Perceived empathy and competence across psychotherapist appearance types: a quasi-experimental repeated-measures study.

INTRODUCTION: Physical appearance, including body weight and clothing, can affect perceptions of physicians' empathy and competence, thereby shaping the quality of the patient-physician relationship. Understanding these influences is essential for teaching about implicit bias in medical education. To examine how medical students' evaluations of psychotherapists' empathy and competence are influenced by external characteristics such as body weight and clothing style. METHODS: The survey is a quasi-experimental, video-based repeated-measures design. A total of 330 second-year medical students participated. Videos of patient-psychotherapist communication were shown portraying four different types of psychotherapists: the white coat, Freud, ecological, and overweight types. In a second video the same scenarios were shown but the psychotherapist wore normal everyday clothing. Students rated psychotherapists shown in standardized visual stimuli using validated questionnaires, including the Jefferson Scale of Patient's Perceptions of Physician Empathy, the Physician Compassion Questionnaire, and Osgood's Semantic Differential Scale. RESULTS: Of 355 eligible students, 330 participated (93.0%; mean age 23.0 years, SD = 3.35; 65.2% women). Therapist appearance systematically shaped students' evaluations of empathy, compassion, prejudice, and competence. The overweight (OSS) type received the most favorable ratings overall, including for taking the patient's perspective (M = 5.51, SD = 1.07), inquiring about everyday life (M = 5.88, SD = 1.21), and understanding (M = 5.51, SD = 1.14), whereas the Freud type was rated least favorably (e.g., understanding: M = 4.37, SD = 1.66). Significant type effects were observed for all empathy items (all p <.001). Students agreed that therapist appearance influenced their judgments, although differences between therapist types were not significant (p = .167). CONCLUSION: External characteristics significantly affected medical students' evaluations of psychotherapists' empathy and competence. These findings highlight the need to integrate reflection on physical appearance and bias into medical training to promote more objective and equitable patient care.