Journal of Substance Abuse Treatment, Vol. 10, pp. 383-389, 1993 Printed in the USA. All rights reserved.

Copyright

0740-5472/93 $6.00 + .OO 1993 Pergamon Press Ltd.

INTERNATIONAL

PERSPECTIVE

Sex Role Stereotypes and Clinical Judgement: How Therapists View Their Alcoholic Patients
COR

A.J. DEJONG, PhD, MD,* WIM VAN DEN BRINK, PhD, MD,?
AND JORIEN
*Roder Heyde, tThe Amsterdam

A.M.

JANSEN, MA*
Oedenrode, Amsterdam, The Netherlands The Netherlands

Institute for Addiction Treatment, Institute for Addiction Research,

Abstract-In the course of a selection procedure for inpatient treatment in an addiction clinic, it was repeatedly noticed that the attitude of staff-members towards male alcoholics was more confronting and critical as compared to a more empathic and supportive attitude towards female alcoholics. Two different processes may account for this phenomenon. Firstly, male and female alcoholics may differ in their interpersonal behaviour towards therapists, and subsequently these different behaviours evoke different attitudes and behaviours in therapists (interaction-hypothesis). Secondly, these different attitudes towards male and female patients may emerge from preconceived ideas among therapists about male and female alcoholics (stereotype-hypothesis). This study describes the stereotypes held by therapists regarding the interpersonal behaviour of male and female alcoholics. Furthermore, it explores the influence of self perceived interpersonal behaviour of therapists on these stereotypes. The results suggest, that the differences in attitude and behaviour towards alcoholics are-at least partly- the result of different male and female alcoholic stereotypes held by therapists. These stereotypes were related to the self perceived interpersonal behaviour of the therapist. Pretreatment matching of patients and therapists should be based on interpersonal attitude rather than on sex. Keywords-sex role stereotypes; interpersonal pretreatment matching. INTRODUCTION
IN THE COURSE of the diagnostic assessment and the selection procedure for inpatient treatment in an addiction clinic, it was repeatedly noticed by sociotherapists that the attitude of staff-members towards male alcoholics was more confronting and critical as compared to a more empathic and supportive attitude towards female alcoholics. In a pilot study, male alcoholics were perceived as more hostile and dominant compared to female alcoholics and female alcoholics as more dependent than male alcoholics by all staff members (4 male and 5 female) of the diagnostic ward (DeJong, 1989). Two different explanations may account for the

behaviour; clinical judgment;

alcoholic inpatients;

Requests for reprints should be addressed to Dr. C.A.J. DeJong, Roder Heyde, Institute for Addiction Treatment, Schijndelseweg 46, 5491 TB Stut-Oedenrode, The Netherlands.

differences in attitude and behaviour of therapists towards male and female alcoholics. The first explanation is that male and female alcoholics differ in their actual interpersonal behaviour towards therapists. In turn, these different patient behaviours probably evoke different attitudes and behaviour in therapists (interaction-hypothesis). According to interpersonal theory (Kiesler, 1986; McLemore & Brokaw, 1987), the confronting and critical attitude towards male alcoholic patients is likely to be the social reaction of the therapist to the hostile-submissive interpersonal behaviour of the patient. The supportive attitude of the therapist towards female alcoholic patients can be explained as a result of the social reaction of the therapist to the friendly-submissive interpersonal behaviour of female patients. Thus, different attitudes of therapists towards male and female alcoholics are the result of actual differences in interpersonal behaviours between male and female patients. The second explanation is that these 383

384 differences in attitude and behaviour towards male and female patients do not result from actual patient behaviour, but rather emerge from preconceived ideas among therapists about the distinct interpersonal behaviour of male and female alcoholics (stereotypehypothesis). The stereotype- and interaction-hypothesis are not mutually exclusive, but rather complementary and partly overlapping. For example, repeated similar patient-therapist interactions may lead to stereotype formation, while the reverse is also possible: preconceived interpersonal attitudes leading to stereotypical patient-therapist interactions. This study focuses on existing stereotypes with regard to the interpersonal behaviour of male and female alcoholics in general among therapists, and the potential influence of gender and interpersonal style of the therapist on these stereotypical beliefs.

C.A.J. DeJong et al. the ICL variables indeed seem to arrange themselves in a circle. However, the variables were not equally spaced around the circle; relatively large gaps were found consistently in the lower left (Hostile-Submissive) and upper right (Friendly-Dominant) quadrant (e.g., Lyons, Hirschberg & Wilkinson, 1980; Wiggins, Steiger & Gaelick, 1981). In order to fill these gaps, we added 32 items (i.e., 2 scales of 16 items) to the original ICL. The extended version of the ICL (Van den Brink, 1989) includes 160 items, representing 10 interpersonal styles (see Figure 1). The 10 dimensions on the two factors are almost equally spaced in a circular pattern (DeJong, Van den Brink & Jansen, 1990). Several raw scores and summary indices were used in the study. ICL scale scores were calculated for each ICL. Together, these scale scores and their circular arrangement form an interpersonal profile. In addition, we constructed a single summary measure (ICL-vector), based on a summary score for Control and Affiliation according to the formulas of Leary (1957) and Paddock and Nowicki (1986). Combining the summary scores for dominance and affiliation results in a vector from the circles centre to one point in the circumplex that summarises the whole interpersonal profile. Finally, for reasons of data reduction and the management of multicollinearity, summary scores (with low intercorrelations) were constructed for therapist self-ratings, using principal component analysis with varimax rotation on the ICL-T scale scores. This resulted in three interpersonal scales: (a) dominance (PA + BC + DE + nNnO), (b) dependence (HI + JK + nFnG + FG), and (c) complaisance (LM + NO) (see Figure 1).

METHOD Subjects and Procedure In order to obtain systematic information on male/ female alcoholic stereotypes held by therapists, all therapists in the South-Eastern region of the Netherlands working with addicts (n = 160) were asked to describe the interpersonal behaviour of a typical male and female alcoholic patient, using the Interpersonal Check List (ICL-stereotype Male/Female: ICL-SM/ICL-SF). In addition they were asked to rate their own interpersonal behaviour in normal (i.e., nontherapeutic) situations (ICL-Therapist: ICL-T). Data were obtained from 98 (61%) therapists (44% males; mean age 36.3 years, s.d. 6.8; in-patient service 48%, out-patient service 52%; mean clinical experience 7.5 years, s.d. 5.0).

RESULTS Table 1 shows means and standard deviations of the ICL-T for male and female therapists, and the ICL-S for male and female alcoholics. No statistically significant differences were found in the self-perceived interpersonal behaviour of male and female therapists (t-test). However, according to the stereotype core made by the therapists, female alcoholic as compared to male alcoholic are thought to be less dominant (PA, BC, nNnO), less hostile (DE), more submissive (HI, JK), and more friendly (LM, NO). The stereotype descriptions of male and female alcoholics were similar for rebellious-distrustful (FG) and detached (nFnG) interpersonal behaviour. Figure 2 summarises Table 1 in the form of vectors for the three ICL scores (ICL-T and ICL-SM/SF). Both male and female therapists describe themselves (in nontherapeutic situations) as dominant-friendly (managerial, social, responsible). According to these therapists, the male alcoholic stereotype can be characterised as hostile-submissive (suspicious-detached),

Instrument

and Measures

An extended version of the Interpersonal Check List (ICL; LaForge & Suszek, 1955) was used to measure both interpersonal stereotypes of male (ICL-SM) and female alcoholics (ICL-SF) and self-perceptions of interpersonal behaviour by therapists (ICL-T). The original ICL includes 128 dichotomous items related to interpersonal style. These items may be separated into eight (16 item) octant scales (PA to NO) each of which taps one of the conceptual styles of interpersonal strategy described by Leary (1957). These interpersonal styles are arranged in a circumplex along the orthogonal dimensions of Control (Dominance-Submission) and Affiliation (Hostility-Friendliness). Each style is a blend of the two axis dimensions reflecting mathematically weighted combinations of Control and Affiliation. The ICL has been used in over 200 studies (Paddock, 1982; Clark & Taulbee, 1981). Psychometric analyses of empirical data have repeatedly shown, that

Sex Role Stereotypes and Clinical Judgement

385

I
DE

I
Ix=
DOM/AFF
=

scores 1

\_/I

vector

FIGURE 1. ICL-vectors for ICL-T (m/f) and ICL-EM/SF. 1 = female alcoholic stereotype; 2 = male alcoholic stereotype; 3a = male therapist; 3b = female therapist. (example: female alcoholic stereotype, ICL-SF).

whereas the female alcoholic stereotype can be summarised as friendly-submissive (dependent-masochistic). Finally, the influence was examined of therapistcharacteristics on therapist stereotype scores. Table 2 shows the results of two regression analyses with stereotype scores as the dependent variable, gender of the therapist as the first and self-perception of the interpersonal behaviour of the therapist (dominance, dependence, complaisance) as the second (set of) predictor variable(s). In the last analysis the variables were entered stepwise. Gender of the therapist has hardly any influence on stereotypes held by these professionals (see also

Figure 2). In contrast, self-perceived interpersonal behaviour of therapists does seem to influence their stereotypical image of male and female alcoholics. The results are summarised in Table 3. Therapists with a relatively high dependence score hold a female alcoholic stereotype that is relatively managerial-autocratic (PA), narcissistic-competitive (BC), sadistic-aggressive (DE), and relatively little rebellious-distrustful (FG). These therapists view male alcoholics as hypernormal-responsible (NO), and relatively little rebellious-distrustful (FG). In clear contrast, therapists with a relatively high dominance score hold stereotypes of male alcoholics that are relatively

386

C.A. J. DeJong et al.

TABLE 1 Scores (Mean, SD) for ICL-T (Males vs Females), ICL-S (SM vs SF) ICL-S (N = 98) ICL-SM (N = 98) ICL-SF (N = 98)

ICL Scale Scores and ICL Dominance/Affiliation ICL-T (N = 96)a Males (N = 55) ICL-Scores: PA BC DE FG nFnG HI JK LM NO nNn0 Dominance Affiliation X 7.7 7.0 7.6 6.3 5.3 5.3 6.2 7.0 7.2 8.2 5.9 1.3 SD 2.4 2.0 2.1 2.8 3.5 3.6 3.0 2.4 2.5 2.8 10.9 7.3 Females (N = 41) X 7.9 6.3 7.4 6.1 4.3 5.2 6.4 7.3 6.8 8.3 6.5 2.9

SD 2.4 2.3 2.5 2.7 2.3 3.5 3.7 2.1 2.8 2.6 9.9 7.6

PA
ns ns ns ns ns ns ns ns ns ns

X
6.3 6.6 6.8 10.6 7.3 8.4 8.3 6.8 6.4 6.8 -6.3 -2.8

SD
3.9 3.1 2.7 3.5 3.1 3.8 3.0 3.2 3.9 3.6 13.0 10.9 behaviour

X
5.1 4.6 5.7 10.5 7.3 10.9 10.2 8.3 9.5 5.9 - .11.8 5.2

SD
3.9 3.1 2.7 3.5 3.1 3.8 3.0 3.2 3.9 3.6 11 .o 11.7

PA
l l l

** ** ns

,,,
l

** ** l ** *
l

aTw~ therapists did not provide self-report * = p < .05. l * = p < .Ol.

data regarding their own interpersonal

=*= =p<

.OOl.

I I
r

General Alcoholic Stereotypes

t-

_-----_

i
I
I L

General Hale-Female SterEotypes

t,lal2-Female Alcoholic Stereotypes

Interpersonal Behaviour of Therapists

S-H/I-H

I-H

Interpersonal Behaviour of Hale / Female Alcoholics

FIGURE 2. Schematic summary of hypotheses and findings. S-H = stereotype hypothesis; I-H = interaction hypothesis.

Sex Role Stereotypes

and Clinical

Judgement TABLE 2 (Sex, Interpersonal Behaviour) on Male/Female by These Therapists Predictor variables Complaisance P

387

Effect of Therapist Characteristics

Alcoholic Stereotypes

Held

Sex I3
ICL-SM scores: PA BC DE FG nFnG HI SK LM NO nNn0 ICL-SF scores: PA BC DE FG nFnG HI SK LM NO nNn0 P

Dominance

El

I3

R
8% 7% 4% 31 % 16% 12% 8% 21% 21% 8%

.06 -.02 -.09 -.02 -.ll -.ll -.20 -.07 .05 .02

ns ns ns ns ns ns ns ns ns ns

.26 .19 .lO -.48 .16 -.19 -.15 .21 .28 .18

ns ns ns ** ns ns ns ns * ns

.ll .18 .ll .25 .36 .16 .08 .16 .17 .12

ns ns ns
l

* ns ns ns ns ns
l

-.03 -.03 .09 -.02 -.03 .27 .17 .30 .24 .14

ns ns ns ns ns * ns
l

ns ns

-.lO -.23 -.20 -.05 -.lO .19 .14 -.12 .13 -.13

ns ns ns ns ns ns ns ns ns ns

.41 .34 .30 -.37 .23 -.16 -.24 .16 -.08 .21

l l

* ns ns ns ns ns ns
l

.13 .13 .12 .20 .I9 .lO -.03 .13 .ll .13

ns ns ns ns ns ns ns ns ns ns

-.03 .20 .09 -.03 .15 -.05 .23 .14 .lO .26

ns ns ns ns ns ns ns ns ns *

19% 27% 17% 19% 14% 9% 10% 9% 4% 18%

Note: Stepwise regression with ICL-SM/lCL-SF scores as the dependent variable, gender of the therapist as the first and interpersonal behaviour of the therapist as the second (set of) predictor variable(s). * = p < .Ol. *= = p < ,001.

rebellious-distrustful (FG) and detached-introverted (nFnG). Finally, therapists with high complaisance scores view their female alcoholic patients as relatively sociable-extravert (nNnO), whereas they view male alcoholics as relatively cooperative-conventional (LM) and masochistic-self-effacing (HI). Work-setting and total years of clinical experience of the therapist did

not effect their view on what constitutes or female alcoholic. DISCUSSION

a typical male

The results of the present study are consistent with a stereotype-hypothesis as an explanation for the clin-

Selfperceived Therapist Interpersonal Behaviour High dependence

Interpersonal

TABLE 3 Behaviour of Therapists and Stereotypes of Female and Male Alcoholics Female Alcoholic Stereotype High: managerial-autocratic narcissistic-competitive sadistic-agressive Low: rebellious-distrustful High: rebellious-distrustful detached-introverted High: sociable-extravert High: cooperative-conventional masochistic-self-effacing Male Alcoholic Stereotype High: hypernormal-responsible

High dominance High complaisance

388

C.A.J.

DeJong et al.

ically observed differences in attitude of therapists towards male and female alcoholics. The male alcoholic stereotype held by therapists can be characterised as suspicious and detached (hostile-submissive), whereas the female alcoholics are thought of as being dependent and masochistic (friendly-submissive). According to the interpersonal complementarity hypothesis (Kiesler, 1986; Brokaw & McLemore, 1983), these differences in stereotypes held by therapists and the projection of these stereotypical attitudes on actual therapist-patient interactions might well be responsible for the observed differences in actual clinical situations. If male alcoholics, irrespective of their actual behaviour, are perceived as hostile-submissive, the therapists will respond with confronting and critical (hostile-dominant) behaviour. If, on the other hand, female alcoholics are perceived as friendly-submissive, this image will pull and reinforce empathic and supportive (friendly-dominant) attitudes in the therapist. Does corroboration of the stereotype-hypothesis automatically imply rejection of the interactionhypothesis, or are the two hypotheses complementary and partly overlapping? The answer to this question depends primarily on the way the stereotypes were constituted. On the one hand, practicing mental health professionals might share the values and norms of the society in which they work, and hence male-female alcoholic stereotypes may reflect general sex-role stereotypes prevalent in our society. On the other hand these stereotypes could be a result of repetitive, genderspecific encounters of therapists with male and female alcoholics. In the study of Rosenkrantz, Vogel, Bee, Broverman and Broverman (1968) and Broverman, Broverman, Clarkson, Rosenkrantz and Vogel (1970), the content of the male and female alcoholic stereotypes closely parallel the general sex-role stereotypes: women being stereotyped as more submissive, less independent, less competitive and less aggressive than men. These findings favour a general stereotype pathway over a repetitive encounter pathway for the development of male-female alcoholic stereotypes. Some observations deserve further discussion. In contrast to our expectations (see Paddock & Nowicki, 1986; Sanderman, Van den Brink & Ormel, 1989), male and female therapists did not differ in their selfreported interpersonal behaviour in nontherapeutic situations. Compared to the self-reported behaviour of American students (Paddock & Nowicki, 1986) and a representative sample of the Dutch population (Sanderman, Van den Brink & Ormel, 1989), the selfreported interpersonal style of both male and female therapists was characterised by relatively little selfeffacing and affiliation. Female therapists were also more managerial-autocratic (PA) and narcissisticcompetitive (BC) than American female students and normal Dutch women. Therefore, the absence of

male-female differences in the self-report data of therapists seems to be the result of a masculine response style (PA-BC) of female therapists. Several processes may be responsible for this tendency. Since female therapists are (were?) often under the guidance of male therapists during their training, they may internalise the values, beliefs and attitudes of their mentors (Loring & Powell, 1988). In addition, female as well as male therapists may develop dominant interpersonal strategies in order to set therapeutic limits to their addicted patients and to survive demanding work circumstances. Like many other studies (Broverman, et al., 1970; Koscherak & Masling, 1972; Lewittes, Moselle, & Simmons, 1973; Schlosberg & Pietrofesa, 1973; Werner & Block, 1975; Billingsley, 1976; Adler, Drake, & Teague, 1990), little influence was found of the therapists gender on the male and female stereotypes. Female therapists viewed female alcoholics as slightly more masochistic due to a relatively low estimation of their narcissistic-competitive (BC) behaviour. A similar overstereotyping by female health professionals of female clients was recently observed by Young and Powell (1985). However, the self-perceived interpersonal behaviour of the therapist did influence the view of therapists on male and female alcoholics in a substantial and intelligible (= complementary) way. Dependent therapists view their female alcoholic patients as relatively hostile-dominant (high on PA, BC, DE, low on FG) and their male alcoholic patients as relatively friendly-dominant (high on NO). In contrast, dominant therapists view their male alcoholic patients as relatively hostile-submissive (high on FG and nFnG). Finally, therapists who perceive themselves as relatively responsible and cooperative think of male alcoholics as relatively friendly-submissive (high on LM and HI) and hold a stereotype of female alcoholics that is relatively sociable (high on nNn0). Dependent interpersonal behaviour of the therapist seems to pull and reinforce dominant behaviour of the patient. Dominant interpersonal behaviour of the therapist pulls submissive behaviour of the patient and a friendly approach by the therapist seems to result in friendly behaviour of the patient. In turn, repetitive interpersonal behaviours of the patient-as a reaction to repetitive interpersonal behaviours of the therapist-may lead to the development of interpersonal patient stereotypes. Based on our results and their subsequent discussion, the following conclusions can be drawn (see Figure 2): 1. Differences in the attitude of mental health professionals towards male and female alcoholics are- at least partly-a result of male and female alcoholic stereotypes held by these professionals. 2. The formation of these stereotypes is a complex process with interactions between (a) the general

Sex Role Stereotypes and Clinical Judgement sex-role stereotypes prevalent in the society as a whole, (b) actual (differences in) interpersonal behaviour of male and female alcoholics, and (c) actual (differences in) interpersonal behaviour of (different) therapists. 3. Gender, work-setting and clinical experience of the therapist hardly influence the male/female alcoholic stereotypes held by the therapist. The results do not suggest that clinicians are especially sexist in their attitudes towards patients. Rather, the attitudes of the sample of therapists are merely reflecting the sex-role stereotypes in our society with an additional colouring through specific therapist-patient interactions. A final remark should be made with regard to the role of the sex of the therapist in pretreatment matching procedures. In the present study male and female therapists did not differ in their self-reported interpersonal behaviour, and they showed only minor differences in their stereotypical view on male versus female alcoholic patients. Furthermore, Zeldow (1978), in a review, concludes that, although male and female therapists may differ in their treatment plans and in their therapeutic interventions, there is no current evidence of sex related differences in outcome. However, the present study showed a significant effect of selfperceived interpersonal behaviour of the therapist on the nature of male and female alcoholic stereotypes held by these therapists. Therefore, our results advocate pretreatment matching of patients and therapists based on interpersonal attitude rather than on sex. Future research should be focussed on the assessment and analysis of actual patient-therapist interactions and the evaluation of therapeutic processes in terms of (anti) complementarity and the timing of asocial (= not expected by the patient) strategies by the therapist.

389
DeJong, C.A.J., Van den Brink, W., & Jansen, J.A.M. (1991). Interpersonal behavior of alcoholic inpatients. Ttjdschrtft voor Psychotherapie, 17, 101-111. Kiesler, D.J. (1986). The 1982 interpersonal circle: An analysis of DSM-III personality disorders. In T. Millon & G.L. Klerman (Eds.), Contemporary directions in psychopathology. Toward the DSM-IV. New York: Guilford Press. Koscherak, S., & Masling, J. (1972). Noblesse oblige effect: The interpretation of Rorschach responses as a function of ascribed social class. Journal of Consulting and Clinical Psychology, 39,

415-419.
LaForge, R., & Suszek, R. (1955). The interpersonal dimension of personality. Ill. Interpersonal checklist. Journal of Personality,

24, 94-l 12.

Lewittes, D.J., Moselle, J.A., & Simmons (1973). Sex-role bias in clinical judgements based on Rorschach interpretations. Proceed-

ings of the gist Annual Convention of the American Psychological Association, 8, 495-496.
Loring, M., &Powell, B. (1988). Gender, race and DSM-III: A study of the objectivity of psychiatric diagnostic behavior. Journalof

Health and Social Behavior, 29, l-22.

Lyons, J., Hirschberg, N., & Wilkinson, L. ture of the Leary interpersonal behaviour havioral Research, 15, 249-257. McLemore, C.W., & Brokaw, D.W. (1987) dysfunctional interpersonal behaviour. (1980). The radix struccircle. Multivariate BePersonality disorders as

Journal of Personality

Disorders, 2, 270-285.
Paddock, J.R. (1982). The interpersonal check list: A reliability and validity study. Unpublished masters thesis, Emery University, Atlanta, GA. Paddock, J.R., & Nowicki, S. (1986). An examination of the Leary circumplex through the interpersonal check list. Journal of Research in Personality, 20, 107-144. Robertson, J., &Fitzgerald, L.F. (1990). The (mis)treatment of men: Effects of client gender role and life-style on diagnosis and attribution of pathology. Journal of Counseling Psychology, 37,

3-9.
Rosenkrantz, P., Vogel, S., Bee, H., Broverman, I., & Broverman, D. (1968). Sex-role stereotypes and self-concepts in college students. Journal of Consulting and Clinical Psychology, 32,

287-295.
Sanderman, R., van den Brink, W., & Ormel, J. (1989). lnterpersonal behaviour; reliability and validity of the interpersonal check list in a representative sample of the Dutch population. Unpublished manuscript. Schlosberg, N.K., & Pietrofesa, J.J. (1973). Perspectives on counseling bias: Implications for counselor education. Counseling

REFERENCES
Adler, D.A., Drake, R.E., & Teague, G.B. (1990). Clinicians practices in personality assessment: Does gender influence the use of DSM-Ill axis II? Comprehensive Psychiatry, 31, 125-133. Billingsley, D. (1976). Sex-role stereotypes and clinical judgement: Negative bias in psychotherapy. Presented at the American Psychological Association meeting, Washington DC. Broverman, I.K., Broverman, D.M., Clarkson, F.E., Rosenkrantz, P.S., &Vogel, S.R. (1970). Sex-role stereotypes and clinical judgements of mental health. Journal of Consulting and Clinical Psychology, 34, l-7. Clark, T.L., & Taulbee, E.S. (1981) A comprehensive and indexed bibliography of the Interpersonal Check List. Journal of Per-

Psychology, 4, 44-54.
Van den Brink, W. (1989). Meting van DSM-Ill persoonlijkheidspathologie. Betrouwbaarheid en validiteit van de SIDP-R en As II van de DSM-Ill [Measuring DSM-Ill personality pathology. Reliability and validity of the SIDP-R and DSM-Ill Axis II], Doctoral thesis, Groningen. Werner, P.D., & Block, J. (1975). Sex differences in the eyes of expert personality assessors: Unwarranted conclusions. Journal of Personality Assessment, 39, 110-l 13. Wiggings, J.S., Steiger, J.H., & Gaelick, L. (1981). Evaluating circumplexity in personality data. Multivariate Behavioral Research,

16, 263-289.
Young, L.M., & Powell, B. (1985). The effects of obesity on clinical judgements of mental health professionals. Journal of Health

sonality Assessment, 45, 505-525.

DeJong, C.A.J. (1989). Perceived interpersonal behavior of male and female alcoholic inpatients: A pilot study. Unpublished manuscript.

and Social Behavior, 26, 233-246.

Zeldow, P.B. (1978). Sex differences in psychiatric evaluation and treatment. An empirical review. Archives of General Psychia-

try, 35, 89-93.