On the Merits of Clinical Judgment: Comment.

Comments on the article by D. Westen and J. Weinberger (see record 2004-19091-002), which criticized academic clinical psychologists for being cynical about clinical judgment and clinical practice. In our view, it seems unlikely that more than a few academic clinical psychologists believe that they have little to learn from clinical practice or experience. In this comment, we examine the arguments about clinical judgment made by Westen and Weinberger (2004). Westen and Weinberger (2004) conflate the effect of training with the effect of experience. Westen and Weinberger (2004) do not mention that the value of training in psychology has been well-supported by research. While Westen and Weinberger (2004) make positive comments about the types of feedback that clinicians receive, for a number of reasons, including the Barnum effect, psychologists can be misled by feedback. Westen and Weinberger (2004) also argue that "psychotherapists tend to have much more direct and immediate feedback than most other medical practitioners, who may prescribe a medication or perform a procedure and not see the patient again for a year" (p. 603). But when psychologists make a diagnosis or describe a personality trait, they frequently do not receive "direct and immediate feedback" on whether they are right or wrong. In contrast, physicians often receive highly valid feedback. Finally, in discussing the value of ratings made by clinicians, Westen and Weinberger (2004) observe that "empirically, we have found surprisingly little evidence of theory-driven observational bias in using clinician-report methods" (p. 601). The issue is important because Westen and Weinberger argue in favor of using clinician ratings to construct diagnostic criteria. If clinicians' ratings are biased, then the criteria will be biased. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical Judgment in Science: Reply.

Replies to comments published by M. S. Schulz and R. J. Waldinger (see record 2005-11115-010), J. M. Wood and M. T. Nezworski (see record 2005-11115-011), and H. N. Garb and W. M. Grove (see record 2005-11115-012) on the original article by D. Westen and J. Weinberger (see record 2004-19091-002). Schulz and Waldinger (2005) make the important point that just as researchers can capitalize on the knowledge of experienced clinical observers through aggregation, they can aggregate the judgment of lay observers in assessing phenomena such as emotion. The reason, as they articulate, is that skills such as "reading" emotion from facial expression, tone of voice, posture, and the constellation of cues provided in everyday life are an area of expertise for most people, one that is now often called social or emotional intelligence. As psychometricians have known for years, one can increase reliability in many different ways. The comments by Wood and Nezworski (2005) and Garb and Grove (2005) do not address our central thesis--namely, the importance of distinguishing two meanings of clinical. The point of the sentence around which Wood and Nezworski (2005) build their comment was simply that the same biases widely attributed to clinicians are common in scientists as well--a point for which we would be delighted to take credit, but it is one that was actually made much more elegantly by the historian and philosopher of science Thomas Kuhn (1962). The authors respond to Wood and Nezworski's (2005) specific concerns about misrepresentation. In their comment, Garb and Grove (2005) challenge us to document our view that anticlinician prejudice is widespread among many academic clinical psychologists. As research on implicit prejudice suggests, surveys of academic clinical psychologists might indicate little about their implicit attitudes, as evident in Garb and Grove's apparent lack of recognition of the offensive nature of comparing a clinician's attempt to revise his or her understanding when the patient says "I don't think what you just said is right" to astrology and Barnum effects. We appreciate Garb and Grove's (2005) point about potential differential effects of training and experience on reliability and validity of clinical judgment. The data they cite are important and bear consideration. We would offer two caveats, however. Finally, we cannot help but note that this series of comments and our reply to them provide a prototypical example of "clinical" judgment in science--that is, subjective, informal aggregation of data, often leading to a "gestalt" judgment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Value of Pooling "Naive" Expertise: Comment.

Comments on the article by D. Westen and J. Weinberger (see record 2004-19091-002), which explored the benefits and limitations of clinical observation and judgment. Westen and Weinberger identify two categories of informants--clinicians and participants--but these categories could be expanded to include other observers who might have particular expertise or experience related to the phenomenon of interest. The type of expert best suited to provide observations depends on the type of expertise required. There are some domains, however, in which those with the greatest expertise are neither specially trained observers nor self-reporters but, rather, lay observers who have a native or learned ability to detect complicated social or psychological phenomena and make subtle discriminations. This type of expertise is often thought of as intuitive because it uses implicit knowledge that is not always accessible to conscious awareness or capable of being fully articulated. One way to harness this intuitive expertise effectively is to pool the judgments of multiple lay observers. Our research has led us to believe that lay observers' intuitive judgments about emotions may in fact capture important information that is lost when coders depend on more commonly used manualized approaches such as the Specific Affect Coding System (SPAFF; Gottman, McCoy, Coan, & Collier, 1996) and the Facial Action Coding System (Ekman & Friesen, 1978). In our zealousness to reduce variability among coders and to make our methods more exportable to other investigators, researchers risk losing the intuitive expertise that people naturally develop in making judgments about the world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Statistical versus clinical prediction: Length of neuropsychiatric hospital stay.

Statistical and clinical prediction methods are compared in a "field" situation, predicting patient stay in a psychiatric hospital. 5 statistical methods from a previous report averaged 71.92% accuracy on the cross-validation sample. 12 clinicians predicting independently in the same hospital over the following 18-mo period achieved an average accuracy of 71.94% on 499 patient predictions. Summaries of the clinicians' reasons for their judgments show some differences between the most and least accurate judges. Neither professional background nor years of professional experience of clinicians was related to predictive accuracy. Actuarial and clinical prediction were not demonstrably different in accuracy. Practical and economic aspects of this prediction problem favor clinical prediction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and statistical prediction: A reformulation and some new data.

A discussion of the controversy aroused by P. E. Meehl's Clinical Versus Statistical Prediction, in which the writer analyzes the predictive process and suggests the remedies as he sees them. "We should try to find the optimal combination of actuarially controlled methods and sensitive critical judgment for any particular predictive enterprise… . We can do this only if clinically and statistically oriented workers… seek to learn from each other." 16 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward strengthening the contingency table as a statistical method.

The contingency method is examined in terms of such issues as small samples, indices of relationship, computational procedures, higher order interactions, and specification of hypotheses. Techniques presently described have improved the interpretation of contingency data, provided a means of quantifying qualitative data, and have contributed to the analysis of more complex problems such as pattern analysis. 45 refs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinical versus statistical prediction: A theoretical analysis and review of the evidence.

Reviews the book "Clinical versus statistical prediction: A theoretical analysis and review of the evidence" by Paul E. Meehl (see record 1996-97896-000). This book talks about a continuing debate among psychologists regarding the relative accuracy and efficiency of statistical (actuarial) predictions and those made by clinicians on the basis of subjective "understanding" of individual cases. This book represents the author's first published statement of his position. In the reviewers opinion, the author has succeeded admirably. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Missing data: A gentle introduction.

Reviews the book, Missing data: A gentle introduction by Patrick E. McKnight, Katherine M. McKnight, Souraya Sidani, and Aurelio Jose Figueredo (see record 2007-06639-000). The authors' goal is to provide a nonstatistical and nonmathematical introduction to the complex topic of missing data. To a large extent, the authors are successful at meeting this goal. As the title suggests, the book provides a gentle introduction to what is known about identifying and handling missing data. For applied researchers, this will be a valuable addition to their collection of statistical reference books. However, adding material about the application of specific missing data procedures using the major statistical packages (e.g., SAS, SPSS), would substantially improve the practical value of this book. Nonetheless, this text is highly recommended as a state-of-the-art introductory book on the topic of missing data. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Survey on the use of clinical and mechanical prediction methods in clinical psychology.

We surveyed 491 American Psychological Association division 12 (clinical psychology) members regarding their professional use of clinical and mechanical data combination (CC and MC) in making clinical predictions; 183 (37%) responded. This is the first report of CC and MC utilization frequency known to us. Nearly all respondents used CC in practice (98%), while fewer used MC (31%). Respondents gave reasons why they did not use MC, the most common being that it is conceptually misguided. In addition to computing odds ratios for variable comparisons, we constructed a multivariate regression model to predict use of MC, using a bootstrapping method that returns an estimate of the model’s cross-validated validity. This procedure returned the null model: no predictor was powerful enough to replicate upon cross-validation. The extent to which MC was discussed in graduate school significantly mediated nearly all other relationships between variables of interest. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The psychologist as an expert witness on the issue of insanity": Comment.

Comments on the original article by R. Jeffrey (see record 1965-06327-001) regarding expert testimony by psychologists in two separate court cases. The current author does not accept the cases presented by Jeffrey as typical of the acceptance that clinical psychologists get in court based on their testimony as expert witnesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Creativity as a decision": Comment.

Responds to the comments by T. B. Kashdan and F. D. Fincham (see record 2002-12932-014), J. C. Kaufman (see record 2002-12932-016 and J. Raven (see record 2002-12932-015) on the articles that discussed creativity in the April 2001 issue of American Psychologist. The current author does not disagree with any of the comments made. He states that although creative people differ in an astonishing number of ways, there is, in fact, one key attribute that they all possess, an attribute consistent with the original articles in American Psychologist's special section on creativity and consistent with these new commentaries as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

It's time to Rework the Blueprints: Building a Science for Clinical Psychology.

The aims in this article are to connect the conceptual structure of clinical psychological science to what the author believes to be the omnipresent principles of evolution, use the evolutionary model to create a deductively derived clinical theory and taxonomy, link the theory and taxonomy to comprehensive and integrated approaches to assessment, and outline a framework for an integrative synergistic model of psychotherapy. These foundations also provide a framework for a systematic approach to the subject realms of personology and psychopathology. Exploring nature's deep principles, the model revives the personologic concept christened by Henry Murray some 65 years ago; it also parallels the interface between human social functioning and evolutionary biology proposed by Edward Wilson in his concept of sociobiology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Additional Source of Manpower: Comment.

Comments on Donald G. Paterson's article "The Conservation of Human Talent" (see record 1958-04138-001.) The author of this comment feels Paterson's paper provides an excellent analysis of many neglected sources of manpower, but makes no mention of a major resource: the emotionally or mentally handicapped. The utilization of the emotionally ill or disabled in the world of work is suggested, and stereotypes and other barriers are discussed. The author of the comment concludes that the efforts of vocational psychologists are equally or more greatly needed to promote the acceptance and utilization of emotionally and mentally handicapped individuals than perhaps for any of the other "neglected sources of manpower" noted in Paterson's article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Reduced clustering during hypnotic amnesia for a long word list: Comment on Wilson and Kihlstrom": Rejoinder to Spanos, Bertrand, and Perlini.

In their comment on Kihlstrom and Wilson's (1986) failure to find disorganized clustering in posthypnotic amnesia, Spanos, Bertrand, and Perlini (1988) commit a number of factual errors, and misinterpret and misrepresent both our findings and their own. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-description as a predictor of rate of promotion of junior Foreign Service Officers.

An experiment to determine relationship between responses to an attitude, interests, and background questionnaire, and rate of promotion of Foreign Service Officers. Ss, who had completed an 89-item questionnaire May 1958, were divided first into an experimental group (N = 20) and a cross-validation group (N = 49), and then into high and low groups on the basis of promotions as of January 1961. Of the scales developed from previous studies, only the Social Isolation one proved to be useful. However, 2 new elements, Optimism and Self-Potency, proved to be effective measures for predicting the criterion. A correlation of .60 was found between the combined scores on these 3 elements and speed of promotion for the cross-validation group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Water-Jar Einstellung Test as a measure of rigidity: Erratum.

Reports an error in the original article by E. E. Levitt (Psychological Bulletin, 1955[Sep], Vol 53[5], 347-370). On page 368, right-hand column; the text: "1. After eight years of research, evidence for the validity of the water-jar test as a measure of validity is still lacking." should read: "1. After eight years of research, evidence for the validity of the water-jar test as a measure of rigidity is still lacking.". (The following abstract of this article originally appeared in record 1958-02905-001.) The primary purpose of the present paper is to examine the validity of the water-jar test as a rigidity measure by critically reviewing studies involving its use as such an index." Correlations between the water-jar test (WJT) and numerous criterion measures are generally statistically nonsignificant. On the basis of several studies it is tentatively concluded that a low negative correlation between the WJT and intelligence exists. The notion that rigidity increases under stress is not supported by the research evidence. The author concludes that evidence for the validity of the WJT is lacking and that the WJT, from a psychometric point of view, is poor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Return of the ego--Self-referent information as a filter for social prediction: Comment on Karniol (2003).

The protocentrism paradigm of social prediction (R. Karniol, 2003) challenges the egocentrism paradigm tacitly accepted by many researchers. The author reviews the 2 paradigms comparatively by focusing on 3 conceptual and 3 empirical issues. On conceptual grounds, the author suggests that the egocentrism paradigm has been proven useful because of (a) its greater breadth and parsimony, (b) the difficulties in documenting the origin of protocenters, and (c) the indeterminate nature of self-as-distinct tags (which are crucial to protocentrism). On empirical grounds, the author argues that in research on perceptions of self-other similarities, the egocentric process of social projection is well-established. Self-referent knowledge (a) is most readily accessible, (b) receives greater weight in prediction tasks than does other-referent knowledge, and (c) tends to be suppressed only temporarily, with effort, and incompletely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Insights, Hope, Kindness, and Confusion: Odyssey of a Psychoanalyst.

Insights from the author's previous systematic research and psychoanalytic observations are summarized. In a nationwide Gallup sample, segregation was found destructive to African Americans and Whites, although differently so. Clinical experience delineated the number 4 as a symbol, the helpfulness of psychoanalysis, and meanings of schizophrenic symptoms. Thematic Apperception Test (TAT) pathogenesis (unconsciously based hurtful parenting) differentiated both parents of schizophrenics and inadequate therapists. A controlled project demonstrated that 70 sessions of psychoanalytic therapy were more helpful than medication with respect to schizophrenic thought disorder, hospitalization, and living a more human life. Masked clinical judgments from Rorschachs, TATs, and interviews were found to be valid. Clinical papers described treating lower socioeconomic status patients, not eating, the 4 bases of delusions, and the necessity to be kind, tolerant, stubborn, and confused and to avoid abstractions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Importance of social connectedness as a moderator in Korean immigrants' subjective well-being.

Subjective well-being theories of goal approach and value-as-a-moderator were applied to examine the role of importance of social connectedness on the relationship between social connectedness and subjective well-being in a community sample of 204 Korean immigrants. It was hypothesized that social connectedness in ethnic and mainstream society is a stronger predictor of well-being to immigrants who highly value/desire it than to those who do not. The results from hierarchical multiple regression analyses provided partial support for the hypotheses. For immigrants who highly valued connectedness in the ethnic community, positive affect increased with greater connectedness in the ethnic community, whereas, for immigrants who did not value it, connectedness in the ethnic community was not associated with positive affect. Implications for theory, research, and practice were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)