What Is Clinical Intuition?

Intuition is not some ‘pink and fluffy’ feeling as some might first think. It generally involves being aware of subtle aspects that fall outside our primary focus. This often includes elements that escape our conscious awareness, the subliminal, unconscious, implicit or subtle information that can easily be missed.

You may become aware of a client’s tone of voice, the implied meaning in their choice of words, their humour, their irony, body language etc... along with a feeling of suddenly ‘just knowing something’ that might be valuable to the client. The more we rule out this type of information, the more it could be seen as missing out on another form of communication, that occurs between the therapist and client.

We might want to see this phenomenon as being able to eliminate mental clutter, activate our right-brain hemisphere along with welcoming any natural embodied responses that arise. We might find ourselves being open to our own inner voices and responding to the ongoing changing dynamics in the therapeutic process. It could be seen as simply paying attention to ‘gut’ feelings and to the spontaneous thinking that has the potential to move conversations in a different therapeutic direction.

It could also be described as having a non-rational knowing awareness or believing that we might have understood something immediately, without analytical thought.

For example, our tone of voice, the use of silence, or a feeling about a client might not always be solely the result of analytic thinking. Rather, it might be because of a ‘sense’ of how to proceed or an internal ‘signal’ that influences us to change the direction of the therapy. With some clients, we may ‘just somehow’ know that our ‘demeanour’ or ‘approach’ could benefit from say being ‘modified’ to help the client feel more comfortable.

Thus, this understanding could allow us to act spontaneously to how the client might be presenting themselves in any given moment. It's where we might experience ‘receptivity’, or ‘sensitivity’ towards how the client ‘is’ in the room. This may lead to understanding our clients at a level that’s different to spoken words.

In some ways intuition may enter the therapist’s or the client’s awareness in various ways by sensory information, flashes of images, metaphors, feelings, sounds, snippets of songs, words, poems or through tastes, smells or a manifestation of thought... Often these can occur in combination or in sequence but the reaction to the intuition information appears and ‘feels’ ‘truthful’ or ‘real’.

We could say the base of clinical intuition comes from curiosity and being observant about ‘catching’ or ‘picking up’ this information and then being curious about that.

Intuitive modes of functioning may include following hunches, having experiences of sudden insights, choosing directions without really knowing why, or having uncanny feelings that sometimes turn out to be of importance to the client.

Using intuitive moments is NOT about giving the clients false hope, predicting their future, guiding/ leading, telling the client what to do or even making statements such as, ‘I can see darkness or negativity’. It’s more about understanding how clinical intuition first sits in a framework. This framework includes how there are no fixed ways to understand how intuitive processes exactly works as intuition typically is about potentially ‘knowing’ without knowing how you know. It seems healthier then to focus on the framework itself and see it more as receiving and offering clients ‘temptations’ towards engagement.

What Does Clinical Intuitive Moments Exactly Look Like?

At first, clinical intuition can be a complex tool to fully grasp and effectively use. However, it’s a tool that can be ‘mixed in’ with any modality. The first step is to try reflecting on what it might look like for you in your practice.

Sometimes it is just the recognition that something is not quite right in the moment that could prompt us to discover together what that something is. By maintaining an open mind, a non-judgmental attitude, intuition could open the door to valid clarifications to client’s difficult struggles or predicaments.

Sometimes noticing or acting on our intuition in or outside of sessions, could be a pivotal point which tends to invite the therapist and client to a different point of discovery. Therapists may form a hypothesis based on intuition which involves having a ‘feeling in or outside the room’ about something that exists despite known facts. We may describe having a sense such as, ‘Oh, I have an idea’ or ‘Oh, something's just come to my mind’. Thus, these comments may cause us to ask a question and then to try to elicit an exploration.

For example, let’s say we have a session with a client, and we can’t put your finger on it, but something feels ‘off’ when a client says he’s ready to finish. The client presents the ‘all assured together look’ and gives you messages that what he’s saying is true and trustworthy. However, on some level you ‘sense’ something’s wrong, and you can’t quite articulate what it is. Of course, you might be wrong but very often we could be picking up something important. This is because when we communicate, a huge chunk of our communication is not explicit at all.

Overall, we may have a feeling that there is more going on that meets the eye and this could be useful to investigate at certain moments in the process, especially when the intuitive moment arrives repeatedly.

Lastly, it’s worth remembering how it’s the client that shapes the meaning of all these intuitive moments. No intuitive statement is fixed but rather more importantly needs to be clarified and confirmed by the client. Intuition moments are at the end of day natural interactions/comments without judgement or conclusions. Therefore, there’s no planning or ‘willing’ the intuitive moment to come, it simply arises in some sessions and maybe not in others. However, when it does arrive, we may want to observe and discuss it if the client chooses.

How Might Intuitive Statements Sound In Practice?

When looking to pursue an intuitive line of inquiry, it may sound like:

“My gut feels uneasy about….”
“Intuitively I have a concern that….”
“I have a hunch and I’m wondering/curious about….”
“My instincts are firing all over the place and I noticed that….”
“It seems to me that...”
“My sense is that…”
“I like your idea there but what’s your gut saying about that?”
“You sound clear about that and yet intuitively something feels off to me, what does it feel like intuitively for you?”
“You explained that in such a positive way, what’s your sense underneath of all this?”

Some clients may want to not engage with these comments and prefer to stick to the ‘rhythm’ of other moments and continue with other pathways in the process.
Others who are more intrigued or connected to these comments may want to spend time in the intuitive moment and explore it further.

There are other questions too, that could spark or ignite more of an Existential curiosity, even if the intuitive comment was way ‘off’ the mark. We could potentially ask questions such as:

“What’s coming up as we’re having this ‘kind of’ intuitive conversation/moment?”
“What has been lost/gained as we’re entertaining this intuitive thought?”
“Who have we become in this ‘particular’ part of this intuitive conversation?”
“Where do we find ourselves standing in this intuitive conversation?”
“What did/didn’t happen for you in this moment?”

Other instances of clinical intuition:

Therapist: "My chest tightened when you said, 'He took her away from me.' Shall we explore this together?"
After the client nodded, she struggled to speak, eventually sharing, "My world has been broken without her. I feel lost, voiceless, stuck in my chest..."
The therapeutic focus shifted towards communicating her truth.

***

Therapist: "When discussing your friend, the room suddenly felt smaller. Can we revisit that part?"
The client hesitated, revealing, "It's hard; we were really close."
Balancing boundaries and exploring independence became integral to the therapy.

***

Therapist: "While listening to your story, everything else faded from my mind, except for one part..."
The client, tearful, disclosed, "I've avoided discussing the hard things, but putting them out there makes them easier to navigate."

***

Therapist: "My brain fogged up; how are you feeling?"
The client, also feeling foggy, expressed, "This therapy is tough."
Addressing resistances and coping mechanisms preceded other therapeutic work.

***

Therapist: "As you spoke about these people, I imagined one sitting next to you. What's your relationship like without the story?"
The revelation— "He's my father, not my uncle"—unveiled a history of avoiding truth and exploring honesty.

***

Therapist:
"I have an urge to hug you. How do you feel?" The client, craving physical affection, admitted, "Hugs were never on the table."
Exploring emotional neglect became a profound part of the therapy.

***

Therapist:
"Goosebumps covered me when you mentioned that. Can you elaborate?"
The client, feeling sad, exposed a dark place, leading to discussions about self-harm and suicidal tendencies.

***

Therapist:
"I felt the room spin when I closed my eyes. What were you thinking?"
The client, contemplating mortality, shared, "Since my uncle died, I've circled around this thought." Confronting fears of death became a central theme.

***

Non-Verbal Example:
While contemplating giving a client a Coke can with their name on it, the therapist felt uneasiness. The client later revealed how meaningful it was, as nobody had taken their name seriously before.

***

Non-Verbal Example:
Stepping slightly to the left on a train platform led the therapist to encounter a client. The client interpreted it as a sign, finding comfort before her interview and eventually securing the job.

***

In therapy, acknowledging and exploring intuitive moments can provide valuable insights and deepen the therapeutic process. Reflect on how you engage with your intuitive moments in your professional practice.

‘I’m not intuitive, I just don’t work like that’

We know there are different ‘modes’ of working as a therapist (emotionally, intellectually, intuitively... and each one is valid. You may want to ask yourself if your comments are mainly intuitive, emotional, intellectually based or if you use a combination, one or alternate modes of working. And, more importantly if you potentially want to expand on any.

You don’t need to be extremely ‘intuitive’ to understand this concept, just an open mind and a readiness to take a risk and expand on your hunches or non-rational thoughts.

Conclusion

Taking on board how nonverbal messages have been shown to dominate interpersonal communication, and since their cues are gathered intuitively, it could be said that’s it’s an advantage for most therapists to be at least familiar with this intuitive phenomenon.

In the world of risk-management, evidence-based practice and among certain therapy circles, intuition is still heavily scorned. However, there is growing evidence that, if not supporting the use of intuition, is at least legitimizing the existence of the phenomenon. Maybe one day it will be scientifically proven, shown to be connected to not just one thing or maybe it will continue to be an ongoing debate.

In the meantime, though, rather than therapy being about a manualized form of treatment that streamlines the decision-making process, clinical intuition could open the process up to the messiness of it all, as we start to become comfortable with uncertainty.

Perhaps it’s time we all cultivated an open, transparent, honest attitude, and a willingness to take a risk with any intuitive information, however it may sound, and consider the potential value of using this natural phenomenon, by being open to potential snippets of intuition when they arise.

Perhaps ultimately it’s time to reduce the stigma and own the word ‘intuition’

Overall, it's important to note that while intuition can be a valuable tool, it’s not good practice to replace it totally with evidence-based practices or clinical judgment. It’s maybe something to ultimately weave in as a supplement to your training, knowledge, and expertise if/when the opportunity arises.

If you are considering exploring this further, email progressiveprocess@live.com.au or click here to book a free online consultation.