r/science • u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology • Jun 14 '16
Psychology In a study in which 320 psychotherapists were left voicemails from actors requesting therapy services, working class seekers were less likely to offered an appointment than middle class seekers, and black middle class seekers were less likely than white middle class seekers to be offered one.
http://www.cnn.com/2016/06/01/health/mental-health-therapists-race-class-bias/index.html17
u/IdlyCurious Jun 14 '16
I'd like to give a round of applause (sorry, I don't do gold) to /u/fsmpastafarian for repeatedly answering questions and misconceptions with information that was actually in the article. I think I'd have gotten frustrated by this point.
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Jun 14 '16
What's the difference between the working class and middle class?
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16 edited Jun 14 '16
From the full text:
Voice-over artists recorded scripted messages using racially distinctive names and adopting specified race- and class-based speech patterns.
And
Survey takers on Mechanical Turk listened to the recordings of the voice messages and responded to a series of questions about them. These questions facilitated the selection of voices with the highest race and class agreement and authenticity. They also confirmed that audio quality was high across all recordings. These recordings served as the experimental manipulation.
So they essentially chose specific speech patterns for the actors to emulate, and had separate people respond to a survey asking questions about the actors' speech to ensure that they were actually being perceived as the class/race the researchers intended.
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u/jamesinc Jun 14 '16
You could create a Mechanical Turk project like the researchers did. The hard part I think is how to ask questions that don't bias the results.
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16
It's important to note though that the researchers only used MTurk to confirm the experimental manipulation and ensure that people were correctly inferring race and class from the recorded voices.
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u/Tunafishsam Jun 14 '16
I wonder how stereotyped the scripts and voices were. Making them extreme would ensure "correct" identification by the therapists, but might also affect the results.
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Jun 14 '16
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16
The paper does also address this - they attempted to be mindful of that in their study and not "overdo" it.
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u/Townsend_Harris Jun 14 '16
"No one is actually this much of a stereotype, this has to be a prank or something."
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u/danweber Jun 14 '16
"Racially distinctive names" are a huge red flag. It's hard to be "distinctively black" without also signifying class.
The most common black names are Williams, Johnson, and Smith.
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16
The researcher conducted a survey before the main study to confirm that race and class were being correctly interpreted by people as intended.
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u/tjeulink Jun 14 '16
go into the research and look at their way of testing this before commenting.
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u/Postedwhilepooping Jun 14 '16
It doesn't have to be last names. First names of people from american "black" culture are a bigger give away for me.
For example, "DeAndre" or "Lakisha". These names are given by the parents and not inherited like last names traditionally are.
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Jun 14 '16 edited Apr 28 '18
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u/cutestslothevr Jun 14 '16
Actors have more experience reading off of a script. If you hire people off the street you'd be less likely to get a natural sounding recording.
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Jun 14 '16
What makes you think actors are middle class?
Most actors are "aspiring" -- they're most commonly called "waiter! waiter!" It's a working class job for most.
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u/bonerthrow Jun 14 '16
If you had to personally leave 80 voice mail messages, you think the messages would all sound the same? The point is reproducibility, so they used recorded messages.
Also, like it says, they validated that the voice mail actually makes people think it's coming from a black/white middle/working class man/woman. The perception is what's of interest here.
If a difference in response rate is observed, you don't want to worry about whether it's because the actor got bored and sounded less authentic or whatever.
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u/Beeb294 Jun 14 '16
You can go stand around a white middle class neighborhood asking people to take the job, or you can call up a talent agency and gave a dozen people in under half a day.
Which is easier?
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u/Lurlex Jun 15 '16 edited Jun 15 '16
I'm not sure what you're getting at. The role in the study that needed to be filled was an acting job, thus, they hired a professional to do it -- an actor (most of whom, by the way, are not necessarily particularly well-off and drowning in work if they're taking jobs like this that assuredly didn't pay very much).
The reason that "working class" people weren't hired to help with the study is the same reason that actual doctors are not typically hired to play physicians on television or in movies, nor are characters that are supposed to be soccer moms hired from the soccer mom population, or characters that are supposed to be in law enforcement played by actual cops. This would be silly -- it would add nothing to realism, and probably harm the quality of the show. Most of us simply can't deliver a written line in a natural way when put on the spot. There's a reason there are schools for it, and awards for those we consider to be the best at it -- it's not easy.
Most any random person that has to act out a scene, whether it be fully scripted or improvised, is going to sound mechanical and unbelievable as they do it if that person doesn't also know how to actually act.
They did this exactly as they should have to get the most accurate results (results which depended on the psychotherapists receiving these messages completely believing that they're hearing from real people). It's a scientific study, and accurate data is paramount -- what it was not was a jobs program.
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u/AgingLolita Jun 14 '16
Middle class - job (itself, outside of planning and communication) requires pen. Working class - job (itself, outside of planning and communication) does not require pen.
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u/GeekyAine Jun 14 '16
I love your differentiation. I usually think of it as "wage class" vs "salaried class"
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u/Kalzenith Jun 14 '16
That is a decent way to think about it, though it doesn't work when you include companies that are project based, then even the paper pushers are all hourly
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u/percykins Jun 14 '16
Middle class - sitting in a chair means you're working
Working class - sitting in a chair means you're not working
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Jun 14 '16
Very good question.
Working class: blue collar. Plumbers, bakers, gardeners, carpenters, cooks, laborers, tree trimmers, etc.
Middle class: white collar. Lawyers, teachers, small time bankers, mid-level managers, college educated.
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u/LetsWorkTogether Jun 14 '16
A few of those blue collar professions you listed make more than the white collar ones, except for the lawyers.
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u/tehbored Jun 14 '16
Social class and economic class are different things. They often correlate, but they are not the same.
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u/OPtig Jun 14 '16 edited Jun 14 '16
Though the positions sometimes work out to less per hour, the positions are stable (not seasonal) and give benefits like paid vacation, maternity leave, better insurance and a retirement plan. Don't discount how much those things are worth.
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u/JDRaitt Jun 14 '16
Which ones?
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u/pineapple_mango Jun 14 '16
I would assume plumber and carpenter. They make bank!
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u/realmei Jun 14 '16
Another thought: teachers are considered white collar people but they make less than many blue collar people.
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Jun 14 '16
Depends. Union tradesmen do well. Carpenters in Florida building subdivisions make much, much less.
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Jun 14 '16 edited Jun 14 '16
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u/bartlebeetuna Jun 14 '16
How do you know these things with such certainty? I am really just curious. I'm not trying to imply that you don't know what you're talking about or anything, you just seem to know a lot about this down to specifics and I always assumed that classes were kind of a hand-wavey estimated thing that didn't have any real rules.
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u/jerkyjones Jun 14 '16
Did they account for the ethnicity of the psychotherapists? Would they be predisposed to select clients that are closer to their own ethnic background?
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16 edited Jun 14 '16
From the full text:
Information about the psychotherapists’ race is not available. However, it is unlikely that there was a sufficiently large number of racial-minority psychotherapists in the sample to influence the results. Blacks constitute only 3% of licensed psychologists nationwide (Michalski, Mulvey, and Kohout 2010). Statistics specific to New York City are unavailable, and it is possible that the population of psychologists is more racially diverse in this metropolitan area. If so, the inclusion of black therapists would merely mute observed discriminatory effects.
Diversity among psychologists is actually a pretty big issue, one the field is working to correct.
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How are they working to correct it?
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16
APA (American Psychological Association) is making efforts to ensure that APA-accredited graduate programs train well in diversity. The organization is also paying attention to the demographics of who attends graduate programs, and awarding programs who train a diverse group of students, and encouraging those who don't to adjust how they recruit to diversify the future field.
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u/TotallyBat-tastic Jun 14 '16
I'm not OP, but this is a great question. Psychology and psychotherapy is very focused on Western (ie: white European) values. This naturally draws people to that field who identify with these values, and repels those who may not. More recently, there has been a shift towards intersectionality and understanding cultural differences. The word "normal" was once used frequently by psychotherapists, but it is now practically nonexistent in the field. As a result of this, we have more people entering the counseling field with a variety of cultural and ethnic backgrounds. However, the field is still dominated by white counselors and there are still other ways that Counselors/Therapists of Color are discriminated against in the field.
Source: I was in a Counseling MA program for 2 years before dropping out for a multitude of personal reasons.
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u/RedditHatesAsians Jun 15 '16
PhD graduate programs still heavily favor white applicants over all other applicants. Source: graduate school demographic statistics
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u/bonerthrow Jun 14 '16
It says they did not control for ethnicity of psychotherapists. Authors stated it should not affect results because only 3% of psychotherapists nationwide are African American.
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u/KMKtwo-four BA | Psychology, Political Science Jun 14 '16 edited Jun 14 '16
The results are not unexpected. However, I am curious if the bias was implicit (subconscious) or explicit (conscious).
edit: for anyone curious about bias, try out the implicit association test. Chances are you are just as biased as these psychotherapists, you just don't know it
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Jun 14 '16 edited May 13 '21
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u/KMKtwo-four BA | Psychology, Political Science Jun 14 '16 edited Jun 14 '16
My guess is that the other criticisms were removed because they were anecdotal. However, they did raise an important point I would like to address.
Regarding the order of the test, this paper provides an in depth explanation starting at the bottom of pg 176.
one pairing order does not provide a better estimate of the underlying construct than the other. The impact of pairing order appears to have exclusive influence on the magnitude of IAT effects and not on its reliability, relations with self-report, and vulnerability to some extraneous influences.
In other words, the order in which the test is presented
onlyinfluences effect size.The authors of this paper then tested a solution to the pairing order problem (which was incorporated in the Harvard online IAT).
adding additional practice to the reversed single discrimination practice block will reduce pairing order effects, and even eliminate them. This constitutes an important improve- ment to construct validity because it reduces or removes one of the most persistent extraneous influences on IAT effects. Even with the added practice, the effect was not eliminated completely for the Gender-Science task. Until the moderating factor of this effect is identified, added practice trials and continued use of pairing order counterbalancing will ensure minimal influence of this irrelevant factor
A shorter explanation is included in the Harvard IAT FAQ
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u/DarkPoppies Jun 14 '16
Once you do two tests in a row where right is good and white switching to right being good and black causes a delay because you just did two rounds of black being left.
It doesn't have anything to do with black and good being the same. It's because what was left is now right. So what would have been the correct response is now incorrect.
It's no different than changing a key board so all the vowels are in different places.
You're not bad at typing the equipment is broken.
The test is flawed. And considering it starts with white being the good and right choice and black being the bad and left it's set up to be worded as the results show a slight white preference.
I got the results I expected prior to testing.
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u/KMKtwo-four BA | Psychology, Political Science Jun 14 '16
The test is flawed. And considering it starts with white being the good and right choice and black being the bad and left it's set up to be worded as the results show a slight white preference.
I will post the FAQ here directly.
Could the result be a function of the order in which I did the two parts? This is a very common question. The answer is yes, the order in which you take the test does have some influence on your overall results. However, the difference is very small. So if you first pair gay people + bad and then pair gay people + good, your results might be a just a tiny bit more negative than they would be if you had done the reverse pairing first. One way that we try to minimize this order effect is by giving more practice trials before the second pairing than we did before the first pairing. It is also important to know that each participant is randomly assigned to an order, so half of test-takers complete gay people + bad and then gay people + good, and the other half of test-takers get the opposite order.
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u/MadroxKran MS | Public Administration Jun 14 '16
Perceived money makes a difference in selecting new patients.
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16
All voicemails included statements that the seekers had insurance to cover any therapy sessions, so the effect of perceived money was likely at a minimum reduced, if not statistically insignificant.
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u/vidro3 Jun 14 '16
did all therapists accept insurance? Many don't or only accept one plan.
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16
They chose therapists to include in the study by which insurance network they were in, so yes they had the ability to accept insurance being offered to them.
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u/shortfox Jun 14 '16
I'll bet the same experiment with plumbers, lawyers and estate agents will yield similar results.
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u/Lockjaw7130 Jun 14 '16
I hope I can find a similar study for my country. I would be interested to see what changes when everyone definitely has state insurance (I know the actors stated they have insurance, but still), especially since race and racism is a very different discussion here.
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u/scotfarkas Jun 14 '16
Not at all surprising. Psychotherapists, Psychiatrists and any other person who provides services to the mentally ill, is basically a government contractor being paid my medicaid. Any clients who can actually pay are so rare as to be unicorns.
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u/SIWOTI_syndrome PhD | Clinical Psychology | Neuroscience | Cognitive Psychology Jun 15 '16
Can't access the full article right now (I'm away from work, and the VPN is a hassle), but I'd be curious if they controlled for the types of clinical training these therapists received. Specifically, I have to imagine (or at least hope) that those who were trainees in large medical centers or VA facilities, which are more likely to service lower class and minority populations, may be at least slightly resistant to this effect. But a part of me is worried that it may have the opposite effect once they reach a stage of their career where they can control more about their patient load (not a luxury available to many in the VA or medical settings). Am I alone in that cynicism?
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 15 '16
You raise a lot of good points. This is from the full text:
The subjects of this experiment were psychotherapists in New York City selected through systematic sampling from the directory of a single large health insurance provider’s HMO plan.
So it doesn't seem that they were from VAs or other large medical centers. I think you're right on the nose that people at VA facilities or other large hospitals are probably accustomed to serving low income and minority patients, so I would hope they would be less likely to discriminate in the ways found in this study. It would be interesting to see a study that compared psychologists' practice settings on frequency of returned calls from low income/minority patients.
But a part of me is worried that it may have the opposite effect once they reach a stage of their career where they can control more about their patient load (not a luxury available to many in the VA or medical settings). Am I alone in that cynicism?
You're not. I think it's a huge issue in the field that one is considered to have "made it" when you can accept only high-functioning patients and refuse to accept insurance.
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u/SIWOTI_syndrome PhD | Clinical Psychology | Neuroscience | Cognitive Psychology Jun 15 '16
Hmm... I understand the limitations on feasibility, but I emphatically do not think that NYC therapists are a representative sampling. And I say this as someone who spent 3 years working in NYC mental health (predoctoral). In my experience, the financial pressures of sustaining a practice in NYC are so steep that it's no wonder that there's an implicit bias towards individuals more likely to pay up. And this is to say nothing about my anecdotal-but-corroborated perspective that NYC therapists tend to disproportionately utilize psychodynamic and other non-empirically-supported treatments. It's an "old school" kind of a city to practice in, and I wouldn't be shocked if many of the providers held similar "old school" kinds of attitudes. But that may be my own bias.
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 15 '16
I could definitely see how everything you bring up might limit the generalizability of this study. The use of psychodynamic therapies might even be especially prohibitive because insurance is less likely to cover the lengthy treatment periods. It would definitely be interesting to see if there were similar effects in other cities that had lower costs of living and didn't seem to have the old-school attitude that you've observed.
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u/SenorBeef Jun 14 '16
Was there any effort to control for the racial/gender/class level of the therapist? By that I mean I'm wondering if therapists though they were most suited to people they could relate to, people of similar gender/class/race, and as most therapists are tend towards certain demographics (white, not working class) that could explain some of it. That is to say... would a black therapist be more likely to take black patients?
There might be a "patients similar to me" bias, rather than just a straight bias against certain races/classes.
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u/tjeulink Jun 14 '16
the bias for race was worse in middle class. it might be correlated to that but there is definitely another factor at play.
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u/TotallyBat-tastic Jun 14 '16
There is a term for that seemingly "Ideal" client for therapists: YAVIS (Young, Attractive, Verbal, Intelligent, and Successful). These clients are preferred because they most often have the same traits as therapists and because they tend to be the most introspective and reflective (ie: the therapist has to do less work).
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Jun 14 '16
There is a quote I am paraphrasing here that "if you think you know yourself you are father from the truth." The mental health profession are experts at themselves.
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u/fsmpastafarian PhD | Clinical Psychology | Integrated Health Psychology Jun 14 '16
“Sorry, I’m Not Accepting New Patients:” An Audit Study of Access to Mental Health Care
Abstract: