A qualitative study of how marriage and family therapists make clinical judgements

Within the field of marital and family therapy (MFT), there is growing recognition among research-practitioners that the advancement of MFT as a viable treatment option rests upon research-practitioners' ability to provide consumers with descriptions of the clinical processes of MFT. However, a research focus on clinical processes is being neglected. Thus, understanding the process of clinical judgment is an essential component of advancing the practice of MFT as a viable treatment option. The traditional approach is based upon the information-processing model and focuses on the internal, subjective judgment processes of the clinician to the neglect of the influence of context and therapist-client interaction on the judgment process. The purpose of this dissertation was to describe the judgment process of clinicians from a contextual assumptive framework. This dissertation moves the research area of clinical judgment into the realm of MFT and attempts to initiate a paradigmatic shift within the broader research community's already existent interest in clinical judgment. A grounded theory approach was used to answer the research question, "how do marriage and family therapists diagnose or arrive at a problem definition during the first session of therapy?" In answering the question, the process which emerged involved, in varying combinations: (1) comparing and contrasting knowledge that existed in the mind of the clinician prior to meeting the client with information obtained from the client during the session; (2) using an understanding of how larger contextual factors affected client and therapist experience during the session; and (3) having an awareness of what is happening between clinician and client, and determining how information from, and the experience of, the client fit with clinicians' previous experiences. Clinicians engaged in two meta-level judgment processes. The distinction between internal and conversational judgment processes was that the clinicians engaged in conversational judgment processes: (I) made overt their judgments and incorporated them into the therapeutic conversation; and (2) relied upon client input about what would or would not be helpful when constructing their judgments.