Johnny Depp/Amber Heard trial, anyone?

[futureapppsy2]

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Anyone else following this?



I’m super impressed by the forensic psychologist testifying for this—she really explains this stuff well.

I am kind of surprised by her comment (not sure if it’s in that clip or another one) that treating clinicians don’t critically access whether or not what their clients claim is accurate or not—we don’t do that as much as pure assessors, but I do think there’s definitely a place for critical appraisal of what the client says in therapy—investigating why the client thinks they have PTSD, ASD, depression, etc.

 

[WisNeuro]

Anyone else following this?



I’m super impressed by the forensic psychologist testifying for this—she really explains this stuff well.

I am kind of surprised by her comment (not sure if it’s in that clip or another one) that treating clinicians don’t critically access whether or not what their clients claim is accurate or not—we don’t do that as much as pure assessors, but I do think there’s definitely a place for critical appraisal of what the client says in therapy—investigating why the client thinks they have PTSD, ASD, depression, etc.

As someone who routinely reads treating clinicians documentation in legal cases, I wholeheartedly agree with her comment. She is absolutely correct when it comes to critically assessing something in terms of the degree of certainty that matters in legal contexts.

 

[futureapppsy2]

As someone who routinely reads treating clinicians documentation in legal cases, I wholeheartedly agree with her comment. She is absolutely correct when it comes to critically assessing something in terms of the degree of certainty that matters in legal contexts.

I agree with overall idea and think the comment made sense in a trial context, but I do think good treating clinicians will do more than just de facto take a client’s word for everything.

 

[BuckeyeLove]

Hahahahah, a 12 hour interview?!? Would love to see that invoice.

 

[Sanman]

I agree with overall idea and think the comment made sense in a trial context, but I do think good treating clinicians will do more than just de facto take a client’s word for everything.

Well yes and no. While I do not take a client's word for everything and often receive collateral info from caregivers and relatives in my job, this is not always documented or diagnosed due to the confines of my job. When I would be breaking confidentiality or do not have permission to discuss a client's behavior with a relative or staff. I might use this info in team consultation to address burnout and patient management (Based on the info I have, patient X likely has a cluster B personality...strong boundaries on returning calls outside work hours please). However, I do not routinely place an axis II dx in the chart as I am not treating it and no one wants to waste time doing the testing to dx it.

 

[WisNeuro]

I agree with overall idea and think the comment made sense in a trial context, but I do think good treating clinicians will do more than just de facto take a client’s word for everything.

It's comforting to think that they would do more than that. But, in practice, not so much. It's rare that I see any attempt by community providers to control for possible invalid reporting, even when it is well known that the person is in litigation.

Hahahahah, a 12 hour interview?!? Would love to see that invoice.

12 hours for the evaluation, or just for the interview?

 

[R. Matey]

I agree with overall idea and think the comment made sense in a trial context, but I do think good treating clinicians will do more than just de facto take a client’s word for everything.

If I did, then half of my patients on postdoc had DID.

 

[BuckeyeLove]

It's comforting to think that they would do more than that. But, in practice, not so much. It's rare that I see any attempt by community providers to control for possible invalid reporting, even when it is well known that the person is in litigation.



12 hours for the evaluation, or just for the interview?

I heard 12 hours of F2F for the interview. Over 2 dates.

 

[futureapppsy2]

I heard 12 hours of F2F for the interview. Over 2 dates.

I think it was 17 hours total, including 12 of F2F interview, IIRC.

 

[AcronymAllergy]

That's...a long interview. Wow. I agree that her testimony was impressive, at least the parts of it I saw.

I also agree that unfortunately (but anecdotally), evaluating the veracity of a person's symptom report isn't often approached systematically if at all in a clinical context, based both on reports I review now in forensic contexts as well as notes I read at VA from other providers. Don't get me wrong, I did see notes that addressed this at VA, some of which pulled absolutely no punches. But these were in the minority and typically in the more extreme cases. Which makes sense, because in a clinical context, it's not always really the clinician's job to determine with a reasonable degree of certainty that the patient is a reliable reporter. It's also not always in the patient's best interests to opine about such in chart notes, even if you do have concerns or have assessed these things. In a clinical context, we're the patient's advocate, and we're working from a place where at least initially, we're inclined to believe what they tell us (or at least part of it).

 

[cara susanna]

Oh man, yes. I have THOUGHTS.
- I don't like how she diagnosed BPD with only an MMPI-2, and one with an elevated validity profile.
- I also think it's weird to diagnose histrionic in this day and age, and especially comorbid with BPD--BPD would account for histrionic sx, imo.
- Her relationship with the defense team is unethical at worst, bad optics at best
- I like that she used the CAPS-5
- I also like that she said trauma doesn't cause BPD

 

[futureapppsy2]

Oh man, yes. I have THOUGHTS.
- I don't like how she diagnosed BPD with only an MMPI-2, and one with an elevated validity profile.
- I also think it's weird to diagnose histrionic in this day and age, and especially comorbid with BPD--BPD would account for histrionic sx, imo.
- Her relationship with the defense team is unethical at worst, bad optics at best
- I like that she used the CAPS-5
- I also like that she said trauma doesn't cause BPD

Agree on the trauma and relationship with the defense thing. With regards to the diagnosis, to be fair, she did use the MMPI-2, a really thorough clinical interview, and a lot of collateral from a number of sources.

 

[cara susanna]

Agree on the trauma and relationship with the defense thing. With regards to the diagnosis, to be fair, she did use the MMPI-2, a really thorough clinical interview, and a lot of collateral from a number of sources.

I just don't think the MMPI-2 is useful for BPD, especially when you could use the PAI instead. Also, the interview was unstructured, right? I would have gone with a SCID-PD.

 

[Sanman]

Oh man, yes. I have THOUGHTS.
- I don't like how she diagnosed BPD with only an MMPI-2, and one with an elevated validity profile.
- I also think it's weird to diagnose histrionic in this day and age, and especially comorbid with BPD--BPD would account for histrionic sx, imo.
- Her relationship with the defense team is unethical at worst, bad optics at best
- I like that she used the CAPS-5
- I also like that she said trauma doesn't cause BPD

This was my initial thought as well. Why two cluster B personality disorders, speaking of accurate dx?

 

[futureapppsy2]

I just don't think the MMPI-2 is useful for BPD, especially when you could use the PAI instead. Also, the interview was unstructured, right? I would have gone with a SCID-PD.

My guess would be that she went with the MMPI-2 because it, IIRC, has more/more well-examined validity scales than the PAI, and given the forensic context and nature of the case—lying/defamation—she wanted as much validity data as possible. I definitely agree that a structured interview like the SCID PD would have been helpful and that the PAI is better for BPD diagnosis overall.

 

[R. Matey]

I think it's totally possible to dx histrionic and borderline overall. They share variance, but have fairly distinct characteristics. In the differential section under BPD, it is specified that more than one personality disorder can be dx'd.

 

[deleted1100659]

I think it's totally possible to dx histrionic and borderline overall. They share variance, but have fairly distinct characteristics. In the differential section under BPD, it is specified that more than one personality disorder can be dx'd.

I agree and don't think its unheard (no pun intended) of to have both. I am not an expert in diagnosing personality disorders when it comes to formal testing though, as this isnt commonly done from the psychiatrist end.

Surprised at the evidence presented during the trial, I thought it would be mainly he said/she said but there seems to be all kind of testimonys, recordings, etc.

 

[Sanman]

I think it's totally possible to dx histrionic and borderline overall. They share variance, but have fairly distinct characteristics. In the differential section under BPD, it is specified that more than one personality disorder can be dx'd.

While this is true, the objective symptom profiles overlap and the differentiating factors are largely about internal motivation for the same external behaviors (fear of abandonment vs being the center of attention). So what leads to a dual dx rather than a dx of cluster B personality disorder(borderline vs histrionic) while ruling out of PTSD. I am not an expert in this area at all, but I would love to hear opposing arguments.

 

[BuckeyeLove]

I feel like testing was superfluous in this case (is in most cases) and likely could have confused the Court. Likely a plethora of records and collateral interviews along with the outlandish 12 hr interview would be perfectly sufficient in order to diagnose a characterological disorder.

 

[R. Matey]

While this is true, the objective symptom profiles overlap and the differentiating factors are laregely about internal motivation for the same external behaviors (fear of abandonment vs being the center of attention). So what leads to a dual dx rather than a DX of cluster B personality disorder(borderline vs histrionic) while ruling out of PTSD. I am not an expert in this area at all, but I would love to hear opposing arguments.

Neither am I, but I would think PTSD would be ruled out by the absence of its clinical criteria. As far as the overlap is concerned, it's not just the internal motivations, but also the externalizing behaviors (e.g., NSSI is diagnostic in BPD, not in HPD). If you look at the RF profiles, there are also key differences in sub-scale elevation between the two. I'm assuming she meant the RF when she said MMPI-2.

Edit: Agree that PAI would've been better. But, why not a Rorschach (I kid, don't hurt me).

 

[cara susanna]

Neither am I, but I would think PTSD would be ruled out by the absence of its clinical criteria. As far as the overlap is concerned, it's not just the internal motivations, but also the externalizing behaviors (e.g., NSSI is diagnostic in BPD, not in HPD). If you look at the RF profiles, there are also key differences in sub-scale elevation between the two. I'm assuming she meant the RF when she said MMPI-2.

Edit: Agree that PAI would've been better. But, why not a Rorschach (I kid, don't hurt me).

I think my issue is that histrionic PD is just such a sketchy diagnosis in general. Also, I could think of how each symptom in the DSM-5 would be attributable to BPD.

 

[R. Matey]

I think my issue is that histrionic PD is just such a sketchy diagnosis in general. Also, I could think of how each symptom in the DSM-5 would be attributable to BPD.

I think the key differences are the self-destructive behaviors, interpersonal aggression, and identity disturbance. Though I do agree that's it's likely a Freudian hold-out and they probably overlap far more than they differ.

Edit: I just referenced my DSM-II (bought at a library sale years ago) and histrionic personality disorder was originally hysterical personality disorder. Borderline doesn't show up until the DSM-III and the differentiation criteria in that version says they often co-occur.

 

[Peacemaker36]

I think the key differences are the self-destructive behaviors, interpersonal aggression, and identity disturbance. Though I do agree that's it's likely a Freudian hold-out and they probably overlap far more than they differ.

Edit: I just referenced my DSM-II (bought at a library sale years ago) and histrionic personality disorder was originally hysterical personality disorder. Borderline doesn't show up until the DSM-III and the differentiation criteria in that version says they often co-occur.

Hysterical was changed to histrionic because hysterical was deemed to be misogynistic.

 

[R. Matey]

Hysterical was changed to histrionic because hysterical was deemed to be misogynistic.

It's listed as both in DSM-II

 

[Cantab109]

I'm curious everyone's thoughts on her response to the question about BPD being overrepresented in women...

 

[MAClinician]

I read in an article (can’t remember which though) that she is not board certified (maybe in forensics? Or both?)

I was much more intrigued by the idiot defense lawyer’s obsession with the muffins.

 

[futureapppsy2]

I read in an article (can’t remember which though) that she is not board certified (maybe in forensics? Or both?)

I was much more intrigued by the idiot defense lawyer’s obsession with the muffins.

Here's her page: Dr. Shannon J. Curry, PsyD, MSCP - Curry Psychology Group

Doesn't like she's boarded.

@BuckeyeLove , I agree, but I think objective testing can add a lot of credibility in the eyes of the jury, in addition to structured interviews. Otherwise, diagnoses can come off as "well, that's just your opinion, man", especially to laypeople.

 

[cara susanna]

Another psychologist testified refuting Dr. Curry. I like that she gave the TSI and PAI. Also she imo raises good points about Dr. Curry's MMPI interp and CAPS5 coding. Wish she'd mentioned the PAI-BOR score!

 

[allantois]

The other psychologist seems like a radical feminist to me

 

[futureapppsy2]

Another psychologist testified refuting Dr. Curry. I like that she gave the TSI and PAI. Also she imo raises good points about Dr. Curry's MMPI interp and CAPS5 coding. Wish she'd mentioned the PAI-BOR score!

Not super wild about her using the CTS filled out by one partner only for the behaviors of both partners, especially when there’s an extreme potential for secondary gain from both partners and other evidence suggests possible mutual abuse.

 

[cara susanna]

Not super wild about her using the CTS filled out by one partner only for the behaviors of both partners, especially when there’s an extreme potential for secondary gain from both partners and other evidence suggests possible mutual abuse.

Yeah, I didn't like that or her language around it (an instrument can't prove that abuse happened).

 

[PsyDr]

I feel like testing was superfluous in this case (is in most cases) and likely could have confused the Court. Likely a plethora of records and collateral interviews along with the outlandish 12 hr interview would be perfectly sufficient in order to diagnose a characterological disorder.

Taking a dump on your marital bed is pretty strong evidence that something is wrong.

 

[CheetahGirl]

Ha- I've been dying to start this thread.

We have to remember about the personality disorder diagnoses...the plaintiff's forensic psychologist would have been more accurate to identify these as Borderline traits or Histrionic traits, rather than the personality disorders themselves. The defendant was highly functioning, and, at most times, consistently during the <2-year marriage, so it may be difficult to prove it was a personality disorder per se, rather than solid patterns of behaviors consistent with personality cluster traits.

Although, shi*ting the adult marital bed is pretty disordered behavior, in most subjective perspectives (unless one was into that sort of kink).

 

[R. Matey]

Another psychologist testified refuting Dr. Curry. I like that she gave the TSI and PAI. Also she imo raises good points about Dr. Curry's MMPI interp and CAPS5 coding. Wish she'd mentioned the PAI-BOR score!

I didn't realize that none of the clinical scales were elevated on the MMPI. Game changer...

 

[allantois]

I wonder if these types of testimonies are pretty typical in forensic line of work?

 

[BuckeyeLove]

never. gets. old.

 

[Sanman]

I didn't realize that none of the clinical scales were elevated on the MMPI. Game changer...

Not sure how much of a game changer any of that is in a trial. Frankly Dr. Curry came off as much more articulate and poised than the rebuttal psychologist or Heard's attorneys. When it comes to who lay people will believe, I know where I am putting my money.

 

[Sanman]

Taking a dump on your marital bed is pretty strong evidence that something is wrong.

 

[futureapppsy2]

I didn't realize that none of the clinical scales were elevated on the MMPI. Game changer...

ETA: she said that the defensive responding scale was elevated, so I don't know how much weight you can give the clinical scales in that context...?

 

[R. Matey]

I didn't hear her say that--I heard her say that none of the malingering skills were elevated...?

11:00-11:15

 

[futureapppsy2]

11:00-11:15

Thanks. Re-watched, and it looks like the defensive responding scale was elevated, so I don't know how much weight you can give the lack of elevated clinical scales in that context...?

 

[PsyDr]

Hysterical was changed to histrionic because hysterical was deemed to be misogynistic.

Nope. The original DSM had "emotionally unstable personality". DSM-II crosswalk for this disorder is "hysterical personality (histrionic personality disorder)". Note where the term disorder lies. However, DSM-II maintained a LOT of diagnoses for hysterical reactions while differentiating many OBGYN medical disorders and neoplasms. DSM-III continued Histrionic Personality Disorder.

 

[cara susanna]

Thanks. Re-watched, and it looks like the defensive responding scale was elevated, so I don't know how much weight you can give the lack of elevated clinical scales in that context...?

But doesnt MMPI-2 correct for the K scale anyway?

 

[R. Matey]

Thanks. Re-watched, and it looks like the defensive responding scale was elevated, so I don't know how much weight you can give the lack of elevated clinical scales in that context...?

Yeah, that was a key issue for me too. If it were me, I would be more inclined to take other data into account than make a stark interpretation of the profile, which is what sounds like happened.

 

[R. Matey]

But doesnt MMPI-2 correct for the K scale anyway?

The RF doesn't and as far as I'm aware research on the k correction shows that it does little to change the profile interpretation.

 

[PsychJustice]

The RF doesn't and as far as I'm aware research on the k correction shows that it does little to change the profile interpretation.

She relied a lot on code types in her testimony and report which makes me think she didn't use the RF.

 

[AcronymAllergy]

Not sure how much of a game changer any of that is in a trial. Frankly Dr. Curry came off as much more articulate and poised than the rebuttal psychologist or Heard's attorneys. When it comes to who lay people will believe, I know where I am putting my money.

And reading the comments on the YouTube video (yes, I did the unthinkable) won't change your mind on that.

 

[R. Matey]

She relied a lot on code types in her testimony and report which makes me think she didn't use the RF.

Ah, ok. Yeah, probably not then.

 

[cara susanna]

And reading the comments on the YouTube video (yes, I did the unthinkable) won't change your mind on that.

Did you see the one that said they should have had psychiatrists testify because they know more than psychologists about psych diagnosis?

 

[AcronymAllergy]

Did you see the one that said they should have had psychiatrists testify because they know more than psychologists about psych diagnosis?

No, but I'm not surprised, given some of the other thoughts expressed in the comments, including those purportedly by "psychologists."