text: UFDC Home | Help | RSS Title: roots of a clinical intuition in counseling CITATION THUMBNAILS PAGE IMAGE ZOOMABLE Full Citation STANDARD VIEW MARC VIEW Permanent Link: http://ufdc.ufl.edu/UF00102712/00001 Material Information Title: roots of a clinical intuition in counseling Physical Description: Book Language: English Creator: Daley, Lauren Pasquarella Copyright Date: 2006 Record Information Bibliographic ID: UF00102712 Volume ID: VID00001 Source Institution: University of Florida Holding Location: University of Florida Rights Management: All rights reserved by the source institution and holding location. Full Text ROOTS OF CLINICAL INTUITION IN COUNSELING: A QUALITATIVE APPROACH By LAUREN PASQUARELLA DALEY A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2006 ACKNOWLEDGMENTS I want to thank my husband, Matthew, for his support, love, and encouragement throughout my entire doctoral program and particularly while writing this dissertation. He was my rock to build upon whenever I struggled during my research. His support and help also gave me the strength and will to finish my research in the times when finishing did not seem probable. Without his love, motivation and assistance, furnishing this project would not have been possible. I also wish to thank my parents, Ron and JoAnn Pasquarella, for instilling a love of education and a sense of curiosity in me, without which I would never have pursued my doctorate. I wish to also thank my advisor, Dr. Peter Sherrard, for giving me his support, encouragement, and freedom to explore a nebulous topic. He gave me the latitude to discover while also helping me when I got bogged down in the details. Our discussions inspired me and triggered my own intuition regarding the direction of my research. Without his guidance and motivation, I would not have finished this project. I also want to thank my methodologist, Dr. Mirka Koro-Ljungberg for her patience, understanding, encouragement and assistance throughout writing my dissertation. I learned a great deal from her during my research and have opened my eyes to a different point of view about science from working with her. Without her timeliness in returning my drafts and direction in my study, finishing this dissertation would not have been possible. Finally, I wish to thank the remainder of my dissertation committee, Dr. Harry Daniels, Dr. Mary Fukuyama, and Dr. Paul Schauble for their patience, assistance, support and understanding while I wrote my dissertation. Without their openness to discuss a topic such as intuition in a scholarly fashion, I would never have started the project. Throughout the dissertation, their support and open-mindedness encouraged my completion of this project. TABLE OF CONTENTS Page ACKNOWLEDGMENTS ................... ......................................................1 FIGURE............................................ ...- -------- -------- ABSTRACT ................... .......................................----------------------V CHAPTER 1 INTRODUCTION ................... ................... .................................... 2 REVIEW OF THE LITERATURE ................... ................... ....................13 3 METHOD ................... ................... ........................................4 Data Collection ................... ................... .....................................5 Sampling ................... ................... ............ . ................... ....5 Participants ................... ................... ......................................5 Interview Procedures ................... .....................................................5 Validity and Reliability ................... ................... ...............................6 Data Analysis ................... ................... .......................................6 4 FINDINGS ................... ................... ......................................6 5 IMPL ICATION S & CONCLUSIONS ................... ................... ................ 8 7 APPENDIX A INITIAL INTERVIEW QUESTIONS ................... ................... ................98 B REVISED INTIAL INTERVIEW QUESTIONS ................... ................... .....99 C FOLLOW-UP INTERVIEW QUESTIONS ................... ................... .......1000 D SAMPLE THEORETICAL MEMO ................... ................... .................101 REFERENCES ................... .................. ................... ...................103 BIOGRAPHICAL SKETCH ................... ................... ..............................11 FIGURE Figure paae 1 Theoretical Model of Clinical Intuition in Counseling ................... ............67 Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy ROOTS OF CLINCIAL INTUITION IN COUNSELING: A QUALITATIVE APPROACH By Lauren Pasquarella Daley May 2006 Chair: Peter A. Sherrard Major Department: Counselor Education The purpose of this study was to better define and understand how counselors make meaning and how counselors use that meaning of their clinical intuition to help clients by developing a preliminary theory of its use in counseling through a series of semi-structured interviews with counselors that were analyzed using constructivist grounded theory methodology. The scholarly nursing, medical and business literature and the personal experiences of counselors suggest that using intuition while counseling can benefit the counseling process and thus benefit the client. However. the way counselors make meaning of their intuitions and how they use them in practice has not been studied. Constructivism states that individuals construct meaning of reality and the events within that reality inside their individual minds. Grounded theory is a qualitative research method aimed at developing a data-based theory. Using constructivism as my theoretical foundation and grounded theory as my methodology, I studied two research questions: how do counselors construct meaning of clinical intuition and how do counselors use the constructed intuitions to help their clients? I interviewed five counselors with varying levels of experience and coded the data according to grounded theory methodology. The theory that emerged from the data is as follows: counselors construct meaning of clinical intuition as a sense of knowing or awareness about their clients, resulting from the counseling relationship, that they then communicate to the client, benefiting the counseling process. The theory incorporates elements of defining what intuition is and how the counselors receive or recognize it as intuition, the importance and cyclical nature of the counseling relationship in generating clinical intuition, how counselors communicate the intuitions to their clients, and also the boundaries and benefits of using clinical intuition. The research confirmed the concept that using clinical intuition while counseling is beneficial to the counselor and the client. As a result, counseling training programs should incorporate some aspect of teaching counselors to trust their intuitions so they use them more regularly. Furthermore, managed care and insurance plans should support counselors using clinical intuition as it moves the client toward therapeutic change more quickly. CHAPTER I INTRODUCTION The Roots of Clinical Intuition in Counseling: A Qualitative Approach The ability to receive information from an unknown source has been a point of psychological contention for many years. From an objectivist perspective, intuition is often considered a nonsensical idea. However, with the surging public interest in these topics, the various anecdotes describing personal experiences with such insights, and the investigation of intuition/clinical intuition in the medical, nursing and business fields, there is a trend toward examining these constructs from a research-based perspective. Although the amount of research on intuition is growing, there have been relatively few studies of the role intuition (clinical intuition) plays in counseling and for counselors. Most of the intuition research has been conducted in the last fifty to sixty years. However, interest in intuition is not new. Those able to "predict" the future have offered guidance to seekers throughout the history of humankind. Intuition is not just the idea that one can predict the future. Intuition is also the sense of knowing something before having hard evidence for it. Additionally, Eastern medicine and native traditions have long believed that warnings about disease and crisis can come through intuitive knowledge (Sue & Sue, 1999). This belief that before any physical manifestation of disease occurs, the mind-body-spirit sends warnings through intuition and dreams is gaining limited acceptance in Western medicine, psychology, and counseling (Barasch, 1993). Despite the long history describing intuition, the idea that everyone has this intuitive ability is a relatively novel idea. Many contemporary authors believe that intuition is an innate, natural, and important skill every person has and can develop further (Day, 1996; De Becker, 1997; Emery, 1999; Faiver, McNally, & Nims, 2000; Klein, 2003; Naparstek, 1997; Schulz, 1998; Shirley & Lagan-Fox, 1996; Vaughan, 1979). Not only is intuition viewed as a natural skill, but it is also considered by some to be the voice of the soul, connecting the mind-body-spirit to its higher self (Naparstek, 1997: Zukay, I989). This study will attempt to further describe and understand the phenomenon of clinical intuition in counseling by interviewing counselors and analyzing the interviews using grounded theory (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Definition of Intuition What exactly is intuition? Many authors define intuition in different ways. However, most definitions of intuition state that it is an unconscious, non-rational means of receiving information. Popular culture and academic authors, although using different language, often describe intuition in similar terms. From a pop culture perspective, Day (1996) defines intuition as "a nonlinear, nonempirical process of gaining and interpreting information in response to questions"' (p. 83). Intuition is comprised of three primary modalities: precognition (knowing future events), the intuitive experience (knowing current events), and dreams (either precognitive or intuitive). Day (1996) noted that we may perceive information from intuition through clairvoyance (seeing), clairsentience (feeling), and clairaudience (hearing). Goldberg (1983) clarifies further that although intuition is often linked to the psychic phenomena of precognition, ESP, telepathy, clairvoyance, and clairaudience, only precognition and ESP are truly intuition. Goldberg (1983) believes that the intuition of precognition occurs when people pick up information not available through our ordinary five senses and is by definition extrasensory. Other contemporary pop culture authors define intuition as "a clear knowing without being able to explain how one knows, or knowledge gained without logical or rational thought. Intuition is the receipt of information from a nonphysical database" (Emery, 1999, p. 5); and/or "when we directly perceive facts outside the range of the usual five senses and independently of any reasoning process" (Schulz, 1998, p. 19). Naparstek (1997) describes intuition as "psi [her italics]--the knowing and sensing that overleaps logic, analysis, and rational thought and just shows up. This is called intuition, ESP. psychic ability, telepathy, clairvoyance, high sense perception, and paranormal intelligence" (p. I5). Scholarly definitions of intuition include similar concepts. One definition of intuition "implies rapid understanding or knowledge without the conscious use of reasoning" (Bowers, Regehr, Balthazard, & Parker, I990, p. 72). Another author describes intuition as "[a] hunch .. events or processes that occur in the absence of conscious mental will .. a bridging function that brings information into awareness in the absence of directed mental activity" (Isenman, 1997, pp. 395-396). Hall (2002) describes intuition as "cognitive 'short-circuiting' where a decision is reached even though the reasons for the decisions cannot be easily described" (p. 216). In addition to defining intuition as a means of obtaining and processing information, intuition is also one of the perceptive functions of Jung's theory of personality type that reveals the possibilities that may exist in what we have perceived (Andersen, 2000). Hogarth (2001, pp. 6-7) provides an in-depth definition of intuition based on its usage in Merriam-Webster's Collegiate Dictionary: It refers, in one sense, to (a) "immediate apprehension or cognition," (b) "knowledge or conviction gained by intuition," (c) "ithe power or faculty of attaining to direct knowledge or cognition without rational thought and inference" and, in a second sense to (d) "quick and ready insight." Thus the common understanding is seen to involve elements of speed of knowing (definitions ar and d) and the lack of a deliberate or rational thought process (definition c). In addition, there is the notion of a store of knowledge that has been built up over time through past intuitions (definition b). Finally, a link is made to the notion of"insight"' (definition d). Examining the concept of intuition in more depth, it is instructive to consider it along the dimensions process, content, and correlatres [his italics . Hogarth (2001) goes on to describe the process of intuition as "characterized by a lack of awareness of how outcomes--or judgments--have been achieved" (p.7); content as ''intuitive judgments are inferences that can look both backward and forward in time"' (p. 8). They can also represent "outcomes of a stock of knowledge"' (p. 8); correlates as ''the term iniuitioon suggests certain correlartes [his italics]. Among these are notions of speed and confidence .. However, neither speed nor certainty are necessarily correlates of intuitive thought" (p. 10); and insight as "the phenomenon whereby people suddenly become aware of the solution, or part of the solution, to a problem with which they are confronted" (p. 12). Definition of Clinical Intuition Hogarth's (2001) definition of intuition incorporates the other definitions into a more thorough explanation that involves elements of quick unconscious knowing, inferences using hypotheses or beliefs to diagnose/describe/interpret past experience or predict future experiences, expertise, certainty that our inferences are correct, and problem solving. Expanding Hogarth (2001) to fit application in counseling, my definition of clinical intuition is the speedy, unconscious knowing of information about a client, used to form hypotheses about a client without rational, logical means of what sort of treatments will work well with a client, and/or used to determine a new course of action with a client if feeling stuck. Carl Jung talked about clinical intuition (the ability of a skilled practitioner to infer a problem without formal diagnosis) and as a means of identifying a personality trait (Osbeck, 1999). Clinical intuition is similar to counselor judgment, which is "the process of developing intuition, gathering information. and drawing conclusions about client concerns" (Haverkamp. 1994, p. 156). Welsh and Lyons (2001, p.299) describe clinical intuition as "the ability to 'sense' when something is not as it appears to be." Myers (2002) states clinical intuition is composed of diagnostic intuition (predicting diagnoses) and therapeutic intuition (predicting the best choice of therapy for the predicted diagnosis). Each of the above clinical definitions touches on the basics of my definition, although they do not describe the use of clinical intuition in moments of uncertainty with clients. These moments of feeling stuck or not knowing how to proceed are ripe situations for eliciting clinical intuition and therefore, an important component of clinical intuition I added with my definition. The Non-Rational Nature of Intuition and Why Studying Intuition is Important Opponents of intuition have posed different views and different dermnitions. Many authors describe intuition (all forms and types, including clinical intuition) as the automatic information-processing that accompanies expertise in a variety of disciplines (Gambril, 1990; Hall, 2002; Isenberg, 1991; Klein, 2003; Myers, 2002). Intuition is also described as faulty thinking, incorrect logic, and full of cognitive biases and error by some contemporary authors (Gambril, 1990, Hall, 2002; Myers, 2002). Despite these criticisms, intuition and clinical intuition are by their definitions, outside reason and therefore outside of rational inquiry. However, we cannot ignore intuition for not fitting nicely into a technical rational "box": it is a valid means of receiving credible information for many people and must be more deeply understood. According to Paul Feyerabend (1978), scientific education and the currently accepted methods of conducting scientific inquiry stifle the growth of knowledge and the discovery of new ideas. He states that although many believe science needs its strict rules to promulgate the authority of science, he believes that such strict rules strangulate the process of discovery. Because the world is a largely unknown entity and we must keep our options open while studying it, strictly adhering to any particular epistemology hurts the progress of knowledge. Furthermore, Feyerabend (1978) states that the way we currently teach science "'cannot be reconciled with a humanitarian attitude" (p. 20) because it encourages suppressing liberty, individuality, and freedom in the name of reason and/or scientific methodology. Feyerabend (1978) stated that the current scientific standard of basing truth and knowledge on verifiable observations and facts is not the sole method of dictating truth and knowledge. By fostering such a standard of thought in our scientific education, we are brainwashing conformists that cannot rely on their creativity or intuitions to find novel research topics or novel approaches to previously studied phenomena. Creating conformity in science allows scientists to maintain their '"authority" and to maintain the status quo of their dominant paradigms by claiming their sole scientific method/approach leads to absolute truth and knowledge. Feyerabend (1978) states that all methodologies are flawed, all theories have inconsistent facts, and that there is no absolute truth, only absolute conformism. To break from the terror of reason, we must become anarchists (Feyerabend, 1978). Feyerabend (1978) defines anarchist as: When choosing the term "'anarchism" for my enterprise I simply followed general usage. However, anarchism, as it has been practised [sic] in the past and as it is being practised [sic] today by an ever increasing number of people has features I am not prepared to support. It cares little for human lives and human happiness .. and it contains precisely the kind of Puritanical dedication and seriousness I detest. .. It is for those reasons I now prefer to use the term Dadatism~ [his italics]. (note, p.21). Feyerabend believes that the brainwashing in our scientific education for using the scientific method as the only valid means of knowing is so intrinsic in our Western culture that even anarchists in other arenas buy into the myth of scientific reason and knowledge. This devotion to the scientific method is pervasive and difficult to escape in our culture. Scientific d'adacists should be able to look beyond this attachment to reason and explore new topics in new ways. Polanyi (1962) states the scientific community is its own political entity, ensuring both the authority of its knowledge and its survival through widespread and subtle manipulation of what is considered "scientific." According to Polanyi, scientific knowledge is judged on its plausibility (credibility of the topic in light of current scientific opinion) and its scientific value (an interplay between the accuracy of, the systematic importance of, and the intrinsic appeal of the topic). The plausibility and scientific value of topics interact with the originality of research ideas, making some scientific topics more "valid" than others based on the quality of the interaction. Polanyi (1962) further elaborates this notion by discussing the nature of facts. To Polanyi, facts are never absolutely true but only considered as truth by the scientific community because they fit in with the current scientific opinion. Polanyi (1962) believes that science must enforce its standards to protect itself from frauds, as a result, this protection becomes a necessary evil in that some ideas are not considered scientific or "in vogue" until the historical era or paradigm changes (Kuhn, 1962/1996). Scientific authority must balance tradition with originality of ideas while simultaneously suppressing quacks and bad science. As more and more journals accept and publish qualitative studies and as there are many researchers in traditionally "rational'' fields (medicine, nursing, and business) studying intuition, it appears that the paradigm is shifting to make room for more qualitative research on intuition. As a result, it appears that the balance amongst plausibility, scientific value and the creativity (Polanyi, 1962) of intuition might now be "right" for studying intuition. Because intuition is, by its very nature, non-rational, it does not mean it is less important or less valuable to human decision-making or experiences. Faithfully adhering to any one way of creating knowledge, such as the awesome devotion our modern Western society gives to the scientific method, can ultimately limit what we know about humans and the world in which we live to topics that may be easily studied by the scientific method. Rationale for the Current Study The rationale for this study is to better define and understand how counselors make meaning of and use their clinical intuitions with clients by using grounded theory (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987: Strauss & Corbin, 1998). Despite the many divergent views of intuition and clinical intuition, there are relatively few empirical studies discussing clinical intuition specifically in counseling. I hope to better understand how counselors construct knowledge about their clients using clinical intuition. I developed a theory/perspective (from a constructivist framework) that furthers understanding of counselors' meaning and use of clinical intuition, based in data from my participants. Since there is little empirical research on clinical intuition in general and even less specifically to its use in counseling, grounded theory is a conceptually helpful way to approach the topic. Additionally, as intuition is non-rational, using grounded theory's more structured set of analytic tools will help to ground the analysis. Subjectivity Statement From an early age, I have had numerous experiences with various types of knowing information without rational explanation. Mainly, these experiences were with picking up the moods and feelings of friends, family, and strangers and the occasional precognitive dream. I can consciously read people's emotions well but my intuitive reading of emotions occurs differently, typically when a person hides her/his true mood/feelings from me. For instance, a person smiles and acts in other verbal/nonverbal ways that should communicate happiness. I frequently can sense when his/her true feelings are quite well masked and are quite different than the emotional face the person is wearing and stories the person is telling. However, I am aware that just because I can sense the true mood/feelings does not mean someone is ready to discuss them. I also intuitively sense the appropriate time for me to confront his/her affective dissonance and not hurt or offend the person/client. Throughout my life, I have seen the true feelings/moods of my friends, family, strangers, associates, and more recently clients in counseling environments. I found myself frustrated quite often that other people did not read me the way I could read their emotions and moods; I thought everyone did it. The more people in my life I spoke with, the more I realized my reading of people was not a trait shared by everyone. I began to grow curious as to how this intuitive ability developed in me (and others like me) but not mn everyone. Additionally, my ability to intuitively pick up emotional cues has also helped me avoid harm throughout my life; somehow, I can gauge if a situation or person is unstable, dangerous, unhealthy, or harmful. I have never been able to explain it rationally nor have I been able to verify the truth of my experience, because I act upon my intuition and will go in the opposite direction from the possible harm; thus, no harm results and I cannot know for certain if I was correct in my feelings. I have had intuitive dreams most of my life. They usually fall more on the side of precognition than on the academic view of intuition. Unfortunately, most of my experiences with precognition involve dreaming about someone dying (usually someone I am acquainted with or close to but occasionally a celebrity or stranger) and then, within a few days, discovering that indeed the person died (except for strangers, I rarely confirm their deaths because I never felt the need). In addition to my death dreams, I often dream of friends in moments of crisis. I may have not spoken to him/her for several months and I will dream of her/him in emotional or physical pain. When I wake up, I feel compelled to check on the person from my dream, and more often than chance, the person is going through a period of upheaval, transition, anxiety, or depression. My precognitive and intuitive dreams always have a different sense to them then my unconscious-working-out-my-daily-residue-ad issues dreams; the precognitive or intuitive dreams are clearer and have a less "dream- like"' quality to them. My friends and family think I am very bizarre for my dreams, so I never assumed that everyone had them (although I believe everyone can). Wondering how my dreams related to my waking intuition relates strongly to my curiosity about the nature of intuition. Once I began seeing clients during my master's and doctoral programs, I realized that my intuitive skills greatly helped me during the counseling process. The experiences of my clinical intuition are too numerous to describe; however, most of my clinical intuitive experiences occurred spontaneously in session, when I could sense something just not "fitting in"' with the clients' words. When I have been stuck with clients, my intuition has helped me find new approaches and paths to follow with clients. I never scientifically tested my experiences but I also never doubted their accuracy and reality. When I began my doctoral training, I found my growing researcher skills and knowledge conflicting with my intuitive processes. I felt caught between my personal experiences and beliefs and knowing that these experiences and beliefs were not "'scientific" or "rational." This cognitive dissonance between rational science and my non-rational experiences sparked a growing curiosity in finding ways to work within the technical rational system in order to bring some rational validity and understanding to my non-rational experiences. Although there is wide acceptance in the non-academic world and growing acceptance in the scholarly world of intuition research, it is often considered too nebulous or mysterious a topic to study. The debate rages on between popular culture and hard science. From my perspective, believing in intuition and believing in scientific research are not mutually exclusive. Because I have such vivid experiences with intuition in my personal life and clinical intuition in my professional life, I do believe that using intuition is an important and vital part of effective counseling. As grounded theory methods depend on the worldview of the analyst, I will try to bracket my subjectivity as much as possible during the data collection and analysis of my study. Significance of Study Intuition has been widely ignored by the scientific community because it was considered implausible and without scientific value. Most writings on intuition involved denigrating and outlining precisely why it was not valid in logical, rational thought and some authors continue to do so despite intuition's growing acceptance in certain H'elds. Recently, disciplines such as business science, nursing, and other medical fields have changed their scientific opinions of intuition and clinical intuition; as a result, many more theories and studies on intuition are appearing in each discipline's literature. It is my belief that the field of counselor education is becoming ready to accept inquiry into the use of intuition/clinical intuition in counseling. CHAPTER 2 REVIEW OF THE LITERATURE The "Scientific" Study of Intuition Despite the scientific community's relative disregard for studies of intuition, many inquiries have been performed on the concept during the past 100 years (Osbeck, 1999). Shirley and Lagan-Fox ( 1996) provide an excellent review of the early theories and early empirical studies conducted on intuition. Many of these initial studies were limited to the recording of anecdotes or were aimed at proving the existence of intuition (Petitmengin-Peugeot, 1999). Recent writing and research into intuition describes it in one of two ways: (1 ) the connection of intuition to the transpersonal, spiritual, and natural healing; or (2) the information-processing/decision-making aspects of intuition and its relationship to how various disciplines make professional decisions. Most of the transpersonal literature agrees that intuition is a valid method of receiving information and there is little debate that intuition exists. The transpersonal perspective is that intuition is a gift that connects us to the universe. Much of the transpersonal literature examines the nature of intuition and how we can use intuition to make our lives (mind-body-spirit) and the lives of those around us more complete. There is much debate in the literature regarding intuition and professional decision-making. Some authors hail it as the way to go beyond what has become the traditional, positivist approach of describing "truth'' (Redding, 2001; Schiin, 1983; Welsh & Lyons, 2001). Some authors view intuition as one preference for processing information (Myers, 1998; Jung, 1921/1971). Other authors view intuition as a natural component of advanced critical thinking skills and/or expertise (De Bono, 1991; Isenberg, 1991; Klein, 2003; Redding, 2001; Schain, 1983). Even other authors describe intuition as riddled with bias and therefore has little part in professional decision-making (Gambril, 1990; Hall, 2001; Myers, 2002). Transpersonal Views of Intuition Attempts to discuss intuition in the transpersonal and/or parapsychological literature are usually aimed at trying to prove the existence of intuitive phenomena and ignore the intuitive experience itself (Petitmengin-Peugeot. 1999). However, there is some mention of the experience of intuition in the literature. Bohart (1999) describes the intuitive experience based on qualitative descriptions of it from artists as nonconceptual, realizations coming out of the blue, and a sense of imminence directly preceding the insight. No formal preparation was necessary; the creative insights merely "dawned" on the person. The Intuitive Experience Goldberg (1983) describes the intuitive experience in terms of incubation (time away from the activity) and insight (when the intuition occurs). The intuition will be holistic and received in a variety of different means through one of our senses, emotions, or it can be a "'flash in the mind" (Goldberg, 1983, p. 72). Based on interviews with people who have experienced intuition, Petitmengin- Peugeot has formulated a generic model of the intuitive experience (1999). Gaining insight from an unknown source is described as a process of four stages: letting go, connecting to a higher source, listening to this higher source, and receiving the intuition. The phase of letting go is a phase of quieting the rational mind, making it possible to shift attention from normal, everyday consciousness to a higher, receptive level of awareness. This can be done through shifting the center of attention from the head to the body by changing posture, a gathering and realignment, transforming the breathing into a slow pace and then shifting consciousness to the back of the skull (Petitmengin-Peugeot, 1999). While performing the body modification, mental activity must also be altered to allow for visualization and/or prayer. A sense of abandoning normal reality occurs, with a sense of feeling connected to the universe and a sense of opening up (1 999). The connection phase occurs once the intuitive state has been reached. This appears to be a deepening of the senses of connecting and opening up to receive information. Based on the individual, this can be achieved unconsciously through focusing on an object and altering your senses. However, some people described a conscious process by introjecting (welcoming the other into one's self), extending (opening the self further to accept the other) or resonating with the higher source (Petitmengin-Peugeot. 1999). After letting go, the person is in calm state, ready to receive insight from the universe. This can be done through a special kind of attention: one that is "internal, peripheral, and involuntary" (Petitmengin-Peugeot. 1999. p. 67). In addition to this attention, the person will usually favor a particular 'listening' style among the visual (clairvoyance), auditory (clairaudience) or kinesthetic (clairsentience) methods. The stage of receiving the intuition is usually immediately preceded by a moment of confusion leading to the clarity of the insight. Based on the preferred sense of receiving the intuition, it will appear, bringing a feeling of certitude and coherence (Petitmengin-Peugeot. 1999). To bring the insight into conscious awareness, the receiver must consciously grasp, chase or welcome the intuition. Spirituality, Psychic Intuition, and Health Several studies presume intuition to exist and examine differences between the modalities. In a study by Steinkamp (1998), the literature involving precognition and clairvoyance testing from 1935-1997 was examined and a meta-analysis was performed to determine which form of intuition is more effective at predicting the future (Steinkamp, 1998). She found that there were no statistically significant differences to support that clairvoyance works better than precognition. (Steinkamp. 1998). In a later study by the same author, precognition was tested against clairvoyant perceptions leading to a premonition. For example, did someone who predicted an airplane disaster actually have a true premonition or did he just psychically pick up on a faulty engine (Steinkamp, 2000)? The results seem to suggest that true precognition may not be possible but that psychic feelings, sounds and visions are a reality (Steinkamp, 2000). Other contemporary views of intuition hypothesize the connection of intuition to the mind-body-spirit. in terms of an early warning system of disease. Many of the early psychological theorists and contemporary researchers believe there is a connection between the body and the mind (Barasch, 1993; Fernald, 2000; Freud, 1900/1965; Jung, 1954/1957/1960/1 977: Myers, Sweeney, & Witmer, 2000, Reich, 1972/1933). Although several early theorists such as Carl Jung and William James acknowledged the role of spirituality in health, serious research in this area has only recently begun (James, 1902; Maltby & Day, 2001; Myers et al., 2000; Thoresen, 1999; Woods & Ironson, 1999). Total health is comprised of and influenced by the interaction of all three elements (Barasch, 1993), i.e., it is logical that warnings of illness could arise in any of the dimensions; be it a psychosomatic illness because of past trauma, the influence of attitude on heart disease, or the mind-body-spirit warning of potential mental or physical illness through intuition and dreams. Intuitive Information-Processing and Decision-Making The Functions of Intuition Vaughan (1979) postulated that there are four levels of awareness for intuitive experiences: physical, emotional, mental, and spiritual. Each level of awareness describes the modality through which intuitive information is received. Physical intuitions are those that "frequently depend on physical and emotional cues that bring them to conscious awareness." (Vaughan, 1979, p. 66). These kinds of intuitions are usually experienced at a physical level, such as a physical symptom or a pit in the stomach. Emotional intuition "comes into consciousness through feelings" (Vaughan, 1979, p. 68) such as an immediate like or dislike to a person without knowing why or a feeling of connection with another person's feelings or thoughts. Vaughan describes mental intuition as "'awareness through images, or what is called 'inner vision'" (p. 73). Examples of this kind of intuition include unconscious pattern recognition that allows a person to solve a problem or the ''Aha!" moment people may experience after trying to solve a problem through rational thought with no avail. Finally, spiritual intuition to Vaughan (1979) is "associated with mystical experience, and at this level, intuition is "pure."' Pure, spiritual intuition is distinguished from other forms by its independence from sensations, feelings, and thoughts"' (p. 77). Examples of spiritual intuition are peak experiences, where one feels connected to the universe and appears to comprehend the nature of reality. Goldberg (1983) classifies intuition in into different functions: discovery, creativity, evaluation, operation, prediction, and illumination. All of the functions describe ways in which intuitive information serves the person receiving the intuitions. Discovery intuition (Goldberg, 1983) is similar to Vaughan's (1979) description of mental intuition, where one discovers a solution to an elusive problem. Creative intuition often works with discovery but allows for novel approaches to art, science, and/or life (Goldberg, 1983). Evaluative intuition does not examine or investigate choices rationally as the name might suggest; examination and investigation are rational methods (Goldberg, 1983). Instead, it gives a "'binary kind of function that tells us go or don't go, or yes or no." (Goldberg, 1983. p. 51) such as when you knowt not to take a particular job offer but can think of no logical reason to decline so you take it and the job ends badly. Operational intuition is the "most subtle, almost spooky form .. [that] guides us this way and that, sometimes with declarative force, sometimes with gentle grace. It prompts us without telling us why, and sometimes without our knowing at all" (Goldberg. 1983, p.54). Operational intuition is similar to evaluative intuition; however, with evaluative intuition, there is a known decision to make or problem to solve. With operational intuition, the "'answer" comes before the problem or decision. Predictive intuition involves some intuitive decision and/or acting about the future, either explicit or implicit, which is precise and not likely to be made by everyone acting on the same limited information. For instance, if I regularly read the stock listings and have seen a gradual increase in a particular stock that I then decide to buy and make a lot of money on, that is not predictive intuition. However, it would be predictive intuition if I knew absolutely nothing about stocks and had not heard about this stock before and then decide to buy it and make a lot of money. Finally, intuition as illumination is similar to Vaughan's (1979) concept of spiritual intuition, in that it refers to those intuitions related to self~-realization, communication with a higher power/the universe, and involves some element of transcendence (Goldberg. 1983). An example of illuminative intuition would be if during meditation, I felt a powerful, strong connection to the universe and understood the nature of death for a fleeting moment that stayed with me after my meditation ended. Jung's Theory of Psychological Type Carl Jung (1921/1971 ) describes intuition as one of his four fundamental psychological functions of the personality. According to Jung. intuition is a means of perception through unconscious processes and is experienced through sensing the deep significance and mystical connections of an everyday object or event (Hall. Lindzey, & Campbell, 1998). According to Andersen (2000), Jung's typology rests on two elements: attitudes (way of reacting in life) & functions (how we orient ourselves in the world; a way of solving problems) p. 47-48). These attitudes and functions are in our conscious awareness. An important element of Jung's theory is that all the different attitudes and functions are equally good; i.e., there is not one combination of attitudes and functions that is the **best." People have a dominant attitude and function that they prefer. These preferences comprise a person's psychological type. There are two different ways of reacting in life: extraversion & introversion. These attitudes differ in their directions of focus and their sources of energy (Andersen, 2000). Extraverts tend to act quickly, are more inclined towards action, and dislike loneliness (Jung, 1921/1971). Introverts tend to react more slowly, integrate outside info and are energized by alone time, unlike their extraverted counterparts (Jung, 1921/1971). Functions describe . the strategies people employ to acquire and process information." (Hall, Lindzey, & Cam~pbell, 1998, p. 91). There are two different groups of functions according to Jung's theory (1921/1971). The first category of function is perception. The perception functions tell us how we perceive the world, the problem or task and/or ways of taking in information (Andersen, 2000). Within this category, there are two levels, sensing and intuition. Sensing is the function that tells us something exists and is perception based on our senses. Sensing types perceive things as they are, have a respect for facts & information, and are detail-oriented. In contrast, the function of intuition reveals the possibilities which may exist in what we have perceived, that tells us about the possibilities in the future, and enlightens us on the atmosphere surrounding all experiences (Andersen, 2000). Intuitive types concentrate on possibilities and are less concerned with the details. They often find solutions directly without basing them on facts . The next function category is j judgment. The judgment functions tell us how we judge a problem or situation once it is perceived and includes our ways of making decisions (Andersen, 2000). There are two levels within the judgment function: thinking and feeling. Thinking is the function that tells us what something is, based on our existing knowledge. Thinking types tend to be analytical, particular, precise, & logical. They see things from an intellectual angle and often miss the emotional sides of a situation/ problem (Andersen, 2000). Feeling is the function that tells us how to relate to our perceptions based on our subjective value system. Feeling types are interested in other people's feelings and dislike analysis. They stick to their own values, their own likes, and dislikes. They enjoy and prefer to work together with other people. (Andersen, 2000). Developed by Isabel Myers and Katharine Briggs in 1940s, the Myers-Briggs Type Indicator (MBTI) is one of the most widely studied and used assessment instruments in the world (Sharf, 2002). The MBTI assesses psychological type based on combinations of the attitudes and functions according to Jung's Theory of Psychological Type and as modified by Katharine Briggs. There are sixteen combinations of types: IST), ISFJ, INFJ, INTJ, ISTP, ISFP, INFP, INTP, ESTP, ESFP, ENFP, ENTP, ESTJ, ESFJ, ENFJ, ENTJ. The last letter represents a third factor, not described by Jung's theory. In addition to the two functions of perceiving and judging, a third factor was added that describes which of the two functions a person finds more important. According to Sharf (2002), judging types are organized, planned, decisive, set goals, and are systematic. In contrast, perceiving types are flexible, spontaneous, tentative, let life happen, undaunted by surprise, and open to change. Andersen (2000) studied if intuitive managers (based on Jungian Type Theory) were more effective managers than those using other decision-making processes. Andersen examined 209 managers' decision-making styles according to Jungian Type Theory, measured by the MBTI and the Keegan Type Indicator Form B. No statistically significant differences found between decision-making style and managerial effectiveness. However, 32% of effective managers used intuition as their primary mode of perception. Although the study found no statistically significant differences between intuitive managers and other managers, Andersen states that this investigation was merely an exploratory & descriptive study to determine if the subject was worthy of further study. Based on the high number of intuitive and effective managers, Andersen states that more research is needed to further explore this connection. Intuition and Creativity Another contemporary view of intuition is that it is the foundation of creativity. According to Bohart (1999), there is support in the literature for the idea that creativity arises from "felt, tacit, intuitive and perceptual knowing" (p. 297). Creativity is not limited to artistic expression. Generating novel ideas and problem solving, particularly in moments of uncertainty can also be viewed as creativity. Sternberg and Lubart (1991, as cited in Myers, 2002) describe five components to creativity: (a) expertise; (b) imaginative thinking skills; (c) a venturesome personality; (d) intrinsic motivation; and (e) a creative environment. Creative people can approach and solve new situations and problems because they may have faced and solved similar situations in the past (expertise); they can recognize patterns and see things in different ways (imaginative thinking skills); they persevere, tolerate ambiguity/risk well, and seek new experiences (venturesome personality); they are interested in solving problems for self-satisfaction and not because of an outside influence (intrinsic motivation); and are in environments were their ideas are sparked and developed in relationship to others (creative environment). Intuition is the means creative people use to gain insight and solve novel problems. Intuition as a Component of Critical Thinking Skills Myers (2002) examined the evidence for the powers and perils of intuition in relationship to decision-making. Myers describes the validity of intuition as a perceptive, automatic, cognitive process affected by memory, attention, expertise, evolution, social experiences, creativity, and mental shortcuts. Intuition results from all of these things interacting with one another and contributes to our effective decision-making. The most intriguing part of Myers' book is his descriptions of divided attention and priming; and the dual attitude system. Myers (2002) postulates that intuition is simply our unconscious recognition and perception of unattended stimuli incorporated into automatic, experiential knowing as a result of implicit memory (learning something without remembering where we learned it). Myers states that there are two ways of knowing: "automatic (unconscious) and controlled (conscious)" (2002, p. 29). Additionally, Myers expounds these different ways of knowing information as either experiential knowing or rational knowing (Epstein, 1994, as cited in Myers, 2002). Experiential knowing is "rapid, emotional, mediated by vibes from past experience, self-evident, and generalized"' (Myers, 2002, p. 30). Rational knowing, on the other hand, is "slow, logical, mediated by conscious appraisal, justified with logic and evidence, and differentiated" (Myers, 2002, p. 30). According to Myers (2002), intuition is therefore a part of our unconscious, experiential knowing system, sometimes valid, but most of the time invalidated by its generalizability and therefore, bias. Much of the disagreement between scientists concerning the substance and significance of intuition results from the non-rational basis of intuition. Science is, by its nature, knowledge received through rational processes, aimed at refuting hypotheses and beliefs in analytical, logical procedures. As described in Chapter 1, intuition is, by its nature, knowledge received through often sudden, non-rational, non-analytical processes, aimed at expanding understanding past or predicting future outcomes. Science and intuition appear to be mutually exclusive. However, several scholars have responded to the criticism of intuition in direct and indirect ways (De Bono, 1991; Feyerabend, 1978; Polanyi, 1966/1983; Schain, 1983). Similarly to Feyerabend (1978) and Polanyi (1962), Schain (1983) argues that Western culture since the Age of Reason has nullified any other means of receiving and verifying information outside the realm of "technical rationality"' (science). As a result, our universities and critical thinkers of the day train future scholars to be future skeptics, only trusting the technical rational method of discovering truth and knowledge. That is, we are trained to believe that anything outside that proscribed scientific realm and methodology is illogical and manipulative of non-critical thinkers. Schiin (1983) described a different method of receiving and verifying information termed "reflection-in-action" that is not necessarily more valid than the scientific method, but occurs more often in practice. Practitioners often do not discover new knowledge scientifically, they discover it through reflecting on the information in the moment, testing their assumptions/hypotheses in the moment, and refuting/accepting these hypotheses in the moment. Information received through reflection-in-action is a function of expertise, a form of acquired tacit knowledge tapping into that automatic knowledge store practitioners develop through their experiences. Schdn (1983) argues that relying solely on a scientific research experiment, removed from the experiences of those in practice, greatly limits our understanding of the world around us. Sch~n's (1983) reflection-in-action through acquired tacit knowledge is similar to Michael Polanyi's (1966/1 983) views when he states that as human beings, .. w~e can know more than wie can tell [his italics] (p. 4), which he terms tacit knowledge. There are two basic structures/kinds of knowing of tacit knowing: specifiably known knowledge (i.e., something we know because we have attended to it) and functional relational aspect of knowledge (i.e., something tacit that we only know because our awareness of attending to the object). He also names these as the distal term (stimulus we attend to, specifiably known) and the proximal term (tacit knowledge arising from our attending to the fact that we attended to the stimulus). Polanyi (1966/1983) further states that our full tacit knowledge of an event/interaction/stimulus is only made available to us by ascribing meaning to the two terms and their interaction. Using Gestalt psychology language to describe the proximal and distal terms, the proximal term represents the parts and the distal term represents the Gestalt (or whole). We are aware of the whole by making meaning out of the parts but we are not truly aware of the parts. This unawareness of the 'parts' is the basis for tacit knowledge: that we know the whole without knowing how we know the parts. Polanyi (1966/1983) further discusses the nature of tacit knowledge by examining the process of awareness. Polanyi states that we can .. make a thing function as the proximal term of tacit knowing, we incorporate it in out body--or extend our body to include it--so that we come to dwell in it." (p. I6). This indwelling of the proximal term is similar to but more detailed than the concept of empathy. We can tacitly experience knowledge of another by making their lives/experiences/ "parts" indwell in our minds. Polanyi (1966/1983) believes that tacit knowledge allows us to bypass the process of knowing through paying extremely close attention to everything around us thus avoiding the problem of losing sight or meaning of something by paying to close attention to it. Additionally, Polanyi states that if we try to elucidate and become aware of the tacit process by which we know life, we will never fully be able to explain the process in a way that makes the knowledge any more valid than it was tacitly. The act of trying to make tacit knowledge conscious may cause us to lose sight of its meaning by paying to close attention. Polanyi's (1966/1983) ideas regarding tacit knowledge are similar to the concept of intuition. Intuition is often defined as knowing something without knowing how we know and not being able to tell how we know the intuition. From Polanyi's (1966/1983) concept of tacit knowledge, we can further develop the concept of intuition to be an unconscious awareness of an object's parts to more fully understand the object itself. Intuition as tacit knowledge supports the view that intuition is a well-developed system of pattern recognition postulated by authors such as Benner & Tanner (1984) and Schiin (1983). De Bono (1991) argues that there are two human thinking systems in decision- making: vertical thinking and lateral thinking, each separate poles on a thinking continuum. Vertical thinking is what we consider typical of a scientific approach to the world; "it is selective. It seeks to judge. It seeks to prove and establish points and relationships. .. It is concerned with stability with finding an answer so satisfactory that one can rest with it" (De Bono, 1991, p. 19). De Bono (1991) further describes vertical thinking as (a) judgment based on the "YES/NO system, and selection is by exclusion of all those ideas to which the NO label can be attached" (p. 19); (b) "analytical . .. interested in where an ideas comes from: this is the backward use of information . used to describe [his italics] what has happened in one's own thinking" (p. 20); (c) "seeks to establish continuity .. one step follows directly from the preceding step in a logical sequence .. the conclusion must come after the evidence" (p. 20); (d) "chooses what is to be considered. Anything else is rejected. This choice of what is relevant depends entirely on the original way of looking at the situation" (p. 21); (e) "'proceeds along well- established patterns because it is seeking proof and proof is most easily found by using such patterns"' (p. 21); and (f) "promises at least a minimal result" (p. 21). According to De Bono (1991), lateral thinking is the opposite of vertical thinking. Lateral thinking is concerned with generating new possibilities, novel ideas, movement, and change. Unlike vertical thinking, which is concerned with the stability of a satisfactory answer, lateral thinking requires no adequate solution but strives to find a better one. Lateral thinking is never an attempt to prove something and always an attempt to generate new ideas. There is no judgment of right or wrong or YES/NO with lateral thinking: in fact, De Bono (1991) states the "only 'wrong' is the arrogance or rigidity with which an idea is held" (p. 20). Lateral thinking uses ideas to generate new ideas if the current idea turns out to be inadequate. In lateral thinking, the conclusion may come before the evidence. However, De Bono (1991) states further: This is not to say that one adopts a conclusion and then seeks to justify it by rationalization. Such a procedure would imply an arrogant certainty in the conclusion that is the opposite of lateral thinking. The process is rather one of making a provocative jump to a new position and, once there, one is suddenly able to see things in a new way. The new way must of course prove itself by being effective (pp. 20-21). Additionally, lateral thinking welcomes an amount of chance in generating new ideas, because chance is one way of creating discontinuity in a situation (De Bono, 1991). Finally, lateral thinking does not promise an answer to the solution, but if skilled in lateral thinking, there is a high probability that a solution will emerge (De Bono, 1991). De Bono ( 1991 ) does not imply that the two processes of thought are separate, one can use both vertical and lateral thinking or a mixture of the two on a continuum. Based on its above descriptions, lateral thinking seems very similar to intuition and is useful in situations where a new approach or solution is needed for an uncertain problem and vertical thinking is useful in determining if the new approach or solution is effective. Unfortunately f~or most problem-solvers, De Bono (1991) states that most people "might use lateral thinking some 5 percent of the time and vertical thinking 95 percent of the time. .. It depends a good deal on the nature of the situation" (p. 22). The good news is that lateral thinking skills can be developed and tuned, just as vertical thinking skills are during our traditional education. Although De Bono (1991) never specifically mentions intuition as being a part of lateral thinking, intuition closely follows the description of lateral thinking. The process of lateral thinking can also explain how intuition is separate from bias, in lateral thinking, one comes up with the solution before the evidence (intuition) but is not seeking to confirm the solution with evidence in the past, as that would negate the process of lateral thinking. Lateral thinking is concerned with "the generating of new ideas and new approaches, and with the escape from old ones. It is not a method for decision or for action. Once the ideas have been generated, one has to satisfy oneself as to their usefidness [his italics] before putting them into action" (p. 23). This appears to be very similar to what occurs during clinical intuition, the generation of ideas outside of logical thought when faced with uncertainty or feeling stuck with a client that are then checked with the client without judgment as to "right or wrong." According to Osbeck (1999), one may infer from the studies and way intuition is described in such studies that there are three characteristics of intuition as a basis for judgment. The first description is that intuition is unconscious processing (Osbeck, 1999). The information received through intuition is implicit and from an unknown source. Secondly, since this information influencing a decision is unconscious, intuition is viewed as an inferential process, similar to the reasoning from a conscious process, but operating at a level below awareness (Osbeck, 1999). Thirdly, information received through intuition is frequently considered irrational. These characteristics lead to the way intuition is viewed by psychological science: that there are two models of information processing occurring, the cognitive system with its logic and reasoning and the intuitive system with its automatic, creative and narrative style (Osbeck. 1999). Intuition as Cognitive Bias in Decision-Making Early cognitive psychologists examined intuition "as a basis for judgment in problem solving" (Osbeck, 1999, p. 231). Osbeck (1999) describes the current interest in intuition and its basis for judgment by comparing intuitive judgments to those formed by more scientific methods. According to Osbeck, the results have so far been inconclusive. Intuitive problem solving seems to be riddled with the same errors and biases in judgments that formal hypotheses are (Osbeck, 1999). According to Osbeck, the studies that have been done on intuition lead to two general conclusions: decisions from intuition are less accurate than traditional reasoning and the accuracy improves with experience. In addition to studying intuitive judgments, contemporary research has focused on decision- making (intuition vs. analysis) and the impact of intuition on various fields (Osbeck, I999). Osbeck (1999) describes the studies on intuition as less accurate than logic. I believe these studies are also biased against the use of intuition and thus reflect that bias in their results. There is a general lack of many outcome studies on intuition. Further outcome studies contradict Osbeck's conclusion by supporting the notion of intuition and generally conclude that more qualitative and quantitative studies are needed. As part of our information-processing systems. humans have developed strategies to quickly process information and then quickly know how to act. These strategies (called heuristics) have kept us alive and evolving, but are often associated with error in non- fight-or-flight situations (Myers, 2002). When applying these heuristics in making decisions, the strategies have associated biases, which can lead to incorrect conclusions and assumptions. As intuition is described by many authors as part of information- processing and decision-making, then it is also subject to the same errors as rational, logical analysis. Many authors have commented on the links between intuition and cognitive error/bias (Eisengart & Faiver, 1996; Gambril. 1990; Hall, 2002; Myers, 2002; Osbeck, 1999; Tversky & Kahneman, 1974). Some of these errors in thinking include (a) memory construction; (b) misreading our own minds: (c) mispredicting our own feelings and behavior; (d) self-serving bias; (e) overconfidence bias; (f) hindsight bias; (g) fundamental attribution error; (h) belief perseverance and confirmation bias; (i) representativeness heuristic; (j) availability heuristic; (k) adjustment and anchoring; (1) framing effect bias; (m) illusory correlation; (n) avoiding harm from acts of commission than from acts of omission; (o) overlooking the normalcy of events; (p) socio-cultural biases. Each of these biases involves making incorrect assumptions based on faulty logic. Belief perseverance and the confirmation bias are most closely involved with intuitive decisions. Belief perseverance is the phenomenon that if we think our beliefs are correct, then they tend to have a certain longevity despite evidence to the contrary (Gambril, 1990; Myers, 2002). The confirmation bias occurs when we form a belief. Humans tend to search for evidence to confirm their beliefs, making cases for something that may be incorrect. "On target" intuitions may actually be erroneous beliefs persevering despite opposing evidence, as we hunt for evidence that confirms our intuitions. In Gambril's (1990) C.ritical Thinking in Clinical Practice, she discusses in detail the errors that may arise in cognition during work with a patient/client, trying to help practitioners become more accurate and precise thinkers and thus, clinicians. Intuition judgments were condemned as inaccurate judgments, erroneously believed to be correct and with longevity that causes the clinician to seek evidence supporting the 'intuition' (confirmation bias). However, throughout a book aimed at eliminating bias from clinical decision-making. much of it is biased toward promoting logic and analysis as the only valid critical thinking skills. By negating the use of intuition in clinical decision-making. Gambril ignores what may be an entirely different information-processing system operating, and may prove to be more accurate than logical/ analytical information- processmng. The literature linking intuition to cognitive bias does not intuitively nor logically feel correct. The literature largely agrees that intuitive knowledge is from an unknown source and therefore, not received through logical, analytical means (lateral thinking). If this is the case, then biases and errors occurring in logical, analytical means (vertical thinking) do not truly apply to the lateral, intuitive process. However, none of the authors addressed the logical leap they made associating the cognitive errors/bias in logical and analytical thinking with intuitive thinking. If the thinking systems are different, then the biases and errors applying to one do not necessarily apply to another. Many positivist authors dismiss intuition's use in decision-making by condemning it as illogical and full of cognitive errors that arise from a different thinking process entirely. As vertical (analytic) thinking is prone to such errors in judgment (and agreed upon in the literature), why are the opponents of intuition not condemning analysis as so full of cognitive errors that we should not use it? Outcome Studies on Intuition and Business Decision-Making Most of the literature on intuition in the business world describes the connection between intuitive thinking and senior management/executives and entrepreneurs. According to Shirley & Lagan-Fox (1996), intuition is becoming a highly valued skill in the business world. Because intuitive processing and decision-making are highly valued skills, there is an increasing amount of research in this area over the last fifteen years. In what has become a landmark study in the field of intuition, Agor (1989) studied over 200 executives' decisions. Agor (1989) found that "'good intuitive decisions were, in part, based on input from facts and experience gained over the years, combined and integrated with a well-honed sensitivity or openness to other, more unconscious processes" (pp. 158-159). Furthermore, Agor's study "suggested that intuition is most useful to managers in uncertain situations where they are faced with insufficient facts and complex alternatives." (Clarke & Mackaness, 2001. p. 147). Allinson, Chell, Hayes (2000) investigated if successful entrepreneurs are more intuitive than managers, based on the unknown nature of starting a business. Using the Cognitive Style Index (a questionnaire measuring intuition versus analysis), the authors compared 156 replies from entrepreneurs with those of 546 managers from various organizations. They found that successful entrepreneurs are more intuitive than general population of junior & middle managers, but are similar in cognitive style to senior managers. The authors adequately describe the limitations of their study as merely an exploratory study and using a convenience sample. Despite these limitations, the study was conducted with many attempts to control biases in the research process and was a good empirical study. The authors state the need for further research in the area, particularly since their hypotheses were supported by their data. Clarke & Mackaness (2001 ) conducted a qualitative study of cognitive mapping and the intuitive elements in cognitive decision making theory of executives. According to the authors, cognitive mapping: is a technique that has been used widely by management researchers in a variety of different contexts to explore individual perceptual schema . can be seen as a model of 'action-oriented thinking' about a situation in which arrows signify influences in a line of argument linking cause and effect. Such mapping makes comprehension transparent. The mapping process involves respondents identifying factors affecting a particular decision-making 'goal'. In case of strategic decisions, this can be some measure of the effectiveness or quality of the decision itself (p. 1 52). Despite all of the theoretical information given in the article, only four interviews were done. Three of the interviews were conducted from managers within a single organization, interviewing a fourth manager from outside the organization for a control group. The authors found that senior managers were more intuitive (used more non- factual information) than functional (lower-level) managers. The authors posited that perhaps the differences were related to experience and not intuition, as their study suggests. Although the authors analyzed the interviews and found general themes, generalizability of their results must be viewed with caution due to the very small sample size. Finally, the authors describe the study as an exploratory study with a small sample and that more research is needed in this area. Intuition, Expertise and Clinical Decision-Making Clinical Intuition in Nursing Numerous articles have been written on the importance of including intuition as a valid part of clinical decision making in nursing. Many of the articles describe nurses' experiences with intuition in their treatment and care of patients, the prevalence of nurses' intuitive experiences with patients, and how it is a powerful diagnostic tool (Benner, 1984/2001; Benner & Tanner, 1987; Brooks & Thomas, 1997; Buckingham & Adams, 2000; Buckingham & Adams, 2000; Miller, 1993; Miller, 1995: Miller & Rew, 1989; Perry, 2000; Redding, 2001; Rew, 1986; Rew, 1987; Rew, 1988; Rew & Barrow, 1989; Ruth-Sahd, 1993: Thompson & Dowding, 2001; Welsh & Lyons, 2001). Because of the growing acceptance of intuition in the nursing field, there are also an increasing number of research studies to explore its connections to clinical skills. Redding (2001) states that advanced critical thinking skills are needed in those making clinical decisions. Critical thinking is "purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which such judgment is based" (Redding, 1991, p. 57). From a nursing perspective, Redding (1991) describes the critical thinking components involved in making clinical judgments as a function of attitudes and dispositions; domain-specific knowledge; cognitive skills and com~petencies; experience/practice; and intellectual and professional standards. From these five components, cognitive skills and competencies can vary as a result of differing levels of cognitive development. Perry (1970) proposed a four stage cognitive developmental model similar to Piaget's Model of Cognitive Development. The first stage is dualism/received knowledge (black or white thinking, no questioning of authority. typical of young children); the second stage is multiplicity/subj ective knowledge (truth determined by internal and subjective means by incorporating diverse opinions, typical of early and middle adolescence): the third stage is relativism/ procedural knowledge (self-confidence in truth-seeking, doubting, discerning what is right and wrong by supportable evidence, typical of postsecondary education); the fourth stage is commitment-in-relativism/constructed knowledge (personal choices of truth after evaluating options, information received through intuition and other people, high tolerance for ambiguity, only some achieve this stage). Redding (2001) states that there are five subprocesses involved with critical judgment, all of which use the last two stages of cognitive development, problem solving, caring, unbiased inquiry (relativism); intuition and reflection-in-action (commitment-in- relativism). Redding (2001) postulates that clinical decision-making is not possible without reaching the relativism/procedural development stage and the last stage of commitment-in-relativism/constructed knowledge allows the practitioner to go more in depth with his/her decisions. Redding (2001 ) claims that caring is a function of empathy, which forms the basis of the nurse's intuition and unbiased inquiry is the basis of reflection-in-action (if in the final stage of cognitive development). Intuition, according to Redding (2001), is "the ability to internally sense that a certain choice or decision is contextually correct without necessarily being able to clearly describe how that sensation is supported .. [and is] generally more accurate in the experienced nurse" (p. 62). From Redding's (2001) descriptions of clinical judgment and cognitive development, intuitive skills only develop in some practitioners, as a function of their empathic skills and cognitive development leading to advanced critical thinking skills. As clinical decision-making is similar in both nursing and counseling, one could infer that the same applies for counseling intuition; i.e., it is a function of empathy and cognitive development and indicative of advanced critical thinking skills. Clinical Intuition Research in Nursing Investigating the use of intuitive judgments in clinical assessments of mental health nurses, Welsh and Lyons (2001, p. 299) defined intuitive judgment in clinical assessment as "the ability to 'sense' when something is not as it appears to be." The authors contend that intuitive judgments are part of Schain's (1983) concept of reflection- in-action and that expertise involves a tacit knowledge base from which we draw intuitive judgments. Welsh & Lyons (2001) conducted a qualitative case study/content analysis, interviewing 8 staff nurses at a psychiatric assessment and short-term treatment center about their clinical judgments regarding cases over a six-month period. The authors hypothesized that nurses would rely on their formal and expert knowledge base (and thus their intuition/tacit knowledge) when faced with complex patient issues, to aid risk assessment and to develop treatment plans. Three themes emerged from their content analysis: research evidence (formal knowledge and its limitations), tacit knowledge (formal knowledge and expertise combined), and advanced practitioner skills (a combination of tacit knowledge and intuition). Welsh and Lyons (2001) concluded that in making clinical assessments, expert nurses will 'sense' when the research evidence for a particular therapy is lacking or not working, bypass linear thinking, and quickly link into his/her tacit knowledge base accumulated through expertise, and accessed through intuition. No study limitations were discussed in the article, but it appears that Welsh's and Lyons' (2001 ) themes must be further studied as they might suffer from some of the cognitive errors in logical analysis. In qualitative studies, the researchers are the research instruments and it is apparent from their tone that Welsh and Lyons strongly believe in the validity of intuition and tacit knowledge in making clinical decisions. Consequently, without outside confirmation of their emergent themes (which was not discussed), Welsh and Lyons could suffer from the confirmation bias, searching for evidence in the interviews to support their hypothesis. In landmark studies exploring intuition in the nursing, feld, Benner (1984/2001) and Benner and Tanner (1987) found links between intuitive abilities, expertise, and level of experience in nurses. Benner (1 984/2001 ) describes a five-stage model of skill acquisition for nurses ranging from novice to expert where experts are more able to recognize patterns from a variety of independent, distinct stimuli acting together to form a whole. Benner (1984/2001) postulates that this pattern recognition may be what is actually occurring with intuitive processes and tacit knowing in nurses' clinical judgments. The concept of pattern recognition distinguishes the intuitive abilities of expert nurses from beginners and implies intuition does not occur until nurses become experts (Perry, 2000). Additionally, Benner and Tanner (1987) describe the process of and how nurses use clinical intuition in practice. From 21 interviews with expert nurses, Benner and Tanner (1987) described six ways expert nurses use intuition: "pattern recogmition, similarity recognition, commonsense understanding, skilled know-how, sense of salience, and deliberate rationality" (p. 23). Pattern recognition allows an expert nurse to see relationships between events or symptoms without knowing the specifics components of a situation whereas similarity recognition is recognizing patterns from previous experiences (and thus comparing how similar one pattern is to another). Commonsense understanding is the skill involved with being so familiar with the language and culture of the field that the nurse is able to pick up subtle cues that appear to go against common sense but in reality, are correct indicators of subtle illness. Skilled know-how allows nurses to rely on their deep understanding and the second-hand nature aspect of their work to feel out the correct way to care for patients. When expert nurses can quickly sum up various situations, distinguishing between serious and not serious patient circumstances/illnesses, the nurse is said to have a sense of salience. Finally, deliberate rationality is the expert nurse's ability to question rational assumptions and seek out alternative explanations for a patient's circumstances when something does not appear to be "right" (Benner & Tanner, 1987). Contradicting Benner and Tanner's concept that only expert nurses use clinical intuition is a study of undergraduate senior year nursing students by Brooks and Thomas (1997). Conducting a descriptive, exploratory, qualitative study of structured interviews, Brooks and Thomas (1997) investigated the decision-making processes of senior undergraduate nursing students in a 'clinical' situation. Each student was given a clinical vignette describing a patient. The nursing students were then interviewed as to how they conceptualized and approached the patient and his treatment. Results suggest that all 18 students approached the vignette differently, citing several different intrapersonal characteristics influencing decision-making (such as experience, personal values and beliefs, culture and lifestyle, etc.). All students shared only one characteristic: all responses perceived and judged the vignette through 'personal knowing' or understanding the situation from the perspective of the subject's own unique self; the student nurses knew what to do and knew what was expected, separate from their education and experience. The concept of personal knowing is very similar to the definition of intuition as an unconscious means of gaining information or knowledge. Brooks and Thomas' (1997) study further suggests that even beginning student nurses used intuition in their clinical decision-making, diagnoses, and treatments. Clinical Intuition Research in Medicine Despite the myriad articles in nursing supporting the use of intuition in clinical situations, the medical literature has relatively f~ew articles promoting the use of intuitive clinical decision-making. This is not surprising, considering the scientific, logical, and rational emphasis in modern medicine. However, there is one study indicating that doctors do use intuition in uncertain and potentially serious situations with patients (Brennan, Somerset, Granier, Fahey, and Heyderman, 2003). Brennan et al. (2003) conducted a qualitative study of how 26 general practitioners diagnose and determine nebulous presenting symptomology in children with possible meningitis. In reaching a diagnosis of meningitis (and/or septicemia), the doctors discussed how they rarely see presenting cases of the disorders but knew that the disorders seldom presented in a typical fashion. Being unfamiliar and uncertain with a serious disease such as meningitis, Brennan et al. (2003) describe that the doctors "relied upon intuitive rather than systematic methods to distinguish serious illnesses from those that are self-limiting. Doctors frequently relied on gut feeling or intuition to identify illnesses that are potentially serious" (p. 628). The doctors also reported, however, that because of the non-systematic means of diagnosis, many doctors commented that they set up "safety nets" (Brennan et al., 2003, p. 628) to cover themselves should their intuitive judgments be incorrect. Finally, the participants in the Brennan et al. (2003) study indicated that specific guidelines for diagnosis and treatment "depersonalize [sic] the doctor-patient relationship, exclude intuitive methods of diagnosis and undervalue the role of experience" (p.629). There were several limitations of the current reported by Brennan et al. (2003): potential researcher bias, miscategorization of data, and misinterpretation of themes. However, these limitations are only limitations when examining a qualitative study with a quantitative lens. Again, this de-valuing of qualitative methodology because it is "biased" in an objectivist field like medicine is also representative of why intuitive clinical decisions are not openly trusted. From all research, there is always the potential for researcher bias; in qualitative research, these biases are acknowledged, made explicit and attempts are made to keep the bias from affecting the analyses. In the Brennan et al. (2003) study, there are some limitations from a purely qualitative perspective. Brennan et al (2003) did not specifically state their biases, as is the norm in qualitative research, to allow the reader to judge the trustworthiness of the conclusions. As such, this exclusion is a limitation of the research. One final limitation of the study is that no specific analysis method is discussed. Brennan et al. (2003) discuss doing interviews and finding themes, but good qualitative research is explicit about the ontology, epistemology, methodology, and methods used to collect and analyze data (Crotty, 2003). Clinical Intuition and Emotional Recognition Counselors work with peoples' emotions and identifying these emotions is one of the primary requirements for good counseling. As humans, we constantly read other people's emotions and thus are usually quite good at distinguishing between various emotional states. Does this emotional recognition improve with training and education? Although there is no specific literature on intuitive emotional recognition in counseling, there was one study examining how naive coders with no training compare with trained coders in determining different emotional expressions (Waldinger, Schulz, Hauser, Allen and Crowell, 2004). Waldinger et al. (2004) investigated the prediction of emotions and marital satisfaction between married couples' emotional expression. A third hypothesis examined how naive, untrained coders of the couples' emotions compared to specifically trained coders (following a detailed rubric) of emotions. Waldinger et al. (2004) believed that nalve coders would identify similar emotions as those with a guideline and training because identifying emotional cues in innate and intuitive in nature. As a result, Waldinger et al. (2004) postulated that the intuitive nature of reading emotions would enable the nalve coders to be as or more productive in distinguishing emotions than the trained coders who must follow specific guidelines (and thus, ignore their intuitions). Results indicated that nalve coders were consistent with the trained coders in identifying emotions and that the nalve coders picked up emotional intensity more frequently than did the trained coders (Waldinger et al., 2004). One limitation of the Waldinger et al. (2004) study is that they used a relatively small sample size for a factor analysis (N=47). Because of the small sample size, results must be viewed with caution and more studies are needed to determine the reliability of results. Despite this limitation, the results do indicate that the act of reading emotions is intuitive by our human nature (Waldinger et al., 2004) and may therefore indicate how some counselors use intuition in clinical decision-making. CHAPTER 3 METHOD Brief Explanation of Grounded Theory Before I discuss the specific elements of the methods in my study, I would like to give you an overview of grounded theory analysis. I outline how I plan to specifically apply grounded theory in my study following this brief explanation of the important components of grounded theory. Grounded Theory All grounded theory data collection and analysis is fueled by the constant comparative method (Glaser & Strauss, I967), which Strauss and Corbin (1998) later call comparative analysis, an analytical tool. With this method of microanalysis, the researcher continually makes theoretical comparisons between and within data, incidents, indicators, contexts, concepts, codes, and categories to delineate the processes, dimensions, properties, and variations of each under different conditions (i.e., the different participants' experiences) (Charmaz, 1983; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Constant comparisons are done at all levels of coding and analysis (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, I967; Strauss, 1987). Comparative analysis/the constant comparative method does not merely describe the different dimensions or properties of the developing concepts and categories; it also analyzes the similarities and differences within and between concepts and categories (Charmaz, 2000; Glaser & Strauss, 1967; Strauss, 1987: Strauss & Corbin, 1998). Glaser and Strauss (1967) discuss the comparing of incident to incident; i.e., comparing the dimensions and properties of each incident to one another to elucidate the categories and theory. Strauss and Corbin (1998) elaborate with the idea of theoretical comparisons. According to Strauss and Corbin (1998), "we not only speak of comparing incident to incident to classify them, but we also make use of what we call theoretical comparisons [their italics] to stimulate our thinking about properties and dimensions and to direct our theoretical sampling" (p. 78). Theoretical comparisons use the similarities, differences, and/or varying degrees of the incidents' properties as tools to better understand the data (Strauss & Corbin, 1998). For example, if I want to initially interview three counselors, then I will compare and contrast my participants, letting the data guide the comparisons. Furthering the example, if level of experience emerges as an important component for counselors to construct meaning of the clinical intuition, I can then group my participants into two categories: experienced counselors and inexperienced counselors. I would theoretically compare them by examining what it means to be experienced or inexperienced, how counselors think/act/counsel when inexperienced or experienced, etc. and then compare the "answers" from each category to each other to further the theory construction and further coding. Theoretical Sampling In qualitative research, participants are be recruited through purposeful, selective sampling (Glesne. 1999; Kuzel, 1999). The different, specific qualitative methodologies or methods sample purposefully using different procedures. Sampling in grounded theory is guided by the emerging categories and themes in a process called theoretical sampling (Charmaz. 1983; Charmaz, 1995; Charmaz, 2000;Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Specifically, Strauss and Corbin (1998) define theoretical sampling as: Data gathering driven by concepts derived from the evolving theory and based on the concept of 'making comparisons.' whose purpose is to go to places, people, or events that will maximize opportunities to discover variations among concepts and to densify categories in terms of their properties and dimensions. (p. 201) Theoretical sampling is flexible and is therefore not rigidly determined before beginning the research to allow for maximum comparisons between concepts that emerge from the analysis and to encourage creativity (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). As a result, criteria for selecting participants will change with emerging categories and interview questions will become more refined with each interview. According to Strauss and Corbin (1998), "theoretical sampling is cumulative. Each event sampled builds from and adds to previous data collection and analysis" (p. 203). Although there is no rigidly followed procedure for recruiting participants in theoretical sampling, it is also not a haphazard process of sampling anyone or anything until the researcher whimsically decides to end his or her sampling procedure. In grounded theory, sampling and analysis must occur simultaneously until no new information emerges, a point called theoretical saturation (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Theoretical sampling must be consistent and systematic to ensure that the data analysis and comparisons made are focusing the developing theory. Initially, theoretical sampling gives the researcher a starting point; consequently, the initial sample and interviews will be guided by several considerations. Strauss and Corbin (1998) state that: The initial decisions made about a project give the researcher a sense of direction and a place from which to launch data gathering. What happens once data collection is underway becomes a matter or how well the initial decisions fit the reality of the data. Initial considerations include the following: 1. A site or group to study must be chosen. .. 2. A decision must be madet about the types of dalta to be used. .. 3. Another consideration is howI long an area should be studied. .. -1. Initially,, decisions regarding the number ofsite~s anrd observations and/or interviews depend on access, available resources, researrch goals, and the r~esearrcher 's time schedule andu energyi. [their italics] (p. 204) Stages of Coding and Sampling Grounded theory's analytic procedures can be useful to many different research questions and different perspectives by building theories that allow the data to speak (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001). There are three main phases of coding in grounded theory analysis: open, axial, and selective (Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Charmaz (1983; 1995; 2000; 2001) names the phases initial and focused coding, generally integrating axial coding into the end of initial coding and into the beginning of focused coding. Each phase has specific goals and is aimed at developing the emerging themes, processes, relationships (between and within), dimensions, and properties of the theory to different degrees. The purpose of theoretical sampling techniques differ as the coding becomes more focused; starting out as open sampling in open coding, moving to relational and variational sampling during axial coding, and ending with discriminate sampling in selective coding (Strauss & Corbin, 1998). Open coding and open sampling. In open coding, the researcher is interested in starting to ground the data by broadly coding each data source, going line-by-line and constantly comparing the basic codes and properties of the codes with each other to discover concepts and categories (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). According to Strauss and Corbin (1998), during open coding, transcript data are "'broken down into discrete parts, closely examined, and compared for similarities and differences. Events, happenings, objects, and actions/interactions that are found to be conceptually similar in nature or related in meaning are grouped together under more abstract concepts termed 'categories."' (p. 102). After fully open-coding the transcript, you then group the open codes/categories by the nature of their relationships and by forming hypotheses (axial coding). In axial coding, the researcher further elaborates the dimensions, variations, processes, relationships (between and within), and properties of each category by constantly comparing more focused, incoming data to existing data to begin to see a broader theory. At the beginning of a study, sampling is open (as is the coding) in that a researcher is trying to maximize variation and information from the data and participants; therefore, when sampling, a researcher in open coding may choose sites and participants that will thus maximize variation and information. Since there are no developing concepts, a researcher may use the existing field literature and/or her/his intuition to guide participant selection (Glaser & Strauss, 1967; Strauss, 1987: Strauss & Corbin, 1998). Axial coding and relational/variational sampling. As data collection continues (with immediate data analysis), concepts begin to emerge that guide the next sampling procedures. During the next phase of coding, axial coding, the researcher is trying to make connections between and within emerging categories to specify the categories' dimensions, properties, and ranges (Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987: Strauss & Corbin, 1998). Strauss and Corbin (1998) define axial coding as "'the process of relating categories to their subcategories, termed 'axial' because coding occurs around the axis of a category, linking categories at the level of properties and dimensions" (p. 123). During axial coding, the researcher is concerned with examining the phenomenon of study's structure (context) and process (actions/interaction over time and their consequences) (Charmaz, 2001; Strauss & Corbin, 1998). As a result, theoretical sampling at this stage involves the researcher sampling participants or previously collected data who/that will give rich data about "incidents and events .. that enable him or her to identify significant variations .. [by] comparing incidents and events in terms of how these give density and variation to the concepts to which they relate" (Strauss & Corbin, 1998, p. 210-211). This comparison is best done by maximizing similarities and differences between participants and is done using intuition, knowledge of participants, or persistence until the concepts emerge. Selective coding and discriminate sampling. Finally, in selective coding, the axial codes are grouped together into one "theoretical structure that enables us to form new explanations about the nature of the phenomena."' (Strauss & Corbin, 1998, p. 103). The goal of selective coding is to incorporate all of the categories' /concepts' dimensions, properties, and relationships (between and within) to develop a cohesive theory and to find where any holes in the theory might be. The data is rigorously compared with each other and with very focused, incoming data to build a cohesive theory that is validated by further data collection and constant comparison (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Discriminate sampling, which occurs in selective coding is therefore, "highly selective .. deliberate [sampling] .. that will maximize opportunities for comparative analysis" (Strauss & Corbin, 1998, p. 21 1). During this phase of coding and sampling, the researcher is rigorously and constantly comparing new incoming data to the current data/theory and seeking new information when final validation or illumination is necessary to reach theoretical saturation. Theoretical Saturation When further theoretical sampling, data collection, and data analysis fail to yield any new theoretically relevant information, the researcher has reached theoretical saturation and can stop further sampling, data collection, and analysis (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Higginbottom, 2004; Strauss, 1987; Strauss & Corbin, 1998). According to Strauss and Corbin (1998). "Saturation is more a matter or reaching the point in the research where collecting additional data seems counterproductive; the 'new' that is uncovered does not add that much more to the explanation at this time"' (p. 136). Theoretical Memos Theoretical memos in grounded theory are analytic reflections by the researcher related to the data, codes, and the developing theory (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Theoretical memos are the flesh and blood of grounded theory analysis; they are where the analysis actually takes place. Theoretical memos are not written to describe the data; they are written to analyze the data. (Glaser, 1978; Strauss & Corbin, 1998). Theoretical memos force the researcher to focus on the data to help develop the emerging concepts (Glaser, 1978). According to Glaser (1978): The core stage [his italics] in the process of generating theory, the bedrock of theory generation, its true product is the writing of theoretical memos. If the analyst skips this step .. he [sic] is not [his italics] doing grounded theory. Memos are the theorizing write-up of ideas about codes and their relationships as they strike the analyst while coding [his italics]. (p. 83). Theoretical memos have four purposes/goals: working with ideas, allowing freedom of thought, developing a memo bank, and easy sorting of the memo back (Glaser, 1978). All researchers should write memos to conceptualize theoretical ideas from the data, expand the properties of concepts and categories, present ideas about the relationships between and within categories, integrate the different ideas/categories, and compare the developing theory with already existing theories (Glaser, 1978). When writing memos, researchers should keep an open mind and not judge what they are writing to keep the ideas flowing (Glaser, 1978). Once memos are written, they should be organized in an easily retrievable system that can be easily sorted into new arrangements to aid with analysis (Glaser, 1978). Since memos are about the constant comparison of the data's concepts and categories, they can also serve to direct theoretical sampling and develop sensitivity to the data (Glaser, 1978) Purpose of the Current Study The purpose of this study is to better define and understand how counselors make meaning and how counselors use that meaning of their clinical intuitions to help clients by developing a preliminary theory of its use in counseling through a series of semi- structured interviews with counselors (i.e., mental health counselors, marriage and family therapists, school counselors, and counseling psychologists) that were analyzed using grounded theory (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Despite the many divergent views of intuition and clinical intuition, there are relatively few empirical studies discussing clinical intuition specifically in counseling. I hope to better understand how counselors construct knowledge about their clients using clinical intuition. I am investigating two main research questions based on the process and meaning of clinically intuitive thought in counselors: (1) How do counselors construct meaning of their clinical intuitions about clients? (2) How do counselors use the constructed clinical intuitions to help their clients? My study is exploratory, aimed at building an initial theory of clinical intuition in counseling that is grounded in data. Ultimately, this study is one step in a longer process of developing a thorough and broad theory of intuition in psychotherapy. Theoretical Perspective Constructivism Constructivism is the epistemological view that an individual constructs knowledge and the meaning of reality through her or his individual mind (Crotty, 2003). It is separate from social constructionism (social constructionism holds that meaning making is an act of co-construction through interaction with another person or the environment) in that constructivists hold that an individual constructs meaning through his or her own mind (Crotty, 2003). Constructivism allows for flexible interpretations of truth and knowledge that will differ according to the perceptions/meaning- making/experiences of individual minds (Charmaz, 2000). According to Schwandt (1994), constructivism is concerned with the first-hand experiences of participants and is based on the idea that "what we take to be objective knowledge and truth is the result of perspective. Knowledge and truth are created, not discovered." (p. 125). Despite the relativist nature of constructivism, Schwandt (1 994) posits that you can be a realist somewhat while still being constructivist in that constructivists sometimes believe in an objective real world where ideas and concepts are invented/constructed to correspond to something in said real world. Guba and Lincoln (1994) state that constructivist inquiry is: (a) ontologically relativist in that there are multiple realities that are the products of our individual minds; (b) epistemologically transactional and subjectivist in that the researcher and object of investigation co-create the findings together in transaction; and (c) is methodologically hermeneutic and dialectical in that the "'individual constructions can be elicited between and among [their italics] investigator and respondents" (p. 1 11) that are then discussed/analyzed through comparison and contrasting to "`distill a consensus construction that is more informed and sophisticated than any of the predecessor constructions"' (p. 111). Constructivist inquiry is evaluated by how well the constructions "'~fit' with the data and the information they encompass; the extent to which they 'work,' that is, provide a credible level of understanding; and the extent to which they have 'relevance' and are modifiablee'" (Guba & Lincoln, 1989, p. 179). As constructivism is theoretically concerned with the individual construction of meaning and knowledge, I explored how individual counselors make meaning out of clinical intuition. Clinical intuition is outside reason by its nature but worth systematically studying to further our construction of knowledge. Because clinical intuition is not fully described or understood, I worked within the constructivist perspective to better describe counselors' perceptions of clinical intuition in counseling based on the two research questions above. I used a constructivist theoretical framework while conducting my research, hoping to fully describe and bring unity to the many divergent experiences of clinical intuition. Grounded Theory & Epistemological Consistency The study's theoretical framework comes from constructivism (Charmaz, 2000; Crotty, 2003; Lincoln & Guba, 1994b; Schwandt, 1994) and I used grounded theory analysis techniques (Charmaz, 1983; Charmaz, 1995: Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Grounded theory is epistemologically ambiguous to me. The original purpose of grounded theory was to develop generalizable theory that is grounded in data using very systematic data collection and analysis procedures (Charmaz, 2000). As a result, grounded theory is rooted in positivism. The most recent descriptions of grounded theory tend to describe the analysis in more constructivist terms (Charmaz, 2000; Charmaz, 2001: Strauss & Corbin, 1998) and that grounded theory methods appear to be compatible with constructivist inquiry (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Guba & Lincoln, 1989). The reflexive search for a common consensus of individual constructions that describes the data better than any one alone seems very similar to the coding/analytical process in grounded theory (Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Although grounded theory methods appear to be more positivist than other qualitative methods (Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998), its adaptation to constructivist inquiry make it a suitable match for a constructivist epistemology. The epistemological confusion creates methodological difficulties for me as the researcher. I tend to be much more constructivist when approaching knowledge and inquiry. I also like the specific, proscribed nature of the techniques in grounded theory. If 1, as a constructivist, use an analysis method with positivist roots (grounded theory), will my study be epistemologically consistent? I believe that because my roots as researcher are constructivist, then I cannot help but apply the method in a constructivist fashion. Grounded theory gives me tools and techniques during my analysis; however, my analysis (as I am constructivist) ultimately has a constructivist flavor. For my study, constructivist grounded theory is an appropriate analytic method for several reasons. First, as I studied a non-rational topic like intuition, I believe having a proscribed yet flexible set of procedures for data collection and analysis adds some needed structure to the study. Secondly, using constructivist grounded theory allowed me to construct themes and meanings while my participants constructed their own personal meanings of clinical intuition while maintaining the structure that facilitated the analysis. Finally, as I am intuitive and studying clinical intuition, using constructivist grounded theory simply felt intuitively right to me. Using grounded theory methods such as conducting interviews, theoretical sampling, constant comparison, various coding strategies, and by writing theoretical memos for my data collection and data analysis, I constructed a theory describing the meaning of clinical intuition for my participants. Data Collection Sampling Initial theoretical samplinglopen sampling. I initially theoretically sampled and recruited participants through criterion sampling (Kuzel, 1999). Criterion sampling involves selecting participants that all meet some outlined criteria. As I am studying the intuitive experiences of counselors (general psychotherapists). all participants met the criteria of typical professional counselors/therapists: (a) are in the counseling field in training, practice, or academia; (b) all participants held at least bachelor degrees and are pursuing or have received advanced degrees in a counseling field; (c) all primarily conduct relationship-based clinical practice; (d) all have had strong or frequent experiences of intuition in counseling; and (e) are diverse according to years of counseling experience. With participants who met all of the criteria, then I used the existing nursing literature on clinical intuition and expertise as an additional criterion, to begin my sample by interviewing, counselors with different levels of experience. I purposefully chose intuitive counselors with varying years of experience (novices with 0-5 years experience, intermediate counselors with 5-15 years experience, and experts with 15+ years experience) to set an initial foundation for theoretical sampling. I started by interviewing one novice, one intermediate, and one expert counselor. I hoped to interview a diverse sample in regards to gender, race, age, ethnicity, sexual orientation, and disability but ended up with a fairly homogenous sample consisting of five white participants, four of whom were female and one male. Based on the emerging themes, I then sampled according to where the data pointed me by seeking information-rich cases. To find information-rich cases, I used my insider knowledge of the participants' degree programs, various students'/graduates' experiences in it, and the local counseling community to choose participants whom I felt had a lot to say regarding my research questions. Additionally, to further identify my subgroup of intuitive counselors, I asked several faculty members in the University of Florida, Department of Counselor Education and the University of Florida Counseling Center to identify several intuitive counselors or intuitive counselors-in-training in the community, department, or state with varying degrees of counseling experience. In an attempt to further increase the diversity of my sample, I also recruited participants through emails sent to counseling listserys asking those who self`-identify as intuitive counselors to participate in my study. To determine the appropriateness of each other-identified or self-identified intuitive counselor, I asked her/him to tell me a brief description of how he/she regularly uses intuition in her/his counseling. I selected only those self-identified intuitive counselors if they met the criteria above, if they appeared to be information-rich cases based on their brief descriptions, and if they increased the diversity of my sample. Focused, relational/variational, and discriminate theoretical sampling. As themes emerged, I sampled participants according to areas of my emerging categories/theory that needed further elaboration, clarification, or explanation until no new information emerged and I reached theoretical saturation (Charmaz, 1983; Charmaz. 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Kuzel, 1999; Strauss, 1987: Strauss & Corbin, 1998). I felt two participants in my initial sample were information-rich cases for the categories I was trying to elucidate and contacted them for one further interview each (Woody and Katie). I needed new participants to illuminate my emerging themes and recruited new participants primarily through asking counseling faculty for counselors or counselors-in-training who would elucidate my emerging themes. One new participant volunteered for the study and was from a different educational background, so I included her in my sample (Jera). I interviewed one of the private practitioners (Molly) suggested by a counselor education professor and found my data saturating after her interview. After a result, no further sampling occurred. Participants My total sample included five interviewees (two participants were interviewed twice and three were interviewed once), as determined by when I reached theoretical saturation (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Kuzel, 1999; Strauss, 1987; Strauss & Corbin, 1998). The exact number of interviews and interviewees was decided during the data collection and data analysis process, when I felt that further sampling was not necessary based on the saturation of data. Interviewing counselors with varying degrees of counseling experience (0-5 yrs, 5-15 yrs, 15+t yrs experience), the participants held bachelor's degrees to doctorates and ranged in age from 30 years to 80 years. I attempted to initially interview people with different demographic information but the diversity I sought ended up primarily as diversity of training and years of experience. To protect my participants' anonymity. I asked all participants to choose a pseudonym (Woody, Katie, Jera, & Molly) and gave a pseudonym to one participant who could not come up with one (Alice). I asked my participants if they would prefer I kept some of their non-essential demographic data confidential by broadening terms when reporting their data. No one clearly indicated that they preferred me to change identifying information; however, if I felt that something would identify my participant, I changed the non-essential information (such as places of work and distinct, named experiences in the community). Woody is a 34 year old, white male, PhD candidate in a Counselor Education program at a large Southeastern United States university. His specialty track is school counseling. Woody has a total of 6 to 7 years experience counseling, both in full-time work and during his master's and PhD training. Woody is currently working as a counselor in a university counseling setting. I conducted one initial and one follow-up interview with Woody. Woody was the first participant I interviewed and as I collected more data, I wanted to investigate how his experiences matched my newly emergent codes. Consequently, I interviewed him again four months after our initial interview. Katie is a 54 year old white female counselor holding a doctorate in Counselor Education (specializing in mental health counseling) from a large university in the Southeastern United States. Katie has a total of 15 to 17 years counseling, including her years prior to going back for her doctorate. Katie is currently seeing clients in a private practice. I conducted one initial and one follow-up interview with Katie. She was my second participant and like with Woody, as I collected more data, I wanted to investigate how her experiences matched my newly emergent codes. Consequently, I interviewed her again five months after our initial interview. Alice is a 33 year old white female student in an MEd/EdS program in Counselor Education at a large university in the Southeastern United States. She is currently in her second year of coursework, is specializing in mental health counseling and has a total of 1.5 years experience in counseling. I conducted one initial interview with Alice. Jera is a 30 year old white female PhD candidate in a Counseling Psychology program at a large Southeastern United States university. She is currently working on her dissertation and completing her APA-approved internship. Jera has a total of 5 to 6 years counseling experience. I conducted one initial interview with Jera. Molly is an 80 year old white female counselor holding a doctorate in Counselor Education from a large university in the Southeastern United States. Molly has a total of 30 +t years of counseling experience. Molly has a private counseling practice and directs a training program for counselors in specific theoretical applications of counseling. I conducted one initial interview with Molly. Data Collection Procedure/Interviews I initially conducted three (one novice counselor, one intermediate counselor, and one expert counselor) individual, semi-structured interviews with my participants in private locations within their academic departments or their offices. I explained that our conversations will be audio-taped but they were free at any time to turn off the tape and stop recording. I described the nature of the study to each participant and gave them the informed consents to read and sign. I also informed each participant that this study is for my dissertation and it will be presented and potentially published. There were eight initial interview questions, with flexibility to probe for more information, should the need arise (please see Appendix A). As categories emerged during simultaneous analysis, the interview questions changed in the direction of the data, making a total of 1 1 initial interview questions (please see Appendix B) for new interviewees (Jera & Molly) and 5 follow-up questions for those two participants (please see Appendix C) I met with again (Woody & Katie). Each interview lasted between 35-90 minutes. After completing each interview, I transcribed the interviews from the audiotapes. After each interview and throughout the analysis procedure, I made reflective notes and theoretical memos about my reactions to the interviews, comments/questions that arose for me, and my thoughts/ideas about the data analysis procedures and content. As my study is based on developing and grounding a theory from data, interview questions evolved during the research process. Analysis of data occurred throughout the data collection process, going more in-depth with interview questions and emerging themes. Participants indicated that the interviews were helpful for them to put their clinical intuition, which they usually do not think about, into words. All interviews went well, although there were times when I felt that I was not asking questions in a way to get at the information. Occasionally, I had reactions to the data, agreeing with what the participants stated or having it trigger some negative reaction in me. When those emotional reactions occurred for me, I wrote about them and worked through them by writing memos. Validity and Reliability There is debate regarding validity and reliability in qualitative research. Traditionally, positivist and empiricist research tends to evaluate the rigor of a study through examining its reliability and validity (Kirk & Miller, 1986). In positivism, if we measure something consistently and get the same results (reliability), then we can feel more confident that we are getting close to the true nature of the phenomenon (Kirk & Miller, 1986). Furthermore, if we have high validity, then we can feel confident that we are measuring the actual true nature of a phenomenon (Kirk & Miller, 1986). Since qualitative research tends to move away from the positivist epistemology of holding that there is an absolute truth that we can objectively measure and evaluate, then using the positivist measures of good scholarship and science do not fit well with these different epistemologies in qualitative research (Angen, 2000; Denzin & Lincoln, 1994a; Giorgi, 2002; Kirk & Miller, 1986; Lincoln & Denzin, 2000). Qualitative researchers are re-defining how to assess rigor in qualitative research with its unique characteristics (Angen, 2000; Giorgi, 2002; Kirk & Miller, 1986; Lincoln & Denzin, 2000). Depending on the epistemology used by the researcher, these methods of insuring rigor can vary (Angen, 2000; Giorgi, 2002; Lincoln & Denzin, 2000) but ultimately are there to try and bring voice to the participants' stories and that the writing was not solely the author's biased interpretation (Richardson, 2000). Instead of using the terms reliability and validity, qualitative researchers discuss rigor in different terms like trustworthiness (whether we as readers can trust the researcher' s interpretations of their participants' voices) and credibility (whether we as readers find the researchers' conclusions reasonable) (Angen, 2000). To help readers trust and find results credible, different researchers are going to take different approaches (Giorgi, 2002; Denzin & Lincoln, 1994a). For example, some authors recommend triangulating data, which is a method aimed at using different ways to locate the data by coming at it from multiple points of view, to increase trustworthiness and credibility in a study (Denzin, 1978, Glesne, 1999; Lincoln & Guba, 1985). Others recommend stating your subjectivities in your writing, using your writing as an additional method of inquiry, keeping a strict audit trail, member checking, writing theoretical memos to increase the rigor of a study (Denzin & Lincoln, 2000; Glaser, 1978; Glesne, 1999; Richardson, 2000; Strauss & Corbin, 1998). In my study, from a constructivist viewpoint, I do not believe we can truly be objective since there is no absolute truth or knowledge. However, I still attempted to best represent my participants' constructions of clinical intuition in counseling by using a variety of methods to ensure that I was accurately representing their voices in my analysis. To do so, I chose counselors from multiple sites (triangulation), wrote and analyzed my theoretical notes/memos/journal from my observations and consistently reflected upon my biases as a researcher, conducted more than one interview with some participants. asking several peers to "'audit" my coding strategies, themes, and transcripts. I also kept a strict paper trail of information regarding when I met with my participants, how I reacted to their interviews, my analytical memos, and how I transcribed their data. Finally, I gave my transcripts to and discussed preliminary results with my participants, trying to ensure that their voices were accurately represented. Data Analysis Theoretical Memo Writing At each stage of coding and analysis, I wrote theoretical memos. My theoretical memos became more focused on theory and comparisons of the data throughout the analysis. Initially, I wrote memos about working through confusion or uncertainty, extracting meaning from the data, and putting my thoughts together to form concepts and categories. In axial coding, my theoretical memos focused more on the process, dimensions, and relationships within and between categories (looking at the contexts, actions/interactions, and consequences of the different concepts). During selective coding, I wrote memos aimed at clarifying and illuminating gaps in my developing theory, working out final confusion or uncertainty, and the constant comparisons between my very focused incoming data with my theory. Open Coding I initially open coded each transcript broadly by underlining and coding phrases that describe the participants' experiences with intuition. I then open coded the transcripts more specifically, constantly comparing phrases that frequently repeated, jumped out at me, were common to more than one transcript, or were different across the transcripts (constant comparison method). While open coding, I underlined, wrote in the margins of the transcripts, and developed code lists of words or phrases of interest. Some initial open codes were: Sense of Knowing; Usually Right; Thought; Vision; Speeds Up the Process (in vivo code); Not Judgmental; Helps Client Feel Understood; Trust Intuition More; and Subtle Sharing of Intuition. Axial Coding Once I completed open coding (through my reflexive notes, theoretical memos, and the constant comparative method), several axial codes (themes and/or categories) emerged that began to describe and integrate the data. The axial codes that described the data were: Sense of Knowing/Connection/Awareness; Spontaneity of Intuition; Using Tentative Phrasing; Using Respectful Phrasing; Checking Out Intuition; Comfort in Being Wrong; Belief that Intuition is Right; Therapeutic Change; Recognized in the Moment; Recognized after the Session; Receiving Intuition in Different Modes; Positive Attitude of Counselor; Negative Clients: Expression of Intuition: Strength of Relationship with Client; Quality of Relationship with Client; Increased Confidence with Experience; Trust of Intuition with Experience; Rapport; and Being Fully Present. Using different color highlighters denoting each of the above axial codes, I then went back through the transcripts highlighting words and/or phrases that fell into the separate categories. I also grouped the open codes from my separate code lists into each of the axial code categories. I continued to write analytical memos during this stage of analysis to further develop the emerging categories from new data collection. My memos in axial coding were much more theoretical than the beginning open coding memos (please see Appendix D). As the data began to frequently repeat, I was eliminated some axial codes and proceeded to the next stage of analysis. Selective Coding Continuing to write memos, during selective coding, I further refined and synthesized the axial codes. The codes that appeared most frequently and were at the core of how counselors make and use meaning of clinical intuition in counseling became my selective codes: Recognizing & Receiving the Intuition: Sense of Knowing or Awareness; Tentative and Respectful Expression of Intuition: The Counseling Relationship; and Therapeutic Change. From these selective codes, I integrated them into a core category (which became my theory statement) that best described how counselors use and make meaning of intuition in counseling. I then verified my emergent theory by constantly comparing the theory with old data and newly collected data to fill in the theory's gaps. When no new information emerged during my first interview with my fifth interviewee (Molly), I completed my analysis and developed a theory figure to offer a visual representation of the results. CHAPTER 4 FINDINGS The theory that developed from my data analysis is: Counselors construct meaning of clinical intuition as a sense of knowing or awareness about clients, resulting from the counseling relationship, that they then communicate to the client, benefiting the counseling process. The theory incorporates elements of defining what intuition is and how the counselors receive or recognize it as intuition, the importance and cyclical nature of the counseling relationship in generating clinical intuition, how counselors communicate the intuitions to their clients, and also the boundaries and benefits of using clinical intuition. Figure 1 illustrates the important elements of the theory in context with each other. The three central elements to the theory are the client. the counselor, and the intuition, which are all connected by the counseling relationship. If a client is too negative, too unhealthy, or not available to the counseling process, then a boundary from the client's side keeps the relationship from truly forming and thus does not generate clinical intuition for the counselor. Likewise, if a counselor has a negative emotional reaction to a client, then a boundary from the counselor's side keeps the relationship from truly forming and thus does not generate clinical intuition for the counselor. If these boundaries do not occur in session, then a sense of rapport, a sense of connection and a sense of presence with the client help create a positive counseling relationship, which helps generate intuitions for the counselor. Boundary to Process Negative Emotional Reaction ion to Client Bound r o Process Cl not available Boundary to Process Cl too 'unhealthv' B undaryt Process Cl too negative Figure 1. Theoretical Model of Clinical Intuition In Counseling Rapport A counselor's level of experience influences how they trust using intuition in a session which also impacts how comfortable they are receiving and recognizing the intuition. After trusting, recognizing, and receiving the intuition through a variety of ways, the counselor usually believes that the clinical intuition is correct, thus giving them a sense that they are right. Concerned about the relationship, the counselor will communicate the intuition in a tentative and respectful way, giving the client safety to disagree, and also are willing to be proven wrong. This way of communicating the intuition improves the counseling relationship, thus creating more opportunities for clinical intuition in the counselor. After communicating the intuition, the benefits of intuition can then start creating positive change for the client. Usually these benefits help the client gain meaning from the intuition, create a turning point for the client, and/or speed up the counseling process. All of these benefits help move the client toward therapeutic change, ultimately impacting the outcome of therapy in a positive way. Defining Clinical Intuition All participants referred to intuition in counseling as either a sense of knowing (Katie, Alice, Jera) or an awareness (Woody, Molly) that they recognize as being relevant to the client but without knowing how they know the information. Despite the intangible nature of the sense of knowing, all participants indicated that when they recognized the intuition as for their client, it was nearly always correct or on target when they followed up on the insight with the client. Furthermore, although all participants trusted their intuition, there seemed to be a difference in comfort level and confidence level in using their intuitions with their clients for the novice, intermediate and expert counselors. Receiving and Recognizing the Intuition Although all participants indicated that they recognize an intuition as being for their client, the modalities for that receiving and recognition varied for some participants. All participants but Katie described the intuition as primarily coming though as a feeling/bodily sensation that they translated into words to make meaning for the client. Katie received and recognized her sense of knowing through several different modes depending on the client and sometimes occurs as a feeling of being "driven to do something." Katie described that she frequently receives intuitive information as thoughts. For Katie, "A thought. .. Or the thought that this poem would be good for that client. So it comes.... It definitely is a thought." All of the modalities for receiving and recognizing intuition link well with how intuition is written about in popular and scholarly literature (Day, 1996; Goldberg, 1983; Naparstek. 1997; Petitmengin-Peugot, 1999) in that it can be recognized through clairsentience (sensing or feeling an intuition kinesthetically or emotionally), clairvoyance (seeing a vision or image that corresponds to a sense of knowing), or clairaudience (hearing or thinking intuitive information). Katie and Jera also receive and recognize the sense of knowing across several modalities. Although Katie refers to it as a thought most of the time, she also refers to it as "sense or see or vision somehow what they were trying to say before they even said it." Jera also described seeing "'very vivid mental pictures of something that I feel expresses what the client might be experiencing." However, Jera also receives and recognizes intuitive information through feeling that something is for her client; for example, she stated "it's like a feeling that you just know." Jera never specifically described receiving or recognizing the intuition as a bodily sensation, although she does mention that when she is not using her intuition in a session that she is "sort out of out my body, in my head." Woody described that he typically recognizes clinical intuition as an emotional feeling that occurs in the moment that helps him figure out if a client is being forthcoming, what the client might be feeling, or what might come next from the client. According to Woody, "Feeling. Definitely feeling. .. I feel like my intuition is maybe more attuned than a lot of people's. There are times I where I can just look at somebody and tell what's going on. .. And it's definitely feeling. Definitely feeling." Once he gets that feeling. Woody then translates it into a thought through his mind. Woody stated "intuition means thinking or becoming aware of something that you're pretty sure about but you wouldn't be able to confirm it unless you actually explore it." Similarly to Woody in that he translates a feeling into thoughts, Alice and Molly receive and recognize the intuition first in the body that they then translate into words through the mind for the client. Unlike Jera and Woody, who use the word "feeling"' to describe their recognition of intuition, Alice and Molly go beyond feeling and describe it as a bodily sensation. Alice stated "And in the body, I would say, I just have a sense of it. It triggers, I don't know, there's movement there. And then it goes directly to my mind. I try to pull myself out of my mind, out of thinking." Molly described her intuition as coming from "somewhere down in your diaphragm, along the power chakra, I think. It's physical. It filters through the mind, everything has to come through the mind to put words to it. It the genesis of it is not in the mind." Additionally, nearly all participants but Katie described recognizing most of their intuitions in the moment, during a session with a client. Although that occurs for Katie, she tends to more frequently recognize the intervention as intuition when she reflects on it after the session. Katie stated "'it's usually afterwards I realize it was intuition. I don't really know it's intuition when it's happening." Trusting of and Comfort in Using the Intuition All participants indicated that they trusted their intuitions about clients; however that trust and confidence in using their intuitions while counseling seemed to grow with more experience. Alice, with the least amount of counseling experience, described herself as still growing comfortable trusting intuition and knowing when to use it in a counseling session. Molly, on the other end of the continuum with over 30 years of counseling experience. indicated that she never questions whether the intuition is valid and brings it into a counseling session frequently. The other participants tended to fall somewhere in between Alice and Molly on the continuum. Despite the different levels of comfort and trust regarding their clinical intuitions, all counselors seemed to describe that their intuitions have not changed as they gained education and experience but the trusting of and confidence in using grew. For Alice, trusting and growing comfortable with her clinical intuition is something that she is learning as she gets more experience. With one and a half years of counseling experience, she is struggling with knowing when to share it with a client to facilitate the counseling process. Alice stated "more often than not, never gets put in the case notes, rarely even gets shared with the client. Because I just use the intuition as a guide." Conceptualizing intuition as a guide for her work but not sharing it with clients, Alice later stated that she thinks[] that's probably more about me and my level of comfort in trusting the process. I sort of have this sense like I can't project onto my clients that .. what may be their truth or not." Alice questions whether or not the intuitions she regularly receives about the world and people is something she can bring into a counseling session for fear of not wanting to impose on the client. As she mentioned, she believes this will change as she grows more comfortable with the counseling process, knowing what is okay to bring into sessions. Molly confirms Alice's comments about her use of intuition when she first started out counseling. Molly described that she has had to "educate my [her] sensing capabilities, my observational sense. Because all my life, I've been very intuitive but I didn't know `where did that come from?"' when she first began counseling. As she gained experience and was in a different mindset than perhaps a novice like Alice, Molly stated "I don't think my intuition has changed but I trust it more. Well, just with experience and finding out what happens ifl come across with some really strong intuition I have. I think it's just experience." Molly further described that acknowledging or verifying her intuition is not necessary. According to Molly, "If I have it, I support it. Not necessary." Jera stated that she is still growing comfortable using her intuitions with clients but that has changed with her experience. She stated: I think the basic change has not been so much the intuition but the confidence level in using it. Because I think my first two or three years of counseling, I did have these feelings but I wonder if this is what it is and if this is what the client needs to be presented with. According to Woody, he always has had the intuition but with experience, he learned how to use it more in the counseling session. Woody described "the feelings have been there all along but I know how to use them almost .. until we have some sort of minimal formal training, we're not exactly sure what to do with what we're able to perceive." Katie actually discussed that she might rely on her intuition less now than she did starting out in the profession, as she now knows what to do from the knowledge she has gained with education and experience. However, Katie states that the amount of intuition she receives in counseling have "'realistically, it's stayed the same."' To explain the difference in relying on her intuition less now, Katie described "Maybe I recognize them a little more now than I did them. I was flying by my seat on intuition a lot more then than I am now. But I don't know if it's changed." Katie tends to conceptualize her clinical intuition as a wonderful surprise when it happens and does not tend to rely on it in case that reliance turns it off. Despite not relying on it, Katie described frequent uses of her clinical intuition but still questions her intuitions with clients. Katie stated '"it just surprises me every time. It' s almost like 'Why won't I trust it?' It just happens and I'm just grateful and then I just move on." Generating Intuition The Counseling Relationship All participants mentioned that the counseling relationship with the client was the most important factor for making meaning of a clinical intuition. Without it, most participants claimed that there would be no intuition coming forth in the session. To be able to develop a relationship with their clients, most participants described a need to be present and engaged in the session with the client for their intuition to also become engaged. Sense of rapport, connection and being present with the client. The clients with whom the participants felt a strong sense of rapport in the counseling relationship felt most present and engaged and thus recognized more intuitive insights about the client. Without the sense of rapport or being present, most participants did not feel like their intuition could engage. All participants mentioned that connection, rapport, and presence as vital to intuition, although some of them discussed this important link in terms of when it was lacking. Jera stated .. where I am noticing some aversive personal habit, I feel like there isn't really the rapport and the strength of relationship there to let the insight come." Jera further goes on to add "Not really present. Not really open. That's what it feels like to not be following my intuition." Woody stated "If you are comfortable enough .. with a client, if you have a good rapport, if you meet for a few times or even if feel that instance rapport, it s easy." Alice, Katie, and Molly tend to describe that sense of being connected to the client when the intuition comes into the session. Katie described ''energy passes between us that passes along that sense of knowing. Their sense of knowing to me. So it becomes a sense of knowing that I have about them." Katie goes on to further add "'intuition is a process .. it isn't stagnant .. it goes from my client to me, from my client to me. .. They're still in my mind, maybe even in my unconscious when something will come up for me. So if I had not had the interaction with them .. there has to be something about them that comes to me that triggers my intuition." Molly describes it as "Nothing's going on if there is no contact. And that means that we can't be in our heads, because nothing we think is ever present. We have to be in our bodies, engaged with each other. And that's an intuitive process." Alice described the connection with the client as "You're connecting with them as a human being and if you are also tapping into the energy that they're presenting with." This is very similar to Katie's and Molly's construction of connection and intuition with their clients. Cyclical nature of intuition and the relationship. Not only did participants indicate that the relationship was fundamental to their individual meaning-making of clinical intuition with clients but the intuition also enhanced the relationship. For participants, disclosing intuitions to their clients allowed the clients to feel more understood which in turn further enhanced the counseling relationship. Woody stated "It [the connection/relationship with a client] would probably enhance it [the intuition]. Because if you are making a connection, then you are probably on the right track and if you are on the right track, the connection can get stronger. .. So it would probably enhance the rapport." For some participants, the connection between the counseling relationship and the intuition made it important to gauge the appropriate time in disclosing that intuition. The timing of disclosure was always linked back to making sure it was not going to hurt the counseling relationship by determining the client's openness and readiness to accept the intuition. Alice reported "when I feel very strongly about something that I don't feel is going to jeopardize or harm the client, I will share it with them .. intuition is a very subtle energy .. even though I am not taking responsibility for them, I'm taking responsibility for what comes out of my mouth." Molly mentions that she "is very cautious about what I do with my intuition, up to a point. And then at some point, I just say 'Well, here it is kiddo' and I put it out .. [with] radical respect." Molly further goes on to describe that she also uses her intuition in determining the time she puts another intuitive insight out to the client. Sometimes, the participants received intuitions about clients before they felt enough of a sense of rapport with the client and were cautious that disclosing the intuition could potentially hurt the relationship. Jera mentioned "if it is a really strong intuition, I have to think about whether the client is ready for it. Because sometimes, I have the intuition and the timing isn't right." Communicating the Intuition Similar to constructing the importance of the counseling relationship with intuition, participants described disclosing intuitive insights to their clients in a very respectful way, aimed at not hurting the strength of counseling relationship. The participants disclosed intuitions using tentative phrasing, respectful questioning and were always willing to be wrong so their clients could disagree with the intuition. Tentative and Respectful Expression of the Intuition All participants mentioned that they tend to use caution and respect when disclosing an intuition for the client so as not to harm the counseling relationship. This caution usually came out with clients as making a disclosure using language that was very hesitant out of respect for the client and the counseling relationship. Woody described this sense of phrasing as "'getting wiggle room" with a client, room to explore an intuition without making it seem as though it is a certain statement of fact before checking it out. Using an example of how he would disclose an intuition with a client, Woody stated "I don't want to offend you, I don't want to scare you but I have something in my mind and I want to check it out." Woody further described the way he discloses and checks out intuitive information with clients as being "very subtle"', which could also influence when he decides to disclose insights to his clients. Woody also discusses frequently how the intuition comes in service of the relationship and thus must be disclosed subtlely to not damage the relationship. He stated that: Sometimes I like students a lot. .. but the fact that I like them a lot, might be a little more subtle about how I disclose because I don't want to damage the relationship. .. and some counselors are like intuition, bam. right in your face, this is what it is and you're wrong and you need to do this and .. it might even be right. However, if the relationship is damaged, how right were they? For Woody, it seemed that having a pushy, overly arrogant attitude with disclosing an intuition could damage the client and not be with sharing since it could harm the counseling relationship and thus process. Jera described a similar feeling to Woody in that she felt that she must assess how the client will react to an intuition before sharing it and always stating it in such a way to allow the client wiggle room. In an example of when she used intuition with a client, Jera described how she shared the intuition with the client as "I said 'Right now, I'm getting this really vivid image and it's very graphic and I wonder if it would be okay if I shared it with you to get your reaction and see what you're thinking about this image I'm having." By stating things in cautious language (1 wonder if, would it be okay if I shared it with you), Jera phrased her intuition in a way to not harm the counseling relationship. Alice also supports what Jera stated, adding that she is "always real careful about how I say things. Try to be. .. There are times when I might just say "You know, I kinda got this sense that X was happening with you." Alice used a powerful metaphor to describe the respect for the client in sharing the intuition: How can I best bring this [intuition] to the client? What ways are they going to be receptive to it? Because if their receptivity is low, then what's the point of sharing the intuition? So, for me, it's like getting a raw diamond. It's beautiful but it's raw. It looks like a rock. So you get an intuition. It's kind of the same thing and you say 'Now, how am I going to cut, how am I going to work with the material? Because I can put some cuts on that diamond and it's not gonna have any sparkle to it. The person is going to look at it and say 'That's useless to me.' Go ahead and cut that diamond in the right way and my god, it just blows you away how beautiful it is. How much you see. It's the same thing. Describing intuition as a raw diamond and cutting it for the client alludes to the idea that for Alice, phrasing an intuition in the right (and respectful) way to the client allows for the client to not feel defensive and get the most of the intuition. Molly describes the tentative phrasing as being cautious and working with the client's system in a respectful way when disclosing an intuition. For example, Molly described what she might say to a client as "'This is coming to mind. I don't know if you want to hear it but if you want to hear it, here it is. And I let them be the judge because it is their system I am working with, not mine." By phrasing it a way using hesitant language like "'I don't know" and "if you want to hear it," Molly is giving her clients the wiggle room and respect to decide if they want to hear an intuition. Katie uses tentative and respectful phrasing in general with clients but tends to work the intuition into the flow of the session. For example, when describing a client she worked with, Katie stated "You know, when I read this poem, your name popped into my head and I just knew immediately this poem was perfect for you." Katie uses stronger language but builds relationships with her clients that they can always disagree with what she is saying so that disclosing the intuition is similar to how she reacts to clients generally. However, with clients that she feels might not be ready to handle an intuition or that it is in a touchy area, Katie stated "No, I wouldn't put it [the intuition] out. I saved it. It also depends on how you put it." Sense of Being Right Since all participants stated that they phrase intuitive information respectfully and cautiously, one reason for being so hesitant with disclosure is that they all feel their intuitions are on target. Caring about the relationship and wanting to respect the client, but feeling that their clinical intuition is by its nature correct, the participants phrased or questioned clients regarding the intuition in such a way to allow the client the room for escape if it was too much for them at a particular time or if it happened to be incorrect. In describing their intuitions as being correct, participants stated it a variety of ways. Molly reported that "intuition to come out into. . it just does what it does. And in my experience, it's right on target." Similarly to other participants, Katie referred to disclosing her intuition as "just like let it out there. If I say to a client 'you seem to be angry' they'll tell me if it's right or wrong. But the intuition is usually right, which is amazing." Katie goes on further to reflect: I only notice it as intuition because it has fallen into place. It if doesn't fall into place. then I notice it but it was just a thought. You know, maybe that's why people with intuition think they're always right. Because if it doesn't fall into place, they don't notice it. Katie's description indicates that when her intuition is not verified by the client, it was not intuition. Jera. Woody, and Alice use similar language to describe the same sense of being right with their intuitions. Jera described it simply when discussing a client with whom she shared an intuitive insight as "it did feel a little risky .. but I never thought 'what if I'm wrong?"' Woody added "obviously if I find out that it's not the case, then I have to change that. But in my experience, I'm usually not far off." Alice stated "It feels so right, cellularly in your body. You just go 'Yes! '" indicating that her intuitions are correct most of the time. Willingness to be Wrong and Safety for the Client to Disagree However, despite this sense that their intuitions are correct, all participants discussed not assuming that the intuition was correct by wanting to check it out with the client. They all check out an intuition with the client to make sure that the intuition had meaning for the client and not just for the therapist. Additionally, this sense of acceptance in being incorrect with the intuition also allowed for their clients to feel a sense of safety in disagreeing with a disclosed intuitive insight, for the participants, creating this sense of safety was vital to the process. Molly described this not wanting to assume an intuition is correct when she stated "it's my stuff and I always make that clear by just putting out 'This is me and I don't know if it reverberates with you at all. And if not, just say so."' Katie referred to her checking it out with the client and acceptance of being wrong as "I don't get turned down too much or told that I'm wrong too often and plus I don't take it personally if I am wrong." Alice also confirmed this by stating "Because number one, I'm okay with rejection in that if they say 'No, that's not true for me."' Using an example of how he would disclose an intuition with a client, Woody stated "Now look, I might be wrong here and if I am, let me know." Jera also discussed phrasing an intuition as "I1 wonder if" to give clients the room to disagree if they aren't ready for it to come into the session. By phrasing their intuitive insights in such careful ways, it creates comfort for the client to say if an intuition is incorrect. However, as stated above, the client rarely disagrees with the counselors' expressed intuitions. Boundaries and Benefits to Using Clinical Intuition After communicating the intuition to their clients, usually the client moves in a positive therapeutic direction. There are times, however, that the counselor does not receive any intuition and thus does not get the benefit of using clinical intuition while counseling. Boundaries that Disengage Intuition All participants described certain instances when their intuition might not be engaged in a session. These reasons for "'turning off the intuition'' participants mentioned are: some clients are too negative (all of the counselors described themselves as positive or optimistic), too deeply enmeshed in their difficulties, have an attitude of this is not worth my time or effort, or who elicit an emotional reaction in the counselor. Usually, these circumstances arose from something elicited in them by a client. For some participants, like Jera or Woody, their intuition "turned off' when clients or a counseling session tended to get their (as counselors) emotions engaged in a negative way. For other participants, it was when the client was not available or open to counseling (Molly) and/or if they were in a very dark, unhealthy place at the beginning of counseling (Katie). Unlike the other participants, attributing the times their intuition was not engaged, Alice stated that it is because of not being present in the room. Alice was hesitant to attribute that lack of presence as reaction to a client although from her description, it almost seems similar to Jera and Woody, somehow getting triggered emotionally and therefore not fully engaged with the client. Jera and Woody both described that their emotional reactions to a counseling session or client would turn off their intuition. For Jera, she described the predominant emotion as anxiety; for Woody, he describes frustration. Jera stated "it's been vitally important to keep my anxiety as low as possible so that I can be open to listening to my own intuition in the room. [The anxiety] definitely gets in the way." Woody discussed that "sometimes a kid frustrates me .. then my intuition is not [engaged] . .and then my emotions have gotten involved because I'm really frustrated with what's going on." Molly described finding it difficult to engage her intuition with clients that are not open or available to counseling but relates that to not fully engaging as a counselor, and not just the intuition, with those clients. She stated "Generally, I think I would say availability. People come in and they think they want to work on stuff but all they really want to do is just gorge, just dump." Those kinds of clients are difficult to engage in true counseling to Molly and thus difficult to engage her intuition. Katie also describes not being fully engaged with some clients, both with those who are not open to counseling and also with those who are in very dark and unhealthy space at the beginning of counseling. Katie stated that "I just think part of it is that they're not open." Furthermore, she said while describing one client, It's like he is suffering so much and he brings this aura with him. .. I do have a sense of my energy, it's tough to push my energy to give that to him a little bit and then to also have intuition working too. I don't know if it's possible, when their energy is sooooo down and black. For Katie, who described herself as a very positive person, the negative feelings coming from the client tended to make her much more knowledge-based in her work since her intuition did not engage. I have to do some real knowledge stuff with people who are down. .. I don't think you engage as much. .. In my experience, the people who I see and have intuitive moments and I reflect with and do that stuff, they're not down at the bottom. They've moved." Benefits of Using Clinical Intuition In disclosing their intuitions with clients, not only are the participants "checking out"' the intuition with the client's experience of an event but also helping the client gain meaning from that event to move the client toward therapeutic change. Discussing an accurate intuition that a client is ready to hear is a powerful moment in therapy, where great movement occurs according to all participants. The interviewees frequently described the disclosure of an intuition leading to a different level of therapeutic work in the session, often leading to intense turning points and speeding up the therapeutic progress. Helping clients gain meaning of intuition. One of the first ways the participants described using their intuitions to help the client move toward change was to help the client make individual meaning out of the intuition. The therapist provided their constructed meaning of an intuition almost as a cue for the client to respond to and draw his or her own individual meaning from it. In an example of when she used intuition with a client, Jera mentioned "The image that I shared with her was very gory, very kind of graphic but it really cemented a couple of insights that she had already come to and coalesced in the image that she was then able to take that image with her." The intuitive image served almost as a trigger for Jera' s client to be able to put everything together and construct her own individual meaning from it that she could then take with her. Alice stated that when she shares an intuition with a client, the client could "say 'Oh my god, yeah. Wow. That's happening for me. .. and it completely takes their little window of how they perceive everything and shifts it just a little bit and suddenly, things move in a different direction for them." The client makes individual meaning out of what Alice presented and uses it to move to a different place therapeutically. Katie described a time with a client when she saw an intense color and connected it to the client. She said "Just like if you were doing a reflection of feeling or reflection of meaning, they tell you. It's like the guy afterwards with the aquamarine said 'You know, when you said aquamarine, I was seeing that color."' Katie brought her intuition of that color into the session and then facilitated the client's individual meaning-making of the color. Woody and Molly did not describe specific instances of helping their clients make meaning of an intuition but throughout their interviews, the focus on checking it out with the client implied to me that they also don't impose a meaning on an intuition. By not imposing their own therapist's meaning on the intuition, they leave the intuition open to the client's own meaning-making. Creating turning points. The participants also described times in which working with an intuition brought about a turning point for the client, either in the session or afterward. However the common connection was that the therapist's intuition sparked a change in the client (once they added their own individual meaning of it) that moved the client to a different space therapeutically. Katie described times when she did not directly disclose an intuition to a client because it came to her as a need to do something. However, Katie ended up working with the product to help the client gain meaning from the output of her clinical intuition. In describing an example of this with a client, Katie said: I felt I HAD to make her this hanging thing with beads and stuff and I wanted to put an origami crane that I made on it. .. I just said "I made you this. Take it to your next place you live."' And first off, she told me red was her favorite color .. and that was it, I didn't hear from her. I didn't think anything more about it. I had been driven to do it and then it was over. About two years later, she wrote me an email and said "Your origami crane has been hanging in my kitchen for the last two years and I cannot tell you how much peace and solace and also how much it has motivate me to do thing. And even though you aren't here, these are the changes I've made in my life." Katie's intuitive drive to make the crane ended up serving as a turning point for the client; a constant reminder of where she wants to go and it gave her the peace and motivation to move to a healthier place. Woody described an instance working with a client when he received an intuition that the client was using drugs, even though there was no indication of that in how she presented. He stated "she would come and see me on a regular basis .. and she would come in and she would talk about surface level stuff and I just flat out asked her 'How often are you smoking marijuana?'" Allowing the client room to deny if she were using marijuana, Woody used that intuition to confront the client. As a result, his intuitive confrontation served as a turning point where they got off the surface level information and then started doing real therapeutic work. Jera described how she frequently sees her intuition in sessions to know what will create turning points for her clients. She discussed: Often at some point, I will just know they are going to turn a corner and I will be so looking forward to their next session. Because my intuition tells me that their readiness is peaked and they have the insight they need and their motivation level is high and this is going to be the week. For Jera, her intuitions can help her know when to use certain techniques or confrontations because she intuitively knows the client is really for the challenge and thus a turning point occurs. Similarly, Molly did not mention a specific example with a client, but implied that her intuition "'gives me all the raw materials to use in coming up with interventions."' As a result of those interventions, she helps her clients come to turning points. Speeding up the counseling process. Using their intuitions in counseling, the participants also described how it allows them to speed up the process of counseling. As with helping a client gain their own meaning and by reaching turning points, the using the intuition ";as a guide" (Alice) or to help get to those turning points faster (Molly, Jera, Woody, & Katie), the intuitive insights about clients move them toward change quickly. Jera stated "it speeds things up so much." Woody described his clinical intuition as "'We're wasting time and the intuition is a way to speed up the process."' Molly, Alice, and Katie all implied that their intuitions help them get to the heart of a client's issue more quickly without specifically stating it. CHAPTER 5 IMPLICATIONS & CONCLUSIONS Reflections on the Research Process Interestingly, my experiences with clinical intuition are somewhat different than my participants' experiences and by conducting research for this dissertation, I feel my individual construction of intuition has changed. My own subjectivity created moments when I was genuinely surprised that the analysis was taking something in a very different direction than how I have personally experienced it. There were very many similarities: I also would describe it as a sense of knowing or an awareness about a client that I respectfully and tentatively express to a client to help move him/her toward therapeutic change. I also use my intuition to determine appropriate interventions and the timing of those interventions as some of my participants described. The main difference is that I have never considered the counseling relationship to be an important aspect to intuition. For me, intuition never seemed to result from having a strong rapport with a client, although it certainly helped me feel more comfortable communicating an intuition to a client. Before starting this research, I never considered the counseling relationship to be a vital factor because I never stopped to consider how I experience intuition differently while counseling than in the rest of my life. As I have had intuitions about people I have not had any contact with before, not having any sort of relationship with that person, I assumed that this was the case in counseling. However, after listening to my participants and analyzing their individualized constructions of clinical intuition, I started to acknowledge that the counseling relationship has been vital for my own experiences with clinical intuition. I cannot recall an instance when I received intuition about a client when I was not engaged, fostering, and using the counseling relationship is some sense. I also found myself agreeing with my participants as to times when my intuition has not been engaged in counseling, usually with very gloomy or unhealthy clients, when I am feeling an emotional reaction in the session (or in life in general), or when a client is not engaged or available to the counseling process. In those instances, I tend to rely much more on the knowledge and tools I have gained through education and experience, similarly to my participants. Limitations of the Current Study and Recommendations for Future Research While such an open topic as intuition does not appear to lend itself well to the structured nature of a grounded theory approach, a data-based theory did emerge from the findings. The topic of clinical intuition is in some respects too broad to study using true grounded theory; however, the initial shaping of the theory on clinical intuition in counseling sets the stage for further research and refinement on the topic. Another limitation is my use of constructivism as the theoretical foundation behind the grounded theory methodology. Grounded theory has positivist roots but can be approached through a constructivist lens (Charmaz, 2000; Charmaz, 2001; Strauss & Corbin, 1998). However, at its core, grounded theory is much more positivist than constructivist. Because the positivism inherent in grounded theory methods and the theoretical foundation of constructivism are not an ideal match, future research on the topic of clinical intuition in counseling should be conducted by more closely matching the methodology to the theoretical foundation. In qualitative research, the researcher is the analytical tool and as a result, personal subjectivity of the researcher can influence the analysis. My personal experiences with clinical intuition in counseling potentially influenced the data collection and analysis; however, I tried to bracket my subjectivity as much as possible to keep it from filtering into my research. By stating my subjectivities and personal reflections on the research process, I hope to increase the trustworthiness and credibility of my data. Although the theory of clinical intuition in counseling that arose in my study is intriguing, it needs to be further developed and refined with a wider variety, number, and type of participants. My sample ended up consisting of mainly white females, with one white male. It is difficult to determine the trustworthiness of my data in reference to counselors of more diverse backgrounds (such as gender, race, ethnicity, sexual orientation, etc.) since they were not included in this study. A limitation that arose during data collection and analysis was that the time between the first interviews for both Woody and Katie and the follow-up interviews was too much too long. Ideally, the follow-up interview would have occurred very soon after their initial interviews but circumstances did not make that possible. Because of the long time between interviews, I did not feel the data collected in the follow-ups was as rich as it could have been if the first interviews had been fresher in their minds. As a result, the less rich data could have potentially led to theoretical saturation more quickly with less new, rich data coming in during the follow-up interviews. In future research, I would continue to study the aspect of counselor experience in further developing the theory. During the initial stages of my analysis, experience appeared to play a larger role in the intuitive process in counseling but did not emerge fully in the final theory. I would want to further study how counselors across different experience levels make meaning of and use their intuitions with clients. The aspect of the counseling relationship is another aspect that I would continue to explore in future research, both in trying to gain a greater understanding of its role in the process and in how it triggers an intuition in a counselor. This is an important aspect that must be studied further to gain a wider understanding of the impact of the counseling relationship variable in making meaning of and using intuition while counseling. Conclusion My analysis revealed that counselors' use of intuition can be of great benefit to the counseling relationship and to the therapeutic progress of a client. By first receiving and recognizing an intuition and then respectfully communicating it to the client, a counselor can move her/him toward therapeutic change more quickly and with more meaning than when their intuitions are not engaged. If using clinical intuition can speed up the process of helping clients become more mentally "healthy," it should be incorporated as a valid part of the counseling process, gaining acceptance and recognition from counselor training programs, licensing boards, and third-party payers. When their clinical intuition was not engaged in the counseling session, it was usually a result of something not occurring within the counseling relationship, that is, some boundary between the counselor and client and their relationship. My research brings awareness to what kinds of clients or what kinds of emotions "'turn off" clinical intuition in counselors, hopefully helping intuitive counselors recognize more quickly when their intuitions were not engaged. Again, as clinical intuition brings great benefit to the counseling session, it is important that counselors become aware of the instances when it is not occurring, so they can improve the counseling relationship and therapeutic progress for their clients. All participants indicated that they felt their intuitions were correct and when checked out, clients usually confirmed that the intuition was on target. If an intuition is usually correct when shared with a client, then it is not faulty thinking or bias as some critics argue (Gambril, 1990; Hall, 2002; Myers, 2002). It seems that in using the counseling relationship to trigger intuitions about the client, a counselor is tapping into some part of the client's reality. How that tapping into process occurs is still a mystery; however, the result of that process, intuition, is not a mysterious, nebulous thing that we must avoid at all costs if we are to be considered legitimate. It is something that seems to greatly facilitate the counseling process. The participants' meaning of clinical is intuition is similar to but different than how I have defined it in chapter one: the speedy, unconscious knowing: (a) of information about a client, (b) used to form hypotheses about a client without rational, logical means (c) of what sort of treatments will work well with a client, and/or (d) used to determine a new course of action with a client if feeling 'stuck'. The participants described a sense of knowing (speedy, unconscious knowing) about the client (of information about the client), that they communicate to their clients (testing their intuitive insights/hypotheses about the client). Both Jera and Molly specifically described using their intuition to help figure out interventions (what sort of treatments work well). None of the participants described using their clinical intuition to determine a new course of action with a client if feeling stuck. In fact, most participants implied that either they did not get stuck with clients very often or that if they did get stuck, it was because their intuition was not engaged in the session. My definition did not incorporate an important aspect of clinical intuition that all participants mentioned in my research: the importance of the counseling relationship in generating a clinically intuitive insight. Very little of the literature mentions the necessary rapport, strength and quality of the counseling relationship as generators of clinical intuition in any discipline (nursing, medicine, business, or counseling). Redding (2001) did postulate that caring is a basis for empathy and thus intuition in nurses, which is similar to the idea of the counseling relationship as the basis of intuition, but she conceptualized it more as qualities within the practitioner and not as a result of the interaction. None of my participants supported the idea that intuition is a form of reflection- in-action or tacit knowledge (Schiin, 1983; Welsh & Lyons, 2001) or that it was mere pattern recognition (Benner, 1984/2001; Benner & Tanner, 1987). They all distinguished between clinical intuition and clinical knowledge in that intuition arises more spontaneously, without knowing where it came from and knowledge is something that we learned in our experience or education that we know we are using to generate clinical ideas. My research indicates that although we primarily gain clinical knowledge with experience and education, we do not gain more clinical intuition with experience, we just trust it more. The nursing literature implies that using intuition to help clients is a skill practitioners gain with experience; thus, the more exposure they have to certain patterns of patient behavior and vital signs, the more the nurses will understand how those patterns fit together quickly. My findings did not support that view of clinical intuition in counseling. Novice counselors have intuition but do not yet trust using it in session. With experience, counselors begin to feel more confident and comfortable trusting and using their clinical intuitions as part of the counseling process. I believe that beginning counselors do not trust their intuitions because the counseling field is becoming focused on outcome-based treatments and rigid diagnoses as we try to gain legitimacy in the scientific and managed care worlds. A novice counselor might enter a counseling program with strong intuition that can be used to help their clients in sessions. However, these intuitions may be trained out, as a beginning counselor learns that they must only use certain proscribed techniques and methods in counseling a client. With time and experience, intermediate counselors learn to again trust those clinical intuitions, matching them up with the knowledge and education from training. Expert counselors have seen the results for many years of bringing their intuitions back into the sessions that they do so more confidently and comfortably on a regular basis. All participants discussed a difference between clinical knowledge, technique, and intuition in session and all discussed the importance of using both when with a client. Making meaning out of clinical insight can help move the client to therapeutic change in a speedy, meaningful way; however, the techniques and clinical knowledge developed in counseling education, help counselors make sense of how to use their intuitions. Contact Us | Permissions | Preferences | Technical Aspects | Statistics | Internal | Privacy Policy © 2004 - 2010 University of Florida George A. Smathers Libraries.All rights reserved. Acceptable Use, Copyright, and Disclaimer Statement Last updated October 10, 2010 - - mvs