Author ORCID Identifier

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Counseling and Psychological Services

First Advisor

Franco Dispenza, PhD

Second Advisor

Dennis Gilbride, PhD

Third Advisor

Donnie Davis, PhD

Fourth Advisor

Melissa Zeligman, PhD

Fifth Advisor

Moneta Sinclair, EdD


Individuals living with a dual diagnosis (e.g., substance use disorder [SUD] and the co-occurrence of a psychiatric disorder) experience numerous challenges to treatment due to the complexity and overlapping nature of symptomology, psychosocial contextual factors, and limited effective evidence-based treatment options (Cochran et al., 2007; Flanagan et al., 2016). Due to the high prevalence rates of clients living with a dual diagnosis, it is likely that counselors-in-training (CITs) will work with a client dealing with a dual diagnosis as early as their practicum or internship experience (Brown et al., 2002; Salyers et al., 2006). I utilized an analogue experimental research design to create a simulated counseling experience to explore how CITs differently discriminate blame and empathy levels toward a fictitious client. The fictitious client had a dual diagnosis of SUD and PTSD, and who experienced a recent relapse to substance use. I explored separate scores of blame and empathy in a sample of CITs (N = 138) over the age of 18, currently seeing clients in a practicum or internship experience, and enrolled in a CACREP accredited program throughout the United States in a 2 x 2 experimental analogue study. CITs were randomly assigned to one of four groups, and asked to read and respond to a short vignette of a fictitious client living with a dual diagnosis of SUD and PTSD, who had recently relapsed. The aim was to explore if and how CITs discriminate differently based on relapse determinants (i.e., intrapersonal self-medicating behavior versus interpersonal high-risk behavior) and relapse substance use type (i.e., alcohol versus crystal meth) among those living with a dual diagnosis of SUD and PTSD. Bivariate correlations and two separate two-way between group ANOVAs were utilized to analyze data. Results revealed that CITs differently discriminated blame toward the fictitious client in the vignette based on the relapse determinants and SU type. However, CITs did not discriminate empathy levels differently toward the same client based on relapse determinants and SU type. Based on the results of this study, even when attribution bias (e.g., blame) was present toward the same fictitious client, these CITs could still endorse consistent ratings of empathy toward the client.


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Available for download on Wednesday, July 24, 2024