Jossey-Bass Inc., Publishers Description: This 432-page book is intended to assist all mental health and other professionals who want to improve their decision-making ability. Very few human beings would not benefit from such improvement inasmuch as the decision-making theorists and researchers have demonstrated the weaknesses we show in the decisions that we make. Very few of us are aware of the decision-making process in which we engage or the fact that there are clear patterns to the errors commonly made when making decisions. Chapter 1 describes those kinds of errors, as they are
typically made in clinical practice and the sources of those errors. Chapter 2
looks at the influences on clinical practice that affect the making of
decisions. Chapter 3 looks at the training of clinicians and how-to-learn skills.
Reasoning and helpful distinctions that may assist in argumentation and
explanation are discussed in Chapter 4. Language, interviews, and possible
errors linked to language usage are dealt with in Chapter 5. In what may be the
most important, though most difficult chapter, Chapter 6 exposes and analyses
common fallacies that can lead to bad decisions. Errors affecting classification
decisions, the focus on pathology, and acceptance of pseudoauthority are
considered in Chapter 7. Chapter 8 examines how data are collected and how
subjective, unacknowledged factors may influence what is observed and reported.
Chapters 9 and 10 essentially deal with debiasing the clinician and overcoming
some of the sources of error discussed throughout the book. The dangers and
errors generated by multi-disciplinary teams and group decision making are
handled in Chapter 11. Factors that may get in the way of improving clinical
decision making are presented and guidelines on steps to maintain necessary
critical thinking skills are found in Chapters 12 and 13. Discussion: In the interaction between the science of psychology and efforts to improve human welfare there is no more critical skill than clinical decision making. Psychology has managed to sell society the idea that it can contribute to improving human welfare, although there are many nonpsychologists who find such claims pompous and pretentious. Nevertheless, there are more and more mental health professionals who are making more and more clinical decisions in more and more arenas and for more and more people. From the design of space vehicles to improving the skills of Olympic champion weight lifters to documenting the visual acuity of the walleyed pike, psychologists have become emboldened to inform, educate and decide. Psychiatrists and social workers look to the science of psychology to undergird and buttress their own pronouncements and professional status. The only thing that can justify the influence of mental health professionals as opposed to decision making by reading chicken entrails, throwing dice, or trial by combat, is the capability to demonstrate that the decisions made are better than chance would produce. At least in the arena of forensic psychology, it would be difficult to establish that claim given the current foundation underlying clinical decisions made by mental health professionals. At the same time that the decision-making process of mental health clinicians appears to be declining in quality, the frequency of mental health professionals being called upon to make decisions that materially and powerfully affect human life is increasing. There are two groups of people who can benefit from Dr. Gambrill's book. The first, of course, are those who make clinical decisions. Patient, persistent, and steady effort based upon the material in this book will raise the quality and accuracy of clinical decision. Psychologists, psychiatrists, social workers, counselors, and anybody else who makes decisions affecting the lives of other people are in debt to an author who so clearly and thoroughly exposes error in decision making and so sympathetically and warmly points out how to make it better. Dr. Gambrill puts her thoughts into small sized bites that can be chewed, swallowed and digested. Though the book may be read in a single sitting, it is not the kind of book that you read, put on a shelf and forget. This is a book that should go on your nightstand or on your credenza to use for reference, to refresh your thinking while you are wrestling with a difficult decision, or to learn how to deal with the monumental "dumbness" you encounter in colleagues and case conferences. The second group of people who can benefit from this book are those who are objects or consumers of clinical decisions made by mental health professionals. These may be patients, clients, attorneys, judges, bosses, other family members, and politicians. A very necessary skill for consumers of clinical decisions is a good balderdash detector. Without such a detector, you cannot tell the score, know the players, nor find the nuggets among the dross. Careful attention to the information in this book can assist in the development of, at least, an improved recognition of what may need to be questioned, what can be safely discarded, and what must be vigorously and aggressively denounced and avoided. This is a book to be bought, studied, carried about, and used. Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota.
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