Try this simple experiment. As soon as you are finished reading this paragraph put this article down and ask your fellow counselors or supervisees if they are biased when they see a client. For example, if the counselor reads the notes in a client's chart, or sees the client's diagnosis, could this hinder the treatment process? Second question: Could the aforementioned factors exert a negative effect on your work with a client? "No way," is that what you and your staff say? "Not me, I'm not biased." I say: Don't be so sure!

In this brief article I'm going to share an extremely powerful method to prove to your counseling staff, class, or workshop participants, that in most cases professionals are indeed biased by a client's record, chart, diagnosis, reputation, or other related information.

Here is how the activity is introduced. "I am going to give each of you a sheet with a description of a client, called the Case of Billy G. Please do not put your name on the sheet. After you read the description of the client you will put the number of sessions, from one to thirty that you personally believe would be required to treat this client. Please do not write me any other messages nor should you put a figure over thirty. The entire assignment will only take you four or five minutes at the most. When you are finished just hand the paper to me face down."

Unbeknownst to the participants there are two different sheets handed out. Half the participants get one while half get the other, though they look nearly identical. Here is what is on the sheets:

Sheet A: The Case of Billy G.
Billy G. is a fourteen-year-old male. He has four symptoms:
1. He curses at his teacher when he gets a grade on a paper lower than a C.
2. He smokes pot (from two to four joints daily).
3. He refuses to clean his room and remarks that he "doesn't mind living in filth."
4. He refuses to attend physical education classes because he feels he looks like a nerd in front of the female students when he wears gym shorts.

Dr. C. Carl Benton, chief of psychiatry, at one of the nation's top hospitals and a world-renown expert in addictions has not seen the child. He did, nevertheless, read the exact four symptoms you just read. Based on his vast clinical experience Dr. Benton has diagnosed this child as suffering from severe schizophrenia. This is a very serious abnormal psychotic condition that Dr. Benton feels " is being intensified by the child's catastrophic pathological marijuana addiction."

Dr. Benton has referred the case to you for treatment. I believe I could cure Billy G. in ____ sessions.

Sheet B: The Case of Billy G.
Billy G. is a fourteen-year-old male. He has four symptoms:
1. He curses at his teacher when he gets a grade on a paper lower than a C.
2. He smokes pot (from two to four joints daily).
3. He refuses to clean his room and remarks that he "doesn't mind living in filth."
4. He refuses to attend physical education classes because he feels he looks like a nerd in front of the female students when he wears gym shorts.

Dr. C. Carl Benton, chief of psychiatry, at one of the nation's top hospitals and a world-renown expert in addictions has not seen the child. He did, nevertheless, read the exact four symptoms you just read. Based on his vast clinical experience Dr. Benton diagnosed this child as "totally normal with typical problems of everyday living."

Dr. Benton has referred the case to you for treatment. I believe I could cure Billy G. in ____ sessions.

Now it is time to analyze the data. Add up the scores for each sheet and then divide by the number of persons who answered to ascertain the mathematical average or the so-called mean. Hence, if you added scenario A up and got a score of two-hundred and there were 20 people who responded, then the average number of sessions to treat Billy G. would be 10.

Surprise, surprise!
Next, simply compare the average number of sessions on sheet A to sheet B and to use the sage verbiage of Gomer Pyle - surprise, surprise, surprise ... perhaps 90 percent of the time the group who was told that Billy G. was a severe schizophrenic and had a catastrophic addiction problem will have a much higher average in terms of the number of sessions needed to cure this child. If this occurs, and again, it usually does - then indeed your treatment staff is influenced by the information contained in the record.

The last time I ran this exercise with a group of counselors, the ones who were told that Billy G. had "problems of everyday living" averaged out at 11.4 sessions. The group who was told he was acutely disturbed and chemically dependent felt on the average that it would take 22.7 sessions to cure him.

And, what if you do the exercise with your staff and there is virtually no difference between the averages? Give your staff a raise or, if you are in the clutches of a budget crunch, perhaps a gold star. I can tell you it is rare.

Counseling in the wake of the Washington Windshield Mystery
After I reveal the data and tell the counselors that I "duped them," I generally share the fascinating story of the Washington Windshield Mystery that occurred in Seattle and the surrounding communities back in 1954.

The saga began when vehicle owners noticed an abundance of pits or dings on the windshields of their automobiles. Initially, the phenomenon was thought to be the work of vandals, however, police were dispatched in droves and nothing was found. One owner spoke to another auto owner and in a short period of time the Washington Windshield Mystery became frontpage news. When windshield pitting reached epidemic levels (about 30,000 windshields!) then President Dwight D. Eisenhower dispatched a group of scientists from the Bureau of Standards to the area. There were numerous theories about what was causing this dilemma. Atomic bomb testing, cosmic rays, the governor's new road program, and a nearby one million Watt Navy transmitter were cited as possible culprits.

Moral of the story
Mass panic set in. Were these small pits foreshadowing of things to come, of radiation, so powerful, it would eventually wipe out large numbers of Americans? Finally, the hysteria was abated when it was discovered that if you look at any windshield too closely - even a new one - you will see dings.

Or, as some experts put it, the epidemic ended when "drivers began looking out their windshields rather than looking at them." Although the saga of the Washington Windshield epidemic is generally analyzed in social psychology circles, the incident is equally pertinent to our work with clients.

Namely, if we look too closely for problems we often find them (e.g., the folks who received Sheet A in the case of Billy G.). When this occurs we often abet a difficulty known as an iatrogenic illness (a term our field originally borrowed from medicine), meaning that we gave the client a problem that he or she didn't have in the first place. The director of a large drug, alcohol, and eating disorders hospital treatment unit told me about a remarkable informal study they conducted. Confederates, who were not clients, went to their intake unit and indicated that they weren't certain if they needed treatment. During the intake interview the individual would reveal one small problem such as "I drank an extra beer at the ballgame last night," or "I've gained an extra four pounds in the last month." Nothing else that was pathological was revealed.

The director was horrified when he discovered that his staff had admitted all but one of these clients for a complete course of long-term treatment! Yes, we want addictions counselors to look for difficulties. But, no we don't want them to put the client under an electron microscope for a molecular inspection.

What does Miss Universe have to do with all of this?
The antithesis of this situation can also be detrimental. That is to say, when we see a record like Billy G., case B, we may see positive attributes in clients so vehemently that we miss or dismiss obvious problems. Let me conclude with a somewhat humorous, slightly embarrassing incident that clearly illuminates this dilemma.

As a teenager I always loved cars. Each year a custom car show would come to our town and, needless to say, I would attend. As a drawing card, the promoters would often have a famous athlete or television star attend. When I was eighteen, the celebrity guest was Miss Universe.

I kept building up in my mind for weeks how attractive this woman would be. When I got to the show I was looking around at the cars when my eyes landed on the Miss Universe booth. I froze. I was convinced that this woman was the most gorgeous creature I had ever seen in my life.

Although, I was somewhat shy at the time, I marched up to the booth and looked her right in the eyes. "Look, " I said, "I know you must hear this a thousand times a day but you deserve to be Miss Universe. I mean you are truly the most beautiful woman I have ever seen."

Nothing could have prepared me for what came next. "You idiot," remarked the young lady, "I'm not Miss Universe, I'm just a girl from South High down the street. They just pay me to look over the booth when Miss Universe is in the powder room putting on her make-up." So if you meet Billy G. or Miss Universe on the road to efficacious treatment merely look through (not at) your windshield and just keep cruising.

Howard Rosenthal, EdD, LPC, NCC, MAC, CCMHC, is a Professor and Program Director of Human Services at St. Louis Community College at Florissant Valley. He is the recipient of a number of awards for his teaching and clinical work. For more information, visit his web site at www.howardrosenthal.com

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