Thinking Errors Are NOT Just a Client Problem: Provider Blind Spots

blog.jpg

To error is human. And yet, there appears to be a certain “elephant in the room” when it comes to our mental health profession. This is the false assumption that “thinking errors” are strictly a client concern, and we providers are somehow immune to the effects of such cognitive distortion or bias. However, in our profession, such oversights can be as destructive as a bull in a China shop (or an elephant as the case may be). Being aware of one’s biases is an important skill to hone in our work, and below appears several of the common thinking errors we providers sometimes stumble into, without even realizing it.

Just World Hypothesis

This is the idea that justice is somehow self-correcting and bad things happen to bad people and good things happen to good people. This bias lends itself “blaming the victim.” While many of us may be able to recognize this bias on a conscious level, it helps to think about the more subtle or implicit ways this bias may manifest itself. For example, do we providers ever perceive client behavior through a moralistic lens of poor choices as opposed to a more scientific lens using a health or wellness mode? Do we ever confuse rehabilitation with reform, even in a subtle way?

Fundamental Attribution Error

This refers to the self-serving tendency to take credit for our successes, but blame others or external events for our failures and shortcomings. It’s a means many of us use to reconcile our cognitive dissonance and maintain the more pleasant version of reality in which we wish to believe. We might even take this a step farther and attribute other people’s success to situational factors and attribute their failures to disposition or internal factors (to maintain the illusion that we are better than average). Think about the ways in which this bias crops up in our work with clients.

Halo Effect

This bias is really just about favoritism, based on appearance, demeanor, status, or some other tangential character feature. Do you ever show favoritism to certain clients, even unconsciously? Do you find it easier to have empathy for more “likeable” or “charming” personalities? Does a person’s physical attractiveness influence how you treat that person?

Group Think

Sometimes in a group setting we lose our individuality and the group takes on a life of its own. We tend to relinquish a certain amount of personal responsibility in a collective effort. Think about your staff meetings at your facility. Do you ever “ride the bandwagon” when the group as a whole takes a stance contrary to your own? Do you ever “go with the flow” sometimes to a fault?

Confirmation Bias

This is when you tend to only focus on evidence that supports your preconceived notions and discarding or omitting the evidence that goes against what you want to believe, in a sort of self-fulfilling prophecy. One common example of this, which has been acknowledged by consumer advocates like Patricia Deegan, is when providers misconstrue every client quirk, anomaly, or eccentricity as a symptom of mental illness. Do you ever hold low hopes for certain clients, but then act unsurprised when a client does not achieve their full potential? Are some providers over-protective of clients, not respectful of dignity of risk? Where is the fine line between accommodating and enabling? How can we be more objective?

Restraint Bias

This occurs when we assume that we would do things so much more perfectly in someone else’s shoes, without taking into account their life experiences, genetic makeup, and environmental factors. This is probably why it’s easier to give advice than to take it!

Locus of Control Bias

The Serenity Prayer reminds us to be realistic when it comes to being mindful of what we have control over and what we don’t. One thing I have noticed is that often-times clients have a Locus of Control that is too external, lending itself to learned helplessness and a perceived lack of personal control. However, do providers ever error too much on the opposite side of the fence? To what extent do providers over-estimate a person’s level of control in certain situations? Are there systemic or external factors we are not considering that play into troubling client behaviors?

Provider Privilege

Sometimes providers forget that often-times, but not always, we have been dealt a somewhat better hand of cards than that of our clients. We may have had certain opportunities that afford us certain luxuries. Clients may lack education, and might even have a long history of homelessness. Providers need to remember that clients may be partly acting in survival mode and relying on old and familiar coping skills in order to navigate their worlds. A major aspect of human motivation is that we act in strategic ways to satiate certain human needs, psychological, physical, or otherwise.

Cognitive Dissonance Bias

This occurs when we rationalize our decisions to maintain a more favorable version of reality. It allows us to act in ways that are less than desirable and at the same time not feel guilty about it. It’s like having our cake and eating it too. For example, providers may show favoritism towards certain clients, but rationalize/justify the discrepancy in their head to maintain their existing (and positive) sense of self.

Counter-transference

Of all the biases in our work, this is probably the most recognized. This is the flip-side of transference, when certain features or personality traits from our clients remind us (even unconsciously) of people from our past. We may respond to certain clients in a similar manner in which we responded to similar personalities during our past interactions. Providers need to be mindful of when clients trigger us in myriad ways, and to try and detach from falling into unhealthy interaction patterns.

These are just some of the thinking errors we providers may fall into from time to time. Truly, it is important to be able to see beyond one’s biases and frame of reference. While it’s important to reduce these distortions where possible, it’s also important to remember that “to error is human”. We mustn’t beat ourselves up too much if we notice some of these pitfalls in our work. In fact, expecting perfection from a human being is probably a thinking error in and of itself!