By Dr. Jason N. Camu
licensed clinical psychologist
In a field seen perhaps more for mystery and art than science, as psychologists we sometimes struggle to explain our methods and procedures. This is especially true when our own emotional experience is used as a less than scientific tool in the moment.
Our patients want to believe and trust that we can help and that we know how to help. Sometimes the notion that you are a very “intuitive” person is reassuring to a particular type of patient—maybe the person who needs to believe in something bigger and more impressive than the tested hypothesis. For others it means the doctor is not bound by reason and the rules of the social sciences, but rather is flakey and magical. After all, other professions like medicine and law make it clear; because it is in fact clear. I wanted an x-ray for my broken elbow, not the physician’s intuitive sense that it was shattered.
“Intuition” may conjure images of a well-timed intervention that freed a patient from his or her internal prison. Conversely it may sound imprecise, affected, and unskilled. Like any of our tools, if intuition is to be judged as useful, discussion of what it actually is may be beneficial.
What then does “intuitive” mean? I posit the following regarding intuition as it applies to clinical work. Many psychologists are remarkably sensitive people with wonderful gifts in terms of reflective capacity, observation, and detail. This natural or innate predisposition of strong affect is then sifted and structured through education and professional training. Consequently, in addition to all of our scientifically derived skills as psychologists we also aim to use of our own feelings and reactions to further understand people—for example, the confusion that occurs at a staff meeting regarding a psychotic patient (parallel-process), or the schoolgirl crush that is privately experienced by a female intern for the handsome and just charming enough young sociopath. These are examples of countertransference in some form or another. When we fail to acknowledge and explain the experience of countertransference or projective identification, the feelings may be priming the inevitable build up of something that becomes intuitive.
Thus the collision between projected material that is felt (identified with) and our own life experience that also results in an intuitive action by the psychologist, is unique because it escapes understanding or articulation, e.g., “I don’t know it just felt intuitive.”
Intuition in clinical practice may be defined as the following:
The accumulation of powerful emotional data gathered via profound sensitivity and attention to both verbal and non-verbal cues and all of the senses known and unknown, that simultaneously elicits feelings in the recipient that are not articulated or understood in the moment, yet may be translated to action or intervention.
The inability to clearly articulate the source of the intuition should spark interest for those of us in the business of introspection and insight. Action without understanding could be risky. Conversely, it could be just what a patient needed, or doctor ordered for that matter.
Dissection of these keen moments of emotional
experience—whether you acted on your intuition or not—may yield incredibly meaningful information about your patient, and maybe more importantly about you. A colleague of mine described a feeling that one of his psychotic patients was in fact safe to have to his home for dinner. Arguably, this patient’s treatment needs included socialization and interpersonal skills. But what of his history I asked. He could be impatient and verbally aggressive and had poor frustration tolerance, including a formal thought disorder. So what was it that my colleague felt that made him so certain this man would be safe with his family? And my colleague by all measures of performance, including treatment outcome, is an excellent psychologist and not foolish. Maybe this was a terrible lapse of judgment, a boundary violation, and a dangerous empathic fantasy to help. I knew I would never do it. Rather than judge and blame, I wondered.
So I had to wonder about the mechanism, or pathway of internal experiences that led my colleague to this place. Perhaps it was an emotional bond with this person. This patient cared enough about the psychologist that the dynamic experience between the two was internalized (a newer object relationship), and caring developed. Caring for the therapist resulted in a moral standard against hurting the therapist or anyone the therapist cares for; and maybe my colleague felt this change. But this would be a clinical explanation after the fact, derived mostly from object relations and psychodynamic theories. My colleague had already acted and invited this patient home from a residential treatment facility. I knew this was well outside of my comfort zone. And years later this patient has thrived from this real-life trusting relationship with the psychologist and en vivo experience with boundaries and rules.
Accuracy and efficacy of intuition—does it work? A word that often precedes intuition is trust: “trust your intuition.” But assessing the accuracy of, or usefulness of your intuitive gifts can be difficult. As psychologists we know that like the people we treat, we are susceptible to our own self-serving biases and the use of defenses. For example, if a patient decompensated following the use of intuition, would it be noted? Would the patient be held responsible for simply defending against the truth. Said differently, the intervention was accurate and useful but it was the patient’s resistance that thwarted the intuitive wisdom—remember it is a patient’s job to use defenses against things that are painful. Maybe operating intuitively was off the mark. Another question that surfaces is, would the misaligned intuitive intervention even be noticed by the clinician? Social psychology tells us that Biased Scanning is used to confirm our biases. Consequently we only notice, acknowledge, and count/log those events that are consistent with what we believe to be true. The evidence that suggests that we might be wrong is never even noticed.
I have found that one of the best ways to keep myself accurate and honest is through the use of supervision, especially peers that will offer honest observations rather than personal judgments. It is the group that will come to see your patterns, strengths and weaknesses even when you don’t. Peers also pose the recurrent question either directly or indirectly, “why do you think this was, or would be helpful for this patient?” This challenge can reorganize the scientist in all of us, allowing for critical reason-based thinking as well as the integration of what I believe is one of our greatest gifts, sensitivity. To correspond regarding this or other articles, please contact me, Dr. Jason Camu via email at: firstname.lastname@example.org.