PATIENT SEX DIFFERENCES AND SELECTION FOR INDIVIDUAL PSYCHOTHERAPY


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Abstract

Previous studies of selection criteria for individual psychotherapy patients have left unclear (1) the variable of patient sex differences and (2) the relationship between selection and the patient's self-reported symptomatology. To assess these factors, all students (N = 594) who attended a university outpatient psychiatric clinic during a given academic year filled out a preintake questionnaire. The questionnaire consisted of demographic questions, a 20-item symptom check list and a section on expectations and attitudes toward psychotherapy.At the end of the year, all outpatient charts were reviewed to determine which patients had been selected for individual psychotherapy. Each selected patient (37 males, 31 females) was matched for age, sex and time spent at the university with a patient who visited the clinic for intake during the same month but was not selected for therapy. The “accepted” and “rejected” groups were then compared on their questionnaire responses. The questionnaires had not been seen by the 10 residents or 3 postdoctoral psychology trainees who made the selection of individual psychotherapy patients from intake.Evaluation of the results indicated consistently significant sex differences. Males selected for therapy (compared to males matched but not selected) (1) marked a significantly greater number of symptoms; (2) indicated problems in the areas of anxiety, personal unhappiness, distance from others and lack of self-esteem; (3) were more likely to have had previous therapy; and (4) tended to have expectations of being seen longer and more frequently in psychotherapy. There were no significant differences in questionnaire responses between females accepted or rejected for therapy. The results obtained did not appear to be the result of differential questionnaire responses by patients of either sex who remained in therapy as compared to those who dropped out. Demographic and social characteristics, including those previous research has indicated distinguish which students from the university community apply to the clinic, failed to discriminate students of either sex who were selected for therapy. Moreover, there were no empirical indications that selection behavior was different for male (N = 10) and female (N = 3) therapists. The small number of female therapists limits the generality of this finding.The findings are discussed in terms of the beginning therapist's differential use of “objective” criteria in selection of male patients and more likely “subjective” criteria in selection of female patients, especially in a setting in which only a very few intake patients (1 in 9 in the present study) will be accepted for extended individual psychotherapy.

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