Psychologists' experiences of decision-making in clinical work : a thematic analysis

Abstract

Within the clinical decision-making literature, one under-researched area is related to psychologists’ decision-making from the perspective of their experience. Given the varied backgrounds of clinical and counselling psychologists, insight is needed into their decision-making experiences to provide a comprehensive overview of clinical practices. This type of approach could offer a bridge between the didactic decision making literature and real world clinical psychotherapeutic work. This qualitative study aimed to explore psychologists’ experiences of clinical decision-making from a critical realist perspective. Eight clinical and counselling psychologists were interviewed, using a gradual reveal case vignette exercise and a semi-structured interview schedule. Data were analysed using Thematic Analysis and the pertinent aspects of participants’ experiences of decision-making were captured in five themes. Each of these themes contains participants’ reflections on the various foci of the therapeutic work that become the point of reference for decision-making at different stages. Additionally, participants discussed the impact of professional experience, reflexivity, and the context of decision-making. Some of the key findings in relation to the decision-making experiences of psychologists show that decision-making is overall a complex and potentially anxiety-provoking aspect of clinical practice. This complexity is a result of uncertainty in the work, which was noted as being tiring. Available literature has thus far neglected these key experiential dynamics within decision-making, creating the potential for a vast gap between theory and practice. Participants have stated that the challenges in ongoing decision-making are balanced by their collaboration with colleagues and attention to self-care. A number of theoretical and clinical implications for research and clinical practice arise as part of the findings of this study. These recommendations are offered with consideration of the cognitive implications of anxiety in clinical decision-making and contextual influences on the varied roles of psychologists.