Should Forensic Psychiatrists Conduct Psychological Testing?

Article excerpt

Forensic psychiatrists occasionally conduct psychological testing, for a host of reasons that may include a lack of access to psychological consultation, a lack of funding for such consultation, or a genuine belief that they are technically and legally qualified to select, administer, score, and interpret the most suitable instruments for informing a particular medicolegal opinion. This phenomenon may have several clinical, ethical, and legal ramifications, depending upon the forensic psychiatrist's level of training, the forensic issues being addressed, and the nature of the psychological tests employed. In this article, the authors distinguish between what constitute "psychological tests" as opposed to appraisals, rating scales, and inventories. Also addressed is the need for formal training and supervision, including familiarity with the mechanics of test construction and statistically determined interpretive limitations. The authors offer recommendations and provide several case vignettes that illustrate how these issues may surface in both civil and criminal law contexts. The article concludes with the caveat that psychiatrists should avoid using psychological tests without obtaining and maintaining necessary credentials.

KEY WORDS: Clinical forensic assessment, forensic psychiatry, forensic psychology, psychiatric ethics.

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.

Somewhat surprisingly, a thorough literature search has uncovered relatively few articles that address this topic - a Situation that may help to explain why some clinicians of various disciplines have no compunction about conducting psychological testing on their own. Berg's contention that "Psychiatrists' complaints that psychologists' test reports are unclear and weighed down by technical jargon" (1984, p. 53) may reflect another reason why some forensic psychiatrists have elected to pursue instrument-based assessment procedures on their own, despite Menninger's (1947) frequently cited observation - also referenced by Berg - that "the competent psychiatrist would no more exclude the special techniques of the psychologist and his diagnostic studies than would a capable internist routinely exclude the findings of the roentgenologist" (p. 48).

What is "psychological testing"?

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. …