Is Understanding Why Necessary for Treatment Choices?
Abstract
Models of the psychodiagnostic process prescribe that clinicians should analyze explanations for their clients’ problems and subsequently use this information to decide upon the most appropriate treatment plan. However, studies of clinical practice suggest that the role of explanations is minimal, and that considering only symptoms gives clinicians enough information to plan treatment. In this experimental study we tested whether different explanations for the same problem are related to different treatment plans. Analyses of the responses given by 151 psychologists for cases of anorexia and conduct disorder in which the explanations were manipulated, suggest that explanations matter. Different explanations for the same constellation of symptoms were related to different treatment plans. This implies that clinical psychologists do not propose a treatment based on symptoms only. Implications of our findings are discussed.
References
. (2000). Diagnostic and statistical manual of mental Disorders (4th ed.). Washington, DC: Author.
(2008). Thinking and deciding (4th ed.). Cambridge, MA: Cambridge University Press.
(2007, April). Diagnostiek in de psychiatrische praktijk [
Diagnostics in psychiatric practice ]. Poster presented at the psychiatry Spring conference. Maastricht, The Netherlands.(2003). Is cognitive case formulation science or science fiction? Clinical Psychology: Science and Practice, 10, 52–69.
(1997). What goes on in a psychotherapist’s mind? Psychotherapy Research, 7, 105–125.
(1992). A normative-prescriptive view on clinical psychodiagnostic decision making. European Journal of Psychological Assessment, 8, 163–171.
(2003). De diagnostische cyclus: Een praktijkleer [
The diagnostic cycle: Theory in practice ]. Leuven: Acco.(2005). The quality of psychotherapy case formulations: A comparison of expert, experienced, and novice cognitive-behavioral and psychodynamic therapists. Journal of Consulting and Clinical Psychology, 73, 579–589.
(1997). Positive affect facilitates integration of information and decreases anchoring in reasoning among physicians. Organizational Behavior and Human Decision Processes, 72, 117–135.
(2005). Medical decision making: A selective review for child psychiatrists and psychologists. Journal of Child Psychology and Psychiatry, 46, 675–689.
(1998). Studying the clinician: Judgment research and psychological assessment. Washington, DC: American Psychological Association.
(2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1, 67–89.
(1992). Some reflections on the meaning of psychodiagnosis. Journal of Personality Assessment, 59, 410–423.
(2008). Psychologists’ judgments of diagnostic activities: Deviations from a theoretical model. Clinical Psychology and Psychotherapy, 15, 256–265.
(2003). Case formulation and design of behavioral treatment programs: Matching treatment mechanisms to causal variables for behavior problems. European Journal of Psychological Assessment, 19, 164–174.
(1984). Choices, values, and frames. American Psychologist, 39, 341–350.
(2007). Generic psychotherapy case formulation training improves formulation quality. Psychotherapy: Theory, Research, Practice, Training, 44, 66–77.
(2002). Clinical psychologists’ theory-based representations of mental disorders predict their diagnostic reasoning and memory. Journal of Experimental Psychology: General, 131, 451–476.
(2004). Theories of conduct disorder: A causal modeling analysis. Journal of Child Psychology and Psychiatry, 45, 727–742.
(2005). The reliability and quality of cognitive case formulation. Behavior Research and Therapy, 43, 1187–1201.
(1999). Differences in experienced and novice counselors’ knowledge structures about clients: Implications for case conceptualization. Journal of Counseling Psychology, 46, 504–514.
(2003). Treatment utility of psychological assessment. Psychological Assessment, 15, 521–531.
(1980). Congruence and typology of diagnosis in school psychology: An empirical study. Psychology in the Schools, 17, 12–24.
(2001). De gz-psycholoog in beeld [
The clinical psychologist in the picture ]. Amsterdam: NIP/NVO/Nippo.(1993). Progress toward achieving a common language in psychiatry: results from the field trials of the clinical guidelines accompanying the WHO Classification of Mental and Behavioral Disorders in ICD-10. Archives of General Psychiatry, 50, 115–124.
(1981). The framing of decisions and the psychology of choice. Science, 211, 453–458.
(2007). Evaluating psychodiagnostic decisions. Journal of Evaluation in Clinical Practice, 13, 10–15.
