certain clinicians believed that anal responses on the
Rorschach indicated homosexuality, and they were
extremely resistant to changing their preconcep-
tions even in the face of intensive training to the
contrary. Such research is a reminder that clinicians
must constantly be on guard against any tendency
to believe that certain diagnostic signs are inevitably
valid indicators of certain characteristics.
Another example comes from a survey of the
effects of clients’socioeconomic status on clinicians’
judgments (Sutton & Kessler, 1986). A sample of
242 respondents read case histories identical in all
respects except that the client was placed in differ-
ent socioeconomic classes. When the client was
described as an unemployed welfare recipient with
a seventh-grade education, clinicians predicted a
poorer prognosis and were less likely to recom-
mend insight therapy.
“Why I Do Not Attend Case Conferences”
In an engaging paper, Meehl (1977) lists a variety of
reasons he gave up attending case conferences. He
catalogs a number of fallacies that often surface at
such meetings. Most of them are entirely relevant
to the interpretive process generally. The following
synopsis of a few of Meehl’s examples provides
something of their general flavor:
■ Sick-sick fallacy: the tendency to perceive people
very unlike ourselves as being sick. There is a
tendency to interpret behavior very unlike our
own as maladjusted, and it is easier to see
pathology in such clients.
■ Me-too fallacy: denying the diagnostic signifi-
cance of an event in the patient’s life because it
has also happened to us. Some of us are nar-
cissistic or defensive enough to believe we are
paragons of mental health. Therefore, the more
our patients are like us, the less likely we are to
detect problems.
■ Uncle George’s pancakes fallacy:“There is nothing
wrong with that; my Uncle George did not
like to throw away leftover pancakes either.”
This is perhaps an extension of the previous
fallacy. Things that we do (and by extension,
things that those close to us do) could not be
maladjusted; therefore, those like us cannot be
maladjusted either.
■ Multiple Napoleons fallacy: There was only one
Napoleon, despite how strongly a psychotic
patient may feel that he or she is also
Napoleon. An objection to interpreting such a
patient’s belief as pathological is buttressed by
the remark,“Well, it may not be real to us, but
it’s real to him (or her)!”Further,“Everything
is real to the person doing the perceiving. In
fact, our percepts are our reality.”If this argu-
ment were invoked consistently, nothing could
possibly be pathological. Even the patient with
paranoid schizophrenia who believes aliens are
living in his nasal passages would be normal
because, after all, this is reality for him.
■ Understanding it makes it normal fallacy: the idea
that understanding a patient’s beliefs or beha-
viors strips them of their significance. This trap
is very easy for clinicians to fall into. Even the
most deviant and curious behavior can some-
how begin to seem acceptable once we con-
vince ourselves that we know the reasons for its
occurrence. This may not be unlike the rea-
soning of those who excuse the criminal’s
behavior because they understand the motives
and poor childhood experiences involved.Communication: The Clinical Report
To this point, we have discussed the process of clini-
cal judgment in assessment. The clinician has com-
pleted the interview, administered the tests, and read
the case history. The tests have been scored, and
hypotheses and impressions have been developed.
The time has come to write the report. This is the
communication phase of the assessment process.
Long ago, Appelbaum (1970) has characterized
the role of the assessor as sociologist, politician,300 CHAPTER 10