Researchers have tended to take one of two mutually exclusive positions concerning the nature and status of clinical decision-making. On the one hand, clinicians are urged to be more rigorous and analytical when assessing a client, to disregard their intuitions and instead utilise explicit rules and algorithms. On the other hand, they are counselled to regard their “gut feelings” as valuable sources of knowledge about clients. As a way of reconciling these two perspectives, it is important to acknowledge that clinical psychologists are confronted with a wide range of assessment and clinical tasks that vary in their degree of structure. Therefore, in order to effectively manage the diverse tasks they face during a typical assessment, they need to possess a wide range of cognitive skills. These skills, and their associated cognitive tasks, will span the cognitive continuum from the intuitive to the analytical poles (Hammond, 1996).

In the course of psychotherapy, psychologists need to make important clinical decisions regarding treatment goal selection, measurement procedures, and treatment methods. These decisions can be made without regard to the epistemic and ethical responsibilities that accompany professional status. Epistemic duties are obligations to obtain and have knowledge, while ethical duties are obligations to apply this knowledge accurately. We argue that these epistemic and ethical responsibilities are invoked and can be adequately addressed in the informed consent process. When the informed consent process is violated or done poorly, our epistemic and ethical responsibilities are not met and the client may be harmed. We argue that what the public assumes it is buying from us (and what we purport to sell) are specialised knowledge and skills; when psychologists are not meeting their epistemic duties, what our clients are receiving instead is intuition and performance art. We discuss errors that occur in the course of psychotherapy, as well as how we as professionals must seek to reduce or eliminate them.

One of the dilemmas in behavioural assessment is the extent to which both specific functional analyses and more general case formulations are dependent on professional judgement and thus subject to bias. While in theory the functional analysis represents hypotheses about controlling variables which can then be subjected to empirical test, the clinical reality is that many such hypotheses are only loosely evaluated, post-hoc, by virtue of the success, or otherwise, of treatment. The role of cultural variables in the development and testing of hypothesised functional relationships is thus particularly difficult to evaluate. This paper suggests guidelines for evaluating the cultural context of behavioural assessment in clinical practice. The proposed criteria are seen as having relevance in assessing clients of both dominant and nondominant cultures. In Aotearoa / New Zealand these issues are examined within a bicultural framework. Legal and moral imperatives defining a partnership between two peoples mandate additional considerations for sound clinical assessment. The practical implications of these issues for ensuring a culturally sensitive application of behavioural assessment principles are examined according to psychometric standards, principles of behaviour change, and ethics.

The present paper argues that discussion of the role of reasoning in clinical neuropsychology has been largely restricted to a debate over the reliability and validity of end-stage decision-making. This has sometimes led to heated debate, but has not resulted in any careful consideration of either the process of clinical reasoning or the cognition of the clinician. There is already a wealth of theory and research on the kinds of errors typical of human judgement and decision-making. Moreover, much of this work is particularly relevant for neuropsychology, being frequently based on research on medical diagnosis. This literature is briefly reviewed, with examples that demonstrate the relevance of research in this area for clinical neuropsychology. Then, a step-by-step approach is taken to examining the process of clinical neuropsychological assessment, with consideration at each step of some of the issues that arise demanding clinical reasoning. Finally, the article is briefly summarised and some implications for clinical training are advanced.

Clinical reasoning is one of the central components of psychological assessment. The identification of a client's psychological difficulties and the subsequent depiction of their onset, development, and interrelationships enables clinicians to plan treatment in a systematic and effective manner. In a recent paper (Ward & Haig, 1997), we presented an abductive theory of method and showed how it offered a useful framework for highlighting and integrating the major phases of psychological assessment. These phases involve detecting clinical phenomena, postulating psychological mechanisms, developing a case formulation, and evaluating a case formulation. In this paper we outline the abductive theory and elaborate on the related clinical dimensions of assessment, while illustrating them with an ongoing case example.

This paper undertakes a conceptual and methodological examination of construct validation from the viewpoint of a scientific realist philosophy of science. It is argued that there is an important need to revise our thinking about the methodology of construct validation and to incorporate the revisions into clinical psychological practice. After a brief characterisation of construct validation, the paper points out the inadequacies of operationalism and cautions against the heavy appeal to definitions in science. Thereafter, psychology's standard construct validation strategies of hypothetico-deductive testing and null hypothesis significance testing are criticised, and the importance of abductive reasoning for construct validation is spelled out.