Clinical vs Forensic Psychology

Approach

Supportive, accepting, empathic.

Neutral, objective.

Primary abilities drawn upon

Psychotherapeutic assessment and treatment skills.

Medico-legal evaluation techniques.

Nature of hypothesis testing

Diagnostic criteria for the purpose of helping the patient.

Legal criteria for the purposes helping the trier-of-fact.

Scrutiny applied to information supplied by the patient/claimant

Self-report is generally accepted at face value.

Self-report is supplemented by multiple sources of collateral information and is scrutinized by the adjudicator.

Nature of relationship

Helping, treating.

Evaluative – respectful, but not designed to treat disorders.

Goal

Help the patient achieve therapeutic goals.

Help the adjudicator answer legal questions.

Role of critical judgment

The basis of the relationship is therapeutic alliance. Critical judgment is likely to be counter-therapeutic.

Critical judgment is essential to maintain objectivity and independence and to seek the truth.

Ethical considerations

Offering opinions for legal purposes places the treating clinician in a potential dual role conflict²

Forensic psychologists avoid dual role conflicts by conducting an evaluation only and not subsequently seeing evaluees for treatment.

Type of “reality”

Psychic reality³

Objective reality

Assessment of symptom exaggeration or feigning

Rarely done because of the likely negative impact on the therapeutic alliance.

An incentive to exaggerate or feign mental disorder symptoms often exists when conducting a forensic mental health evaluation.⁴

Agency – for whom does the psychologist work?

For the benefit of the patient.

For the benefit of the adjudicator.

Footnotes

1 Adapted from: Greenberg, S. A., & Shuman, D. W. (1997). Irreconcilable conflict between therapeutic and forensic roles. Professional Psychology: Research And Practice, 28(1), 50-57. doi:10.1037/0735-7028.28.1.50 and Strasburger, L. H., Gutheil, T. G., & Brodsky, A. (1997). On wearing two hats: Role conflict in serving as both psychotherapist and expert witness. The American Journal Of Psychiatry, 154(4), 448-456.

2 See Specialty Guidelines for Forensic Psychology, 4.02 Multiple Relationships: “A multiple relationship occurs when a forensic practitioner is in a professional role with a person and, at the same time or at a subsequent time, is in a different role with the same person; is involved in a personal, fiscal, or other relationship with an adverse party; at the same time is in a relationship with a person closely associated with or related to the person with whom the forensic practitioner has the professional relationship; or offers or agrees to enter into another relationship in the future with the person or a person closely associated with or related to the person (EPPCC Standard 3.05). Forensic practitioners strive to recognize the potential conflicts of interest and threats to objectivity inherent in multiple relationships. Forensic practitioners are encouraged to recognize that some personal and professional relationships may interfere with their ability to practice in a competent and impartial manner and they seek to minimize any detrimental effects by avoiding involvement in such matters whenever feasible or limiting their assistance in a manner that is consistent with professional obligations.”

3 See Strasburger, L. H., Gutheil, T.G., & Brodsky, A. (1997). On wearing two hats: role conflict in serving as both psychotherapist and expert witness. American Journal of Psychiatry, 154, 448-456. - “The process of psychotherapy is a search for meaning more than for facts. In other words, it may be conceived of more as a search for narrative truth … than for historical truth. Whereas the forensic examiner is skeptical, questioning even plausible assertions for purposes of evaluation, the therapist may be deliberately credulous, provisionally “believing” even implausible assertions for therapeutic purposes. The therapist accepts the patient’s narrative as representing an inner, personal reality, albeit colored by biases and misperceptions. This narrative is not expected to be a veridical history; rather, the therapist strives to see the world ‘through the patient’s eyes.’ Personal mythologies are reviewed, constructed, and remodeled as an individual reflects on himself or herself and his or her functioning.”

4 See Gold, L. H., Anfang, S. A., Drukteinis, A. M., Metzner, J. L., Price, M., CM, Wall, B. W., Wylonis, L., & Zonana, H. V. (2008). AAPL practice guideline for the forensic evaluation of psychiatric disability.The Journal of the American Academy of Psychiatry and the Law, 36(4), S3–S50. - "Although it is not possible to determine precisely how frequently disability claimants feign or exaggerate mental problems, studies and estimates over the past 25 years have suggested that the incidence may be as high as 30 percent. When conducting a disability evaluation, therefore, the psychiatrist should always consider the possibility that the claimant is malingering. Exaggeration or magnification of symptoms is often more common than complete faking of illness or injury and can make the objective assessment of true impairment and symptoms more challenging" (p. S19).