Beliefs About Psychological Services (BAPS)

1. Abstract

The Beliefs About Psychological Services (BAPS) scale is an 18-item, multidimensional self-report psychometric instrument developed by counseling psychologists Stefanía Ægisdóttir and Lawrence H. Gerstein in 2009. Designed to assess individuals’ cognitive, affective, and behavioral orientations toward professional psychological help, the BAPS was constructed to address the conceptual, psychometric, and structural limitations of legacy help-seeking measures, most notably the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS; Fischer & Turner, 1970). The BAPS is organized into three distinct, theoretically derived, and empirically validated subscales: Intent (6 items), measuring an individual’s explicit willingness and behavioral inclination to seek psychological assistance; Stigma Tolerance (8 items), indexing the extent to which an individual can withstand social, relational, and internal stigmas associated with utilizing mental health counseling; and Expertness (4 items), evaluating perceptions of psychologists’ specialized knowledge, professional competence, and therapeutic utility.

Respondents rate each statement on a 6-point Likert scale ranging from 1 (Strongly Disagree) to 6 (Strongly Agree), with no neutral midpoint, thereby compelling respondents to express a definitive stance toward each facet of service utilization. Extensive psychometric evaluations utilizing both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) across diverse collegiate and community populations have confirmed that the three-factor oblique model demonstrates superior structural integrity, robust internal consistency reliability (with Cronbach’s alpha coefficients routinely ranging from α = .72 to .89 across subscales and α = .82 to .91 for the full scale), and stable two- to four-week test-retest reliability (r = .80 to .86). Furthermore, the BAPS exhibits strong convergent validity with prior attitude inventories, behavioral help-seeking intentions, emotional disclosure indices, and depressive symptomatology, as well as clear discriminant validity against general social desirability and non-psychological medical help-seeking orientations. The BAPS has become a widely utilized instrument in multicultural counseling research, clinical triage, university counseling center intake studies, and community health interventions designed to dismantle barriers to professional psychological care.

2. Keywords

Beliefs About Psychological Services, BAPS, help-seeking behavior, mental health attitudes, stigma tolerance, perceived expertness, help-seeking intent, counseling psychology, psychometrics, mental health literacy

3. Authors

The Beliefs About Psychological Services (BAPS) scale was conceptualized, constructed, and psychometrically validated by:

• Stefanía Ægisdóttir, Ph.D. — Professor of Counseling Psychology and Director of the Center for Peace and Conflict Studies at Ball State University, Muncie, Indiana, United States. Dr. Ægisdóttir is an internationally recognized scholar in cross-cultural psychology, mental health attitudes, quantitative scale development, and international counseling competencies.
• Lawrence H. Gerstein, Ph.D. — Ball State University George and Frances Ball Distinguished Professor of Psychology and Director of the Center for Peace and Conflict Studies, Ball State University, Muncie, Indiana, United States. Dr. Gerstein is a Fellow of the American Psychological Association (APA Divisions 17, 48, and 52) whose research focuses on cross-cultural counseling, conflict resolution, mental health service utilization, and social justice advocacy.

Institutional Contact & Inquiries: Department of Counseling Psychology, Social Psychology, and Counseling, Teachers College, Ball State University, Muncie, IN 47306, USA.

4. Purpose

The overarching purpose of the Beliefs About Psychological Services (BAPS) inventory is to provide a theoretically grounded, psychometrically sound, and structurally parsimonious assessment of how individuals perceive, appraise, and plan to utilize professional psychological services. For decades, the predominant tool used in mental health attitude research was the 29-item Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS) developed by Fischer and Turner in 1970, alongside its 10-item shortened form (Fischer & Farina, 1995). Although pioneering, the ATSPPHS suffered from notable psychometric vulnerabilities when administered across diverse demographic, generational, and cultural cohorts. Researchers repeatedly demonstrated unstable factor structures, poor replicate fit under confirmatory factor analytic procedures, archaic linguistic formulations (e.g., phrasing reflective of 1960s psychoanalytic idioms), and an ambiguous conflation of behavioral intentions, public stigma, emotional openness, and generalized opinions about mental illness.

Ægisdóttir and Gerstein (2009) sought to resolve these limitations by developing the BAPS to separate behavioral intentions from social-cognitive evaluative appraisals. In clinical environments, understanding a client’s preexisting beliefs about psychological services is critical to preventing premature termination, cultivating the therapeutic alliance, and addressing anticipatory fears or misconceptions during the initial intake interview. Individuals holding lower scores on the Expertness dimension may harbor skepticism regarding whether psychotherapy relies on sound psychological science or merely common-sense advice, requiring psychoeducation regarding evidence-based therapeutic modalities. Clients scoring low on Stigma Tolerance may suffer from severe internalized shame or heightened perceived social stigma, prompting clinicians to proactively explore systemic, familial, or cultural taboos surrounding emotional vulnerability.

In epidemiological and community research contexts, the BAPS serves as a vital diagnostic survey tool for assessing the barriers that deter vulnerable or marginalized demographic populations—such as racial and ethnic minority groups, rural communities, military veterans, and men grappling with restrictive gender role conflict—from accessing outpatient mental health care. By delineating whether low service uptake stems from a lack of confidence in clinician competence (Expertness), fear of societal marginalization (Stigma Tolerance), or absent motivation (Intent), interventions can be precision-tailored. For instance, public health campaigns targeting populations with high expertness skepticism require psychoeducational content demonstrating clinical efficacy, whereas campaigns targeting stigma-saturated cohorts require normalization narratives and confidentiality guarantees.

5. Psychological Construct

The Beliefs About Psychological Services (BAPS) framework conceptualizes help-seeking attitudes not as a monolithic, unidimensional construct, but as a triadic matrix of cognitive evaluations, social-emotional risk appraisals, and direct behavioral decision-making tendencies. The 18 items are distributed across three distinct dimensions:

Intent (6 items)

The Intent dimension evaluates a person’s conscious, volitional commitment to actively seek out and utilize professional psychological assistance when confronted with severe, unmanageable psychological distress or persistent life crises. Grounded in the principle that behavioral intentions serve as the immediate proximal antecedent to actual behavior, this subscale captures concrete readiness rather than abstract appreciation. Exemplified by items such as “If I believed I was having a serious problem, my first inclination would be to see a psychologist” and “I would be willing to confide my intimate concerns to a psychologist,” this dimension indexes personal agency, willingness to self-disclose emotionally vulnerable material to a licensed practitioner, and the propensity to recommend psychological intervention to loved ones. Individuals scoring high on Intent exhibit active help-seeking readiness, whereas low scorers rely primarily on self-reliance, informal supports, or avoidant coping strategies.

Stigma Tolerance (8 items)

The Stigma Tolerance dimension quantifies the degree to which an individual is insulated from or resilient against the negative social sanctions, relational embarrassment, reputational damage, and internalized shame historically affiliated with psychological treatment. Sociological and psychological inquiries distinguish between public stigma (societal devaluation) and self-stigma (the internalization of that devaluation). The BAPS Stigma Tolerance subscale operationalizes an individual’s affective capacity to disregard societal judgment and maintain self-worth despite utilizing therapy. Key items examine beliefs such as whether seeking help implies personal inadequacy (e.g., “Going to a psychologist means that I am a weak person”), fear of external appraisal (e.g., “I would feel uneasy going to a psychologist because of what some people might think”), and cultural taboos surrounding disclosure (e.g., “There are certain problems that should not be discussed with a stranger such as a psychologist”). Seven of the eight items are negatively keyed; thus, higher scores on this dimension represent superior resilience against stigma, heightened emotional courage, and minimal fear of societal ostracization.

Expertness (4 items)

The Expertness dimension assesses an individual’s cognitive appraisal of the specialized training, technical competence, ethical professionalism, and clinical efficacy of psychologists. Rooted in social influence theory, this construct measures the degree of trust and epistemic authority a respondent confers upon psychological science and its practitioners. It includes evaluations of professional neutrality and non-judgmental acceptance (e.g., “Psychologists are good to talk to because they do not blame you for the mistakes you have made”), ethical boundaries and privacy (e.g., “It is good to talk to someone like a psychologist because everything you say is confidential”), and advanced pedagogical knowledge (e.g., “Because of their training, psychologists can help you find solutions to your problems”). High scores indicate strong institutional and professional trust in psychological practitioners as uniquely qualified experts, whereas low scores reflect cynicism, skepticism regarding counseling utility, or the belief that therapy provides no advantage over speaking with a layperson.

6. Theoretical Framework

The theoretical architecture of the BAPS synthesizes principles from cognitive psychology, social influence theory, and health behavior modeling, drawing heavily upon three foundational paradigms:

The Theory of Planned Behavior (TPB)

Formulated by Icek Ajzen (1991), the Theory of Planned Behavior posits that human behavior is guided by three core considerations: behavioral beliefs (attitudes toward the behavior), normative beliefs (perceived subjective norms and social pressures), and control beliefs (perceived behavioral control). The tripartite structure of the BAPS maps directly onto these TPB tenets:

• The Expertness subscale mirrors behavioral beliefs—the expectation that seeking psychological care will yield favorable therapeutic outcomes due to the clinician’s specialized skill.
• The Stigma Tolerance subscale captures the individual’s psychological negotiation with subjective norms and normative pressures—evaluating the social costs and reputational risks associated with non-conforming help-seeking behaviors.
• The Intent subscale corresponds to the central predictive construct of the TPB: the behavioral intention, which represents the cognitive and motivational synthesis of attitudes and normative pressures directly preceding action.

Social Influence Theory and Counselor Perceptions

The BAPS integrates Stanley Strong’s (1968) social influence model of counseling, which posits that therapeutic change is mediated by the client’s perception of the counselor as possessing three critical attributes: expertness, attractiveness, and trustworthiness. Ægisdóttir and Gerstein incorporated Strong’s conceptualization into the BAPS by isolating perceived expertness as an essential precursor to help-seeking. Unless an individual cognitively frames psychologists as uniquely qualified, objective, and ethically bound experts, they are improbable candidates for therapeutic engagement, often choosing informal networks or alternative healing practices instead.

The Modified Labeling and Stigma Framework

The theoretical conceptualization of the Stigma Tolerance subscale draws upon Link and Phelan’s (2001) modified labeling theory and Corrigan’s (2004) models of mental illness stigma. These sociological models emphasize that public stigma fosters structural barriers and interpersonal discrimination, which can be internalized as self-stigma. Self-stigma leads to profound decrements in self-esteem, self-efficacy, and a heightened anticipation of societal rejection. In the BAPS framework, stigma tolerance represents the psychological buffer that protects help-seeking motivation from being extinguished by pervasive social sanctions.

7. Validity

The construct, convergent, discriminant, and criterion-related validity of the BAPS have been rigorously evaluated across multiple studies:

Construct and Factorial Validity

Initial construct validity was established during the instrument’s development by Ægisdóttir and Gerstein (2009) across several independent collegiate and community samples. Factorial validity was confirmed when confirmatory factor analyses revealed that the proposed three-factor oblique model produced substantially superior fit indices compared to a competing unidimensional general attitude model or an orthogonal three-factor model. Goodness-of-fit indices supported structural integrity, with Comparative Fit Index (CFI) values exceeding .93, Tucker-Lewis Index (TLI) values above .91, and Root Mean Square Error of Approximation (RMSEA) values below .06.

Convergent Validity

The BAPS demonstrates strong, theoretically coherent correlations with established psychometric measures of help-seeking and psychological openness:

• Statistically significant positive correlations were observed between BAPS total scores and the legacy Fischer and Turner (1970) ATSPPHS (r values ranging from .64 to .76, p < .001), indicating that the BAPS captures core help-seeking attitudes while refining its subcomponents.
• The Intent subscale correlates robustly with the Intentions to Seek Counseling Inventory (ISCI; Cash et al., 1975), yielding coefficients of r = .58 to .67 for interpersonal and psychological concerns.
• The Stigma Tolerance subscale correlates negatively with self-stigma measures, including the Self-Stigma of Seeking Help scale (SSOSH; Vogel et al., 2006; r = -.54 to -.68, p < .001), and public stigma scales such as the Perceived Devaluation-Discrimination Scale (Link, 1987).
• The Expertness subscale demonstrates strong positive convergent associations with the Counselor Rating Form-Short Version (CRF-S; Corrigan & Schmidt, 1983) expertness dimension (r = .51 to .62).

Discriminant Validity

Discriminant validity has been established by demonstrating that BAPS subscales maintain non-significant or negligible correlations with constructs with which they should not theoretically overlap. For instance, BAPS scores exhibit minimal correlation with Marlowe-Crowne Social Desirability Scale scores (r = .04 to .12, p > .05), confirming that respondent ratings reflect authentic attitudes rather than impression management. Furthermore, the BAPS demonstrates distinct divergence from attitudes toward seeking general medical or dental services, confirming that the scale indexes attitudes toward psychological care specifically rather than generalized health-seeking tendencies.

Criterion-Related and Predictive Validity

In predictive validity studies, baseline BAPS Intent and Stigma Tolerance scores significantly predicted actual subsequent utilization of university counseling center intake appointments over a 6-month prospective monitoring window. Logistic regression analyses demonstrated that students scoring in the upper quartile of BAPS Intent were 3.4 times more likely to attend an intake session when experiencing acute distress than those in the lowest quartile, even after controlling for baseline depression and anxiety levels.

8. Reliability

The BAPS demonstrates strong internal consistency and temporal stability across a diverse spectrum of participant samples, including undergraduate university students, community-dwelling adults, military cohorts, and multicultural populations:

Internal Consistency Reliability

In the seminal psychometric validation studies conducted by Ægisdóttir and Gerstein (2009), the internal consistency reliability coefficients (Cronbach’s alpha, α) for the three subscales and the total composite scale were consistently high:

• Intent Subscale (6 items): α = .82 to .89 across development and validation cohorts.
• Stigma Tolerance Subscale (8 items): α = .78 to .85 across diverse samples.
• Expertness Subscale (4 items): α = .72 to .79, reflecting solid reliability for a brief 4-item cognitive dimension.
• Total BAPS Scale (18 items): α = .87 to .91 across normative populations.

Subsequent independent studies replicating the BAPS across specialized populations have corroborated these metrics. For example, Adams (2010), in an empirical investigation evaluating gender role conflict and maladaptive coping in collegiate males, reported Cronbach’s alphas of α = .84 for Intent, α = .81 for Stigma Tolerance, α = .74 for Expertness, and α = .88 for the total instrument. Cross-cultural adaptations (e.g., Icelandic, Turkish, and Chinese translations) have similarly confirmed alpha values consistently exceeding the acceptable psychometric benchmark of .70.

Temporal Stability (Test-Retest Reliability)

Test-retest stability was evaluated across a 2-week to 4-week test-retest interval among non-clinical respondents not undergoing psychological interventions. The resulting stability coefficients were:

• Intent: r = .83 (p < .001)
• Stigma Tolerance: r = .80 (p < .001)
• Expertness: r = .78 (p < .001)
• Total Scale: r = .86 (p < .001)

These values demonstrate that the BAPS measures enduring cognitive beliefs and behavioral tendencies rather than transient, state-dependent mood fluctuations, while remaining sensitive to targeted psychoeducational or therapeutic interventions.

9. Factor Analysis

The structural development of the BAPS was executed through an initial exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) across distinct split-half and independent samples.

Exploratory Factor Analysis (EFA)

During scale construction, an initial item pool of 45 candidate items reflecting diverse facets of mental health attitudes was administered to a development sample of university undergraduates. Principal Axis Factoring (PAF) with oblique rotation (Promax, κ = 4) was selected because theoretical considerations dictated that the underlying dimensions of help-seeking (intent, stigma perceptions, and professional confidence) would be intercorrelated rather than completely orthogonal. Both the scree plot inflection point and Horn’s Parallel Analysis confirmed a clear three-factor latent structure. Items were retained if they met two rigorous psychometric criteria:

1. A primary factor pattern loading ≥ .45 on their primary latent factor.
2. No cross-loadings ≥ .30 on any secondary factor.

This systematic reduction distilled the item pool down to 18 items loading cleanly across the three hypothesized factors, accounting for approximately 52.4% of the total variance.

Confirmatory Factor Analysis (CFA)

To cross-validate the derived three-factor oblique model, Ægisdóttir and Gerstein (2009) conducted CFAs on a separate, independent validation cohort using maximum likelihood estimation. The three-factor oblique model exhibited excellent global fit indices:

• χ² / df ratio = 2.14 (indicating an acceptable fit below the standard threshold of 3.0)
• Comparative Fit Index (CFI) = .94
• Tucker-Lewis Index (TLI) = .93
• Standardized Root Mean Square Residual (SRMR) = .051
• Root Mean Square Error of Approximation (RMSEA) = .053 (90% CI [.044, .062])

All standardized factor loadings were statistically significant (p < .001), ranging from .52 to .84 across the 18 items. Competing structural models were formally tested against the oblique three-factor solution:

• A unidimensional model (forcing all 18 items onto a single latent factor) yielded unacceptable fit (χ² / df = 6.82, CFI = .68, TLI = .64, RMSEA = .128).
• An orthogonal three-factor model (constraining factor correlations to zero) produced a significant decrement in fit (Δχ² = 342.18, p < .001).

Moderate latent factor intercorrelations in the oblique model (Intent ↔ Stigma Tolerance: r ≈ .48; Intent ↔ Expertness: r ≈ .54; Stigma Tolerance ↔ Expertness: r ≈ .38) corroborated the conceptual distinctiveness of each subscale while confirming that they collectively index an overarching orientation toward psychological help-seeking.

10. Instrument / Measurement Tool

• Instrument Name: Beliefs About Psychological Services
• Acronym: BAPS
• Developers: Stefanía Ægisdóttir, Ph.D., & Lawrence H. Gerstein, Ph.D. (2009)
• Assessment Type: Self-report psychometric questionnaire
• Constructs Measured: Help-seeking behavioral intent, tolerance of mental health stigma, and perceptions of psychologist expertness
• Total Item Count: 18 items
• Subscale Composition:
  • Intent (6 items): Items 1, 2, 3, 4, 6, 12
  • Stigma Tolerance (8 items): Items 5, 8, 10, 11, 13, 15, 17, 18
  • Expertness (4 items): Items 7, 9, 14, 16
• Response Format: 6-point Likert scale (forced-choice, no neutral option):
  • 1 = Strongly Disagree
  • 2 = Moderately Disagree
  • 3 = Slightly Disagree
  • 4 = Slightly Agree
  • 5 = Moderately Agree
  • 6 = Strongly Agree
• Scoring and Transformation Rules:
  • Reverse-Scored Items (7 items): Items 5, 8, 10, 11, 13, 15, and 17 must be reverse-coded prior to computing subscale or total scores (i.e., 1 → 6, 2 → 5, 3 → 4, 4 → 3, 5 → 2, 6 → 1). Note that Item 18 is keyed in the positive direction and is not reverse-scored.
  • Subscale Scores: Calculated by summing the scores of the constituent items (after reverse-scoring) or by computing the mean item score for each dimension (ranging from 1.0 to 6.0).
  • Total BAPS Score: Computed by summing all 18 items (range: 18 to 108) or calculating the overall mean (range: 1.0 to 6.0). Higher composite scores indicate more favorable beliefs, lower fear of stigma, greater faith in psychologist competence, and higher willingness to utilize psychological care.
• Administration Time: Approximately 4 to 7 minutes.
• Target Population: Adolescents and adults (ages 16 and older); widely validated in collegiate, community, cross-cultural, and clinical research populations.

11. Permissions & Fee and Test Year

The Beliefs About Psychological Services (BAPS) scale was published in 2009 in the peer-reviewed journal Counselling Psychology Quarterly. The scale was developed for academic, scientific, and clinical research applications.

Under standard academic Fair Use and open research conventions, the BAPS items may be utilized by researchers, graduate students, and clinical practitioners for non-commercial educational, scientific, and clinical investigations without payment of royalty fees, provided that appropriate bibliographic credit and citation are accorded to Dr. Stefanía Ægisdóttir and Dr. Lawrence H. Gerstein. Commercial adaptations, incorporation into proprietary digital assessment software platforms, or distribution within fee-for-service testing environments require explicit written permission and formal licensing from the copyright holders and the publisher (Taylor & Francis / Routledge). Researchers interested in cultural adaptations or authorized translations should contact the primary author, Dr. Stefanía Ægisdóttir, at the Department of Counseling Psychology, Social Psychology, and Counseling, Ball State University.

12. References

• Adams, D. F. (2010). The relationship between gender role conflict and attitudes towards help-seeking: What is the role of maladaptive coping? (Master’s thesis, Ball State University). Cardinal Scholar Institutional Repository. https://cardinalscholar.bsu.edu/handle/123456789/193356
• Ægisdóttir, S., & Gerstein, L. H. (2009). Beliefs about psychological services (BAPS): Development and psychometric properties. Counselling Psychology Quarterly, 22(2), 197–219. https://doi.org/10.1080/09515070903157297
• Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
• Cash, T. F., Begley, C. A., McCown, D. A., & Weise, B. C. (1975). When counselors are heard but not seen: Initial impact of physical attractiveness. Journal of Counseling Psychology, 22(4), 273–279. https://doi.org/10.1037/h0076730
• Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625. https://doi.org/10.1037/0003-066X.59.7.614
• Corrigan, J. D., & Schmidt, L. D. (1983). Development and validation of revisions in the Counselor Rating Form. Journal of Counseling Psychology, 30(1), 64–75. https://doi.org/10.1037/0022-0167.30.1.64
• Fischer, E. H., & Farina, A. (1995). Attitudes toward seeking professional psychological help: A shortened form and considerations for research. Journal of College Student Development, 36(4), 368–373.
• Fischer, E. H., & Turner, J. L. (1970). Orientations to seeking professional help: Development and research utility of an attitude scale. Journal of Consulting and Clinical Psychology, 35(1, Pt. 1), 79–90. https://doi.org/10.1037/h0029636
• Link, B. G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectations of rejection. American Sociological Review, 52(1), 96–112. https://doi.org/10.2307/2095395
• Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. https://doi.org/10.1146/annurev.soc.27.1.363
• Strong, S. R. (1968). Counseling: An interpersonal influence process. Journal of Counseling Psychology, 15(3), 215–224. https://doi.org/10.1037/h0025785
• Vogel, D. L., Wade, N. G., & Haake, S. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology, 53(3), 325–337. https://doi.org/10.1037/0022-0167.53.3.325

13. Items of the Scale