Unfortunately, the presentation of this example
has been one-sided. Little has been made of the clin-
ical student who believed that the Christmas tree
suggested an interest in forestry. Therefore, consider
two additional observations. First, there are individ-
ual differences in clinical sensitivity. Second, for
every instance of brilliant and sensitive clinical infer-
ence, there probably lurks in the unrecalled recesses
of memory an equally impressive misinterpretation.
Clinical interpretation, then, involves the sen-
sitive integration of many sources of data into a
coherent picture of the patient. It also fulfills a
hypothesis-generating function that is best served
by guidance from a well-articulated theory of per-
sonality. But it behooves responsible clinicians to
make every effort to articulate the cues involved
in their judgments and to explicate the manner in
which they make the leap from cues to conclusions.
It is not enough to be good clinicians. There is also
a responsibility to pass on these skills to others.
The Case for a Statistical Approach
A quantitative, statistical approach to clinical judg-
ment is particularly effective when the outcome or
event to be predicted is known and specific. Indeed,
in such cases, additional clinical data of an impres-
sionistic nature usually add little. This is especially
true when dealing with fairly large numbers of per-
sons and when the percentage of correct predictions
is more important than the correct prediction of the
performance of any one individual. Were the task
solely one of predicting the grades of an incoming
class of college freshmen, the clinician would be well
advised to use the objective data of high school
grades and ability test scores. Because good grades
in college can generally be predicted from ability
and its previous effective use, more ubiquitous and
subtle personality factors may add little.
Many of the failings in purely subjective, clinical
approaches result from the tendency to depend on
vague criteria. Too often, a clinician will make the
following judgment: The patient, based upon
MMPI-2 Scale 7 scores, will benefit from psycho-
therapy. This vague statement contains no explicit
referents. What constitutes benefit? Will the conclu-
sion that the patient has or has not benefited from
therapy be based on the patient’s own assertions or
on the therapist’s judgment? The loose conceptuali-
zation of the foregoing prediction precludes an
empirical test. But suppose that the clinician explicitly
defined the outcome as, say, remaining in rational-
emotive therapy for 12 months, coupled with a ther-
apy success rating of 7 or higher (on a 10- point scale)
by an outside observer? Then it might be possible to
develop a formula based on objective interview or
test criteria that would successfully predict to a
defined universe of therapists.
Clinical terms are often used loosely and with-
out explicit meaning. An objective, statistical
approach forces greater specification of meaning
that should eventually lead to more specific predic-
tions which could be represented in formulas. This
would attenuate much of the unreliability of judg-
ment inherent in more intuitive approaches.
Another reason for adopting the statistical
approach is that so many clinical descriptions
seem applicable to everyone. As noted in a previ-
ous chapter, personality descriptions should show
incremental utility; they must reveal something
beyond what everyone knew before the assess-
ment began. More precisely, clinicians must
develop descriptions of their patients that are
meaningful and will lead to explicit predictions.
Too often, however, clinicians make interpreta-
tions that seem valid but in actuality characterize
everybody. This is known as theBarnum effect—a
notion that goes back to a report distributed by
D. G. Paterson that was later cited by Meehl
(1956). Barnum statements appear to be self-
descriptive, but in reality, they describe almost
everyone and are not very discriminative. For
example, who would deny the personal relevance
of the following statements?
At times, I am unsure of my sexual maturity.
I am not always as confident as most people
think I am.
Often, I keep my real feelings to myself unless I
am around people I like.CLINICAL JUDGMENT 287