Clinical Intuition and Working Memory: Implications for Training and Supervision
Main Article Content
Abstract
Competence with emergent intuitive awareness, from fringe-of-consciousness hunches to compelling difference-in-kind realisations, is an imprecise qualitative skill and, on this basis, one generally overlooked in clinical psychology training and supervision. This situation is at marked odds with an expanding literature highlighting that intuitions emerging from unconscious inferential cognition serve as a primary resource in the decision-making of expert practitioners across a dissimilar range of professions. Additionally, (i) over forty years extensive and distinct research into working memory conclusively demonstrates that System 1 autonomous inferential reasoning is the mind’s powerhouse, yet moreover (ii) plays a determining role in attention allocation and thereby meta-level reasoning processes (i.e., System 2; cognitive control/metacognition), the very constituents of reflective practice. In short, the case appears overwhelming for clinical intuition competency training. Additionally, a substantial reflective practice training literature which could readily be modified to include clinical intuition considerations sits immediately at hand. One difficulty, however, is that an accommodating model which will seamlessly link, firstly, difference-in-kind S1 emergent awareness, and, secondly, meta-level reflective practice, is yet to be highlighted. Remarkably, coherence-based reasoning sits in plain sight as a potential bridging position. Finally, expanding upon elementary suggestions in the literature, the toolbox skills ‘slow-onset speech’, ‘affective inquiry’, and ‘therapeutic presence’ are put forward as therapy technique functional for enhancing a clinician’s intuition sensitivity.
Keywords:
Intuition, Difference-In-Kind Awareness, Coherence-Based Reasoning, Working Memory, Reflective Practice
Article Details
How to Cite
JOHN, Michael Austin.
Clinical Intuition and Working Memory: Implications for Training and Supervision.
Medical Research Archives, [S.l.], v. 11, n. 2, feb. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3552>. Date accessed: 03 may 2025.
doi: https://doi.org/10.18103/mra.v11i2.3552.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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29. Oberauer K. Working memory and attention – a conceptual analysis and review. Journal of Cognition. 2019;2(1):1-29. https://doi.org/10.5334/joc.58
30. Kolanczyk A. When affect supports cognitive control – a working memory perspective. Polish Psychological Bulletin. 2016;47(1):29-42. https://doi.org/10.1515/ppb-2016-0004
31. Schwartz BL, Metcalf J. Tip-of-tongue (TOT) states: retrieval, behaviour and experience. Memory and Cognition. 2011; Springer 4 January: 1-13. https://doi.org/10.3758/s13421-010-0066-8
32. Price MC, Norman E. Intuitive decisions on the fringes of consciousness: are they conscious and does it matter. Judgement and Decision Making. 2008;3(1):28-41.
33. Thompson V. Why it matters: the implications of autonomous processes for dual process theories – commentary on Evans & Stanovich (2013). Perspectives on Psychological Science. 2013;8(3):253-256. https://doi.org/10.1177/1745691613483476
34. Strle T. Metacognition and decision making: between first and third person perspective. Interdisciplinary Description of Complex Systems. 2012;10(3):284-297. https://doi.org/10.7906/indecs.10.3.6
35. Arango-Munoz S. Scaffolded memory and metacognitive feelings. Review of Philosophy and Psychology. 2013;4:135-152. https://doi.org/10.1007/s13164-012-0124-1
36. Zander T, Horr NK, Bolte A, Volz K. Intuitive decision making as a gradual process: investigating semantic intuition-based and priming-based decisions with fMRI. Brain and Behaviour. 2016;6(1):e00420:1-22. http://dx.org/10.1002/brb3.420
37. Oizumi M, Albantakis L, Tononi G. From phenomenology to the mechanisms of consciousness: integrated information theory 3.0. PLoS Computational Biology; San Francisco. 2014;10(5):1-36. https://doi.org/10.1371/journal.pcbi.1003588
38. Gentner D. Structure mapping: a theoretical framework for analogy. Cognitive Science. 1983;7:155-170.
https://doi.org/10.1207/s15516709cog702_3
39. Holyoak KJ, Thagard P. Analogical mapping by constraint satisfaction. Cognitive Science. 1989;13:295-355.
https://doi.org/10.1207/s15516709cog1303_1
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42. Markman AB, Gentner D. Structure mapping in the comparison process. American Journal Psychology of Psychology. 2000;113(4):501-538. https://doi.org/10.2307/1423470
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44. Cushman F. Rationalisation is rational. Behavioural and Brain Sciences. 2020;43(e28):1-59. https://doi.org/10.1017/S0140525X19001730
45. Holyoak K, Powell D. Moral judgement as reasoning by constraint satisfaction. In: May J, Precis of regard for reason in the moral mind. Behavioural and Brain Sciences. 2019;42(e156):1-60. https://doi.org/10.1017/S0140525X18002546
46. Simon D, Holyoak KJ. Ex ante coherence shifts. In: Cusman C, Rationalisation is rational. Behavioural and Brain Sciences. 2020;43(e47):35-36. https://doi.org/10.1017/S0140525X19002103e47
47. Thagard P. Explanatory coherence. Behavioural and Brain Sciences. 1989;12(3):435-502. https://doi.org/10.1017/s0140525x00057046
48. Broder A, Scharf S, Jekel M, Glockner A, Franke N. Salience effects in information acquisition: no evidence of a top-down coherence influence. Memory and Cognition. 2021;Springer 16 June:1-18. https://doi.org/10.3758/s13421-021-01188-9
49. Fries P. Rhythms for cognition: communication through coherence. Neuron. 2015;88(October):220-235. https://doi.org/10.1016/j.neuron.2015.09.034
50. Egorov M, Verdorfer AP, Peus C. Taming the emotional dog: Moral intuition and ethically-orientated leader development. Journal of Business Ethics. 2019;160:817-834. https://doi.org/10.1007/s10551-018-3876-4
51. Andow J. Why don’t philosophers do their intuition practice? Acta Analytic. 2018:1-13. https://doi.org/10.1007/s12136-018-0377-0
52. Van den Brink N, Holbrechts B, Brand PLP, Stolper ECF, Van Royen P. Role of intuitive knowledge in the diagnostic reasoning of hospital specialists: a focus group study. BMJ Open. 2019;9e022724. http://doi:10.1136/bmjopen-2018-022724
53. Mega LF, Gigerenzer G, Volz KG. Do intuitive and deliberate judgements rely on two distinct neural systems? A case study in face processing. Frontiers in Human Neuroscience. 2015;9(456):1-15. https://doi.org/10.3389/fnhum.2015.00456
54. Damnjanovic K, Novkovic M, Pavlovic I, Ilic S, Pantelic S. A cue for relational reasoning: introducing a reference point in cognitive reflection tasks. Europe’s Journal of Psychology. 2019;15(1):25-40. https://doi.org/10.5964/ejop.v15i1.1701
55. Scholz A, Krems JF, Jan G. Watching diagnoses develop: eye movements reveal symptom processing during diagnostic reasoning. Psychonomic Bulletin Review. 2017;24:1398-1412. https://doi.org/10.3758/s13423-017-1294-8
56. Brezina I. Unfolding intuition – Zen tradition in cognitive psychology lenses. Studia Psychologica. 2011;53(2):215-220.
57. Trungpa C. Mudra. Early Poems and Songs. Shambhala Publications, Inc., Boston Massachusetts; 2001. isbn:978-0-87773-051-4(pbk.)
58. Division of Clinical Psychology. Good practice guidelines on the use of psychological formulation. Leicester: The British Psychological Society; 2011.
59. Kabat-Zinn J. Full catastrophe living Using the wisdom of your body and mind to face stress, pain, and illness. Delta Health Psychology, Random House, New York; 2005. isbn:0-385-30312-2(pbk.)
2. Cowan N. The many faces of working memory and short-term storage. Psychology Bulletin Review. 2017;24:1158-1170. https://doi.org/10.3758/s13423-016-1191-6
3. Thompson VA. What intuitions are … and are not. Psychology of Learning and Motivation. 2014;60:35-75. https://doi.org/10.1016/B978-0-12-800090-8.00002-0
4. Ackerman R, Thompson VA. Meta-reasoning: Monitoring and control of thinking and reasoning. Trends in Cognitive Sciences. 2017;27(8):607-617. https://doi.org/10.1016/j.tics.2017.05.004
5. Velichkovsky BB. Consciousness and working memory: current trends and research perspectives. Consciousness and Cognition. 2017;55:35-45. http://dx.org/10.1016/jconcog.2017.07.005
6. Chai WJ, Abd Hamid AI, Abullah JM. Working memory from the psychological and neurosciences perspectives: a review. Frontiers in Psychology. 2018;9(401):1-26. https://doi.org/10.3389/fpsyg.2018.00401
7. Miller EK, Lundqvist M, Bastos AM. Working memory 2.0. Neuron Perspective. 2018;24:463-475. https://doi.org/10.1016/j.neuron.2018.09.023
8. Jekel M, Glockner A, Broder A. A new and unique prediction for cue-search in a parallel-constraint satisfaction network model: the attraction search effect. Psychological Review. 2018;125(5):744-768. https://doi.org/10.1037/rev0000107
9. de Chantal P, Newman IR, Thompson V, Markovits H. Who resists belief-biased inferences? The role of individual differences in reasoning strategies, working memory, and attentional focus. Memory & Cognition; New York. 2020;48(4):655-671. https://doi.org/10.3758/s13421-019-00998-2
10. Thompson VA, Prowse Turner JA, Pennycook G, Ball GJ, Ophir Y, Ackerman R. The role of answer fluency and perceptual fluency as metacognitive cues for initiating analytic thinking. Cognition. 2013;128(2):237-251. https://doi.org/10.1016/j.cognition.2012.09.012
11. Logan RK, Tandoc M. Thinking in patterns and the pattern of human thought as contrasted with AI data processing. Information. 2018;83(9):1-15. https://doi.org/10.3390/info9040083
12. Heidenreich T, Noyon A, Worrell M, Menzies R. Existential approaches and cognitive behavior therapy: challenges and potential. International Journal of Cognitive Therapy. 2021;14:209-234. https://doi.org/10.1007/s41811-020-00096-1
13. Epstein S. Demystifying intuition: What it is, what it does, and how it does it. Psychological Inquiry. 2010;21(4):295-312. https://doi.org/10.1080/1047840x.2010.523875
14. Kahneman D. Thinking, fast and slow. Griffin Press, Penguin Group (Australia); 2011. isbn: 978-0-141-03357-0 (pbk.)
15. Okoli JO, Weller G, Watt J. Information processing and intuitive decision-making on the fireground: Towards a model of expert intuition. Cogn Tech Work. 2016;18:89-103. https://doi.org/10.1007/S10111-015-0348-9
16. Zollo L, Pellegrini MM, Ciappei C. What sparks ethical decision making? The interplay between moral intuition and moral reasoning: Lessons from the Scholastic doctrine. Journal of Business Ethics. 2017;145:681-700. https://doi.org/10.1007/s10551-016-3221-8
17. Ward T, Clack S, Haig BD. The abductive theory of method: Scientific inquiry and clinical practice. Behaviour Change. 2017;33:212-231. http://dx.org/10.1017/bec.2017.1
18. Thompson VA, Prowse Turner JA, Pennycook G. Intuition, reason and metacognition. Cognitive Psychology. 2011;63(3):107-140. https://doi.org/10.1016/j.cogpsych.2011.06.001
19. Ackerman R. Heuristic cues for meta-reasoning judgements: review and methodology. Psychological Topics. 2019;28(1):1-20. https://doi.org/10.31820/pt.28.1.1
20. Vega S, Mata A, Ferreira MB, Vaz AR. Metacognition in moral decisions: judgement extremity and feelings of rightness in moral intuitions. Thinking and Reasoning. 2020; 27(1):124-141. https://doi.org/10.1080/13546783.2020.1741448
21. Bennett-Levy J, Thwaites R, Chaddock A, Davis M. Reflective practice in cognitive behavioural therapy: The engine of lifelong learning. In: Stedman J, Dallos R, eds. Reflective practice in psychotherapy and counselling. Maidenhead: Open University Press; 2009: 115-135. https://doi.10.13140/2.1.111.9040
22. Bennett-Levy, J., McManus, F., Westling, B., & Fennell, M. (2009). Acquiring and refining CBT skills and competencies: Which training methods are perceived to be most effective? Behavioural and Cognitive Psychotherapy. 2009;37(5):571-583. https://doi.org/10.1017/s1352465809990270
23. Haarhoff B, Gibson K, Flett R. Improving the quality of cognitive behaviour therapy case conceptualisation: The role of self-practice/self-reflection. Behavioural and Cognitive Psychotherapy. 2011;39(3):323-339. https://doi.org/10.1017/s1352465810000871
24. Bennett-Levy J, Lee NK. Self-practice and self-reflection in cognitive behaviour therapy training: What factors influence trainees’ engagement and experience of benefit? Behavioural and Cognitive Psychotherapy. 2014;42(1):48-64. https://doi.org/10.1017/s1352465812000781
25. Lewis D, Virden T, Hutchings PS, Bhargava R. Competence assessment in integrating reflective practice in a professional psychology program. Journal 0f the Scholarship of Teaching and Learning. 2011;11(3):86-106.
26. Wood H, Lea L, Holttum S. Finding the personal in the clinical psychology swamp. The Journal of Mental Health Training, Education and Practice. 2013;8(1):15-25. http://dx.org/10.1108/17556221311307998
27. Nachev P, Roberts RE, Husain M, Kennard C. The neural basis of meta-volition. Communication Biology. 2019;2(1):1-22. https://doi.org/10.1038/s42003-019-0346-1
28. Baddeley A. Working memory. Current Biology. 2009;20(4):1-5. https://doi.org/10.1016/j.cub.2009.12.014
29. Oberauer K. Working memory and attention – a conceptual analysis and review. Journal of Cognition. 2019;2(1):1-29. https://doi.org/10.5334/joc.58
30. Kolanczyk A. When affect supports cognitive control – a working memory perspective. Polish Psychological Bulletin. 2016;47(1):29-42. https://doi.org/10.1515/ppb-2016-0004
31. Schwartz BL, Metcalf J. Tip-of-tongue (TOT) states: retrieval, behaviour and experience. Memory and Cognition. 2011; Springer 4 January: 1-13. https://doi.org/10.3758/s13421-010-0066-8
32. Price MC, Norman E. Intuitive decisions on the fringes of consciousness: are they conscious and does it matter. Judgement and Decision Making. 2008;3(1):28-41.
33. Thompson V. Why it matters: the implications of autonomous processes for dual process theories – commentary on Evans & Stanovich (2013). Perspectives on Psychological Science. 2013;8(3):253-256. https://doi.org/10.1177/1745691613483476
34. Strle T. Metacognition and decision making: between first and third person perspective. Interdisciplinary Description of Complex Systems. 2012;10(3):284-297. https://doi.org/10.7906/indecs.10.3.6
35. Arango-Munoz S. Scaffolded memory and metacognitive feelings. Review of Philosophy and Psychology. 2013;4:135-152. https://doi.org/10.1007/s13164-012-0124-1
36. Zander T, Horr NK, Bolte A, Volz K. Intuitive decision making as a gradual process: investigating semantic intuition-based and priming-based decisions with fMRI. Brain and Behaviour. 2016;6(1):e00420:1-22. http://dx.org/10.1002/brb3.420
37. Oizumi M, Albantakis L, Tononi G. From phenomenology to the mechanisms of consciousness: integrated information theory 3.0. PLoS Computational Biology; San Francisco. 2014;10(5):1-36. https://doi.org/10.1371/journal.pcbi.1003588
38. Gentner D. Structure mapping: a theoretical framework for analogy. Cognitive Science. 1983;7:155-170.
https://doi.org/10.1207/s15516709cog702_3
39. Holyoak KJ, Thagard P. Analogical mapping by constraint satisfaction. Cognitive Science. 1989;13:295-355.
https://doi.org/10.1207/s15516709cog1303_1
40. Holyoak KJ. Analogy and relational reasoning. In: Holyoak KJ, Morrison RG, eds. The Oxford Handbook of Thinking and Reasoning. Oxford University Press, N.Y.; 2012:234-250.
41. Hegel GWF. Phenomenology of spirit. In: Miller AV, trans. Hegel’s Phenomenology of Spirit. Oxford University Press, New York; 1807/1977. isbn:978-0-19-824597-1(pbk.)
42. Markman AB, Gentner D. Structure mapping in the comparison process. American Journal Psychology of Psychology. 2000;113(4):501-538. https://doi.org/10.2307/1423470
43. Ullman T D. Heroes of our own story: self-image and rationalising in thought experiments. In: Cushman C, Rationalization is rational. Behavioural and Brain Sciences. 2020;43(e28):39-40. https://doi.org/10.1017/S0140525X19002280, e51
44. Cushman F. Rationalisation is rational. Behavioural and Brain Sciences. 2020;43(e28):1-59. https://doi.org/10.1017/S0140525X19001730
45. Holyoak K, Powell D. Moral judgement as reasoning by constraint satisfaction. In: May J, Precis of regard for reason in the moral mind. Behavioural and Brain Sciences. 2019;42(e156):1-60. https://doi.org/10.1017/S0140525X18002546
46. Simon D, Holyoak KJ. Ex ante coherence shifts. In: Cusman C, Rationalisation is rational. Behavioural and Brain Sciences. 2020;43(e47):35-36. https://doi.org/10.1017/S0140525X19002103e47
47. Thagard P. Explanatory coherence. Behavioural and Brain Sciences. 1989;12(3):435-502. https://doi.org/10.1017/s0140525x00057046
48. Broder A, Scharf S, Jekel M, Glockner A, Franke N. Salience effects in information acquisition: no evidence of a top-down coherence influence. Memory and Cognition. 2021;Springer 16 June:1-18. https://doi.org/10.3758/s13421-021-01188-9
49. Fries P. Rhythms for cognition: communication through coherence. Neuron. 2015;88(October):220-235. https://doi.org/10.1016/j.neuron.2015.09.034
50. Egorov M, Verdorfer AP, Peus C. Taming the emotional dog: Moral intuition and ethically-orientated leader development. Journal of Business Ethics. 2019;160:817-834. https://doi.org/10.1007/s10551-018-3876-4
51. Andow J. Why don’t philosophers do their intuition practice? Acta Analytic. 2018:1-13. https://doi.org/10.1007/s12136-018-0377-0
52. Van den Brink N, Holbrechts B, Brand PLP, Stolper ECF, Van Royen P. Role of intuitive knowledge in the diagnostic reasoning of hospital specialists: a focus group study. BMJ Open. 2019;9e022724. http://doi:10.1136/bmjopen-2018-022724
53. Mega LF, Gigerenzer G, Volz KG. Do intuitive and deliberate judgements rely on two distinct neural systems? A case study in face processing. Frontiers in Human Neuroscience. 2015;9(456):1-15. https://doi.org/10.3389/fnhum.2015.00456
54. Damnjanovic K, Novkovic M, Pavlovic I, Ilic S, Pantelic S. A cue for relational reasoning: introducing a reference point in cognitive reflection tasks. Europe’s Journal of Psychology. 2019;15(1):25-40. https://doi.org/10.5964/ejop.v15i1.1701
55. Scholz A, Krems JF, Jan G. Watching diagnoses develop: eye movements reveal symptom processing during diagnostic reasoning. Psychonomic Bulletin Review. 2017;24:1398-1412. https://doi.org/10.3758/s13423-017-1294-8
56. Brezina I. Unfolding intuition – Zen tradition in cognitive psychology lenses. Studia Psychologica. 2011;53(2):215-220.
57. Trungpa C. Mudra. Early Poems and Songs. Shambhala Publications, Inc., Boston Massachusetts; 2001. isbn:978-0-87773-051-4(pbk.)
58. Division of Clinical Psychology. Good practice guidelines on the use of psychological formulation. Leicester: The British Psychological Society; 2011.
59. Kabat-Zinn J. Full catastrophe living Using the wisdom of your body and mind to face stress, pain, and illness. Delta Health Psychology, Random House, New York; 2005. isbn:0-385-30312-2(pbk.)