Patient perfectionism and clinician impression formation during an initial interview.

OBJECTIVES

The negative impact of pre-treatment patient perfectionism on therapeutic alliance and outcomes has been well documented. However, there is much to learn about how patient perfectionism impacts the development of the therapeutic alliance. Our study addressed this by examining the extent to which trait and self-presentational components of perfectionism influence clinician's perceptions of patients during an initial interview.

DESIGN

In a re-analysis of data from Hewitt et al., 2008, Psychiatry, 71, 93-122, participants were 90 treatment-seeking adults (aged 19-64, M  = 36.2; 40 men) recruited from outpatient mental health clinics. Each patient had a one-on-one, semi-structured interview with a clinician that lasted approximately 50 min.

METHOD

Patients completed self-report measures assessing trait perfectionism, perfectionistic self-presentation, and symptom distress before the interview. Patients were then invited to discuss reasons for seeking treatment and to reflect on the two most challenging situations in their lives in which they had not coped well. Following the interview, clinicians indicated their overall impressions of patients by responding to three self-report questions and rated patients' distress and hostility via nine adjectives.

RESULTS

After controlling for patients' symptom distress, other-oriented perfectionism and non-display of imperfection had small positive relationships with clinician-rated hostility; self-oriented perfectionism, socially prescribed perfectionism, and non-disclosure of imperfection had small-to-moderate negative relationships with clinician impressions. Additionally, path analysis revealed other-oriented perfectionism and non-display of imperfection indirectly predicted less favourable clinician impressions through clinician-rated hostility.

CONCLUSIONS

Findings highlight the importance of evaluating and addressing trait and self-presentation components of perfectionism early in the therapeutic process.

PRACTITIONER POINTS

Higher levels of other-oriented perfectionism and non-display of imperfection were associated with greater clinician-rated hostility during an initial interview. Patient hostility mediated the relationship between patients' other-oriented perfectionism, non-display of imperfection, and less favourable clinician impressions. Our study highlights the importance of assessing and attending to patient perfectionism and displays of hostility during the earliest stages of therapeutic contact.