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Developing Clinical Judgment in the Neophyte Counselor

Michael Haderlie. Developing Clinical Judgment in the Neophyte Counselor. Defining clinical judgment. The judgments, inferences, and practices of clinicians A process of critical thinking in order to integrate data and make a decision Idiographic Unstructured Multidimensional Subjective.

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Developing Clinical Judgment in the Neophyte Counselor

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  1. Michael Haderlie Developing Clinical Judgment in the Neophyte Counselor

  2. Defining clinical judgment • The judgments, inferences, and practices of clinicians • A process of critical thinking in order to integrate data and make a decision • Idiographic • Unstructured • Multidimensional • Subjective

  3. Related terms • Decision making • Clinical prediction

  4. What types of judgments do counselors make?

  5. Process of clinical decision making • Define the problem/task • Collect data • Integrate the data • Make decision/judgment • Evaluate outcome of decision • Continue to re-evaluate as necessary

  6. Data sources?

  7. Controversies in judgment research • Clinical vs. actuarial (statistical) prediction • Which is more accurate? • The role of experience • Does clinical judgment improve with experience?

  8. Expert versus novice differences in decision-making • Time spent understanding problem • Knowledge base (size and structure) • Automatic processing and efficiency • Long- and short-term memory • Depth of patterns identified • Number of ideas generated • Self-monitoring

  9. Barriers to developing clinical judgment in counseling • Complexity of tasks • “ill-defined” problems • Lack of feedback about judgments • Cognitive biases

  10. Cognitive biases • Anchoring-and-adjustment heuristic • Information that comes first is focused on • Later information is ignored or downplayed • Confirmatory bias • Tendency to seek and overweigh evidence that is consistent with one’s beliefs • Confirmatory hypothesis testing

  11. Cognitive biases • Hindsight bias • Knowledge of an outcome leads us to believe that the outcome was easily predictable • Availability heuristic • Making judgments based on how easily information comes to mind • “Fad” diagnoses • Ignoring base rates

  12. Developing clinical judgment • Recognize limitations of clinical judgment • Increase knowledge base • Develop clear definition of the judgment to be made • Specific training relevant to the judgment task

  13. Developing clinical judgment • Incorporate reliable standardized data (combine statistical and clinical approaches) • Focus on decision-making process, rather than outcome • Identify rationale for decisions

  14. Developing clinical judgment • “Debiasing” strategies • be aware of cognitive biases • seek disconfirmatory evidence • Consider base rates • Seek immediate feedback regarding decisions

  15. Spengler et al. (1995) scientist-practitioner model

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