what issues a patient wants to discuss when they schedule an appointment. In my own case, I *deliberate* sought out a Christian counselor because I (correctly) assumed they would reinforce my faith group’s view of condemnation of homosexuality. I was NOT disappointed by the counseling because it was this reinforcement of negative views that I wanted. I conceived of my emotional issues and needing negative reinforcement that had a course of action for me to take to **rid** myself of homosexuality. I got the counseling and the course of action and I employed it with rigid determination. What got me was that I became somewhat addicted to finding increasingly more rigid boundaries. I did that until I simply could not find anyone in my own faith group who would reinforce the boundaries to the degree I wanted.

    My solution for that? i became a Mormon.

    Belive me, friends. The LDS church will provide all the reinforcement you can handle and not merely in their religious literature. The social side of the church crushed me when I confided in my ward’s bishop in confidence and he **immediately** broke that confidence. I got what I came for: 100% isolation. I started looking longingly at bridge abutments I saw on the way to work. I was asked to come before a panel of elders that demanded that I confess **every** instance I could remember of acting on my homosexuality. The reward was that I’d be put on a probational course to reverse my excommunication. I complied. It was easy. I had **never** acted on my sexual orientation even ONCE. It was all a matter of what occured in my mind. I’m *completely* confident of the truth of that claim. They didn’t know what to do with me after that except incinuate that I was lying to them. They simply isolated me socially and that, as the say, was that.

    Fast forward. One horrible day I got my hands on a phone book and looked for *any* mental health counselor who could see me with the exception that I *deliberately* avoided calling anyone who billed themselves as a Christian counselor.

    That random counselor I found saved my life. He counseled my wife as well and what he basically “affirmed* was that when human beings are being dispised, the most nature and health thing they can do is GET AWAY FROM THOSE how dispise them. That’s the best advise I ever had. Is it “affirming” when you are told to leave behind those who deliberate seek to cause you emotional distress, who lie to you, who say they love you but hate your sin, who are friends only until you DON’T lie to them?

    I’ll take that affirmation even when it’s pigeon holed as “gay-affirmation”.

  • ken

    Warren# ~ Feb 3, 2012 at 8:48 am

    “Let me add that Bussee is correct, gay affirmative therapists who assume the client’s problems are due to some factor known in advance by therapist are just as guilty as the reparative therapist.”

    I do want to point out that there IS a difference between a therapist using his/her knowledge to guide a client in exploring possible factors involved with a client’s problems and going on a quest to “prove” the therapists pet theory about why a client is having problems.

  • StraightGrandmother

    GayGrandfather you add much, MUCH MUCH to the discussion here.

    What I am sure you don’t know is I came here oh maybe about a year ago, not knowing much about homosexuality and the ability of anyone to change their sexual orientation. I came here strictly for academic reasons, academic research. The answer to if Sexual Minorities can change their sexual orientation has ramifications in the law, immutable, and that is what I was interested in. I have learned so MUCH from first off Warren, Teresa, Jayhuck, Michael Bussee, Richard Wilmer, Zoe Brain, Ken, Lynn David, David, David M. and a HOST of others.

    And now comes GayGrandfather and I am learning from you. I kid you not, up until I came to Warren’s website about a year ago it never occurred to me that a gay man would marry a heterosexual woman. Or the same for a woman, that a lesbian woman would marry a heterosexual man. I did not know these marriages existed. Honestly I never knew, it never occurred to me.

    I have become a sponge for knowledge and absorbed everything you have taught me here. And have become a good foot solider in the battle for Civil Rights for Sexual Minorities, and it is a battle. Each of your stories affect me and teach me. Thank you to everyone and now to GayGrandfather.

    This is what I have learned. Sexual Orientation is not learned. It is discovered by each individual, what their innate sexual orientation is. It may take some people longer than others to discover their sexual orientation, but once discovered it very rarely changes. Attempts to change sexual orientation do not work for individuals who are homosexual. They may, with a lot of willpower be able to change their behavior, but their sexual orientation for 99.9% of the population, does not change. If individuals are bi-sexual they may work on only seeking relationships to an orientation opposite of theirs, and so it may look like change to others on the outside that they “changed” but it really isn’t a true sexual orientation change. They are, and will always be, bi-sexual.

    I already knew before coming here that Homosexuality is on the NORMAL Scale of Human Sexuality, there is nothing wrong with it. It is not a disease and does not need to be cured. All homosexuality is, is a Minority on the Human Sexuality Scale. There are not many people who are homosexual, they are a Minority to the Majority who are Heterosexual. This is why I do not use the acronym LGBT very often, I choose to use the accurate description, Sexual Minority. They are a Minority based on their Sexual orientation or Gender Identity.

    Ken if it is you posting over at the Mercator website, OMG thank you SO MUCH. If I see others posting against prejudicial and denigrating comments towards Sexual Minorities I feel the burden is taken off of me to respond to every single dehumanizing comment. So if that is you, just know I am so thankful for your help. Mercator runs a lot of anti gay articles that are authored by Members of NARTH. If you go read the previous articles and look at the credentials of the authors you will find it. They put up an anti gay article about every Monday or Tuesday, so if others can help out telling the truth over at Mercator I would appreciate it. Peace Out- SG

  • Michael Bussee

    It’s the difference between wondering “what’s going on here?” and assuming “I already know.”


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