Should Forensic Psychiatrists Conduct Psychological Testing?

Frank Dattilio, Ph.D., ABPP, Bob Sadoff, M.D., Eric Drogin, J.D., Ph.D., ABPP, 

and Tom Gutheil, M.D.

Journal of Psychiatry & Law (Vol. 39, #3), Spring 2012

Most forensic experts have encountered at least one civil or criminal case in which a forensic psychiatrist has independently conducted psychological testing.

In some instances, the psychiatrist will consult a psychologist on the interpretation of test outcomes, while in others he or she may simply rely on one of the many computerized scoring programs that provide a "canned" analysis and narrative interpretation of results.

Predictably, this phenomenon has occasionally stirred controversy regarding the clinical, ethical, and legal dimensions of appropriateness of selection, skillfulness of administration, accuracy of scoring, validity of interpretation, sufficiency of training, and codified scope of forensic practice.

The primary purpose of this article is to address the ambiguous nature of psychiatrists employing psychological testing in their forensic work, and to arrive at a definitive answer as to whether or not forensic psychiatrists should offer services in this domain.

Key to making this determination will be a review of what differentiates psychological tests from other forms of assessment, such as appraisals, rating scales, and inventories.

 Also addressed are jurisdictionally based legal and ethical issues and a review of what would constitute adequate training and supervision.

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A clear distinction needs to be made between what constitutes a 'psychological test' versus an 'appraisal,' 'rating scale,' or 'technique.'   Rating scales, such as the Zung Depression Scale or the Beck Anxiety Inventory, have no standardized format for administration and lack complexity in scoring and interpretation.  Projective techniques (i.e., Draw a Person, etc.) are so variably conducted that their best use is typically in support of psychotherapy formulations as opposed to forensic application.  However, these terms are often interchangeable with the terms 'psychological test' or 'psychodiagnostic test.

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Forensic psychiatrists without access to--and proper review of--administration manuals may be eroding the reliability of psychological test results from the outset.

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When asked about psychological tests in court, most psychiatrists respond by saying that they have not been trained to administer, score, or interpret psychological tests and that it would be inappropriate and unethical for them to administer them without proper training.  Furthermore, most psychiatrists do not comment on testing because they are not able to provide a comprehensive or valid response due to their lack of expertise.

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It is our opinion that psychiatrists should never administer psychological tests without intensive training and supervision.  Once again, proper training and education remain critical and, without such training, they should not attempt to incorporate psychological testing into their own examination procedures.  Forensic psychiatrists would need to become familiar with the nuances of standardization and how important it is to the test results and interpretations.  It may also be essential when administering psycho-logical tests to take certain notes regarding observations.  Some of these notes and observations are generated by individuals who administer the tests and score them, interpreting the results on a regular basis, which, obviously, can only come from being very familiar with the tests administered and with scoring.

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The issue at hand is not one of territoriality--as some might surmise--but rather one of forensic standards and professional ethics, particularly as they pertain to protecting the public.  The appropriate selection, administration, scoring, and interpretation of psychological tests require extensive training and supervision, of a sort that cannot be obtained during a weekend seminar or on the basis of casual, incidental supervision.  Proper testing in forensic cases calls for a thorough grounding in test construction and assessment procedures as well as a firm knowledge of instrumental reliability and validity.  Cross examination on such notions as 'standard error of measurement,' 'confidence intervals,' and 'normative populations' is fair game.  Test users unfamiliar with core psychometric principles expose their reports and testimony to negative scrutiny, imperil the work of retaining counsel, haphazardly affect the fate of litigants, and run the risk of allegations of unethical behavior.  In keeping with the current trend in professional training and development, psychological testing should be viewed as a 'competency'.

The author note provides the following contact information: Frank M. Dattilio, Ph.D., ABPP, Department of Psychiatry, Harvard Medical School, MMHC-Shattuck, 180 Morton St., Jamaica Plain, MA 02130. E-mail: frankdattilio@cs.com.

Thanks to Ken Pope for the information and excerpts.

Time to concentrate on human factors in mental illness

Sami Timimi consultant child and adolescent psychiatrist

NHS Lincolnshire, Lincoln, UK

BMJ 2011;343:d4377

Drug companies losing interest in psychiatry is great news for psychiatry and mental health services but most of all for patients.¹ Other research funding sources may also recognize that a focus on the brain is not a credible, evidence based choice likely to contribute to better care for those who have mental distress. Drug companies have found mental health highly lucrative, with multibillion pound blockbuster drugs such as the misnamed (for marketing purposes) antidepressants and antipsychotics. Sooner or later it would become apparent that the evidence based cupboard was empty—that all of the drugs were of dubious effectiveness, had varying degrees of neurotoxicity, created abnormal mental states (which can be lifesaving for some at certain points in their distress) rather than corrected them, and were different from illicit drugs only through who provides them and how they are subsequently used rather than because of discoveries of some particular therapeutic potency.

In biological psychiatry a reliance on psychotropic drugs has encouraged some remarkable developments such as an increase in the numbers and a worsening of the long term prognosis for those categorised as mentally ill,² and an increase in stigma that is associated with the model that mental illness is “an illness like any other illness.”³ Freed from the corrupting shackles of the pharmaceutical industry we can put money into better understanding the factors that have the biggest effects on outcome: social factors outside of treatment and the therapeutic relationship within treatment.⁴

Competing interests: None declared.

¹ Wise J. Research into treatments for mental illness is under threat. BMJ 2011;342:d3747. (14 June.)

² Whitaker R. Anatomy of an epidemic . Crown, 2010.

³ Read J, Haslam N, Sayce L, Davies E. Prejudice and schizophrenia: a review of the

‘mental illness is an illness like any other’ approach. Acta Psychiatr Scand 2006;114:303-18.

⁴ Timimi S. Campaign to Abolish Psychiatric Diagnostic Systems such as ICD and DSM (CAPSID). 2011. Available at: www.criticalpsychiatry.net/?p=527.