Psychotherapy Volume 27/Spring 1990/Number 1 THE EFFECT OF PATIENT AND CLINICIAN IDEOLOGY ON CLINICAL JUDGMENT: A STUDY OF IDEOLOGICAL COUNTERTRANSFERENCE JOHN GARTNER Loyola College in Maryland ANN HOHMANN Loyola College in Maryland MORTON HARMATZ University of Massachusetts at Antherst DAVID LARSON Duke University Medical Center ALISON FISHMAN GARTNER Sheppard Pratt Hospital The influence of patient and clinician ideology on clinical judgment was studied. Therapists each rated two cases. One case had been altered to reflect either an extreme left-wing or extreme right-wing ideological orientation and the other case reflected no ideological commitment. Limited support was found for three hypotheses concerning therapist response to these cases. It is suggested that patient ideology, therapist ideology and their interaction influence clinical judgment and that clinicians need to be sensitive to possible "ideological countertransference." A patient walks into a therapist's office and says that he is anxious, depressed, and wants counseling. He has prayed, fasted and, attended healing services for relief, and though he still believes that only those in his small religious sect are saved, he thought he would try counseling with a "non-believing" therapist. What influence does the patient's ideology have on the therapist's We would like to thank Trina Hosmer, M.A., and Mark Lenzenweger, Ph.D. for their critical reading of this paper. Correspondence regarding this article should be addressed to John Gartner, Loyola College, 7135 Minstrel Way, Suite 101, Columbia, MD 21045. professional assessment and personal response to the patient? Previous research has investigated the effect which factors such as a patient's race, sex and social class have on the clinical judgments which therapist's make about them (Abramowitz & Do- kecki, 1977). Typically "clinical judgment ana- logue" studies involve asking therapists to rate case histories on a variety of clinical dimensions, where the race, sex, or social class of the patient has been systematically manipulated while all other aspects of the case are kept constant. Inasmuch as the average person tends to dislike people whose values are vastly different from their own (Byrne, 1971), it has been hypothesized that clinicians might also be vulnerable to such "ideo- logical countertransference," and thus make biased clinical judgments about clients whose values di- verge from theirs (Mendes, 1977; Szasz, 1974). Thus far, investigations of the effect of values on clinical judgment have produced inconsistent findings (Abramowitz & Dokecki, 1977). Using the clinical judgment analogue method described above we examined this question from three per- spectives: (1) the effect of patient values on clinical judgment; (2) the effect of clinician values on clinical judgment; and (3) the interaction of patient and clinician values on clinical judgment. Patient Values Though research in this area has been mixed, "patient values appear to be the second most pow- erful predictor of clinician bias; only patient social class is stronger" (Abramowitz & Dokecki, 1977, 98 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.