Evidence-based practice necessitates the inclusion of client identity and contextual information when conceptualizing diagnosis.
To examine how therapists’ perceptions of Generalized Anxiety Disorder is influenced by client environmental contextual and identity factors, like class and race.
Therapists (n = 138; 76% women; M  = 38.3) were randomly assigned three of six client vignettes and asked to provide diagnostic recommendations, confidence in diagnosis, and perception of client’s concerns. Vignettes differed in their description of client class, race, and contextual factors. A linear mixed-model was used to test confidence in diagnosis and generalized linear mixed-models were conducted to predict diagnosis and client concerns.
Therapists altered diagnosis, confidence, and client concerns based on client contextual factors-but not identity factors.
Therapists consider contextual factors in making clinical decisions, with overall tendency towards diagnosis regardless of if symptoms met the diagnostic criteria of being “excessive” given the environmental context.

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