CLINICAL JUDGEMENT IN CONTEXT: A REVIEW OF SITUATIONAL FACTORS IN PERSON PERCEPTION DURING CLINICAL INTERVIEWS

/ ChitdPsyctioL Psychiat. Vol. 26, No. 3, pp. 369-380, 1985. 0021-9630/85 $3.00 + 0.00Printed in Great Britain. Pergamon Press Ltd.

© 1985 Association for Child Psychology and Psychiatry.

CLINICAL JUDGEMENT IN CONTEXT: A REVIEW OFSITUATIONAL FACTORS IN PERSON PERCEPTION

DURING CLINICAL INTERVIEWS

T O N Y C LINE

Schools Psychological Service, Inner London Education Authority

Abstract—The literature on the clinical interview and clinical judgement has generally tended toignore relevant research in social psychology. It is argued that the basic psychological processesinvolved in clinical judgement can be compared with those involved in everyday social judgement.This review summarises evidence on the sophistication and complexity of clinical judgement andon the likely impact on it of a number of factors: the judge's personality, the stimulus background,institutional norms, objectives in the interview, and the interaction process as influenced by situationalfactors. It is suggested that a model of clinical judgement is required that can encompass, interpretand find value in the artifacts of the clinician's situation.

Keywords: Interview, clinical judgement, person perception

INTRODUCTION

WITH some notable exceptions the literature on the clinical interview and clinicaljudgement has tended to ignore relevant research in social psychology. Specificomissions are coverage of work on person perception (Livesley & Bromley, 1973)and on the impact of situational variables on judgement and behaviour. There havebeen earlier reviews which drew on this work incidentally (Adinolfi, 1971; Bieri,Atkins, Briar, Leeman, Miller & Tripodi, 1966) and theoretical texts and experi-mental reports addressing specific issues (Davis, 1971; Eiser & Stroebe, 1972), butno general review of the impact of the clinical situation on clinical judgement.Writers on clinical applications of social psychology have tended to focus on factorsaffecting the client directly rather than those influencing the clinician's judgement(Brehm, 1976; Hoch, 1971; Sheras & Worchel, 1979). In this context clinicaljudgement is defined simply as the impression formed by a member of one of thehelping professions of the clients he meets with an overtly consultative purposerelated to a problem of social or personal well-being.

An assumption is made that the basic psychologiczil processes involved in clinicadjudgement are at least ancdogous, and probably identical, to those involved in every-day social judgement (cf. Bieri et al., 1966). The training that a member of the helpingprofessions receives builds on what Heider termed a *naive psychology' that maybe assumed to have lasting influence on him as a way of thinking about how otherpeople behave and how one can make sense of what they do and say (Heider,

Accepted manuscript received 30 April 1984

Requests for reprints to: Tony Cline, 105 Constantine Road, London NW3 2LR.

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Kendall, 1973; Sandifer, Hordern & Green, 1970); the process of describing andrepeatedly analysing a recalled episode has been shown in studies of eye witnessesof crimes to lead in itself to subtle kinds of distortion (Clifford & Bull, 1978).

6. CONCLUSION

Bringing together the evidence on how clinical judgement may be affected bycontext seems to lend support to particular trends in current practice: increasing useof systematic induction to the clinical interview (Jacobs, Charles, Jacobs, Weinstein& Mann, 1972; Roter, 1979); prolongation of assessment over an extended period;increased use of structured observation in natural settings; reappraisal ofthe impactof residential assessment (D.H.S.S., 1981); above all, an increasing healthy scepticismabout professional pretences to omniscience.

It is noticeable that little of the research reviewed here has involved workers otherthan the clinicians themselves in the direct investigation of processes of clinicaljudgement in a field setting. More such work is needed to clarify the application tothis challengingly sophisticated subject group of the relatively simple constructsemployed so far in the study of person perception. Clinicians must be in a positionto take full account ofthe impact of their setting on their own perceptual processes.This might lead to specific developments in practice: carrying out a systematic reviewofthe context of an interview before and after it has taken place; considering thepossible impact of each feature of the context on the impression formed of theclient; and making specific reference to such contextual factors in reporting on theclient.

An adequate reflexive model of clinical judgement is thus required that willencompass, interpret and find value in the artifacts ofthe clinician's situation. Itmay compare with Farr's model of investigation in social psychology or Mair's"conversational model for psychological inquiry" (Farr, 1978; Mair, 1970). Theeffects of context and interviewer behaviour on clients' self-presentation will notbe relegated to the status of peripheral factors—sources of technical unreliability oradditional insight about clients. Such processes will have a more central place in themodel of how a judgement is formed. The impact of context on the interviewer'sown expectations and reactions will also be viewed as a central factor in the inter-pretation that is made of clients' behaviour. The process of forming a judgementwill be subjected to a searching analysis so that the final assessment of clients'behaviour is based on a full awareness that contextual factors in the interviewer'sresponse to them are no less important than the processes traditionally studied underthe heading of countertransference. If clinicians do not develop a model of this kindand work explicitly to it, the interview is likely to lose credibility further as a viablesituation in which other people can be usefully understood.

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