Clinical Forensic Psychology and Law

Kaitlyn McLachlan

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780815388098
• eBook ISBN: 9781351161541
• Edition: 1
• Topic: Law
• Subtopic: Law Theory & Practice
• Index: Law

Clinical Forensic Psychology and Law is a compilation of recent and classic articles providing comprehensive coverage of the field of clinical forensic psychology and law. Selected articles sample the major areas of the discipline, including criminal and civil forensic assessment, forensic treatment, youth assessment and intervention, and professional and ethical issues in forensic practice. The volume is designed for use by scholars, graduates and undergraduates in psychology and law schools.

Part I

Criminal Forensic Assessment

[1]

Violence risk assessment: Science and practice

Kevin S. Douglas* and David N. Cox

Simon Fraser University, Canada

Christopher D. Webster

Simon Fraser University, University of Toronto (Psychiatry and Criminology) and Earlscourt Child and Family Centre, Toronto, Canada

Within the conceptual framework of the scientist–practitioner model, this paper describes how the science of risk assessment has progressed to a point where it can be of definite assistance to clinicians. Similarly, clinicians can be of marked help to researchers as they play a role in concept definition and as they design and carry out studies to determine the accuracy of their predictions. Risk assessments ought to be carried out in accord with state-of-the-discipline knowledge. Until fairly recently, it may have been argued that the state of knowledge did not provide any sort of reliable or trustworthy direction on violence risk assessment. This position seems no longer tenable. Topic areas discussed include violence and risk assessment generally, the actuarial-clinical prediction debate, the validity of violence risk assessments, predictors of violence, violence risk assessment schemes (empirically validated structured clinical decision-making), communication of risk assessment findings, and implications for training.

In recent years, there has been an encouraging number of well conceived and executed research studies showing that, contrary to earlier opinion, there is every justification for trying to improve the accuracy of predictions of violence and the quality of assessments of violence risk (for a review, see Douglas & Webster, 1999a). The authors wish to describe a process through which violence risk assessments can be carried out. This process, involving the use of violence risk assessment schemes, calls for collaboration among researchers and clinicians and can, it is to be hoped, benefit some patients, convicted persons, and even young children inclined toward early aggression and violence.

The authors believe that the gap between scientists and practitioners is wide, and is narrowing only slowly, if at all. Routine practice is little influenced by strong scientific findings, and frequently research has minimal links to the actualities of everyday clinical life. The authors^’ position, however, is that each sphere must inform the other in order to attain a level of sophistication in both the science and practice of violence risk assessment that is commensurate with its importance.

This paper is based on the scientist-practitioner model of training in clinical psychology. In such a model, clinical work is guided as much as possible by research findings. Violence risk assessment entails making clinical decisions that, more often than not, can have important consequences. The well-known dilemma is that persons who would not be violent if they were released may end up being detained, and violent individuals, who really ought to be confined to an institution, are released. Both types of errors are serious, and it is highly desirable to reduce them. The authors’ position is that the goal of minimizing errors can be forwarded by adopting violence risk assessment strategies that are based in research– ‘empirically validated’ violence risk assessments. This paper first lays a conceptual foundation based on the scientist-practitioner model of clinical psychology, and then discusses how it may apply to the contemporary science and practice of violence risk assessment.

Science and practice

The 1949 Boulder Conference established a model for training clinical psychologists which has endured since that time. Simply put, clinical psychologists would be trained both as researchers and as practitioners. It has been described as a ‘grand aspiration that rarely has been achieved in individual psychologists’ (stricker & Trierweiler, 1995, p. 995). Goldfried & Wolfe (1996) state that since this conference ‘the field has struggled to foster the synergy between therapy, research and practice’ (p. 104). They go on to suggest that the differences between practice and research need to be examined very closely, as it is a dysfunctional relationship in which both sides view the other with disdain. Kanfer (1990) acknowledges that some individuals have demonstrated how effective practice is based on a knowledge of science; however, his concern is that there is only minimal support for those who are systematically involved in building the relationship between the two. He states: ‘A failure to resolve the “scientist-practitioner crisis” not only would lessen the potential impact of advances in psychological science on practice but would also endanger the credibility of a psychological profession by dismantling its most substantial foundation’ (p. 269). Nezu (1996) concludes, like Kanfer, that the debate which exists between practitioners and researchers in psychology could have major negative consequences if it continues, as ultimately both sides will lose. He comments that ‘despite the definition of psychology as being the science of human and animal behavior, those individuals engaged in the attainment of psychological knowledge continue to be at odds with those engaged in the application of such knowledge’ (p. 161; emphasis in original).

While practitioners criticize researchers for being out of touch with the realities of clinical work, researchers suggest that clinicians who are out of touch with the research literature cannot provide effective treatment. What is of greatest concern is the apparent lack of any willingness to reconcile differences. Hayes (1996), while acknowledging that psychology is still a very young field, describes the ‘Virtual disconnection’ that still exists between science and practice. Beutler, Williams, Wakefield & Entwistle (1995) believe that it is the body of knowledge behind these two positions which is the basis for conflict. Researchers feel that empirical findings are a necessity for correct clinical practice, and clinicians argue that researchers are insensitive to the practicalities of their needs and fail to demonstrate relevance in the context of clinical concerns. They point out that the scientist–practitioner duality pervades disciplines where the scientific method is the primary source of knowledge. Following a national survey of psychologists, they concluded that clinicians use research findings in their work more than academics give them credit for, while academics are less likely to acknowledge the usefulness of clinical work. They take the further position that ‘it should be remembered that scientists are more dependent on the practitioner community for the survival of their findings than practitioners are on scientists’ (p. 991).

An extreme position is that taken by Fensterheim & Raw (1996), who believe that integration of research and practice is not possible. They feel that it is a model which does not work, as these are two distinct fields. Their plea is for deintegration, as they feel that integration impedes progress. They argue that the two areas should interact on the basis of mutual respect while remaining independent. Somewhat in contrast to this position is Meehl’s (1954) concept of the ‘honest clinician’, an individual who constantly questions success and seeks to know through maintaining a research-scholarly attitude, if it is possible to do better. As stricker (1992) points out, the honest clinician derives certainty from empirical evidence and recognizes the responsibility to maintain a scholarly attitude that is intended to provide clients with the best treatment possible on the basis of current knowledge. This position is perhaps most strongly stated by Singer (1990), who believes that a central ethic of clinical practice is that it is based on a current knowledge of the research literature.

This concern is crucial to the present discussion of risk assessment as it raises the issue of ethical practice. In summarizing Singer’s concerns, stricker (1992) states: ‘Thus, the position that research drives practice is endorsed, and it is also elevated to a principle of ethics. Not only are practitioners who are not informed by research offering an inferior brand of treatment, not only are they less than honest clinicians, but they are unethical in their practice’ (p. 546). stricker pursues his concerns- in a convincing manner while attempting to determine the ethical issues involved. He concludes initially that it is not unethical to practice in the absence of specific evidence, as such certainty is not possible within the limits of the existing body of knowledge. However, he states that ‘although it may not be unethical to practice in the absence of knowledge it is unethical to practice in the face of knowledge. We all must labor with the absence of affirmative data, but there is no excuse for ignoring contradictory data. An insistence on relying on overlearned, favored, but invalid approaches is not justifiable’ (p. 546). He cautions against rigid adherence to a particular approach, while recognizing that no clinician, no matter how well experienced or educated, can be competent in all approaches. Out of this recognition comes the ethical obligation to refer clients to other practitioners who possess the necessary competence to deal with a specific problem. This concern over the ethical implications of ignoring the scientific method is perhaps stated most strongly by Meehl (1997) who, in condemning a reliance on clinical experience rather than empirical findings, concludes that: ‘As for our many prescientific practices, I believe that if we do not take strong steps to clean up our act, some smart lawyers and sophisticated judges will either discipline or discredit us’ (p. 98).

It is in this context that the authors’ concern about the current ‘state-of-the- discipline’ knowledge with respect to violence risk assessment becomes relevant. Borum (1996), in his article on how risk assessment in clinical practice might be improved, cites the statement made by Webster, Douglas, Eaves & Hart (1997b) that ‘the greatest challenge in what remains of the 1990s is to integrate the almost separate worlds of research on the prediction of violence and the clinical practice of assessment. At present the two domains scarcely intersect’ (p. 1). It is a balance in the scientist-practitioner model that is sought, and yet, as the preceding paragraphs have suggested, it is not clear how this balance is to be attained. Within the area of risk assessment the authors have commented that it is this balance that is in urgent need of being achieved (Webster & Cox, 1997). The indications are, as discussed in this article, that the science of risk assessment has progressed to the point where it is important, and perhaps ethically necessary, that this information be made available to, and be used by, clinicians in assisting them make what has been described as one of the most complex predictions in behavioural science and law (Grisso & Appelbaum, 1992).

A worthwhile by-product of this process is that an example may be provided of how a truly workable scientist-practitioner model can be achieved. Clearly it is possible to focus on the failings of the model. This may give rise to a sense of the differences between research and practice as being insurmountable. Yet the present authors’ position inclines toward optimism. Research and practice should benefit one another. The synergy described earlier is a real possibility. As stricker (1992) has pointed out, there are different levels of research use in which a practitioner can engage. The first occurs simply through an awareness of research. The second involves the active consideration of the implications that research has for practice. The third possibility, which is identified as the highest order of use, involves the active integration of research and practic...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Series Preface
• Introduction
• PART I CRIMINAL FORENSIC ASSESSMENT
• PART II CIVIL FORENSIC ASSESSMENT
• PART III FORENSIC TREATMENT
• PART IV YOUTH ASSESSMENT AND INTERVENTION
• PART V FORENSIC PRACTICE: PROFESSIONAL AND ETHICAL ISSUES
• Name Index