First, do no harm: Institutional Betrayal in healthcare

University of Oregon
Eugene, Oregon
DOI: 10.18258/3179
Raised of $3,900 Goal
Funded on 10/20/14
Successfully Funded
  • $3,920
  • 100%
  • Funded
    on 10/20/14

About This Project

Sick or injured patients depend upon healthcare providers to heal what ails them. But what if the very act of seeking healthcare was harmful? Healthcare institutions are often trusted to abide by the Hippocratic oath to "First, do no harm." In most cases, compassionate care allays concerns and speeds recovery. I seek to understand how the violation of this trust - institutional betrayal - may impact health and health-related behavior.

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What is the context of this research?

For several years, under the supervision of Dr. Jennifer Freyd, I have been conducting research on institutional betrayal related to traumatic experiences using a measure we developed called the Institutional Betrayal Questionnaire (IBQ). I have found that institutional betrayal is common, harms both psychological and physical health, and predicts disengagement from institutions.

Much of this research has been done with college students describing their experiences within universities. If a similar process is occurring within healthcare institutions, we can uncover an explanation for questions that have consistently plagued healthcare:

  • Why do some patients fail to improve with care?
  • Why do some patients ignore medical advice?
  • Why do some patients never return?

What is the significance of this project?

It is well documented that the degree to which a patient trusts their healthcare provider predicts their willingness to engage in treatment as well as their health outcomes. Yet, these healthcare relationships take place within larger healthcare institutions (e.g., hospitals, insurance companies) on which we are dependent for access to care. The influence these institutions have on patients' trust, health behaviors, and health outcomes has been a largely neglected topic in medical research.

My research aims to understand the effects of institutional failure to prevent or respond effectively to unexpected or negative healthcare experiences - what we call institutional betrayal.

What are the goals of the project?

The immediate goal of this project is to
collect a large amount of data about experiences in healthcare, previous traumatic events, psychological and physical well-being. The actual study itself will be somewhat simple - people completing confidential surveys online. However, this is the first time institutional betrayal has been applied to understanding negative healthcare experiences and we suspect that this concept will make huge waves. The research we have conducted on institutional betrayal surrounding campus sexual assault has impacted how schools and media talk about the harm of letting this problem go unaddressed. We want to change the conversation about healthcare in a similar manner. Once we have collected the data, I will write it up for my doctoral dissertation. However, the immediate plan (following the business of defending said dissertation) is to publish the study in a peer reviewed journal as well as publicize the results in various op-eds and professional presentations. Your support helps us take the first step!


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The idea of studying institutional betrayal in healthcare is very novel and (I think!) very exciting. Yet, in order for large granting agencies like the National Institute of Health to fund research, they need some evidence that the research is worthwhile (I guess you can't fault a science-based foundation for that attitude). Funding for this first study of institutional betrayal in healthcare is critical to launching a larger program of research. Everything about this project is ready to launch: my dissertation committee and institutional review board have agreed it's a good study of sound design, my online survey is constructed, my Amazon Mechanical Turk account is set up -- but I need funds to compensate my participants.

All of the funding requested for this project will go directly to the costs of data collection. In order to access the widest range of adults who have accessed healthcare in the United States, participants will be recruited through's Mechanical Turk, an online community of individuals who complete internet-based tasks for pay. Collecting data this way also allows for quick results - most studies of this size can be completed in just a few weeks!

Meet the Team

Carly Smith
Carly Smith
Jennifer Freyd
Jennifer Freyd

Team Bio

I am a doctoral candidate (meaning just my dissertation is left!) in clinical psychology at the University of Oregon where I work under the supervision of Dr. Jennifer Freyd. I earned a master’s degree in experimental psychology from Wake Forest University. My doctoral research has extended the theoretical base of Dr. Freyd’s interpersonal trauma framework (Betrayal Trauma Theory) to encompass institutions and provided the first empirical investigations of the form, impact, and mechanisms of Institutional Betrayal using the Institutional Betrayal Questionnaire. My work has been published in The Journal of Traumatic Stress and American Psychologist. In addition to my research, I love teaching courses at the University of Oregon including the Psychology of Trauma, Research Methods, and Statistics. I also work as the editorial assistant for the Journal of Trauma & Dissociation and co-edited a special issue on Systemic Trauma. Next year, I am looking forward to completing my clinical internship in a healthcare system and getting to apply what I learn with this project!

Carly Smith

I know I'm supposed to be most excited about finishing my PhD so I can "finally start my career", but I am already doing what I love - research that can help change important institutions, teaching at a great university, and working with people who are struggling to overcome past trauma and current challenges. It's incredible to get to ask limitless questions and get rewarded (and even paid!) for it. I suppose I have to eventually stop being a student, but I will never stop learning.

Jennifer Freyd

Jennifer J. Freyd, PhD, is Professor of Psychology at the University of
Oregon. Freyd directs a laboratory investigating the impact of interpersonal and institutional trauma on mental and physical health, behavior, and society. She has published over 150 articles and she is author of the award-winning Harvard Press book Betrayal Trauma: The Logic of Forgetting Childhood Abuse. Her new co-authored book Blind to Betrayal was published in English by John Wiley & Sons in March 2013. It has been translated into Traditional Chinese and Portuguese. Additional translations of her Blind to Betrayal into Simple Chinese, Russian, and Korean are in process. Freyd has received numerous honors including the Award for Outstanding Contributions to Science in Trauma Psychology from the American Psychological Associations’s Trauma Division. She is a Fellow of the American Psychological Association, the American Psychological Society, and the American Association for the Advancement of Science. She currently serves as the Editor of the Journal of Trauma & Dissociation.

Additional Information

The dynamics lab website, featuring information about institutional betrayal research

A summary of my research conducted with Dr. Freyd


Project Backers

  • 31Backers
  • 100%Funded
  • $3,920Total Donations
  • $126.47Average Donation
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