Featured Article
Article Title
Feedback in forensic mental health assessment
Authors
Stanley L. Brodsky Ph.D - Clinical and Forensic Psychologist, Tuscaloosa, Alabama, USA
Julie Goldenson Ph.D - Clinical and Forensic Psychologist, University of Toronto, Ontario Institute for Studies in Education, Toronto, Ontario, Canada
Abstract
The provision of feedback in forensic mental health assessment has received little attention. The scant research literature suggests that giving feedback is not only infrequent among forensic mental health examiners, but in some circumstances, it is considered inappropriate. This paper puts forth some of the challenges related to the provision of feedback in the context of forensic mental health assessments. It also suggests that in some cases, the provision of carefully vetted feedback could be consistent with the aims of therapeutic jurisprudence and trauma-informed principles. Ultimately, we suggest that feed-back is not a unitary construct and that the timing and type of feedback warrant independent consideration that is often seated in practical, clinical, and ethical considerations. We conclude that while feedback is optional, consideration of different scenarios for feedback expands the range of professional options.
Keywords
Feedback; forensic mental health assessment; therapeutic jurisprudence; evaluator option (Folk Psychology; Forensic Testimony; Therapeutic Jurisprudence; Cognitive Heuristics; False Operational Causal Sequences (OCS); Sanism in Forensic Mental Health Law; Case Law Analysis; Judicial Fact-Finding Process)
Summary of Research
“Assessment feedback has been described as often having therapeutic value in terms of helping clients develop insight and potentially improve their well-being… Perhaps the most cogent reason to abstain from providing forensic feedback is that the examinee is not the client. Rather, the referring attorney, court, or agency is typically the client of the examiner, and that entity should be receiving the report, with the associated observations, inferences, and opinions” (p. 359).
“Clinical assessors provide feedback often in the context of developing treatment plans. No such context exists in the specific goal-directed assessments in psycho-legal referrals such as competencies or mental states… As with most professions, forensic psychology is evolving in terms of practice. There is a push to consider the human rights of justice-involved individuals and issues of social justice, more broadly… Therapeutic jurisprudence (TJ) is an emerging school of thought that addresses the central question of whether psycho-legal professionals should modify their practices to enhance secondary therapeutic effects, or at a minimum, avoid harming justice-involved individuals, without compromising due process or clinical objectivity…
Research has highlighted that a significant number of FMHA examinees come from marginalized backgrounds, have been exposed to various forms of violence and maltreatment, and have disproportionately high levels of trauma-related psychopathology as compared to the general population. A case has been made that trauma-informed principles that involve transparency and empowering examinees to the extent possible is relevant to the non-therapeutic undertaking of FMHAs. In the current forensic zeitgeist, then, it could be worthwhile to explore the provision of feedback related to FMHAs, especially as psycho-legal practices are being reconsidered in terms of their impacts on examinees” (p. 360).
“In cases in which the examiner is not prepared to provide substantive feedback, an issue that arises is maintaining the rapport necessary to complete the assessment and not being perceived as unduly with-holding. Power differentials are compelling between the examiner and examinee, especially when evaluating people from marginalized backgrounds. Statements phrased like, ‘I am not at liberty to reveal results’ could be interpreted as sterile and unsympathetic to an anxious examinee… Although there has been longstanding controversy about the use of empathy in forensic evaluations, there has been a cogent argument that the judicious use of empathy can build rapport, facilitate information gathering, and demonstrate respect for the examinee” (p. 363).
“Providing thoughtful but selected feedback before additional legal proceedings could have the potential to mitigate emotional harm. On the other hand, the possibility exists that the provision of feedback before the legal proceedings could cue examinees to amend their presentation, and potentially interfere with the court’s ability to make an informed legal decision… it might be helpful for examiners to reflect professionally on the assessment findings as they relate to examinee characteristics in terms of deciding about the timing of feedback” (p. 368).
“When considering feedback, it is best to view this construct as having various dimensions and multiple levels. There will be different considerations related to feedback that is solicited by the examinee or offered voluntarily by the examiner… Forensic assessments, however, have moved to a place at which some constructive and respectful outcomes can potentially emerge from discussing with the examinee non-probative aspects about the assessment” (p. 369).
Translating Research into Practice
“...Assuming that feedback will always be well-received is simplistic, especially when assessment findings do not serve the goals of the examinee… Conveying selected findings after the assessment and/or the report are complete is also consistent with trauma-informed forensic mental health practices and therapeutic jurisprudence principles in terms of acting in a transparent fashion, empowering participants, and potentially assisting examinees to gain personal knowledge through the process” (p. 366- 367).
“Examiners may describe the psychological testing, anticipated recipients of assessment results, and mandated reporting situations. One policy option may be to provide a statement around feedback, including whether feedback will be available for the examinee upon completion of the assessment. Providing this information can structure expectations and reduce the possibility of frustration and challenges to rapport in the event that the evaluator does not answer some of the examinee’s questions” (p. 367).
“Delivering feedback is a dynamic process. If chosen, ideally it involves a thoughtful explanation of the assessment. It is a process that is preferably absent from jargon and is offered in language that clients can understand” (p. 368).
Other Interesting Tidbits for Researchers and Clinicians
“When weighing the decision about how to respond to examinee queries, examiners might consider:
a) the scope of what is being asked: e.g., are examinees asking about how they performed on a cognitive test or measure, asking about diagnosis, or asking about an ultimate psycholegal issue?;
b) the evaluator may wish to consider how equivocal the findings are in relation to the examinee’s request for feedback;
c) and finally, the evaluator may wish to consider the impact on rapport of withholding readily available information from the examinee” (p. 362).
“Trauma-informed service delivery involves attention both to content of the service and interpersonal process. On a practical level, applying trauma-informed principle to the provision of feedback would provide results in as non-pathologizing manner as possible and would attend to and reflect upon the examinee’s unique historical, developmental, and socio-cultural context. The examiners’ interpersonal sensitivity, clinical acumen, and self-awareness about their own positionalities are likely of importance when engaging in a trauma-informed feedback session” (p. 369).
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