Academic journal article American Journal of Psychotherapy

Making Sense of Client Data: Clinical Experience and Confirmationism Revisited

Academic journal article American Journal of Psychotherapy

Making Sense of Client Data: Clinical Experience and Confirmationism Revisited

Article excerpt

The purpose of this study was to examine if the order in which case file material is presented to clinicians and length of clinical experience affect clinical judgment. Using think-aloud procedures, 36 clinicians (trainees and veterans) diagnosed the case files of a middle-aged hospital outpatient. In one version, a neutral but vivid datum was placed near the start; in the second version it was placed toward the end. Protocols generated were coded on the dependent variables, confirmation and disconfirmation of earlier inferences, and dispositional and situational inferences. MANOVA results indicate that there is an interactive order-by-experience effect on proportion of confirmatory inferences articulated by participants. Other analyses indicate that order of information presentation but not level of practitioner experience is related to the variance in the proportion of contextual and dispositional inferences articulated by participants. Implications for praxis and for training programs are examined.

MAKING SENSE OF CLIENT DATA: CLINICAL EXPERIENCE AND CONFIRMATIONISM REVISITED

The primacy effect in information processing, as evidenced in the "configurai" model for person perception developed by Asch (1946, 1997; Fiske & Taylor, 1991), has important implications for information processing in counseling and psychotherapy. This model states that an initial, global impression of another's personality exerts pressure on later, relevant information to take on meaning consistent with the initial impression. In this perspective, the point at which critical client information is revealed in a clinical session can seriously affect the formulation of diagnoses and the processing of information on which diagnoses are based. An alternative "algebraic" model, which essentially denies the proactive impact of prior judgments on later meaning-making, contrasts markedly with the configurai model, and it has received some support (cf., e.g., Fishbein & Ajzen, 1975; Anderson, 1996) in the literature. Evidence, however, has accumulated in the clinical literature that information divulged early in the therapeutic process influences the shaping of a diagnosis more than will equally significant, and perhaps contradictory, information that comes to light later (e.g., Friedlander & Phillips, 1984; Nisbett & Ross, 1980; Richards & Wierzbicki, 1990; Tversky & Kahneman, 1974). One aspect of this dynamic, popularly known as the anchoring effect, unfolds through the interplay of a number of strategies and causal devices (see, e.g., Nisbett & Ross, 1980, pp. 41-42, for a succinct explication of this phenomenon). The anchoring effect is a continuous variable and is moderated by factors such as data availability and vividness (e.g., Friedlander & Stockman, 1983; Spengler, 2000) as well as the cognitive complexity of the clinician (Martin, 2001; Spengler & Strohmer, 1994). The character of this process, its psychological properties, and the tangential dynamics it releases have not yet been fully examined. This effect has called for consideration of a confirmationist bias in clinical information processing (e.g., Garb, 1998; Pope & Vasquez, 2005; Snyder & Thomsen, 1988; Strohmer, Shivy, & Chiodo, 1990; Strohmer, Boas, & Abadie, 1996), a bias that has been shown to be a robust component of the dynamics of clinical judgment (Ganzach, 2000; Pope & Vasquez, 2005; Strohmer & Shivy, 1994). The bias has consequences for (a) the inhibition of inferences that disconfirm previous hypotheses bearing on clients' problems or dysfunctions and (b) the generation of inferences or clinical hypotheses that are consistent with initial assessment propositions.

Social psychological research concerning bias among lay and professional evaluators provides support for the view that evaluators preferentially seek out confirmatory information when testing a hypothesis (e.g., Mahoney, 1976; McKenzie, 2004; Pfeiffer, Whelan, & Martin, 2000; Snyder & Swann, 1978; Snyder & Thomsen, 1988). …

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