The study of clinical judgment: an ecological approach

Reviews of the clinical judgment literature in psychology frequently conclude that therapists are subject to a number of biases that negatively influence the accuracy of their clinical judgments. As a consequence, therapists seem to be poor decision-makers, a finding that has serious implications for clinical training and practice. We argue that the concept of clinicians as poor decision makers requires considerable clarification. The clinical judgment literature is important, but it suffers from an inadequate framework for understanding different types of judgments and different contexts within which judgments are made. As an initial attempt to clarify some of the complexities inherent in the study of clinical judgment, we discuss a framework borrowed from cognitive psychology that is designed to provide a more comprehensive analysis of the clinical judgment ecology. The model includes: (a) characteristics of the therapist, (b) information processing strategies made available to the therapist, (c) criterial tasks that define the major focus of specific judgments, and (d) the nature of the clinical materials that provide the basis for judgments. These four factors interact to influence therapists' judgments. Implications of the model for research on clinical judgment as well as clinical practice and training are discussed.