Examination of the Role of Implicit Clinical Judgments During the Mental Health Intake

Abstract

We examined the characteristics of therapists’ implicit clinical judgments during the mental health intake. Following the intake sessions with new clients, we conducted 129 semistructured interviews with 47 therapists. We found that 82% of therapists and 75% of interviews included reference to implicit clinical judgments. Therapists referred to these judgments as a cognitive process that relied on knowledge acquired through past clinical experiences and was primarily based on nonverbal cues and affective communication. Therapists used implicit processes when evaluating how to facilitate a good working alliance, what diagnostic information to collect, and how to decide on a diagnosis. The majority of therapists described elements of good rapport, such as being listened to, as central for a positive outcome of the intake. We concluded that implicit clinical judgments were vital to allow therapists to integrate the plethora of information from different channels of communication they collect during the intake.