When first contacted by a lawyer, the forensic psychologist must clarify the referral question to determine whether the questions asked fall within the assessor`s expertise and whether an evaluation is likely to determine the answers to the questions asked. When conducting an audit, it is the responsibility of the evaluator to ensure that he or she has the skills, training and skill level necessary to conduct the assessment and provide answers to relevant psychological questions. Standard 2.01(a) of the APA Code of Ethics states: „Psychologists shall conduct, teach and conduct research with populations and in fields only within the limits of their competence, based on their education, training, supervised experience, counselling, education or work experience“ (APA, 2017). Guideline 2.01 of the Specialty Guidelines also emphasizes the need to assess one`s own competence: Vandevelde S, Vander Laenen F, Van Damme L, Vanderplasschen W, Audenaert K, Broekaert E, et al. Dilemmas in the application of strengths-based approaches in working with offenders with mental illness: a critical multidisciplinary review. Violent assault Beh. 2017;32:71–9. In any medico-legal assessment where there may be an external motivation to exaggerate or minimize symptoms and psychopathology, it is important that the possibility of deception and the general reaction style be carefully evaluated (Heilbrun et al., 2009; Melton et al., 2018). Numerous articles have been written on the evaluation of simulation in trauma survivors, and it is important for the evaluator to ensure that they apply interventions that have been adequately standardized and validated in traumatized populations (Brand, Schielke, Brams, & DiComo, 2017b; Brand, Tursich, Tzall & Loewenstein, 2014; Braun, 2009; Rogers, Payne, Correa, Gillard & Ross, 2009). In addition, it is important for forensic reviewers to be aware of how the reactions of survivors of complex trauma may seem exaggerated or rigged (Brown, 2009). It is also important to understand the differences between clinical and medico-legal roles (Greenberg and Shuman, 1997). In their influential article, Greenberg and Shuman list ten specific differences between clinical and medico-legal roles and describe the many ethical difficulties and conflicts that affect a clinician`s ability to give a forensic opinion about their client.
They stress the need to respect these differences in roles and convincingly argue that ignoring the role conflict compromises both therapeutic and medico-legal efforts for the patient and the rights of all involved. Since the publication of this article, there has also been a growing awareness of the ethical challenges that arise when forensic psychologists are asked to take on a clinical role after the legal case closes (Drogin 2019; Melton et al., 2018). The dataset analyzed in this study is not publicly available. Our analysis is based on qualitative interviews with mental health professionals working in a forensic context. The privacy of our study participants would be compromised if we shared all transcripts publicly. However, we may provide the portions of the transcripts relevant to this document upon reasonable request. This work is part of the larger research project „Agequake in prisons – second part: Mental health care and forensic evaluation of aging prisoners and persons serving security measures in Switzerland“ and was supported by the Swiss National Science Foundation (grant number 166043). The funding agency was not involved in any phase of the research project, such as study design, data collection and analysis, data interpretation, and manuscript writing. Practicing clinicians are increasingly facing the legal system on a variety of issues. Ethical and Legal Issues for Mental Health Professionals: Forensic Settings features not only psychiatrists, but also advocates who advocate for mental health professionals who engage in legal and ethical discussions relevant to the field.
This powerful resource provides important and up-to-date knowledge to graduate students and clinicians. The final book in the three-volume series will focus on special populations/treatment modalities. If you really care about the patient, the [problems] of humanity that are part of these patient cases, we must guide them to regain their humanity. This means that no crime should be committed again, which reduces the risk of recidivism. And you can`t do that job ignoring the justice system. In the case of forensic assessment of complex trauma and dissociation, the assessor typically includes assessment tools, which are comprehensive measures of personality and potential cognitive function, as well as trauma-specific assessment tools (Brand, Schielke, Brams, & DiComo, 2017b; Braun, 2009; Dalenberg et al., 2017). When using general personality measures such as PAI or MMPI, the psychologist needs to know how trauma survivors respond to these interventions, both in terms of validity and clinical scale (Brand et al., in press; Brand, Schielke, Brams and DiComo, 2017b; Braun, 2009; Eakin, Weathers, Benson, Anderson & Funderburk, 2005; Lange, Sullivan & Scott, 2010). In accordance with ethical standards 9.08 and 9.09, the tests used must be up-to-date and, when test assessment and interpretation services are used, the psychologist must ensure that interpretations are based on accurate data and validated standards for use with the population being assessed (APA, 2017). The assessor may also be pressured by the hired lawyer to add or retain statements that the lawyer deems potentially harmful or detrimental to his client. This is especially true if the plaintiff has a long and long history of complex trauma and the lawyer is concerned that discussing the person`s past trauma may harm the case. It is important for the forensic psychologist to make it clear to counsel that all relevant histories must be researched and disclosed, and that the psychologist`s role is to produce an independent assessment, not a plea report.
The psychologist should be guided by ethical principle B of loyalty and responsibility as well as principle C: integrity in adherence to standard 5.01 to avoid false or misleading statements (APA, 2017). In addition, Specialty Guidelines 11.01 and 11.04 provide guidance on accuracy, fairness, and the prevention of deception, as well as the complete and accurate presentation of opinions in reports (American Psychological Association, 2013). Psychiatrists interviewed said that the dual conflict of loyalty presents them with difficult choices when choosing the type and amount of information they share with colleagues in non-medical professions. They reported that a dilemma was created by their obligation to share important information with other professionals while ensuring trust and confidentiality towards the patient. This was pointed out by two participants: These participants accept that their patients do not always agree with this program, but they still try to motivate them by insisting that the treatment is in their own interest and not only helps them improve their mental well-being, but also ensures that they are less likely to relapse. They also pointed out that the mandatory aspect of therapy can often serve as a first resort to motivate patients to participate in treatment. They believe that if they manage to establish a therapeutic relationship at the beginning, the mandatory aspects will later play a second role, because patients want to perform therapy of their own volition. In addition to the use of general measures, a competent and ethical forensic assessment of trauma and dissociation should include measures that specifically assess these traumatic experiences and symptoms (Brand, Schielke, Brams, & DiComo, 2017b; Braun, 2009; Dalenberg et al., 2017; Foote and Lareau, 2013; Frankel, 2009). Careful selection of these trauma-specific interventions will help the evaluator use interventions that are properly standardized and validated and have demonstrated effectiveness in assessing trauma-related symptoms. Some of them, such as STI-2, also contain validity measures. All instruments used must, of course, be carefully and correctly evaluated using appropriate standards.
Sen P, Gordon H, Adshead G, Irons A. Ethical Dilemmas in Forensic Psychiatry: Two Case Illustrations. J Med Ethics. 2007;33(6):337–41. In the context of complex trauma and PTSD, issues of cultural competency and diversity must be addressed, particularly when the assessor and evaluator come from different ethnic, socio-economic and/or racial backgrounds. Principle E of the APA Code of Ethics states that: Since childhood victimization increases susceptibility to subsequent revictimization (Classen, Palesh, & Aggarwal, 2005; Widom, Czaja , & Dutton, 2008), forensic psychologists may also be asked to assess the effects of traumatic events occurring in adulthood, although there is also a history of other traumatic events (see Brown, this issue, for further discussion). You may also need to deal with the consequences of traumatic events in childhood and draw conclusions about how these traumatic events affected the person`s life journey. In the criminal field, forensic psychologists may be asked to assess the impact of traumatic events on a person`s mental state at the time of a crime or to explain their behaviour when pursuing an alleged crime.
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