have psychotic mood disorders are more likely to be
misdiagnosed with schizophrenia than are similar
White patients. (b) Even when presenting the same
constellation of symptoms, men are more likely to be
diagnosed as antisocial and women are more likely to
be diagnosed as histrionic. (c) Middle-class patients
are more likely to be referred for psychotherapy than
lower-class patients. (d) Black patients are more likely
to be prescribed antipsychotic medications than
members of other racial groups, even when the
Black patients are not more psychotic.
Garb (1997) made the following recommenda-
tions to help clinicians overcome these and other
biases: (a) Be aware of and sensitive to the biases
that have been documented in the literature.
(b) Attend to the diagnostic criteria in diagnostic
manuals. (c) Whenever possible, use statistical predic-
tion rules instead of clinical judgment or prediction.
Experience and Training. Faust (1986) has noted:
To whom do these studies of low judgment
performance apply? The answer is not that
they apply to hacks or novices alone. There
is limited evidence—in fact, almost none—
that experts or those with exhaustive
experience perform significantly better than
“regulars”or“relative beginners.”(p. 420)
To date, almost all major studies examining this
issue do not support the position that increased clin-
ical experience results in increased accuracy in pre-
diction (Dawes, 1994; Garb, 1989, 1998; Grove et
al., 2000). This seems to fly in the face of conven-
tional wisdom. Why do we not see evidence for the
effect of clinical experience in clinical psychology
and other mental health fields? There are several pos-
sibilities (Dawes, 1994). First, the accuracy of predic-
tions is limited by the available measures and
methods that are used as aids in the prediction pro-
cess. If scores from psychological tests, for example,
are not strongly correlated with the criterion of
interest (i.e., they are not highly valid), then it is
unlikely one could ever observe an effect for clinical
experience. The accuracy of predictions will remain
modest at best and will not depend on how“clini-
cally experienced”the clinician is. Second, we often
cannot define precisely what we are trying to predict
(e.g.,“abusive personality”), and no gold standards
for our criteria exist to enable us to assess objectively
the accuracy of our predictions. As a result, true
feedback is impossible, and diagnosticians are not
able to profit from experience. Third, we tend to
remember our accurate predictions and to forget
our inaccurate ones. Therefore, more experience in
the prediction process does not necessarily lead to
increased accuracy because the feedback that is
incorporated is incomplete.
A recent, large-scale meta-analysis of clinical
judgment studies, however, suggested that clinical
experience mayslightlyimprove clinical judgment.
Spengler et al. (2009) analyzed results from 75 studies
of clinical judgment published between 1970 and- To be included, all studies focused on clinical
judgment, clinical judgment bias, or clinical versus
statistical prediction. Further, studies focused on
mental health issues, and judges were graduate-
level trainees or mental health professionals. Clinical
experience was defined by a range of variables across
these studies, including: number of clients seen,
length of treatment, number of psychological tests
administered, number of graduate courses taken,
years in training, level of training, and amount of
clinical supervision received, for example. As for
the nature of the clinical judgment in these studies,
most focused on the clients’problems, symptoms, or
diagnosis. Other clinical judgments included severity
of the problem, treatment needed, or prognosis.
Across all studies, there is a slight, but significant,
association between level of experience and accuracy
of clinical judgment (weighted mean effect size = .12).
This small effect means that practically, greater clini-
cal experience or training improved judgment accu-
racy by 13%. This is a relatively small improvement
in accuracy, overall. Also interesting is that a number
of factors influenced whether or not clinical experi-
ence significantly improved accuracy.
■ More experienced mental health professionals
were more accurate in diagnosis and in for-
mulating treatment recommendations consis-
tent with empirical guidelines than were those
less experienced.294 CHAPTER 10