The Necessity of Multiple Test Methods in Conducting Assessments: The Role of the Rorschach and Self-Report

This article presents a logical and empirical argument for the necessity of a multi-method approach to psychological assessment. Both in clinical and forensic psychology, self-report methods such as questionnaires and interviews are popular. The Rorschach is presented in this article as an additional test method. The article describes recent meta-analyses that evaluate the construct validity of individual Rorschach scales and that serve as major guideposts in the development of a new Rorschach system (Rorschach Performance Assessment System). The combination of self-report and Rorschach methods is used to discuss the importance of multi-method assessment in the context of incremental validity and dissimulation. Practically speaking, the assessor should consider the test method as an indispensable part of the formula when choosing tests, writing reports, and generally understanding the client.     

Incorporating index offence analysis into forensic clinical assessment

Purpose. Assessment is a core skill of clinical and forensic psychology practice and forms the basis of all ongoing engagements with offender/patients. In forensic settings, assessment involves the systematic gathering of reliable data on the characteristics of offenders and the offences which they have committed in order to develop understanding of the dynamics of offending and relevant intervention strategies. However, whilst the assessment process is aided by various protocols, no such instrument appears to exist for the assessment of an offender/patient's index offence. This paper presents a draft ‘index offence analysis guide’ designed by the present authors for this purpose and which has been piloted on prisoners and patients in secure settings. Argument. Evidence suggests that for various reasons, many clinicians do not routinely review crime scene data while working with offenders. However, this practice is arguably questionable, because how can decisions about admission, amenability to treatment, risk of reoffending, and discharge be made if there is limited awareness of what the offender/patient has done? The present authors argue that knowledge of the index offence is important to understanding the offender and suggest this can be obtained using a guide such as the one presented here. This is illustrated with an anonymous case. Conclusion. Index offence analysis should be a core task of any forensic clinician engaged in the assessment of offender/patients as it can provide a better understanding of crime scene actions and offence motivations. This can help guide treatment planning and improve risk assessments.     

Understanding and Using the Rorschach Inkblot Test to Assess Post-Traumatic Conditions

Partially, in response to recent and current military conflicts, many forensic and clinical researchers and practitioners have devoted increasing interest to post-traumatic stress disorder (PTSD) and the individual variations in response to trauma. Such efforts have produced a considerable amount of research and opinion supporting the assessment of post-traumatic conditions with the Rorschach Inkblot Test. Based on PTSD and Rorschach research and an appreciation as the Rorschach as a performance test, five interpretive considerations are presented (1) cognitive constriction, (2) trauma-related imagery, (3) trauma-related cognitive disturbances, (4) stress response, and (5) dissociation. These five provide a conceptual starting point for the understanding and application of the test to post-traumatic conditions. Implications for the clinical and forensic evaluation of post-traumatic conditions and for research are presented.     

Psychological assessment of forensic psychiatric outpatients

The 1960s decrease in long-term residential mental health care resulted in former psychiatric patients being admitted to correctional and forensic psychiatric facilities. Although psychologists face challenges in managing and treating this displaced population, assessment data plays a pivotal role in the determination of appropriate aftercare for the mentally ill parolee. This article discusses the assessment protocol utilized by the Forensic Conditional Release Program (CONREP) in California, summarizes data from these patients, and uses case excerpts to illustrate the potential value of assessment with a forensic psychiatric (outpatient) population. Special emphasis is given to the use of the MMPI-2 and Rorschach.     

Expert Testimony Using the Rorschach Performance Assessment System in Psychological Injury Cases

The Rorschach Performance Assessment System (R-PAS; Meyer et al. 2011) is a new system for administering, scoring, and interpreting the Rorschach Inkblot Test that is designed to make the best possible use of currently available scientific and clinical evidence. Many features of R-PAS are well-suited to forensic evaluation generally and to psychological evaluations in psychological injury cases in particular. Among them, R-PAS: (a) offers an alternative to self-report methods that adds incremental validity, (b) provides a useful check against exaggerated or minimized symptom presentation, (d) generates evidence concerning implicit traits and behavioral tendencies, (e) offers techniques for adjusting for abnormal response sets, (f) uses internationally applicable reference data that do not exaggerate or minimize pathology, (g) organizes results according to the strength of the evidence, and (h) presents results on which are interpretations are based in a manner easy for the intelligent layperson to grasp. Despite its recent formal introduction to the professional assessment community, R-PAS takes advantage of decades of research in peer-reviewed publications (including the insights of Rorschach critics) and builds on established validity and general acceptance for most of its procedures and features. The article describes the standards and criteria applying to expert psychological testimony in U.S. federal and state courts and applies them to Rorschach-based testimony in general and R-PAS-based testimony specifically. It is argued that when the system is properly used and applied and when such testimony is appropriately formulated, it should be found admissible in both state and federal courtrooms     

A Bayesian Item Response Theory Approach to Symptom Validity Detection: Evaluating Psychological Screening Inventory-2 Response Profile Likelihoods

Invalid data in forensic assessment are most often indicated by excessive endorsement of psychiatric symptoms. Although this method of identifying invalid profiles is generally effective, it does not make use of all conditional dependencies in data. Modern psychometric methodologies can be used to identify aberrant response profiles through model-based indices known as person fit statistics. Specifically, the likelihoods of examinees' response profiles can be compared against observed or simulated likelihoods that are derived from empirical models of emotional and psychiatric functioning. This study demonstrates how person fit indices based on item response theory models can be used to detect misfitting response profiles in forensic assessment. Archival data from the Psychological Screening Inventory-2 (R. I. Lanyon, 2010a) were evaluated with Bayesian estimation and posterior predictive model checking to compare the response profile log-likelihoods of 74 forensic participants with 1,046 normative participants. Results suggest 61 % of forensic examinees but only 5 % of normative examinees had misfitting data. Misfitting “fake bad” forensic profiles appeared to be associated with overly discrepant endorsement of symptoms, and misfitting “fake good” forensic profiles appeared to be associated with overly narrow endorsement of symptoms. The high rate of misfit among forensic examinees challenges the appropriateness of basing interpretations of forensic data on reliability and validity coefficients from normative samples. However, because aspects of the methodology are still untested in forensic and clinical assessment (e.g., the use of priors in this study), future research is needed to evaluate its appropriateness for clinical practice.     

Assessing reliability, validity, and clinical utility of the BEST-Index in measuring living skills among forensic inpatients

The assessment of behavioral change as a result of inpatient treatment in forensic psychiatry is an important precondition for violence risk prediction in forensic psychiatry. In relation to a multitude of diagnostically based risk assessment instruments, there is a shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments that are behaviorally based and therefore appropriate for use within varied psychiatric contexts. There is also a need for instruments which will offer assessors the opportunity to examine possible relationships between criteria of social risk and criteria of more general aspects of social functioning. Tapping the issues pointed out above, the authors present an overview of a normatively based social profiling instrument (the BEST-Index), and discuss evidence for its validity, reliability, and aspects of clinical utility.     

The use of the Personality Assessment Inventory (PAI) in assessing offenders

The intersection between the legal and mental health professions is sometimes marked by controversy, and the application of psychological assessments to forensic issues is no exception. However, the field of psychological assessment holds particular promise for clarifying decision making within the forensic arena, as it can bring a particularly well-established body of theory and data to bear upon clinical forensic practice. This article describes one psychometric instrument, the Personality Assessment Inventory, as an example of how particular assessment instruments can help inform this process.     

Doing justice to justice

Adshead's recognition that only when taken together can the many different conceptions of justice accommodate what is called for in the particularly demanding setting of forensic mental health care, is to be applauded. Each must be honoured and built into the systems of assessment and treatment that are the tasks of the forensic psychiatrist, she demonstrates. Adshead's far‐reaching revisions could resolve much that is troubling about the present practice of forensic psychiatry. Yet how much these revisions can overcome the moral dilemmas associated with dual roles in forensic psychiatry, is not so clear.     

Dynamic risk factors: scientific kinds or predictive constructs

ABSTRACT

There are a number of theoretical problems evident in the concept of dynamic risk factors that arise from their (increasing) importation into the explanatory and treatment domains of forensic and correctional practice. More specifically: (a) the concept of dynamic risk factors has not been well defined; (b) relatedly, there is a lack of clarity whether dynamic risk factors refer to causal processes or are predictive constructs; and finally (c) because of the above problems no one is sure how best to integrate them into clinical assessment and treatment. I will examine each of these three conceptual problems in this paper and make some suggestions about how to utilise dynamic risk factors in explanations of offending.     

Development of a computerized sexual assessment laboratory

Computer-assisted psychological assessment has been operational for 25 years. It has been well received by patients and shows a degree of reliability that is comparable to that of conventional testing. The authors report on the development of a computerized psychosexual assessment laboratory in a forensic facility housing convicted sex offenders who volunteered for treatment. The development of the laboratory was in response to the need for uniform psychosocial data on each resident that can be used for making better diagnoses, developing personalized treatment programs, and assessing treatment outcome. The process of selecting the psychological tests and programming them for interactive administration is described, as are the testing procedures using the penile plethysmograph with stimuli based on the Tanner developmental stages. A computer-assisted psychosocial assessment that produces a psychosocial history was developed. The laboratory's overall value in the treatment program is assessed.     

HCR-20 violence risk assessments as a guide for treating and managing violence risk in a forensic psychiatric setting

Abstract

Over the past decades there has been a vast development in the research into risk factors for violence and the development of risk assessment instruments. One instrument that has been given special attention is the HCR-20 violence risk assessment scheme. However, little attention has been paid to the clinical applicability of this tool, i.e. how does this assessment scheme perform when utilized in clinical practice as a tool to guide intervention and management in order to alleviate risk of violent behaviour? The present study was a true prospective study into the utilization of the HCR-20 as a clinical routine. Data on forensic psychiatric patients (n = 81) from a forensic unit in Denmark are presented. As part of a clinical routine all patients were assessed for risk of future violence utilizing the structured professional judgement model, the HCR-20. Outcome measures were aggressive episodes during hospitalization and new convictions post discharge. The predictive validity of the HCR-20 was lower compared with previous findings. It is argued that this does not necessarily indicate poor predictive accuracy of the HCR-20. Rather, it may indicate that the HCR-20 is suitable for guiding risk management in order to prevent violent behaviour.     

Impact of Common Mental Health Disorders on Cognition: Depression and Posttraumatic Stress Disorder in Forensic Neuropsychology Context

The assessment and diagnosis of posttraumatic stress disorder (PTSD) and depression in forensic evaluations may lack an acknowledgement of the neurocognitive impact of these disorders and how they interact with other causative factors, such as traumatic brain injury (TBI), pain or fatigue. Both PTSD and depression have a complex, growing and consolidating neuroscientific and neuropsychological evidence base, and both can affect neuropsychological test results. In forensic neuropsychological assessments, they are often considered to be confounding factors in evaluating TBI and neurodegenerative disorders but not a source of cognitive impairment in their own right. Yet, an accurate neuropsychological assessment of both cognition and affect is vital to causality determination, prognosis and treatment planning. To complicate matters, selective brain injuries, contingent on the location of injury, can produce symptoms of depression that also affect the neurocognitive profile. Therefore, behavior can overlap not only due to overlapping or comorbid diagnoses, but also due to similar neuroanatomical correlates of both conditions. This paper focuses on reviewing and integrating the available empirical evidence from neuroscience and neuropsychology regarding the cognitive impact of PTSD and depression. Our critical review will emphasize the implications of the more recent evidence for forensic assessment determinations regarding causality, diagnosis, and the impact on function, prognosis and treatment. Hence, electronic search engines, PubMed, PsycINFO, and Google Scholar (up to January 2018) were screened and reviewed both for the neuroscience and neuropsychological literature related to depression and PTSD.     

The inpatient evaluation and treatment of a self-professed budding serial killer

The authors present the case of a man who was hospitalized after claiming that he was about to become a serial killer. The patient presented with extensive written homicidal fantasies and homicidal intentions without evidence of actual homicidal acts. In addition to routine assessments, hospital staff members used case conferences, psychological testing, outside forensic consultation, and a forensic review process to make decisions regarding diagnosis, treatment planning, and discharge. The patient was discharged after 8 months of inpatient treatment and was apparently free of homicidal impulses or symptoms of severe mental illness. A 2-year court commitment allowed for the enactment and potential enforcement of a discharge plan that was endorsed by the patient, the hospital, and community care providers. The authors review diagnostic and risk management issues. Comparisons with known features of typical serial killers are made.     

Treatment planning with the Psychopathy Checklist-Revised (PCL-R)

The Psychopathy Checklist-Revised (PCL-R) is an essential component of any assessment protocol within forensic and correctional settings. Both nomothetic and idiographic interpretations aid the clinician in screening and treatment planning. Whereas the PCL-R can be effective in identifying those who are at highest risk of disrupting treatment efforts and jeopardizing the safety of those around them, through item analysis, it also provides clues to the nonpsychopath's unique treatment needs. Specific recommendations are offered regarding the implementation of the PCL-R for screening and treatment planning, and illustrative case examples are provided to enliven essential points.     

What can we learn from the first community-based epidemiological study on stalking in Germany?

There is a lack of community-based studies on prevalence rates of stalking and the impact of stalking on victims in continental European countries. The authors published the first community-based epidemiological study on stalking in Germany. The purpose of this paper is to discuss possible implications of these epidemiological data for the mental health system, forensic psychiatry and legal regulations in Germany. For these reasons some data of our epidemiological study are outlined and reanalyzed. To examine lifetime and point prevalence rates of stalking, behavioural and psychological consequences for victims and the impact of stalking on current psychological well-being in a German community sample, a postal survey was conducted with 2000 inhabitants randomly selected from Mannheim (response rate 34.2%, n=679). The survey included a stalking questionnaire and the WHO-5 well-being scale. Almost 12% of the respondents reported having been stalked. This study identified a high lifetime prevalence of stalking in the community. Effects on victims' psychological health were significant and there was a high rate of physical (31%) and sexual (19%) violence in the context of stalking. Our data suggest that the phenomenon deserves more attention in future forensic psychiatric research and practice. Implications for forensic psychiatric assessment and treatment of stalkers as well as for management of stalking victims are discussed.     

Violence risk profile of medium- and high-security NGRI offenders in Belgium

Under Belgian law, offenders not guilty by reason of insanity (NGRI) are committed by the courts to forensic mental health treatment. The use of violence risk assessment tools has become routine in these settings. However, there are no national statistics regarding violence risk assessment in the Belgian forensic population. A study was undertaken to collect risk assessment data (PCL-R, VRAG, HCR-20) on a large cohort of forensic patients committed to Medium Security units in the Flanders region and in High-Security units in the Walloon region. Flemish patients were expected to present a lower risk compared with their Walloon counterparts. Instead, data yielded by a structured risk assessment method demonstrate the opposite. Moreover, the majority of patients in Flemish facilities had committed violent offenses and were institutionalized for shorter periods whereas the majority of Walloon patients had committed sexual offenses and were institutionalized for markedly longer periods.     

交通事故中脑外伤所致精神障碍与精神伤残相关因素分析

目的分析交通事故致颅脑损伤后精神伤残等级评定的相关因素。方法收集157例交通事故致颅脑损伤后精神伤残的鉴定案例,根据鉴定结论分为轻度组、中度组和重度组。对3组的一般人口学资料、临床病史资料、鉴定资料进行比较,并以上述资料为自变量,以组别为应变量,进行logistic回归分析。结果3组一般人口学资料的差异均无统计学意义（P〉0.05）,而昏迷时间、颅内出血区域大小、工作能力、家庭职能、社交功能、生活自理能力、智商的差异有统计学意义（P〈0.05）。颅内出血灶、家庭职能、社交功能、生活自理进入logistic回归方程。结论颅脑损伤的严重程度对后遗精神伤残有一定影响,鉴定时伤者的家庭职能、社交功能和生活自理是决定伤残等级的主要因素。     

Use of the MMPI-2 in the treatment of offenders

The MMPI-2 is among the most frequently relied upon inventories for personality assessment. The test is utilized across a variety of nonforensic settings (e.g., psychiatric inpatient and outpatient) as an aid in formulating treatment plans, assessing treatment progress, and measuring treatment outcome. The MMPI-2 can also be utilized in forensic settings in a manner similar to its use in other settings, such as identifying treatment goals and evaluating treatment efficacy. Various MMPI-2 scales can identify an individual's treatment needs, reveal potential obstacles to treatment, and serve as a measure of treatment efficacy. Such information can be very helpful to the clinician in formulating or modifying a course of treatment for offenders. This article provides an overview of the use of the MMPI-2 in treatment planning and describes the relation between scores on the validity, clinical, and various supplementary scales and treatment-related issues.