Do therapists bias their ratings of patient functioning under peer review?

The present study was an attempt to examine the rating bias of therapists participating in an evaluation of an experimental quality assurance system at a community mental health center. The test program was intended to identify patients who demonstrated lack of progress or poor level of functioning after two months of treatment, and to employ a clinical assessment process by independent clinicians to evaluate problems in the quality of care. It was believed that the therapists knowledge that they might have their clinical work assessed would lead to biased ratings of more severe symptomatology in their patients. The results of this study partially supported the hypothesis. Patients in the peer review system were rated as more dysfunctional at admission on Psychological Functioning than patients in the control groups. No differences, however, were found on Basic Life Functioning, Anti-Social Behavior, or Mental Processes. The implications for these results relative to psychotherapy research, quality assurance, and program evaluation are discussed.