Ways of Knowing and Limits of “Clinical Judgment”

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Many educators often use Socratic questioning methods to nudge students towards providing a rationale for their statements that goes beyond opinion or to clariy their position on an issue. In essence, Socratic questioning is a way of asking, in various wordings, “What is the evidence to support your position?”, or “What are your assumptions?”, or “What is a counter-argument?”. I have to say that this questioning can sometimes be annoying and frustrating for students. I have certainly had experiences in which I stated an opinion and was challenged by someone to back it up. While frustrating, in the world of counseling we do need to step beyond our assumptions and biases to provide a justification that taps into some deeper rationale or evidence. This is an essential element of a scholar-practitioner approach. With this in mind, consider some different ‘ways of knowing’. Essentially these are ways that humans come to know something or develop particular beliefs. There are different models of ways of knowing and I have pulled 5 major ones according to McBride (2013) and also from Cooper (2012). Here are some ways of knowing to consider:

  1. Authority – This is basically the idea that some things are accepted to be truth because a person of authority said it was so (Cooper, 2012). For instance, one could argue that many of Freud’s initial theories were accepted as truths because he was a person of authority.
  2. Intuition – Common sense or what we personally feel to be truth (McBride, 2013).
  3. Tradition (or tenacity) – A belief or idea that has been passed down as truth and is thus accepted because it has been believed to be true in the past (Cooper, 2012).
  4. Deduction (or rational analysis) – This utilizing logical reasoning to determine truths and cause-effect (McBride, 2013).
  5. Scientific Method – Observation, experimentation, efforts to reduce bias, replication (Cooper, 2012).

All of these approaches can potentially have merit. Socratic Questioning is a method to encourage folks, in critical dialogue, not only to consider the justification for their position but also what way of knowing their position is rooted in and whether or not there is conflicting evidence from other Ways of Knowing. One reason it is important that counselors, and critical consumers of information in society, consider Ways of Knowing is that humans are very susceptible to cognitive biases and these have implications for how we behave. While there are many types of cognitive biases, in very general terms cognitive biases may be considered to involve distortion of rational judgment or evaluation due to subjectivity (e.g., likes, dislikes, opinions, etc.). A specific example of how this can play out in the counseling realm is demonstrated in a study by Hannan et al. (2005). The researchers in this case asked counselors in an outpatient clinic to determine, using “clinical judgment”, which clients were at risk of dropping-out of counseling services and were likely to experience a negative outcome during a given time period. At the same time, actuarial data (i.e., a measure of client outcomes) was being collected on clients at the clinic. The results indicated that clinicians using “clinical judgment” accurately predicted 1 out of 40 clients that deteriorated and were at-risk of drop out. The actuarial data accurately predicted 36 out of the 40 clients that were at-risk of dropping out.

The above mentioned finding speaks to the tendency for counselors to gravitate towards self-assessment bias and this is not a stand-alone finding. Indeed, many other studies, including a study by Walfish, McAlister, O’Donnell, and Lambert (2012) have demonstrated that mental health professionals often overestimate their effectiveness and underestimate their treatment failures with clients. Thus, we must consider our “ways of knowing” in a broader sense of research, but also in a specific sense regarding our evaluations about our clients and their progress. Clinical judgment, while useful, is also often inaccurate when it comes to client outcomes so mental health professionals need alternate ways to check their “knowing”.

 

 

 

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