Some Legal Issues Patients May Face While in Therapy

This article on forensic family therapy touches upon a few of the major germane ethical and legal dicta which regulate and circumscribe psychotherapy practice. Differences between ethical and legal rulings are delineated. Some of the problems which may confront and even engulf individuals, couples, and families during their life cycle and which bring them into the orbit of the legal and/or judicial systems before, during, or after the period of assessment and treatment are explored. Some issues that have received the least coverage in the family forensic literature are highlighted; and some of the areas that have been accorded a great deal of attention elsewhere are mentioned only briefly. A short commentary on the forensic family professionals’ potential role in each arena of practice is provided.     

Ethical Considerations of Multiple Roles in Forensic Services

Attorneys increasingly rely on the services of mental health practitioners. Although some practitioners lack training, the promise of professional rewards lead some to accept opportunities with resulting ethical quandaries. Due to significant differences between the objectives of traditional mental health services and expert testimony, problems occur when clinicians venture into forensic services. Attorneys and judges, unfamiliar with mental health specialties, may seek to press a mental health practitioner into multiple roles. Although not all multiple roles are ethically inappropriate, caution demands careful parsing of particular roles: (a) academic/behavioral science expert; (b) fact witness as a treating therapist; (c) expert witness based on a clinically oriented assessment; (d) pretrial and/or trial consultant; and (e) professional critic of other experts. Possible ethical issues and risks associated with accepting multiple roles are identified and strategies for avoiding or minimizing harm or exploitation are discussed.     

Standardizing the psychological autopsy: addressing the Daubert standard

The psychological autopsy, as a research, clinical, and forensic tool, has gained widespread usage in suicidology over the last half century. In forensic settings, the lack of standardization and problems determining the procedure's validity and reliability pose significant issues for the procedure's admissibility under the Daubert standard of evidence. The Daubert standard requires that evidence must be founded on scientific knowledge and established five guidelines for judicial decisions regarding the admissibility of expert testimony. In this paper we examine expert opinion regarding the psychological autopsy and recommend a standardized protocol or template regarding areas and lines of inquiry for a psychological autopsy used in legal cases.     

Post-traumatic stress disorder in Vietnam veterans: Assessment in a forensic setting

The recognition and proper evaluation of Vietnam veterans' demonstrating Post-Traumatic Stress Disorder syndromes is reviewed. The special problems of accurate diagnosis and assessment of former Vietnam combatants is emphasized. The forensic evaluation of Vietnam veterans' raising the Post Traumatic Stress Disorder syndrome in either civil or criminal proceedings is comprehensively discussed. The question “What are the clinical techniques necessary to accomplish a competent forensic evaluation of the Vietnam veterans?” is specifically addressed with special emphasis on legal dispositions and treatment implications. The relationship between the criminal acts of combat veterans and their exposure to the psychological trauma of war is explored.     

The non-problem of free will in forensic psychiatry and psychology

This article demonstrates that there is no free will problem in forensic psychiatry by showing that free will or its lack is not a criterion for any legal doctrine and it is not an underlying general foundation for legal responsibility doctrines and practices. There is a genuine metaphysical free will problem, but the article explains why it is not relevant to forensic practice. Forensic practitioners are urged to avoid all usage of free will in their forensic thinking and work product because it is irrelevant and spawns confusion.     

Katrina: Macro-Ethical Issues for Engineers

Hurricane Katrina was one of the worst disasters in United States history. Failures within New Orleans’ engineered hurricane protection system (levees and floodwalls) contributed to the severity of the event and have drawn considerable public attention. In the time since Katrina, forensic investigations have uncovered a range of issues and problems related to the engineering work. In this article, my goal is to distill from these investigations, and the related literature that has accumulated, some overarching macro-ethical issues that are relevant for all engineers. I attempt to frame these issues, using illustrative examples taken from Katrina, in a way that might be of pedagogical use and benefit for engineering educators interested in engaging their students in discussions of engineering ethics, societal impact of engineered systems, engineering design, or related topics. Some of the issues discussed are problems of unanticipated failure modes, faulty assumptions, lack or misuse of information, the importance of resiliency, the effects of time, balancing competing interests, attending to the details of interfaces, the fickleness of risk perception, and how the past constrains the present.     

Constructs, operational definition, and operational analysis

We argue that a certain picture of the relationship between language and the world informed Meehl’s outlook on how science worked. That picture authorized talk about constructs and has led to construct proliferation and other problems. Operational analysis offers an alternative view and suggests that a major shortcoming of soft psychology is its lack of disciplined limits on acceptable verbal behavior.     

The Forensic Examination of Posttraumatic Stress Disorder

Abstract

The diagnosis of posttraumatic stress disorder (PTSD) has achieved a major level of significance in our judicial system. The forensic examination of PTSD is identified as a specialized assessment that is non-biased and non-prejudicial. This article attempts to provide a standard methodology to offer an objective and neutral forensic assessment and diagnosis of PTSD that will stand up to legal scrutiny by identifying problems in diagnosing PTSD and establishing a six-step methodology for the differential diagnosis of the disorder. Procedures for providing a forensic examination of PTSD and details of the author's methods of providing a forensic examination are presented.     

Schematherapie bei antisozialem Verhalten und Psychopathie

In the Netherlands schema therapy is the first evidence-based treatment to be recommended for patients with personality disorders in forensic settings. Initial results show that schema therapy can even be effective in cases of “psychopathy”. The central concept in schema therapy are schema modes which can also be seen as emotional states or “parts of the personality”, which dominate temporary thoughts, emotions and behavior. Schema modes are the basis of individual mode models, which guide understanding and treatment of the disorder throughout the complete therapy. The schema therapeutic analysis of delinquency is part of the schema mode model and connects the sequences of the crime with the offender’s schema modes. With respect to the mode treatment, emotion-focused techniques and the therapeutic relationship are of special importance. The schema therapeutic treatment plan combines short-term behavior-related therapeutic goals with the underlying themes (needs and modes) in order to plan concrete interventions based on this. This has to be embedded into the individual structure of therapeutic options in the respective institutions (e.?g. individual psychotherapy, nursing staff, occupational therapy). This article demonstrates the practice of the schema therapeutic approach with a forensic case study and discusses resources and limits of the schema therapeutic approach in a forensic setting.     

Wo steht der Jugendmaßregelvollzug in Deutschland aktuell?

With up to 67% of all young offenders suffering from mental illnesses, the question of how professional care should be arranged for them arises. The ability to detain a young offender for an indefinite period of time in a forensic psychiatric institution represents the final solution in juvenile law. This currently affects approximately 300 patients nationwide, of which there is precise data available only for patients who were detained before the age of 18. This is due to the differing nationwide organisational structures within specific forensic psychiatric institutions for adolescents. There is currently a lack of forensic psychiatric units in several federal states providing treatment for adolescents. When examining under what basis, and when the relocation of a person from a young forensic psychiatric institution into the corresponding adult one occurred, and how long specific pedagogic facilities were provided to these individuals, the differences between various adolescent forensic psychiatric institutions become apparent. This especially concerns young adolescent offenders suffering from delayed mental development.     

法医学鉴定循证实践的局限性及其对策

循证法医学实践尚处于起步阶段,存在循证意识薄弱、循证素养有待提高、证据资源匮乏、专业信息共享平台缺乏等局限性.要用发展的眼光看待循证法医学,知其优劣,寻找对策,将其理论辩证地应用于法医学实践中.     

Sexueller Sadismus und Sexualkriminalität

The categorization of sadism has turned out to be a versatile phenomenon, which covers a spectrum from harmless symbolic rituals to extremely violent acts where strong impulses or prolonged fantasies and rituals are involved. As the phenomenon is versatile its causes and appearances vary as well, although so-called BDSM (bondage & discipline & dominance & submission & sadism & masochism) practitioners and persons with severe sadism in a forensic context share only few common preferences. Based on own clinical experiences with sadism in forensic patients the authors support the proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) especially the diagnostic disjuncture of sadism and masochism. Sexual sadism appears more frequently in forensic contexts in combination with sadistic, antisocial and borderline personality disorders but rarely with masochism. Masochism is otherwise reported to be more prevalent in patients of general psychiatry, however, combined with depression or dependent personality traits rather than with sadism. Moreover, the authors believe that if use of the diagnostic term sadism is perpetuated the establishment of the proposed new diagnosis “paraphilic coercive disorder” is unnecessary. The diagnostic term is also important for treatment and assessment. Despite the lack of reliable long-term studies with larger samples, it is reasonable to assume that medication, sometimes even anti-androgenic treatment, can be indicated in patients with severe sadism.     

Justification as Declaration and Deification

Theological accounts of the way God justifies sinners often struggle to combine forensic or declarative ideas about justification with transformationist ones. Luther seems to have especially steep problems here, not because he fails to think of justification as transformation – indeed deification – but because his forensic claims seem to take back what he says about transformation. Yet in the end Luther shows how forensic and transformationist ideas of even the boldest sort can cohere. At one level the concept of justifying faith as union with Christ extra nos combines the two, but their deeper unity is trinitarian: it lies in the Father's eternal verdict on the work of his incarnate Son, whose death and resurrection win for us the coming of the Spirit.     

Gaps and Barriers in Services for Children in State Mental Health Plans

Significant gaps exist in children’s mental healthcare, and barriers prevent access to existing services. Current federal initiatives call for state governmental agencies to recognize and resolve deficits in their systems of care. Previous work has acknowledged some of the problems in meeting the mental health needs of children within a system of care. This current project sought to discriminate between gaps (e.g., non-existent services) and barriers (e.g., problems that prevent access to existing services) within state mental health care plans. Because acknowledging barriers and gaps in mental health services is a step towards systems improvement, the present project describes how state governments recognize the limits of their children’s mental health care systems. We analyzed state mental health plans submitted to the federal government in applications for block grant funds. Results illustrate that a varied number of gaps and barriers are acknowledged in state plans. Overall, 90% of state plans discussed barriers and 84% of state plans discussed service gaps. The gap most frequently recognized was lack of providers (74%), while lack of funding (52%) was the most common barrier. This project points to some recognition of system limits in the states and reflects potential efforts to create policies for system improvement for children and families.     

Identity-Related Dysfunction: Integrating Clinical and Developmental Perspectives

Recent changes to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders highlight the importance of identity dysfunction within several psychiatric diagnoses. Despite a long-standing tradition of identity research and theory in the developmental literature, there is limited work establishing intersections between clinical and developmental conceptualizations of identity problems. The relative lack of integration between decades of clinical and developmental work is unfortunate, and likely limits progress in both areas. In this commentary, the authors argue for greater interdisciplinary collaboration and highlight contributions from developmental and clinical theories, which, if integrated, could enhance identity scholarship. The developmental psychopathology perspective is introduced as an ideal framework to promote these goals.     

Research-Based Guidelines for Child Forensic Interviews

Abstract

We present important considerations for conducting forensic interviews with children who are witnesses to or alleged victims of crime. Specifically, we (a) present the basic principles of the forensic interview and review some of the best structured forensic protocols currently available; (b) provide a detailed, practical blueprint for conducting a structured forensic interview and emphasize how the components of the interview are based upon empirical research; and (c) discuss special con siderations for interviews with children of different age groups and children who have special needs or circumstances, and interviews involving various crime circumstances. We end with suggestions to assist legal and social service professionals in accessing the social science research literature that should inform forensic interview techniques.     

Personality,confirmation bias,and forensic interviewing performance

Confirmation bias is a universal characteristic of human cognition, with consequences for information processing and reasoning in everyday situations as well as in professional work such as forensic interviewing. Cognitive measures such as general intelligence are also related to personality traits, but there is a lack of research on personality and confirmation bias specifically. This study focuses, firstly, on the relationship between Big Five personality traits and confirmation bias as measured by the Wason selection task, and secondly, how these dispositions are related to observed performance in real forensic interviews of child victims. In a sample of police interviewers, Openness (i.e., the facets Ideas and Fantasy) and Neuroticism (i.e., the facets Anxiety and Vulnerability) were independently associated with confirmation bias (N = 72). Scores on the selection task, the Openness facet values, and the Extraversion facets Assertiveness and Activity were consistently related to interview performance (N = 46). Implications of these findings are discussed for the empirical and conceptual relations of cognitive ability to personality and for the selection and training of police interviewers and their professional development.     

Gender differences in psychopathy in a Swedish offender sample

In this study we examined gender differences in the PCL:SV employing a variety of statistical methods with two subsets of psychopathic individuals drawn from larger samples of 129 female and 499 male Swedish offenders. The larger samples included forensic psychiatric patients, forensic psychiatric evaluees and criminal offenders. We found gender differences in antisocial behavior, as defined in factor 2 of the PCL:SV, with female psychopaths (PCL:SV>or=18) displaying significantly more lying, deceitfulness and lack of control, while male psychopaths were more antisocial as measured by the PCL:SV. We conclude that it might be meaningful to use gender specific definitions in the assessment of psychopathy or, alternatively, slightly revise the diagnostic tools. Our results support the use of the three-factor model of the PCL-R and PCL:SV introduced by Cooke and Michie (2001) in female populations.     

The use of a linkage analysis as evidence in the conviction of the Newcastle serial murderer,South Africa

The linking of a series of crimes to one individual has always been problematic, especially in the absence of eyewitness or forensic evidence. During the investigation, another means whereby this can be done is through linkage analysis. Yet a linkage analysis can also play a role during the trial of a serial offender. This paper examines the use of a linkage analysis report as evidence during the trial of the Newcastle serial murderer in South Africa. The linkage analysis examined the circumstances of the crime, modus operandi, and signature behaviour of the offender, to come to the conclusion that all the offences were committed by one individual, despite the lack of eyewitness or forensic evidence linking the suspect to two of the four incidents. This evidence was admitted by the court and the presiding officer concurred that the accused was guilty of committing the crimes during the third and fourth incidents. Copyright © 2006 John Wiley & Sons, Ltd.     

Further Evidence for Reliability and Validity of the Triarchic Psychopathy Measure in a Forensic Sample and a Community Sample

Psychopathy is often described as a constellation of personality characteristics encompassing features such as impulsivity and antisociality, and a lack of empathy and guilt. Although the use of self-reports to assess psychopathy is still debated, there are distinct advantages to such measures and recent research suggests that they may not be as problematic as previously thought. This study further examined the reliability and validity of the Triarchic Psychopathy Measure (TriPM) in a community sample (N = 496) and forensic psychiatric patient sample (N = 217). Results indicated excellent internal consistencies. Additionally, the TriPM total and subscale scores related as expected to different subscales of the Psychopathic Personality Inventory –Revised (PPI-R) and to the Reactive and Proactive Aggression Questionnaire, reflecting good construct validity. Most importantly, ROC curve analyses showed that the TriPM evidenced better discrimination between the community sample and forensic psychiatric patients than the PPI-R. The current study extends the existent evidence demonstrating that the TriPM can be used as an efficient self-report instrument.