Chapter 10

Clinical Judgment
 Process and Accuracy

• Clinical Interpretation
– Influence of theoretical framework
• This framework influences interpretation
• Can also help to generate new hypotheses
– Samples, Signs, and Correlates
• Sample of general behavior
• Sign of underlying state or condition
• Behavioral, attitudinal, or emotional correlate
 Process and Accuracy

• Clinical Interpretation
– Levels of Interpretation
• Level I---involves little inference; dataprediction
• Level II---involves inference about person in general
(descriptive generalization; hypothetical construct)
• Level III---involves inference about individual in a
particular situation
 Process and Accuracy

• Theory and Interpretation

– Behavioral clinicians
• Levels I and II
– Psychometrically-oriented clinicians
• Levels I and II
– Psychodynamic clinicians
• Level III
Interpretation of Data
 Quantitative vs. Subjective Approach

• Quantitative/Statistical Approach
– Obtain scores for one or more relevant
characteristics; use these to predict outcome
– “Mechanical” prediction
– Must keep careful records of test data,
observations, etc. so that
interpretations/judgments can be quantified
 Quantitative vs. Subjective Approach

• Subjective/Clinical Approach
– More subjective and intuitive
– Integrate data from multiple sources
– Summary of behaviors
 Quantitative vs. Subjective Approach

• The case for the Quantitative/Statistical

Approach
– More specificity
– Predictions are “mechanical”
– Large group application
– Avoid Barnum effect
 Quantitative vs. Subjective Approach

• Why don’t clinicians use the quantitative

approach?
– Predictors seem short-term and not profound
– Clinicians remember their successful predictions
and forget their errors
– Ethical arguments
 Quantitative vs. Subjective Approach

• The case for the Subjective/Clinical Approach

– Formulas are not available for all prediction
situations
– Judgment can add to prediction in some situations
where statistical approach does not allow for
flexibility
– Clinician as data gatherer
 Clinical and Quantitative Approaches

• Many comparison studies

• Goldberg (1965)
– Clinicians made judgments solely on MMPI scores
– Statistical predictions made with a variety
algorithms using MMPI scores
– The results of these two approaches compared to
actual diagnoses from patients’ records
– Statistical predictions were comparable to or
outperformed clinicians’ predictions
Results of Goldberg (1965)
 Comparing Clinical
and Quantitative Approaches

• Grove et al. (2000):

– Quantitative superior 50% of studies
– Clinical only 6%
• Quantitative less expensive
• Limitations of clinical
– Applications
– Definitions
 Comparing Clinical
and Quantitative Approaches

• Objections to findings
– Studies had limitations
– Not “true” experts
– Not real clinical prediction tasks
• Human “need” for predictability---don’t want
to hear that we are not particularly good at
this
 Comparing Clinical
and Quantitative Approaches

• Bias in clinical judgment?

– Little support for belief that lower socioeconomic-
class patients judged to be more seriously
disturbed; women judged to be more
dysfunctional
– Strong support for bias that Blacks and Hispanics
misdiagnosed with schizophrenia; even with same
symptoms, men more likely diagnosed as
antisocial, women as histrionic; black patient
more likely to be prescribed antipsychotic meds.
 Comparing Clinical
and Quantitative Approaches

• Experience and training

– No strong support for increased clinical
experience resulting in increased accuracy in
prediction
– One profession not better than another
– “Myth” of experience
 Comparing Clinical
and Quantitative Approaches

• Clinical approach is valuable when

– No adequate tests available
– Rare or unusual events are to be predicted
– No statistical equations have been developed
– Circumstances may negate accuracy of equation
 Comparing Clinical
and Quantitative Approaches

• Statistical approach is valuable when

– Outcome to be predicted is objective and specific
– Interest in individual case is minimal
– There is reason to be concerned about human
judgment error or bias
 Improving Judgment and Interpretation

• Information processing: although there are

many bits of information available, we must
guard against over-simplifying and “cherry-
picking”
• Reading-in syndrome: don’t over-pathologize;
note strengths too
• Validation and records: record your
interpretations and predictions to track later
 Improving Judgment and Interpretation

• Vague reports, concepts, criteria: be specific

as possible
• Effects of predictions: knowledge of prediction
may influence actions and perceptions of
others
• Prediction to unknown situations: risky
without knowledge of situational influence on
behavior
 Improving Judgment and Interpretation

• Fallacious prediction principles: failure to

consider base rates, regression to the mean,
etc.
• Influence of stereotyped beliefs: belief despite
empirical evidence to the contrary
 The Clinical Report

• Referral source: address the referral question!

• Aids to communication
– Language
– Individualize reports
– Level of detail
• Cite items and observations
Sample Psychological Report
Sample Psychological Report (cont’d)
Sample Psychological Report (cont’d)