CLINICAL JUDGMENT AND DECISION MAKING*

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Key Words personality assessment, psychological assessment, psychodiagnosis, behavioral prediction, statistical prediction

Abstract When clinical psychologists make judgments, are they likely to be correct or incorrect? The following topics are reviewed: (a) methodological advances in evaluating the validity of descriptions of personality and psychopathology, (b) recent findings on the cognitive processes of clinicians, and (c) the validity of judgments and utility of decisions made by mental health professionals. Results from research on clinical judgment and decision making and their relationship to conflicts within the field of clinical psychology are discussed.

CLINICAL JUDGMENT AND DECISION MAKING

Upon receiving the Bruno Klopfer Distinguished Contribution Award from the Society for Personality Assessment, Caldwell (2004) gave an example of his success interpreting the Minnesota Multiphasic Personality Inventory (Hathaway & McKinley 1943):

We got a severe 4-6-8 profile on a young woman. I looked at the tortured implications of the pattern and somehow said, "She will have something like cigarette burn scars on her hands, where her father prepared her to steel herself to the suffering of life." The round burn marks were on her hands and extended a little way up her arms (Caldwell 2004, p. 9).

This is a remarkable interpretation. However, it is anecdotal in nature. Caldwell did not present scientific data to support his style of test interpretation. Instead, he selectively related his experiences.

Clinical psychologists are likely to have one of two reactions to the claims made by Caldwell, depending on whether they are influenced by romantic or empiricist ideas (Wood et al. 2003, pp. 92-94). Romantics are likely to be greatly impressed and inspired by Caldwell's accomplishments. Those from the empiricist tradition are likely to have a more skeptical attitude. Empiricists insist that grand claims be scientifically tested. Their point of view is exemplified by a new journal, The Scientific Review of Mental Health Practice, which is devoted to the objective investigation of controversial and unorthodox claims in clinical psychology, psychiatry, and social work. The distinction between romantics and empiricists seems especially apt, given the title of Caldwell's address: "My Love Affair with an Instrument."

In this article, research on clinical judgment and its relationship to the romantic and empiricist traditions in clinical psychology is examined. First, the following topics are covered: (a).