Clinical Psychology

A

s scientific and objective as clinical psychology

is, it is still virtually impossible to evaluate its

diagnostic and assessment techniques apart from the

clinician involved. The very title of this chapter,

“Clinical Judgment,”is enough to suggest that clin-

icians sometimes use inferential processes that are

often far from objective. The process, accuracy,

and communication of clinical judgment are still

very often extremely personalized phenomena.

In this chapter, we examine some of the means

by which the clinician puts together assessment data

and arrives at particular conclusions. In addition, we

discuss the accuracy of clinical judgments and

impressions. Finally, we examine briefly the

method by which the results of assessment are typi-

cally communicated—the clinical report.

Process and Accuracy

Our discussion of clinical judgment begins with its
basic element—interpretation.

Interpretation

Interpretation is an inferential process that takes up
where assessment leaves off. The interviews have
been completed; the psychological tests have been
administered. Now, what does it all mean, and
what decisions are to be made?
At the very least,clinical interpretationor judg-
ment is a complex process. It involves stimuli—an
MMPI-2 profile, an IQ score, a gesture, a sound. It
also involves the clinician’s response.“Is this patient
psychotic?”“Is the patient’s behavior expressive of a
low expectancy for success?”Or even“What is the
patient like?”It also involves the characteristics of
clinicians such as their cognitive structures and the-
oretical orientations. Finally, situational variables
enter into the process. These can include every-
thing from the type and range of patients to the
constraints that the demands of the setting place
on predictions. For example, a clinician in a

university mental health center may make a range

of recommendations—from hospitalization to psy-

chotherapy to just taking time away from school—

whereas a clinician in a prison setting may be

limited to many fewer options.

The Theoretical Framework. As mentioned

throughout this book, clinical psychologists strive

to discover the etiology, or origins, of psychological

problems and to understand patients so that they

can be helped. Clinical problems can be conceptu-

alized in a variety of ways (e.g., behavioral, cogni-

tive, psychodynamic). The kinds of interpretations

made by a Freudian are vastly different from those

made by a behavioral clinician. Two clinicians

may each observe that a child persistently attempts

to sleep in his mother’s bed. For the Freudian,

this becomes a sign of an unresolved Oedipus

complex. For the behaviorist, the interpretation

may be in terms of reinforcement. Indeed, one

way in which clinicians can evaluate interpretations

is by examining their consistency with the theory

from which they are derived. The number of inter-

pretations that can be made from a set of observa-

tions, interview responses, or test data is both

awesome and bewildering. By adopting a particular

theoretical perspective, clinicians can evaluate inter-

pretations and inferences according to their theoret-

ical consistency and can also generate additional

hypotheses.

Theory and Interpretation

Currently, clinicians may be assigned to three very

broad interpretive classes. First, there are the behav-

ioral clinicians. As we have seen, the strict behav-

iorist avoids making inferences about underlying

states and instead concentrates on the behavior of

the patient. The behavioral clinician typically seeks

patient data based on personal observation or on

direct reports from the patient or other observers.

These data are regarded as samples.

A second group of clinicians prides themselves

on being empirical and objective. In particular,

these clinicians are likely to use objective tests to

predict to relatively specific criteria. For example,

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