My involvement with the courts and the legal profession has become more frequent over the past ten to fifteen years. My clinical focus however is that of a generalist practice of clinical psychology. That is important in that there are psychologists who conduct only forensic evaluations. Those of us who maintain a clinical practice are sometimes viewed more positively by the courts.
In either case, whether you are dealing with a psychologist in general practice or one who “specializes” in forensics, there are limits to their expertise. If an attorney should come to a psychologist for assistance, they should inform that attorney of their professional restrictions and the limits of their knowledge base and competency. After receiving a thumbnail sketch of the case in which they might become involved, they should explain to an attorney the many things that they can help with and those which they cannot.
When an attorney works with a psychologist, he or she should recognize that this is an individual who has been trained in the understanding of human behavior with a significant emphasis on the individual. Certainly some psychologists specialize in group dynamics or have a family or group orientation. However, in the study of clinical psychology, individual behavior is the core. So in addition to educational differentiations from a psychiatrist (who is a medical doctor and then completes a four year residency in psychiatry), or a social worker (who typically, although not always, has received a terminal Master’s Degree with a systems orientation), a psychologist brings both specialized AND limited skills.
It is my belief that the core of clinical psychology is individual personality assessment. That individual personality assessment is central not only to the work we do as treatment agents, but also in the context of the evaluations of a forensic nature. It is important to note that there are no “specialty” board certifications in psychology. While one may take continuing education courses or even postdoctoral training in forensics, child psychology, family violence, or group dynamics, such training is just that, training. Neither the American Psychological Association nor most state boards certify or license psychological specialties.
A knowledge of the practice of psychology and the field of psychology in general may also be helpful, because understanding the field will help you utilize a psychologist more effectively. As we are all well aware, over the past ten years there has been a remarkable change in health care reimbursements, which have typically scaled down physician reimbursement, as well as psychologist reimbursement.
It has been my observation that as such changes have occurred, there has been a great push by many psychologists (and in fact, the profession as a whole) to develop “niche psychologies” to find new ways to market psychologists and receive remuneration. There has been a plethora of new diagnostic and interview instruments developed in the recent past. There has also been a phenomenal increase in the number of continuing education presenters and continuing education experts. There has even been a push by psychologists to secure prescription privileges. Further, there has been a tremendous effort (not at all negative), to develop empirically-based assessment instruments and empirical systems for the interpretation of even those instruments which traditionally have been subjectively interpreted.
Despite all these “new” methodologies, it has been my experience that a skilled clinician must be willing to utilize a standardized and comprehensive interview technique. That interview will serve as the foundation for further assessment. From that interview, the psychologist can glean as much or more information from the individual they are assessing than with the use of the sometimes excessive administration of self-report techniques which many psychologists now utilize.
It’s likely that in the course of retaining psychologists in forensic cases, you will see that they frequently administer a long list of “objective tests”. However, you might also find in the investigation of those methods, that they are more often than not self-report questionnaires deemed empirical in that they have high “reliability” (that is, patients will answer similarly on multiple administrations) and “valid” (in that the people answering honestly will likely provide information which in fact reflects their typical behavior).
Still, as a traditionally trained clinical psychologist, I believe that attorneys and forensic clients are being short-changed by a clinician’s over-reliance upon what (only on paper), appears to be a comprehensive and extensive battery of testings.
I believe that an attorney is better served by a clinician who spends a significant portion of the evaluation process in face to face contact with their client; whose clinical judgment, education and experience are integrated into the report. A clinician whose choice of test instruments reflects a multimodal approach based on clinical psychological training and expertise. Don’t be impressed by the number of tests used. Be impressed by the psychologist’s willingness to explain his findings.
Also be impressed if the psychologist limits the evaluation to his areas of expertise. Such an evaluation should be focused upon the assessment of your client’s personality and the generation of hypotheses based on that assessment. It should tell you how personality will affect behavior of the individuals who are being evaluated.
A discussion of a psychologist’s predictions also warrants some attention. Mental health professionals are notoriously inadequate in their ability to predict behavior. The research indicates that the best predictor of future behavior is behavior of the past. If you are working with a psychologist who indicates to you that he or she can predict the future, ask to see their crystal ball.
The psychologist’s poor predictive skills notwithstanding, some personality dynamics or personality types are known to have certain impacts. For example, a psychologist can reasonably assess whether an individual is more or less amenable to suggestion, help, or intervention. A psychologist can reasonably assess the propensity toward explosiveness or hostility.
Again, however, a “propensity toward” is different than a “prediction of”, and it is predictions with certainty that should give an attorney pause. It is reasonable to assume that a psychologist can assess an individual’s mental health status, needs for treatment and propensity toward the seeking of inappropriate relationships. It is also reasonable to assume a psychologist can assess a person’s likelihood to have lapses in judgment, an ability or inability to nurture, a capacity to accept differences in others, empathic ability and the ability to focus on others rather than self.
It is the role of an attorney, if possible, to provide a context of the need for evaluation from their client’s perspective. The psychologist should seek that context from all parties involved; that too is data. The context provided, in addition to being data, affords the psychologist the opportunity to consider providing information (if appropriate), beyond that which he or she traditionally might otherwise include. Every case has its own questions and its own underpinnings. Rule number one for the psychologist is, before you do an evaluation, understand the questions. It is the ethical psychologist’s responsibility to answer legitimate questions if he can, if it is within the area of his expertise and if such questions can be answered with the collection of available data.
In essence, the psychological evaluation by a competent psychologist derives from careful history-taking and formal psychological assessment, with close scrutiny by a psychologist who utilizes reasonable educational, scientific and experienced-based methodologies.