Personality differences between fee-paying and non-fee-paying patients seen for psychological testing

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Administered the MMPI to 17 21-62 yr old male patients who did not pay their clinic bills and 17 patients who did pay their bills. MMPI and clinical data suggest greater reality disturbance and distortion for the non-fee paying group than for the fee-paying group, and that fee-payment behavior is situationally determined and not a generalized characteristic.

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The use of objective personality inventories to aid in clinical diagnosis and personality assessment has increased greatly in the past 40 years. In the face of a great deal of initial opposition and continual rejection by some professionals in both psychoanalytic and behavioral camps, some inventories like the Minnesota Multiphasic Personality Inventory (MMPI) have gained wide acceptance. As a matter of fact, many researchers place such confidence in the MMPI that they employ the scales as criteria for clinical research studies. How has the objective personality assessment approach that was originally viewed as an unwanted stepchild been elevated to the role of a messiah in clinical research? This has come about both through the strengths of the objective inventory approach and through weaknesses in the clinical research field—particularly the frustrating search for dependable external criteria.
Compared the MMPI profiles of 23 randomly selected fee-paying clients (FP group) of an out-patient psychiatry clinic to those of 23 clients who left unpaid bills (NFP group). All Ss had been terminated at least 2 months. No differences between groups were found on age, education, income, fee level, number of therapy sessions, sex, or marital status. The NFP group scored significantly higher on the F, Paranoia, and Schizophrenia scales. Additionally, the NFP group endorsed significantly more critical items and generated a greater number of mean scale scores over 70. These results suggest a relationship between degree of psychopathology and non-fee-payment.
Investigated the effects of a workshop fee on stress-management skills and workshop evaluations of 34 women (aged 24–62 yrs) who participated in a 2-evening stress-management workshop. Ss were randomly assigned to 1 of 2 groups: $30 treatment fee or no fee (control). At the conclusion of training, all Ss completed the State scale of the State-Trait Anxiety Inventory twice (before and after using stress reduction techniques), a cognitive recall test, and a workshop evaluation. Two weeks after training, Ss responded to a scale measuring their present level of experienced stress. Significant differences were found between the groups: Those paying for the workshop scored significantly higher in content recall of stress reduction techniques and significantly lower in follow-up stress levels than Ss who paid no fee. (16 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the midst of a sociopolitical debate regarding access to health services, an evaluation is required of the therapeutic impact of the direct participation by some patients in the cost of their psychiatric treatment. Empirical clinical concepts regarding the need for a direct payment of treatment by the patient have evolved. Initial rigorous practice systems have lead to more flexible methods allowing for the recognition of third-party financing. Psychoanalytic theory has addressed the issue most extensively, but other conceptual frameworks have reached similar conclusions as well. The experimental evidence to either support or refute the position that the direct payment of a fee has a beneficial effect on therapeutic outcome remains limited. The focus has been on studying the impact of fee manipulation, but a tested correlation of other motivators such as patient's insight, therapist's attitudes and behaviour and social pressures is mostly lacking. Two patient populations appear to be delineated. Fee participation is of particular value to the financially secure and to the educated while patients in need of less intensive involvement, with reality testing disturbance and limited insight benefit particularly from third party insurance. Different patient populations should have the right to choose different payment options.
Fees for mental health services is a subject that is often discussed but seldom researched. Fee information that pertained to 112 adult outpatients who returned a follow-up questionnaire and 147 who did not return it was reviewed in light of several indices of patients' response to clinic services. The study also assessed impact of change in a facility's billing format. Differences in billing format were in terms of amount of charge and whether fees were per session or lump-sum. Nonparametric statistics were applied to determine any relationship that (a) assessment by the clinic, (b) source of payment, (c) assessment to the patient, and (d) payment had with (a) return to clinic, (b) number of sessions, and (c) reports of help and satisfaction. The only association found was between presence of third-party coverage and likelihood that the patient returned. Change in billing format did not bear upon return to the clinic or satisfaction with services rendered, but did influence payment. Finally, some of the findings suggest that payment is associated with a predisposition to honor requests and obligations.
The impact of fee setting procedures on psychotherapy has received little research attention. Furthermore, there is a shortage of information about this area which is useful for both mental health management and clinicians. Procedures for establishing fees were examined from several perspectives: fees, cash, no shows, number of sessions, cancellations, months of service, ratings by the therapists of treatment outcome, satisfaction of the clients, and the ratings by the clients of treatment outcome. Overall, the results suggest that the procedures used to set fees may have no adverse effects upon the welfare of the clients or the operations of a center, although some client perceptions may be altered. Hence, rigorous future research with stronger manipulations becomes more ethically feasible.
A discussion of the controversy aroused by P. E. Meehl's Clinical Versus Statistical Prediction, in which the writer analyzes the predictive process and suggests the remedies as he sees them. "We should try to find the optimal combination of actuarially controlled methods and sensitive critical judgment for any particular predictive enterprise . . .. We can do this only if clinically and statistically oriented workers . . . seek to learn from each other." 16 references. (PsycINFO Database Record (c) 2006 APA, all rights reserved).