Ratings of Dimensional Traits in Clinical Practice: Comparing Therapist and Client Perspectives

Research has repeatedly evidenced the structural validity of the five-factor model (FFM), but questions remain about the use of its dimensions in clinical practice. Samuel and colleagues (2018) found therapists reported their clients had lower levels of personality pathology compared with clients' own self-reports when using the unipolar Personality Inventory for the DSM-5 (PID-5) scale. The present study utilized the same sample of 54 client-therapist dyads to examine their use of the bipolar FFM Rating Form. When comparing the clinical ratings to expertly rated healthy profile ratings, clients rated themselves as more aligned with healthy than their therapists rated them. Alternatively, clients were up to 3.6 times more likely to use the extreme (i.e., theoretically pathological) ratings of the FFM Rating Form compared with their therapists. These results suggest that therapists and clients use these measures quite differently, and we cannot firmly conclude which source reports more pathology. Theoretical explanations, limitations, and future directions are discussed.