counselors' attribution of responsibility, etiology, and counseling strategy

J O U R N A L O F C O U N S E L I N G & D E V E L O P M E N T • S U M M E R 2 0 0 1 • V O L U M E 7 9304

Counselors constantly seek to understand the behavior of their clients. In the process of at- tempting to understand their clients, counselors observe clients’ behaviors and the context in which those behaviors are imbedded and

make inferences concerning what could have produced suchbehavior. These inferences may indict dispositional characteris-tics of the client, environmental forces, or a combination of both(Heider, 1958). Diagnostic decisions, symptom recognition, andpredictions concerning treatment response and outcome canbe influenced by counselors’ explanations for the cause ofclients’ presenting problems (Lopez & Wolkenstein, 1990).

The role attributions play in counselor decision makinghas not been sufficiently explored (Murdock & Freemont,1989). The majority of clinical attributional research hasfocused on questions of self-perception (see Harvey &Galvin, 1984, for review). Few studies of clinical attributionhave focused on person perception (Lopez & Wolkenstein,1990). Studies that have been conducted in this area haveproduced mixed results. For example, Strohmer, Haase,Biggs, and Keller (1982) examined counselors’ attributionsalong three dimensions: the degree to which the clientcould control difficulties (controllability), whether theproblem was long term or temporary (stability), and thedegree to which the problem pervaded the client’s life(globality). Counselors were then asked to predict the likeli-hood of the client’s progress in counseling. The researchersconcluded that attributions might not significantly influ-ence counselor decision making. In a later study, counselors’attributions of controllability in diagnosis of affective

disorders were found to play a role in diagnostic decisions(Strohmer, Biggs, Keller, & Thibodeau, 1984). Specifically,the researchers found that attributions significantly affecteddiagnostic discriminations between bipolar and unipolardisorders.

Additional evidence for the influence of counselors’ attri-butions on counseling decisions is provided by Batson (1975)and Murdock and Freemont (1989). Batson compared theattributions and treatment recommendations of professionaland nonprofessional helpers in a simulated referral agency.In general, participants in the study tended to match treat-ment referrals to attributions. Clients whose problemswere attributed to personal factors (mental disorder) weregiven referrals to agencies concerned with personal change(mental hospital, residential treatment center), whereasclients whose problems were viewed as stemming fromsituational factors (unemployment, lack of job skills) weregiven referrals to social change agencies (state employmentagency, social services). Murdock and Fremont, likewise, hadcounselors rate clients along four attributional dimensions(locus, stability, globality, and controllability). Counselorswere then asked to make decisions on treatment urgency,duration of the problem, and on ideal treatment modality.Attributions regarding the stability of the cause and dura-tion of the problem best predicted treatment decisions(Murdock & Freemont, 1989).

If attributions play a significant role in counselors’ decision-making processes, issues of responsibility are one importantset of attributions to consider. People tend to hold othersmore responsible for their situations if they perceive those

Jerry L. Kernes is a doctoral candidate, and J. Jeffries McWhirter is a professor, both in the Counseling Psychology Program at Arizona State University,Tempe. This article is based on the master’s thesis completed by Jerry L. Kernes under the direction of J. Jeffries McWhirter. The research was funded, in part,by a grant from the Research Support Program at Associated Students of Arizona State University, Graduate College and Vice President for Research. Anearlier version of this article was presented in August 1998 at the 106th Annual Convention of the American Psychological Association in San Francisco. Theauthors thank Richard T. Kinnier and Barbara Kerr for their comments and assistance in conducting this study. Correspondence regarding this article shouldbe sent to Jerry L. Kernes, c/o J. Jeffries McWhirter, Counseling Psychology Program, Division of Psychology in Education, Arizona State University, Box870611, Tempe, AZ 85287-0611 (e-mail: [email protected]).

Counselors’ Attribution of Responsibility, Etiology, andCounseling Strategy

Jerry L. Kernes and J. Jeffries McWhirter

This study surveyed 167 counselors working at university counseling centers on their etiology and responsibility attributions andmodels of helping. Participants responded to vignettes describing either a male or female client experiencing symptoms of eitheran identity or adjustment problem. Counselors endorsed all of P. Brickman et al.’s (1982) models of helping for both problem types.Predictions concerning etiology attributions were partially supported. Counselors selected attributions logically consistent withan internal cause for the identity problem. However, counselors did not make external attributions for the adjustment problem. Nosignificant results were observed for the influence of client sex.

J O U R N A L O F C O U N S E L I N G & D E V E L O P M E N T • S U M M E R 2 0 0 1 • V O L U M E 7 9 305

C o u n s e l o r s ’ A t t r i b u t i o n o f R e s p o n s i b i l i t y, E t i o l o g y, a n d C o u n s e l i n g S t r a t e g y

individuals as having been in control of their previous behav-iors (see Weiner, 1993). In addition, people are less likely towant to help others whom they perceive to be responsible fortheir situations (Schmidt & Weiner, 1988). According toFeinberg (1970), the question of moral responsibility in-volves two separate issues—blame and control. Blame isattributed to individuals if they are seen as responsiblefor creating their problems. Control is attributed to peopleif they are held responsible for changing or influencingevents in their lives. These dimensions undoubtedly influ-ence counselors’ clinical decisions. Specifically, counselors’attributions concerning clients’ responsibility for causingand solving their problems may affect treatment decisionsand helping behavior.

Brickman et al. (1982) provided a theoretical frameworkfor classifying models of helping and coping according toattributions of responsibility for the cause and solution of aclient’s problems. Their analysis yielded four fundamentallydifferent orientations to the world said to exist in the mindsof helpers, aggressors, and recipients of help or aggression.Brickman and his colleagues contended that people mightbe unaware of the assumptions they hold regarding respon-sibility for the causes and solutions of problems but that“they cannot, as social actors, avoid making suchassumptions”(p. 370). Karuza, Zevon, Rabinowitz, andBrickman (1982) pointed out that in a clinical setting theassumptions implicit in these orientations might color thediagnosis, treatment choice, intervention strategy, and be-havior of helpers. Brickman et al.’s model of helping andcoping has been applied to a number of settings and clini-cal concerns including cancer patients’ beliefs about theircancer, prevention of suicidal behavior, interventions withthe elderly, drug addiction, congruence in beliefs betweenclient and counselor, alcoholism, and cross-cultural counsel-ing (see Avants, Margolin, & Singer, 1993; Jack & Williams,1991; Karuza, Zevon, Gleason, Karuza, & Nash, 1990; Morojele& Stephenson, 1992; Tracey, 1988; West & Power, 1995; Young& Marks, 1986, respectively).

FOUR ORIENTATIONS OF THE MODEL

Medical Model

In this model, clients are not held responsible for eitherthe cause of their problem or its solution. Clients are seenas suffering from illness they did not cause and must acceptthe interventions of trained experts in order to improve.Helpers are to use their training to identify the client’s prob-lems and provide the necessary services for change. Accordingto Brickman et al. (1982), the advantage of this model isthat it allows clients to seek and accept help without beingblamed for their weakness. However, the model also promotesa sense of client dependency.

Moral Model

This model can be seen as the converse of the medical modeland is best typified by self-help movements. In this model,

clients are seen as responsible for both causing and solvingtheir problems. Clients view themselves, or are viewed by oth-ers, as creating their problems through a deficit in moral char-acter (i.e., laziness, stubbornness, lack of willpower) and areexpected to strive to overcome problems. Helpers are essen-tially viewed as motivators or coaches. The advantage of thismodel is that clients are recognized as being totally respon-sible for their lives and are likely to be more motivated toproduce changes. The drawback of this model is that it can betaken to the extreme to believe that victims are responsiblefor their own victimization (Brickman et al., 1982).

Compensatory Model

This model holds clients responsible only for solving theirproblems but not for causing them. Clients are seen as suf-fering from the failure of their social environments to meettheir needs. The relationship between client and helper is apartnership, with the helper assuming a subordinate role.Helpers are expected to be teachers and provide educa-tion, skill building, and opportunities. Examples of thismodel include community action programs and rehabilita-tive therapy. Brickman et al. (1982) have claimed that theadvantage of this model is that it actively involves clients infinding solutions to their problems while discounting theclients’ past failures. The potential drawback of this model,however, is that it may make clients feel undue pressure athaving to continually solve problems they did not createand may foster a negative view of the world.

Enlightenment Model

This model holds clients responsible for causing their prob-lems but not for solving them. In this model, clients are seenas guilty individuals whose lives are out of control. The aimof this model is to provide clients with enlightenment aboutthe nature of their problems and the difficulty inherent insolving them. Clients are expected to submit to the will ofthe authority figure or helper who knows the course of ac-tion to follow. The advantage of this model is that it providesclients with a sense of relief that their problems are beyondtheir control and a sense of shared community and suffering.A disadvantage of this model is that it may lead clients tostructuring their entire life around the source of authority.

In addition to the role played by attributions of responsi-bility, counselors’ etiology attributions also seem importantin their influence on counselor decision making and help-ing behavior. According to Dumont (1993), the formationof an etiology assessment “inevitably implicates a particu-lar vision of the development of a disorder and the treat-ment of choice for remediating it” (p. 197). Most of theresearch in this area has focused on larger assessments ofcausality. For example, Weiner (1979) identified three di-mensions along which attributional judgments may vary:locus of cause (internal vs. external), the pervasiveness ofthe cause (global vs. specific), and the degree to which thecause is seen as changing over time (stable vs. unstable).Likewise, Hansen (1980) distinguished between three gen-


K e r n e s a n d M c W h i r t e r

eral types of explanations observers can make for a behavior:They may attribute the behavior to dispositions of the person(traits, personality, etc.); they may attribute the behavior tocharacteristics of the stimulus with which the person is inter-acting; or they may attribute the behavior to the circumstancesin which the behavior is taking place. Finally, research has iden-tified a number of expectancies and biases (e.g., dispositional,representative, availability) implicated in determining wherea client’s problem lies (see Batson, O’Quin, & Pych, 1982;Morrow & Deidan, 1992). It is surprising that very little re-search has examined specific etiology attributions. Most ofthe research that has been conducted on specific etiology as-sumptions has looked only at clients’ assumptions about thenature of their problems.

Townsend (1975) studied cross-cultural beliefs of mentalhealth clients and found that American mental health clientstended to believe their disorders were due to environmentalfactors, whereas German mental health clients tended to be-lieve both that mental disorders are reactions to psychologicalevents and are curable and that mental disorders are inheritedand cannot be cured. Foulks, Persons, and Merkel (1986) at-tempted to link beliefs about causes of psychological prob-lems to therapeutic process. They developed a 47-item inven-tory of psychiatric patients beliefs about their own illnesses.They found that patients who endorsed medical-model causesfor their illness and rejected nonmedical-model causes mademore visits to psychiatric clinics than patients who endorseda nonmedical model of causation and rejected a medicalmodel. Similarly, Pistrang and Barker (1992) developed aninventory of clients’ beliefs about the causes and treatmentsof their own psychological problems. Beliefs about cause andtreatment were strongly associated (e.g., clients who saw theirproblems as resulting from psychodynamic issues such asearly childhood problems also endorsed a psychodynamictype of treatment).

Still, little is known about the specific etiology beliefs andtreatment recommendations of mental health professionals.Atkinson, Worthington, Dana, and Good (1991) investigatedclients’ and counselors’ beliefs about the etiology of psycho-logical problems and preferences for counseling orientations.They used an empirical procedure to produce a list of spe-cific beliefs about the causes of psychological problems (ir-rational concerns, career or academic difficulties, physical ill-ness, trauma or pain, lack of social skills, genetics, and badluck). Results indicated that the majority of both clients andcounselors ranked irrational concerns as the cause of psy-chological problems. The major focus of the study, however,was on the etiology attributions made by clients, thereforeproviding little data on the attributions of counselors. In ad-dition, the study examined etiology attributions of psycho-logical problems in general rather than focusing on attribu-tions made for specific disorders.

Worthington and Atkinson (1993) applied the Brickmanet al. (1982) model of responsibility attribution to the at-tributions made by counseling center counselors of clinicalvignettes describing a student with an adjustment disorderor an identity disorder. Among their findings was that coun-

selors varied their helping orientation according to the typeof disorder presented. Specifically, counselors subscribedto a compensatory model of helping for the adjustment disor-der and were equally divided between the compensatory andthe moral models of helping for the identity disorder. Coun-selors did not endorse the medical or the enlightenment mod-els for either disorder type. Worthington and Atkinson alsoexamined the etiology attributions the counseling center coun-selors made for these disorders. In general, counselors selectedetiology attributions logically consistent with the assumptionof an internal cause for an identity disorder and an externalcause for an adjustment disorder. Specifically, counselors rankedlack of self-understanding as the primary cause of the iden-tity disorder (86%) and specific trauma as the primary causeof the adjustment disorder (55%). Moreover, specific traumawas never endorsed as a primary etiology attribution forthe identity disorder, whereas lack of self-understandingreceived only minimal endorsement as the primary causeof adjustment disorder.

One limitation Worthington and Atkinson (1993) ac-knowledged in their investigation was the examination ofcounseling center counselors’ attributions for only femaleclients. They suggested that attributions of responsibilityand etiology and recommended counseling strategy mightvary as a function of client sex, and they called for addi-tional research investigating counselors’ attributions of maleclients. A long line of research on gender bias and stereo-types indicates that gender may play an important part inattributions made by mental health professionals. Beckerand Lamb (1994); Broverman, Broverman, Clarkson,Rosenkrantz, and Vogel (1970); O’Malley and Richardson(1985); Robertson and Fitzgerald (1990); and Swenson andRagucci (1984) all spoke of differential evaluations madeof male and female clients. Much of this research indicatedthat women are perceived in more negative terms than aremen and that psychotherapy may function to reinforcetraditional roles for women (see Abramowitz, Abramowitz,Jackson, & Gomes, 1973; American Psychological Associa-tion Task Force, 1975). Other research suggested thatcounseling and psychotherapy might also function toreinforce traditional roles for men (see Costrich, Feinstein,Kidder, Marcek, & Pascale, 1975; Fitzgerald & Cherpas, 1985;Robertson & Fitzgerald, 1990). Still other research reportedthat mental health professionals might not hold differentialviews of men and women (see Phillips & Gilroy, 1985; Poole& Tapley, 1988; Smith, 1980).

The present study seeks to build on the findings ofWorthington and Atkinson (1993) and Brickman et al.(1982) regarding counselors’ attributions of responsibilityand etiology and to extend these findings by adding clientsex as an independent variable. The purpose of the presentstudy is to investigate the relationship between disordertype and client sex on counselors’ ratings of client respon-sibility, problem etiology, and recommended counselingstrategy. On the basis of the findings of Worthington andAtkinson, we predicted that the majority of counselorswould endorse a compensatory model of helping for an ad-



justment disorder and would be “equally” divided in theirendorsement of a moral model and a compensatory modelof helping for an identity disorder. We also predicted thatcounselors would select etiology attributions logically con-sistent with an internal cause for identity problems and anexternal cause for adjustment problems.

In addition to these replication hypotheses, based on re-search on dispositional biases in counseling, we predictedthat counselors would attribute greater internal causality,greater stability, and greater controllability to the symptomsof clients described as exhibiting an identity problem thanto clients described as exhibiting an adjustment problem.Likewise, we predicted that counselors would report beingmore likely to engage in interventions aimed at changing theclient’s environment or activities for clients exhibiting anadjustment problem and would be more likely to engage ininterventions aimed at changing the client’s thoughts or feel-ings for clients exhibiting an identity problem.

METHOD

Participants

Participants were 167 counselors (85 women and 82 men)from university counseling centers in the United States andCanada. Participants ranged in age from 24 to 65 years, witha mean age of 46.2 years and standard deviation of 9.15years. The participants held advanced degrees in the fol-lowing specialties: counseling psychology (81), clinical psy-chology (41), counselor education (24), social work (11),and other (10). The participants held the following posi-tions: center director (90), senior staff (52), assistant direc-tor/training director/program coordinator (14), staff (5), andother (6). Years of professional experience beyond highestdegree ranged from 1 to 36, with a mean of 12.5 years andstandard deviation of 9.58 years.

The following theoretical orientations were represented amongthe participants: psychodynamic (34), cognitive-behavioral(37), humanistic-existential (18), eclectic (69), family systems(4), and other (5). The ethnic (self-reported) representation ofthe participants was Native American (3), African American(5), European American/White (154), Asian American (1),Chicano/Latino/Hispanic (1), multiethnic (1), and other (2, whodid not indicate ethnicity).

Instruments

Counselor Preferences and Practices Survey. A revised formof the Counselor Preferences and Practices Survey (CPPS;Worthington & Atkinson, 1993) was used in the presentstudy to assess attributions of responsibility and etiologyand to examine recommended counseling strategies. TheCPPS consists of four parts. The first part requests basicdemographic information (age, sex, ethnicity) of the par-ticipants. The second part requests information regardingyears of professional experience, type of degree, and theo-retical orientation. In the present study, theoretical orien-tation was collapsed into six categories (psychodynamic,

cognitive-behavioral, humanistic-existential, family systems,eclectic, and other) because of Worthington and Atkinson’sfinding that few respondents subscribed to some of the theo-ries listed on the CPPS.

The third and fourth parts of the CPPS consist of twovignettes taken from the DSM-III Case Book (Spitzer,Skodol, Gibbon, & Williams, 1981) and a series of ratingsthat addressed client responsibility for causing and resolv-ing problems, counselor etiology beliefs, and recommendedcounseling strategy. One vignette describes a female clientexhibiting symptoms of an adjustment problem, and theother describes a female client exhibiting symptoms ofan identity problem. Worthington and Atkinson (1993)developed the vignettes to test Brickman et al.’s (1982)assumption that counselors would vary their model ofhelping based on the client’s responsibility for causing andresolving the problem and on Furman and Ahola’s (1989)assumption that counselors would vary their attributionsof etiology based on the type of problem presented. Twoadditional vignettes were created in the present study byaltering the sex description of the clients in the originalvignettes to include descriptions of male clients with adjust-ment and identity problems.

After reading the vignettes, participants rated a client’sresponsibility for causing and resolving their problems onseparate 6-point scales that ranged from 1 (not at all) to 6(completely). Participants also rank ordered the top 3 causesof the client’s problems from a list of 12 causes of psycho-logical problems (genetics, unresolved feelings, specifictrauma, social isolation, stress, lack of self-understanding,dysfunctional family, sick society, maladaptive learning, bio-logical imbalances, physical illness, irrational thinking) takenfrom existing etiology models (see Atkinson et al., 1991;Daws, 1967; Foulks et al., 1986; Kedric, 1985; Maloney,1985; Robertson & Fitzgerald, 1990). Finally, participantswere asked to indicate their likelihood of engaging in coun-seling strategies aimed at changing the client’s environment,changing the client’s interactions, and changing the client’sthoughts and feelings. Participants were asked to rate theirlikelihood of engaging in each strategy on separate 6-pointscales that ranged from 1 (extremely unlikely) to 6 (extremelylikely). No reliability or validity data is available for the CPPS.

Helping-Coping Attribution Scale. The therapist version ofthe Helping-Coping Attribution Scale (HCAS; Tracey, 1988)was used to measure counselors’ helping and coping attribu-tions toward vignette clients. Tracey developed the HCAS tomeasure the blame and control dimensions of Brickman etal.’s (1982) model of responsibility attribution. The HCAScontains four items. Two of the items measure attribution ofthe cause of the client’s current difficulty (e.g., “this client isresponsible for his or her current problem” and “this client’sproblem is more a result of the situation he or she is in ratherthan his or her own inability to cope”). The remaining twoitems were designed to measure attributions regarding theclient’s responsibility for resolving the problem (e.g., “solvingthe client’s problem is more the client’s responsibility thanmine” and “this client would not be able to change without



my or others’ aid”). Counselors rated each of the four itemsusing a 7-point Likert-type scale that ranged from 1 (verystrongly disagree) to 7 (very strongly agree). The items on thetwo scales were summed to produce two scores (blame andcontrol). High scores on the Blame scale indicated the clientwas viewed as responsible for the cause of the problem, andhigh scores on the Control scale indicated the client wasviewed as responsible for the solution to the problem.

Tracey (1988) reported 1-week test–retest reliability forthe Blame and Control subscales of the therapist version ofthe HCAS as .71 and .68, respectively. Internal consistencyof the subscales was estimated using the Spearman-BrownProphecy formula to be .45 for the Blame subscale and .50for the Control subscale. Tracey also reported that the Blameand Control subscales were relatively independent of eachother with correlations between scales at –.15.

Causal Dimension Scale. A revised version of Russell’s(1982) Causal Dimension Scale (CDS) was used to assesscounselors’ attributions of the locus of causality, stability, andcontrollability of clients’ problems. The CDS was originallydesigned to assess how an individual perceived the causesthey have stated for an event. The CDS contains nine itemswith three questions each measuring the subscales of Locusof Causality, Stability, and Controllability. Responses weremeasured on 9-point semantic differential scales. A total scorefor each subscale was arrived at by summing the responsesfor each scale (Locus of Causality items = 1, 5, 7; Stabilityitems = 3, 6, 8; Controllability items = 2, 4, 9). High scoreson these scales indicated a cause was perceived as internal,stable, and controllable, whereas low scores indicated a causewas perceived as external, unstable, and uncontrollable.Russell investigated the validity of the individual semanticdifferential scales by subjecting each item to separate analy-ses of variance. For each item, the largest main effect wasobserved for the dimension the item was intended to mea-sure. The subscales were found to be only moderately re-lated to one another, with correlations ranging from .19 to.28. Russell found the three scales to be internally consis-tent. Alpha coefficients for the Locus of Causality, Stability,and Controllability subscales were .87, .84, and .73, respec-tively. Similarly, Vallerand and Richer (1988) reported alphacoefficients for the Locus of Causality, Stability, and Con-trollability scales at .80, .73, and .50. Abraham (1985) testedthe usefulness of the CDS as a tool for measuring attribu-tions made about the mental health of others. Alpha coeffi-cients for the Locus of Causality, Stability, and Controllabil-ity subscales were .68, .90, and .88. The CDS was modifiedfor use in the present study by changing the wording of theitems from self-attributional statements (e.g., “Is the causesomething that reflects an aspect of yourself?”) toattributional statements made of clients (e.g., “Is the causesomething that reflects an aspect of the client?”).

Procedure

A packet consisting of a cover letter, the CPPS, the HCAS,the CDS, and a self-addressed stamped envelope was mailed

randomly to each counseling center director listed inGallagher’s (1995) National Survey of Counseling CenterDirectors in the United States and Canada. In the cover let-ter, directors were asked for their assistance in gatheringdata by passing the materials on to an experienced staffmember. Specifically, they were informed that the condi-tions of the study necessitated responses from experiencedmental health professionals with ongoing caseloads of cli-ents. Directors were invited to participate themselves if theybelieved they met the criteria.

Participants read packets consisting of one of four versionsof the CPPS (male identity problem vignette with male ad-justment problem vignette, male identity problem vignettewith female adjustment problem vignette, female identityproblem vignette with female adjustment problem vignette,or female adjustment problem vignette with male identityproblem vignette). Vignettes were counterbalanced accord-ing to problem type and client sex to prevent any potentialorder effects. Three hundred thirty packets were mailed inthe initial mailing. Six packets from this initial mailing werereturned as nondeliverable. A follow-up letter was mailed 3weeks after the initial mailing. A second follow-up letter wasmailed 3 weeks after the first reminder. This procedure re-sulted in the return of 177 questionnaires, which representeda 53.6% return rate. Ten of these questionnaires were re-jected due to incomplete or missing data.

RESULTS

Endorsement of Model

Ratings on the attributions of responsibility for causing andsolving the problems described in the vignettes were summedacross the two measures assessing responsibility (CPPS andHCAS) and recorded as low (ratings of 1–10) or high (rat-ings of 11–20). Each model in Brickman et al.’s (1982)conceptualization posits a different degree of responsibil-ity for causing and solving the problem at hand. Briefly, themedical model does not hold clients responsible for eithercausing or solving their problems. The moral model holdsclients responsible for both the cause and the solution oftheir problems. The compensatory model holds clients re-sponsible only for solving their problems, whereas the en-lightenment model holds them responsible only for caus-ing their problems. Cross-tabulations were developed toassess these models and the results presented in Table 1.

Table 1 indicates that participants subscribed to all fourof the models for both problem types presented. For theadjustment problem, counselors were relatively evenly di-vided in their endorsements of a compensatory model(48.80%) and a moral model (44.64%). Counselors alsoendorsed medical and enlightenment models (4.16% and2.38%, respectively). For the identity problem, counselorsgenerally favored a moral model (51.20%) over a compen-satory model (37.95%). Again, small percentages of coun-selors also endorsed medical and enlightenment models(4.81% and 6.02%, respectively).



To determine if counselors altered their model of help-ing to match the disorder presented, a 2 (disorder type) by4 (helping model) cross-tabulation was submitted to a chi-square analysis. The chi-square value was nonsignificant,χ2(3, 334) = 5.741, p = .125, thus indicating that there wasno association between model endorsement and type ofproblem presented.

Table 1 also indicates that counselors endorsed all fourmodels of helping for both male and female clients. For maleclients, counselors were relatively evenly divided in theirendorsements of a compensatory model and moral model ofhelping (48.25% and 44.18%, respectively). A small percent-age of counselors also endorsed enlightenment and medicalmodels of helping (4.65 and 2.90%, respectively). For femaleclients, counselors generally favored a moral model of helping(51.85%) to a compensatory model (38.27%). A small per-centage of counselors also endorsed medical and enlighten-ment models (6.17% and 3.70%, respectively).

Etiology Attributions

The prediction that counselors would select etiology attri-butions logically consistent with an internal cause for anidentity problem and an external cause for an adjustmentproblem was partially supported. As can be seen in Table 2,

etiology attributions varied across the two disorders. For theidentity disorder, the majority of counselors (81.32%) clearlyselected etiology attributions consistent with an internal cause(lack of self-understanding). The internal attributions of ir-rational thinking and unresolved feelings accounted for 5.42%and 4.21% of etiology attributions, respectively. Thus, nearly91% of counselors’ attributions reflected a belief in an inter-nal cause for identity problems.

For the adjustment problem, counselors selected moreinternal than external attributions. The internal attributionsof unresolved feelings, lack of self-understanding, and irra-tional thinking accounted for nearly 55% of counselors re-sponses (38.09%, 8.92%, and 7.73%, respectively). The ex-ternal attribution of specific trauma accounted for only33.92% of counselors’ attributions.

A 2 (problem type) by 12 (etiology attribution) was sub-jected to chi-square analysis to determine if counselorsaltered their attributions based on problem type presented.Chi-square results were significant, χ2(9, 334) = 199.171,p = .005. Thus, counselors’ attributions were associated withproblem type presented. A 2 (client sex) by 12 (etiologyattribution) cross-tabulation was performed to determinewhether counselors made differential etiology attributionsbased on client sex. As can be seen in Table 2, counselorsselected similar etiology attributions for both male and

TABLE 1

Counselors’ Endorsement of Model by Problem Type and Client Sex

Brickman et al.’s (1982) Model Type

Problem Type Client Sex

Adjustment Identity Male Female% % % %

MedicalMoralCompensatoryEnlightenment

775824

4.1644.6448.802.38

8856310

4.8151.2037.956.02

576838

2.9044.1848.254.65

1084626

6.1751.8538.273.70

Note. Percentages reflect rounding error.

TABLE 2

Counselors’ Etiology Attributions by Problem Type and Client Sex

Etiology Attribution

Problem Type Client Sex

Adjustment Identity Male Female% % % %

GeneticsSick societySocial isolationDysfunctional familyBiological imbalanceLack of self-understandingUnresolved feelingsStressSpecific traumaPhysical illnessMaladaptive learningIrrational thinking

10202

15648

5706

13

0.590.001.190.001.198.92

38.094.76

33.920.003.577.73

10112

135761039

0.600.000.600.601.20

81.324.213.610.600.001.805.42

10311

74398

2805

12

0.580.001.740.580.58

43.0222.674.65

16.270.002.906.97

10003

76326

3004

10

0.610.000.000.001.85

46.9019.753.70

18.510.002.466.17

Note. Percentages reflect rounding error.



female clients. Specifically, counselors selected lack of self-understanding as the primary etiology attribution for bothmen and women (43.02% and 46.90%, respectively). A largenumber of counselors also selected the internal attributionof unresolved feelings for both men and women (22.67%and 19.75%, respectively). Specific trauma was identifiedas the most important external etiology attribution for bothmen and women (16.27% and 18.51%, respectively).

Ratings on the Causal Dimension Scale

A 2 × 2 multivariate analysis of variance (MANOVA) (disor-der type by client sex) was conducted for the three ratings ofthe Causal Dimension Scale (locus of causality of the client’sproblem, stability of the client’s problem, and controllabilityof the client’s problem).

There was a significant main effect of type of problem(Λ = .852 F = 19.067, p = .001, η = .15). A follow-up one-way analysis of variance (ANOVA) indicated significantdifferences between groups for ratings of locus of causality,F(1, 332) = 47.319, p = .001. In general, clients describedas experiencing an identity problem were rated as havinggreater internal locus of causality than those clients describedas experiencing an adjustment problem. A follow-up one-way ANOVA also indicated a significant difference betweengroups for ratings of problem stability, F(1, 332) = 10.140,p = .002. Counselors ascribed more permanence to thesymptoms of clients described as having an adjustmentproblem than to clients described as having an identityproblem. A follow-up one-way ANOVA also revealedsignificant differences between groups for ratings of the con-trollability of the problem, F(1, 332) = 30.845, p = .001.Counselors ascribed more control over their problems toclients with an identity problem than to clients with anadjustment problem. Means and standard deviations arepresented in Table 3.

Ratings on Specific Interventions

A 2 × 2 MANOVA (disorder type by client sex) wasconducted for ratings of the three specific interventions ofrestructuring the client’s environment, changing the client’sinteractions, and modifying the client’s thoughts or feelings.There was a significant main effect of type of problem

(Λ = .976 F = 2.74, p = .043, η = .02). A follow-up one-wayANOVA indicated a significant difference between groups forrestructuring the client’s environment, F(1, 332) = 7.620,p = .006. In general, counselors endorsed this intervention asmore appropriate for clients with an adjustment problem (M =3.48) than for clients with an identity problem (M = 3.09).

DISCUSSION

Predictions concerning counselors’ endorsement of theo-retical models were not supported. No significant relation-ship was detected between endorsement of theoreticalmodel and disorder type. Counselors endorsed all ofBrickman et al.’s (1982) models of helping for both disor-der types. These results are in contrast to Worthington andAtkinson’s (1993) findings that counseling center counse-lors endorsed only the compensatory and moral models ofhelping across disorder types. The number of counselorsendorsing medical and enlightenment models of helping inthe present study was quite small, however. For the adjust-ment disorder, 4.16% of counselors endorsed a medical modeland 2.38% endorsed an enlightenment model. For the iden-tity disorder, 4.81% of counselors endorsed a medical modeland 6.02% endorsed an enlightenment model. A more chal-lenging finding is that counselors “equally” endorsed a com-pensatory and moral model for helping clients with anadjustment disorder and favored a moral model for helpingclients with an identity disorder. These findings contrast withWorthington and Atkinson’s finding that counseling centercounselors favored a compensatory model for helping cli-ents with an adjustment disorder and were equally dividedin their endorsement of moral and compensatory models forhelping clients with an identity disorder.

Although no significant relationship was observed be-tween endorsement of theoretical model and disorder type,clearly the majority of college counseling center counse-lors adhere to either a moral or compensatory model ofhelping (91.3%). These findings, although not as encourag-ing as those of Worthington and Atkinson (1993), shouldbe viewed favorably if one accepts Brickman et al.’s (1982)assumption that “models in which people are held respon-sible for solutions (the compensatory and moral models)are more likely to increase people’s competence than mod-els in which they are not held responsible for solutions (themedical and enlightenment models)” (p. 375).

Although counselors in the present study generally favorthe moral and compensatory models of helping, they donot seem to distinguish between these models in theirconceptualization of client problems. Both the moral andcompensatory models view clients as responsible for find-ing solutions to their problems. The issue of responsibilityfor causing those problems differentiates these models, withthe moral model holding clients responsible for causing theirproblems and the compensatory model avoiding discussionof causal responsibility. It is possible that the scenario prob-lems were too innocuous to enlist any significant differencesbetween endorsement of these two model types. Moreover,

TABLE 3

Counselors’ Ratings on the CausalDimension Scale

Variable

ControllabilityStabilityLocus of Causality

AdjustmentIdentity

M M MSD SD SD

16.6819.95

4.693.95

11.329.84

4.773.62

11.6414.21

4.414.05

Causal Dimension Scale



if these problems were too innocuous, causal responsibilitymight have been distorted. Further research should examinewhether counselors endorse different model types when theproblems experienced by clients are more severe.

Predictions concerning etiology attributions were partiallysupported. Counselors clearly selected attributions logicallyconsistent with an internal cause for the identity problem.Specifically, lack of self-understanding accounted for 81.32%of the responses. This finding is consistent with Worthingtonand Atkinson (1993). Attributions were less supportive ofpredictions for the adjustment problem. In fact, counselorsmore frequently endorsed internal etiology attributions thanexternal attributions. Although specific trauma did accountfor a large percentage of counselors’ attributions (33.92%),this is less than Worthington and Atkinson’s finding of 55% ofcounselors endorsing specific trauma.

As seen in Table 2, lack of self-understanding, the mostfrequently endorsed etiology attribution for the identityproblem, received only minimal endorsement for the ad-justment problem (8.92%). Likewise, specific trauma andunresolved feelings, the most frequently endorsed etiol-ogy attributions for the adjustment problem, received onlyminimal endorsement for the identity problem (.60% and4.21%, respectively). These results indicate that counse-lors do make differential etiology attributions based ondisorder type presented.

Predictions concerning the three dimensions of the CausalDimension Scale (causality, stability, controllability) weregenerally supported. As predicted, the symptoms of clientswith an identity problem were rated as having greater in-ternal locus of causality than were symptoms of clients withan adjustment problem. Similarly, the prediction that coun-selors would attribute greater controllability to the symp-toms of clients with an identity problem was also supported.These findings suggest that counselors view identity problemsas more dispositional in nature than adjustment problems.However, the prediction that identity problems would be ratedas more stable than adjustment problems was not supported.In fact, counselors ascribed more permanence to the symp-toms of adjustment problem clients. This finding is curious.Perhaps it is possible that counselors paid attention to thelarger context of clients’ symptoms (i.e., reaction to a mother’sdeath for the adjustment problem and a general sense of notknowing who one is for the identity problem). Erikson’s (1980)personality theory suggests that identity confusion, althoughpervasive, lasts only for a circumscribed period from adoles-cence through early adulthood. In this sense, a mother’s deathis a permanent event, whereas identity confusion is tempo-rary. This explanation is tenuous. Future research might ex-plore how variations in descriptions of disorder types mightaffect ratings of symptom permanence. Further research wouldbe more informative if it allowed counselors to provide a ra-tionale for their responses. For example, counselors could beasked to provide commentary at the end of the vignettes de-scribing their working hypotheses.

Whether these findings reflect a “dispositional bias” orare merely good clinical judgment remains an open ques-

tion. Certainly Diagnostic and Statistical Manual of MentalDisorders, fourth edition (DSM-IV; American PsychiatricAssociation, 1994) criteria for the diagnosis of adjustmentand identity problems indicates different loci of client re-sponsibility in contributing to their problems. There is aquestion as to whether it is biased for clinicians to assumethat clients presenting with different problems are differ-entially responsible for the cause of those problems. Lopez(1989) has suggested there is a conceptual difference be-tween a clinician who errs in adjusting diagnostic normsand one who errs because of prejudicial attitudes. It is pos-sible that counselors may make an error by not consideringindividual differences in shaping their interventions and sim-ply evaluating client needs based on categorization into suchgross membership as “adjustment problem” or “identityproblem.” However, this error differs from one made be-cause of the influence of prejudicial attitudes based on cli-ent background.

A similar question arises regarding responsibility for over-coming one’s problems. If a client’s difficulties lie with thefact that there is something “about the client” (i.e., person-ality traits or characteristics), counselors are less likely tohold that client responsible for overcoming their difficul-ties than they are clients whose problems stem from a re-action to an event. That is, clinicians may view dispositionalcharacteristics as less amenable to change. Again, the prob-lems presented in the current study were rather innocuous.It is quite possible that a different pattern of responsibilityattribution would emerge if the scenarios had presentedmore severe forms of identity and adjustment problems.Certainly, one can logically argue that counselors shouldhold those who are contributing to the cause of their prob-lems as more responsible for the resolution of those prob-lems than they would clients whose problems are largelyreactions to significant events. The answers to those ques-tions lie outside the scope of the present study.

Predictions for specific interventions were supported forchanging the client’s environment. Counselors viewed mak-ing changes in a client’s environment as more appropriate forclients with an adjustment problem than for clients with anidentity problem. These results are generally consistent withRoyce and Muehlke’s (1991) findings that internal attribu-tions of clients’ problems were associated with treatment aimedat changing the person, whereas stable attributions were linkedto strategies aimed at changing behaviors and systems. It isunlikely that given such limited information as case vignettes,counselors were able to form a complete treatment plan.However, the fact that any specific interventions were en-dorsed indicates how quickly such a plan can be set in mo-tion. Meehl (1960) suggested that clinicians formulate aclient’s problems in a few sessions and that these formula-tions remain largely unchanged over the course of therapy.

Client sex seemed to play an insignificant role in thepresent study. No significant results were observed for theinfluence of client sex in counselors’ endorsement of theo-retical models or in etiology attributions. Likewise, clientsex failed to influence ratings on the CDS and ratings



concerning specific interventions. This seems in oppositionto claims made for differential attributions based on clientsex (see Phillips & Gilroy, 1985, for an overview). One plau-sible explanation for this finding is that counselors may betrained to pay particular attention to a client’s sex whenmaking clinical decisions in order to avoid any potential “gen-der biasing.” In an “innocuous” situation such as presentedhere, client sex is not seen as a salient attribute in makingdiagnostic and treatment decisions. At the same time, how-ever, counselors are inextricably linked to their own genderrole socialization and hence may make decisions based onsuch. Although a client’s sex may not play much of a role inclinical decisions, counselors cannot escape entirely the in-fluence their own sex may have in such decisions. Furtherresearch should examine the interplay of client sex, counse-lor sex and presenting issue when a client’s sex might begermane (pregnancy, impotence, etc.). In addition, futureresearch should more precisely investigate the potential roledifferences in counselor training (i.e., specialty areas) mightplay in counselors’ attributions. Further research must alsoexpand the restrictive nature of the definition of bias and ofthe biased clinician (Lopez, 1989). For example, researchmust investigate not only instances of “overpathologizing” ofwomen but also explore the existence of “minimizing bias”in the evaluation of feminine gender role symptomatology.

In addition to some of the limitations already discussed,the present study is limited by threats to internal and exter-nal validity common to analogue studies. Although reliabil-ity and validity data are available for some of the instrumentsused in the present study, the lack of reliability and validitydata for the CPPS and the marginal reliability of the HCASlimits the conclusions that can be drawn. However, the CPPSdoes use some of the suggestions Worell and Robinson (1994)make for improving analogue research methods, and theCPPS and HCAS represent the only measures specificallydesigned to test Brickman et al.’s model of responsibilityattribution. The development of more reliable and valid mea-sures is clearly needed. Results of this study cannot bedirectly generalized to college counseling centers. Althoughthis study did employ university counseling center counse-lors as participants, judgments made of fictional “clients” mayonly remotely parallel diagnostic and treatment decisionsmade with actual student clients. Logically, additional researchneeds to include counselor evaluations of actual clients.

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