The Conflict between Forensic and Therapeutic Roles - Essay Example

The Conflict between Forensic and Therapeutic Roles Affiliation The Conflict between Forensic and Therapeutic Roles More often than not, invariable conflicts occur when both forensic and therapeutic roles are assumed by a professional when treating a patient (Simon & Gold, 201). Therapeutic roles basically require clinicians to improve their patients’ well-being by developing long-term supporting and empathetic relationships with the patients. On the contrary, forensic roles require clinicians to report to a third party regarding a given individual’s psycho-legal issues by gathering and integrating information from varied sources (Greenberg & Shuman, 1997). Given the inherent differences in therapeutic and forensic roles, it is inevitable to avert conflict when both roles are assumed by clinicians. Therefore, forensic and therapeutic roles cannot ethically coincide in any given circumstance. The issue of dual role is a common area of contestation in forensic psychiatry and forensic psychology. To that effect, commentators in the fields of forensic psychiatry and forensic have developed the principle of avoiding dual roles (Heilbrun, DeMatteo & Marczyk, 2004). Failure to adequately distinguish between therapeutic and forensic roles often result into deleterious consequences. According to Greenberg and Shuman (1997), these dual roles can potentially cause (either intentionally or inadvertently) harm to the individual being evaluated or treated, damage profession’s credibility or reputation, compromise provision of quality services and hamper legal proceedings. Based on the dangers borne of these dual roles, professional guidelines and ethical standards have been developed to explicitly address the principle of avoiding dual roles. The American Psychological Association (2002), the American Academy of Psychiatry & the Law (1995) and the Committee on Ethical Guidelines for Forensic Psychologists (1991) represents the three professional bodies that have addressed themselves to the issue of dual roles. The detrimental impacts of dual professional engagements have been recognized by the American Psychological Association (APA, 2003) in its “Ethical Guidelines for Clinical Psychologists”, as well as by the Committee on Ethical Guidelines for Forensic Psychologists (1991) in its “Specialty Guidelines for Forensic Psychologists”. These guidelines negate assumption of dual professional roles and require clinicians to minimize harm in cases where dual roles are unavoidable. Irreconcilable Differences between Forensic and Therapeutic Roles An individual is normally presented to a therapist solely for treatment. Conversely, the same is scarcely the case for individuals presented for forensic evaluations. In essence, therapy generally refers to the process followed in treating illness, injury or behavioral disorder. Forensic evaluations, on the other hand, lent more focus on informing decision-making with regards to adversarial matters, such as court proceedings, parole board decisions and/or licensing board decisions (Greenberg & Shuman, 1997). The clear distinction between therapeutic and forensic roles brings to the forefront implications for disclosure or informed consent, as well as the use and control of confidential information gathered during individual evaluation (Berge, 2004). While therapeutic alliance makes assurance on confidentiality, the same cannot be said of forensic services. In the context of forensics, non-confidentiality is assumed as a general matter. However, the issue of confidentiality is a general rule in the therapeutic context (Simon & Gold, 2010). Since forensic evaluations are used to inform adversarial decisions, forensic experts do not owe examinees a duty of confidentiality in many instances (such as statutory mandated or court ordered evaluations). On the other hand, therapists owe individuals a duty of confidentiality from the onset. Stringent disclosure procedures are thus followed by forensic experts to provide expert testimony unlike treating therapists (Berge, 2004). The conflicting roles between therapists and forensic experts make it impossible to merge the two roles at the same time. As expert professionals, psychiatrists and psychologists may testify before a court of law as fact or expert witnesses. Fact witnesses simply provide first-hand observations before a court regarding their interactions with individuals. On the other hand, expert witnesses usually have specialized knowledge not possessed by the average person. Such specialized knowledge is crucial in providing facts and opinions that aid a court make a just judgment (Shuker & Sullivan, 2010). Against such a background, psychiatrists and psychologists are usually qualified to testify in a court of law as treating experts, in the sense that they possess specialist knowledge to offer clinical prognosis and diagnosis. Such knowledge is not possessed by ordinary individuals (Berge, 2004). Conversely, role conflict usually occurs therapists attempt to double as forensic experts in court proceedings. Much as therapists can provide expert opinion in court cases, attempt to use them as forensic experts becomes inconsequential since clinical psychiatrists and psychologists do not acquire sufficient training in forensic ethics (Simon & Gold, 2010). Even though ethical issues have generally improved in graduate training, clinical psychiatrists and psychologists are exposed to ethical training touching on dual roles that may taint their professionalism. Such dual roles mainly include sexual and other unprofessional conduct with patients (Berge, 2004). Clinicians do not usually blend well with legal issues and the only time they are exposed to legal issues is when discussing ethical codes of clinical practice and licensing laws (Sheker & Sullivan, 2010). Limited knowledge of legal issues automatically disqualifies therapists from assuming forensic roles. For instance, therapists are usually not trained to differentiate standard of proof, rules of evidence and rule of procedures for clinical practice and for legal proceedings (Berge, 2004). A therapist is competent enough to offer forensic services; likewise, a forensic examiner can competently provide therapy. However, it does not imply that both services can be offered to an individual at the same time (Simon & Gold, 2010). Each of these roles requires psychiatrists and psychologists to ask substantially distinct questions. Furthermore, forensic and therapeutic roles follow conflicting approaches that interfere with the performance of each role. The approach followed to gather and verify information differs considerably in forensic and therapeutic practice (Berge, 2004). The veracity of gathered information is never a subject of assumption for forensic experts. Consequently, forensic experts rely of multiple techniques and sources to enhance the veracity of any information relied upon when rendering expert opinion in court proceedings. Despite veracity also being an issue in therapy, the inducements for plaintiffs is more insightful and invasive (Simon & Gold, 2010). For instance, it is rare for therapists to routinely interrogate their patients’ spouses, family members, employers and friends. Furthermore, therapists do not read deposition transcripts or carry out collateral interview to verify and corroborate a patient’s claims (Berge, 2004). Therefore, the veracity of information required in court proceedings disqualifies therapists from doubling as forensic experts. One of the common areas that make it difficult to reconcile therapeutic and forensic roles is informed consent. Informed consent is necessary to both forensic and therapeutic practice. Therapists are obligated to obtain consent prior to treating patients and forensic experts are not required to force individuals to provide required information (Berge, 2004). Conversely, the differences between requirements for obtaining informed consent in both roles exemplify the irreconcilability of forensic and therapeutic roles. The principles of nonmaleficence and beneficence define informed consent. When providing therapy, informed consent and concomitant disclosure puts more emphasis on the patient’s welfare. Accordingly, any therapy given to patients should be chosen based on its benefits to the patient (APA, 2002). Notwithstanding the principles of nonmaleficence and beneficence, expert witnesses take an oath that obligates them to provide wholly truthful information. The information provided by an expert witness before a court of law is not intended to benefit the patient. On the contrary, such information disregards the harm that may be caused to a patient-litigant when confidential information is disclosed (Berge, 2004). In view of that, clinicians who ask patients to provide informed consent for concurrent forensic and therapeutic roles assume essentially inconsistent positions. Nevertheless, it will be unethical and double standard for a therapist to disclose a patient’s confidential information when he/she acts as a forensic expert (Simon & Gold, 2010). Another conflict area between therapeutic and forensic roles is the kind of diagnosis made in both cases. While therapists are not considered poor diagnosticians per se, the type of questions they ask their clients greatly differs from those asked by forensic experts (Berge, 2004). In practice, all evaluation questions asked in therapy and forensic services are very distinct. The kind of information gathered from competent therapeutic assessment is scarcely enough to satisfy forensic requirements. Information gathered from therapeutic assessment is meant for determining the kind of treatment to provide to the patient. In a remarkable contrast, information gathered from forensic evaluation is determined by legal requirements and rarely places secondary thought on therapy (Weiner, Freedheim & Goldsten, 2003). Forensic roles are normally defined by substantive legal provisions and often focus on capacity and competence (Berge, 2004). For instance, the court may require a forensic expert to gather evidence from a victim of sexual abuse to facilitate a just ruling. In the same caveat, a therapist’s role is to provide psychological support to the victim of sexual abuse, in addition to treating sexually transmitted infections. The given example sufficiently illustrates the sharp differences in diagnostic procedures between therapeutic and forensic roles. Regrettably, courts do not hinder therapists from providing expert opinion in court on pertinent issues that are not impeded by privilege (Greenberg & Shuman, 1997). The conflicting therapeutic and forensic roles discussed in the preceding sections bring into focus the issue of mutually exclusive choices (Weiner, Freedheim & Goldsten, 2003). Therefore, the decision to offer forensic and therapeutic services requires clinicians to make mutually exclusive professional choices. To begin with, provision of each service requires psychiatrists and psychologists to make a mutually exclusive choice between assisting the court and promoting patient welfare. Second, experts will have to make a mutually exclusive choice between fostering a patient-litigant relationship based on empathy and trust or on distance and doubt (Berger, 2004). Conclusion The irreconcilable differences between forensic and therapeutic roles imply that the patient-litigant has two roles: therapy patient and plaintiff before court proceedings. A therapist renders services to the patient-litigant for purposes of treatment. On the other hand, a forensic examiner renders services to the attorney for purposes of litigation (Berge, 2004). Based on this relationship, a therapist acts in the interest of the patient-litigant while a forensic examiner acts in the interest of the attorney. Compelled disclosure of information gathered from a therapist-patient relationship is legally protected by therapist-patient privilege. Such privilege can only be waived by either a court order or a patient. In the case of forensic examiner-litigant relationship, compelled disclosure is governed by the attorney (Shuker & Sullivan, 2010). While a therapist provides care and is usually accepting, supportive and empathetic, a forensic examiner serves as an assessor and is often objective, neutral and detached (Simon & Gold, 2010). A therapist is required to be competent in treatment of impairment and clinical assessment in order to perform his/her evaluative mandate. On the flip side, a forensic examiner is required to be competent in psycholegal issues relevant to an ongoing case, as well as in forensic examination procedures. In essence, a forensic examiner is obligated to be familiar with the elementary law relating to the examination of a specified impairment claimed by a patient-litigant (Berge, 2004). Another role conflict lies in the manner in which decisions are made. Therapists rely on their expertise to analyze conflicting diagnostic hypotheses to determine the most efficacious therapeutic intervention. Forensic examiners rely on their expertise to analyze conflicting psycholegal hypotheses emanating from legal components applicable to ongoing legal matters. The procedures used to test the veracity of information gathered from patient-litigants greatly differs in both cases, and historical truths play divergent roles in each case. Forensic evaluations are essentially more structured compared to therapeutic evaluations. Most importantly, forensic evaluations are adversarial (though not essentially hostile or friendly) in an attempt to uncover the truth than in therapeutic process (Berge, 2004). Nevertheless, therapy is provided for the benefit of the patient-litigant and the principles of nonmaleficence and beneficence form the foundation of therapist-patient relationship. For that reason, a therapist intervenes to enhance quality of life and avert any harm. The ultimate goal of therapy is provision of most effective therapy, and this is defining principle for therapeutic relationship (Shuker & Sullivan, 2010). On the contrary, a forensic examiner does not strive towards achieving a positive outcome for the patient. In fact, the ultimate goal of forensic examination is normally the opposite of fostering a patient-litigant’s quality of life. A forensic examiner is obligated to provide candid, independent and neutral findings irrespective of the outcome from forensic evaluation (Berge, 2004). Requisite expertise and skills are not only the requirements to perform competent forensic assessment. A forensic examiner must also exercise unbiased and untainted judgment when performing forensic roles. However, unbiased and untainted judgment is likely to be compromised when both forensic and therapeutic services are concurrently provided to the same individual (Berge, 2004). The provision of forensic and therapeutic services encompasses a specialized set of roles, with each role substantially asking divergent questions that require divergent area of competency. Inasmuch as one individual can possess both forensic and therapeutic expertise, the central problem in role conflicts is never about expertise or the lack of it (Shuker & Sullivan, 2010). Most therapists are competent to make diagnosis for therapeutic purposes and may also evaluate patient-litigants for forensic purposes. Possession of expertise in both forensic and therapeutic assessment does not mean that psychiatrists and psychologists can provide both services at will. Avoiding dual roles does not however mean that psychiatrists and psychologists are not competent enough to provide both services. Conversely, both roles are irreconcilably mutually exclusive. Consequently, an expert cannot adequately and ethically provide both forensic and therapeutic services to the same patient-litigant regardless of their dual competencies. Therefore, psychiatrists and psychologists should not attempt to provide both services to the same individual at the same time merely because they posses dual expertise. Towards that end, the mutual exclusivity of forensic and therapeutic roles makes both roles ethically irreconcilable and it is prudent for psychiatrists and psychologists to avoid dual roles. References American Academy of Psychiatry & the Law. (1995). Ethical guidelines for the practice of forensic psychiatry. Available at: http://www.aapl.org/ethics.htm American Psychological Association. (2002). Ethical principles of psychologists and code of conduct: 2002. American Psychologist, 57, 1060–1073. Berger, S. H. (2004). Ethics and dual agency in forensic psychiatry. Psychiatric Times, 15, 6. Committee on Ethical Guidelines for Forensic Psychologists. (1991). Specialty guidelines for forensic psychologists. Law and Human Behavior, 15, 655-665. Greenberg, S.A., & Shuman, D.W. (1997). Irreconcilable conflict between therapeutic and forensic roles. Journal of Professional Psychology: Research and Practice, 28, 50-57. Heilbrun, K., DeMatteo, D., & Marczyk, G. (2004). Pragmatic psychology, forensic mental health assessment, and the case of Thomas Johnson: Applying principles to promote quality. Psychology, Public Policy, and Law, 10, 1-2, 31-70. Shuker, R., & Sullivan, E. (eds) (2010). Gendon and the emergence of forensic therapeutic communities: Developments in research and practice. Hoboken, NJ: John Wiley. Simon, I. R., & Gold, H. L. (eds) (2010). The American Psychiatric Publishing textbook of forensic psychiatry. Arlington, VA: American Psychiatric Publishing. Weiner, B. I., Freedheim, K. D., & Goldsten, M. A. (eds) (2003). Handbook of psychology, forensic psychology (2nd ed.). Hoboken, NJ: John Wiley. Read More