Increasing Accuracy of Decision Making

Ralph Underwager, Psychology Editor

The interaction between Terence Campbell and Richard Gardner on the issues raised by Dr. Gardner's proposal of indicators of pedophilia is part of what the editors of this journal believe is a necessary next step in responding to allegations of child sexual abuse.¹  We believe it is time to move forward from entrenched and polarized adversarial positions based on dogma to a common ground.  The common ground that appears in both Dr. Campbell's position and in Dr. Gardner's response is increased accuracy of the decision-making process.

Dr. Gardner begins with the all too real clinical conundrum that we can never wait for all the information to be in before acting.  People are being accused, charged, and imprisoned.  But he is very clear in understanding the need for as much accuracy as possible.  That's why he proposes a systematic way of gathering information and organizing it.

Dr. Campbell sees the problem of validators who pursue adherence to dogmas and ignore accuracy and pleads for increased attention to making the best possible decisions.  He emphasizes the necessity for increasing reliability by improving the precision and specificity of indices and draws our attention to the pitfalls of depending upon clinical judgment.  He stresses attending to base rates and notes that the relative infrequency with which pedophilia occurs in the general population increases the probability of false-positive errors when ambiguous and unreliable indices are wed.

The cognitive activity of the clinician is the beginning of all clinical decisions.  What we think and the quality of that thought is the initial arena for increasing accuracy.  One clinical behavior that works to reduce accuracy is pressure to conform to rhetoric or dogmas and thereby produce greater subjective certainty than is warranted (Gambrill, 1990).  This is what has led to extreme polarization (Ceci & Bruck, 1993).  Yet clinicians can control their impressions and thoughts.  In controlled experiments, changing cognitions to emphasize accuracy does have the effect of increasing accuracy (Fiske) 1993).  Here is the common ground that Gardner and Campbell both point to in their concerns and presentations.

It is necessary to start someplace.  Gardner starts with clinical observations and subjective impressions as well as limited scientific data relating to the construct, pedophilia.  This is how all such efforts to systematize knowledge and observations begin, in the subjective, often intuitive, experience of the observer who develops an hypothesis.  This is Richard Gardner's métier.  As Campbell understands, Gardner's brilliant, insightful, and creative intellect interacts with his largeness of heart and compassion to generate the courage to take the first step and offer a systematic approach.  Science needs people with enough ability, ego, and boldness to break out of the conventions and take first steps into new areas.

Even when some procedure aimed at producing valid and reliable information is constructed on the basis of a criterion that may be sloppy, weak, and subjective, it can finally end up showing greater construct validity and increased reliability than the initial criterion (Cronbach & Meehl, 1955).  In the process, purely subjective judgments may be wed as Binet wed teacher judgments in developing the Binet scale for intellectual ability.  Now, however, after years of development, if the test performance does not match the teacher's judgments so that a child seen by teachers as limited scores in the superior range, we do not conclude it is a test miss but rather look for factors that may have depressed the school performance (Cronbach & Meehl, 1955).  This is the "bootstraps" phenomenon described by Dawes and Meehl (1966).  The approach of mixed group validation is what allows a psychologist to deal with open concepts, that is, a category for which he does not have a clear or precise idea of what he means by the term but does not want to abandon the concept.

Campbell's compassion and clinical astuteness are evident in his concern for greater accuracy and a way of systematically organizing information to assist in discriminating pedophiles from non-pedophiles.  He is insightful in meticulously and carefully examining the nature of the signs that Gardner suggests.  He has immediately grasped the major difficulty in pursuing the next step in the development of assessment techniques for pedophiles, that is, the problem of determining what constitutes a sign.  Little attention has been given to this issue but in a largely unknown report Meehl (1965) suggests how to go about this task.

Few clinicians demonstrate even rudimentary awareness of the measurement issues that Campbell clearly understands and attends to in doing clinical work.  Every clinician benefits from those few who do seek the potential for scientific rigor that must undergird all clinical activities.  Campbell's ready grasp of the issues involved in antecedent probabilities and his rare ability to we this concept in a pragmatic and effective manner are both impressive and helpful.  Campbell's commitment to a scientific clinical psychology is maintained with intellectual power and a breadth of knowledge few can match.

Both Campbell and Gardner demonstrate another quality that is almost universally absent in current discourse within the mental health community.  The emphasis upon doing therapy and being therapists seems to have led to a culture within which nobody ever gives anybody else negative feedback.  All actions are rewarded by friendly attention.  Meehl (1973) describes this phenomenon in his explanation for not attending case conferences.  Unfortunately when everyone is deemed right, nobody is wrong.  There is then no challenge to anything and nothing can change.  There can be no educational progress and nothing different gets learned.

When Gardner and Campbell are both willing to be frank, admit to irritation, and to point to something they hold to be wrong, not only are both showing courage and forthrightness, they are creating the necessary ground for the rest of us to learn something.  Therefore we honor both and are grateful for their cooperation in presenting this form of scholarly, scientific discourse.
  

References

Ceci, S. J., & Bruck, M. (1993). The suggestibility of the child witness: A historical review and synthesis. Psychological Bulletin, 113, 403-439.

Cronbach, L. J., & Meehl, P. E. (1955). Construct validity in psychological tests. Psychological Bulletin, 52, 281-302.

Dawes, R. M., & Meehl, P. E. (1966). Mixed group validation: A method for determining the validity of diagnostic signs without using criterion groups. Psychological Bulletin, 66, 63-67.

Fiske, S. T. (1993). Social cognition and social perception. In L W. Porter, & M. R. Rosenzweig (Eds.), Annual Review of Psychology, 44 (pp.155-194). Palo Alto. CA: Annual Reviews, Inc.

Gambrill, E. (1990). Critical Thinking in Clinical Practice (). San Francisco: Jossey-Bass Publishers.

Meehl, P. E. (1965). Detecting latent clinical taxa by fallible quantitative indicators lacking an accepted criterion. Reports from the Research Laboratories of the Department of Psychiatry, University of Minnesota. Report no. PR-65-2. Minneapolis, MN. University of Minnesota. May 25, 1965.

Meehl, P. E. (1973). Why I do not attend case conferences. In Psychodiagnosis: Selected Papers ()() (pp. 265-302). Minneapolis. MN: University of Minnesota Press.