Journal of Counseling Psychology Copyright 1989 by the American Psychological Association, Inc.

1989, Vol. 36, No. 3, 352-356 0022-0167/89/S00.75

Social Desirability, Psychological Distress, and Consumer Satisfaction

With Mental Health Treatment
Stephane Sabourin, Noella Laferriere, Francesca Sicuro,
Jean-Claude Coallier, Louis-Georges Cournoyer, and Pierre Gendreau
Universite de Montreal, Quebec, Canada

The purpose of the present study was to determine the strength of the relationship between social
desirability, psychological distress, and consumer satisfaction with mental health treatment. More
specifically, our goal was to assess whether socially desirable responding accounts for much more
variance in reports of client satisfaction than in self-reports of psychological distress. The sample
consisted of 82 clients in therapy at the Center for Eclectic Psychology, a clinic affiliated with a
large francophone university. Subjects completed the Balanced Inventory of Desirable Respond-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ing, the Symptom Checklist-10, and the Client Satisfaction Questionnaire. Correlational analyses
This document is copyrighted by the American Psychological Association or one of its allied publishers.

revealed that both consumer satisfaction reports and psychological distress scores were contami-
nated by socially desirable responding. These findings are discussed in terms of the validity of
client satisfaction measures.

Whereas in the past client satisfaction with mental health
treatment was given low status as a research variable (Mar-
golis, Sorenson, & Galano, 1977), there is now some agree-
ment that outcome assessment in program evaluation and
clinical practice needs to include measures of client satisfac-
tion (Bornstein & Rychtarik, 1983; Kazdin, 1986; Lambert,
Shapiro, & Bergin, 1986). However, the word satisfaction is a
broad term and various definitions of this concept have been
proposed. Pascoe (1983), acknowledging the different concep-
tualizations of client satisfaction, defined it as "the recipient's
reaction to the context, process, and result of his service
experience" (p. 189).
The investigation of consumer satisfaction is particularly
interesting for several reasons. To begin with, these measures
supply information about the acceptability of different psy-
chosocial interventions and thus provide much wanted quality
assurance and social validity data (Wolf, 1978). Secondly,
satisfaction is moderately related to the client's view of treat-
ment outcome (Lebow, 1983). Thirdly, client satisfaction has,
with some exceptions (Zamostny, Corrigan, & Eggert, 1981),
proven to be a good predictor of the client's compliance with
treatment, premature termination, and future help-seeking
behavior (Kokotovic & Tracey, 1987; McNeill, May, & Lee,
This research was supported in part by the Social Sciences and
Humanities Research Council of Canada through a Canada Research
Fellowship to Stephane Sabourin. It was also supported by grants to
Stephane Sabourin and Pierre Gendreau from the Conseil Quebecois
de la Recherche Sociale and from University of Montreal Comite
d'Attribution de Fonds Internes.
We thank Cristopher Earls, Robert Haccoun, Dave Ross, Michael
Patton, and the anonymous reviewers for their editorial assistance
with the development of this article. We also gratefully acknowledge
the collaboration of the therapists of the Center for Eclectic Psychol-
ogy.
Correspondence concerning" this article should be addressed to
Stephane Sabourin, Departement de psychologic, Universite de Mon-
treal, Case postale 6128, Succursale A, Montreal, Quebec H3C 3J7,
Canada.
352
1987; Sabourin, Gendreau, & Frenette, 1987; Ware & Davies,
1983).
Unfortunately, the usual methods of scaling consumer sat-
isfaction are limited in numerous ways (Lebow, 1983; Lewis
& Magoon, 1987; Pascoe, 1983). In this respect, social desir-
ability constitutes, theoretically, an important confound of
consumer satisfaction reports (Berger, 1983; Garfield, 1983).
However, despite the concept's influential history, agreement
on the definition and measurement of social desirability has
proven to be somewhat elusive. There is a general understand-
ing that social desirability is a multidimensional phenomenon
(Messick, 1960). However, the precise nature of these multiple
components was, until recently, an unresolved issue.
To address this problem, Paulhus (1984, 1986) conducted
two factor analytic studies of well-known social desirability
measures: the Eysenck Personality Inventory Lie scale, the
Minnesota Multiphasic Personality Inventory (MMPI) Lie
scale, the Self-Deception Questionnaire, the Other-Deception
Questionnaire, the Marlowe-Crowne scale, the Edwards Social
Desirability scale, the Wiggins Social Desirability scale,
Byrne's Repression-Sensitization scale, and Block's Ego Re-
siliency scale. The results suggest that these measures cluster
around two factors that can be interpreted as self-deception
and impression management. The first component, self-de-
ception, reflects denial of psychologically threatening thoughts
and means of protection from painful knowledge about the
self. The Self-Deception Questionnaire (SDQ; Sackeim &
Gur, 1978) is the best marker of this factor. The second
component, impression management, corresponds to favora-
ble self-presentations to other people. The clearest prototype
of this factor is Sackeim's and Gur (1978) Other-Deception
Questionnaire (ODQ). Self-deception and impression man-
agement are thus response styles that could distort client
satisfaction data. The establishment of two conceptually and
operationally distinct factors should provide a clearer per-
spective on the relation between social desirability and client
satisfaction.
Although the influence of these confounding factors has
received an enormous amount of conceptual attention, it is
somewhat surprising that there are few empirical studies
 SOCIAL DESIRABILITY
examining the relation between consumer satisfaction reports
and the tendency to respond in a socially desirable manner.
Moreover, it is frequently assumed, implicitly or explicitly,
that client satisfaction data are much more affected by social
desirability than are reports of psychological distress. This
hypothesis should be tested in a rigourous way because several
studies have indicated that measures of psychological distress
are substantially correlated with socially desirable responding.
For example, Linden, Paulhus, and Dobson (1986) have
demonstrated that subjects who engage in self-deception and
impression management report significantly fewer psycholog-
ical and physical symptoms than do those who do not. Simi-
larly, Tanaka-Matsumi and Kameoka (1986) found impres-
sive correlations (ranging from -.49 to -.85) among anxiety,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
depression, and social desirability.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Considering that client's tendencies to respond in a socially
desirable way are quite probably contaminating variables that
decrease the construct validity of consumer satisfaction re-
ports, we designed the present study with the following objec-
tives: (a) to determine the strength of the association between
social desirability and consumer satisfaction reports, and (b)
to assess whether social desirability captures more variance in
reports of consumer satisfaction than in self-reports of psy-
chological distress.
Method
Sample and Procedure
The sample consisted of 82 clients (53 women and 29 men) who
sought individual psychotherapy at the Center for Eclectic Psychol-
ogy, a clinic associated with the psychology department of a large
francophone university. They were seen by one of seven psychother-
apists (3 Ph.D. psychologists, 2 counseling psychologists with a mas-
ter's degree, and 2 counseling psychology interns). Respondents
ranged in age from 18 to 52 years with a mean of 33. Their mean
educational attainment was 16 years. All subjects were Caucasians;
of these, 34% were single, 12% were separated or divorced, and 54%
were married or cohabiting. The majority of clients were diagnosed
with dysthymic disorder, generalized anxiety disorder, adjustment
reactions with mixed emotional features, or mild to severe personality
disorders.
All clients were given a questionnaire packet that consisted of the
Client Satisfaction Questionnaire, the Symptom Checklist-10, and
the Balanced Inventory of Desirable Responding. To maximize var-
iance in psychological distress and consumer satisfaction scores, we
selected clients who were at different stages in the therapeutic process.
Treatment length varied among the clients, ranging from 6 to 200
weeks, with an average length of 46 weeks. We selected clients who
were in the initial (6 months or less, n = 27), middle (between 6 and
12 months, n = 26) or ending phase (between 12 and 50 months,
= 29) of the psychotherapeutic process. In all instances, confidential-
ity was stressed and subjects were ensured that their answers would
not be communicated to their therapists. Clients were requested to
return the questionnaire packet as soon as possible. A total of 82
clients (73%) returned the questionnaire packet. There were no
differences between returners and nonreturners on the following
variables: age, t(\ 10) = 1.12, p> .05; sex,X 2 (l, N = 82) = 1.24, p >
.05; education, t(l 10) = .88, p > .05; length of treatment, t(\ 10) =
.95, p > .05; and marital status, X2(2, N = 82) = .75, p > .05.
353
Measures
The Client Satisfaction Questionnaire (CSQ-8; Larsen, Attkisson,
Hargreaves, & Nguyen, 1979) is an eight-item questionnaire that
assesses consumer satisfaction with mental health treatment. The
CSQ-8 evaluates many dimensions of service delivery that are primary
targets of satisfaction ratings by clients: (a) physical surroundings; (b)
kind or type of service; (c) treatment staff; (d) quality of service; (e)
amount, length, or quantity of service; (f) outcome of service; (g)
general satisfaction; and (h) procedures. There are four response
choices for each question, scored 1 through 4. Scores range from 8 to
32, with higher scores reflecting higher satisfaction with treatment.
Highly satisfactory alpha values were reported for this brief ques-
tionnaire (alpha ranges from .85 to .93). Larsen et al. (1979) and a
number of other authors (de Brey, 1983; Nguyen, Attkisson, &
Stegner, 1983; Sabourin & Gendreau, 1988) have factor analyzed the
CSQ-8 and repeatedly found a unidimensional factor solution. The
CSQ-8 has very good concurrent validity. Client satisfaction scores
are moderately correlated with various, but not all, measures of
psychotherapeutic outcome: self-reports of global improvement,
changes in psychological symptomatology, and therapist's ratings of
clients' progress (Attkisson & Zwick, 1982; Larsen et al., 1979; Le-
Vois, Nguyen, & Attkisson, 1981; Sabourin, Perusse, & Gendreau, in
press; Wilier & Miller, 1978). In addition, the CSQ-8 relationship to
drop-out rates is fairly consistent (Attkisson & Zwick, 1982; Koko-
tovic & Tracey, 1987; Larsen et al., 1979; McNeill et al., 1987;
Sabourin et al., 1987).
The Symptom Checklist-10 (SCL-10; Nguyen et al., 1983) is a 10-
item scale measuring global psychological distress. It was derived
from the SCL-90 developed by Derogatis, Lipman, and Covi (1973),
Based on a factor analysis of the SCL-90 reported by Hoffman and
Overall (1978), Nguyen et al. selected 10 items that had the highest
loadings on the three most important factors. Because depression was
the most salient factor, six items from this factor were selected (e.g.,
How much were you distressed by feeling lonely? How much were
you distressed by feelings of worthlessness?). In addition, two items
were selected to represent somatization (How much were you dis-
tressed by feeling weak in part of your body? How much were you
distressed by heavy feelings in your arms or legs?) and phobic anxiety
(How much were you distressed by feeling afraid to go out of your
house alone? How much were you distressed by feeling afraid in open
spaces or in the streets?).
The SCL-10 has been administered to 3,628 clients of 76 collabo-
rating clinical facilities. Scores range from 0 to 40, with higher scores
reflecting high levels of psychological distress. Internal consistency is
reported to be .88 (Nguyen et al., 1983). Reliability data indicated
that, for the French-Canadian version, coefficient alpha was high
(.84). Temporal stability coefficients over a period of 4 months were
satisfactory (.59). A principal component analysis yielded a one-factor
solution. Thus, the scale can reliably be described as a client-rated
measure of dysphoria, demoralization, and global psychological dis-
tress. The SCL-10 was found to be highly correlated (.81) with the
Psychiatric Symptom Inventory (Ilfeld, 1976), a 29-item scale de-
signed to measure psychological distress in community samples (Sa-
bourin, Veronneau, & Gendreau, 1988). We decided to use a brief
psychological distress scale instead of the more established SCL-90
for four related reasons: (a) many studies have found that a very large
proportion of the total variance in the SCL-90 is accounted by the
first unrelated factor (see Cyr, McKenna-Foley, & Peacock, 1985, for
a review); (b) correlations between extracted factors ranged from .50
to .70, suggesting the presence of an underlying single dimension
(Brophy, Norvell, & Kiluk, 1988); (c) correlations of each factor with
the total score are also quite high, ranging, for example, from .74 to
.91 (Brophy et al., 1988); and (d) there is an absence of evidence for
the discriminatory validity of the SCL-90 (Cyr et al., 1985). These
 354 SABOURIN, LAFERRIERE, SICURO, COALLIER, COURNOYER, GENDREAU
findings suggest that to determine global psychological distress, a
shorter unidimensional scale should constitute an adequate substitute
for the longer SCL-90.
The Balanced Inventory of Desirable Responding (BIDR; Paulhus,
1984) is a 40-item questionnaire that uses a seven-point scale to assess
two factors defining social desirability: self-deception and impression
management. The self-deception subscale (SDQ) was originally de-
veloped by Sackeim and Gur (1978) to assess the denial of thoughts
about psychologically threatening but presumably universally true
statements (e.g., I have sometimes hated one or both of my parents,
I have sometimes felt like I wanted to kill someone, I have felt joy
over someone else's failure, I often have sexual fantasies). Only the
respondents can possibly confirm the truth or falsehood of the re-
sponse. Scores range from 20 to 140, with higher scores reflecting
high levels of self-deception. Paulhus (1984) refined the scale by
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
balancing the keying direction (the original keying was negative for
This document is copyrighted by the American Psychological Association or one of its allied publishers.
all items and thus self-deception scores were contaminated by an
acquiescence bias) and by replacing items with low part-whole cor-
relations. For the SDQ, internal consistency coefficients range from
.70 to .80. Temporal stability coefficients over a 4-week period are
satisfactory (.81). The construct validity of the SDQ has been sup-
ported in numerous studies (Gur & Sackeim, 1979; Linden et al.,
1986; Paulhus, 1982, 1984; Paulhus & Levitt, 1987; Roth & Ingram,
1985; Sackeim, 1983; Winters & Neale, 1985). Even after controlling
for psychopathology, the denial of psychologically threatening
thoughts is a good predictor of hindsight bias, benefactance, and
physical health. In addition, in the Gur and Sackeim (1979) study,
which was later replicated (Sackeim, 1983), high self-deception scorers
have been shown to deny their own voice when psychological meas-
ures indicated that they recognized it. This was especially true for
subjects who had just undergone a failure experience. Finally, in
factor analyses, the SDQ was located at the center of a group of
measures of defensive tendencies (Edwards Social Desirability scale,
Block's Ego Resiliency scale, and Byrne's Repression-Sensitization
scale; Paulhus, 1984, 1986).
The impression management subscale (ODQ; Sackeim & Gur,
1978) is a 20-item self-report instrument containing statements about
socially desirable but infrequent behaviors (e.g. I always tell the truth,
I have received too much change from a salesperson without telling
him [her], I always obey traffic laws even if I'm unlikely to get
caught). Scores range from 20 to 140, with higher scores reflecting
high levels of impression management. Paulhus (1984) refined the
scale by balancing the keying direction and replacing some items. For
the ODQ, alpha coefficients range from .72 to .75. The ODQ scores
are significantly correlated with measures of psychological distress
and physical health (Linden et al., 1986). In factor analyses, the ODQ
appears at the center of a cluster of measures of impression manage-
ment including the MMPI Lie scale, Wiggins Social Desirability scale,
and the Positive Malingering scale (Paulhus, 1984, 1986).
Results
Means, standard deviations, and correlations between self-
deception, impression management, psychological distress,
and client satisfaction are reported in Table 1. Inspection of
the correlation matrix reveals that self-deception shows a
significant relation with psychological distress. Self-deceptive
responding predicts attenuated reports of symptoms. How-
ever, impression management is significantly related to both
psychological distress and client satisfaction. Fisher's z' trans-
formations (Cohen & Cohen, 1975) were computed to com-
pare the rs among impression management, psychological
Table 1
Means, Standard Deviations, and Intercorrelations Among
the Variables
Variable 2 3 4 M SD
1. CSQ-8 -.04 .20* .08 28.2 3.1
2. SCL-10 -.44** -.52** 12.3 6.8
3. IM .39** 103.0 13.4
4. SD 94.5 13.4
Note. CSQ-8 = Client Satisfaction Questionnaire, SCL-10 = Symp-
tom Checklist-10, IM = Impression Management, and SD = Self-
Deception.
*p<.05. **;><.01.
distress, and client satisfaction. The difference in magnitude
of the coefficients reached statistical significant, z(82) = 2.45,
p = .01. Thus, in the present sample, self-reports of psycho-
logical distress are more contaminated by impression man-
agement scores than are consumer satisfaction reports. To
determine if restriction of range for the CSQ-8 scores led to
an underestimation of the relation between client satisfaction
and impression management, we applied Cohen and Cohen's
(1975) recommended correction for such cases (Equation
2.11.9, p. 67). First, we located the study for which the
standard deviation of CSQ-8 scores was the highest (Nguyen
et al., 1983; SD = 4.01). Afterwards, an estimate of the
correlation that would be obtained using this larger standard
deviation was computed. The computed estimate was .26.
The difference between the original coefficient (r = .20) and
the corrected estimate is not significant (p > .05).
To determine if the relations among client satisfaction,
psychological distress, and social desirability were moderated
by sex or treatment length, multiple regression analyses were
conducted. In the first equation, psychological distress scores
served as the criterion variable. The predictors were: impres-
sion management, self-deception, treatment length, sex, the
interaction of impression management and treatment length,
the interaction of self-deception and treatment length, the
interaction of impression management and sex, and the in-
teraction of self-deception and sex. The interaction terms did
not reached significance. In the second equation, client satis-
faction scores served as the criterion variable; we used the
same predictors as before. Again, the interaction terms were
nonsignificant. In summary, neither sex nor treatment length
proved to be moderators of the relation between client satis-
faction, psychological distress, and socially desirable respond-
ing.
Discussion
The present results clearly suggest that response styles re-
flecting impression management and self-deception influence
consumer satisfaction and psychological distress reports. The
associations among self-deception, impression management,
and psychological distress replicate the findings of previous
researchers (Cole, 1988; Linden etal., 1986;Tanaka-Matsumi
& Kameoka, 1986), namely, the more likely individuals are
to distort information about the self (self-deception) and to
 SOCIAL DESIRABILITY
adopt a strategic form of self-presentation (impression man-
agement), the less likely they are to report psychological
distress. The relation between impression management and
client satisfaction suggests that individuals who characteristi-
cally engage in other-deception would tend to affirm positive
therapeutic experiences. Thus, the client's tendencies to report
high satisfaction levels and to suspend critical judgment may
be conceptualized as a form of strategic self-presentation
designed to make a favorable impression on one's therapist.
Impression management accounts for more variance in self-
reports of psychological distress than in reports of consumer
satisfaction. This finding supports the construct validity of
client satisfaction measures. The fact that client satisfaction,
unlike psychological distress, was not related to self-deception
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
is also consistent with the previous assertion. However, this
This document is copyrighted by the American Psychological Association or one of its allied publishers.
interpretation remains tentative and awaits future replication.
It is possible that the difference in magnitude of explained
variance was due to a constricted range of client satisfaction
scores.
Future researchers may adopt a systematic sampling strat-
egy designed to include clients who are typically not satisfied
with mental health treatment (for example drop-out or re-
ferred cases). This strategy would increase variance in client
satisfaction scores and allow a stronger test of the hypothesis
that consumer satisfaction reports are less confounded by
social desirability than are self-reports of psychological dis-
tress. Likewise, to determine if the relation between psycho-
logical distress, consumer satisfaction, and socially desirable
responding should be given substantive rather than artifactual
interpretations (McCrae & Costa, 1983), self-reports of psy-
chological distress and reports of consumer satisfaction should
be compared to clinician's judgment of client's distress and
satisfaction. The resultant validity coefficients will allow us to
decide whether the consumer satisfaction and psychological
distress scores should be corrected for social desirability.
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Received August 19, 1988
Revision received November 28, 1988
Accepted November 29, 1988

Mineka Appointed Editor of Journal of 'Abnormal Psychology, 1990-1995

The Publications and Communications Board of the American Psychological Association
announces the appointment of Susan Mineka, Northwestern University, as editor of the
Journal of Abnormal Psychology for a 6-year term beginning in 1990. As of January 1, 1989,
manuscripts should be directed to
Susan Mineka
Northwestern University
Department of Psychology
102 Swift Hall
Evanston, Illinois 60208