Decisions, Decisions: How Professional Affiliation Shapes Mental Health Trainees' Clinical Judgments and Approach to Care Público

Abstract

Abstract
Decisions, Decisions: How Professional Affiliation Shapes Mental Health
Trainees' Clinical Judgments and Approach to Care
By Rachel A. Askew
This mixed-methods study compares how mental health trainees from various
professional disciplines approach, diagnose and treat their patients or clients, paying
particular attention to differences that arise based on a trainee's professional affiliation
and theoretical orientations. The study focuses on advanced clinical trainees enrolled in
three training programs - the top professional training programs in psychiatry, clinical
psychology, and social work in Georgia. In order to assess the amount and source of
variation in clinical decisions, I asked trainees to evaluate an identical written case study
of a patient manifesting symptoms of anxiety and depression. In order to gauge trainees'
views of their work and general approach to working with patients I concurrently
conducted in-depth, semi-structured interviews with a subset of trainees from each of the
professional programs. Results indicate that trainees' diagnostic- and treatment-related
judgments and the way they work with patients reflect neither full uniformity nor
complete divergence. Trainees share broad ideas regarding diagnosis and treatment yet
diverge in their application of these ideas based on professional affiliation and preferred
theoretical orientations to care. This study suggests that professional beliefs and practices
will never be homogenous in an organizational field that contains multiple disciplines
competing for clients.

Decisions, Decisions: How Professional Affiliation Shapes Mental Health
Trainees' Clinical Judgments and Approach to Care
By
Rachel A. Askew
M.A., Rutgers University, 2000
Advisor: Timothy J. Dowd, Ph.D.
A dissertation submitted to the Faculty of the
James T. Laney School of Graduate Studies of Emory University
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy
in
Sociology
2010

Table of Contents

TABLE OF CONTENTS

Chapter 1: Introduction
1
Chapter 2: Theoretical Framework and Background
14
Chapter 3: Research Methodology
63
Chapter 4: Trainees' Diagnostic Decisions and Use of Diagnosis in Clinical
122
Work





Chapter 5: Trainees' Treatment Decisions and Approach to Care
167
Chapter 6: Conclusion
261
Bibliography
274

About this Dissertation

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Sociology
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Sociology, Organizational Sociology, General
Palavra-chave	mental health trainees professions approach to care clinical decisions sociology of professions clinical psychology neoinstitutional theory psychiatry social work
Committee Chair / Thesis Advisor	Dowd, Timothy J, Emory University
Committee Members	Druss, Benjamin G, Emory University Scott, Tracy L, Emory University Johnson, Cathryn, Emory University Boli, John E, Emory University

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