As research strategies for studying competence to stand trial evolve, interest in the decision-making process of clinicians and the factors that may influence the clinical process has grown. This study assesses the reliability of clinical opinions regarding the basis for competence decisions and the influence that severity of the offense has upon the clinical determinations of competence. One-hundred eighty-eight criminal defendants in an outpatient forensic clinic were evaluated by pairs of clinicians (psychiatrists and clinical psychologists). Each clinician was asked to complete a questionnaire regarding the defendant's overall degree of competence on a 0 to 10 rating scale, ability to understand charges and proceedings and ability to assist in one's defense, and the likelihood that the defendant was malingering. Results demonstrated a high degree of reliability not only in clinical determinations of competence (agreement in 187 of 188 cases), but in estimates of overall degree of competence and the basis for findings of competence or incompetence (e.g., the Dusky criteria). Misdemeanor defendants were more likely to be found incompetent to stand trial. However, degree of competence was only associated with offense severity for defendants found incompetent to stand trial. There was no relationship between these variables for competent defendants. These results suggest that clinicians may require a higher degree of competence for defendants charged with more serious offenses, although this process may not apply equally to competent and incompetent defendants. Furthermore, conducting competence interviews jointly appears to increase the concordance of competence opinions.