Forensic fellowships

[nancysinatra]

Sorry if there's already a thread on this (I couldn't find it if there is), but does anyone know of a good way to assess the strengths/weaknesses of the various forensic psych programs out there? Are there unofficial rankings anywhere?

Thanks!

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[whopper]

There were but they're old and things change.

Strengths:
1) Psychological testing: the program will teach you how to use psychological testing. A doctor's ability to tell if one is lying is no better than a layman, a point Phil Resnick hammers into his residents each year. If you go on the stand and testify, you better have something more than just mere clinical opinion.

Several tests exist that could help in this regard such as a SIRS, TOMM, an M-FAST among several others. There are also plenty of other tests that could be useful such as the HCR-20 (for predicting future violence), the Static-99 (sex offender evaluation) among several others. Most programs that I'm aware of have no experience with psychological testing.

2) Good exposure to cases: what's the range of cases you'll see? E.g. disability, competency to stand trial, malpractice, not guilty by reason of insanity, mitigation cases, psychological autopsies, guardianship, fitness for duty, etc.

Some places will not let you have involvement in the major cases, others will.

3) The safety of the institution: Most forensic fellowships will have you work at a prison or forensic psychiatric facility that pretty much will be along the same lines or slightly better than this...

You need to figure what are the odds you'll be attacked working everyday in a facility like that?

4) Distance of the forensic institution from the fellowship: The two are not the same. Most fellowships are in the university, but the actual work is in the prison that is literally a 3-4 hour drive away. Many forensic fellowships require that you show up to both in the same day. During my interviews, I was told by several programs to expect to put 30K miles on my car that year from the fellowship alone. Some programs have an apartment set up for the fellows at the "other" location" so they could sleep at one place at the end of the day.

How prevalent is this issue? It was the overwhelming majority when I interviewed.

5) Training on writing: Forensic psychiatry requires extensive writing of reports and most M.D.s forgot how to do this and are more used to writing things to the effect of...

70 yo CM w/ HX of BPD with SI an HI.
On Li 450 QBID.

When writing a report, it has to be grammatically correct and understandable to a court. For example
Mr. Smith, a 70-year-old white man with a history of bipolar disorder was allegedly suicidal and homicidal during our evaluation. He is currently being treated with lithium, a medication for the treatment of bipolar disorder at 450 mg twice a day.

It takes months to relearn how to write. As my PD brought up, we were probably better writers in high school than we are after residency.

6) Teaching: This does not need explanation.

7) Training in giving expert opinion on the witness stand: Several programs give fellows little exposure to being in Court or mock trials. You want a program that gives you very good experience in this area.

8) Furthering your career in this field after you graduate: Some programs literally are using fellows to do the dirty work evaluations, have an attending sign them, and the attending pockets the money for the evaluation.

I've noticed that several aspects of this field are controlled by a pseudo-fraternity of judges, lawyers, and specific forensic psychiatrists. It's not an open field where someone could just set up shop as a forensic psychiatrist and expect cases to fall on their lap. Lawyers tend to continue to work with forensic psychiatrists where they've established a relationship, and it's easy to understand why. When on the stand, the psychiatrist and the lawyer need to work well together, just like in court-room dramas where the lawyer and the witness, just be facial expressions can tell what the other is thinking..

http://www.youtube.com/watch?v=V-TemfMIxrk&feature=related
start at 1:00

(Of course, you want to be working for an honest lawyer, not the smooth evil mafia one).

Will the program help you to get your foot into the door of the cigar-smoked filled room where the bigshots discuss the big cases of the local area?

9) Is the forensic psychiatrist honest? I've seen quite a few give completely bull$hit testimonies because they were paid enough. Well completely is not accurate but BS to the point where the judge and jury bought it and the psychiatrist carefully worded their statement so they would not be caught. I hate saying this but I know a PD in an namebrand institution that IMHO gave a completely BS testimony on a rape case, and when I asked him about it in a non-confrontational manner, he became red-faced and started screaming at me (I was a resident at the time). The specific question I asked was that given that the forensic psychiatrist had testing highly suggesting the defendant was malingering, and all this guy had was clinical opinion, and that clinical opinion is far more inaccurate than testing, why didn't he do psychological testing? The guy had to admit he didn't know how to do the tests (again a reason why you need to go to a program where they'll teach you this), and it was apparent his testimony was merely just a plausible story that fit the set of available facts but several other plausible stories could've fit. IMHO that was merely spinning the events and not a real explanation that met a scientific standard of any sort.

10) Will the program pay for you to attend AAPL and the board review course taught there?

11) All the other factors you'd expect from any program: the pay, do they treat residents well, what are the hours like?

I don't know how every single program is but I can tell you given what I do know here are the better ones...
U Mass: PD last I heard was Pinals who has a great rep. Several prominent forensic psychiatrists and psychologists work and teach there. One of the top forensic psychologists is there as well and it also has (or at least had) a forensic psychology program and the two programs worked hand in hand.
Case Western: Resnick resides here but so too does Steve Noffsinger, another top-notch forensic psychiatrist. Both advanced the field, both are great teachers, and the program is considered one of the best if not the best.
UC Davis: Charles Scott heads this program and he's now the current president of AAPL.
U of Cincinnati: Headed by Douglas Mossman, a Guttmacher award winner. He advanced the field of predicting future violence and literally wrote several of the guidelines used as the standard for AAPL.

I know for a fact that all of the above programs all teach psychological testing very well or at least have a PD that knows it because I've either seen it with my own eyes or read journal articles where the PD was the author and it involved psychological testing.

 

[nancysinatra]

Thanks Whopper! That is really helpful!

I see what you mean about writing. And it's not just writing--it's medical speech in general. The other day, I was at the VA, and a 50-something y/o HEMV (homeless edentulous malodorous veteran) was talking about something, and he used a word that seemed really fancy--do you know what the word was? "Consequently." It wasn't fancy because he was a HEMV and he was at the VA--it was fancy because it was a 4-syllable non-medical word the likes of which few doctors would ever use! I was pretty impressed.

Do you know if there is a good way to find out which programs are the most solid in some of the areas you mentioned? Without having a particular geographical preference, I'm curious which are the best in terms of psych testing, exposure to cases, witness stand experience, writing, furthering your career...

Also can I ask about that unethical forensic psychiatrist you mentioned? My understanding is that the field frowns upon these hired guns, but what's to stop them? How can the field enforce a standard? It's not patient care, after all, and you don't need a "license" to be an "expert witness" do you? In theory, couldn't my mom could be an expert witness in a forensic psychiatry type case? Won't a bad witness eventually just get a bad reputation and get blackballed?

 

[whopper]

Just to give you an overview of the program I graduated...
1) Psychological testing: taught very well here. I did the HCR-20, Georgia Court Competency test at least 100 times before I graduated among several other tests. While you can only do an MMPI if you're a psychologist we did have an extensive lecture on the MMPI from a forensic perspective. Scott Bresler, a forensic psychologist and one of the top guys running the program is a name-brand in the field of psychology and virtually every single test you can think of that has any forensic relevance and he works hand-in-hand with the felllows.

2) Very good exposure: I was exposed to several big cases including a few with famous athletes, serial rapists, not guilty by reason of insanity cases, etc. One of my cases, I was able to come to my opinion because the defendant was on a documentary and I was able to use the footage from the documentary where he boasted he loved being in prison would do anything to get back into prison if released. The guy was trying to get a not guilty by reason of insanity defense.

Once every other week, fellows are expected to give testimony in real court, about 8 cases a day. In many program they never let their own fellows ever give testimony.

3) Safety of the institution: Most of the work is done in Summit Behavioral Healthcare, the state's long-term and forensic psychiatric center, where the state paid for every expense to make it a state-of-the art facility.

This place was literally the best designed in terms of safety and aesthetics I've seen until I worked in a private facility (the Lindner Center).

The facility is very safe, well-lit, you are given a "spider," an electronic device where if you feel you are in danger, you press a button you wear on your ID and within literally 0-30 seconds the campus police will run up to your location.

It also comes with several things useful for evaluations such as interview rooms with one-way mirrors.

4) Distance of the forensic institution from the fellowship: University of Cincinnati's forensic psychaitry fellowship office is about a ten to fifteen minute drive to Summit Behavioral Healthcare, and about the same distance to Greater Cincinnati Behavioral Health, a community mental health agency where fellows treat forensic psychiatric patients in the community.

Compare that to pretty much every other program I interviewed at where I was expected to drive at least 3 hours a day or be on a train for that amount of time.

5) Training on writing: Doug Mossman gave me one-on-one writing training at least an hour a week.

6) Teaching: Mossman gave me one-on-one teaching about 2-3 hours a week, and spent another 2-3 hours a week with the fellows teaching. There was a lecture every week. Bresler and Mossman invited fellows to do private cases and even offered them to do some where they were paid.

7) Training in giving expert opinion on the witness stand: U of C has a partnership where we did mock trials in cooperation with or against Resnick and his fellows. As mentioned, fellows are on the witness stand in court every other week about 8 cases each time.

8) Furthering your career in this field after you graduate: This highly varies depending on how well the program liked you and if you stay in the area. My program kept a relationship with several of its graduates even if they didn't stay in the area, and have been very welcoming to me. They're the ones that got me that court-gig I used to work at, and they're opening the door to me to take on several private cases. Bresler and I worked together on a presentation at the American Academy of Forensic Sciences and he's been introducing me to lawyers in the area.

9) Is the forensic psychiatrist honest: Mossman is one of the most honest and ethically-minded people I've ever met. Trust me on this. He could've used his position to be making big bucks but instead is focused on research and teaching. I had a private case that Bresler gave me as a fellow and my opinion was actually not what the hiring lawyer wanted. Bresler told me that in no way shape or form were we going to fudge or lie to give the lawyer the outcome most profitable on this case. Instead we told him our honest opinion, and worked with that lawyer so that he could come up with the best way to play the honest angle in helping his client.

Trust me, if I ever detected any fudging or lying I wouldn't have chose to still stay active with my former teachers. I do have former teachers that I do know fudged or lied from general residency (not fellowship) and I have not chosen to maintain a relationship with them.

10) Will the program pay for you to attend AAPL and the board review course taught there? Yes at U of C. This is the case at most programs but some will not do this.

11) All the other factors you'd expect from any program: The pay at U of C is one of the highest among the fellowships plus moonlighting opportunities are very good. I made as much as an attending during my fellowship. I was given my own office, treated well, and was not made to work unreasonable hours.

Some other nice perks: fellows take a law class with law student fellows who want to specialize in mental health law. The professor of that class is one of the best teachers I ever had, fellows do some teaching-they get to teach a lecture or two to the residents, Mossman is one of the top guys in the field, and half the time I walked into his office he was having a conversation with a big wig or reviewing an article for publication (he's on editor for several journals), and asked for a few minutes of time while he wrapped up, while I was in awe of what he was doing.

 

[whopper]

Do you know if there is a good way to find out which programs are the most solid in some of the areas you mentioned? Without having a particular geographical preference, I'm curious which are the best in terms of psych testing, exposure to cases, witness stand experience, writing, furthering your career...

I would focus on what is the most solid based on the research interests of the people in the program. Mossman, for example, has a knowledge of statistics far better than most Ph.D.s in math (I'm not exaggerating and the impressive thing is he learned this on his own). U. Mass is filled with several experts in forensic psychology. Resnick specialized in doing some of the highest profile cases in the country.

I'd still stick with the programs I mentioned above. I can tell you that I got a very good feeling from Tulane and when I stacked all the programs where I interviewed. Tulane was #2, just a smidgen below Cincinnati, and ultimately I chose Cincinnati because my wife didn't want to be in New Orleans.

I had several friends that did forensic fellowship in NYC and they told me the best one there was Albert Einstein because the PD there, Merrill Rotter, was an excellent teacher and went out of his way to give his fellows top notch teaching. The PD of U of Wisconsin was also very welcoming and I got a good feeling from him. His office was littered with several teaching awards.

I will also add that I do know of a few programs where despite the name-brand of the institution or the PD, I wouldn't want to be there. Like I said in some other threads, it's more important to have a teacher where you have a good relationship more so than their academic prestige. Some top doctors with great prestige are lousy teachers and are very difficult people.

Also can I ask about that unethical forensic psychiatrist you mentioned?

Well...you can ask...

but what's to stop them?

Well not much. This guy, for example, none of the other professors I knew in my general residency program knew what he was doing because they didn't go to court and watch it themselves. They just knew him as the forensic psychiatrist that did lectures for them. I was a resident at the time, and my PD from years 1-3 was incredible (and a forensic psychiatrist) and he left by fourth year. I pretty much figured out by by fourth year that the new PD was a newbie that didn't have much experience and it was not even worth bringing up the issue to her because let's just say as a chief I brought up other issues (like an attending who was incompetent) and she didn't do much there.

Like I said, there's a cigar-smoke filled room that most people don't know what goes on in some of them. No, these days there is no more cigar smoke but you get the drift.

There's another forensic psychiatrist of high prestige that literally has a reputation for being a sell-out. I was at an AAPL and everytime this guy's name was mentioned most people had a few bad things to say about him, but when he's there, he's still given up-front to his face respect and still wins awards.....
go figure.

 

[nancysinatra]

Whopper--thank you so much for all this information! It is so helpful and informative! I'm going to check out the programs you mentioned. It's interesting that you mentioned safety as an issue--I know it seems obvious, but even in residency I feel like it keeps coming up as something of a problem here and there, and yet I don't really think about it as something to look for in advance.

Anyway thanks again and I will use all this information!

 

[splik]

just necrobumping this thread because it is the most useful thread for thinking about forensic fellowships and what questions to ask when interviewing!

whopper - i found this very helpful and it made me look very thoughtful in my interview! lots of good practical advice you wouldn't think about otherwise.

 

[notdeadyet]

just necrobumping this thread because it is the most useful thread for thinking about forensic fellowships and what questions to ask when interviewing!

In terms of thoughts for new applicants as to what specifically to ask:

1. Psychological testing- "What is the training, who provides it, and what will my role be?"
This the domain of PhDs. They are very protective of the testing and much of it requires (by policy, not necessarily skill) a good background in psychometric testing training. Many of the tests (such as MMPI) you will not be able to conduct independently. But many of the tests you will. The ideal is that your program has a full-time psychologist with a background in forensic psychological testing available to you. Everyone will get some exposure, but the better programs will give you the opportunity to do as much as you'd like to take on. This is a big plus.

2. Civil casework- "What percentage of my time will be spent on criminal vs. civil cases?"
Everyone wants to work with criminal cases, but the learning curve can be higher in civil cases and the opportunity for exposure is MUCH less. The worst forensic programs will give you plenty of criminal exposure but very little civil. You want to go to a program that will give you lots of civil work. If you don't get it in fellowship, it's a lot harder to build expertise one someone else's dime (many, many dimes).

3. Location and Types of Training Sites- "Can you show me a typical weekly schedule with where I will be working and provide me with a list of where I will be training?"
Aside from the location of the service site (typically a jail or prison) that compensates much of your salary, you want to know what kind of diversity you'll get in your training. You want to hear about specialized clinics you'll be working in, not "you'll see a lot of that" or other vague promises. Here are a few things to look for or ask about:
- Prison or jail? The ideal is both. You will see different pathology and give different testimony. Many programs will have you working in one or the other, but it's better to have exposure to both.
- Sex offenders? Do you get clinical experience in a sex offender clinic?
- Disability? Do you have specific exposure in a clinic focusing solely on disability assessments? C&P at the VA is one, but it's better to also have civilian exposure to this.
- Collaborative Care courts? Any formalized exposure?
The price of a wide breadth of exposure is travel time. In urban programs, it may be less of an issue, but get an idea for how much time you'll spend in transit between them.

4. Didactics- "How many hours of protected time do we have for didactics?"
Get a feel for what is on the schedule weekly as protected time. You don't want to hear vague promises of "8 hours" or somesuch, which may be a sum of mostly chalk talks. You want to see how much time on the schedule you have assigned for formal training in landmark cases, history, etc. Another plus is whether the program has you train at an affiliated law school, which some of the better programs do. Those that poo-poo it likely don't have the relationship for reasons outside their control.

5. Protected time for report writing- "Where is time allocated on the schedule for writing reports?"
See it and make sure it's adequate. You don't want to see a packed schedule with the assumption you'll be working most nights after dinner on your evaluations.

6. Style of training- "How much autonomy do I get in my cases?"
Forensic fellowship, like all of psychiatry, is built on the apprenticeship model. But I actually avoided several of the best-known programs because even though they have some of the greats in the field, their fellows spent most of the time working on tasks under their supervision and playing second fiddle. That's fine starting out, but you want to be managing your own cases with support by the end.

7. Choose your location wisely
I think the statistic is something like 75% of psychiatrists end up practicing within 50 miles of where they trained (don't quote me on the exact numbers). Some of that is life itself (married, kids, etc.) but also because local reputation means a lot. This goes triple for forensics. You will get a reputation in the courts and among lawyers where you do fellowship. If your program is good, they will get more offers of work than they can handle and they will refer their overflow to graduates of their program who can take them. It is much, much easier to drum up forensic work where you train than by moving to a new town. I think this is probably not appreciated enough. In my opinion, you're better off going to a B program in the area you're going to settle down than going to an A program then moving across the country.

 

[splik]

thanks for your input. i am guessing by "psychological testing" whopper was referring to using the various psychometric tools that can be used in forensic evaluations for things like competency, malingering etc as opposed to formal psychological testing but could be wrong.

i can also tell from your comments where you will be doing your forensics fellowship!

 

[EatSleepForensics]

I think that the aforementioned factors are very useful to consider, but have a different take on some points.

1. Psychological testing: while I think exposure to testing is important, I would caution against placing too much emphasis on getting hands-on experience. The major tests with forensic applications are indeed the province of psychology. What you really need to learn in forensic psychiatry is the utility of the major tests because it speaks to a critical skill set: knowing what you don't know, the limits of what you can say based on available data, and what additional assessment(s) can provide important information to resolving the questions at hand.

2. Exposure/types of cases: I agree that finding civil cases is very important, but this is much easier said than done. Most programs offer very little of this because they are based in criminal forensic and/or correctional facilities that fund the fellowship.

3. Writing: this is another critical skill, but is not easily taught. For fellows who are not naturally good writers, I think this can only be done effectively through a high volume of cases, close supervision of reports, and VERY importantly, group supervision. Group supervision not only exposes you to multiple other writing styles and common errors, but it is very effective in developing opinion formulation and stylistic aspects of how certain types of dense information can be succinctly summarized and described. Also, building on #2, group supervision greatly increases your exposure to case material.

4. Teaching: this requires very dedicated supervisors with set-aside teaching time in individual and group settings. Didactics and law school experiences are highly variable between programs, to my knowledge. There is an enormous amount of information to cover in forensics, so didactics must be well-done in order to provide a reasonable introduction to major topics, case law and legal issues. I would inquire how well the program's didactics cover the material in the forensic review course. The 1000-page syllabus should essentially all be covered, in my opinion. With respect to law school, will you be surveying a course that has very little to do with the practice of forensic psychiatry, or will you have access to courses that are densely focused on mental health law?

5. Testimony: I consider heavy experience with this in fellowship to be pretty overblown. If you're getting a ton of exposure to straightforward commitment hearings or even competency hearings, I view that activity as having diminishing returns from learning value standpoint. The best experiences come from adversarial questioning in contested cases - and no matter where you do your fellowship, the odds are pretty low that you will get many such opportunities during the course of a year (this is more likely to come through watching very established supervisors in trials and depositions). So, in my opinion what you need to learn in fellowship is the art of opinion formulation, practice of effective direct testimony preparation and delivery, and practice of response to common cross-examination techniques as well as consideration and analysis of contesting opinions. Most of this can be accomplished through rigorous mock trials (ideally with dueling expert opinions) and focus on opinion formulation (e.g. learning how to craft opinions that account for fact vs inference vs speculation and address counterpoints and potential disagreements).

6. Furthering your career: I also disagree with choosing a program based on geography in order to help establish your work afterwards. If you really develop a good foundation for performing forensic evaluations after fellowship, you can travel anywhere with those skills and will be able to build work no matter where you land. Fellows who go to the most competitive programs come from all over the country and most do not stay around the program area; networking from the people in your program can help you get started in a new locale. It is true that many areas have a small group of people doing much of the forensic work, but it's also true that often that those individuals are experienced clinicians but not particularly knowledgeable forensic practitioners. This can be overcome with work and time, as referral sources will see and appreciate the difference in quality you can offer (if you can).

7. The notion of "Protected report writing time" and general lifestyle issues: One year is an incredibly brief amount of time to build a solid foundation in forensics. In order to be doing enough cases, getting enough teaching, doing enough reading for didactics and framework/methodology of performing assessments, and having the kind of experiences I've mentioned to build that solid foundation, you WILL be writing reports at night and on the weekends. I'd say plan for 60-70 hour weeks, with occasional heavier weeks, if you want to do forensics fellowship seriously.

 

[whopper]

Nothing really being added to the thread for people looking into fellowship but I am now at SLU and my opinion remains unchanged with U of Cincinnati. I highly miss them. I did another lecture at an international conference with Scott Bresler, someone I consider a mentor, and I got to work with him very closely after I became an assistant professor at U of Cincinnati.

It was not my desire to leave Cincinnati. My wife got a professor's position in St. Louis and couldn't find anything near as good in Cincinnati so it was either let her career suffer and stay in Cincinnati, or go to St. Louis where she could flourish but so could I. I left a lot of people I miss and I get a lot of mails from them telling me they'd like me back.

Just to mention some of the things that happened there in the last few years: a recent grad became a TED-Talker, and wrote a forensic psychiatric book, another developed a scale (with assistance from Dr. Mossman) to be used in child psychiatry, being a graduate gives you a heads-up in a lucrative court position in the area, one of the faculty had to evaluate a high profile case that had high exposure on the national news (even international)-front page material I'm talking here, while I was still there I also worked on a high profile case-clinically, with someone that was on the national news.

One of the reasons why I didn't put my foot down against my wife and tell her to stay in Cincinnati for my career is that SLU has one of the greatest forensic psychiatrists in the country there-Alan Felthous and I work with him closely. Another thing is I also work closely with Henry Nasrallah, not a forensic psychiatrist but one of the most respected schizophrenia researchers in the country and George Grossberg, an internationally renown geriatric psychiatrist that was instrumental in the development of memantine.

SLU doesn't currently have a forensic fellowship but we're working on getting one started and have a forensic psychiatrist from UC-Davis, William Neuman that will be joining us. Dr. Neuman IMHO is a better forensic psychiatrist than myself (at least as far as I can tell so far), and is a potential up-and-coming force in the field.

Still miss Cincinnati and I stand by my comments that it is a great fellowship program. The only complaint I had was that I didn't like the weather so much in the area but there were a lot of things there that made up for it including the extremely nice people, the city having a closer sense of unity vs other cities I've seen, and that the psychiatric infrastructure was one of the best I've seen in the country on so many levels-PES, inpatient, private psych facilities, a great forensic facility, an excellent community psych center (Greater Cincinnati Behavioral Health).
-

 

[splik]

1. Psychological testing: while I think exposure to testing is important, I would caution against placing too much emphasis on getting hands-on experience. The major tests with forensic applications are indeed the province of psychology. What you really need to learn in forensic psychiatry is the utility of the major tests because it speaks to a critical skill set: knowing what you don't know, the limits of what you can say based on available data, and what additional assessment(s) can provide important information to resolving the questions at hand.
how to craft opinions that account for fact vs inference vs speculation and address counterpoints and potential disagreements).

what about things like HCR-20, VRAG, M-FAST, Static-99, MacCAT? clearly there are fellowships that are providing training in actually administering these instruments and there are forensic psychiatrists using them. seems depending on geography, where you train etc, people have different opinions on the importance of getting training in these things?

 

[splik]

i wish i had resurrected this thread before - good to hear people chime in, but too late for me now!

 

[notdeadyet]

what about things like HCR-20, VRAG, M-FAST, Static-99, MacCAT? clearly there are fellowships that are providing training in actually administering these instruments and there are forensic psychiatrists using them. seems depending on geography, where you train etc, people have different opinions on the importance of getting training in these things?

People who train at places where they are emphasized find them critical and people who train at places where they are not do not. Not a big shock.

Looking at the better programs, there is a healthy variance in the importance they place on psychological testing. Most of the good ones that don't emphasize it seem to have it as an option for folks to do more of it if they are hung ho and want to devote the time. The ones that can be administered by non PHDs are not rocket science.

 

[EatSleepForensics]

To the above comments, I don't consider forensic instruments like SPJ materials (HCR-20, WAVR-21) psychological tests; I have been trained on them, use them and find them helpful. The utility of things like the MacCAT (or instruments for criminal responsibility assessment) in my opinion is fairly limited provided you've been trained in assessment of competency to stand trial in a way that ensures you consistently account for the major domains of court-related information and the aspects of decision-making, etc. important to commenting on the ability to rationally approach defense strategy. We have frequent discussions at work (in a place with dozens of very experienced forensic psychologists) about the fact that gray-area competency cases almost always hinge on nuances of the impact of psychosis on decision-making, the scope of information that a cognitively-challenged defendant really needs to know and understand in order to resolve their legal case, etc. Competency instruments rarely provide much additional guidance in reaching an opinion on difficult cases. As for learning to use actuarial tools like the VRAG, I think it just depends on whether you are interested in doing work like pre-sentencing assessments, etc. where the decision-makers would actually want the type of info it provides. Most scenarios where forensic psychiatrists provide risk assessments are more interested in an SPJ approach with practical management guidance.

So to summarize my long-winded comments, if one were choosing between two fellowships where a significant difference were exposure to "testing," I'd look closely at the types of instruments and tests that fellows actually get trained in, the realistic depth of the training you'll get and ponder your interest level. If all else is equal between the programs, great, but if the program that doesn't emphasize instruments focuses more on report writing, for example, I'd go with the latter.

 

[Therapist4Chnge]

Excellent thread.

From the psychologist perspective (and someone who frequently is involved in medico-legal assessment and consultation), I'd rank mentorship #1, exposure and training in psych testing #2, and report writing #3. Didactics and other training opportunities are important, but that can be supplemented as neeed…solid mentorship is much harder to secure. I believe one of the most important aspects of good mentorship is learning the difference between clinical evaluation and forensic evaluation. The tools are often the same, but the perspective, application, and analysis of the data are far far different. Testifying and looking the part isn't high on the list because that can be taught later. However, knowing what you don't know (and the limitations) will get you much farther than exposure to the day-to-day experience in a courtroom. As for being competitive afterwards…if you are fellowship trained, you will never hurt for work unless you do some egregious.

 

[whopper]

Psychological tests aren't an end-all-be-all, but to go to court and not know anything about them IMHO puts one at a disadvantage. Aside from that these tests give one a foundation to base a Daubert standard (they have numbers attached-allowing one to state an error rate, and the various Daubert challenges such as if it's replicatable, etc), if you understand the tests, it helps you to understand the methodology of objective considerations.

There have been times I've disagreed with the tests but to have graduated and know their purpose, limitations, usefulness, and be able to mentally spar against someone that does know how to do the tests as well is invaluable.

I know of some programs that still don't use them that are headed by highly respected forensic psychiatrists with a name in the field. My personal opinion is the future will go to those that know the testing better.

http://www.aapl.org/docs/newsletter/65887 April 12.pdf

At a minimum, a well-rounded forensic psychiatrist should have the ability to administer such tests as the M-FAST, SIMS, SIRS, TOMM, PCLR, HCR-20, VRAG, ILK, SVR-20, SORAG, and Static-99/Static 2002 among many others. If you don’t immediately recognize all of these tests and feel competent in administering them, then take that message as a wake up call. If forensic assessments are “your business” then you must become skilled in the basic structured assessments to complement your forensic interview. If you choose not to, proceed professionally at your own peril.

From Charles Scott, former AAPL president.

One could still go to an area and not use testing and get away with it, but it wouldn't be for a good reason. The reason would be that there's a shortage of forensic psychiatrists so one in an area could get away without the tests because there's no competition to show the courts that the only guy they got is missing something someone else could offer.

While in Cincinnati, I've noticed that the judges and lawyers knew more and it was because there were more forensic psychologists and psychiatrists. In fact there's a community of them. The head lawyer for the mental health board regularly consults with lawyers and also understands quite a bit about the field. If the judges there don't understand something they have easy access to people that can teach them.

In other areas, I've noticed the judges don't know much if at all, and they tend to rely completely on the one person they can get their hands on that has the power to greatly mislead them. In a neighboring town, the psychologist that town always utilized told the courts that it's perfectly appropriate to do an insanity and competency evaluation all at the same time even if the person is not competent to stand trial (so then how can that person agree to an insanity plea that would then later on require the insanity evaluation-they are supposed to be done separately and the the Supreme Court even stated that if you do an evaluation your report/conclusion could only be for that evaluation, not for other types of evals).

So I testify in that town's court one day and told them I cannot do an insanity and competency evaluation at the same time. Yeah well I put that court in for a loop. A lot of awkward gazing at each other while I'm showing them in-print that this type of thing isn't supposed to be done.

That psychologist in that town developed a local rep among the other forensic psychologists and psychiatrists as being a carpetbagger, but hey, she got away with it, was still getting away with it when I left and was making good money doing so.