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Psychologists' perceptions of older clients: The effect of age, gender, knowledge, and experience

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Psychologists' perceptions of older clients: The effect of age, gender, knowledge, and experience

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Content PSYCHOLOGISTS’ PERCEPTIONS OF OLDER CLIENTS: THE EFFECT OF AGE, GENDER, KNOWLEDGE, AND EXPERIENCE by Beverly Evan Treadwell A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY EDUCATION (COUNSELING PSYCHOLOGY) May 2002 Copyright 2002 Beverly Evan Treadwell UMI Number: DP71400 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. in the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMI D issertation R jblishing UMI DP71400 Published by ProQuest LLC (2015). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code uesf ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 UNIVERSITY OF SOUTHERN CALIFORNIA The G raduate School U niversity Park LOS ANGELES, CALIFORNIA 90089^1695 This dissertation, w ritte n b y Beverly Evan JTreadwell _ U nder th e direction o f h±s... D issertation C om m ittee, a n d approved b y a ll its m em bers, has been p resen ted to a n d accepted b y The G raduate School, in p a rtia l fu lfillm e n t o f requirem ents fo r th e degree o f DOCTOR O F PH ILO SOPH Y o f Graduate Studies D ate May 1 0 , 2002 i^SER TA T IP N CO M M ITTEE chairperson Dedication To my family and friends, whose support and encouragement sustained me. ill Acknowledgements I would like to thank those special individuals whose guidance and support contributed to the success of this endeavor. First, I would like to thank my committee chair. Dr. Rodney Goodyear whose support and guidance was essential throughout this journey. I am greatly indebted to Dr. Goodyear for his assistance with the development of this project. Second, I would like to express my gratitude to Dr. Robert Knight, whose teaching and mentoring greatly influenced my desire to learn, aspire, and contribute. Finally, I would also like to acknowledge the support given by colleagues, university staff and faculty members. Without their ongoing support and encouragement, the completion of this project would not have been possible. IV Table of Contents Dedication................................................................................... ii Acknowledgments.......................................................................................... iii List of Tables................................................................................................. vi Abstract........................................................................................................vii Chapter 1 : Conceptual and Empirical Foundations of the Study Definitions........................................................ 4 Demographic Changes in the Older Adult Population............................. 8 Under-service of Mental Health Services to Older Adults......................10 General Views oh Older Adults and Elderly Mental Health................... 1 1 Therapists’ Views on Older Adult Clients............................................. 18 Therapists’ Characteristics............................................. 27 Methodological Considerations........................................................... 33 Summary of Literature Review............................................................36 Research Questions............................................................................. 37 Chapter 2: Methods Participants........................................................................................ 39 Measures..................................................................................... 39 Procedures.......................................................................................... 44 Chapter 3: Results Descriptive Statistics...........................................................................46 Examination of the Research Questions............................................... 5 1 Chapter 4: Discussion Interpretation of Results.............................................. 62 Comparison of Results to Existing Research........................................ 65 Consideration of Lack of Significant Findings..................................... 66 Practical Implications..........................................................................68 Suggestions for Future Research....................................... 71 V References..................................................................................................... 72 Appendix A: Client Vignette........................................................................... 82 Appendix B: Age Group Evaluation & Description Inventory (AGED).............. 83 Appendix C; Facts on Aging and Mental Health Quiz (FAMHQ)...................... 85 Appendix D: Fraboni Scale of Ageism (FSA), Altered...................................... 86 Appendix E: Demographic Information Sheet................................................... 88 VI List of Tables 1 . Means and Standard Deviations for Vignette by Client Age and Client Gender.......................... 49 2. Means and Standard Deviations for the Age Group Evaluation and Description Inventory (AGED) Evaluative Dimensions....................... 50 3. Means and Standard Deviations for the Age Group Evaluation and Description Inventory (AGED) Descriptive Dimensions................ 51 4. Means and Standard Deviations for Training by the Fraboni Scale of Ageism (FSA)....................................................................................54 5. Means and Standard Deviations for the Facts on Aging and Mental Health Quiz (FAMHQ) by the Fraboni Scale of Ageism (FSA)....................... 56 6. Means and Standard Deviations for Personal Experience by the Fraboni Scale of Ageism (FSA).............................. 57 7. Means and Standard Deviations for Therapists’ Gender by Fraboni Scale of Ageism (FSA).......................................................................59 8. Means and Standard Deviations for Client Age and Therapists’ Age Groups by the Fraboni Scale of Ageism (FSA)................................................ 6 1 v il Abstract Researchers continue to explore the reasons for the low proportion of adults age 65 and over who seek mental health treatment. It has been suggested that negative attitudes affect both older adults’ help-seeking behaviors and the quality of care provided to them. For example, it is believed that a lack of knowledge and or misinformation about normal aging may lead to inappropriate over-diagnosis or under-diagnosis of mental health disorders among older adult clients. Further, therapists’ generally negative attitudes about aging and older adult mental health are believed to contributed to the problem of under-service of mental health services to older adults overall. This study examined the attitudes and behaviors of 102 psychologists randomly selected from the membership of the American Psychological Association’ s Division of Psychotherapy. Participants were given one of six versions of a vignette depicting a client who presented with paranoid ideation and reports of a prior depressive episode: The vignettes all were the same except that the client was introduced as either male or female, and as either 75,35 or with no age specified. Participants were asked to rate the likely diagnosis and prognosis from a list of four possibilities. Participants also completed measures of knowledge about elderly mental h^lth and attitudes toward older adults. Results revealed that the psychologists in this study were slightly more positive about working with older adult clients than with younger clients and were found to be highly educated about aging and elderly mental health issues. In terms viii of diagnosis and prognosis, no statistically significant results were found regardless of client age and gender. Additionally, no differences were found between attitudes toward older adults regardless of therapists’ gender, knowledge, training or experience. However, a significant relationship was found between therapists’ age and measures of antilocution and discrimination subscales. Results showed that the younger therapists were less likely than were older therapists to engage in negative talk or make discriminatoiy statements about older adults. These findings provide support for the notion that education may be tiie key to promoting positive attitudes toward older adults and preparing psychologists to work with this growing population. Chapter One Conceptual and Empirical Foundations for the Study White racists don’t turn Black, Black racists don’t become white, male chauvinists don’t become women, anti-Semites don’t wake up and find themselves Jewish - but we have a lifetime of indoctrination with the idea of the difference and inferiority of the old, and on reaching old age we may be prejudiced against ourselves. (A. Comfort, 1983, p. 74) Negative attitudes toward older adults (adults age 65 and over) are believed to be widespread in American culture (Butler, 1969; Menec & Perry, 1995; Perlick & Atkins, 1984; Ray, McKinney, & Ford; 1985). Because they are part of the broader culture, it is unlikely that mental health care providers are immune to these attitudes and stereotypes (Grant, 1996). In fact, it has often been questioned whether negative attitudes towards older adults by mental health professionals might play a role in accounting for the low number of older adults who seek and or receive adequate mental health services (Knight, 1985-1986; Royal, 1988; McConatha & Ebener, 1992). In 1986, for example, only 4 percent of the clients seen by therapists were older adults, yet this group represented 12 percent of the U.S. population (Knight 1985-1986). As expected, discussions and research about the under-service of mental health services to older adults continues to be a topic of great interest in the literature (Meeks, 1990). Currently, person’s 65 years of age and over represent 12.7 percent of the United States population (American Association of Retired Persons [AARP], 1999). However according the AARP, a significant growth is expected between the years 2010 and 2030 - when the baby boomer generation reaches age 65. At this point, there will be about 70 million older adult Americans. That is, the older adult population is expected to more than double during this period. As a result, it seems likely that we can also expect an increase in the number of older adults in need of mental health services (Hillman, Strieker, & Zweig, 1997; Knight, 1999). Given these statistics, it is important to consider the possible reasons for older adults’ under-utilization of mental health services. In particular, there is a great deal of controversy in the literature as to whether or not counselor bias affects the number of older adult clients who seek the assistance of mental health professionals. Indeed, studies show evidence of negative bias against older adults in general (e.g., Reuben, Fullerton, Tschann, & Croughan-Minihane, 1995). Other studies indicate that therapists prefer to treat younger clients rather than older clients (e.g.. Dye, 1978; Zivian, Larsen, Knox & Gekoski, & Hatchette, 1992), assign poorer prognosis to older than to younger clients (Ford & Sbordone, 1980) and view older clients as less likely to benefit from psychotherapy than younger clients vrith identical symptoms (James & Haley 1995; Ray, McKinney, & Ford, 1987). Furthermore, Hillerbrand and Shaw (1989) found that counselors were less likely to assess for suicide when clients are viewed as older than when clients are viewed as younger. Knight (1985-1986) on the other hand, disagreed with the literature that suggested that therapists’ attitudes are a factor in the underservice of older clients. His finding showed that therapist attitudes were not correlated with either proportion of older clients seen or the desire to work with older adult clients. In fact, some studies (e.g., Menec & Perry, 1995) have found evidence not only of negative attitudes but also of positive attitudes toward older adults. Additionally, there is also evidence to support the view that variables other than age influence attitudes toward older adults (Gekoski & Knox, 1990). For example, it has been suggested that a lack of knowledge (Butler, 1993) and training in gerontological issues (Beall, Baumhover, Simpson, & Pieroni, 1991) may influence psychologists’ reluctance to treat older clients. However, little attention has been given to how negative attitudes and or a lack of knowledge about older adult mental health may affect counselors’ diagnosis and treatment of older clients (Meeks, 1990). Despite the plethora of research in the area of attitudes toward older adults, the relationship between psychologists’ attitudes, knowledge of and reactions toward older clients, and older adult mental health service provision is unclear. The present study was designed to examine whether therapists’ attitudes toward older adults and knowledge of elderly mental health affect diagnostic assessment of older clients. Further, the relationship between therapists’ 4 perceptions of older adults and such other therapists’ variables as age, gender, training, experience and personal contact with older adults was explored The purpose of this study was to further extend the body of research in this area by testing the general hypothesis that psychologists who have had more training, experience, and knowledge about aging and older adult mental health would exhibit more positive attitudes toward older adult clients. Definitions “Ageism” or negative attitudes based on age (Butler, 1969) is a problem that all individuals will likely experience at some point in their lives. Although ageism can affect any individual or group of individuals (Kimmel, 1988), it is considered to be especially damaging to members of older age groups (Ray et al., 1985). Robert Butler coined the term “ageism” in 1968 (Butler, 1990; Cook, 1992; Fraboni, Saltstone & Hughes, 1990; Hillerbrand & Shaw, 1989; Kimmel, 1988) to describe a societal pattern of attitudes and stereotypes that devalue aging and older adults (Cook, 1992). “Stereotypes” or the overgeneralized belief that all members of a group possess certain characteristics (Conway-Tumer, 1995) ultimately may lead to actions that constitute age prejudice and discrimination (Rohan, Berkman, Walker & Holmes, 1994). “Ageism can be seen as a systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this with skin color and gender” (Butler, 1993, p. 75). Like racism and sexism, ageism is also believed to arise from one’s own fears (Butler, 1980). “Ageism reflects a deep seated uneasiness on the part of the young and middle-aged - a personal revulsion to and distaste for growing old, disease, disability; and fear of powerlessness, ‘uselessness,’ and death” (Butler, 1969, p. 243). Although ageism may be seen as similar to other forms of prejudice and discrimination such as racism or sexism (Ray et. al., 1985), ageism differs in that it implications are much more far-reaching. That is, almost everyone gets old. As Butler (1975) points out, ageism is unlike racism and sexism in that eveiyone is at least dimly aware that he or she ultimately will face the personal reality of aging and death, therefore becoming the object of our own prejudice (see Hopkins, 1980 for a thorough discussion of the similarities and differences between racism, sexism, and ageism). It is important to point out some of the difficulties inherent in defining and researching ageism. For example, as a result of the numerous conceptual and methodological considerations involved in age-related studies, the ability to compare research findings is often quite challenging. For instance, despite knowledge that “the elderly” represent a heterogeneous group, some researchers continue to ask questions as if older adults make up a homogenous group (Coupland & Coupland, 1993). Perhaps more importantly, as with sexism and racism, we must be careful not automatically to assume a connection between systematic stereotyping and discrimination (Cook, 1992) because the link between attitudes and behavior is imperfect Therefore, simply knowing that attitudes exist does not tell us how subjects actually will react in situations (Davis, 1988). Further, defining ageism as “prejudice against older persons” is problematic because the term “older people” does not refer to a unitary construct (Schwalb & Sedlacek, 1990). Consequently, findings can be confusing because research is not always designed with the same idea of “older people”. In fact, it has become clear that consistency in research findings and discussions are further complicated by of the use of other age=related terms (“old”, “elderly”, “senior citizen” etc.) which may have negative and varying connotations associated them (Schwalb & Sedlacek, 1990; see Schaie, 1988 for a discussion about ageism in psychological research). It also is important to underscore that, stereotypes toward older adults can be either socially acceptable or socially unacceptable (Conway-Tumer, 1995). In fact, there is sufficient evidence in the literature to surest that some responses to older individuals may reflect what might be termed “positive ageism” (Menec & Perry, 1995). That is, older people may evoke positive versus negative reactions in certain situations and may therefore benefit from stereotypes ascribed to older adults (Knight, 1985-1986). In contrast to negative and positive stereotyping, “compassionate ageism” reflects benevolence toward older individuals (Ferraro, 1992; Reynolds, 1997) and is believed to be the result of the stereotypical view of older adults as vulnerable and frail (Mosher-Ashley & Ball, 1999; Revenson, 1989). Although benevolent. the effect of this perspective, like negative and positive ageism, is to keep older adults from being seen as they actually are. Even so, the more frequent use of the term “ageism” probably reflects society’s increased sensitivity to this important issue, both politically and morally (Coupland & Coupland, 1993). Butler (1993) suggested that there have been some improvements such as federal laws regarding age discrimination (e.g.. Age Discrimination in Employment Act, amended in 1978; and, the 1975 Age Discrimination Act) and a greater sensitivity toward older people generally since he coined the term ageism. Additionally, the Social Security’s automatic Cost of Living Adjustments and increased political advocacy in support of older adult Americans have helped to bring about improvements in the lives of older adults. As a result however, a new manifestation of ageism has evolved. That is, the belief among some that older individuals command a disproportionate amount of the federal budget (social security and health benefits) and have therefore been advantaged at the expense of children in our society (Butler, 1993). For the purpose of this study, ageism is defined as stereotyping of older adults based on age, whether the stereotypes are negative, positive, or compassionate. The term “older adults” will be used to refer to adults who are 65 years of age and over. Of course, stereotyping of individuals (perceiving all older adults as a homogenous group) is problematic in that it may eventually lead to prejudice, segregation, hostility and discrimination (Fraboni et al., 1990; Kalab, 8 1985; Rohan et. al., 1994). However, it is necessary to define and research such concepts in order to better understand the culturally embedded societal attitudes and beliefs about aging and older adults which can have a profound effect on how older adults are viewed and ultimately how we view ourselves. Demographic Changes in the Older Adult Population In 1999, there were 34.5 million older adults (individuals age 65 and over), representing almost 1 3 percent of the American population (Administration on Aging, 2000). The Administration on Aging estimates that those aged 65 and over will increase to 39.4 million in 2010. Furthermore, this population is expected to grow rapidly between the years 2010 and 2030 when the “baby boom” generation reaches age 65 (AARP, 1999). During this period, the American population of adults age 65 and over is expected to grow to over 69 million (Administration of Aging, 2000). With the growth of the older adult population in the United States, we can expect there will also be an increase in the number of older adults who seek psychological services (Hillman et al, 1997). However, estimates of the prevalence of mental health disorders among older adults vary greatly (Benedict & Nacoste, 1990; Feinson, 1987). For example, among older adults, depression is believed to be one of the most common emotional disorders (Benedict & Nacoste; Meeks, 1990), even though researchers disagree about the prevalence of depression among this group (Gatz & Hurwicz, 1990). Moreover, it is also asserted that the prevalence of major depression is increasing in recent birth cohorts and this increased prevalence will have an additional impact on the need for elderly mental health services in the future (Lewinsohn, Rohde, Seeley, & Fischer 1993). However, results of at least one cross sectional study (Gatz & Hurwicz, 1990) did not provide convincing support for this notion. Gatz and Hurwicz found instead that depression does not increase in a linear fashion, decade-by-decade. Rather there is higher symptom endorsement among younger adults, lower endorsement in middle age and late middle age, and an increase after approximately age 75. The authors suggested that in fact, older people might not be excessively depressed, but rather coming to terms with some of the realistic constraints of their lives. Others have also noted the difficulty encountered in the differential diagnosis of depression and dementia. For example, depression is more often misdiagnosed as dementia than the other way around (Benedict & Nacoste, 1990). This is particularly disturbing because depression generally is a treatable disorder. However, the overlapping cognitive and affective symptoms make it extremely difficult to accurately recognize and diagnose some disorders among older adults (Benedict & Nacoste, 1990). Nevertheless, in addition to population growth, the greater social acceptance of psychological interventions, as well as changes in Medicare and growth of managed care plans will likely add to the increased need for elderly mental health services (Knight, 1999). 10 Under-service of Mental Health Services to Older Adults The 65 years of age and over group currently makes up about 13 percent of the American population. However, of the 10 to 30 percent of the older adult population who have mental health problems (Waxman, Camer, & Klein, 1984) only a fraction of that group will receive professional treatment (Roybal, 1988). Perhaps one contributing factor is the availability of service. In fact, relatively few counselors and therapists are currently involved in direct service to older persons (McConatha & Ebener, 1992). There is some evidence to suggest that older adults are more likely to rely on their primary physicians when seeking help for psychological problems (Lundervold & Lewin, 1990;Waxman et al., 1984). However, it has been estimated that between 10 to 30 percent of all the treatable mental disorders among older adults are misdiagnosed as untreatable (Butler, 1980). The serious underutilization of mental health services by the older adults has been well documented (e.g. Knight, 1985-1986; McConatha & Ebener, 1992; Schmotkin, Eyal, & Lomranz, 1992; Waxman et al, 1984). Private mental health practitioners are estimated to only spend between 2 to 5 percent of their professional time working with older adults (Ford & Sbordone 1980; Knight, 1985- 1986; Lundervold & Lewin, 1990; Roybal, 1988; Waxman et al., 1984). Similarly, the number of older adults with mental health concerns who are served by 11 community mental health centers is estimated to range between 4 to 10 percent (Lundervold & Lewin, 1990; Roybal, 1988; Waxman et al, 1984). A number of interrelated factors are believed to contribute to the low proportion of older adults seeking treatment for mental health concerns. For example, economic constraints (e.g. Medicare’s lower benefit payment compared to private insurance), inhibition on the part of older adults to seek psychological treatment, lack of available therapists trained in aging and gerontological counseling, lack of outreach and therapists’ negative attitudes (Butler, 1980; Butler, 1990; Ford & Sbordone, 1980; James and Haley, 1995; Ray, et al., 1985; Royal, 1988; Schmotkin et al., 1992; Zivian, Larsen, Gekoski, Knox, & Hatchette, 1994) all may negatively affect mental service utilization by older adults. Similarly, Schonfeld and Dupree (1994) suggested that ageism contributes to the low proportion of older adults in alcohol abuse treatment Whatever the reasons, the available data suggests that the older adult population is more seriously under-represented among people who receive mental health services than is any other age group (Roybal, 1988). Certainly, there is no reason to believe that the need for mental health services is less for the 65 and over age group than for other age groups (Knight, 1985-1986). General Views on Older Adults and Elderly Mental Health Negative attitudes and stereotypes about aging and older adults are pervasive in American society (e.g. Braithwaite, Gibson, & Holman, 1985-1986; Butler, 1980; Ferraro, 1992) and ageist language has become a key part of our 12 vocabulary and speech (Kalab, 1985). Ageism in American culture is perpetuated through literature, movies, television and advertising (Butler, 1980). A review of the literature suggested that negative stereotypes ascribed to older people include characteristics such as helpless, dependent, irritable, frail, forgetful, and rigid (Braithwaite et. al., 1985-1986). Consequently, discussions about and empirical research regarding stereotypes and attitudes toward older adults, aging and elderly mental health are not only worthwhile but critical (Sorgman & Sorensen, 1984). For instance, several studies found evidence that older targets are viewed less positively tiian are younger targets Q)eAngelo, 2000; Hummert, Garstka, & Shaner, 1997; Hummert, Garstka, Shaner, & Strahm, 1995) and that subjects rated older patients compared to younger patients as more ineffective, dependent, and personally unacceptable (Reuben et al., 1995). Additionally, a study of the public’s attitudes toward older adults found that subjects who were more ageist were less likely to report a willingness to help victims of elderly abuse than were other subjects (Blakely & Dolon, 1998). Another study found that within the general public, people of all ages expressed strong bias against the benefit of psychotherapy for older adults compared to younger age groups (Zivian et al, 1994). Similarly, older adults reported that they do not feel very positive about the effectiveness of mental health professionals (Lagana, 1995; Waxman et al., 1984) and express a preference for seeking help from their primary health physicians if they have psychiatric symptoms (Waxman et al., 1984). 13 However, findings suggest that when older adults seek psychological and or medical services, they are likely to encounter ageist views by their service provider (Bouman & Arcelus, 2001; Perlick & Atkins, 1984). Several studies (Greene, Adelman, Charon, & Hoffinan, 1986; Hillberand & Shaw, 1989; Uncapher & Arean, 2000;) showed evidence of age bias among physicians. For instance, Hillerbrand and Shaw (1989) found that compared to younger patients presenting with the same symptoms, geriatric patients were referred less often for psychiatric consultation and less likely to be assessed for suicidal ideation and past psychiatric history. The Hillerbrand and Shaw study was unique in that a retrospective evaluation of patient’s records was used, thereby avoiding subject contamination (i.e., halo effects). Another study (Uncapher & Arean, 2000) revealed that although primary care physicians recognized the presence of depression and suicidal ideation in older and younger patients equally well, they reported less willingness to treat the older suicidal patient compared with the younger patient. These findings are particularly discouraging considering the high rate of suicide among older adults compared to other age groups (Hillerbrand & Shaw, 1989). Greene et al. (1986) also found physicians to be less respectful, less patient, less engaged and less egalitarian in their communications with older patients than with their younger patients. There is, however evidence for the existence not only of negative stereotypes but positive stereotypes of older adults as well (Menec & Perry, 1995) which suggests that other factors may be influencing negative stereotypes 14 (Hummert et al., 1997). In fact one study (Davis, 1988) found mixed results. That is, subjects were found to hold both negative and positive stereotypes about older adults. Similarly, Menec and Perry (1995) did not find support for the notion of negative attitudes when both young and older groups exhibited stigmas. In fact, in this study, older targets evoked more positive emotional reactions than did younger targets (particularly when stigmas were ascribed to uncontrollable factors such as blindness) and in these instances subjects reported more willingness to help older individuals more than young individuals. Gekoski and Knox (1990) also found that target health status was substantially more powerful than that of target age. The authors proposed that it is not age per se, but other attributes such as poor health that engender negative beliefs and attitudes toward older adults. That is, people may not view older adults more negatively because of their age per se, but because of the presence of other attributes such as poor physical or mental health. For instance, James and Haley (1995) found that factors other than ageism were found to be more salient in determining differences in the treatment of older adults. The authors suggested that ” healthism" (i.e., discrimination against those in poor health) might be more pervasive than ageism among mental health providers. However, James and Haley (1995) pointed out that these findings also suggest the potential for a kind of double prejudice. That is, older adults in poor health may be more harshly discriminated against than are older adults in good 15 health. Several others also support the notion of a double standard, not only for older adults in poor health but for older women (Lipka, 1987) and older people of color (Conway-Tumer, 1995). Another study also found further evidence of a double standard in that subjects showed higher agreements with suicide attempts for older females than for any other target group (Stillion, White, Edwards, & McDowell, 1989). Palmore’s (1971) review of the literature on attitudes toward older adults as shown by humor revealed that while older adults were most often portrayed negatively, this was especially true for older women. Another study however, (Kelly, Knox, Gekoski, & Evans, 1987) did not find a relationship between the appreciation for humor about older people and attitudes toward them. There is however, some empirical support for the notion of an unintentional and unconscious component of ageism (Perdue & Gurtman, 1990). Other studies have also found evidence of significant gender and age differences in attitudes toward older individuals (Hawkins, 1996; Kalavar, 2001; Kogan & Mills, 1992; Thorson & Perkins, 1981). For example, Kalavar (2001) found that male students scored higher on measured ageism than did female students. Interestingly, students scoring higher on the trait of aggression demonstrated significantiy more negative attitudes toward older adults (Thorson & Perkins, 1981). Another study revealed that male respondents generally viewed older adult females more negatively than did female respondents (Hawkins, 1996). These findings suggest that age may be more salient for males than for females. In 16 fact, Kogan and Mills (1992) found that males tend to show a stronger youth bias than females when making judgments. Males have also been found to exhibit significantly more anxiety about personal aging than do females (Lasher & Faulkender, 1993). Older students, however, where found to hold more positive attitudes toward older individuals than younger students (Thorson & Perkins, 1981). Predictably, Mosher-Ashley and Ball (1999) found that traditionally aged college students (18-22 years) were significantly more concerned about personal aging than were nontraditionally aged students (age 23 years and over). Even children in our society express negative feelings about their own aging (Newman, Faux, & Larimer, 1997). For a discussion of children’s attitudes about aging and older adults see Newman et al. (1997) and Slaughter-Defoe, Kuehne, and Straker (1992). Whereas television viewing was found to have a significant affect on children’s attitudes toward aging and older adults, the same results were not found among adults (Passuth & Cook, 1985). One study, however, found that films showing positive depictions of older adults enhanced positive attitudes and decreased negative attitudes in adults, while fihns portraying negative images of older adults had no significant affect on attitudes (Patchner, 1986). Additionally, Ragan and Bowen (2001) revealed that providing information about older adults (via video) in addition to positive reinforcement to change attitudes, yielded more positive attitude change for one group compared to a control group. 17 Still other studies suggest evidence of compassionate ageism toward older adults (e.g., Revenson, 1989; Reynolds, 1997; Williams, 1996). Reynolds (1997) analyzed public conservatorship records and found that older adults are less likely to be given psychotropic medications and less likely to be placed in locked facilities than are younger adults. Williams (1996) also found evidence of compassionate ageism in their study of intergenerational communication vignettes. This study showed that the older targets were consistently perceived more positively than were the younger targets. That is, subjects tended to make allowances for older targets that they were unwilling to make for younger targets. Evidence of compassionate ageism also has been found among physicians. For instance, Revenson (1989) found that physicians who had more contact with older patients rated them as more ineffective and dependent, lower in psychological adjustment, and in greater need of all types of support and information than the middle aged target. On the other hand, physicians who had less contact with older patients rated them as less in need of support and information than the middle aged targets, however, they rated the two target groups similarly in terms of psychological adjustment, effectiveness, and autonomy. The authors concluded tiiat their findings suggest that the high contact physicians appeared to be influenced by compassionate ageism toward older adults. Nevertheless, despite increased publicity and concern over the rights of older person in our society, attitudes do not seem to be changing overall (Ferraro, 1992; Paris, Gold, Taylor, Fields, Mulvihill, Capello et al., 1997; Schwalb & 18 Sedlacek, 1990). For example, Schwalb and Sedlacek (1990) examined whether negative attitudes persist over time by examining college freshmen’s attitudes toward older person in 1979 and 1988. They found that college students maintained the same generally negative attitudes toward older people over the period studied. In addition, Paris et al. (1997) examined the attitudes of medical students toward older adults at three different years (1986,1991 and 1994) and obtained similar results. Similarly, another cross sectional study, found that whereas there seems to be an growing sympathy and support for older people in general, stereotypical thinking about older adults had not changed between 1974 and 1981 (Ferraro, 1992). Therapists’ Views on Older Adult Clients It has been suggested that therapists and other mental health professionals share society’s age-based prejudices against older adults (Butler, 1975; Ivey, Wieling, & Harris, 2000) and that these negative attitudes contribute to the low number of elderly who seek mental health treatment. Yet these findings are not consistent. One study compared the attitudes of college students and therapists and found that therapist's attitudes toward the older adults were significantly more positive than were those of college students (Kni^t, 1985-1986). But, in another study, although clinical and counseling psychologists did not openly express ne^tive attitudes about working with older clients, they did express a preference for working with younger clients (Dye, 1978). 19 McConatha and Ebener (1992) examined the attitudes of students enrolled in a counseling program. In this study, students were asked to read a scenario of a dialogue between a client and a counselor and then to complete a questionnaire. Client age was varied (34 years old and 66 years old). However, the number of presenting problems and severity of problems were equivalent. Results indicated that although prospective counselors expressed no differences in their willingness to work with older clients, when asked to recommend the client to another counselor, age appeared to be a significant variable for consideration. More specifically, the McConatha and Ebener study revealed that 48 percent of those who read the older-client scenario suggested that the older client would be most compatible with a therapist over the age of 45. Also, 69 percent of those who read the younger-client scenario suggested that the younger client would be most compatible with a therapist under the age of 45. It is not clear, though, whether this is evidence of prejudice versus anticipation of what age configurations would seem most “credible” to the client; that is, credible on the basis of matching of level of life experience and age similarity. Interestingly, in another study that seems to shed some light on this question, Lauber and Drevenstedt (1993) found that when given a choice, older adults expressed a preference to be treated by older therapists rather than younger therapists. Another study (Zivian et al., 1992) focused on psychiatrists’ and psychologists’ degree of preference for treating clients who belonged to one of three groups i.e., young-age (20-30 years); middle-age (35-50 years); and old-age 20 (65-80 years). The therapists preferred to treat young-age clients over middle-age clients and preferred to treat middle-age clients over old-age clients. Significantly, the authors found that the preference for treating older clients was related to the degree of the therapist’s professional experience and knowledge of geriatric psychotherapy. Hillman and Strieker (1998) examined the attitudes of clinical psychology students. In this study, students responded to vignettes differing along two dimensions i.e., patient age (46 years old, 66 years old and 88 years old) and patient pathology (major depression, and major depression with borderline personality disorder. Notably, seventy-five percent of the students indicated that they had never worked clinically with an older adult. Although the students did not reveal evidence of global, negative, age-related bias they did reveal certain specific, negative age-related bias toward the 88-year-old client. That is, the students in this study revealed negative bias only toward the oldest age group. In a similar study, Hillman et al. (1997) surveyed psychologists rather than students. Only thirteen percent of the psychologist in the study reported having had some previous counseling experience with older adult clients. Findings indicated however, that psychologist displayed specific, appropriate, age related diagnostic and treatment biases, particularly when they reported having specialized gerontological training or course work. However, neither more years of experience nor the presence of gerontological training was associated specifically with more positive attitudes toward the older adult clients. The authors concluded that not 21 therapist negative attitudes, but poor social support and inadequate reimbursements for treatment likely affect the underutilization of mental health services to older adults. Similarly, James and Haley (1995) found that doctoral-level psychologists viewed older adults as being less appropriate for therapy and as having a poorer prognosis than younger adults. Additionally, another study found that marriage and family therapists were less likely to perceive relational and health concerns experienced by older adults as seriously as the same concerns when experienced by younger couples (Ivey et al., 2000). Research findings suggest that clinical and counseling psychologist consistently prefer to treat younger clients to older chents, regardless of diagnostic category (Dye, 1978) and to exhibit unwarranted pessimism with regard to the prognosis of older adults (Meeks, 1990). For example. Ford and Sbordone (1980) found that psychiatrists were inclined to regard older patients as less ideal for their practices and as having poorer prognoses. In this study, psychiatrists were also less likely to choose psychotherapy as a primary treatment modality for older patients than for younger clients. Similarly, in a study using equivalent client depictions, counselor trainees perceived the number of perceived problems and the severity of depression to be greater for younger than for older clients (McConatha & Ebener, 1992). In fact, numerous studies in which psychiatrists and psychologists were asked to respond to case vignettes have noted significantly lower ratings of older 22 clients than of younger clients. For example, therapists rated older clients as less ideal for psychotherapy, assigned significantly poorer prognoses (Ford & Sbordone, 1980; Ray et al., 1985; Ray et al., 1987; Settin, 1982) and were less likely to recommend psychotherapy for older clients than younger clients with identical symptoms (Ford & Sbordone, 1980; Ray et al., 1987). But, although these results are suggestive, the problem with analogue studies, though, is that it is difficult to generalize results to real-world situations (Meeks, 1990; Reekie & Hansen, 1992). Ford and Sbordone (1980) analyzed practicing psychiatrists’ responses to a questionnaire requesting their opinions regarding clinical vignettes. The vignettes for each questionnaire were identical except that the age of the client was varied (65 years old or older and age younger than 45). Analyses indicated that psychiatrists were significantly more likely to regard the older patient as less ideal to work with than the younger patient who had identical symptoms and histories. Psychiatrists also gave poorer prognoses to the older patient than to the younger patient. Additionally, psychiatrists in this study were less likely to choose psychotherapy as a primary treatment for the older patient. The authors concluded that psychiatrists viewed older patients as less ideal because they viewed them as having poorer prognoses. Ray et al. (1985) found that psychiatrist’s orientation influenced the extent of age bias toward older adult clients. This study was conducted using a self administered questionnaire and clinical vignettes describing clients as manic 23 alcoholic, agoraphobic or depressed. Psychiatrists were asked to rate clients’ suitability for therapy within their practice, and give prognoses and treatment information. Client ages were described as either below 45 years of age (middle aged) or above 65 years of age (older). Each vignette was duplicated for each age group. However, no one subject was given both age vignettes. This study found negative bias on the part of psychiatrists regardless of theoretical orientation. In this study, all three groups (i.e. psychoanalytic, psychodynamic and eclectic psychiatrists) demonstrated stronger and more consistent negative evaluations of the prognosis for older patients than the prognosis of middle-aged patients. Eclectic psychiatrists, however, showed less bias than did the psychoanalytic and psychodynamic psychiatrists. The Ray et al. (1985) study also revealed that psychiatrists preferred to work with younger patients and held more negative attitudes toward older patients versus younger patients. In addition, the psychoanalytic and psychodynamic groups, but not the eclectic group deemed prognoses as poorer for older clients with the same personality disorders as younger clients. Further, the psychodynamic psychiatrists demonstrated more prejudice overall than the other two groups. The authors suggested that the latter finding is likely reflective of the theoretical and historical underpinnings of the Freudian view. That is, it reflects psychoanalytic theory’s traditionally pessimistic view regarding the efficacy of conducting psychotherapy with older persons. 24 In another study, Ray, et al. (1987) utilized four identical vignettes except that the age of the client described in the vignettes varied (below 45 and above 65). In responding to case vignettes, clinical psychologists recommended more medication and less long-term psychotherapy for the older client than for the younger client. That is, younger clients were perceived as significantly more ideal for psychotherapy and had better prognoses (at least for some categories) than did older clients. In a similar study, Settin (1982) mailed psychologists a clinical vignette, which depicted a client with symptoms of depression. Client age, sex and class were varied and each therapist received one of eight possible combinations of the vignette. Results indicated that psychologists held significantly more negative views toward the 72-year-old client than toward the 46-year-old client and were more likely to perceive the older client as having a poorer prognosis. In contrast, Reekie and Hansen (1992) used a similar approach to assess the attitudes of clinical social workers. This study, like the others employed a clinical vignette. Each subject received an identical clinical vignette, except that the age and gender of the client were varied (i.e. a 32-year old male; a 62-year old male; a 32-year old female; and a 62 year old female). However, this study did not find that social work clinicians rated the older client to be less ideal, less likely to progress in treatment, or more severely impaired than the younger client. On the other hand, Perlick and Atkins (1984) provide another example of the inclination of therapists to give more severe diagnoses on the basis of age. 25 This study examined how variations in the reported age of the client affect the diagnosis given by clinical psychologist. Participants responded to taped interviews of a client 55 years of age (middle age) or 75 years of age (older). Perlick and Atkins found that the older client was judged more negatively and diagnosed more harshly than was the middle-age client. In particular, when subjects believed the target to be older, a depressed patient was viewed as more organically impaired, less depressed, and less responsive to antidepressant therapy then when the target was believed to be middle-age or when age was unknown. However compelling, these studies do not address actual barriers to therapy but attitudes and quality of care. In fact, Knight (1985-1986) found that neither the number of elderly clients seen nor the motivation to work with o l^ r clients were correlated with therapists’ attitudes. In this study, therapist work-site accounted for 25 percent of the variance in clinical contact with older clients. One study however, specifically addressed the notion of the “reluctant therapist” (Schmotkin et al., 1992). In this study, clinical psychology graduate students showed much lower motivation to work with the older adults than with any other age group. In fact, 55 percent of the students in this study explicitly expressed a desire not to work with the older adults. Schmotkin et al. (1992) reported that the two most powerful predictors of motivation to work with older adults were explained by attitude toward psychotherapy for older adults and past professional experience in this field (38% of the variance). 26 A one-year study which reviewed patient records, also found evidence of age bias among social workers treating adult oncology outpatients (Rohan et al., 1994). The findings of this study suggested that ageism may be common in the screening, diagnosis and treatment of cancer patients. Specifically, Rohan et al. (1994) compared the records of cancer patients who ranged in age from 18 to 64. They found that social workers spent more time overall, spent more time in individual treatment, had more patient-social worker contact, and had longer duration of treatment with the younger patients than with the older patients. The authors concluded that these findings indicate that social workers are reluctant to woric with older adults and that this reluctance is likely the result of ageism. Schmotkin et al. (1992) further proposed that a number of variables might affect therapists’ reluctance to work with older adult clients. These variables may include for example, general societal age bias, anxieties and fear about one’s own aging, aging parental figures, and or fears related to disease and dying. However, these authors found that personal characteristics were less significant than were professional ones in predicting motivation to work with the older chents. That is, according to these authors, factors such as relationship with parents and personal feeling about aging and death had less of an affect on motivation to work with older adults than did professional motivations. However, Schmotkin et al. (1992) suggested that professional ageism may be an issue in need of particular consideration, especially in terms of the potential to under diagnose and or over diagnose particular disorders among the elderly. 27 Similarly, Butler (1975) urged therapists to reexamine their attitudes toward older adults and to be aware of countertransference issues that may interfere with treatment. In fact, one study using case studies showed how ageist attitudes, misinformation about normal aging, and countertransference hindered treatment for therapists working with older adult women (Altschuler & Katz, 1996). Therapist Characteristics Education. It is generally agreed that education is the antidote to negative attitudes and discrimination toward older adults (Butler, 1993; Ferraro, 1992; Rohan et al., 1994). That is, based on general knowledge about attitudes, fears, and countertransference, education may be the key to increasing awareness about aging and older adults (Rohan et al., 1994). Further, educated people are generally regarded as more aware of cultural differences and therefore less likely to exhibit stereotypical negativity towards others (Ferraro, 1992). Although there is evidence to support this notion in regard to sexism and racism, much less information is available regarding age discrimination (Ferraro, 1992). However, one study did find that education not only increased knowledge but also improved attitudes about aging (Angiullo, Whitboume & Powers, 1996). Katz (1990) also found that education was an effective tool for increasing positive attitudes toward older people. Uniquely, a board game designed to increase knowledge and awareness about older adults was also successful in changing attitudes (Israel, Dolan, & Caranasos, 1992). 28 In particular, education in human development and aging is believed to be imperative in the preparation for gerontological counseling (McConatha & Ebener, 1992). That is, an awareness of the normal aging process among mental health service providers will likely help them to avoid misdiagnoses of older clients based on stereotypes and or a lack of knowledge about older adult mental health. However, textbooks, important in the education of future psychologists expose students to negative (Kalab, 1985), stereotypical, and limited perceptions of older adults and aging (Whitboume & Hulicka, 1990). For example, an examination of psychology textbooks revealed that little attention was given to the topic of aging and older adults, and that when aging was addressed, the texts tended to focus on the negative aspects without differentiating between normal aging and disease processes (Whitboume & Hulicka, 1990). In a similar stucfy, Kalab (1985) found that negative language was often used in sociology textbooks to refer to older adults. One of the first studies on attitudes and aging, Tuckman and Lorge 1953, found that even education graduate students held many misconceptions and stereotypes about aging (Angiullo et al., 1996). However, another study which examined the attitudes of leaders of older adult agencies found that gerontologist scored higher in knowledge about older adult mental health than did other professionals, especially in the area of age related changes in learning (Galbraith & Venable, 1985). 29 Training and Experience. Most of the psychologists in one study, reported having had little experience counseling older adults and also expressed concerns about their abilities due to a lack of training and experience to work with this population (Dye, 1978). Beall, Baumhover, Simpson, and Pieroni (1991) found similar complaints among physicians See Knight (1999) for a discussion about of the adaptations needed in psychotherapeutic interventions with older clients and Knight and McCallum (1998) for a discussion of the differences and similarities in providing psychotherapy with older and younger clients. Zank (1998) reported that the only significant predictor of therapists’ desire to work with older clients was previous experience. This author found no relationship between interest in working with older clients and therapist’s knowledge or therapist’s age. Nevertheless, Yarhouse & DeVries (2000) found a positive relationship between higher ethical scores on one measure and coursework (geropsychology or aging), speciahzation in older adult issues, and high professional contact with older clients. Personal Contact. The social contact hypothesis predicts that increased exposure to older people will decrease one’s reliance of age stereotypes and increase perceptions of individual attributes (Revenson, 1989). Revenson (1989), however, found that physicians who had more older adult patients than patients of other ages, rated older patients as more dependent, ineffective, less adjusted, and more in need of support than they rated middle-aged targets. In contrast. 30 physicians who had little or no contact with the elderly rated the elderly as equal to middle-aged targets on all attributes. Consequently, the findings of this study appear to contradict the social contact hypothesis. Additionally, another study found that direct contact did not foster more positive attitude change than did a didactic learning experience (Angiullo et al., 1996). However, other studies (e.g., Murphy-Russell, Die, & Walker, 1986; Newman et al., 1997) found support for the theory that direct contact fostered positive attitudes. Also, an intergenerational program found that attitudes toward older adults could be significantly improved (Aday, Sims, McDuffie, & Evans, 1996). Additional studies however, found that quality rather than frequency of contact was significantly related to more positive attitudes toward older adults (Knox, Gekoski, & Johnson, 1986; Schwartz & Simmons, 2001). More specifically, Knox et al. (1986) found that the quality of contact was a rehable predictor and that personal experience with older adults had the greatest influence on attitudes toward and perceptions of older adults. The results of the Schwartz and Simmons (2001) study also showed support for the hypothesis that quality, but not firequency of contact was significantly related to more positive attitudes toward older adults. On the other hand, Riddick (1985) found that although degree of contact with older adults emerged as significantly influencing increased gerontological knowledge, it did not influence positive attitudes change. 31 Gender of Therapist Thorson and Perkins (1981) found that in a general population, females exhibited more positive attitudes toward older people than males. However, there is some evidence to suggest that female clinicians might harbor more negative views of older clients than male clinicians. For example, Ray et al. (1985) found that although both male and female psychiatrists discriminated against older patients, female psychiatrists discriminated more than did male psychiatrists. More specifically, female psychiatrists assigned poorer prognoses to older patients than did male psychiatrists, and tended to rate older patients as less ideal than did male psychiatrists. Certainly, this finding appears to be contrary to the traditional view of females as more nurturing than males. The authors proposed however, that due to societal attitudes toward youth and appearance, females may have a heightened awareness and may therefore be more threatened by interactions with older individuals. Even so, another study revealed that female social workers considered psychodynamic issues to be less important for older clients than for the younger clients (Reekie & Hansen, 1992). In fact, in this study, female social workers viewed psychodynamic issues as less important for older women clients and more important for younger men clients. But because male social workers were not included in this study, between-gender comparisons were not possible. Age of therapist. Some evidence has been found of an association between the age of patient and age of practitioner. For example, one study found that older psychiatrists held more negative attitudes toward older patients than they did toward younger patients (Ford & Sbordone, 1980). That is. Ford and Sbordone 32 (1980) found a negative correlation between the psychiatrists’ own age and their attitudes toward older clients. The authors suggested that older psychiatrists may inadvertently develop more cynicism as a result of professional experience. Additionally, they hypothesized that for older therapists in particular, certain disorders (e.g. affective) may evoke personal anxiety due to particular life experiences. Ray et al. (1985) examined the correlation between age of psychoanalytic psychiatrists and appraisal of older and younger patients. For some diagnostic categories (i.e., affective disorders) age of psychoanalyst was negatively correlated with age of patient. That is, older psychoanalytic psychiatrists tended to offer poorer prognoses to older patients than to younger patients. On the other hand, Ray et al. (1987) hypothesized that younger psychologists (who presumably have been exposed to newer and less rigid conceptions of the older adults) would demonstrate more favorable attitudes toward older adult clients. However, contrary to this expectation, older psychologists in their study tended to regard older clients more positively than did younger psychologist. However, another study revealed that older physicians (70 years and over) were less positive toward older patients than were younger physicians (Hellbusch, Corbin, Thorson, & Stacy, 1994). Perhaps, as the authors propose, older patients serve as a reminder to older therapists of their own aging and mortality. Nevertheless, this finding appears to be in direct conflict with the age matching 33 theory, which suggests that older clients prefer older therapist based on the assumption that older therapists would be more understanding of older clients than would younger therapists (Lauber & Drevenstedt, 1993). Interestingly, older psychiatrists have reported concerns about experiencing ageism in their work environment. For example, Weiner (1990) reported that older therapists expressed concerns about receiving fewer referrals, which they believed, was at least partly the result of ageism. Methodological Considerations Historically, little attention has been given to age bias in mental health research and clinical interventions (Ivey et al., 2000). However, it is crucial that psychologist become actively aware in order to avoid inadvertently supporting ageist bias (Grant, 1996) which can ultimately result in adverse consequences for older adults (Schaie, 1988). See Schaie (1988) for a thorough discussion of the ageism in psychological research. For example, evidence of age stereotyping (both positive and negative) was found when the target was generalized but not when the target was specific (Braithwaite, 1986). More specifically, when targets are known, less negative attitudes are found (Sanders & Pittman, 1987). Similarly, when ratings of age- specific targets are compared to ratings of non-age specific targets more negative attitudes are revealed (Intrieri, von Eye, & Kelly, 1995; Schwalb & Sedlacek, 1990). Also, more positive attitudes have emerged when non-stereotypical older adults have been used as the targets (Wingard, Heath, & Himelstein, 1982). 34 Moreover, most empirical studies have been conducted on sample of restricted age ranges, (especially student populations) and only a few studies include adults of various ages, including older adults (Ferraro, 1992). As a result of these findings, it has been proposed that the phenomenon of old age stereotyping has been greatly exaggerated (Braithwaite et al., 1985-1986). In fact, it has been theorized that the incidence of ageism found in much of the research may not be related to chronological age but other issues such as preference for age similarity (Kimmel, 1988). Additionally, the way research questions are asked, the respondents selected, analysis of the data or the interpretation of the results may also account for some of the differences found (Schaie, 1988; Schaie, 1993). Methodological differences appear to be at least in part responsible for the inconsistent findings in the age-related research. Sharps, Price-Sharps, and Hanson (1988) found that attitudes toward older adults in America are mixed, neutral, or even somewhat positive and suggested that possibly the differences found across studies, depend upon the methods utilized. One of the major methodological issues in age related research has to do with within-subjects versus between-subjects designs (James & Haley, 1995; Knox & Gekoski, 1989; Wingard et al, 1982). According to these authors, when subjects are asked to compare older versus younger targets (as with within-subjects designs) differences found are more extreme than when judgments are isolated (as with between-subjects designs). That is, when subjects are asked to compare targets of varying ages, age is more salient. As a result, within-subjects designs tend to yield 35 results indicating more extreme negative views of older adults. In contrast, less extreme results are more often found in research using between-subjects designs. Similarly, studies using clinical vignettes and between subjects designs have elicited less negative attitudes than the more traditional attitudes measures (Braithwaite, 1986). For example, the scaling methods developed in the 50’s and 60’s (such as semantic differential and adjective checklists) focused mainly on the assessment of stereotypes of older adults and represented only the cognitive aspect of attitudes (Fraboni et al., 1990). These scales have also been criticized because of the use of dated language and stereotypical statements (Hilt, 1997; Hilt & Lipschultz, 1996). However, the 70’s and 80’s assessment instruments included subscales and measured more specific constructs. For example, Palmore’s Fact on Aging Quiz (FAQ) developed in 1977 diverged from the others by developing items that were empirically based (Fraboni et al., 1990). The FAQ was foimd to be a fairly valid and reliable indicator of the accuracy of knowledge and perceptions about aging and older adults (Gibson, Park Choi & Cook, 1993; Michielutte & Diseker, 1984- 1985). However, the FAQ has been criticized for being focused on stereotypical and static images of aging and older adults rather than being directed at the process of aging and the dynamic behavioral change that occur as a result (Galbraith & Venable, 1985). The FAQ has also been criticized because it can only be used in studies in which the combination of knowledge and attitudes are acceptable (Kline, Scialfa, Stier & Babbitt, 1990), 36 Also, studies using vignettes have been generally criticized because in most clinical situations, far more information is available about clients. Therefore, diagnosis and prognosis may be more ambiguous and difficult than usual (Meeks, 1990). That is, because information is so limited, the bias ehcited may not continue after the therapist has learned more about the client (Braithwaite, 1986). Nevertheless, the use of clinical vignettes in a between-subjects design offers the opportunity to control variables and study the effect of age on therapists judgements in a way not possible in naturalistic research (Reekie & Hansen, 1992). Summary of Literature Review Despite increased attention to issues involving older adults and aging in American society, older adults continue to be underrepresented among those who receive mental health services. In order to understand this phenomenon, researchers have been examining mental health professional’s attitudes and perceptions toward older adults. The assumption is that attitudes toward older adults will determine how mental health professionals treat older adult clients. Although, mental health professionals generally deny having negative attitudes towards older adults, there is some empirical evidence to the contrary. Specifically, therapists consistently express a preference for treating younger clients over older clients, assigned poorer prognoses to older clients, and are doubtful that older adults well hkely benefit from psychotherapeutic interventions. In contrast, however, some studies have reported finding that older adults elicited 37 more positive attitudes than did younger adults. Evidence for the notion of compassionate ageism toward older adults has also been reported. In addition, it has been suggested that therapists' lack knowledge, training and experience to work with older adult also may influence their perceptions and reactions toward older adult clients. Indeed, some studies found a correlation between therapists' knowledge, experience and training and their attitudes toward older adult clients. Similarly, some evidence has been found to suggest that therapists' age and gender also may affect their perceptions of older adult clients. Overall, research in the area of relationships between therapist variables and their attitudes, perceptions, and reactions toward older adults is mixed. Unfortunately, findings are complicated by methodological problems including lack of uniformity in definitions, methods employed, and interpretations. In order to take a closer look at some of the variables that contribute to therapists' attitudes and reactions toward older adults, the present study will examine this issue via a variety of assessment approaches. It is hypothesized that more knowledge of aging and elderly mental health would positively correlate with reported attitudes toward older clients. Further, it is proposed that a therapist’s professional experience, training, personal contact with older adults, age, and gender would influence his or her attitudes toward older clients as well. Research Questions 1 . Would age and gender of clients depicted in a vignette affect diagnostic impressions and perceptions of the older adult client? 38 2. Would therapists with more professional experience with older adults exhibit more positive or more negative attitudes toward older adults? 3. Would therapists with more training to work with older adults exhibit more positive or more negative attitudes toward older adults? 4. Would therapists with greater factual knowledge of elderly mental health and aging exhibit more positive or negative attitudes toward older adults? 5. Is there a relationship between more personal experience with older adults and attitudes toward older adults? 6. Is there a relationship between psychologist’s gender and attitudes toward older adults? 7. Is there a relationship between psychologist’s age and attitudes toward older adults? 39 Chapter Two Methods This chapter describes the individuals who participated in the study and the measures and procedure used. Participants Participants included 102 psychologists (62 males, 37 females, and 3 participants who did not specify their gender). Participants had a mean age of 58.9 years (SD = 11.48). Participants ranged in age from 35 to 91 years of age. Ninety- five percent of the participants self-identified as Caucasian American, 3 percent as African American, 1 percent as Other, and 3 percent of the participants did not specify ethnicity. Almost all participants (86 percent) held a Ph.D., and 92 percent were licensed to practice therapy. The number of years licensed ranged from 3 to 47 years, mean 21.13 (SD = 9.26). Measures The four instruments used to collect data in this study are described below: Client Vignette (Meeks, 1990), the Age Group Evaluation and Description Inventory (Knox, Gekoski, & Kelly, 1995), the Facts on Aging and Mental Health Quiz (Palmore, 1998), and the Fraboni Scale of Ageism (Fraboni et al., 1990). Additionally an information sheet was developed for this study in order to obtain demographic information and inquire about therapists’ professional experience, training related to older adult clients and personal contact with older adults. 40 Case Vignette. The written chent vignette was adapted from the Meeks (1990) study. The vignette was written in the format of a brief clinical report designed to approximate the type of information therapists often use in making diagnostic decisions. The case description (see Appendix A) depicted a client presenting to an outpatient client with paranoid ideation and a prior depressive episode. This particular vignette was selected because depression is believed to be commonly misdiagnosed among older adults in particular (e.g. Meeks, 1990). Participants were asked to make three judgments on a 10-point Likert-type scale ranging from 1 (not at all likelvl to 10 (almost certain). First was the likelihood of the diagnosis for the client depicted in the vignette is a major depressive episode. Second, another psychiatric disorder. Third, a medical (somatic) disorder. Additionally, participants were asked to rate the prognosis for the client from 1 (very good) to 10 (extremely good). The Meeks study using a within-subjects design found that the reliability of responses showed great variability (ranging from .90 to .20 and lower). However, for this investigation, unlike the Meeks study, a between-subjects design was utilized. That is, each participant received one of six possible versions of the clinical vignette. The vignettes were identical except that the client was described as male or female, age 75,35, or no age specified. The Age Group Evaluation and Description Inventorv (AGEDl. The AGED was used to assess how respondents perceived particular age groups. The AGED allows users to focus on attitudes or the evaluative dimensions (i.e. 41 goodness and positiveness) as well as cultural stereotypes or the descriptive dimensions (i.e. vitality and maturity) of specific age groups (Knox et al., 1995). Attitudes are defined as the evaluative aspect of how targets are viewed whereas stereotypes are defined as a set of beliefs about a target. Naturally, attitudes and stereotypes are both aspects of how targets are perceived. However, unlike prior measures of this type, the AGED allows users to separate attitudes and stereotypes in order to get a better understanding of exactly what is being measured. The AGED consists of 28 bipolar adjective pairs and uses a 7-point semantic differential response scale (see Appendix B). Scores range from 1 (negative! to 7 (positive). Various factor analyses revealed that the evaluative items and descriptive items are extremely robust (Knox et al., 1995). Reliability coefficients for each dimension are as follows: Positiveness r =. 57 (range, .48 to .63); Vitahty r = .75 (range, .57 to .84); Goodness r = .72 (range, .61 to .75); Maturity r = .73 (range, .59 to .77). For this study, the AGED was altered in order to expand the information obtained about the therapist’s impressions of the client in the vignette. That is, respondents were asked to place a mark along the semantic differential scales that best described the person they had just read about in the clinical vignette. Facts on Aging and Mental Health Quiz (FAMHQ). The FAMHQ consists of twenty-five (25) statements designed to deal with the empirically based facts and misconceptions about mental illness and its treatment among older adults (see 42 Appendix C). Additionally, the FAMHQ can be used to measure attitudes. That is, by using the net bias scores, information can be gathered about the tendency for an individuals to think positively or negatively about older adults (Palmore, 1998). The usefulness of the FAMHQ is supported by the fact that studies show higher scores among those with more experience and training in gerontology (Palmore, 1998). Cole and Dancer (1996) compared four groups of health-care professional and reported scores averaging between 70 to 75 percent correct on the true-false version of the FAMHQ. However, no studies have been conducted to confirm the reliability and validity of the multiple-choice version. In the current study, the FAMHQ (true-false format) was used to measure therapists’ levels of information and to determine the most common misconceptions about aging and elderly mental health. Higher scores indicate greater knowledge about aging and mental health issues among older adults. Fraboni Scale of Ageism (FSA), Altered. The FSA was designed to measure the affective component of attitudes toward older adults in addition to the cognitive aspect commonly measured by other instruments (Fraboni et al., 1990). The FSA was intended to reflect Robert Butler’s construct of ageism. This is a 29- item measure with three factor-analytically-derived scales. These scales correspond to three of Allport’s levels of prejudice i.e. antilocution, avoidance, and discrimination. More specifically, items developed for the antilocution construct were designed to bring out expressions of antagonism and antipathy, which are brought 43 on by misinformation or myths about older people. Items developed for the avoidance construct were designed to show preferences or behaviors indicating reluctance to interact socially with older adults. The discrimination construct (considered to be the more extreme) is designed to reflect more active prejudice such as interference in the political rights i.e. segregation of older adults. The FSA is reported to have adequate internal consistency reliability. Analysis revealed an alpha of .85, and a mean of 57.89 (SD = 11.86). Given that the subscales can be used independently, information is provided for each separately. The antilocution items yielded an alpha of .75, and a mean of 21.73 (SD = 5.77). An alpha of .77, and a mean of 18.94 (SD ~ 3.08) was obtained for the avoidance items. The discrimination items produced an alpha of .65, and a mean of 1 7 .2 3 (^ = 3.42). The original FSA was in a true-false format. For this study, (see Appendix D) the format was altered to include a 5-point Likert scale ranging firom 1 (stronglv disagree) to 5 (stronglv agree). Participants were asked to indicate their response to the statements by placing a mark along the continuum. Demographic Information Sheet. The demographic information sheet was divided into two sections (see Appendix E). The first section asked participants for essential demographic information. That is, information was requested about their 44 age, ethnicity, gender, highest degree earned, theoretical orientation, number of years as a therapist, whether or not they were licensed to practice therapy, and if so, how long they had been licensed. The second part of the information sheet asked for specific information about participant’s professional and personal experiences with older adults. First, participants were asked whether or not they had provided therapy to clients who were 65 years of age or over and the percentage of older clients they had worked with in general. The participants were then asked to rate there experience working with older adults clients compared to their experience working with younger clients using a 10-point Likert type scale ranging fi-om 1 (more negative) to 10 (more positive). Second, participants were asked whether they had received specific training to work with older adult clients (i.e., read literature, taken courses, or attended seminars) and if so to indicate the quantity of each. Lastly, participates were asked whether or not they had ever lived in a same household with an older adult, and if so to rate their experience on a 10-point Likert type scale ranging from 1 (mostly negative) to 1 0 (mostly positive). Procedures Four hundred seventy eight (478) members of the American Psychological Association’s Division 29 (Psychotherapy) were randomly selected to participate in the study using the 2000 Membership Directory. Random selection was achieved by starting at an arbitrary place in the hsting of names and then selecting every tenth person. 45 Selected members were mailed a packet of material containing a cover letter, a client vignette, the three questionnaires, and a demographic information sheet. Each packet contained only one version of the six possible versions of the vignette. The different forms of the vignettes were sent alternately to members selected. The packets also included a stamped, self-addressed return envelope. The envelopes contained a code number so that responders and non responders could be identified for later follow-up requests as needed. Participants were informed of the purpose of the code numbers and informed that their responses were completely anonymous. To ensure their anonymity, participants were asked not to write their name or any other identifying information on the questionnaire. One-month later, a postcard request to return surveys was mailed to those who had not yet responded. Twenty-eight questionnaires were returned unopened because of faulty addresses. Of the remaining questionnaires, 113 were returned. However, 1 1 of the returned questionnaires were not included in the study because either they were not completed or were too incomplete to be useable. Therefore, the responses of 102 participants were used in this study, resulting in an overall return rate of 22 percent. Of the participants who returned the questionnaire, 21 responded to the 75 year-old female vignette; 18 responded to the 75 year-old male vignette; 9 responded to the 35-year old female vignette; 15 responded to the 35-year old male vignette; 1 5 responded to the age unspecified female vignette; and 24 responded to the age unspecified male vignette. 46 Chapter Three Results The results of the data analyses will be presented in this chapter. First descriptive statistics are provided. Then, statistical analyses and results are presented in accordance with each of the research questions. Descriptive Statistics Of the therapists sampled, 88.2 percent reported that they had prior experience conducting therapy with someone age 65 or over. Only 7.8 percent reported they had no previous experience providing therapy to someone 65 years of age or over. Respondents were asked what percentage of the clients they had worked with were older adults (clients age 65 and over). Of the respondents, 57.8 percent reported that less than 5 percent of their case load included older adults; 29.4 percent reported that more than 10 percent of their case load included older clients; 7.8 percent reported that more than 25 percent of their case load included older clients; and 2.0 percent reported that more than 50 percent of their case load included older clients. Therapists also rated their experience with older clients compared to younger clients on a scale ranging from 1 (more negative) to 10 (more positive). The mean score was 6.16 (SD = 1.42), indicating that this sample perceived working with older adult clients to be somewhat more positive than working with clients younger than age 65. 47 More than half (52.0 percent) of the sample reported that they had not received training to work with older adults. However, of those who had received training, 24 percent reported they had attended courses, seminars and read literature; 50 percent reported they had attended seminars and read literature; and 21 percent reported they had read literature only. Participants had a mean score of 18.47 (SD = 2.70) on the knowledge of aging and mental health measure (i.e. FAMHQ). For this group, scores ranged from 7 to 23 of a possible 25 total score. The most frequently missed questions regarding older adults and elderly mental health are as follows: Item 7 - 55.9 percent answered false, when asked if fewer older adults have mental impairments than other age groups. Item 8-69.6 percent answered false, when asked if the primary mental illness of older adults is cognitive impairment. Item 9-61.8 percent answered false, when asked if Alzheimer’s disease is the most common type of chronic cognitive impairment among older adults. Item 20 - 83 percent answered false, when asked if the majority of nursing home patients suffer from mental illness. Item 22-45.1 percent answered true, when asked if major depression is more prevalent among older than among younger adults. Personal experience (contact with older adults) was assessed by one question - Had they ever lived in the household with an older person? Over half (51 percent) reported that they had lived in a household with an older adult. 48 Participants were also asked to rate their experience living with an older adult on a scale from 1 (mostlv negative) to 10 (mostlv positive). Responses ranged from 2 to 10, mean 6.16 (SD = 1.42), indicating that this sample perceived living with an older adult as a slightly more positive than negative experience. Means and standard deviations for the sample are reported in Tables 1-3. 49 I I I a I j ! i> i i il ! Ill III P . .2 8 : s i z 8 8 S I z 8 S I z I I S! <r> <n 0\ S ON 00 m N N o\ <N CN m ON i> g « r > TT <N r- 00 "4- <N f - 4 R r- rn 00 s “ s f -t & 5 s S ) p vS « r l vS «r> * r! vS fS 00 f—t ON »n R s % s 00 00 § r - . <N r -4 o m <r> s. g P 'O 'O VO v S NO « ri <N 00 O n V) T-4 <N 6 §; m # § a P g « r> Tf vS V) vS CN 00 On I T3 fS J 2 1 i 1 i 1 i z i I I c/3 % I 50 Table 2 Means and Standard Deviations for Age Group Evaluation and Description Inventory (AGED) bv Client Age and Gender (Evaluative Dimensions) Client Vignette Goodness Positiveness N M SD N M SD Female 20 23.20 3.68 19 33.21 5.51 Age 75 Male 18 23.78 2.44 17 32.35 3.98 Female 9 23.11 4.62 8 35.13 4.85 Age 35 Male 1 2 24.25 1.60 1 1 34.45 5.84 Female 1 3 23.92 2.63 1 3 32.62 5.75 NS Male 19 23.05 2.57 1 9 33.74 4.40 Note: NS = Age not specified 51 T a b les Means and Standard Deviations for Age Group Evaluation and Description Inventory (AGED) bv Client Age and Client Gender (Descriptive Dimensions) Client Vignette Vitality Maturity N M SD N M SD Female 20 28.60 5.01 20 32.90 3.68 Age 75 Male 1 8 25.39 4.51 18 34.94 4.44 Female 9 30.33 4.66 8 34.00 5.13 Age 35 Male 1 2 28.33 5.26 12 33.25 3.84 Female 1 3 27.38 4.81 1 3 32.46 4.59 NS Male 18 27.00 3.20 19 32.84 2.71 Note: NS = Age not specified Examination of the Research Questions For each of tiie 7 research questions, attitude was assessed using a series of multivariate analysis tests. Research Question One: Would age and gender of clients depicted in a vignette affect diagnostic impressions and perceptions of the older adult client? To examine this question two 3 (client age: 75,35, no age specified) X 2 (client gender) MANOVAS were run. The first, used as a dependent measure the three scales related to the diagnosis of the person in the vignette: depression, some other psychiatric disorder, a medical (somatic) disorder, and prognosis. The second 52 used as a dependent measure the four semantic differential scales: goodness, positiveness, vitality, and maturity. The first MANOVA yielded no statistically significant result for the age X gender interaction (F (6,170) = .96, p = .45) or for the main effect of either gender (F (3, 84) = .38, p = .77) or age (F (6,170) = 64, p = .70). The second MANOVA yielded no statistically significant result for the age X gender interaction (F (14,140) = .66, p = .81) or for the main effect of either gender (F (7,69) = 1.09, p = .38) or age (F (14,140) = .84, p = .63). Research Question Two: Would therapists with more professional experience with older adults exhibit more positive or more negative attitudes toward older adults? It was not possible to answer this question, for the large majority of the sample had experience providing therapy to clients who were 65 years of age or over. Of the 102 participants, four did not answer this question. Of those who did answer, 91.8 percent reported having this experience. Research Question Three: Would therapists with more training to work with older adults exhibit more positive or more negative attitudes toward older adults? This question was tested with three analyses. The first was a 2 (training “Yes” versus training “No”) X 3 (age of vignette client: 75,35, no age specified) MANOVA in which the dependent variables related to the diagnosis of the person 53 in the vignette: depression, some other psychiatric disorder, a medical (somatic) disorder, and prognosis. The first MANOVA yielded no statistically significant result for the training X age interaction (F (6,166) = 1.84, g = .09) or for the main effect of either training (F (3, 82) = 1.09, g = .36) or age (F (6,166) = .69, g = .66). The second analysis was a 2 (training “Yes” versus training “No”) X 3 (age of vignette chent: 75,35, no age specified) MANOVA in which the dependent variables were the four semantic differential scales: goodness, positiveness, vitality, and maturity. This analysis yielded no statistically significant result for the training X age interaction (F (8,156) = .53, g = .83) or for the main effect of training (F (4, 77) = 1.70, g =16) or age (F (8,156) = .74, g = .65). The third analysis was a series of t-tests, where the independent variable was training or no training. The dependent variables were the three FSA attitude measures (antilocution, discrimination, and avoidance). None were statistically significant. The first was t (93) = -. 60, two-tailed g = .55. The second was t (94) = -1.36, two-tailed g = .18. The third was t (91) = - .60, two tailedg= .55. Table 4 summarized the descriptive statistics for this analysis. 54 Table 4 Means and Standard Deviations for Training bv Fraboni Scale of Ageism (FSA) Training to Work with Older Adults FSA Yes No N M SD N M SD Antilocution 44 21.48 4.74 51 22.02 4.09 Discrimination 45 16.16 2.50 51 16.90 2.84 Avoidance 45 21.8 3.42 48 22.25 3.47 Research Question Four: Would therapists with greater factual knowledge of elderly mental health and aging exhibit more positive or negative attitudes toward older adults? To examine this question, participants were blocked on their FAMHQ scores into high (19 or higher) or lower (18 or lower) scores. Then, three analyses were run. The first analysis was a 2 (high versus lows level of knowledge) X 3 (age of vignette client: 75,35, no age) MANOVA where the dependent variables related to the diagnosis of the person in the vignette: depression, some other psychiatric disorder, a medical (somatic) disorder, and prognosis. This MANOVA yielded no statistically significant differences for the knowledge X 55 age interaction Q F (6,170) = 1.24, g = .29) or for the main effect of knowledge (F (3,84) = 1.9, g =13) or age (F (6,170) = .32, g = .93). The second analysis was a 2 (high versus lows level of knowledge) X 3 (age of vignette client: 75,35, no age specified) MANOVA where the dependent variables were the four semantic differential scales: goodness, positiveness, vitality, and maturity. This analysis yielded no statistically significant differences for the knowledge X age interaction (F (8,156) = .88, g = .54) or for the main effect of knowledge (F (4, 77) = .09, g = .98) or age (F (8,156) = .73, g = .66). The third analysis was a series of t-tests, where the independent variable was knowledge score (high versus low). The dependent variables were the three FSA attitude measures: antilocution, discrimination, and avoidance. None were statistically significant. The first was t (94) = -1.04, two-tailed g = .30. The second was t (95) = -. 60, two-tailed g = .55. The third was t (92) = .68, two tailed g = .50. Table 5 summarized the descriptive statistics for this analysis. 56 Table 5 Means and Standard Deviations for Facts on Aging and Mental Health (FAMHQ)/Knowledge Score bv Fraboni Scale of Ageism (FSA) Knowledge Score FSA Low High N M SD N M SD Antilocution 36 21.06 4.74 60 22.03 4.31 Discrimination 37 16.27 2.56 60 16.62 2.90 Avoidance 35 22.29 3.80 59 21.78 332 Research Questions Five: Is there a relationship between more personal experience with older adults and attitudes toward older adults? This question was tested with three analyses. The first was a 2 (personal experience “Yes” versus personal experience “No”) X 3 (age of vignette client: 75, 35, no age) MANOVA where the dependent variables related to the diagnosis of the person in the vignette: depression, some other psychiatric disorder, a medical (somatic) disorder, and prognosis. This MANOVA yielded no statistically significant results for the personal experience X age interaction Q F (6,164) = .45, g = .85) or for the main effect of personal experience (F (3,81) = .68, g = .57) or age (F (6 ,164) = 56, g = .76). The second analysis was a 2 (personal experience “yes” versus personal experience “no”) X 3 (age of vignette client: 75,35, no age) MANOVA in which 57 the dependent variables were the four semantic differential scales: goodness, positiveness, vitality, and maturity. This analysis yielded no statistically significant differences for the personal experience X age interaction (F (8,154) = .53, p = .84) or for the main effect of personal experience (F (4,76) = 1.08, p = .37) or age Œ (8, 154) = 82, g =59). The third analysis was a series of t-tests, where the independent variable was personal experience or no personal experience. The dependent variables were the three FSA attitude measures: antilocution, discrimination, and avoidance. None were statistically significant. The first was t (92) =1.38, two-tailed g = .17. The second was t (93) =1.13, two-tailed g = .26. The third was t (90) = .45, two tailed g = .33. Table 6 summarized the descriptive statistics for this analysis. Table 6 Means and Standard Deviations for Personal Experience bv Fraboni Scale of Ageism (FSA) FSA Yes Personal Experience No N M SD N M SD Antilocution 44 22.43 4.50 50 21.18 4.29 Discrimination 45 16.87 2.97 50 16.24 2.44 Avoidance 45 22.18 3.81 47 21.85 3.08 58 Research Questions Six: Is there a relationship between psychologist’s gender and attitudes toward older adults? This question was tested with three analyses. The first was a 2 (therapist’s gender) X 3 (age of vignette client: 75,35, no age) MANOVA where the dependent variables related to the diagnosis of the person in the vignette: depression, some other psychiatric disorder, a medical (somatic) disorder, and prognosis. This MANOVA yielded no statistically significant results for the therapist’s gender X age interaction g (6,166) = 1.67, g = .13) or for the main effect of therapist’s gender (F (3,82) = 1.70, g =. 17) or client age (F (6, 166) = .89, g = .51). The second analysis was a 2 (therapist’s gender) X 3 (age of vignette client: 75,35, no age specified) MANOVA in which the dependent variables were the four semantic differential scales: goodness, positiveness, vitality, and maturity. This analysis yielded no statistically significant differences for the therapist’s gender X client age interaction (F (8,156) = .89, g = = .53) or for the main effect of therapist’s gender (F (4,77) = .57, g = .69) or client age (F (8, 156) = .68, g = .71). The third analysis was a series of t-tests, where the independent variable was therapist’s gender. The dependent variables were the three FSA attitude measures (antilocution, discrimination, and avoidance). None were statisticWly significant. The first was t (93) = -. 25, two-tailed g = .81. The second was t (94) = -. 37, two-tailed g = .72. The third was t (91) = 1.35, two tailed g= .18. Table 7 summarized the descriptive statistics for this analysis. 59 Table 7 Means and Standard Deviations for Therapist’s Gender bv Fraboni Scale of Ageism (FSA) FSA Male Therapist’s Gender Female N M SD N M SD Antilocution 60 21.68 4.20 35 21.91 4.75 Discrimination 61 1648 2.49 35 16.69 3.07 Avoidance 59 22.41 3.60 34 21.41 3.08 Research Questions Seven: Is there a relationship between psychologist’s age and attitudes toward older adults? To examine this question participants were blocked on their own age into three groups; 35-51 (26 percent), 52-65 (46.1 percent) and 66 and over (26.3 percent). Then, three analyses were run. The first was a 3 (therapist’s age level) X 3 (age of vignette client: 75,35, no age) MANOVA where the dependent variables related to the diagnosis of the person in the vignette: depression, some other psychiatric disorder, a medical (somatic) disorder, and prognosis. This MANOVA yielded no statistically significant results for the therapist’s age X client age interaction (F (12,243) = 1.74, p = .06) or for the main effect of therapist’s age (F (6,160) = 1.76, p = .11) or client age (F (6,160) = .46, p = .84). 60 The second analysis was a 3 (therapist’s age) X 3 (age of vignette client: 75, 35, no age specified) MANOVA in which the dependent variables were the four semantic differential scales: goodness, positiveness, vitality, and maturity. This analysis yielded no statistically significant differences for the therapist’s age X client age interaction (F (16,308) = 1.30, g = .20) or for the main effect of therapist’s age (F (8,150) = 2.07, g = .04) or client age (F (8,150) = 1.56, g = .14). The third analysis was a MANOVA in which the independent variable was therapist’s age level (35-51,52-65, and 66 and over) and the dependent variables were the three FSA attitude variables: antilocution, discrimination, and avoidance. A statistically significant multivariate F was obtained: F (6,173) = 3.43, g = .003. In follow-up univariate analyses, significance was obtained for antilocution and for discrimination, but not for avoidance. Scheffé post hoes revealed that for antilocution, the youngest group was significantly different (g < .01) from both the middle and older groups; the middle and older group did not differ from one another. With respect to discrimination, the exact same between-group differences were observed, though in this case the significance was g < .05. Table 8 summarized the descriptive statistics for this analysis. 61 Table 8 Means and Standard Deviations for Client Age and Therapist’s Age Groups bv Fraboni Scale of Ageism (FSA) Client TAG Antilocution Discrimination Avoidance N M SD N M SD N M SD Age 75 I 1 1 19.64 3.75 1 1 15.27 2.33 1 1 22.00 3.13 Age 35 5 17,80 2.17 5 15.60 3.36 5 21.60 3.36 NS 10 19.50 3.24 10 15.30 2.95 9 20.22 3.90 Age 75 II 18 22.17 4.37 18 16.61 2.20 18 22.67 3.11 Age 35 12 23.25 5.14 1 2 17.83 2.41 1 1 23.55 3.88 NS 1 5 22.13 4.02 1 5 16.40 2.69 1 5 22.53 3.70 Age 75 III 7 23.14 4.53 8 17.13 3.27 8 23.25 2.31 Age 35 5 24.00 6.56 5 17.80 3.90 4 20.50 2.89 NS 12 23.00 3.69 12 17.08 2.31 1 2 20.42 3.48 NS = Age not specified TAG = Therapist’s Age Groups (I = 35-51; Age II = 52-65; Age H I = 66 +) 62 Chapter Four Discussion This chapter will review and interpret results, noting how these findings compare to existing research on therapist’s attitudes toward older adults. Also, implications of the findings will be discussed and areas for further research considered. Interpretation of Results This study examined the client and therapist variables that affect therapists’ perceptions toward older adults. No significant relationship was found between the client’s age or gender in the diagnosis and or prognosis of the client described in the vignettes. In addition, no significant relationship was found between therapists’ gender, the amount of knowledge possessed in regard to older adults and elderly mental health, professional or personal experience and their perceptions of older adult clients. A significant difference was found, however, in relation to therapists’ age and attitudes toward older adults. That is, younger therapists (age 35-51) were less likely to either talk negatively (antilocution) or to exhibit discriminatory reactions toward older adults than were older therapists (i.e., 52-65 or 66 and over). Although only one of the four measures showed a difference, this finding is in agreement with a prior studies that also found an inverse relationship between professionals’ own age and their attitudes toward older adult clients (e.g. Ford & Sbordone, 1980; Hellbusch et al., 1994). 63 In other words, in this study, older therapists were found to be more ne^tive toward older adults than were younger therapists. Taken on &ce value, this finding appears to conflict with the notion of age matching (Lauber & Drevenstedt, 1993). Consequently, matching therapists with clients based simply on age and life experience may not be as appropriate as previously assumed. That is, older therapists may possess more negative attitudes toward older adults in general, and therefore may not necessarily be a better match for older clients than are younger therapists. This finding also underscores the fact that ageism toward older adults is not limited to younger or middle aged individuals, but older adults as well. As a whole, the participants in this sample were relatively well educated about aging and elderly mental health, there was no indication that younger therapists were more knowledgeable than the two older age groups studied. It is possible to speculate, though, that younger therapists may have been exposed to more recent research on cultural sensitivity to older adult as an heterogeneous group than are older therapists (Whitboume & Hulicka, 1990). That is, these younger therapists may have benefited fi“ om being educated with more recent literature that would have decreased negative attitudes toward older adults in general. Nevertheless, another empirical study (Ray et al., 1987) using a similar assumption about younger therapists obtained an oj^sing finding, that is, older therapists were more positive than were younger therapists in regard to their attitudes toward older clients. 64 Another possibility, though, is that the younger therapists also may have had less experience with older adults than the older two groups, and that this distinction may account for the differences found. That is, the responses of younger therapists may have been similar to the older therapists if they had more experience with older adults and older adult clients. Unfortunately, data obtained for this study did not permit a comparison of the level of experience between older and younger therapists. In addition, the one measure that showed this difference in attitudes toward older adults was designed to directly measure ageism. As a result, it is notably the most blatant in comparison to the other measures in terms of item content. For example, the term “old people” was repeatedly used to refer to older adults. Perhaps, younger therapists are more sensitive than are older therapists to the use of such dated terms and therefore less likely to agree with statements that refer to older adults in a way that is now considered pejorative. Interestingly, no significance relationship was found on the other subscale (avoidance), for any of the three groups. That is, regardless of therapist’s age, there does not appear to be the tendency to actively avoid interacting with older adults. In fact, the current study found no support for the notion that therapists’ generally hold negative attitudes toward older adults. This finding is compatible with several other studies that found that attitudes toward older adults are not globally negative (e.g., Hillman et al., 1997; Mosher-Ashley & Ball, 1999). In fact. 65 prior studies have showed that attitudes toward older adults might be negative, positive and even mixed (Dye, 1978; Hummert et al., 1997; Sharps et al, 1988). Comparison of Results to Existing Research Contrary to a number of studies, there did not appear to be substantial evidence of ageism toward older adults among the therapists studied. Moreover, no differences were found in the diagnosis and prognosis of clients regardless of client age or gender. However, as already noted, the therapists in the current study were highly educated about aging and elderly mental health. Therefore, it is possible that these findings lend indirect support to the prior research that suggested that knowledge is important in the combating negative attitudes toward older adults (Hillman et al., 1997; McConatha & Ebener, 1992; Zivian et al., 1992). In addition, younger therapists, who most likely have benefited from the most recent information available, exhibited even less bias toward older adults than did the older therapists. Furthermore, the therapists in this study indicated having slightly more positive attitudes than negative attitudes toward working with older adult clients then younger clients. This findings, however, appear to be contrary to much of the research and literature that have suggested that therapists hold negative attitudes toward older adults and that these negative attitudes influence their interaction with older adult clients. It should be pointed out that, despite the 40-year history of research regarding attitudes toward older adults, it remains a relatively new area of study. 6 6 Moreover, the study of therapists’ attitudes toward older clients is even newer. As with any new area of research, the lack of uniformity in concepts, methodology and analysis utilized make it extremely difficult to accurately measure and compare attitudes across studies. In fact, many of the concepts and instruments used in the assessment of attitudes toward older adults are still be appraised for construct validity and reliability. Consideration of Lack of Significant Findings The connection between attitudes and behaviors is imperfect. In fact, it can be argued that the relationship between attitudes and behavior is too complex to be measured by current instruments. Needless to say, discussions are still ongoing about the myriad of variables that potentially influence attitudes toward this growing population. However, like all studies with similar results, there are a number of reasons that probably account for the lack of significant findings. For example, although the sample in the current study ranged in age (35-91), they were very similar in a number of other important ways. That is, in this study the therapist were similar in terms of their level of knowledge (as indicated by high scores on the knowledge measure) and professional experience working with older adults (almost all had some experience). Also, about half of this group also had personal experience living with an older adult. As a result, finding differences among such a homogenous group is less likely than if the group were less similar. 67 Another issue that likely may have had an affect on the findings has to do with the measures selected. In fact, the finding of this study appear to be compatible with the literature that suggests that findings are often the result the use of research designs and measures proven to exaggerate minor differences. In particular, the methods selected for this study were selected because they were less likely to result in exaggerated differences. That is, caution was taken so that the findings would be reflective of actual differences among therapists’ attitudes and not the result of exaggerated findings which would likely have been found if such cautions were not taken. For example, this study connected the semantic differential responses to the vignette described in order to create a more specific target. Specific targets are known to evoke less negative attitudes than non-specific targets. Additionally, for one measure, a true-false response was replaced with a continuum response scale and included a neutral scale. This was done not only to obtain more information about subjects’ attitudes (i.e. maximize variance), but also to avoid the problems inherent in forced response measures. Additionally, this study utilized a between- subjects versus a within-subjects design because the latter has also been found to reveal more exaggerated differences. However, the small number of respondents per cell almost certainly affected the statistical power. Another factor that may have had some unknown effect on the findings was the relatively high average age of the participants. That is, the 68 ages of the therapists sampled may not have been representative of the members of the APA Division from which they were selected. Another consideration is that, because this investigation did not control for the order of the measures as presented to the participants, order bias may have affected the results. However, because no differences were found in relation to the age of die client, this is probably not a factor. Nevertheless, as with any study, the use of additional and or different statistical analysis may have also provided more significant results. In summary, the findings of the current study appear to support prior research findings that argued that the results found are often dependent on the research design and measures used. Specifically, for this study, the use of particular measurement devices (e.g. the use of between-subjects vignettes, specific targets etc.) likely evoked less extreme attitudes and therefore likely accounted for the lack of significant differences found overall. Practical Implications There may be any number of reasons why older adults do not generally seek mental health services compared to other groups. Although some literature suggests that that negative attitudes (i.e., ftierapist bias) may affect the way older adults are viewed, there is not overwhelming evidence that those attitudes affect the way older clients are diagnosed and or treated in therapeutic situations. Furthermore, as mentioned earlier, the therapists in this study reported feeling slightly more positive about working with older adults than with younger adults 69 and no significant relationship was revealed to suggest that the therapist in this sample held negative attitudes toward older adults in general. Of course these findings should not necessarily lead one to believe that our society’s youth-based culture and the subsequent miti-aging frame of reference does not also affect therapists. We can reasonably assume that because we also live in a very “tolerant” and “politically correct” era, bias against others for any reason (i.e., race, sex, age, etc.) is strongly discouraged in our society. As a result, age bias may therefore be especially difficult to detect and or measure. In addition, therapists are a particularly savvy group ~ known to be especially culturally aware and cognizant of society’s expectations. Therefore, studies of therapists’ attitudes on any topic may be particularly difficult because they are generally highly education and sophisticated. At the same time, self-report measures cannot reveal whether therapists privately act on this youth oriented and anti-aging societal bias toward older adult clients. Certainly, discussions about bias and discrimination of any kind are not always easy, but necessary. Acknowledging and then becoming actively aware of our own biases about aging and older adults is likely to evoke feelings of fear, denial and perhaps even anger (Butler, 1969). Further, dealing with the fact that we will all likely be affected by ageism (unlike, racism and sexism) at least at some point in our lives may be even more difficult on some levels. Ultimately, however, the changing demographics will require that we deal with the issues involving older adults, aging and elderly mental health. The feet 70 that, on average, human beings live longer than their predecessors and the fact that in the near future the populations of older adults will make up a larger percentage of society will demand that attitudes toward older adults be addressed. That is, as the baby boomer generation comes of age, we can expect a significant increase in the number of adults age 65 years and over. Accordingly, we anticipate an increased need for knowledge about this growing population. Mental health professionals and researchers wül likely continue to take the lead in insuring that information about attitudes toward older adults is adequate and appropriate in order to enhance awareness and knowledge about the needs of older adults. Therefore, seminars and courses designed to aid therapists’ in addressing the needs of older adult clients in particular, and opportunities to examine their own concerns about aging, will likely all enhance awareness in this area and ultimately lead to a better understanding of the human experience overall. Increased knowledge about older adults and elderly mental health issues is likely the key to developing and maintaining positive attitudes about older adults, aging and elderly mental health. Counselors are encouraged to obtain knowledge and training, and to seek out opportunities to gain experience working with older clients as a part of their ongoing education. In addition, opportunities to evaluate one’s own personal fears about aging should become a standard part of the education and training of therapists regardless of therapist’s own age or level of experience. 71 Suggestions for Future Research Discussions and research about ageism and therapists’ attitudes toward older adults is important to facilitate a more complete understanding of the reasons for the low proportion of older adults who seek mental health services. In addition, continued research on the influence of societal bias on therapist’s perspectives of older adults in therapy seems warranted. In particular, research designed to promote awareness of the potential for countertransference issues to negatively impact therapeutic interventions with older adult clients is important to continued developments of this area. Moreover, it is important that we continue to examine these issues in order to recruit and sufficiently train therapists who can adequately address the mental health needs of the growing older adult population in our society. Although, conceptual and methodical differences make this a challenging endeavor, continued efforts will ultimately lead to the same kind of awareness and changes in therapeutic interventions that resulted from prior discussions and research about other culturally based biases (i.e., gender and race). In particular, tools that more accurately tap into therapist’ s attitudes and stereotypes about older adults need to be developed. Most importantly however, discussions and research about the potential for age bias in research needs to remain at the forefi’ ont in order to avoid exaggerated differences that may ultimately adversely affect the lives of older adults (and ultimately ourselves). 72 References Aday, RH., Sims, C.R., McDuffie, W., & Evans, E. (1996). Changing children’s attitudes toward the elderly: The longitudinal effects of an intergenerational partners program. Journal of Research in Childhood Education, 10(2), 143- 151. Administration on Aging: Aging into the 2 1 ® ^ Century (n.d). Growth of the Elderly Population. Retrieved July 9,2001 from tiie World Wide Web; http://www.aoa.dhhs. gov/aoa/stats/aging21 /demography.html Altschuler, J. & Katz, A.D. (1996). Sexual secrets of older women. Countertransference in clinical practice. Clinical Gerontologist, 17(2), 51-67. American Association of Retired Persons - AARP (1999, November). A Profile of Older Americans 1999. Retrieved July 17,2001 from the World Wide Web: http://research.aarp.org/^neraI/profîle99.html Angiullo, L. & Whitboume, S.K., & Powers, C. (1996). The effects of instruction and experience on college students’ attitudes toward the elderly. Educational Gerontology, 22(5), 483-495. Beall, C., Baumhover, L.A., Simpson, J.A., & Pieroni, R E. (1991). 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Kelly, L.E., Knox, V.J., Gekoski, W.L., & Evans, K.M. (1987). Age-related humor as an indicator of attitudes and perceptions. Journal of Social Psychology, 127(3), 245-250. Kimmel, D.C. (1988). Ageism, psychology, and public policy. American Psychologist, 43(3), 175-178. Kline, D.W., Scialfa, C.T., Stier, D., & Babbitt, T.J. (1990). Effects of bias and educational experience on two knowledge of aging questionnaires. Educational Gerontology, 16(3), 297-310. Knight, B. (1985-1986). Therapists’ attitudes as explanation of underservice of elderly in mental health: Testing an old hypothesis. International Journal of Aging and Hianan Development, 22(4), 261-269. Knight, B.G. (1999). The scientific basis for psychotherapeutic interventions with older adults: An overview. Journal of Clinical Psychology, 55(8), 927-934. Knight, B.G. & McCallum, T.J. (1998). Adapting psychotherapeutic practice for older clients: Implications of the contextual, cohort-based, maturity, specific challenge model. 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Waxman, H.M., Camer, E.A., & Klein, M. (1984). Underutilization of mental health professionals by community elderly. Gerontologist, 24(1), 23-30. Weiner, M.F. (1990). Older psychiatrists and their psychotherapy practice. American Journal of Psychotherapy, 44(1), 44-49. Whitboume, S.K. & Hulicka, I.M. (1990). Ageism in undergraduate psychology American Psychologist, 45(10), 1127-1136. 81 Williams, A. (1996), Young people’s evaluations of intergenerational versus peer underaccommodation: Sometimes older is better? Journal of Language and Social Psychology, 15(3), 291-311. Wingard, J.A., Heath, R., & Himelstein, S.A. (1982). The effects of contextual variations on attitudes toward the elderly. Journal of Gerontology, 37(4), 475- 482. Yarhouse, M. A. & DeVries, H.M. (2000). When psychologists work with older adults: A survey of ethical beliefs and practices. Journal of Clinical Geropsychology, 6(3), 149-163. Zank, S . (1998). Psychotherapy and aging: Results of two empirical studies between psychotherapists and elderly people. Psychotherapy: Theory, Research, Practice, Training, 35(4), 531-536. Zivian, M.T., Larsen, W., Knox, V.J., Gekoski, W.L., & Hatchette, V. (1994). Psychotherapy for the elderly: Public opinion. Psychotherapy: Theory, Research, Practice, Training, 31(3), 492-502. Zivian, M.T., Larsen, W., Knox, V.J., Gekoski, W.L., & Hatchette, V. (1992). Psychotherapy for the elderly: Psychotherapists’ preferences. Psychotherapy: Theory, Research, Practice, Training, 29(4), 668-674. 82 Appendix A Instructions: Please read th e paragm ph and respond to the questions below. A 75-yeai"-ol4 female was referred to an outpatient clinic by her husband after she became convinced that her neighbors were conspiring to do her harm. A clinical interview and mental status examinations revealed the presence o f recent memory deficits, poor concentration and multiple somatic complaints including aches and pains, sleeplessness and poor appetite. The patient did not report or exhibit dysphoric mood. Psychiatric records reveal a brief hospitalization four months earlier at which time the patient was diagnosed with major depressive episode. Given this limited case infonnation... 1. How likely do you think It Is that the primary diagnosis for the client Is a ma^or depressive episode? 1 2 3 4 5 6 7 8 9 10 Notât Almost all likely certain 2. How likely do you think it is that the primary diagnosis for the client is some other psychiatric disorder? 1 2 3 4 5 6 7 8 9 10 Notât Almost all likely certain 3. How likely do you think it is that the primary diagnosis for the client is some medical (somatic) disorder? 1 2 3 4 5 6 7 8 9 10 Not at Almost all likely certain 4. What prognosis would you make for the clients' return to full functioning with the year? 1 2 3 4 5 6 7 8 9 10 Very Extremely good good 83 Appendix B Instructions: We are interested in how you characterize the client described in the vignette you’ ve just read. Please use your clinical and personal experiences as the basis for rating this client. On the next page you w ill find listed a series of bipolar adjectives, each accompanied by a scale. You are asked to place a mark along the scale at a point that, in your opinion, b est describes this person. For example, if you believe that this client is slightly more brave than cowardly, then you should place your mark as follows: cowardly :_ _ :_ _ :_ _ :_ _ :_ _ : _ _ x_:_ _ _ :_ _ : brave IMPORTANT: 1. Place your marks in the middle of the spaces not on the boundaries 2. Be sure you check every scale - do not omit any 3. Never put more than one mark on a single scale Please mark each item as a separate and independent judgment. Do not try to remember how you have marked earlier item s even though they may seem to have been similar. It is your first im pression or im m ediate reactions about each item that is wanted. 84 consiiderate independent boastful hopeful dishonest sexless trustful inflexible impatient expectant other-oriented unproductive insincere active satisfied unsociable sensitive timid undignified imaginative foolish busy temperamental involved generous cautious demanding optimistic incoi dependent modest dejected honest sexy suspicious flexible patient resigned self-oriented productive smcere passive dissatisfied sociable insensitive assertive dignified unimaginative wise idle even-tempered apathetic selfish . adventurous accepting pessimistic 85 Appendix C XnustFuctioiis: For each of the following questions, please indicate your response by m arking (X) either true or false. 1 . The majority of persons over 65 have some mental illness severe enough to impair their abilities 2. Cognitive impairment (memory loss, disorientation, or confusion) is an inevitable part of the aging process 3. If an older mental patient makes up false stories, it is best to point out tiiat he or she is lying 4. The prevalence of neurosis and schizophrenia increases in old age 5. Suicide rates increase with age for women past 45 6. Suicide rates increase with age for men past 45 7. Fewer of the aged have mental impairments, when all types are added togethCT, more than other age groups 8. The primary mmtal illness of the eldwly is cr^nitive impairment 9. Alzheimer's disease is the most common type of chrrmic c(%nitive iirçairment among the aged 10. There is no cure for Alzheimer’s disease 11. Most patients with Alzheimer's disease act the same way 12. Organic brain impairment is easy to distinguish from functional mmtal illness 13. It is best not to look directly at old mental patients when you are talking to them 14. It is best to avoid talking to demented patients because it may increase their confusion 15. Demented patients should not be allowed to talk about their past because it may depress them 16. The prevalence of cognitive impairment increases in old age 17. Isolation and hearing loss are the most frequent causes of paranoid disorders in old age 18. Poor nutrition may produce mental illness amoi% the elderly 19. Mental illness is more prevalent among the elderly with l^ s income and education 20. The majority of nursing home patients suffer frtan mental illness 21. The elderly have fewer sleep problems than younger persons 22. Majw depession is more prevalent among the elderly than among younger persons 23. Widowhood is more stressful for older than for younger women 24. More of the aged use mental health services than do younger persons 25. Psychotherapy is usually ineffective with older patients True False _True False True False _True False True False True False True False True False True False True False True False True False True False True False True False True False True False True False True False True False True False True False True False True False True False 86 Appendix D Instructions: For each of the following questions, please indicate your response by m arking (X) a t the appropriate place on the continuum from Strongly Disagree to Strongly Agree. 1 . Teenage suicide is more tragic than suicide among the old Strongly Disagree ___ Disagree Neutral __A gree Strongly __A gree 2. There should be special clubs set aside within spmts fecilities so that old people can compete at their own level Strongly Disagree Disagree Neutral Agree Strongly Agree 3. Many old people are stingy and hoard their m<mey and possessions Strongly Disagree Disagree Neuhal __A gree Strongly __A gree 4. Many old people are not interest in making new Mends preferring instead the circle of friends they have had for years Strongly Disagree ___ Disagree Neutral _ _A gree Strongly Agree 5. Many old people just live in the past 6. I sometimes avoid eye contact with old peqrle when I see them Strongly ___ Disagree Strongly Disagree ___ Disagree Disagree Neutral Neutral _ _A gree A$xee Strongly Agree Strongly Agree 7. I don't like it when old people try to make conversation with me Strongly Disamee ___ Disagree Neutral Agree Strongly — Agree 8. Old people deserve the same ri^ts and freedoms as do other members of our society Strongly ___ Disagree ___ Disagree Neutral Agree Strongly — Agree 9. Complex and interesting conversation cannot be expected from most old people Strongly ___ Disagree ___ Disagree Neutral Agree Strongly Agree 10. Feeling depressed when around old people is probably a common feeling Strongly Disagree Disagree Neutral Agree Strongly Agree 11. Old people should find friends their own age 12. Old people should feel welcome at the social gatherings of young people Strongly ___ Disagree Strongly Disagree ___ Disagree Disagrœ ___ Neutral Neutral Agree Agree Strongly Agree Strongly Agree 13.1 would prefer not to go to an open house at a senior’ s club, if invited Strongly ___ ^Disagree Disagree ___ Neutral __A gree Strongly Agree 14. Old people can be very creative 15. I personally would not want to spend much time with an old person Strongly ___ Disagree Strongly Disajgee ___ Disagree Disagree Neutral ___ Neutral Agree Agree Strongly Agree Strongly __A gree 16. Most old people should not be allowed to renew their drivers' licenses Strongly ___ ^Disagree Disagree Neutral Agree Strongly Agree 17. Old people don't really need to use our cmnmunity sports fecilities Strongly Disagree Disafflee Neutral Agree Strongly Agree 87 18. Most old people should not be trasted to take care of infants Strongly ___ Disagree ___ Disagree _ Neutral Agree Strongly Agree 19. Many cdd people are happiest when they are with people their own age Strraogly ___ Disagree ___ Disagree _ Neutral Agree Strongly Agree 20. It is best that old people live where they won't bother anyone Strongly ___ Disagree ___ Disagree _ Neutral Agree Strongly Agree 21. Ihectanpany ofmostoldpeq)leis quite enjoyable 22. It is sad to hear about the p li^t of the old in our society these days Stnaigly ___ Disagree Strongly ___ Disagree ___ Disagree _ ___ Disagree _ Neutral Neutral Agree Agree Strongly Agree Strongly Agree 23. Old people should be encouraged to speak c M it politically Strongly ___ Disagree Disagree _ Neutral Agree Strongly Agree 24. Most old people ate inter^ting, individualistic people StTO Tgly ___ Disagree ___ Disagree _ Neutral Agree Strongly Agree 25. Nfost old peq>le would be considered to have poor personal hygiene Strongly ___ Disagree ___ Disagree _ Neutral Agree _ Strongly Agree 26. I would prefer not to live with an did person 27. Most old people can be irritating because they tell the same stories over and over again Strongly Disagree Strongly Disagree Düîagree _ Disagree _ Neutral Neutral Agree Agree Strongly Agree Strongly Agree 28. Old people oranplain more than other people do 29. Old people do not need much money to meet their needs Strongly ___ Disagree Strongly ___ Disagree Disagree _ Disagree _ Neutral Neutral Agree _ Agree Strcmgly Agree Strongly Agree 88 Appendix E Please provide the following information about yourself; Age; (years) Ethnicity:_ _ Caucasian___African American___ Asian___ Latino___ Other_______ (specify) Gender: Male Female Highest Degree(s) Earned________________ Graduate Level Major____________________ Specialization Area______ __________ Theoretical Orientation _____________________________ Number of years as a therapist_ _ _ Licensed? Yes No If yes, how many years?____ Have you provided therapy to a client who was 65 years or older? Yes No Based on the number of clients you have worked with, what percentage of them would you say are 65 years or older? a Less than 5 % □ More than 10 % □ More than 25% □ More than 50% □ 100% Briefly describe your experience, (if any) with older clients. How would you say working with clients 65 years and older differs from working with younger clients? On the scale below, rate your experience working with older adults compared to younger adults: 1 2 3 4 5 6 7 8 9 10 More negative More positive 89 Have you received training designed to help you work with elderly adults? Yes No If yes, please check the boxes that apply; Type Quantity a Enrolled in Course (s) □ 1-5 □ 5-10 □ 10 or more a Attended Seminars □ 1-5 □ 5-10 □ 10 or more □ Read Journal Articles and Books □ 1-5 □ 5-10 □ 10 or more Are you now or have you ever lived in the household with an elderly person? Yes No If yes, rate your experience below: 1 2 3 4 5 6 7 8 9 10 Mostly negative Mostly positive Thank you for your time and input!

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Psychologists' perceptions of older clients: The effect of age, gender, knowledge, and experience

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Asset Metadata

Creator Treadwell, Beverly Evan (author)

Core Title Psychologists' perceptions of older clients: The effect of age, gender, knowledge, and experience

Degree Doctor of Philosophy

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag education,OAI-PMH Harvest,Psychology,Social Sciences

Format application/pdf (imt)

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c37-56509

Unique identifier UC11632627

Identifier DP71400.pdf (filename),usctheses-c37-56509 (legacy record id)

Legacy Identifier DP71400.pdf

Dmrecord 56509

Document Type Dissertation

Format application/pdf (imt)

Rights Treadwell, Beverly Evan

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA