Counselor-Patient Problem

For Educational Purposes

Consent Form

I, the undersigned, understand that the basic intent of these tasks is to understand reasoning and how it develops.  This is entirely voluntary and I may stop at any time. I understand that the information I have given regarding my personal history, as well as the responses I give to the tasks, will be kept strictly confidential. I understand that my identity and personal history will not be divulged in any discussion, student report, lecture, address, or publication derived from this project.

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Signature                                       Month      Day      Year

Instructions

Please answer all parts of this questionnaire.  Read each section and answer the questions in the order given.  Do not go to the following section before you have finished the previous section.  Remember this is not a test of your ability as an individual.  Rather, we wish to know how adults, in general, reason about the issues presented here.  The order of answering is essential to this study about adult reasoning. 

What is most important is not only what you consider to be good, but the reasons for your choices.  Therefore, it is essential that you state your reasons why you make the choices that you make. 

45:30:14;26-01-03-20 (Sunday, January 26, 2003; 2:30:45 pm)
© 1989, 1990, 1991, 1993, 1994, Dare Association, Inc.  Cambridge, MA 02138-1328,

Counselor-Patient Problem

Date of Birth:	Month
                     	Day
                          	Year
                         	Subject Number
                        	
Place of Birth:

                     City	

                       Country or State	Place of Residence:

                            City	

                          Country or State	                        
 	
Sex:        M  	F	Zip code:	Age:	Religion:         	
If married:	1st        2nd     	3rd             4th	marriage		
If not married:	Single  	Divorced       	Spouse deceased	Domestic partner	
Child in family:	1st        2nd	3rd       4th	Other                  		
# Sisters	Father's occupation:	Mother's occupation:	Spouse's occupation:	Your occupation: 	
# Brothers	
				
	Father's education:

	Mother's education:	Spouse's education:	Your previous occupation:

	
					
Please indicate your	
Years in school	
Major/Minor	
Year graduated	
Degree earned	
Grade school		                    			
High School					
College					
Grad School					

_____________	    ______________________	_______________	     ________________
Month/Day/Year    Experimenter Email address 	Experimenter Name	     Experimenter Telephone

Methods of administration:

    Mailed to subject who wrote answers
    Handed out to subject who wrote answers
    Subject wrote answers while experimenter was       	present
   Subject wrote answers and response to 	experimenter probes

    Subject wrote answers while experimenter probed 	and taped
    Experimenter wrote answers
    Experimenter wrote answers and probed
    Experimenter taped and probed for answers

The Ideal Counselor-Patient Relationship.

Answer all questions as fully as you can.  Please elaborate in your explanation so that we may understand exactly what you mean to say.  If writing space is not enough use back of paper or additional paper.

1.	What is your idea of an ideal Counselor-Patient informed-consent process?  

2.	Give the best reasons why that is an ideal informed-consent process.

3.	What is your idea of a poor Counselor-Patient informed-consent process?

4.	Give the best reasons why that is poor informed-consent process?

5.	Why does the Counselor-Patient informed-consent process matter to you?

6.	Why are those things important to you and why do you care?

The Counselor-Patient Interaction

The following 10 stories are set in another country.  In each story, a Counselor tries to help a competent Patient to solve a given set of problems.  The problems are serious.  It is now time choose a treatment to improve the situation.  All the Counselors care for their Patients equally.  All the Counselors highly recommend and provide the same basic treatments.  But, the Counselors arrive at their choice of how to help in different ways.  In every case, the problems worsen and those who are affected suffer.  During a general review of these bad results, each Counselor's method of choosing a treatment was looked at.  Below, the Counselors give accurate accounts of their usual talk with their Patients.  Read all five accounts carefully and then answer the questions that follow.

The Counselors’ Methods
Counselor Bowers offers a treatment that has been studied and is shown to work well.  Bowers shares the fact that not everyone has had a positive outcome from the treatment.  Bowers then reads a description of the treatment and its risks from a colleague’s book.  Bowers points out that any treatment will have risks.  Bowers asks if the patient if they understand the treatment and its outcome possibilities.  After thinking carefully, Bowers patient feels comfortable that Bowers is a capable clinician.  Feeling that Bowers knows best, the patient prepares to undergo the treatment.
	
Counselor Brown offers the Patient a treatment preferred by colleagues.  Brown says that others who are friends use this treatment.  A colleague is called in to tell the Patient again about the treatment.  With great concern, Brown asks if the Patient would like to hear a third person explain the treatment.  Brown’s Patient is told that these people explain the treatment.  Brown’s Patient is told that these people had good results with that treatment.  Brown instructs the Patient to support the treatment.  Brown’s Patient thinks seriously about what Brown has said.  Feeling that Brown knows best, Brown’s Patient prepares to undergo the treatment.
	
Counselor Heath offers a treatment which performs relatively better than others.  Heath relates the effects and side-effects of each treatment including taking no action.  Then Heath asks the Patient questions about the treatments making sure the Patient understood.  Heath asks if the Patient feels comfortable making a decision with the present information.  Since the Patient is satisfied, Heath tells the Patient to think carefully before choosing a treatment.  Heath's Patient thinks about what Heath has said.  Feeling that Heath knows best, Heath's Patient prepares to undergo the treatment.

Counselor Kents recently completed training on a treatment that was designed for the patient’s problem.  Kents says that the best counselors recommend this treatment.  Kents explains the method and tells the patient that it will probably work for the patient.  Kents also tells the patient about other methods that may work.  The patient is asked if they have any questions.  The patient does not have questions, and Kents ask them if they want to accept the recommended treatment.  Feeling that Kents knows best, the patient prepares to undergo the treatment.	
				
Counselor Young offers a treatment that best suits the needs of the patient. Young explains all aspects of the treatment and describes at length the pros and cons of alternatives, including doing nothing. Young seeks to understand the patients needs and concerns, and asks many questions in order to gain the patient’s perspective and understanding. Young does not push the patient to accept any treatment but rather encourages the patient to make a choice that makes them feel comfortable. The patient considers this.  Feeling that Young knows best, the patient decides to undergo the treatment.

		

A.  Rate (circle) the Counselors' methods.  A rating of 1 means you think that Counselor has the worst method.  A rating of 6 means you think that Counselor has the best method.  Not all the ratings need to be used and a particular rate may be given to more than one Counselor.
	
			RATINGS
		Worst							Best
		Method							Method
1.	Counselor Bowers	1	2	3	4	5	6
2.	Counselor Brown		1	2	3	4	5	6
3.	Counselor Heath 		1	2	3	4	5	6
4.	Counselor Kents		1	2	3	4	5	6
5.	Counselor Young 	1	2	3	4	5	6

Why did you rate the Counselors' methods the way you did?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

		

			

B.  Rate (circle) the Counselors according to how well they consider the Patient's viewpoint.  A rating of 1 means that the Counselor was extremely poor at considering the Patient's viewpoint.  A rating of 6 means the Counselor considered the Patient's viewpoint extremely well.  You may use the same rating for more than one Counselor.

				RATINGS
		Extremely				Extremely
		Poor					Well	
6.	Counselor Bowers	1	2	3	4	5	6
7.	Counselor Brown		1	2	3	4	5	6
8.	Counselor Heath 		1	2	3	4	5	6
9.	Counselor Kents		1	2	3	4	5	6
10.	Counselor Young 	1	2	3	4	5	6

Why did you rate the Counselors' methods the way you did?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

C.  Rate the degree to which the Counselors attained informed-consent from their Patients.

			RATINGS
				Extremely				Extremely
				Poor					Well
11.	Counselor Bowers	1	2	3	4	5	6
12.	Counselor Brown		1	2	3	4	5	6
13.	Counselor Heath 		1	2	3	4	5	6
14.	Counselor Kents		1	2	3	4	5	6
15.	Counselor Young 	1	2	3	4	5	6

Why did you rate the Counselors this way?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

	

D.  Rate how well the Counselors informed their Patients.

				RATINGS
		Extremely				Extremely
		Poor					Well
16.	Counselor Bowers	1	2	3	4	5	6
17.	Counselor Brown		1	2	3	4	5	6
18.	Counselor Heath 		1	2	3	4	5	6
19.	Counselor Kents		1	2	3	4	5	6
20.	Counselor Young 	1	2	3	4	5	6

Why did you rate the Counselors this way?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

E.  Rate how well the Counselors attained consent from the Patient.

			RATINGS
		Extremely				Extremely
		Poor					Well
21.	Counselor Bowers	1	2	3	4	5	6
22.	Counselor Brown		1	2	3	4	5	6
23.	Counselor Heath 		1	2	3	4	5	6
24.	Counselor Kents		1	2	3	4	5	6
25.	Counselor Young 	1	2	3	4	5	6

Why did you rate the Counselors this way?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

	

The Counselor-Patient Opinion Poll

Use back of paper or scratch paper if you need more writing space for each answer.  Please print as clearly as possible.

F.	Suppose you were listening to these Counselors give their account of the treatment methods in a hearing.  Rate the degree to which you believe the Counselors to be telling the truth.  How believable do you find their accounts?

				No Chance of										Certainty of
				being true											being true
26. Counselor Bowers	1		7		23	 	50		77		93		99	
27. Counselor Brown		1		7		23	 	50		77		93		99	
28. Counselor Heath		1		7		23	 	50		77		93		99	
29. Counselor Kents		1		7		23	 	50		77		93		99	
30. Counselor Young		1		7		23	 	50		77		93		99	

	Why these estimates?

G.	Given that each Counselor's treatment failed, how likely is it that each Counselor's method would make him or her personally liable for damages or malpractice?

					No Chance										Certainty of 
					of being Liable									being Liable
31. Counselor Bowers	1		7		23	 	50		77		93		99	
32. Counselor Brown		1		7		23	 	50		77		93		99	
33. Counselor Heath		1		7		23	 	50		77		93		99	
34. Counselor Kents		1		7		23	 	50		77		93		99	
35. Counselor Young		1		7		23	 	50		77		93		99	

	Why these estimates?

H.	Given the degree to which you believed that the Counselors were personally negligent, how likely is each of the Counselors to be sued?
					No Chance										Certainty
36. Counselor Bowers	1		7		23	 	50		77		93		99	
37. Counselor Brown		1		7		23	 	50		77		93		99	
38. Counselor Heath		1		7		23	 	50		77		93		99	
39. Counselor Kents		1		7		23	 	50		77		93		99	
40. Counselor Young		1		7		23	 	50		77		93		99	

	Why these estimates?

	

I.	Given the degree to which you believed that the Counselors were liable, how much money should the Patient be awarded in the event of actual legal proceedings?  Note that the severity of the bad outcome was the same for all of the Patients.

			No Money															Most Money
41.	Counselor Bowers	0	30,000		60,000		100,000		600,000		1,000,000	3,000,000
42. 	Counselor Brown		0	30,000		60,000		100,000		600,000		1,000,000	3,000,000
43. 	Counselor Heath	 	0	30,000		60,000		100,000		600,000		1,000,000	3,000,000
44. 	Counselor Kents		0	30,000		60,000		100,000		600,000		1,000,000	3,000,000
45. 	Counselor Young 	0	30,000		60,000		100,000		600,000		1,000,000	3,000,000

	Explain why you made these awards.

J.	Below is a list of Counselors' explanations of their methods.  Which explanations match the Counselors' methods (see page 5) for choosing treatment?  Write the Counselor's name in the space below each explanation.  If you think an explanation represents more than one Counselor, write all the Counselors' names next to each other in the space provided.  If you do not think an explanation matches a Counselors method, write a zero in the blank.

Counselors' explanations of their methods for choosing treatment.
46.		I choose a treatment that has been tested and approved by experts in the educational field.  Counselors must follow strict guidelines.  Treatments are carefully tested and only those that are most helpful are used.  A Counselor has the responsibility to follow these guidelines.  Sometimes Patients ask questions before agreeing with the best treatment.

47.		I choose a treatment that I have seen stops the problems.  I have to be very careful or I will get sued.  When I see that a treatment works, I make the decision to use it.  I am the one who is supposed to know what treatment to use.  I have to be in charge or I can't help the Patient.  That way I avoid problems.  The Patient has to agree with the treatment so I tell them to do agree.

48.		I choose a treatment only after I know how it works.  The most important thing is to understand how a treatment works.  I take note of what the different treatments do.  Once I know which treatment produces the most helpful outcome, I tell the Patient all about it.  That way the Patient knows what to expect.  They always agree with it.

49.		I choose a treatment with the Patient.  I explain the various results of different treatments and how they work.  Then I ask Patients to tell me how they think the suggested treatment works.  If the Patient does not want a treatment, I suggest another.  Which treatment is chosen is up to the Patient.  When a treatment is viewed as acceptable, it is given to the Patient.

50.		I choose a treatment that helps Patients.  Patients usually do not know what to do about their problems.  The Counselor has to tell the Patient which treatment to take.  That's what the Counselor is there for.  The Patient does what the Counselors says and does well.  Patients go to Counselors so the Counselor will make them do well.  That is why they agree with the best treatment. 

51.		I choose a treatment that is commonly used for the specific problems.  If I am not sure what treatment to use, I check with another Counselor that I know personally.  The Counselors I know well want to aid their Patients.  When the Patient sees a lot of Counselors saying the same thing its easier to accept the treatment.  The Patient has to be guided.

52. 	I choose a treatment along with the Patient.  I discuss the good and bad results of different treatments and why they happen.  Then I ask Patients to tell me how they think the treatments work.  When the Patient knows what the choices mean, I offer the Patient the choice.  When a Patient views a treatment as acceptable, it is given to the Patient.

53. 	I choose a treatment that I know helps Patients.  Counselors use their personal experience.  Patients usually do not know what to do about their problems.  The Counselor has to tell the Patient which treatment to take.  That's what the Counselor is there for.  Patients choose the treatment the Counselor says is best because they know the Counselor is right. 

The Counselor-Patient Interaction

The following 10 stories are set in another country.  In each story, a Counselor tries to help a competent Patient to solve a given set of problems.  The problems are serious.  It is now time choose a treatment to improve the situation.  All the Counselors care for their Patients equally.  All the Counselors highly recommend and provide the same basic treatments.  But, the Counselors arrive at their choice of how to help in different ways.  In every case, the problems worsen and those who are affected suffer.  During a general review of these bad results, each Counselor's method of choosing a treatment was looked at.  Below, the Counselors give accurate accounts of their usual talk with their Patients.  Read all five accounts carefully and then answer the questions that follow.

The Counselors’ Methods
Counselor Corey offers a treatment which is highly regarded by many colleagues and accepted by the community at large.  Corey fully explains the treatment to the patient by describing the benefits and potential risks involved.  Corey adds that the proposed treatment is liked by many patients in this situation and that they have been happy.  Corey asks what the patient is feeling about the treatment.  Corey encourages the patient to think about what they have heard but to pursue this treatment.  The patient thinks about the situation.  Feeling that Corey knows best, the patient decides to undergo the treatment.  

Counselor Flynn offers an effective treatment that compares well to other treatments for this problem.  Flynn explains the helping effects of every treatment.  Flynn describes all the risks of these treatments.  Flynn asks the Patient to relate back that explanation.  Flynn says it is up to the Patient to support a treatment.  Flynn asks if the Patient supports the suggested treatment.  Flynn's Patient thinks about what Flynn has said.  Feeling that Flynn knows best, Flynn's Patient prepares to undergo the treatment.

Counselor Jones offers a carefully thought out treatment based on personal experience.  The Patient is told that the treatment has worked before with other Patients, especially the last ten.  Then, Jones says that experts whom Jones knows well choose this treatment.  To make sure the Patient understands, Jones gives the Patient an easy multiple choice test.  After the Patient passes the test, Jones urges the Patient to agree to the treatment.  Jones' Patient thinks carefully about what Jones has said.  Feeling that Jones knows best, Jones' Patient prepares to undergo the treatment.

Counselor Smith meets with the patient to discuss treatment.  Smith and the patient cover benefits and risks of Smith's preferred therapy.  They discuss other forms of treatment related to the patient's situation, including doing nothing, and the benefits and risks of each.  Smith feels the patient competently understands the discussion based on the patient's questions and body language.  Smith asks the patient whether they now feel ready to make a decision or they need more time to consider the information and options.  Feeling Smith knows best, the patient decides to undergo the treatment.

Counselor Spire offers a new effective treatment that has been researched with excellent results and published in different professional journals.  Spire explains the details of the treatment to the patient along with it benefits and side effects.  Spire then states that there are other options that could be looked at, including the possibility of doing nothing.  Spire reviewed the other treatments with the patient, but felt they would not be as effective as the newer treatment.  Spires asks the patient if they feel secure with this treatment.  Feeling Spire knows best, the patient prepares to undergo the treatment.							

K.  Rate (circle) the Counselors' methods.  A rating of 1 means you think that Counselor has the worst method.  A rating of 6 means you think that Counselor has the best method.  Not all the ratings need to be used and a particular rate may be given to more than one Counselor.
	
			RATINGS
		Worst					Best
		Method					Method
54.	Counselor Corey		1	2	3	4	5	6
55.	Counselor Flynn 		1	2	3	4	5	6
56.	Counselor Jones		1	2	3	4	5	6
57.	Counselor Smith		1	2	3	4	5	6
58.	Counselor Spire 		1	2	3	4	5	6

Why did you rate the Counselors' methods the way you did?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

L.  Rate (circle) the Counselors according to how well they consider the Patient's viewpoint.  A rating of 1 means that the Counselor was extremely poor at considering the Patient's viewpoint.  A rating of 6 means the Counselor considered the Patient's viewpoint extremely well.  You may use the same rating for more than one Counselor.

				RATINGS
		Extremely				Extremely
		Poor					Well	
59.	Counselor Corey		1	2	3	4	5	6
60.	Counselor Flynn 		1	2	3	4	5	6
61.	Counselor Jones		1	2	3	4	5	6
62.	Counselor Smith		1	2	3	4	5	6
63.	Counselor Spire 		1	2	3	4	5	6

Why did you rate the Counselors' methods the way you did?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

M.  Rate the degree to which the Counselors attained informed-consent from their Patients.

			RATINGS
				Extremely				Extremely
				Poor					Well
64.	Counselor Corey		1	2	3	4	5	6
65.	Counselor Flynn 		1	2	3	4	5	6
66.	Counselor Jones		1	2	3	4	5	6
67.	Counselor Smith		1	2	3	4	5	6
68.	Counselor Spire 		1	2	3	4	5	6

Why did you rate the Counselors this way?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

								

N.  Rate how well the Counselors informed their Patients.

				RATINGS
		Extremely				Extremely
		Poor					Well
69.	Counselor Corey		1	2	3	4	5	6
70.	Counselor Flynn 		1	2	3	4	5	6
71.	Counselor Jones		1	2	3	4	5	6
72.	Counselor Smith		1	2	3	4	5	6
73.	Counselor Spire 		1	2	3	4	5	6

Why did you rate the Counselors this way?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

O.  Rate how well the Counselors attained consent from the Patient.

			RATINGS
		Extremely				Extremely
		Poor					Well
74.	Counselor Corey		1	2	3	4	5	6
75.	Counselor Flynn 		1	2	3	4	5	6
76.	Counselor Jones		1	2	3	4	5	6
77.	Counselor Smith		1	2	3	4	5	6
78.	Counselor Spire 		1	2	3	4	5	6

Why did you rate the Counselors this way?  Explain as fully as you can.  Use back of paper or scratch paper if you need more writing space to answer.  Please print as clearly as possible.

	The Counselor-Patient Opinion Poll

Use back of paper or scratch paper if you need more writing space for each answer.  Please print as clearly as possible.

P.	Suppose you were listening to these Counselors give their account of the treatment methods in a hearing.  Rate the degree to which you believe the Counselors to be telling the truth.  How believable do you find their accounts?

				No Chance of										Certainty of
				being true											being true
79. Counselor Corey		1		7		23	 	50		77		93		99	
80. Counselor Flynn		1		7		23	 	50		77		93		99	
81. Counselor Jones		1		7		23	 	50		77		93		99	
82. Counselor Smith		1		7		23	 	50		77		93		99	
83. Counselor Spire		1		7		23	 	50		77		93		99	

	Why these estimates?

Q.	Given that each Counselor's treatment failed, how likely is it that each Counselor's method would make him or her personally liable for damages or malpractice?

					No Chance										Certainty of 
					of being Liable									being Liable
84. Counselor Corey		1		7		23	 	50		77		93		99	
85. Counselor Flynn		1		7		23	 	50		77		93		99	
86. Counselor Jones		1		7		23	 	50		77		93		99	
87. Counselor Smith		1		7		23	 	50		77		93		99	
88. Counselor Spire		1		7		23	 	50		77		93		99	

	Why these estimates?

R.	Given the degree to which you believed that the Counselors were personally negligent, how likely is each of the Counselors to be sued?
					No Chance										Certainty
89. Counselor Corey		1		7		23	 	50		77		93		99	
90. Counselor Flynn		1		7		23	 	50		77		93		99	
91. Counselor Jones		1		7		23	 	50		77		93		99	
92. Counselor Smith		1		7		23	 	50		77		93		99	
93. Counselor Spire		1		7		23	 	50		77		93		99	

	Why these estimates?

S.	Given the degree to which you believed that the Counselors were liable, how much money should the Patient be awarded in the event of actual legal proceedings?  Note that the severity of the bad outcome was the same for all of the Patients.

			No Money															Most Money
94. 	Counselor Corey		0	30,000		60,000		100,000		600,000		1,000,000	3,000,000
95. 	Counselor Flynn		0	30,000		60,000		100,000		600,000		1,000,000	3,000,000
96.	Counselor Jones		0	30,000		60,000		100,000		600,000		1,000,000	3,000,000
97. 	Counselor Smith		0	30,000		60,000		100,000		600,000		1,000,000	3,000,000
98. 	Counselor Spire		0	30,000		60,000		100,000		600,000		1,000,000	3,000,000

	Explain why you made these awards.