Clinical judgment, clinical training, and professional experience.

Reviews studies on training, experience, and clinical judgment. The results on the validity of judgments generally fail to support the value of on-the-job experience in mental health fields. The validity results do provide limited support for the value of training. Other results suggest that experienced clinicians are better than less experienced judges at knowing which of their judgments are likely to be correct and which are likely to be wrong. Reasons why clinicians have trouble learning from experience are given. Recommendations are made for improving training and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

HIV, confidentiality, and duty to protect: A decision-making model.

Mental health professionals are confronted with complex issues surrounding confidentiality and duty to protect when treating clients with HIV. These professionals need to consider various factors when applying Tarasoff principles to protect potential victims, including the foreseeability of harm, the identifiability of the victim, and appropriate protective action. Professional ethical guidelines and legal mandates also need to be considered. The purpose of this article is to discuss the ethical and legal dilemmas faced by clinicians and to introduce a decision-making model that takes into account individual state laws. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinicians, microcomputers, and confidentiality.

[Correction Notice: An erratum for this article was reported in Vol 19(4) of Professional Psychology: Research and Practice (see record 2008-10700-001). In this article, the address given on p. 286 for correspondence to the author is incorrect. The erratum includes the correct address.] Despite the microcomputer's ever-increasing popularity, one of its greatest strengths, the ability to store enormous quantities of text and data on small, concentrated types of magnetic media, could turn out to be an important structural weakness in the wall of client confidentiality that psychologists have so carefully constructed over the years. In this article I examine the possibilities for such breaches of confidentiality when psychologists use microcomputers in their practice or research. Examples illustrate the ease and rapidity with which the microcomputer's magnetic media can be duplicated, damaged, or destroyed. Recommendations are made for guidelines and techniques to ensure and maintain the confidentiality of clinical and research information when one is using a microcomputer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research on human judgment and its application to clinical practice.

Discusses what the author considers to be unsatisfactory performance levels typical on clinical judgment tasks. Two underlying causes are identified: (1) problematic judgment habits such as underuse of base rates, assessment of covariation, and confirmatory strategies; and (2) human cognitive limitations such as the capacity to use additional information and performance on multiple-cue tasks. It is suggested that problematic habits and judgment limitations may be of central relevance to longstanding puzzles and difficulties within psychology, which include low diagnostic reliability and validity, the comparative success of psychometric instruments and diagnostic strategies, problems in uncovering specific treatment effects, and the minimal gains accrued through experience. The application of judgment findings to diagnosis, treatment, and the interpretation of feedback is considered. Corrective measures that are likely to improve judgment accuracy are discussed, particularly testing for diagnostic signs, use of disconfirmatory strategies, and recognition of predictive uncertainty. (79 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Privacy, ethics, and confidentiality.

Discusses privacy and confidentiality with respect to primary providers of psychological services, focusing on the client–practitioner relationship, and does not attempt to resolve questions about data bases and the like. Confidential information should not be disclosed, except if required by law; but changes in laws should be sought where needed. Casual breaches in privacy should be avoided, and psychologists should generally not answer questions on the telephone. They should have a will calling for destruction of records or their being given to a responsible colleague for disposition, in case of death. All matters regarding confidentiality should be made clear to the client at the start of therapy. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impediments to accurate clinical judgment and possible ways to minimize their impact.

Recent research in cognitive psychology has begun to uncover some of the factors that make clinical judgment a difficult task. Five impediments to accurate judgment are discussed: inability to assess covariation, influence of preconceived notions, lack of awareness of one's judgmental processes, overconfidence, and the hindsight bias. To minimize the impact of these impediments, 3 strategies are suggested: active consideration of alternative outcomes, increased attention to certain types of usually ignored data, and minimization of the role of memory. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In defense of clinical judgment, credentialed clinicians, and reflective practice.

Although clinical psychology is rightly characterized by its commitment to science, the author argues that clinical practice cannot rely entirely or primarily on scientific evidence and empirically supported treatments. Too many of the problems that clinicians encounter will invariably fall outside the purview of scientific evidence. Whether grounded in questions of value or the particularities of human experience, clinicians inevitably deal with uncertainty and cannot avoid clinical judgment. An overly narrow and hyperskeptical approach to clinical practice would impoverish clinical training and would both disenfranchise and impose excessive restrictions on conscientious clinicians. A more inclusive definition of evidence-based practice is necessary, one that values scientific and clinical evidence and reasoning equally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypothesis formation and testing in clinical judgment.

Examined the influence of a counselor characteristic (cognitive complexity), a general client observation (disability status), and a specific client observation (positive, negative, or inconsistent personality test results) on the quality of clinical hypotheses counselors develop about clients' problems and the number of questions they generate to test these hypotheses. 35 graduate students in counselor training completed a measure of cognitive complexity (the Paragraph Completion Method) before being presented with the case folders of 6 hypothetical clients. Ss were asked to read the material and form hypotheses concerning why the clients sought counseling. The case folders had varied client observations. Results show no effect of any of the independent variables on hypothesis quality; however, there was a significant interaction between specific and general client observations on the number of questions developed to test clinical hypotheses. Results suggest that both specific and general observations are important factors in clinical judgment. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role conflict in forensic clinical psychology: Reply to Arcaya.

I agree with Arcaya that there is potential for serious role conflict in conducting forensic evaluations, but I disagree with how this problem is characterized and explained. Arcaya's contentions are reformulated as research hypotheses that can be empirically tested. The American Psychological Association's Ethical Principles of Psychologists are relevant and are cited in support of several proposals for safeguarding defendant rights and reducing the potential for role conflict in forensic evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonlinear models of clinical judgment: Meehl's data revisited.

Previous attempts to detect nonlinearity in clinical judgments have not succeeded because of a lack of good nonlinear models. Much research in this area was based on data collected by P. Meehl, which include clinicians' judgments of mental disorder on the basis of MMPI profiles. In this article, Meehl's data are reanalyzed using several versions of the scatter model in which nonlinearity is represented by the within profile scatter(s) of the cues. The author finds that these versions give a better fit to the data than does the linear model. He also finds systematic patterns of nonlinearity that lend themselves to psychological interpretation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The politics of clinical judgment: Early empirical returns.

Reviews research pertinent to charges that clinicians' judgments are biased against minority and counternormative persons. Evaluative prejudice is found to be a more circumscribed phenomenon than critics of the mental health establishment have forecast. Clinical analogues in which patient race, sex, and value attributions were systematically varied have generally yielded null or marginally supportive results. Social-class designation has been more consistently found to affect psychological appraisals, but even here the drawing of a bias inference is precluded by the rival interpretation of effective environmental-cue utilization by clinicians. Evidence that practitioner political values or experience moderate patient labeling effects has likewise proved unconvincing. Methodological strategies are suggested for strengthening empirical tests of political bias formulations per se by reducing the logical compellingness of the expectancy-cue utilization explanation for any patient attribution effects obtained. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical considerations in treatment of personality dysfunction: Using evidence, principles, and clinical judgment.

Clinical work with clients suffering from personality disorders can be among the most challenging for psychologists. These clients may have a wide range of clinical presentations, and many practitioners may lack the specialized training needed to provide successful treatment to these clients. Clinicians are faced with several challenges in making treatment decisions that are ethically informed and based on available research findings. Because of the relative dearth of evidence-based treatments for these clients, clinicians are encouraged to use a cost–benefit analysis approach when weighing the benefits versus disadvantages of specific interventions and treatment approaches. Recommendations for effective and ethical treatment of clients with personality dysfunction are provided that are based on an empirically grounded framework. Three expert commentators provide insights into the state-of-the-art of clinical work with these clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An informational analysis of clinical judgment.

Information theory was used as a theoretical model and methodological tool for the study of certain aspects of the clinical judgment process. By means of such a model, the capacity of a group of clinicians to process case information was studied. 3 types of input conditions were systematically varied with 3 types of judgments. It was found that the number of discriminations made by each group was close to the maximum of 3.00 bits, although the number of reliable discriminations was more limited, ranging from .88 to 1.49 bits. An increase in reliable discriminations as a consequence of adding more case information was rather slight. The 3 judgment systems were found to be highly interrelated, suggesting a common underlying response dimension. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing anchoring errors in clinical judgment.

When anchoring occurs, estimates of client pathology and prognosis are differentially related to the time judges are exposed to salient, pathognomonic case material. In the present study with 73 undergraduates, a debiasing condition was contrasted with a no-debiasing condition. In the debiasing condition, Ss were warned of possible anchoring errors and how to avoid them. M. L. Friedlander and S. J. Stockman (see record 1983-31114-001) found a robust anchoring bias among experienced clinicians. Results indicate that debiasing was irrelevant because neither the replication sample nor the debiased sample demonstrated significant anchoring errors in their judgments. Post hoc tests showed that (a) Ss' mean judgments did not differ significantly from those of the clinicians in Friedlander and Stockman but that (b) Ss reported significantly less confidence in their performance than the professionals. The implication that relatively more experienced, confident judges may be more susceptible to anchoring errors is discussed with respect to consistency and information-processing explanations for anchoring bias. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social class bias in clinical judgment.

Reexamined the findings of S. D. Lee (1968 doctoral dissertation) on the tendency of psychiatric residents to ascribe more severe psychopathology to lower-class patients. 15 clinical psychologists and 32 undergraduates were asked to rate a series of paragraphs which described stimulus persons who were either (a) lower or middle class, as indicated by their occupations; (b) normal, neurotic, or psychotic, as indicated by behavioral statements; and (c) neutral or depressed in emotional state. Results show a significant effect of social class on judgments of likelihood of need for professional help for an emotional problem, but in the opposite direction from Lee's findings. Middle-class persons in the present study were generally rated more likely to need help. The social class effect was expecially marked when the ratings were done by laymen, when the stimulus person was normal in behavior, or when he was neutral in mood. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The paramorphic representation of clinical judgment.

"This paper has been concerned with the manner in which information is utilized in decision making or in judgment situations. It is shown that mathematical models provide a way of describing mental processes which would otherwise be accessible only through introspection or electro-physiological techniques. A linear model and a configurational model are described, and illustrations furnished for each. Such models make possible the testing of hypotheses concerning method of combination, individual differences in judgment ability, effects of training, personality correlates, idiographic interpretation of case materials, etc." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"When laws and values conflict: A dilemma for psychologists": Reply.

That a majority of 100 senior psychologists surveyed by K. S. Pope and T. Bajt (1988) failed to obey reporting laws is not surprising given that these laws were not framed by psychologists, require predictions of violence, and subordinate professional responsibility and clinical judgment to a policing function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Research on human judgment and its application to clinical practice": Response to Garb.

In response to the comment by H. N. Garb (see record 1988-18224-001) on the article by the present author (see record 1987-05373-001) concerning research on human judgment and its application, the present author refutes Garb's criticisms and maintains that many core aspects of the original argument remain untouched. (PsycINFO Database Record (c) 2010 APA, all rights reserved)