Building the Best Explanation: Reflections on Clinical Thinking

One of the reasons I was drawn to psychology is because I've always been fascinated by human behavior. Long before I became a therapist, I found myself wondering why people think, feel, and behave the way they do. More than 20 years into my career, that curiosity continues to guide the way I approach every individual I meet.

When someone walks into my office, my mind naturally begins looking for patterns. I consider developmental history, family relationships, personality, learning, emotional regulation, cognition, life experiences, and yes, diagnosis. Each piece offers important information, but none tells the whole story by itself.

Over the years, I've found myself returning to one question more than any other:

What is the best explanation for what I'm observing?

To me, that question changes everything.

Two children may avoid school.

From the outside, the behavior appears identical.

Yet one child may be overwhelmed by anxiety. Another may struggle with executive functioning and feel defeated before the day even begins. A third may experience sensory overload. A fourth may feel chronically misunderstood by peers. The behavior is the same.

The explanation is not.

I've found this principle extends well beyond any specific diagnosis.

Two individuals may both meet criteria for ADHD, Autism Spectrum Disorder, OCD, or anxiety, while requiring very different treatment approaches because of differences in development, cognition, family dynamics, motivation, learning style, personality, or life experiences. A diagnosis helps organize information, but it rarely tells the complete story of who someone is or what they need.

For me, this is where clinical reasoning becomes one of the most valuable skills we develop as mental health professionals.

Clinical reasoning requires us to remain curious. It asks us to gather information thoughtfully, consider multiple possibilities, recognize patterns, challenge our assumptions, and allow our understanding to evolve as new information becomes available. Rather than searching for the quickest answer, it encourages us to build the most accurate explanation we can.

I've found that when we better understand the individual, treatment naturally becomes more individualized. Families often feel more understood. Interventions become more practical because they're based on understanding rather than assumption.

These reflections are not presented as research findings or established theory. They represent observations that have developed through more than two decades of clinical work with children, adolescents, young adults, adults, and families across therapeutic schools, outpatient settings, and private practice. I share them simply to encourage thoughtful discussion among clinicians, educators, and families about the complex process of understanding human behavior.

As I begin offering Clinical Supervision for Licensed Social Workers pursuing New Jersey LCSW licensure and Professional Consultation for mental health professionals, I hope to use this blog to share many of the clinical observations and questions that have shaped my thinking throughout my career. My goal is not to provide definitive answers, but to encourage curiosity, thoughtful discussion, and continued growth as we work to better understand the individuals and families we serve.

After all, I believe one of the most important questions we can continue asking ourselves is not simply,

"What diagnosis fits?"

but rather,

"What is the best explanation for what I'm observing?"

I suspect I'll never stop asking that question.