Advanced Family Law Conference, Psychologist Panel,

Tucson, Arizona, 2015

Forensic Therapy 101:

Evidence-Based Resources,

Therapy Recommendations,

& Best Practices (2015)

Thomas M. Brunner, PhD

Forensic, Clinical, and Consulting Psychology

www.doctorbrunner.com

Dedication

Four Goals

Best practices update: psychotherapy (AAFC term)

Tips for not fumbling the therapy ball

Make an immediate impact with one worrisome case

Identify a way pointer for how we evolve the system

Who does Forensic Therapy?

A diverse mixture of professionals

Dramatically varying levels of training

Negatively defined (i.e., context dependent) Professional serving a client in the legal

system

American Psychological Association Forensic Guidelines (2011): What is

forensic psychology?

For the purposes of these Guidelines, forensic psychology refers to professional

practice by any psychologist working within any sub-discipline of psychology (e.g.,

clinical, developmental, social, cognitive) when applying the scientific, technical, or

specialized knowledge of psychology to the law to assist in addressing legal, contractual, and administrative

matters.

AAFC-Guidelines for Court-Involved Therapy (2010)

Distinctions - those conducting “psychotherapy”:

Community Th* (CL** not involved in legal system)

Court Involved Th (CL involved in legal system at some point)

Court Appointed Th (Court designates which therapist)

Court Ordered Th (Treatment ordered, no therapist named)

*denotes “therapy” **denotes “client”

Behavioral health: A young science

No basic unit of analysis yet (Focus: alleviate distress) E.g., Biology=cell/Physics=atom

No unified model - human functioning (vs Western medicine)

Cultish-quality (“True Believers” vs. social scientists)

Schools of thoughts (e.g., psychoanalysis) morphing

into systematic taxonomy (e.g., behavioral analysis)

Who does therapy well? Psychologist perspective –

Heed the “Iron Triangle”

Use empirically supported treatments (EST’s) or principles

Applied via Systematic Treatment Selection (STS)

Personality driven: (def: individual’s collection of states and traits)

-E.g., ADHD Experienced, Expressed, and Controlled uniquely

Truth about Effectiveness

Several professional bodies (e.g., LCSW, Counselors, Psychologists, Psychiatrists)

Who has the therapy “black belt”? EST-based or draw from principles or clear rationale

STS/Personality tailored

Measured outcomes (using “Psychological Vital Signs”)

Refer to social science literature for treatment rationale

What are the “gold standard” references?

Empirically Supported Treatments (EST’s)

Adults: https://www.div12.org/psychological-treatments/

-Search by disorder or by treatment (over 60 techniques)

Minors: http://effectivechildtherapy.org/content/specific-treatments

http://effectivechildtherapy.org/content/about-child-adolescent-symptoms

Attention Deficit Hyperactivity Disorder Bipolar DisorderBorderline Personality DisorderChild and Adolescent DisordersChronic or Persistent PainDepressionEating Disorders and ObesityGeneralized Anxiety DisorderInsomniaMixed AnxietyObsessive-Compulsive DisorderPanic DisorderPosttraumatic Stress DisorderSchizophrenia and Other Severe Mental IllnessesSocial Phobia and Public Speaking AnxietySpecific Phobias (e.g., animals, heights, blood, needles, dental)Substance and Alcohol Use Disorders

Trend: Organizations needing more advanced

mental health management to minimize risk, decrease

recidivism, and protect minors/victims

Like schools, the courts are increasingly “mental health

centers”

Examples of radioactive problems requiring comprehensive treatment recommendations to

contain pathology + protect child and victims

Borderline Personality Disorder

Substance abuse

Pathological lying

Explosive Anger

PTSD

Coercive-controlling violence style (e.g., Beck)

Entrenched Narcissism

The wisdom of (fictitious) Los Angeles attorney Mickey Haller: “You know what my father said about innocent clients?... He said the scariest client a lawyer will ever have is an innocent client. Because if you f____ up and he goes to prison, it’ll scar you for life… He said there is no in-between with an innocent client. No negotiation, no plea bargain, no middle ground. There’s only one verdict. You have to put an NG up on the scoreboard. There’s no other verdict but not guilty”

Levin (Haller’s assistant) nodded thoughtfully.

“The bottom line was my old man was a damn good lawyer and he didn’t like having innocent clients,” I said. “I’m not sure I do, either”

--Michael Connelly, The Lincoln Lawyer (2005)

Poor assessment >therapy “handoffs” do not adequately protect the “innocent” clients

Ultimate focus: legal system categorization

Critical psycholegal variables glossed over (e.g., insight)

Therapy structuring, particulars are afterthoughts

Poor/Vague Psychological Assessment – 85% analysis, 10% integration in summary &

5% structuring treatment recommendations

No statutory criteria or guidelines requiring specific kinds of recommendations

AAFC-Guidelines for Court-Involved Therapy (2010)

Whether therapist “court appointed” or “court-ordered”…

“…the Court may describe the expected treatment”

-P.2, AFCC, 2010

We must evolve to live up to Parens Patriae

[Latin, Parent of the country.] A doctrine that 

grants the inherent power and authority of the 

state to protect persons who are legally unable 

to act on their own behalf.

“Recommendation” Statute mirroring specificity of best interests

statute (AZ 25-403) The court shall, driven by best interests of minors and/or

victims, and aligned with AZ 25-403, outline an increasingly specific set of treatment parameters, in proportion to the level of impairment identified, regarding not just the type, frequency, and intensity of treatment(s), but also - and based on reference to court ordered psychological assessment data gathered:

--articulate areas of needed insight and what kind of data would compellingly indicate client is taking appropriate responsibility that would reasonable ensure safety of victims or family members, and

--define likely empirically supported treatments/principles and measurable criteria for defining successful treatment of psychological variables critically bearing upon psycholegal issues.

Examples of how the forensic therapy role is hampered…

Much less defined

Most vulnerable

May be artificially time-limited

Attorney defined/coerced/manipulated

Psycholegal focus leads to hollow improvements

Ten Differences Between Therapeutic and Forensic Relationships*

*Adapted from Greenberg, Stuart A., Shuman, Daniel W., Irreconcilable Conflict Between Therapeutic and Forensic Roles, Professional Psychology: Research and Practice (1997) Vol. 28, No. 1, 50-57

  Care Provision Forensic Evaluation Forensic TherapyThe goal of the professional in each relationship

Therapist attempts to benefit the patient by working within the therapeutic relationship

Evaluator advocates for the results and implications of the evaluation for the benefit of the court

Improve psychological functioning especially related to improving psycholegal variables 

Whose client is patient/litigant? The mental health practitioner The attorney The Attorney and Therapist

The relational privilege that governs disclosure in each relationship

Therapist-patient privilege Attorney-client and attorney work-product privilege

Varies

The cognitive set and evaluative attitude of each expert

Supportive, accepting, empathic Neutral, objective, detached Hybrid of both, but possibly because of care provision align with client

 The differing areas of competency of each expert

Therapy techniques for treatment of the impairment

Forensic evaluation techniques relevant to the legal claim

Therapy techniques for treatment of the impairment and psychological protocols

The nature of the hypothesis tested by each expert

Diagnostic criteria for the purpose of therapy

Psycholegal criteria for purpose of legal adjudication

Hybrid of first 2 columns

The scrutiny applied to the information utilized in the process and the role of historical truth

Mostly based on information from the person being treated with little scrutiny of the information by the therapist

Litigant information supplemented with that of collateral sources and scrutinized by the evaluator and the court

Depends, can be affected by “demand characteristics”

The amount and control of structure in each relationship

Patient structured and relatively less structured than forensic evaluation

Evaluator structured and relatively more structured than therapy

Patient (and possibly attorney) Structured

The nature and degree of “adversarialness” in each relationship

A helping relationship; rarely adversarial

An evaluative relationship; frequently adversarial

Potentially adversarial (possibly toward evaluator)

The impact on each relationship of critical judgment by the expert

The basis of the relationship is the therapeutic alliance and critical judgment is likely to impair that alliance

The basis of the relationship is evaluative and critical judgment is unlikely to cause serious emotional harm

Need alliance and critical judgement and savviness with psycholegal dynamics

How success is defined 

Increased insight and behavioral change

Identify psycholegal factors to legal status

Level of improvement in psycholegal status

Look, all we can do is review diagnoses and make generic

recommendations …

Selection of diagnosis as grouping variable lacks sensitivity to demand characteristics of treatments (Beutler, 2000, 2005)

Symptoms are targets, but should not be exclusive target, as the effective mechanisms of change transcend diagnostic categories

Wide variability in receptivity to treatment because…

There are patient indicators not captured by diagnosis that can serve as contraindicators for treatment

Dx alone not good distinguishers of appropriate treatment to use

Why need more than diagnoses > EST’s?

Want development of intuitive judgement but within optimally empirically grounded decisional

structure that uses existing research findings

to define both state and trait-like patient indicators

and contra indicators

for utilizing different psychotherapeutic strategies,

in the form of classes of interventions

Leave treatment details up to the therapist?

Complexity demands substantive frontloading beyond diagnosis

Less structured, more chance therapy litigated away

Minimizes therapist being tag-teamed > impotency

More chance for assessment findings to fizzle

Substantive frontloading: more durable protection of innocent

Attorneys/Court/Victims/client better defined success formula

Ambiguity is exploited by perpetrator’s attorney

How to not fumble the therapy ball

Judges: more specificity with Tx recommendations

More accountability with Tx success criteria

E.g. measuring “insight”

Psychologists: MUCH more “prescriptiveness” with Tx rec’s

Attorneys: More substantive discussions/framework for therapy

Demand more specificity from evaluators

Your worrisome case What is something you can do to

….ensure the therapy ball not fumbled

…..assessment findings do not fizzle

…..push for more specificity from evaluator

……or more “ownership” by offender via clear therapy goals

So why is a successful handoff of the therapy ball so

important again?

Single greatest indicator of which children

will be resilient in face of

challenging situations:

Presence of a Mentor

“Better to have died as a small child than to fumble this football.”

--John Heisman