View of Scripted Thinking and Faulty Problem Representation: The Effects of Theoretical Orientation, Level of Experience, and Temporal Order Causal Judgement

Canadian Journal of Counselling/Revue Canadienne de Counseling/1991, V o l . 25:2 146

Scripted Thinking and Faulty Problem Representation:

The Effects of Theoretical Orientation, Level of Experience,

and Temporal Order on Causal Judgement

Tina Goodin Waxman, Socrates Rapagna, Frank Dumont

McGill University

Abstract

T h i s paper examines some of the sources of bias that enter into counsellors' formulations o f causal hypotheses and client problem representations. First, there will be presented a brief overview of attribulional research bearing on certain heuristics used by counsellors in the selection of data for consideration as well as certain logical errors and hazard-prone strategies that lead to erroneous or inadequate problem representation. Second, a study of the think-aloud protocols of 32 subjects, counselling psychologists, as they examined the file of o n e clinically diagnosable individual is presented. T h e strategies they employed in representing the problem of the client are examined in the light of subjects' theoretical orientation a n d experience. T h i r d , the implications of the findings for the training of counselling psychologists are explored. T r a i n i n g exercises and procedures as well as instructional modules are suggested for attenuating the distorting effects of theoretical set, primacy-recency in data presentation, m o o d and affect in the clinician, and the manifold pitfalls of a logical character to which counsellors are prone in matters of social judgement. R é s u m é

L e p r é s e n t article examine quelques sources de biais qui s'insèrent dans les formulations é m i s e s par les conseillers et conseillères sur les hypothèses causales et les i n t e r p r é t a t i o n s de cas. E n premier lieu, il y sera p r é s e n t é une brève d é m o n s t r a t i o n sur les recherches portant sur certains "heuristiques" utilisés par les conseillers et conseillères dans leur sélection de d o n n é e s pour leurs évaluations ainsi que certaines erreurs de logique et de stratégie pouvant ê t r e dangereuses et qui peuvent amener à des conclusions e r r o n é e s . En second lieu, une e x p é r i e n c e faite avec 32 sujets, tous des conseillers psychologiques, porta sur l'examen du dossier d ' u n individu au profil psychiatrique. Les stratégies qu'ils et qu'elles ont utilisées seront e x a m i n é e s dans l'optique de leurs orientations t h é o r i q u e s et de leur e x p é r i e n c e . E n t r o i s i è m e lieu, nous explorerons les r é p e r c u s s i o n s qui pourront influencer la formation des conseillers et des conseillères dans leur pratique. Nous s u g g é r e r o n s des exercices et des p r o c é d u r e s aussi bien que des modules d'instruction pouvant aider à a t t é n u e r la distorsion des p r é c o n c e p t i o n s t h é o r i q u e s , le t e m p é r a m e n t et l ' é m o t i o n d u clinicien o u de la clinicienne, et les divers p i è g e s de c a r a c t è r e logique dont les conseillers et conseillères sont m e n a c é s en m a t i è r e de j u g e m e n t social.

C O U N S E L L O R V A R I A B L E S T I I A T I N F L U E N C E I N F E R i l N T I A L P R O C E S S Theoretical and Research Background

T h e r e n o w exists a significant body o f research findings, gathered p r i n c i p a l l y i n the last decade, bearing o n the clinical reasoning that m e n t a l health professionals engage i n w h e n they attempt to help those w h o have c o m e to t h e m for h e l p (e.g., A r k e s & H a m m o n d , 1988). S o m e o f the questions that they have asked are: H o w d o counsellors, social workers, clinical psychologists, a n d other helpers build an i n f o r m a t i o n base with

Scripted T h i n k i n g 147

w h i c h they can adequately represent the problems w h i c h their clients b r i n g to them? H o w do they configure such i n f o r m a t i o n in view o f accurately f o r m u l a t i n g , not only the p r o b l e m , but also the etiology of the p r o b l e m a n d its treatment? W h a t characterizes the reasoning or, more broadly, the inferential processes by w h i c h they formulate, first, tentative, then definitive hypotheses about what is t r o u b l i n g the helpee? A n d what are the personality a n d theoretical variables that are most influential i n giving d i r e c t i o n to clinicians as they try to puzzle out, in collaboration with their clients, the nature of the p r o b l e m that faces them?

It s h o u l d be noted at the outset of this discussion that the p r o b l e m representations that counsellors a n d other clinicians must make are based o n a reality that is m u c h m o r e c o m p l e x than that w h i c h faces a physicist or engineer or other practitioner of one of the natural sciences. T h e i n f o r m a t i o n that troubled people present to counsellors is often d i s o r g a n i z e d , fragmentary, a m b i g u o u s , distorted, inconsistent, emotion-laden, cryptic, symbolic, a n d defensive ( D u m o n t & L e c o m t e , 1987). It is not only c l i n i c i a n s ' task to make sense of a body of i n f o r m a t i o n that may reflect the true state o f affairs, it is their task to seek out such i n f o r m a t i o n , verify it, discard what, in their j u d g m e n t , is suspect a n d self-serving if not d o w n r i g h t false, a n d finally decide w h e n they have all the facts that are necessary to proceed with a final diagnosis a n d a treatment o f choice.

Needless to say, experts generally a p p r o a c h this c o m p l e x a n d f o r m i d a b l e task with m o r e efficient strategies, greater rapidity, a n d a m o r e sensitive response to serendipitous cues than d o those who have IitUe experience a n d training ( D u m o n t , in press). Moreover, the k i n d of training one has received a n d the paradigms one has been trained to work i n a n d feel comfortable in p r o f o u n d l y influence the kinds o f i n f o r m a t i o n one seeks out. O n e only has to c o m p a r e the p r o b i n g strategies o f a stricüy stimulus-response behaviourist with those o f a psychodynamicist. N o t only w o u l d their typescripts reveal sessions that vary differendy in terms of interactional structure, but the i n f o r m a t i o n focused o n w o u l d relate to different aspects of the counsellee 's life. In many cases they w o u l d seem to be reaching for different realities.

A t a m o r e basic level, i n d e p e n d e n t o f depth of knowledge, expertise, or character of training, the very n o t i o n of what a clinical fact is is not well appreciated by many clinicians. It has been f o u n d that many clinicians, not to m e n t i o n students, are insufficienüy sensitive to the inferential character of the i n f o r m a t i o n o n which they build a diagnosis a n d (consequently) a treatment plan (Nisbett & Ross, 1980). It has been established that clinicians, experienced as well as neophyte, make j u d g e m e n t s about their clients that courts of law w o u l d never tolerate. Yet

148 T i n a G o o d i n Waxman, Socrates Rapagna, Frank D u m o n t

there is o f t e n n o less at stake i n terms of the future w e l l b e i n g o f the client i n the o n e context than i n the other.

A U c o m m u n i c a t i o n is by its nature partial a n d fragmentary. I n d e e d , a c l i e n t ' s reality, we recognize, can never be fully revealed to a helper, especially t h r o u g h the m e d i u m o f a conversation. If o n e defines a n inference as any j u d g m e n t that goes beyond the i n f o r m a t i o n that is given, then o n e must place every c o m m u n i c a t i o n o n a c o n t i n u u m o f inferential content. T h i s is as true o f the t a l k i n g that goes o n in a c o u n s e l l i n g session as that w h i c h goes o n in the k i t c h e n . Ialk about a person 's reality i n the aseptic e n v i r o n m e n t o f o n e ' s c l i n i c or office is a pale a n d fragmented representation o f that reality; it is certainly very different f r o m living o r having lived it.

Theories As Belief Systems

Systems f o r h e l p i n g people with psychological, behavioral, or e m o t i o n a l p r o b l e m s c a n be considered i n most instances to be belief systems. C o u n s e l l o r s as well as other k i n d s o f therapists become p r o f o u n d l y c o m m i t t e d to those systems, w h i c h explain n o t only the causes o f p e o p l e 's behaviour, b u t also the u n f o l d i n g dynamics o f those behaviours i n a clinical setting (Bishop & Richards, 1984; IIouts, 1984). In fact, there is a considerable literature (Snyder, 1984) a f f i r m i n g that c l i n i c i a n s ' theoretical convictions as they get expressed i n the h e l p i n g relationship b r i n g a b o u t the very behaviour that confirms their belief i n their system. Clients c a n even be b r o u g h t to t h i n k that they have h a d the experiences that the theoretical a p p r o a c h o f their clinician presumes t h e m to have h a d . N o less a c l i n i c i a n than F r e u d (as cited i n T u r k & Salovey, 1987, frontispiece) a d m i t t e d that the sexual seductions that certain of his clients seemed to r e m e m b e r h a d never o c c u r r e d a n d that he h i m s e l f may have been responsible for leading t h e m to make such admissions. M o r e seriously, it has been suggested that researchers' theoretical orientation influences the ways i n w h i c h their research is c o n d u c t e d ( K a z d i n , 1983). T h e findings that eventually shape professional practice are themselves d e t e r m i n e d by the theories that gave rise to the research that generated t h e m . T h e o r y , practice, a n d research are symbiotically tied together, caught, as it were, i n a self-reinforcing cycle.

In a w o r k that stands as a l a n d m a r k o f psychological scholarship B a n d u r a (1969) stated:

S c h o o l affiliations not only determine the range o f procedures that a therapist will e m p l o y in his practice, they also define the client's central p r o b l e m s w h i c h the techniques o f the school arc designed to resolve. Psychoanalysts will uncover a n d resolve O e d i p a l conflicts; A d l e r i a n s w i l l discover inadequacy problems a n d alter...compensatory

Scripted T h i n k i n g 149

power; Rogerians will unearth self-[vs]-ideal discrepancies; Rankians will resolve separation anxieties; existentialists will — p r o m o t e awareness o f self-consciousness, (p.80)

Psychotherapists often formulate their diagnostic ideas within the first 30 to 60 seconds of the initial assessment interview ( G a u r o n & D i c k i n s o n , 1969). Sandifer, H o r d e r n , 8c G r e e n (1970) c o n c l u d e d that "the first three minutes of observation have a significant a n d sometimes apparenüy decisive, impact u p o n the final diagnostic d e c i s i o n " (p. 968). T h i s tendency for mental health professionals to precipitously formulate diagnoses was f o u n d to exist regardless of their theoretical orientation or their level of experience.

Limitations of Expertise

T h e r e is a broad literature emanating f r o m the field o f cognitive science that examines the skills that experts in various domains b r i n g to the practice of their profession. W h e t h e r one is speaking of radiologists or physicians or chess players or microbiologists, there are characteristics of their practice w h i c h they seem to have i n c o m m o n . J o h n s o n , D u r a n , Hassebrock, M o l l e r , Prietula, Feltovich, 8c Swanson (1981) f o u n d that experts are able to recognize the salient aspects of a p r o b l e m a n d interpret quickly the i n f o r m a t i o n that is related to the solution. T h e y are better able than novices to look for the operations that can be utilized to solve the p r o b l e m ( G r e e n o 8c S i m o n , 1985). F o r example, they are very efficient at searching for, a n d m a k i n g selective use of, data that are m e a n i n g f u l w i t h i n their own frame of reference. T h e e n c o d i n g a n d retrieval of i n n u m e r a b l e facts in long-term m e m o r y , a n d the a p p l i c a t i o n of conventional procedures occur with relative ease a n d a certain automaticity. T h e question arises, "what i n f o r m a t i o n will I use a n d what will I discard?". As one counselling routine or another is triggered, i n f o r m a t i o n that others using a different a p p r o a c h w o u l d consider i m p o r t a n t is rejected as irrelevant. T h e question then arises, are the tentative diagnoses that are formulated o n the basis o f one set of data different f r o m those formulated using a different set of data? O n e can plausibly suspect they would be.

T h e r e are other characteristics of expert systems that have implications for practitioners of the h e l p i n g relationship regardless of the discipline. H i g h l y experienced professionals operate on a more abstract level than do the newly trained. They have a repertoire of principles, often reduced to time-saving rules of thumb, that they swiftly apply even before they have m a d e a full assessment of a case. T h e ore that they m i n e is that which their l o n g experience indicates will reward a search. T h e r e is reason to suspect that this speed is often at the cost of accuracy a n d of due

150 T i n a Goodin Waxman, Socrates Rapagna, Frank D u m o n t

consideration of variables that are given less p r o m i n e n c e in their theoretical a p p r o a c h . T h e study described below investigated whether this was true or not.

A corollary o f the above is that novices are not as fast as experts in p r o b l e m representation. Whether this is true of counsellors as well as chess players n e e d e d to be studied. P a u l M e e h l demonstrated 30 years ago (1960) that clinicians tended to formulate clients' p r o b l e m s i n the first sessions of a h e l p i n g relationship. T h e y also tended to m a i n t a i n t h e m over the next 20 sessions. W h a t needs to be d e t e r m i n e d is whether such rapid p r o b l e m assessment is an unalloyed g o o d . A c c o r d i n g l y , a m o n g the many other characteristics that may distinguish experts f r o m novices that n e e d to be addressed (for example, the matter of skilled p a t t e r n i n g a n d c h u n k i n g o f data a n d of transferring skills f r o m one c o u n s e l l i n g d o m a i n to another) is the p e n c h a n t for premature closure.

T h e r e is evidence in die personality and social psychology literature (as well as that o f educational psychology) diat everything that we learn about a person has a potential to influence later perceptions that we may f o r m o f that person o n the basis of further i n f o r m a t i o n ( A n d e r s o n , 1965; Jones, Rock, Shaver, Coethals, & Ward, 1968). For example, if we are i n f o r m e d that an i n d i v i d u a l is deceptive and manipulative, later i n f o r m a t i o n that he is generous or highly sociable tends to be interpreted as in the service o f those former attributes. T h e classic, often-cited investigation of this effect was done by S o l o m o n A s c h (1946). IIe asked subjects to evaluate a person w h o was intelligent, industrious, impulsive, critical, stubborn, a n d envious. T h i s series o f descriptors moves f r o m attractive to increasingly repellent qualities. H e discovered that their evaluation was m o r e positive than if those adjectives were presented in a reverse order, b e g i n n i n g with envious a n d stubborn. Favourable or unfavourable impressions created by the early impressions tended to persist. A comparable p h e n o m e n o n occurs with advance organizers (Ausubel, 1960). In psychopedagogy it has been proven useful to present a conceptual overview of a c o m p l e x system as it helps to shape our later cognitive organization of diat system. A mistake early in one 1 s political career seems to have a m u c h m o r e disastrous effect

than a c o m p a r a b l e one later o n . Later mistakes are palliated by "a g o o d r e c o r d " .

Whatever die case may be for any one of these situadons, the implications of tiiis p h e n o m e n o n are evident for the assessment of a case file or o f a client presenting for the first time. T h e most reliable i n f o r m a t i o n p r o v i d e d to clinicians is that w h i c h follows the establishment o f trust a n d g o o d rapport, not that w h i c h is presented before. The question arises then: are o n e ' s representations of client p r o b l e m s shaped m o r e by the earlier-divulged than by the later-divulged i n f o r m a t i o n ? If so, there is the danger that client data that are more distorted, g u a r d e d ,

Scripted T h i n k i n g 151

self-protective, a n d i n n o c u o u s to the self-image of the client will be disproportionately influential i n shaping the assessment.

T h e study that is described below has systematically investigated this variable as well as others referred to above.

E X P E R I M E N T

In view of the statement of the p r o b l e m , it is not yet clear: (1) what factors influence clinicians' diagnostic reasoning processes d u r i n g the first interview, a n d given those factors, (2) i n what ways clinicians t h i n k about their clients' problems. T h e present study sought to determine the effects o f clinicians' theoretical orientation, level of experience, a n d t e m p o r a l o r d e r of client i n f o r m a t i o n o n client p r o b l e m representation, diagnostic impressions, hypothesis f o r m u l a t i o n , a n d hypothesis-testing strategies. Theories as belief systems seem to determine the character o f causal attributions made i n f o r m u l a t i n g client problems. T w o factors relating to the causes o f client problems that are of particular i m p o r t a n c e to this study are dispositional attributions a n d contextual attributions. T h e term

dispositional refers to i n f o r m a t i o n that is predominantly intrapsychic in k i n d . Data of a dispositional nature emanate f r o m within the i n d i v i d u a l . T h e y describe personality characteristics, characterological traits, cognitions, affect, m o o d , a n d behaviour that are causally related to the i n t e r n a l personality structure of the individual. A l t h o u g h primarily related to the distant past, data of a dispositional nature can be l i n k e d to the recent past as well as to the immediate present. T h e y may be real or fictive in nature. T h e term contextual, o n the other h a n d , refers to i n f o r m a t i o n that is

predominantly s i t u a t i o n a l i n k i n d . C o n t e x t u a l d a t a are environmentally-determined a n d act as external stimuli or stressors for the i n d i v i d u a l . As an external force acting on the individual, these stressors may potentiate or heighten the expression of an existing characterological trait. However, in causal terms, they derive f r o m the e n v i r o n m e n t . A l t h o u g h data of a contextual nature describe external stimuli that are l i n k e d primarily to the recent past a n d immediate present, in some instances contextual data are linked to the remote past. It is u n d e r s t o o d that, in practice, the terms dispositional a n d contextual are not mutually exclusive. A l d i o u g h they are not independent, it is the predominance oí one or the other that indicates into w h i c h category the data fall.

This study investigated the following dependent variables: (1) character o f the attribution (is it dispositional or contextual?), (2) hypoüiesis-testing strategy (is i l a preliminary, confirmatory, or disconfirrnatory strategy), a n d (3) final diagnostic operation (is the attribution made for the first time, or if not, is it either retained or rejected?). T h e i n d e p e n d e n t variables are: (1) theoretical orientation (were clinicians psychodynamically-oriented or

152 l i n a G o o d i n Waxman, Socrates Rapagna, Frank Dumont

behaviourally-oriented?), (2) level o f experience (were they novice or expert?), a n d (3) temporal o r d e r of i n f o r m a t i o n (was dispositional i n f o r m a t i o n presented first, followed by contextual i n f o r m a t i o n o r contextual i n f o r m a t i o n first followed by dispositional i n f o r m a t i o n ? ) .

Method Subjects

A n invitation to participate i n a study o n inferential reasoning was sent to 190 c o u n s e l l i n g psychologists practising in a multiplicity o f settings such as M o n t r e a l schools, universities, hospitals, clinics, as well as i n d i e private sector. A personal data f o r m was i n c l u d e d with the invitation to participate. Those clinicians wishing to participate were asked to complete the f o r m a n d return t h e m with the signed agreement- to-participate f o r m . Subjects were selected a c c o r d i n g to two factors: (1) their preferred theoretical orientation a n d (2) their level of experience. After receiving a n d processing the f o r m , 32 subjects were selected to participate i n the study. T h e o r e t i c a l orientation, the first inclusion-exclusion factor, was calculated by asking clinicians to report tiieir preferred theoretical o r i e n t a t i o n . C l i n i c i a n s w e r e requested to place themselves o n a c o n t i n u u m f r o m o n e to ten; o n e , b e i n g the most psychodynamic a n d ten, the most behavioral. F o r the purpose of this study, those w h o rated themselves as one t h r o u g h four or seven t h r o u g h ten were considered to have m e t the i n c l u s i o n criteria for theoretical o r i e n t a t i o n . It is understood that there is a degree o f overlap with regard to the philosophical, theoretical, a n d clinical u n d e r p i n n i n g s o f the psychodynamic a n d cognitive-behavioral/behavioral schools o f thought. However, for the purpose of this study it was thought that the selected orientations w o u l d adequately capture the between-groups differences for the variables u n d e r investigation. T h e second inclusion-exclusion factor, level o f experience, was ascertained by calculating the n u m b e r of years of c o n t i n u o u s practice the c l i n i c i a n h a d experienced. F o r the purpose o f this study, clinicians participating i n a n internship at either the masters or doctoral level or those in their first year o f practice were referred to as low- e x p e r i e n c e d (or novice); clinicians with five or m o r e years o f clinical practice were referred to as high-experienced (or expert).

Procedure

C l i n i c i a n s w h o met the selection criteria were contacted a n d a meeting was arranged. At d i e meeting subjects were presented with d i e case file o f an individual n a m e d John S. a n d were i n f o r m e d that a t h i n k - a l o u d p r o c e d u r e w o u l d be utilized. The entire procedure was audiotaped by cassette recorder.

Scripted Thinking 153

T h e case file that was presented to subjects is an elaboration o f a case reported i n the DSM-III-R Case B o o k (Spitzer, G i b b o n , S k o d o l , Williams, & First, 1989). A s reported in the Case B o o k , the "Stubborn Psychiatrist" (p. 107) exhibits the symptoms of a n d meets the criteria for passive-aggressive personality disorder, indicated on Axis II as 301.84. It was d e c i d e d that, in order to study clinicians' reasoning processes in greater depth, a more elaborated case w o u l d be appropriate. T h e r e f o r e , material was a d d e d to the case that would better describe the symptomatology. Interraters using D S M terminology agreed that the material added to the case placed John S. in the category o f both passive-aggressive a n d narcissistic personality traits. T h e criteria for passive-aggressive personality a n d narcissistic personality were used descriptively in order to develop a symptomatology in the case history that was consistent with the DSM-III-R. Thus it was the accuracy o f clinicians' descriptive p r o b l e m representations relative to the symptoms that were presented in the case file that were studied. Preparation for the assessment o f the case file was accomplished by way of three practice tasks. T h e practice tasks enabled subjects to become comfortable with the think-aloud p r o c e d u r e that they w o u l d follow d u r i n g the main task. P r i o r to both tasks subjects were asked to read a l o u d instructions w h i c h were presented to t h e m o n the c o m p u t e r screen ( A p p e n d i x A ) . U p o n c o m p l e t i n g the m a i n task, subjects were asked to make a summary assessment o f the case.

Expérimental Manipulation

T w o versions of the case file were utilized. In version one, the first p o r t i o n o f the case file c o m p r i s e d i n f o r m a t i o n that was primarily contextual in nature. T h i s was followed, in the second p o r t i o n o f version one, by i n f o r m a t i o n that was primarily dispositional in nature. T h e content o f version two was identical to the content of version one. However, in version two the client i n f o r m a t i o n was in the reverse order to version one. In version two, i n f o r m a t i o n of a primarily dispositional nature was presented in the first p o r t i o n . This was followed, i n the second p o r t i o n of version two, by i n f o r m a t i o n of a primarily contextual nature. After subjects were d e s i g n a t e d as p s y c h o d y n a m i c / l o w e x p e r i e n c e d , p y c h o -d y n a m i c / h i g h - e x p e r i e n c e -d , cognitive-behavioral/low-experience-d, a n -d cognitive-behavioral/high-experienced, they were randomly assigned to one o f the two versions o f the case file.

Data Coding

T h e c o d i n g categories for inferences posited while reading the case file were as follows: (1) p r e l i m i n a r y dispositional, (2) p r e l i m i n a r y contextual,

disconfir-154 T i n a Goodin Waxman, Socrates Rapagna, Frank D u m o n t

matory dispositional, a n d (6) disconfirmatory contextual. T h e f o l l o w i n g categories were used for inferences stated d u r i n g a summary assessment that followed the reading of the text: (1) preliminary dispositional, (2) p r e l i m i n a r y contextual, (3) retain dispositional, (4) retain contextual, (5) reject d i s p o s i d o n a l , and (6) reject contextual. Finally, there were two a d d i t i o n a l categories, (1) unclassifiable and (2) non-inferential. A n interrater reliability o f .95 was achieved, m o n i t o r e d , a n d m a i n t a i n e d t h r o u g h o u t .

Design

A quasi-experimental analogue, 2 X 2 X 2 factorial design ( C o o k e & C a m p b e l l , 1979) was e m p l o y e d . T h e between-subjects factors are: (1) theoredcal orientation, (2) level o f experience, a n d (3) case file version. E a c h factor has two levels: (1) psychodynamic versus cognitive-behavioral/behavioral; (2) low-experienced versus high-experienced, a n d (3) version 1 versus version 2, respectively.

Results Attribution

Proportion of dispositional inferences to total inferences. T h e r e are strong theoretical g r o u n d s for t h i n k i n g that psychodynamically-oriented clinicians w o u l d be m o r e likely to attribute presenting problems to characterological aspects of the client (that is, dispositions) than w o u l d behaviourally-oriented clinicians. W h e n analyses of variance were u n d e r t a k e n to examine the proportion of dispositional inferences to total

inferences , no significant difference was f o u n d for psychodynamicists a n d behaviourists, /•"(1,24) = 2.47, p = 0.129. A n examination o f the s u m m a r y data for the p r o p o r t i o n of dispositional inferences to total inferences, presented i n Table 1, reveals the following: of the total n u m b e r o f dispositional a n d contextual inferences posited by psychodynamicists a n d behaviourists, 77% and 8 1 % are dispositional in nature, respectively. Conversely, 2 3 % a n d 19% are contextual in nature, respectively.

T h e total n u m b e r of dispositional and contextual inferences posited by psychodynamicists a n d behaviourists is presented in summary Table 1. Psychodynamicists make m o r e inferences than behaviourists ( A i = 129.13, A i = 95.63, respectively). However, it can be seen that b o t h psychodynamicists and behaviourists draw more dispositional ( A f = 98.13, A i = 78.31, respectively) than contextual (Af = 31.00, Af = 17.31, respectively) inferences. Psychodynamicists drew an average of 67.13 m o r e dispositional inferences d i a n contextual inferences. Behaviourists m a d e an average o f 61.00 m o r e dispositional inferences than contextual inferences.

Scripted T h i n k i n g 155

T A B L E 1

Means for the Dependent Variâtes Used to Measure the Dependent Variable, Attribution, for the Main Effect of Theoretical Orientation

Dependent Variate Theoretical Orientation

Psychodynamicists Behaviourists Dispositional T o t a l 98.13 78.31 C o n t e x t u a l T o t a l 31.00 17.31 D i s p - C o n t T o t a l 129.13 95.63 D i s p P r o p o r t i o n 0.77 0.81 C o n t P r o p o r t i o n 0.23 0.19

Note. Disp = dispositional, C o n t = contextual.

Dispositional and contextual inferences: Absolute number. T h e question c o n c e r n i n g the tendency a m o n g psychodynamicists a n d behaviourists to attribute client problems to trait (dispositions) or state (context) was answered by e x a m i n i n g the frequency of dispositional a n d contextual inferences based on absolute n u m b e r only. A n analysis of the absolute

number of contextual inferences reveals that the n u l l hypothesis may be rejected for inferences of a contextual nature, F ( l , 2 4 ) = 6.33, p = 0.019. Psychodynamicists posited m o r e contextual inferences i n absolute n u m b e r ( M = 31.00 ) than behaviourists ( M = 17.31) (see Table 1). Surprisingly, psychodynamicists are m o r e likely than behaviourists to attribute client p r o b l e m s to external factors. T h e analysis of variance reveals that there was n o significant difference in the absolute number of dispositional inferences posited by psychodynamicists a n d behaviourists, F( 1,24) = 1.81 , p = 0.19. Interestingly, clinicians of either orientation are not more likely to attribute client problems to characterological traits. EvidenÜy, whether clinicians are psychodynamically-oriented or behaviourally-oriented significandy affects the relative n u m b e r of contextual inferences they posit about their clients' problems, but may not affect the relative n u m b e r of dispositional inferences.

Results based o n absolute n u m b e r s n e e d to be interpreted with c a u t i o n . T h e significant differences based o n absolute numbers may be a f u n c t i o n o f the greater n u m b e r of overall inferences posited by psychodynamicists than behaviourists. If psychodynamicists infer m o r e i n total, the l i k e l i h o o d that they attribute client problems to b o t h trait a n d state increases as well. Further, analyses revealed n o significant difference i n levels o f dispositional or contextual inferences as a function of any interactions o f the factors, irrespective o f how they were calculated. Finally, analyses

156 T i n a Goodin Waxman, Socrates Rapagna, Frank Dumont

revealed that the m a i n effects for level o f experience a n d for t e m p o r a l o r d e r d i d not account for significant differences i n levels of dispositional or contextual inferences, irrespective o f how they were calculated.

Hypothesis-Testing Strategies

Preliminary dispositional and preliminary contextual inferences: Absolute number.

It was o f interest to examine the ways in w h i c h clinicians behave (eg. the hypothesis-testing strategies they utilize) when e x a m i n i n g a case file. C l i n i c i a n s begin by p u t t i n g forth a hypothesis about client problems; this was referred to as a p r e l i m i n a r y inference. T h e p r e l i m i n a r y inference can bear o n a trait or bear o n a state. In view of this, another set o f analyses (see Figure 1), p e r t a i n i n g to preliminary dispositional a n d preliminary

contextual inferences, indicates that the absolute n u m b e r of p r e l i m i n a r y contextual inferences varied significandy as a f u n c t i o n of the two-way interaction of tiieoretical orientation a n d level of experience, /•"(1,24) = 4.22, p= .051.

30 H

c

Novice Expert

Level of Experience

Figure 1. P r e l i m i n a r y contextual inferences posited as a f u n c t i o n o f the two-way interaction of theoretical orientation a n d level of experience.

T h a t is, the n u m b e r o f p r e l i m i n a r y contextual inferences posited by clinicians, f r o m both schools is not the same when seen together with level

Scripted T h i n k i n g 157

of experience. A m o n g psychodynamicists, experts ( M = 26.75) stated many m o r e p r e l i m i n a r y contextual inferences than novices ( A i = 13.63). S i m i l a r results, however, were not f o u n d f o r behaviourists. Expert-behaviourists ( M = 8.88) stated fewer p r e l i m i n a r y contextual inferences than novice-behaviourists ( A i = 11.50). Further, i t i s observed that the difference in the n u m b e r o f preliminary contextual inferences p u t forth by novice behaviourists ( M = 11.50) a n d expert behaviourists ( M = 8.88) is negligible. Whereas expert-psychodynamicists are more likely, at the outset, than novice-psychodynamicists, to attribute client problems to e n v i r o n m e n t a l stressors, expert-behaviourists are less likely, at the outset, than novice-behaviourists, to attribute client problems to e n v i r o n m e n t a l stressors.

It can also be noted (see Figure 1) that both novice a n d expert psychodynamicists posited m o r e preliminary contextual inferences than b o t h novice a n d expert behaviourists. C a r e f u l examination o f the descriptive data shows that novice-psychodynamicists (M = 114.63) a n d expert-psychodynamicists ( M = 143.63) stated m o r e inferences i n total than novice-behaviourists ( M = 108.63) a n d expert-behaviourists ( M = 82.63). A g a i n , the limitations of results based o n absolute numbers apply.

Proportion of confirmatory dispositional to total dispositional inferences. A f t e r p u t t i n g forth initial hypotheses about client problems, clinicians develop these ideas by p i c k i n g u p o n i n f o r m a t i o n that either c o n f i r m s o r disconfirms their preliminary hunches. A g a i n , these follow-up hypotheses about client p r o b l e m s can be conceptualized as long-term intrapsychic or e n v i r o n m e n t a l problems. Results of an analysis o f variance p e r t a i n i n g to the proportion of confirmatory dispositional to total dispositional inferences indicate that the p r o p o r t i o n o f confirmatory dispositional inferences varied as a f u n c t i o n of level of experience, /"(1,24) = 4.13, p = .053. O f the total n u m b e r o f dispositional inferences, novices posited m o r e c o n f i r m a t o r y dispositional inferences than experts. These results reveal that recendy-trained clinicians tend more than experienced clinicians to generate data that prove their initial trait hypotheses correct. T h e s e f i n d i n g s p r o v i d e p a r t i a l e v i d e n c e f o r t h e r e s e a r c h o n hypothesis-confirmation ( M e r t o n , 1957; Scheff, 1966; Skrypnek & Snyder, 1982; Snyder, T a n k e , & Berscheid, 1977). In this study, results, based o n results: absolute n u m b e r as distinguished f r o m p r o p o r t i o n a l figures, p e r t a i n i n g to confirmatory dispositional inferences, d i d n o t yield significance for any o f the i n d e p e n d e n t factors. However, the results revealed that level of experience d i d significantly affect the results:proportion o f confirmatory dispositional inferences to total dispositional inferences posited by clinicians. Novices are m o r e apt than experts to c o n f i r m their p r e l i m i n a r y dispositional inferences. T h e evidence a d d u c e d supports the n o t i o n that counsellors d o engage in

158 T i n a Goodin Waxman, Socrates Rapagna, Frank D u m o n t

hypothesis-confirmation strategies by seeking validation for their first-adopted o p i n i o n s .

Proportion of confirmatory contextual to total contextual inferences. A n o t h e r analysis e x a m i n e d the c o n f i r m a d o n of hypotheses that attribute client p r o b l e m s to e n v i r o n m e n t a l stressors. Results of an analysis o f variance indicate that the proportion of confirmatory contextual to the total number of

contextual inferences varied as a f u n c d o n o f temporal o r d e r of i n f o r m a t i o n , F ( l , 2 4 ) = 5.65, p = .025. W h e n presented with contextual informaüon first, forty-four percent o f the clinicians' inferences were c o n f i r m a t o r y contextual. W h e n presented with disposidonal i n f o r m a t i o n first,twenty-six percent o f the clinicians' inferences were confirmatory contextual. This result points to a primacy-recency effect. T h e o r d e r i n w h i c h client informaüon is presented d i d affect the p r o p o r t i o n o f confirmatory contextual inferences to the total contextual inferences posited by clinicians.

It appears that clinicians d o engage i n hypothesis-confirmation behaviour as a f u n c d o n o f the order i n w h i c h client informaüon is presented. T h e y tend to c o n f i r m their inferences that attribute d i e p r o b l e m to the e n v i r o n m e n t w h e n they are presented with contextual followed by disposidonal informaüon. T h e types o f inferences they c o n f i r m are affected by the sequencing of client informaüon. T h i s f i n d i n g supports the research p o s i t i n g that temporal o r d e r o f informaüon influences di e judgements o f clinicians ( A n d e r s o n , 1965; A s c h , 1946Jones, R o c k , Shaver, Goethals, & W a r d , 1968; Pain k Sharpley, 1988, 1989; R i c h a r d s & W i e r z b i c k i , 1990). T h i s implies that clinicians n e e d to pay close attention to d i e type o f i n f o r m a t i o n clients present d u r i n g the first interview. If clients present with primarily informaüon o f a situational nature first a n d then move o n to primarily informaüon o f a characterological nature, clinicians tend to c o n f i r m p r o p o r t i o n a l l y more contextual inferences than if clients present with p r i m a r i l y i n f o r m a t i o n of a characterological nature first a n d then move o n to p r i m a r i l y i n f o r m a t i o n o f a situational nature.

Disconfirmatory inferences: Proportion and absolute number. W h i l e d e v e l o p i n g their diagnostic impressions, clinicians may retract o r d i s c o n f i r m their initial hypotheses o f one type o r another (eg. dispositional or contextual). Results indicate that n o significant differences were f o u n d i n the proportion

or the absolute number of disconfirmatory inferences to the total number of inferences

as a f u n c t i o n o f any of the factors. T h e descriptive data indicate that clinicians d i s c o n f i r m only 12 to 14% of their total n u m b e r o f inferences across the i n d e p e n d e n t variables, a süikirigly small p r o p o r t i o n i n d e e d .

A c c o r d i n g to the literature o n hypothesis disconfirrnation, individuals prefer to strengthen their expectancies. They tend to utilize occurrences

Scripted T h i n k i n g 159

and u n d e r u t i l i z e nonoccurrences ( C r o x t o n , 1989; L o r d , Ross, & L e p p e r , 1979; Shustak & Sternberg, 1981; Snyder & C a n t o r , 1979). In light of the findings reported in the literature, it is not surprising that significant differences pertaining to disconfirmatory inferences were not f o u n d for any of the i n d e p e n d e n t variables in this study. T h e i m p l i c a t i o n is that clinicians-in-training need to become aware of the often unwarranted tendency to h o l d o n to their p r e l i m i n a r y inferences. In view of this tendency, professionals in training institutions might do well to draw attention to the stickiness of first-posited inferences. Ibey are not likely to be discarded, irrespective of theoretical orientation, level of experience, or temporal order.

Final Diagnostic Operations

Dispositional and contextual inferences to total inferences posited during the summary: Proportion and absolute number. It was of interest to e x a m i n e the types of c o n c l u d i n g or final inferences made by clinicians. T h e findings indicate that the theoretical school to w h i c h clinicians subscribe affects the p r o p o r t i o n of dispositional inferences to total inferences posited d u r i n g the summary, F{\,24) = 5.12, p = .033. O f the total n u m b e r o f final inferences posited, 9 3 % of behaviourists and 8 2 % of psychodynamicists were dispositional.

Results based on absolute n u m b e r s indicate that theoretical orientation marginally accounted for variance in the n u m b e r of contextual inferences, /(1,24) = 3.95, p = .058. D u r i n g the summary, psychodynamicists (Af = 3.31) m o r e often than behaviourists ( A i = 1.25) attribute client p r o b l e m s to e n v i r o n m e n t a l stressors.

In a d d i t i o n , the proportion of dispositional inferences to total inferences posited

during the summary varied as a function o f temporal order /•'(1,24) = 4.13,

p = .053. Ninety-diree percent o f the inferences stated by clinicians presented with contextual i n f o r m a t i o n first were those that attributed presenting problems to characterological aspects o f the client. Eighty-two percent of the inferences made by clinicians presented with dispositional i n f o r m a t i o n first were those that attributed presenting p r o b l e m s to characterological aspjects of the client. D u r i n g the final diagnostic assessment, the tendency a m o n g clinicians to attribute client p r o b l e m s to dispositions appears to be a f u n c t i o n of the specific order of i n f o r m a t i o n , that is, contextual i n f o r m a t i o n followed by dispositional i n f o r m a t i o n .

Inferences retained: Absolute number. D u r i n g the c o n c l u d i n g stages of the assessment process, do clinicians tend to retain inferences that attribute client problems to trait or state? Results reveal that the absolute n u m b e r of dispositional inferences retained varied as a function of the interaction (see Figure 2) between theoretical orientation and temporal o r d e r o f

160 T i n a G o o d i n Waxman, Socrates Rapagna, Frank D u m o n t

i n f o r m a t i o n , /•"(1,24) = 5.39, p= .029. T h e descriptive data indicate that psychodynamicists presented with contextual informaüon first ( A i = 12.75) retain m o r e inferences that atüibute client p r o b l e m s to üait than psychodynamicists presented with disposidonal informaüon first ( A i =9.13). Behaviourists presented with disposidonal i n f o r m a t i o n first ( A i = 14.38) retain m o r e inferences that atüibute client p r o b l e m s to üait than behaviourists presented with contextual i n f o r m a d o r ! first ( A i = 8.25).

16 n -O u c OC H C O O Q 14 12 10 -Psychodyn Behaviourists Cont-Disp Disp-Cont Temporal Order

Figure 2. D i s p o s i d o n a l inferences retained as a f u n c d o n of theoretical orientation a n d temporal order.

Relative to the above result, it appears that an inverse relationship exists for theoretical orientation a n d temporal o r d e r o f i n f o r m a t i o n . Psychodynamicists retain more inferences that are attributed to üait w h e n they are presented with contextual i n f o r m a t i o n first than w h e n they are presented with dispositional i n f o r m a t i o n first. However, results f o u n d for behaviourists are in the opposite d i r e c t i o n . Behaviourists retain fewer inferences that are attributed to üait w h e n they are presented with contextual i n f o r m a t i o n first tiian w h e n they are presented with dispositional i n f o r m a t i o n first.

In a d d i t i o n , analysis o f variance indicates that the absolute n u m b e r of contextual inferences retained varied as a function o f d i e m a i n effect o f theoretical orientation, /•'(1,24) = 5.08, p= .033. However, an analysis o f

Scripted T h i n k i n g 161

dispositional inferences retained revealed no significant differences f o r theoretical orientation, /(1,24) = 0.03, p = .859. Psychodynamicists (Ai=2.63) retained more contextual inferences than behaviourists ( M = 0.69).

T h e results for level o f experience indicate that the absolute n u m b e r o f dispositional inferences retained varied as a function o f level o f experience, /(1,24) = 5.96, p = .022. Novices ( M = 13.69) retained more dispositional inferences than experts ( M = 8.56). T h i s result is related to the previous significant f i n d i n g c o n c e r n i n g the p r o p o r t i o n o f confirmatory dispositional inferences to the total preliminary a n d confirmatory inferences for novices, /(1,24) = 4.13, p= .053. Novices n o t only c o n f i r m e d m o r e o f their p r e l i m i n a r y dispositional inferences than experts, they also retained m o r e dispositional inferences than experts.

inferences rejected: Absolute number. D o clinicians finally rescind their initial hypotheses? If so, d o they tend to cancel one type, that is, those that are dispositional or contextual, m o r e than another? T h e results indicate that n o n e o f the factors accounted for variances i n the n u m b e r o f dispositional a n d contextual inferences rejected. A p p a r e n d y , whether clinicians are psychodynamically-oriented or behaviorally-oriented, novice or expert, a n d process contextual or dispositional i n f o r m a t i o n first does not affect the absolute n u m b e r o f dispositional a n d contextual inferences rejected. O n c e established, clinicians tend not to a n n u l their initial hypotheses o f either type.

Summary of Results

1. N o significant difference was f o u n d i n the p r o p o r t i o n o f dispositional inferences to total inferences for psychodynamicists a n d behaviourists, /(1,24)=2.47, p= 0.129.

2. Psychodynamicists posit m o r e contextual inferences i n absolute n u m b e r than d o behaviourists, /(1,24)=6.33, p= .019.

3. N o significant difference was f o u n d i n the absolute n u m b e r o f dispositional inferences posited by psychodynamicists a n d behaviourists /(1,24) = 1.81, p= 0.19.

4. T h e absolute n u m b e r o f p r e l i m i n a r y contextual inferences varied significantly as a function o f the two-way interaction o f theoretical orientation a n d level of experience, /(1,24)=4.22, p = .051. Expert-psychodynamicists posit many more preliminary contextual inferences than novice-psychodynamicists. Expert-behaviourists posit fewer p r e l i m i n a r y contextual inferences than novice-behaviourists.

162 T i n a G o o d i n Waxman, Socrates Rapagna, Frank D u m o n t

5. Novices posit m o r e confirmatory dispositional inferences than experts, /^1,24)=4.13, p = .053.

6. T h e order i n w h i c h client i n f o r m a t i o n is presented significandy affects the p r o p o r t i o n o f confirmatory contextual inferences to the total contextual inferences posited by clinicians, F ( l , 2 4 ) =5.65, p = .025.

7. N o significant differences were f o u n d in the disconfirmatory inferences (either proportionately o r i n absolute terms) of a dispositional or contextual nature as a function o f any o f the factors.

8. T h e theoretical school to w h i c h clinicians subscribe affects the p r o p o r t i o n o f dispositional inferences to total inferences posited d u r i n g the summary, F(\,24)=5.12, p = .033. Behaviourists posit a greater p r o p o r t i o n o f inferences that are dispositional than d o psychodynamicists.

9. D u r i n g the summary assessment, a n d based o n absolute numbers, psychodynamicists m o r e often than behaviourists attribute client p r o b l e m s to e n v i r o n m e n t a l stressors, F( 1,24)=3.95, p = .058.

10. T h e p r o p o r t i o n of dispositional inferences to total inferences posited d u r i n g the summary varied as a function of temporal order,

F{ 1,24)=4.13, p= .053.

11. T h e absolute n u m b e r o f dispositional inferences retained varied as a f u n c t i o n o f the interaction between theoretical orientation a n d temporal order o f i n f o r m a t i o n , /'"(1,24)=5.39, p= .029. Psychodynamicists presented with contextual i n f o r m a t i o n first retain m o r e inferences that attribute client p r o b l e m s to traits than psychodynamicists presented with dispositional i n f o r m a t i o n first. Behaviourists presented with dispositional i n f o r m a t i o n first retain more inferences that attribute client p r o b l e m s to traits than behaviourists presented with contextual i n f o r m a d o n first .

12. Psychodynamicists retain m o r e contextual inferences than behaviourists, /•"(1,24)=5.08, p = .033.

13. Novices retain more dispositional inferences than experts,

F( 1,24)=5.96, p= .022.

14. N o n e o f the factors a c c o u n t e d for variances i n the n u m b e r o f dispositional a n d contextual inferences rejected.

T h e above results indicate that theoretical orientation, level o f experience, a n d t e m p o r a l o r d e r o f i n f o r m a t i o n differentially affect the types o f inferences (namely, dispositional a n d contextual), the hypothesis-testing strategies (namely, preliminary, confirmatory, a n d disconfirmatory), a n d the final diagnostic operations utilized by clinicians (namely, initiate, retain, a n d reject). These findings have i m p o r t a n t implications for counsellor education a n d are discussed below.

Scripted T h i n k i n g 163

D I S C U S S I O N : I M P L I C A T I O N S F O R C O U N S E L L O R T R A I N I N G

People act o n their beliefs. B u t they h o l d to those beliefs with m o r e c o n f i d e n c e than the e m p i r i c a l basis f o r t h e m warrants. T h i s is as true i n scientific as i n p h i l o s o p h i c a l , political, or religious domains. T h e e m o t i o n that atomic scientists o r medical geneticists invest i n their theories a n d the strident, p u b l i c disputes they engage i n attest to this. It is n o t surprising that the field of counselling a n d psychotherapy has been the scene o f similar e m o t i o n a l debates. M o s t o f the discussions g o o n with litde acknowledged consideration o f the cognitive limits of certitude i n the positions h e l d . C l i n i c i a n s practice as i f their theoretical models o f h u m a n d e v e l o p m e n t were truthful representations o f the w o r l d rather than tentative a n d inherently obsolescent models that were vulnerable to radical i m p r o v e m e n t if not rejection. Students a n d trainees are n o less p r o n e to partisanship than are their teachers or, for that matter, expert clinicians w h o after 30 years o f practice h o l d tenaciously to the p a r a d i g m , hardly altered, that they learned i n graduate school.

Probabilistic Disciplines

A l t h o u g h most branches of psychology are, u n l i k e mechanics, opücs, a n d other specialties of physics, highly probabilistic disciplines, o u r counsellor—trainees tend to treat t h e m as natural sciences. Further, most students c o m i n g f r o m an undergraduate p r o g r a m in psychology d o n o t know the basic principles o f d r a w i n g logical inferences f r o m data. It is for this reason that it is advisable to spend the initial weeks o f a year-long theories course at the masters level o n the philosophy o f science. It is useful to g o into some basic principles of logical reasoning, with special emphasis o n modus ponens a n d modus tollens, two operations f o r testing hypotheses. T h e way a n d the extent to which these principles are violated in both research a n d practice, a n d the faulty heuristics that are c o m m o n l y used i n solving problems c o u l d be the basis for a year-long course. T h e authors o f this article spend perhaps 6 to 9 class hours o n these issues, just e n o u g h to create a healthy scepticism about the conclusions o n e draws about even the most m u n d a n e matters.

When Is a Fact a Fact ?

Related to this issue is the even m o r e fundamental matter o f u n d e r s t a n d i n g when o n e has truly made an inference. O n e makes inferences, o f course, without always being fully aware o f it. C l i n i c i a n s can i m p l i c i d y assume a c o n d i t i o n to exist t h o u g h there are only tenuous reasons f o r believing it. Even w h e n theoreticians begin with a speculation, once they have rehearsed it often e n o u g h , it can assume the character o f

164 T i n a G o o d i n Waxman, Socrates Rapagna, Frank D u m o n t

a fact. It is then no longer questioned. It may be that ideological or religious notions that y o u n g c h i l d r e n hear a n d rehearse h u n d r e d s of times in their c h i l d h o o d a n d youth assume the quality of incontrovertible facts in the same way.

T h e authors of this paper have f o u n d that most e n t e r i n g students in their programs have some difficulty d i s d n g u i s h i n g facts f r o m near-facts or factoids. A n y clinical p r o g r a m c o u l d usefully incorporate some training in placing informaüon as well as conclusions f r o m it o n a c o n t i n u u m o f credibility.

Exploring the Psychology of Theory building

Each counsellor reading this text has probably m a d e a choice o f a theory of counselling or psychotherapy a n d is governed in practice by die constraints of that theory. A l t h o u g h some have chosen to be eclectic in their practice, they are thereby led into some contradictions by virtue of the fact that the u n d e r l y i n g principles of some systems are i n c o m p a t i b l e and irreconcilable. It is difficult to be existentialist, in w h i c h one assumes that clients have a free will a n d are i n f l u e n c e d their entire life by die cultural, social, e c o n o m i c dynamics of the society i n w h i c h they live, a n d at the same time psychoanalytic, in w h i c h one assumes that people are shaped by forces that can be characterized as deterministic, historical, instinct-driven, unconscious, a n d pansexual. A brief e x a m i n a t i o n o f die difficulties of w o r k i n g simultaneously w i t h i n two c o n f l i c t i n g frames of reference will repay the effort. T h i s is, in o u r view, a useful c o m p o n e n t of a t r a i n i n g m o d u l e in any of die mental health and h e l p i n g professions.

It is useful to look at die work of Feyerabend, Lakatos, M a n n h e i m , K u h n , a n d others w h o explore the way professionals c l i n g tenaciously to paradigms, even in die face of seriously d i s c o n f i r m i n g facts a n d research. T h a t there is not a s o u n d e m p i r i c a l f o u n d a t i o n for m u c h o f what is practised is something that needs to be e x p l o r e d with üainees. I h e r e are h u n d r e d s of different therapies, all o f w h i c h have their ardent apologists and practitioners. Each professional practices the one of his or her choice without t h i n k i n g of the many other ways in w h i c h the client c o u l d have been treated by colleagues w h o were i n d u c t e d into other belief systems. W e c a n n o t afford to give this too m u c h thought as it w o u l d tend to i m m o b i l i z e us.

The Value of Tentaliveness

Irainees need to be indoctrinated in the n o t i o n that a diagnosis is always vulnerable to d i s c o n f i r m a t i o n . D e t e r m i n i n g how to do this is still a challenge. T h e research literature indicates that practitioners have die

Scripted T h i n k i n g 165

tendency to f o r m a definitive j u d g e m e n t as soon as they find one cue, one fact that fits their theoretical schema. A friend of one o f the authors said that he had had a heated argument w i d i his father when he was 14-ycars o l d . " A h a — u n r e s o l v e d oedipal c o n f l i c t " was the response. T h e therapist magnified the importance of that i n c i d e n t a n d repeatedly injected it i n other matters. That client d a t u m needed to be tested before it was r e i n f o r c e d . The event fit nicely i n t o the therapist's theoretical template. It may as a result have been given an importance it d i d not deserve — if one assumes that the construct, oedipal conflict, has value to begin with.

Single-cause Etiologies

I h e h u m a n psyche is a resultant of i n n u m e r a b l e life experiences overlaid o n a c o m p l e x physiological substrate. O u t of those myriad a n d powerful factors, all of which have interacted to f o r m the personality o f the individual in treatment, it seems unlikely that there is one alone that can explain a pattern of behaviour whatever. One-trial learning docs o c c u r in a Skinner b o x or a d o g cage — a n d that with a powerful aversive stimulus. It n o doubt has h a p p e n e d in u n c o n t r o l l e d h u m a n experience; it s h o u l d not however, be presumed to have h a p p e n e d in o n e ' s client. Students must be trained not to stop their search when they have f o u n d what they think is a sufficient cause of a p r o b l e m , but to seek m o r e complete explanations, if i n d e e d , explanation is what one wants. L o o k i n g for a "universal p a t h o g e n " is a lure. It leads one to overlook medical, familial, recreational, cultural, vocational, dietary, a n d financial-economic factors. It is d o u b t f u l that one can adequately account for a psychological disorder by a l l u d i n g to one cause. W o r k s h o p components and practica within masters a n d doctoral programs c o u l d usefully integrate exercises a n d lessons that address this issue.

Contextual and Dispositional Variables

People w h o enter counselling programs are almost by d e f i n i t i o n psychologically-minded. T h e h u m a n m i n d fascinates them. T h e liability in this virtue is that they, and perhaps their instructors, focus so intensely o n the m i n d that they lose sight of the circumstances, very often terrible circumstances, that precipitate a n d m a i n t a i n disorders. Assume for purpose of argument that all people are prepsychotic in the sense that it only requires the proper a n d sufficiently intense application of stressors to precipitate a breakdown. In that sense, all nonorganic disorders are post-traumatic stress disorders. The possibility that this is true s h o u l d , by itself, lead practitioners to routinely begin an assessment by e x a m i n i n g the actual contextual forces that press u p o n their clients. T o overlook these leaves

166 T i n a G o o d i n Waxman, Socrates Rapagna, Frank D u m o n t

counsellors with a truncated a n d distorted assessment of their c l i e n t s ' c o n d i d o n .

T h e r e is a m p l e evidence that clinician-observers are p r o n e to e x p l a i n the behaviour o f anyone they are clinically observing by a l l u d i n g to intrapsychic rather than contextual variables. Cases rich in situadonal material as well as disposidonal material n e e d to be presented to students so that they may be trained to assess the impact of e n v i r o n m e n t on their c l i e n t s ' behaviour a n d e m o d o n a l health.

Developing Etiologies

F l o w i n g f r o m the above is a r e c o m m e n d a d o n that students be trained to develop two or m o r e alternative edologies for c o m p l e x case histories w h i c h they have been given to analyze. O n e edology c o u l d be p r e d o m i n a n d y contextual in character. T h e other, intrapsychic. F o l l o w i n g this they c o u l d be b l e n d e d , integrated into a coherent a n d balanced one. O n the other h a n d , edologies can represent two or m o r e disdnct therapeutic orientations for d e a l i n g with a psycho-emodonal disorder. Students can be r e q u i r e d to formulate two such assessments; i n a second m o m e n t they c o u l d be asked to integrate them in one (or more) balanced a n d plausible f o r m u l a d o n s with a treatment a p p r o a c h appropriate to each.

T o i m p l e m e n t a training m o d u l e o f this k i n d w o u l d require professors a n d mentors o n academic staff w h o were individually expert i n different schools o f c o u n s e l l i n g , different treatment modalities, a n d different fields o f c o u n s e l l i n g , not least vocational a n d developmental.

Some Heuristics

Vividness. T h e r e are a n u m b e r of heuristics that operate out of awareness a n d are simple-mindedly a p p l i e d by novices a n d experts alike in solving problems. O n e of the best d o c u m e n t e d of these is that we give m o r e i m p o r t a n c e to factors that are concrete, vivid, pungent, h u m o r o u s , absurd, or flamboyant than to those that are pedestrian, prosaic, a n d p a l l i d . Because an i n c i d e n t is vivid and m e m o r a b l e does not make it intrinsically m o r e p e r d n e n t than, let us say, a data set of omissions by a negligent spouse. Trainees need to be instructed a n d rehearsed i n this i m p o r t a n t p r i n c i p l e .

T h i s is not unrelated to the fact that clients provide an a b u n d a n c e of self-serving details a n d incidents that are vivid a n d repeated. Clients may n o t be fully aware of their need to protect their self-esteem (a laudable objective in se) by giving a more florid e x p l a n a d o n o f their p r o b l e m s a n d their origins. Emphasis may need to be given to d i s c r i m i n a t i n g a m o n g clues relative to their c o n t r i b u t i o n to client problems.

Scripted T h i n k i n g 167

Statistical mindsets. People generally are insensitive to the p r i o r probability o f outcomes i n w h i c h they are interested. Th e y are prone to infer spurious correlations between antecedent A a n d consequent B, w h i c h they have observed, with little consideration o f the probability that B w o u l d have o c c u r r e d i n any event. In short, they i g n o r e baseline data. T h e y d o n o t search out, even superficially, other plausible i f less likely explanations for a s y m p t o m o r a n outcome. A study o f this error within the context o f a p r a c t i c u m m i g h t be rewarded by a later reduction o f its incidence i n professional practice.

T h e same must be said o f students' insensitivity to sample size. Before, let us say, c h o o s i n g an academic course, or school, or profession, or airline, o r n e i g h b o u r h o o d to live i n , it w o u l d be wise to consult with two or m o r e people w h o have already h a d experience with them. Most people are n o t aware o f the power o f seeking three o p i n i o n s over one o p i n i o n . It is good to lead students t hrough a series o f exercises i n w h i c h they will be sensitized to the power o f sample size f o r either e n h a n c i n g o r r e d u c i n g probability o f error.

T h e r e are other procedural biases that clinicians are p r o n e to make, still m o r e so, students and layfolk. Surprisingly, there is little evidence that many university training programs address these sources o f clinical misjudgment. T h e r e will be m u c h m o r e said about this i n the future.

References

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed. rev.). Washington, O C : Author.

A n d e r s o n , N . H . (1965). Primacy effects in personality impression formation using a generalized order effect paradigm. Journal of Personality and Social Psychology, VoL 2, p. 1-9. Arkes, H . R . , & H a m m o n d , K . R . , (Eds.). (1988). Judgment and decision making: An

interdisciplinary reader. Cambridge: Cambridge University Press.

A s c h1S . (1946). Forming impressions of personality. Journal of Abnormal and Sodai Psychology,

41, 258-290.

Ausubel, D . P . (1960). T h e use of advance organizers in the learning a n d retention of meaningful verbal material. Journal of Educational Psychology, 51, 267-272.

Bandura, A. (1969). Prindples of behaviour modification. New York: Holt, Rinehart and Winston. Bishop, J.B., Sc Richards, T . F . (1984). Counselor theoretical orientation as related to intake

judgements. Journal of Counseling Psychology, 31, 398-401.

Cooke, T . D . , Sc Campbell, D . T . (1979). Quasi-experimentation: Design and analysis issues for field

settings. Chicago: Rand McNally.

C r o x t o n . J . S . (1989). Attributional activity in explaining disconfirmed expectancies: T h e search for constraint Social Cognition, 7, 4,138-152.

D u m o n t , F., & Lecomte, C (1987). Inferential processes in counselling a n d psychotherapy: An inquiry into the logical errors that affect assessment and treatment Professional

168 l i n a G o o d i n Waxman, Sócrates Rapagna, Frank D u m o n t

Frederiksen, C H . , Breulcux, A . , Renaud, A . , Sc Perrault, R. (1987). On-Line: A user's manual (Technical Report #1). Laboratory for Applied Cogniuve Science, McGiII University, Montreal.

G a u r o n , E.F., Sc Dickinson, J.K. (1969). T h e influence of seeing the patient first o n diagnostic decision-making in psychiatry. American Journal of Psychiatry, 126, 199-205.

Greeno, J.G., Sc Simon, H A . (1985). Problem solving and reasoning. In R . C . Atkinson, R.J. Hernstein, G . Lindzey, & R . D . Luce ( E d s ) , Stevens' Handbook of experimental psychology, (rev. ed.). New York: Wiley.

Houts, A C . (1984). Effects of clinician theoretical orientation and patient explanatory bias on initial clinical judgments. Professional Psychology: Research and Practice, 15, 284-293. J o h n s o n , P.E., D u r a n , A S . , Hassebrock. F., MoIler1J., Prietula, M . , Feltovich, P J . , Sc Swanson,

D.B. (1981). Expertise a n d error in diagnostic reasoning. Cognitive Sáence, 5, 235-283. Jones, E E . , Rock, L , Shaver, K . G . , Gocthals, G.R., & Ward, L M . (1968). Pattern of

performance a n d ability attribution: A n unexpected primacy effect Journal of Personality

and Social Psychology, /0,517-340.

Kazdin, A . E . ( 1985). Treatment research: T h e investigation and evaluation of psychotherapy. In M . Hersen, A . E . Kazdin, Sc A.S. Bellack (Eds.), The clinical psychology handbook. New York: Pergamon.

Loesch, L . C . , Sc McDavis, R.J. (1978). A scale for assessing counseling orientation preferences.

Counselor Education and Supervision, 17, 262-271.

L o r d , C . G . , Ross, L . , & Lepper1 M.R. ( 1979). Biased assimilation and the attitude polarization: T h e effects of prior theories on subsequently considered evidence. Journal of Personality

and Soaal Psychology, 37, 2098-2109.

M e e h l1P . (1960). T h e cognitive activity of the clinician. American Psychologist, 15, 19-27. Merton, R.K. (1957). Social theory and social structure New York: Free Press.

Nisbett, R., Sc Ross, L. (1980). Human inference: Strategies and short-comings of social judgment. New York: Prentice-Hall.

Pain, M . D . , & Sharpley, C F ' . (1988). Case type, anchoring errors, and counselor education.

Counselor Education and Supervision, 28, 55-58.

Pain, M . D . , & Sharpley, C F . (1989) Varying the order in which positive a n d negative information is presented: Effects on counselors' judgements of clients' mental health.

journal of Counseling Psychology, 36, 1, 5-7.

Richards, M . S . , Sc Wierzbicki, M . (1990). A n c h o r i n g effects in clinical-like judgments. Journal

of CUnical Psychology, 46, 3,558-366.

Sandifer, M . G . , H o r d e r n , A . , & Green, L M . (1970). T h e psychiatric interview: T h e impact of the first three minutes American Journal of Psychiatry, 126, 968-973.

Scheff.J. (1966). Being mentally ill Chicago: Aldine.

Schustak, M . W . , Sc Sternberg, R.J. (1981). Evaluation of evidence in causal inference. Journal

of Experimental Psychology: General 110, 101-120.

Skrypnek, B J . , Sc Snyder, M . (1982). O n the self perpetuating nature of stereotypes about women a n d men. Journal of Experimental Sodai Psychology, 18, 277-291.

Snyder, M . (1984). When belief creates reality. In L. Berkowitz (Ed.), Advances in experimental

social psychology (Vol. 16). New York: Academic Press.

Snyder, M . , Sc Cantor, N . (1979). Testing hypotheses about other people: T h e use of historical knowledge. Journal of Soaal Psychology, /5,330-542.