THE EFFECT OF CLI ENT RACE AND SOCIAL CLASS

ON CLI NI CAL J UDGMENTS

Joel Fischer and Henry Miller
The last several years have brought with them an extreme con-
sciousness of the possibility of "race" and social class as forms of
clinical bias. The general ideological climate within the country at
large has been the chief instrument of this new consciousness, and
the profession of social work has been keenly sensitive to the possibil-
ity. The precise nature of the presumed intrusion into clinical judge-
ment of these variables, however, has been somewhat ambiguous.
The literature, in fact, suffers from a disturbing absence of careful
empirical work in regard, particularly, to the issue of "race." Social
class bias, however, has a more substantial empirical tradition.
Thus, in the decade of the 1960's, the literature of casework and
psychotherapy found many references bearing on work with people
from divergent social class backgrounds. This was stimulated in part
by Hollingshead and Redlich's (1958) study which, among other
things, found that psychiatrists' diagnoses, forms of treatment, and
personal opinions were significantly shaped by client social class.
Other research tended to support this conclusion (Briar, 1961; Haase,
1964). Most of the literature centered around two propositions: (1)
lower social class clients are "different" from middle class clients
(and also from predominantly middle class social workers); and (2)
lower social class clients should be treated differently also (see, e.g.,
Riessman, e t a l . , 1964). The major point, with reference to the investi-
gation reported here, is that client social class status has important
implications for clinical practice. It is necessary, however, to be clear
about the ways in which perception of clients, and judgments based
on those perceptions, do in fact differ according to the social class
status of the client.
While not quantitatively as dramatic an increase as the material
on social class, the literature discussing the importance to treatment
of racial differences between social worker and client also grew con-
siderably in the 1960's (see, e.g., Fibush, 1965; Simmons, 1963; Rosen
JOEL FISCHER & HENRY MII,LER i01
& Fr a nk, 1964; Cur r y, 1964; Bl och, 1968). Al l of t he s e ar t i cl es car r i ed
a c o mmo n mes s age: " When t he cas ewor ker a n d t he cl i ent ar e mem-
ber s of di f f er ent r aci al gr oups, t he f act or of r ace becomes a n i mpor -
t a n t var i abl e i n t he casewor k t r e a t me n t pr oces s " ( Cur r y, 1964, p.
131). Fa i l ur e t o t ake i nt o account r aci al di f f er ences a n d expl or e t he
i mpl i cat i ons of t hes e di f f er ences wi t h t he cl i ent wa s s een a s a di s t i nct
bar r i er t o t r e a t me nt . The sever al a ut hor s agr ee t h a t be t we e n i ndi vi d-
ual s f r om di f f er ent r aci al - et hni c gr oups e nga ge d i n a " he l pi ng rela-
t i ons hi p" : (1) t her e are (or, at l east , t he r e ma y be) s u b s t a n t i a l differ-
ences; a n d (2) a pr i or i t y t a s k for t he soci al wor ker i s t o be a wa r e of
( and expl or e wh e n necessar y) t hes e di f f er ences. I n s um, t he l i t er at ur e
adds up t o a n e xhor t a t i on to di f f erent i al l y percei ve me mb e r s of differ-
i ng r aci al a n d / o r et hni c groups.
However , except for t he soci al ps ychol ogi cal l i t er at ur e, whi c h
s hows a c ons i s t e nt r el at i ons hi p bet ween di f f er ences i n r aci al gr oup
me mbe r s hi p a n d bot h decr eased i nt e r pe r s ona l a t t r a c t i on a nd in-
cr eased soci al di s t a nc e (Li ndzey, 1969; Tagi ur i , 1969), t he soci al wor k
l i t er at ur e r eveal s a pauci t y of r es ear ch on t he subj ect . Cons equent l y,
t he ques t i on as i t r el at es to pr of es s i onal pr act i t i oner s r e ma i n s open.
Does t he r ace of t he cl i ent affect cl i ni cal j udgme nt s , a n d i f so, i n wh a t
way? I f r ace is not a fact or, ar e pr a c t i ~one r e i gnor i ng as pect s of real-
i t y? I f r ace is a fact or, do j udgme nt s t e nd t o be mor e ne ga t i ve or mor e
posi t i ve for cl i ent s f r om r aci al gr oups di f f er ent f r om t he wor ker s ?
Thus , even t h o u g h t he l i t er at ur e gener al l y agr ees t h a t cl i ent so-
ci al cl ass a n d r ace shoul d be " cons i der ed" by pr act i t i oner s , i t i s not
al ways compl et el y cl ear t h a t t he y do. But whe n t he y do, par t i cul ar l y
for l ower soci al cl ass cl i ent s ( and p e r h a p s for bl ack cl i ent s a s well, as
can be i nf er r ed f r om soci al ps ychol ogi cal st udi es), t he effect is gener-
al l y i n t he di r ect i on of l eadi ng t o l ess f avor abl e j u d g me n t s by t he
percei ver, a pos i t i on whi c h pr e s uma bl y woul d be a t va r i a nc e wi t h t he
"i deal " wa y i n whi c h j udgme nt s of cl i ni ci ans s houl d be affect ed.
METHOD
A de s i gn us i ng mai l ed ques t i onnai r es wi t h wr i t t e n case hi st or i es
as the stimulus condition w a s c h o s e n as b o t h m o s t e c o n o m i c a l a n d
m o s t feasible for the experimental m ~ n i p u l a t i o n of the t w o k e y vari-
ables: client race a n d client social class. A 2 x 2 x 2 factorial design w a s
utilized--wherein t w o distinct cases, e a c h w i t h t w o social class a n d
t w o race versions, w e r e systematically varied. T h i s d e s i g n lends itself
very well to a three-way analysis of variance.
T w o case s u m m a r i e s w e r e u s e d in a n a t t e m p t to insure that the
effect of the m a j o r experimental variables w o u l d n o t b e case~specific.
T h e cases w e r e intended to b e representative of the k i n d of case a
102 CLINICAL SOCIAL WORK JOURNAL
soci al wor ker woul d be l i kel y t o see i n pr act i ce, a n d wer e var i ed pri-
mar i l y a l ong t he di mens i on of degr ee of " ps yc hopa t hol ogy. " Cas e X
was de s i gne d to refl ect mi l d pat hol ogy, whi l e case Y wa s des i gned t o
refl ect sever e pat hol ogy. Ther e wa s 100% a g r e e me n t a mo n g prel i mi -
na r y pr et es t r e s ponde nt s t ha t t he cas es coul d i nde e d be di f f er ent i at ed
on t he bas i s of severi W of pat hol ogy. Four ve r s i ons of each case were
devel oped, var i ed al ong t he l i nes of r ace a n d s oci al cl ass. Thi s was
accompl i s hed, i n t he case of r ace, by us i ng t h e t e r m " whi t e" to de-
scri be h a l f t he cases, and " bl ack" t o descr i be t he ot he r hal f . For soci al
class, h a l f t he cases i ncl uded des cr i pt i ons of t he cl i ent i n whi c h- - on
t he Hol l i ngs he a d a nd Redl i ch (1958) cr i t er i a- - l ower cl as s occupat i on-
al a n d educat i onal char act er i s t i cs wer e ascr i bed, whi l e t he ot her h a l f
of t he cases h a d ascr i bed to t he m uppe r cl ass oc c upa t i ona l a nd educa-
t i onal cri t eri a. To s ummar i ze, t he r e were, t he n, t wo di s t i nct cases
each of whi c h var i ed i n r egar d to t wo ki nds of s oci al cl ass a n d t wo
ki nds of race.
A Tr e a t me n t Deci si on I n v e n t o r y (TDI) was de s i gne d t o secure
j udgme nt s t h a t woul d be r e a s ona bl y r e pr e s e nt a t i ve of t he ki nds of
deci si ons ma de - - i mpl i c i t l y or expl i ci t l y- - i n act ual pr act i ce. Twent y-
four i t e ms wer e col l ect ed f r om di ver s e sources, pa r t i c ul a r l y t he wor k
of St r upp (1960). The t went y- f our i t e ms wer e i n t e n d e d t o r epr es ent
t hr ee t ype s of j udgme nt s a s s ume d to be pa r t of t he cl i ni cal process: (1)
" di agnos t i c" j u d g me n t s (e.g., "over - al l degr ee of di s t ur ba nc e of cli-
ent"); (2) " t r e a t me nt " j u d g me n t s (e.g., " woul d you t e n d to deal ma i n l y
wi t h i nt r a ps yc hi c or i nt er per s onal be ha vi or wi t h t hi s cl i ent ?"); a nd
(3) " a t t i t udi na l " j udgme nt s (e.g., " how woul d you char act er i ze your
per s onal r eact i on t o t hi s cl i ent ?"). Re s pons e s t o t he i t e ms were bas ed
on si x- poi nt scal es wher ei n t he r e s p o n d e n t i ndi c a t e d t he degree to
whi ch h e j udged one or t he ot he r pol e appl i cabl e t o t he cl i ent whos e
case he h a d r ead.
The s a mpl e for t hi s s t udy cons i s t ed of 360 pr of es s i onal soci al
wor ker s empl oyed by t he St at e of Cal i f or ni a. Ea c h s ubj ect r et ur ned a
mar l ed ques t i onnai r e c ont a i ni ng one of e i ght pos s i bl e case sum-
mar i es ( as s i gned r andoml y) , t he Tr e a t me n t Deci s i on I nve nt or y a nd
t wo pa ge s r eques t i ng de mogr a phi c i nf or ma t i on. Th e f i nal des i gn was
compos ed of 360 subj ect s, r a n d o ml y a s s i gne d t o e a c h of t he ei ght ex-
pe r hne nt a l condi t i ons.
Of t he 360 subj ect s, 155 (43%) wer e ma l e of wh o m 76% were mar -
ried, whi l e 205 (57%) wer e f emal e wi t h 46% mar r i ed. I n a ddi t i on to t he
r el at i vel y h i g h per cent age of me n i n t hi s s t udy c o mp a r e d t o NASW
as a whol e ( St omm, 1969), t her e wa s al so a h i g h pe r c e nt a ge Gf young-
er peopl e; 32.5% were bet ween t he ages of 20-29; 25.4% bet ween t he
ages of 30-39; 23.6% bet ween t he ages of 40-49; a n d 18.5% were 50
year s a n d over. Thi r t y- ni ne (10.8%) of t he subj ect s wer e nonwhi t e s (26
bl ack, 9 Or i ent al , a nd 4 "ot her").
JOEL FISCHER & HENRY MILLER 103
RESULTS
A f act or a na l ys i s of t he i t ems of t he Tr e a t me n t Deci s i on I nven-
t or y wa s car r i ed out . The v a r i ma x s ys t e m of r ot a t i on wa s us ed a nd
fi ve cl ear f act or s emer ged. Fact or A wa s bes t des cr i bed as a gl obal
" As s e s s me nt " f act or a nd cons i s t ed of t he f ol l owi ng i t ems: (1) degr ee
of i ns i ght s h o wn by client; (2) l evel of e mot i ona l ma t ur i t y; (3) degr ee
of di s t ur bance; (4) degr ee of soci al a dj us t me nt ; (5) pr ognos i s i f t reat -
me nt wer e n o t unde r t a ke n; a nd (6) di agnos i s , ba s e d on degr ee of se-
ver i t y of pr obl em. Fact or B was cal l ed " Sui t abi l i t y f or Tr e a t me n t "
a n d cons i s t ed of t hr ee i t ems: (1) e s t i ma t e of cl i ent ' s ge ne r a l intelli-
gence; (2) cl i ent ' s sui t abi l i t y for cas ewor k t r e a t me nt ; a n d (3) prog-
nosi s i n t r e a t me nt . Fact or C deal t wi t h t he degr ee to whi c h a subj ect
j udged a cl i ent i n need of a "Soci al Emp h a s i s i n Tr e a t me n t . " I t was
r epr es ent ed by t wo i t ems: (1) woul d t he cas ewor ker deal ma i n l y wi t h
hi st or i cal or c ur r e nt mat er i al wi t h t hi s cl i ent ; a n d (2) woul d t he case-
wor ker deal ma i n l y wi t h i nt r a ps yc hi c or i nt e r pe r s ona l mat er i al . Fac-
t or D wa s cal l ed " Tenor of Re l a t i ons hi p" a n d c ont a i ne d t hr e e i t ems:
(1) woul d t he cas ewor ker t end to be s t r i ct or pe r mi s s i ve wi t h t hi s cli-
ent; (2) woul d t he casewor ker t e nd t o be act i ve or pas s i ve; a n d (3)
woul d t he cas ewor ker t end to be di r ect i ve or nondi r ect i ve. Fa c t or E
was a n " At t i t ude " fact or, a nd cons i s t ed of t wo i t ems: (1) how woul d
t he cas ewor ker char act er i ze hi s pe r s ona l r eact i on ( at t i t ude) t owa r d
t he cl i ent ; a n d (2) how ent hus i as t i c woul d t he wor ker be to ha ve t hi s
per s on as a n act ual client.
Ana l ys e s of var i ance were car r i ed out on each of t he fi ve fact ors.
I n addi t i on, t o a dd mor e speci fi c i nf or ma t i on r e ga r di ng t h e i t ems i n
each fact or, a ser i es of t-tests wer e ut i l i zed for i t em anal ys es . (The
r esul t s of t he i t em anal ys es are r epor t ed i n Fi s cher , 1970.)
The f i r s t a na l ys i s of va r i a nc e wa s f or Fa c t or A: " As s e s s me nt . "
(All t a bul a r d a t a ar e omi t t ed f r om t h i s report . Thi s d a t a c a n be ob-
t ai ned f r om t he aut hor . ) The mos t s t r i ki ng a n d power f ul effect on as-
s e s s me nt i s t he effect of t he t wo cases wh i c h was s i gni f i c a nt beyond
t he .01 level. Des i gned to refl ect di f f er ent i al degr ees of pa t hol ogy, t he
s t r ong s i gni f i c a nt effect appear s t o be a r ef l ect i on of r ecogni t i on by
subj ect s of t h a t fact: Case Y ( t he mor e sever el y pa t hol ogi c a l cl i ent )
recei ved a s i gni f i cant l y l ower ( mor e pat hol ogi cal ) me a n scor e on t he
a s s e s s me nt f act or . Whi l e t he ma g n i t u d e of t he di f f er ence wa s not as
st r i ki ng, t h e r ace of t he cl i ent al so exer t ed a n effect on t r e a t me n t deci-
si ons ( p ~ .05). Me a ns for t he a s s e s s me n t var i abl e wer e hi ghe r - - i n-
di cat i ng a mor e posi t i ve a s s e s s me n t - - wh e n t he cl i ent s wer e bl ack;
t hus, bl ack cl i ent s were seen as s i gni f i c a nt l y l ess pa t hol ogi c a l t h a n
whi t e cl i ent s. Ther e was al so a n i nt er act i ve effect of r ace a n d soci al
cl ass (p ~ .05), i ndi c a t i ng t hat , for a s s e s s me n t of cl i ent s, t he t ype a n d
f avor abl enes s of t he as s es s ment , whi l e not af f ect ed by soci al cl ass
104 CLINICAL SOCIAL WORK JOURNAL
alone, i s affected when the level of anot her vari abl e race--i s speci-
fied. Thus, when the social class of t he client is low, and t he race is
white, clients were seen more negat i vel y (more pathological) t han in
any of t he other conditions.
The second anal ysi s of vari ance was on Fact or B: "Suitability for
Treat ment . " There was one si gni fi cant mai n effect on j udgment s re-
gardi ng t he suitability of the client for t r eat ment - - soci al class of t he
client. When the client was of low social class, he was j udged less
suitable for t reat ment t han when t he client was upper class. There
was also an interaction effect bet ween case and social class. When
Case Y (who had been judged si gni fi cant l y more di st urbed on Fact or
A) was t he low S.E.S. client, t he case was j udged si gni fi cant l y less
suitable for casework t reat ment t han in any of t he ot her case-class
combinations. Finally, a t hree-way interactive effect bet ween case,
race, and social class was appar ent (p <: .05). While t hree-way effects
are often difficult to interpret, it appears in this situation, j udgi ng by
the levels of the means for each of t he cells, t hat t he special condition
of Case Y, white, low S.E.S. creates t he three-way combi nat i on whi ch
receives t he most negative scores on t he suitability factor, while the
case version involving Case X, black, hi gher social class was judged
most suitable for casework t reat ment .
The t hi rd anal ysi s of vari ance was on Fact or C: "Social Empha-
sis in Treat ment . " The mar gi nal means on t hi s fact or i ndi cat ed a
strong over-all t endency for subjects to place great er emphasi s on so-
cial-interpersonal t reat ment t han on intrapsychic-historical. How-
ever, when significant effects did appear, t hey i l l ust rat ed agai n t hat
a maj or influence on deciding whet her the emphasi s i n t r eat ment
should be more weighted t oward "t he social" or "t he psychological"
st emmed from the case condition and social class of t he client. Case
Y, the more disturbed case, was seen as needi ng deci dedl y more social
emphasis in his course of t r eat ment (p < .01), whi l e t he lower S.E.S.
client also was seen as in need of great er emphasi s on social factors
in t reat ment (p <~.05).
The fourth anal ysi s of vari ance was on Fact or D: ' "renor of Re-
lationship." There were no si gni fi cant effects of ei t her t he case, race,
or social class of the client on t he recommendat i ons regardi ng t he
tenor of t he relationship (necessity for "structure"). However, t he
margi nal means of the anal ysi s of vari ance reveal ed t hat for black
clients, there was a t endency to emphasi ze more permi ssi veness and
nondirectiveness and great er passi vi t y on the par t of t he caseworker.
This emphasi s was also revealed for t he hi gher S.E.S. clients. Both of
these findings continue t he predomi nant pat t ern of more positive
j udgment s for t he black and upper class clients.
The l ast anal ysi s of vari ance was on Fact or E: "At t i t ude. " Again,
social class is demonst rat ed to have a powerful effect on clinical judg-
JOEL FISCHER & HENRY MILI,ER 105
ment s . I n t hi s s i t uat i on, l ower cl as s cl i ent s ar e s i gni f i cant l y l ess l i ked
t h a n uppe r cl ass cl i ent s (p < .01). An d whi l e t he di f f er ences wer e not
si gni f i cant , Cas e X (less di st ur bed) a n d t he bl ack cl i ent s t e nde d t o be
mor e l i ked t h a n Case Y a nd t he whi t e cl i ent s, c o n t i n u i n g t he ear l i er
t r ends. The r e was al so a s i gni f i c a nt (p <. 05) t hr ee- way i nt e r a c t i on
effect of case, race, a n d soci al cl ass. I n t hi s s i t uat i on, i t a ppe a r s t o
i ndi cat e t h a t t he c ombi na t i on of Ca s e Y, whi t e, l ow S. E. S. i s si gni fi -
cant l y l ess l i ked, whi l e Case X, bl ack, h i g h S. E. S. i s s i gni f i cant l y
mor e l i ked.
DI SCUSSI ON
Over-all, t he a na l ys i s of t he d a t a pr oduced t he f ol l owi ng resul t s:
t her e ar e cl ear i ndi cat i ons t h a t al l t hr e e var i abl es - - cas e, race, a n d
soci al cl ass of cl i ent - - af f ect cl i ni cal j udgme nt s . Soci al cl as s h a d a
cons i s t ent l y s t r ong effect on j udgme nt s : l ower soci al cl as s cl i ent s
were seen mor e negat i vel y t h a n uppe r cl as s cl i ent s on al l j u d g me n t
var i abl es. Th e s t r e ngt h and c ons i s t e nc y of t he f i ndi ngs r e g a r d i n g t he
effect s of soci al cl ass on t he j u d g me n t s of pr a c t i c i ng soci al wor ker s
i ndi cat e t h a t soci al cl ass ma y be a n even mor e pot e nt var i abl e i n
cl i ni cal per cept i ons t h a n her et of or e h a d been t h o u g h t t o be t he case.
Var i at i ons i n t he r ace of t he cl i ent wer e al so f ound to af f ect cl i ni cal
j udgme nt s . Bl ack cl i ent s gener al l y wer e j udge d mor e pos i t i vel y t h a n
whi t e cl i ent s. Whi l e t hes e f i ndi ngs r e a c he d s t at i s t i cal s i gni f i cance
less f r equent l y t h a n t hos e of cl i ent soci al cl ass, t he p a t t e r n was con-
si st ent acr oss case a n d soci al cl ass cl i ent ver si ons. Fi nal l y, t he mos t
cons i s t ent s t i mul us var i abl e t o r e a c h s t at i s t i cal s i gni f i cance was t he
effect of t he t wo di f f er ent cases (11 out of t h e 16 i t em a na l ys i s t -t est s
were s t at i s t i cal l y si gni f i cant ) . I n gener al , case Y, t h e mor e sever el y
" pat hol ogi cal " case, was j udged mor e ne ga t i ve l y t h a n cas e X. An d
t hi s ne ga t i ve e va l ua t i on of t he mor e di s t ur bed case i s bor ne out by
i nt er cor r el at i ons of i t ems on t he Tr e a t me n t Deci si on I nve nt or y
whi ch s howe d t h a t s t r ong ne ga t i ve at t i t udes wer e he l d by subj ect s
t owar d cl i ent s of mor e severe " pa t hol ogy. "
The gener al t hr us t of t hes e f i ndi ngs - - e s pe c i a l l y r e g a r d i n g t he ef-
fects of soci al cl as s a nd case c o n d i t i o n s - - h a v e ser i ous i mpl i cat i ons
for cl i ni cal pr act i ce. The ne ga t i ve effect s of l ower soci al cl as s on cllni-
cal j u d g me n t s fi t s i n wi t h t he f i ndi ngs of mos t s t udi es of t hi s nat ur e.
However, t he Hol l i ngs head a n d Redl i ch s t udy (1958), for one, i n fi nd-
i ng s i mi l ar r eact i ons f r om i t s subj ect s, never t hel es s de a l t wi t h obser-
vat i ons of r eal t her api s t s i nt e r a c t i ng wi t h r eal cl i ent s. Pr e s u ma b l y
t hen, as Hol l i ngs he a d a n d Redl i ch i n f act st at e, t he r e wer e s ome real
di fferences bet ween pat i ent s of uppe r a n d l ower cl ass ba c kgr ounds
whi ch l ed t he r a pi s t s t o f or m l ess desi r abl e j u d g me n t s ( al t hough
106 CLINICAL SOCIAL WORK JOURNAL
these differences scarcely excuse t he process). But i n our study, hi gh
and low social class clients were not at all different from each oth-
er--ordy t he social class label was changed.
While t hese findings are based on a hypot het i cal , r at her t han an
actual t r eat ment situation, one implication for pract i ce is t hat t he
notion of impartial, objective eval uat i on of cl i ent s--i ncl udi ng the
diagnosis and recommendat i ons for t r eat ment fl owi ng from t hat
di agnosi s- - may not al ways be a realistic expectation. If, by simply
labeling a client as coming from a lower class background, t hat client
is seen by caseworkers as less suitable for t r eat ment and offered less
desirable forms of t reat ment t han an upper class client wi t h exact l y
the same problems, caseworkers would not be able to l ay claim to
i mpart i al i t y in treatment. If this were t he case i n act ual practice, it
would mean t hat a "double st andar d" would exist i n casework treat-
ment: one set of diagnoses and t herapeut i c t echni ques for t he middle
and upper Class, one set for t he lower cl ass--even when these differ-
ences are not warrant ed by differences in client problems.
Second, t he numerous fi ndi ngs in ot her st udi es t hat t here ap-
pears to be a maj or problem in clinical t reat ment r egar di ng t he suc-
cessful cont i nuat i on of lower class clients in t r eat ment (e.g., Briar,
1966; Brill & Storrow, 1964; Overall and Aronson, 1964) seem more
underst andabl e now, but hardl y more acceptable. Apparent l y, dat a
regardi ng social class background of clients may act as a sort of "sen-
sitizer," perhaps producing a set of initial expectations which, in t he
form of a "self-fulfilling prophecy, " i nsure t hat lower social class cli-
ents will not achieve a successful experience. These t ermi nat i ons be-
cause "t he client would not cooperate," "client was not ready, " "client
was not able to meani ngful l y part i ci pat e in t r eat ment , " may, then,
actually be t ermi nat i ons because t he caseworker was not able to over-
come the initial set of biases produced by knowi ng t he client' s social
class origins. It was not t hat t he client was "not sui t ed" for treat-
ment, nor necessari l y t hat the t r eat ment was "not sui t ed" for t he cli-
ent. More likely, it was t hat t he practitioner was suited to neither.
Similarly, t he consistent t endency to regard one case more nega-
tively on numerous di mensi ons--presumabl y on t he basi s of more se-
vere di st urbance--can have equally serious repercussions. While
clinicians can be applauded for differentially recogni zi ng and assess-
ing "pathological" states, cont i nui ng at t ri but i on of more negat i ve
characteristics to such clients may be, in act ual practice, a det errent
in itself to t he possibility of successful t reat ment . Grant ed, as Gold-
man and Mendel sohn (1969) have shown, clinician8 do t end to prefer
"heal t hi er" clients. And these preferences may si mpl y reflect a re-
alistic eval uat i on of a client' s potential i n t reat ment , since severe
pathology, unlike client race and social class, is more difficult to deal
with in an act ual clinical situation. However, the question arises as to
JOEL FISCHER & HENRY MIIJ. F. R 107
whe t he r t he s e ar e mer e pr ef er ences, or wh e t h e r t he cons equences of
h a v i n g mor e sever e pr obl ems ar e de t r i me nt a l t h r o u g h o u t t he t reat -
me n t pr ocess. As t he cl i ent f r om a l ower soci al cl ass i s l abel ed as l ess
sui t abl e, t he r e by pot ent i al l y l i mi t i ng hi s t r e a t me n t oppor t uni t i es , so
ma y t he cl i ent who, i n real i t y, i s e xpe r i e nc i ng mor e i nt e ns i ve or ex-
t ens i ve pr obl ems , be l abel ed as a mor e "di f f i cul t case, " i f he is l ucky,
or a " hopel es s case, " i f he is not . An d if, as t hi s s t u d y s e e ms t o in-
di cat e, c or r e s pondi ng to t ha t l abel comes ne ga t i ve a t t i t ude s on t he
pa r t of t he "hel per , " i t woul d a ppe a r t h a t t he cl i ent woul d ha ve sig-
ni f i cant l y l ess of a chance to achi eve a s ubs t a nt i a l degr ee of hel p
f r om s ome one wi t h s uch a n opi ni on. Gi ven a di a gnos t i c s ys t e m
whi ch ge ne r a l l y i ns i s t s on a f or ma l di a gnos i s i n or der t o gui de t he
cl i ni ci an i n ma k i n g appr opr i at e choi ces for t r e a t me nt , i t s eems equal -
ly possi bl e t h a t use of a f or mal di a gnos i s c a n i n f act h a v e sever e a n d
unj us t i f i ed cons equences for t he cl i ent . I t ma y j us t " gui de" t he clini-
ci an to a n a priori deci si on t h a t he is n o t goi ng t o h a v e a successf ul
course of t r e a t me n t wi t h a gi ven cl i ent , a n d agai n, t he sel f-ful fi l l i ng
pr ophe c y ma y i ns ur e t ha t he does not .
The c ons i s t e nt di r ect i onal i t y of t he f i ndi ngs , a l t h o u g h n o t al-
wa ys s t at i s t i cal l y si gni f i cant , wa s s uf f i ci ent t o d e mo n s t r a t e t he ef-
fect of cl i ent r ace on cl i ni cal j udgme nt s . Subj ect s t e nde d t o j udge t he
bl ack c l i e nt s - - r a t he r t ha n, as mi g h t be expect ed, t he whi t e cl i ent s - -
mor e posi t i vel y. (The race of t he subject wa s f ound t o exer t no effect
on t r e a t me n t deci si ons. ) Thes e r es ul t s c ont r a di c t t he v a s t ma j or i t y of
f i ndi ngs f r om soci al ps ychol ogi cal r e s e a r c h whi ch, a l mos t wi t hout
except i on, h a v e f ound r aci al di f f er ences t o exer t a ne ga t i ve effect on
i nt e r pe r s ona l at t r act i on a nd s oci omet r i c s t a t us ( Li ndzey, 1969; Ta-
gi uri , 1969). Some degr ee of e xpl a na t i on for t hes e f i ndi ngs mi g h t be
f ound i n t he di f f er i ng popul at i ons i nvol ve d a n d t ypes o f j u d g me n t s
r equi r ed bet ween t hi s a nd mos t soci al ps ychol ogi cal r es ear ch. The
subj ect s i n t hi s st udy, as pr of es s i onal soci al wor ker s, wer e not re-
qui r ed to ma k e j udgme nt s r e ga r di ng i nt i ma t e , f r i e nds hi p behavi or s ,
but wer e conf i ned t o pr e s uma bl y mor e obj ect i ve ( "pr of essi onal ") j udg-
me nt s r e g a r d i n g t he di agnos i s a n d t r e a t me n t of cl i ent s who wer e
s t r a nge r s t o t hem. On t he Other h a n d , a l ar ge pa r t of t he soci al psy-
chol ogi cal r esear ch, mu c h of wh i c h h a s been conduct ed on chi l dr en
a nd adol es cent s , deal s wi t h f r i e nds hi p choi ces a n d deci si ons r egar d-
i ng i n t i ma c y - - b o t h of whi ch ar ous e di f f er ent set s of emot i ons , a n d
pr e s uma bl y, di f f er ent set s of behavi or .
But i t i s al so l i kel y t ha t t he j u d g me n t s ma d e i n t hi s s t udy wer e
af f ect ed by a not he r set of c i r c ums t a nc e s , whi c h p e r h a p s c a n mor e
r eadi l y a c c ount for t he effects of r ace whi c h wer e f ound. Th e f i ndi ngs
of t he effect of r ace ma y b e a r ef l ect i on of t he c ur r e nt soci al cl i mat e,
t he poi nt i n hi s t or y of awar enes s of a n d c onc e nt r a t i on on t he pr obl em
of r aci s m i n Ame r i c a n society.
108 CLI NI CAL S O C I A L WORK J OURNAL
I n t he r ecent past , t he e mpha s i s on ci vi l r i ght s , bl a c k st udi es i n
t he uni ver s i t i es , a nd on bl ack i nde pe nde nc e i n ge ne r a l , cas t bl ack
Ame r i c a ns i n a ne w l i ght i n t he Uni t e d St at es . Ame r i c a n bl acks, wi t h
pr i de a n d di gni t y, ha ve de ma nde d a n equal s t a ke i n t he oppor t uni t i es
of t he na t i on. The s e st i r r i ngs l i kel y wer e not l ost on t he subj ect s of
t hi s s t udy. As soci al wor ker s t e nd to be, t he s e s ubj ect s pr obabl y ar e
bot h s ens i t i ve to a n d awar e of t he ne ga t i ve effect s of r a c i s m. Gi ven a
s y mp a t h e t i c pr edi sposi t i on, a nd c ur r e nt soci al condi t i ons , t he t en-
dency t o wa r d mor e posi t i ve j u d g me n t s f or bl ack cl i ent s mi g h t be a n
expect ed one. Pe r ha ps t hi s c a n be s een as a k i n d of " l e a ni ng over
ba c kwa r ds " by pr e domi na nt l y whi t e soci al wor ke r s i n a n effort to
i ns ur e t h a t t he i r j udgme nt s were, a t t he l east , "f ai r . " Bu t i n ma k i n g
t hes e j u d g me n t s , i n vi ol at i ng obj ect i vi t y ( al bei t p r e s u ma b l y wi t h
good i nt ent i ons ) , as ma n y cl i ent s wer e unde s e r ve dl y j udge d negat i ve-
ly as wer e j udge d posi t i vel y. For t he conver s e of t h e pos i t i ve j udg-
me nt s for bl a c k cl i ent s was r el at i vel y mor e ne ga t i ve j u d g me n t s for
whi t e cl i ent s.
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School of Social Work
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University of Hawaii
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Cl i ni cal Soci al Wor k J our nal
Vol. 1, No. 2, 1973