Treatment and psychopathy in forensic settings

People commonly question whether highly psychopathic offenders are treatable. Little scientific research has addressed this question despite key developments in the last 20 years in two relevant areas: reliable measurement of psychopathy, and effective treatments for reducing criminal and antisocial behavior in offenders. One obstacle to progress is confusion about defining psychopathy; a necessary preliminary step to advancing intervention. After outlining the principal definitional issues, we review past and recent research on psychopathy and treatment, concluding that a handful of newer, well-designed studies suggest grounds for optimism about psychopathy and treatability. Although psychopathy characteristics—along with other indices of criminal risk—signal responsivity challenges, well-conceived programs for higher risk offenders can reduce recidivism in highly psychopathic offenders and appear to do so by reducing dynamic risk factors. There are no clear indications yet of whether PCL-psychopathic offenders differ from other high-risk offenders in their ability to respond to such treatments. The questions of whether psychopathy itself responds to treatment, and if so, what forms such treatment might take have not yet been addressed. We conclude by suggesting that advances will come from the use of more divergent measures of psychopathy, and in particular, dynamic measures of psychopathy traits that will allow us to document whether change is occurring.     

Fixing forensic patients: Psychiatric recommendations for treatment in pretrial settings

This article is concerned with psychiatric recommendations for treatment at the Metropolitan Toronto Forensic Service (METFORS), a clinical assessment agency providing both 1-day and 30-day evaluations of criminal defendants in Toronto, Canada. Analysis of both psychiatric reports and quantitative research instruments demonstrated the saliency of treatment as a central forensic issue at METFORS. Among a sample of 592 defendants, 134 were considered in need of outpatient care. Persons recommended for hospitalization were most likely to exhibit histories of mental health rather than criminal justice contacts; to be arrested for nonviolent offenses; to manifest psychotic behavior while at METFORS; to be found unfit for bail, incompetent to stand trial, in need of further assessment and dangerous to self; and to experience higher rates of hospitalization, but lower levels of criminalization during the two years following their initial forensic assessment. Psychiatric reports at METFORS tended to merge recommendations for treatment and assessment; to suggest prison or probation as means for securing clinical treatment; and to provide little written support for judgments about the need for intervention. Along with competency and dangerousness, treatment is a key issue in forensic practice, and warrants further attention in the psycholegal literature.     

Addressing the dual relationship problem in forensic and correctional practice

The dual relationship problem in forensic and correctional practice emerges from conflict between two sets of ethical norms: those associated with community protection and justice versus norms related to offender/defendant well-being and autonomy. The problem occurs because forensic practitioners typically have their professional roots in mental health or allied disciplines such as psychiatry, clinical psychology, social work, or law, and as such, often struggle to ethically justify aspects of forensic and/or correctional work. First, the problem of dual relationships will be described and its nuances explored. As will become apparent, the problem extends beyond the straightforward conflict of roles and resides at the very heart of professional practice. It is a core normative conflict created by practitioners varying ethical allegiances. Second, contemporary ways of resolving the dual relationship problem will be briefly outlined, that is, approaches that assert the primary of one set of codes over the other or involve the construction of hybrid ethical codes. Third, after briefly reviewing the shortcomings of these approaches I present a possible way forward drawing from relational ethics and the concept of moral acquaintances.     

Juvenile crime and juvenile justice: Patterns,models, and implications for clinical and legal practice

While rates of juvenile crime have declined over the past decade, public preoccupation with youth violence remains high, periodically fueling judicial and legislative “get-tough” policies and social movements. For most young people, criminal activity, if any, is mild, infrequent, peer-driven, and peaks in late adolescence and early adulthood, declining steadily thereafter. A small subset of persistently antisocial youths begin their criminal careers earlier, commit more frequent and more serious offenses, continue their offending throughout the life-course, and are characterized by a number of neurocognitive, personality, and diagnostic features. Individual, familial, and social forces all combine to influence juvenile criminal behavior, but another small subset of youths, with a characteristic cognitive and temperamental profile, appear to be staunchly resilient to the criminogenic influences around them. The success of intervention and treatment modalities for childhood antisocial behavior depends both on the type of subjects to which they are applied and the consistency and comprehensiveness with which they are implemented and carried out.     

MMPI-A characteristics of male adolescents in juvenile justice and clinical treatment settings

The current study investigates the extent to which the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) profiles of 196 male adolescents evaluated in a South Carolina detention center could be successfully discriminated from the protocols of 200 male adolescent psychiatric inpatients in three states and 151 dually diagnosed male adolescents. Results showed significant differences in mean T-score values among these three groups of adolescents across a variety of MMPI-A scales and subscales. Results from discriminant function analyses indicate that treatment setting can be predicted effectively from MMPI-A profiles. Beyond the MMPI-A profile differences established for adolescents in these groups, the similarities of adolescents were also noted, particularly in terms of the frequent occurrence of Within-Normal-Limits profiles for adolescents in all groups. Potential directions for future research with the MMPI-A are presented.     

Treatment of Time in the TAT

Part of a larger empirical investigation to identify and classify subjective probability notions and explore their relationship to personality variables (Lipgar, 1965). Four factors that distinguished four types of subjective probability notions had been obtained from a matrix of intercorrelations among 30 Ss' Q sort ratings on patterns of “head-tail” guesses. To investigate the possibility that subjective probability notions are associated with other orientational activities in situations of uncertainty, a typology of time orientations and rating scales was derived from TAT stories by those Ss who best represented the four subjective probability factors. These and other stories were rated by four judges independently, and an association between treatment of time in the TAT and subjective probability notions was substantiated.     

The lawyer and the forensic expert: Boundaries of ethical practice

The role of attorneys in relationship to mental health experts is examined. Issues which are discussed include the necessity of expert testimony, selection of the expert, and the data underlying the expert opinion. In addition, the attorneys' responsibilities in presenting the mental health expert in court is discussed with reference to different elements of the trial process.     

Sources of male chauvinism in the TAT

Potential sources of antifemale bias in TAT stimuli were evaluated by having 358 undergraduate subjects rate 17 male and 17 female TAT figures on 7-point anchored scales. Data from the five independent rating conditions were examined by 2 x 2 ANOVA. Biases toward greater Mental Health and Intelligence for female figures were seen to be insufficient counterbalancers of biases toward greater Cultural Favorability and Identification for male figures. Achievement status was rated equivalently. TAT stimuli appeared to show a "built in" source of male chauvinism systematically "pulling" male-sex identification. Potential for unfavorable clinical evaluation was seen to be greater for female TAT subjects compared with male subjects.     

A consideration of challenges to psychological assessment instruments used in forensic settings: Rorschach as exemplar

In this brief primer, we provide an outline of key issues that will help psychologists organize and prepare their expert testimony. These issues include the need to obtain essential sources of research, a review of the actual legal standards regarding admissibility of test data in expert testimony, the nature of the expert relative to the assessment instrument in expert testimony, the nature of legal versus scientific debate, and the examination of appropriate qualifications of expertise when offering legal testimony. In addition, we use a summary of information contained in several recent articles to address challenges directed against forensic psychological testing. We use the empirical literature on the Rorschach as an exemplar in discussing these issues, as the admissibility of the Rorschach in particular has been challenged, and the issues frequently focused on with the Rorschach are equally applicable to other psychological measures. In this article, we provide essential sources of Rorschach research regarding several empirical studies that summarize important information and directly address previous criticisms of the measure.     

Accountability and dignity: Ethical issues in forensic and correctional practice

Our aim in the special issue is to address some of the more abstract and fundamental ethical problems evident in the criminal justice system and to inquire into their significance for those individuals who assess and deliver rehabilitation programs to offenders. In order to provide an appropriate theoretical framework for an investigation of ethical concerns in the forensic and correctional practice domains, we first outline an ethical framework that is intended to help practitioners reflect systematically on their practice [Ward, T., & Syversen, K., (2009). Vulnerable agency and human dignity: An ethical framework for forensic practice. Aggression and Violent Behavior, 14, 94–105]. Second, we explicitly examine the relationship between two normative frameworks evident within the criminal justice system, punishment and rehabilitation, and inquire into their relationship. Finally, we briefly describe each of the papers comprising the special issue.