Teaching Tip Sheet: Counselor Attitude Bias

Counseling Psychology Courses

Important Issues or Topics in Psychology

Therapist attitudes and biases are important to areas of study in psychology in that they impact on the process of psychotherapy. Therapists' attitudes include beliefs reflected in emotional responses and behavior as well as cognitions. Because of the sociocultural nature of the AIDS epidemic, therapists can be especially vulnerable to being influenced by their own attitudes and biases. Working with persons affected by HIV disease can trigger powerful and complex personal and professional issues surrounding discrimination and oppression, sexuality, substance use and abuse, and issues of mortality. It is important that therapists be cognizant of their own biases and attitudes and the subsequent impact of their work in counseling persons with HIV disease.

Lessons Learned from HIV/AIDS

HIV/AIDS has contributed to our understanding of counselor attitude/bias. Overall, the research suggests that the personal attitudes and biases of psychologists may affect their professional treatment and decision making. The impact of HIV/AIDS to this area of literature is illustrated below.

Psychologists may be vulnerable to negative biases towards clients. Mental health workers have demonstrated biases against persons with AIDS. Crawford et al. (1987) found that mental health workers indicated that persons with AIDS were more responsible for their illness, less deserving of sympathy, and more dangerous to the general public than clients with leukemia. These workers reported less willingness to attend a party or work where a person with AIDS was present.

Homophobic attitudes may affect psychologists work. Homophobic attitudes have been expressed by counselors working with clients with HIV disease and this attitude relates to their discomfort with gay clients. Hayes and Gelso (1993) found in their sample of male counselors that counselors experience greater discomfort with HIV-infected clients than HIV negative clients, and counselors' homophobia predicted their discomfort with gay male clients. Homophobic attitudes in psychologists may have an impact on their decision making around ethical issues. McGuire et al. (1995) found a significant relationship between homophobia and likelihood of breaking confidentiality in situations where a client was perceived as dangerous to others.

Counselor biases' can contribute or mediate counselors' ability to diagnose and plan interventions appropriately. Psychologists may overlook indicated treatment interventions for their client with AIDS. Walker and Spengler (1995) found when assessing a client who had AIDS and endogenous depression, psychologists may mistakenly overlook appropriate pharmacological interventions. AIDS is such a salient issue for clients that therapists react with their own stereotypes, (e.g., depression is an understandable reaction to AIDS), and in so doing disregard indicated treatment options. This was moderated by clinicians' cognitive complexity in that clinicians with higher cognitive complexity, were more likely to recognize the appropriateness and need for antidepressant medications when a patient had AIDS and major depression than those demonstrating less complexity.

Psychologists may misdiagnose persons with AIDS. Walker and Spengler (1995) also found that psychologist may mistakenly fail to diagnose depression in AIDS patients or attribute symptoms of depression to an understandable reaction to a terminal and stigmatizing illness.

Training can reduce counselor bias. Training may help to reduce negative counselor bias. Crawford et al. (1987) found that mental health workers with HIV/AIDS training or education were less likely to hold biases. There is a need for training that includes a focus on content and counselor attitudes. Carney, Werth, and Emanuelson (1994) found that positive attitudes toward persons who are gay and toward persons with AIDS corresponded with high levels of knowledge. Results suggest the importance of training that includes knowledge based material as well as exploration of attitudes.

Teaching Strategies

The field of HIV/AIDS has helped to underscore the importance of training in dealing with counselor bias. Thus, it is helpful for the instructor to create an environment that is conducive to the exploration of students' personal attitudes and values. An experiential/didactic method format in teaching this course material may be beneficial in helping students recognize their own attitudes and biases as well as others. Encouraging students to share their personal experience (or lack there of) with HIV/AIDS can help shed light on their respective attitudes.

The inclusion of a panel of persons whose lives have been affected by HIV/AIDS can be a helpful learning tool in confronting stereotypical attitudes. Deal positively with students misinformation and fear. Legitimate fears should be acknowledged. Acknowledge the importance of confronting and managing such feelings.

Help students learn to recognize their own feelings about sexual orientation and in particular their potential homophobic reactions. Use educational materials that are multicultural.

Confront use of language and model appropriate use of terms. Sensitivity of semantics needs to be stressed through the class. The use of assignments that facilitate exploration of personal values and attitudes can be helpful. For example, asking students to keep a reaction journal, assigning them to interview someone with HIV/AIDS or visiting a hospice with persons with AIDS can prompt students to explore their own responses.

Key References

Carney, J., Werth, J. L., & Emanuelson, G. (1994). The relationship between attitudes toward persons who are gay and person with AIDS, and HIV and AIDS knowledge. Journal of Counseling and Development, 72(6), 646-650.

Crawford, I., Humfleet, G., Ribordy, S. C., Ho, F. C., & Vickers, V. L. (1991). Stigmatization of AIDS patients by mental health professionals. Professional Psychology: Research and Practice, 22(5), 357-361.

Hayes, J. A., & Gelso, C. J. (1993). Male counselors' discomfort with gay and HIV-infected clients. Journal of Counseling Psychology, 40(1), 86-93.

McGuire, J., Nieri, D., Abbott, D., Sheridan, K., & Fisher, R. (1995). Do Tarasoff principles apply in AIDS-related psychotherapy? Ethical decision making and the role of therapist homophobia and perceived client dangerousness. Professional Psychology: Research and Practice, 26(6), 608-611.

Walker, B. S., & Spengler, P. M. (1995). Clinical judgment of major depression in AIDS patients: The effects of clinician complexity and stereotyping. Professional Psychology: Research and Practice, 26(3), 269-273.


Paula J. Britton, PhD
Assistant Professor, John Carroll University