Emily Lake

Document Type


Date of Award


Degree Name

Doctor of Philosophy (PhD)


Counseling and Human Services

First Advisor

Adam Hardy


Abstract Research has discussed ethical dilemmas for professional counselors working with managed care. Professional counselors are faced with the implications of providing a diagnosis to clients to receive reimbursement by managed care and to assist clients in receiving care. The purpose of the study is to better understand the counselor’s role in intentional misdiagnosis due to billing requirements from insurance companies. Furthermore, the researcher is interested in the personal and professional characteristics of counselors predictive of the decision to engage in intentional misdiagnosis. Participants in this study were asked to complete the Marlowe-Crowne Social Desirability Scale and a researcher-created survey. Results were analyzed to conclude (a) the prevalence of licensed counselors intentionally misdiagnosing for billing purposes, (b) whether CACREP-accreditation status is associated with counselors intentionally misdiagnosing for billing purposes, (c) whether licensure status is associated with counselors intentionally misdiagnosing for billing purposes, and (d) whether years in the profession is predictive of counselors intentionally misdiagnosing for billing purposes. In order to answer these questions, the researcher evaluated the data using descriptive statistics, binary logistic regression, Fishers Exact Test, and Fisher-Freeman-Halton Exact Test. The researcher concluded one factor to be predictive of intentional misdiagnosis, licensure status. Licensure status showed predictive of intentional misdiagnosis. Implications for professional counselors and counselor education are discussed. Limitations within the study are identified and recommendations are made for future research.

Subject Categories

Mental and Social Health


Diagnosis, Managed Care, Professional Counselors

Number of Pages



University of South Dakota



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