International Journal of Social Psychiatry 1–9 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764015573086 isp.sagepub.com E CAMDEN SCHIZOPH Mental disorders, which have a lifetime prevalence rate near 50% in the United States (Kessler et al., 2005), are increasingly construed as biomedical illnesses (Pescosolido et al., 2010). This conceptual shift may influence the types of treatment that clinicians choose (Ahn, Proctor, & Flanagan, 2009), as well as how affected individuals view their own symptoms (Lebowitz, 2014; Lebowitz, Ahn, & Nolen-Hoeksema, 2013; Lebowitz, Pyun, & Ahn, 2013). However, studies to date have not addressed how clini- cians’ endorsement of biological conceptions of mental disorders may impact how they are perceived by potential clients. This represents an important gap in the literature, especially as tens of millions of Americans seek mental- health treatment each year (Olfson & Marcus, 2010). The current research examined this issue through the lens of warmth and competence judgments, which are con- sidered the universal dimensions of social perception (Fiske, Cuddy, & Glick, 2007; Fiske, Cuddy, Glick, & Xu, 2002). Warmth refers to the extent to which people are per- ceived as well intentioned and includes attributes such as likeability and perceived friendliness. Competence cap- tures the extent to which they are perceived as capable of carrying out their intentions and includes attributes such as intelligence and skill. Using these two dimensions, this research applies methods from social cognition and inter- personal perception research to a domain of public-health importance. Warmth and competence are particularly important in mental health, as clients’ perceptions of their therapists as warm and competent are crucial for the therapeutic alli- ance – the working relationship between patient and treat- ment provider (Ackerman & Hilsenroth, 2003). This alliance has long been recognized as an important determi- nant of successful mental-health treatment, across various patient populations and treatment approaches (Elvins & Green, 2008). Indeed, recent meta-analyses have under- scored the therapeutic alliance’s critical role in the effec- tiveness of treatment for mental disorders; high-quality therapeutic alliances were found to be significantly associ- ated with reduced risk of patient dropout from treatment and lower post-treatment symptom severity (Horvath, Del Sometimes more competent, but always less warm: Perceptions of biologically oriented mental-health clinicians Matthew S Lebowitz, Woo-kyoung Ahn and Kathleen Oltman Abstract Background and aims: Biological conceptualizations of psychopathology are ascendant, including among mental-health clinicians. However, it is unknown how this might affect people’s perceptions of clinicians, which in turn could have considerable public-health implications. The present studies sought to address this issue. Methods: In the present research, participants imagined that they or their loved ones were suffering from a mental disorder and then rated their perceptions of one clinician espousing the view that ‘mental disorders are brain diseases’ and another describing them as ‘disorders of thoughts and emotions’. Results: Biologically oriented clinicians were perceived as more competent and effective only when the disorder in question was judged to be biologically caused. Otherwise, there was no significant difference in perceived competence, and biologically oriented clinicians were rated less effective. Regardless, all participants perceived the biologically oriented clinician as significantly less warm on average than the psychosocially oriented clinician. Conclusion: These findings may have important clinical implications for the crucial therapeutic alliance between therapists and patients. Keywords Causal explanations, mental disorders, therapeutic alliance, social perception, warmth, competence Department of Psychology, Yale University, New Haven, CT, USA Corresponding author: Matthew S Lebowitz, Department of Psychology, Yale University, Box 208205, New Haven, CT 06520-8205, USA. Email: matthew.lebowitz@yale.edu 573086ISP 0 0 10.1177/0020764015573086International Journal of Social PsychiatryLebowitz et al. research-article 2015 Article at Yale University Library on August 17, 2015 isp.sagepub.com Downloaded from