April 28, 2013

Forensic practice: A no-compassion zone?

Murder trial prompts professional dialogue

Do empathy or compassion have a place in a forensic evaluation? Or should an evaluator turn off all feelings in order to remain neutral and unbiased?

That question is at the center of a controversy in the murder trial of Jodi Arias that I blogged about last week, with the prosecutor accusing a defense-retained psychologist of unethical conduct for giving a self-help book to the defendant.

Under heavy-artillery fire, Richard Samuels* denied prosecutor Juan Martinez's accusation of "having feelings for" the defendant, who killed her ex-boyfriend and is claiming self defense. Samuels testified he gave Arias a book because he is a "compassionate person" and thought the book would help her, but that his objectivity was never compromised. The exchange prompted a juror to ask Samuels:  "Do you believe absolutely that it is possible to remain purely unbiased in an evaluation once compassion creeps in?"

Martinez called a rebuttal witness to testify that gift-giving is a boundary violation and unethical. Newly minted psychologist Janeen DeMarte, testifying in court for only the third time, testified that a forensic evaluator should never feel compassion for a defendant, as such feelings compromise integrity (a position she modified under cross-examination).

Given these starkly divergent positions, I was curious what other forensic psychologists think. So, I initiated a conversation with a group of seasoned professionals, publishing two brief video excerpts of the relevant testimony on YouTube (click on the images below to watch the excerpts) to guide the conversation.

View the Richard Samuels excerpt (18 minutes) by clicking on the above image.

View the Janeen DeMarte excerpt (10 minutes) by clicking on the image.

Gift-giving: A bad idea

Contrary to the prosecutor’s insistence, our Code of Ethics does not prohibit gift-giving. Nor do the Forensic Psychology Specialty Guidelines (which are aspirational rather than binding). It's an ethical gray area.** As with much involving ethics, it all depends. But still, the consensus was that giving a book to a defendant is a mistake. Whether or not it affects one's objectivity, it gives the appearance of potential bias. And in forensic psychology, maintaining credibility is essential. "Gift giving," as one colleague put it, "gives the appearance of either a personal or therapeutic relationship with the defendant."

Samuels's error lay in failing to think through his action, and recognize how his blurring of boundaries could damage his credibility and thus undermine his testimony. Ultimately, by discrediting his own work, he potentially caused harm to the very client whom he was attempting to help.

The nature of the book itself further undermined the expert's credibility in this case. As another colleague pointed out, what good is a self-help book, Your Erroneous Zones: Step-by-Step Advice for Escaping the Trap of Negative Thinking and Taking Control of Your Life, going to do a woman who is in jail and facing the death penalty for stabbing and shooting someone to death?

On the other hand, although gift-giving is a slippery slope, there are times when only a curmudgeon would not give. For example, if you are conducting a lengthy evaluation and you decide to buy yourself a drink or a snack from the vending machines, do you refuse the subject a soda, for fear it would undermine objectivity or lend an appearance of bias? How rude!

Empathy: It's only human 

The general consensus was that, without some measure of empathy, one cannot hope to understand the subject or the situation. One is left with "an equally problematic perspective that dehumanizes and decontextualizes the evaluation,' in the words of another psychologist.

"There is an orientation toward forensic work that is strikingly cold," noted yet another colleague. "I have seen some highly experienced forensic examiners who use their 'objectivity' with icy precision and thereby fail to establish the kind of rapport necessary to obtain a complete account of the offense or other important information…. The absence of empathy can be just as biasing as too much of it."

Or, as Jerome Miller wrote, in one of my favorite quotes from the forensic trenches, "It takes unusual arrogance to dismiss a fellow human being’s lost journey as irrelevant."

In other words, without empathy, any claim to objectivity is illusory, because there is no true understanding. And that, too, is dangerous. DeMarte's extreme position thus errs in the opposite direction from Samuels', in advocating for forensic psychologists to be automaton-like technocrats.

Indeed, the main danger of empathy as discussed by leaders in our field, such as Gary Melton and colleagues in Psychological Evaluations for the Courts, is not that it biases the evaluator, but that it potentially seduces vulnerable subjects into revealing too much, thus unwittingly increasing their legal jeopardy. For this reason, Daniel Shuman, in a minority position in the field, argues that using clinical techniques to enhance empathy is unethical because this can -- wittingly or unwittingly -- cause harm to evaluatees. 

After all, our training as therapists makes us good at projecting understanding, and at least the illusion of compassion. Our subjects often let down their guard and experience the encounter as therapeutic, even when we clearly inform them that we are not there to help them in any way, and even when we remain vigilant to control our expressions of empathy.

"The best forensic evaluations bring all the clinical skills learned to promote self-disclosure and emotional emitting (empathy, reflective comments, attention to feelings, suspension of moral judgment, etc.)," a colleague commented. "We know how to get people to talk about things that they might otherwise wish to hide from others and themselves. Most defendants feel understood or at least feel they have been heard at the conclusion of an assessment."

Behaviors, not emotions, can be unethical

A third general consensus emerging from our professional dialogue was that feelings themselves are "almost never unethical." Which is fortunate, as we can never know for certain what another person is thinking or feeling. Rather, it is the behavior that follows that can be problematic; we must remain alert to what feelings a subject is evoking in us, lest they lead us astray. Sticking close to the data, and being transparent in our formulations, can keep us from behaving incompetently or problematically in response to our feelings, whether of empathy and compassion or -- at least as problematic -- dislike or revulsion. 

Bottom line: Do not check your empathy at the jailhouse door. You need it in order to do your job. And also to remain human.

Thanks to all of the many eloquent and insightful colleagues who contributed to this conversation.


*Samuels has taken down his website (svpexpertwitness.com), so I am providing a link to an old cached version.  

**Psychology ethicist Ofer Zur has written more on gift-giving in psychotherapy, with links to the gift-giving provisions of various professional ethics codes.

April 25, 2013

Diagnostic controversies: Registration open for my Hawaii workshop

A shameless plug for my upcoming training workshop in Honolulu, sponsored by the American Psychological Association. CE's in paradise; what's not to like? To register (or get more information), click HERE.

April 17, 2013

'Digital lynch mob' assaults expert witness in televised murder trial

Imagine you are testifying in a high-profile murder case being live-streamed over the Internet. Suddenly, an angry mob swarms all over you. More than 10,000 people sign an online petition urging a boycott of your lecture contracts. Your book gets a thousand negative hits on Amazon. You are stalked, and a photo of you dining with the trial attorney is posted on Facebook, implying unethical conduct. You even get death threats.

That is the social media-coordinated avalanche that hit domestic violence expert Alyce LaViolette, testifying for the defense in the capital murder trial of Jodi Arias. The unrelenting cyber assaults so rattled LaViolette that she suffered an anxiety attack that landed her in the emergency room.

But the ER visit may only encourage the cyber-stalkers, who revel online over her discomfiture and obvious emotional deterioration over the course of seven grueling days of court testimony.

This type of Internet mobbing, in which cyber-posses enforce social norms through public shaming, is becoming more and more commonplace. One of the most widely known examples of such Internet vigilanteism was the 2005 case of "Dog Poop Girl," a South Korean woman who gained infamy after she refused to clean up after her dog on a Seoul subway; the harassment eventually escalated to the point that she was forced to quit her university job. 

But what was LaViolette's crime?

The domestic violence counselor had the audacity to opine that Jodi Arias was a victim of domestic violence -- that she was dominated and abused (physically, emotionally and sexually) by the man she eventually killed. Such an opinion bolsters Arias's claim that she killed her ex-boyfriend in self defense.

Murder tragedies as entertainment

Unfortunately for LaViolette, her analysis runs counter to the dominant narrative in a gendered morality play produced by media conglomerate Turner Broadcasting and distributed through its cable channels HLN, CNN and In Session. In this good-versus-evil melodrama, Arias is a psychopathic female who killed a morally righteous man in a fit of jealous rage. Period. End of story. Airbrushed out are all the nuances, the shades of grey inevitably present in any such violent tragedy. 

The burgeoning infotainment industry has perfected a profit-making formula of sensationalized true-crime "reporting" that plays on viewers' emotions, whipping audiences into a frenzy of self-righteous indignation in which they clamor for guilty verdicts -- very often against female transgressors. Nancy Grace's shrill ranting over the Casey Anthony murder acquittal garnered HLN a record of almost three million viewers. More recently, HLN went after another woman, Elizabeth Johnson, suspected in the mysterious disappearance of her baby. 

The Arias case seems Heaven-sent for this voyeuristic style of entertainment, in which vulturous pundits mete out tantalizing morsels of crime "facts" to their addicted audience. Travis Alexander provides titillation from the grave via thousands of graphic emails, instant messages, texts and phone chats in which he degrades his paramour as a "whore," "slut," "corrupted carcass" and "three-hole wonder" whom he can sexually violate at will. For her part, Arias is a demonstrable liar. When her ex-boyfriend was found with a gunshot wound to the head, a slit throat, and more than two dozen stab wounds, she initially claimed innocence. After police demolished her alibi defense, she then claimed that two intruders broke into the home and killed Alexander, before finally admitting to the killing but claiming self defense.

Cast in the starring role of swashbuckling hero in this sordid drama is prosecutor Juan Martinez, a dapper man with a quick mind and an acerbic style, whose meteoric rise from the son of Mexican immigrants to a top government attorney is the stuff of American legend. Women line up outside the Maricopa County, Arizona courthouse, swooning at the sight of him as they jockey for photographs and autographs.

"This is murder trial as entertainment," Josh Mankiewicz, a correspondent for NBC's Dateline program (which ran two segments on the case), told reporter Michael Kiefer of the Arizona Republic. "This is not a trial like O.J. (Simpson's) that sheds new light on society. This is not about race or money. It's a perfect tabloid storm. It is occurring in the absence of any other tabloid storm."

Nancy Grace, "Dr. Drew" and the other pundits capitalizing on such trials foster a false sense of intimacy by calling everyone by first names. They encourage vicarious audience participation on Facebook, Twitter, online polls and other social media. But this is no value-neutral production. This is an archetypal trope that requires a guilty verdict; as one insightful media critic noted, acquittals do not produce the desired catharsis.

Public shaming run amok

In such an emotionally charged climate, anyone affiliated with the defense automatically becomes a villain. However, it is interesting to observe the disparate treatment of LaViolette as compared with a male expert witness, psychologist Richard Samuels. The prosecutor aggressively attacked them both. Playing not only to the jurors but to his sizeable out-of-court fan base, Martinez paced back and forth like a tiger smelling blood, demanding of his cornered prey that they give only "yes or no" answers to his myriad questions. Under his withering cross-examination, both witnesses came across as defensive and evasive. Both were vulnerable due to their confirmatory biases -- a failure to seek out evidence that might disconfirm their case theories. But, objectively, Samuels would seem to invite at least as much criticism as LaViolette, due to his bumbling style, his test scoring errors, and his questionable case formulation (he diagnosed posttraumatic stress disorder using a rating scale on which Arias endorsed a fictitious trauma, of witnessing Alexander's murder at the hands of imaginary intruders).

However, the public's palpable fury against LaViolette far outstrips that targeting Samuels. Consistent with the Turner Network's gendered narrative of criminal villainy, the cyber-posse is fueled by a potent combination of misogyny and homophobia: The expert witness in their crosshairs is "emasculating," "a bull dyke," "a man-hater," "fat," "buck-teethed," "a bitch."

The Internet fosters this culture of hate. Its cloak of anonymity is disinhibitory, emboldening people to spew bile with impunity. In The Cult of the Amateur, Andrew Keen warns that the deluge of anonymous online content is altering public debate, manipulating opinion, blurring the boundaries between experts and the uninformed and weakening the vitality of professional media -- newspapers, magazines, music and movies.

The proliferation of bottom-feeders on Twitter and YouTube is one thing. But it is quite another thing when cyber-bullying seeps into the courtroom, intimidating witnesses and threatening the presumption of innocence.

Can inundated jurors remain unbiased?

Legal experts worry that a virtual deluge of unreliable and biased information -- readily available at the click of the mouse or a TV remote -- is undermining jurors' neutrality. In their off hours, curious jurors in the Arias case can tune in not only to the cable TV and social media debacle, but can watch the defendant's entire videotaped police interrogation -- including excised portions -- as well as a police interview with Arias's parents, in which they speak of her mental problems. Pro- and anti-Arias websites have sprung up. And it's not just outsiders who are furiously Tweeting, texting and blogging about the case.  Witnesses are watching the trial from home and texting the prosecutor with suggestions for cross-examination. Jodi Arias herself is tweeting from the jail, through a friend. ("HLN is an acronym for Haters Love Negativity," she tweeted.)

It would be naive to suppose that the Arias jury is immune to the inflammatory rhetoric swirling around the Internet. Some of the more sarcastic questions that jurors submitted for the expert witnesses sounded scripted by Nancy Grace. For example, one juror asked psychologist Samuels whether a bad haircut could induce posttraumatic stress disorder (PTSD), Samuels's diagnosis for Arias.

Yet trial judge Sherry Stevens -- who allowed cameras into the courtroom in the first place -- is now relying on the honor system rather than regaining control by sequestering the jury.  Complained defense attorney Kirk Nurmi: "The court asks the question of the jurors every morning, 'Have you seen anything on the media?' No one raises their hand... It is a fairy tale to assume that this jury is not hearing any of this. It is all over the news."

Kiefer, the Arizona Republic reporter who broke the story of witness LaViolette's cyber-bullying, gave examples of juror social-networking misconduct in other cases: A Michigan juror who posted a Facebook preview of her verdict ("Gonna be fun to tell the defendant they're GUILTY"); a juror in Britain who polled her social-media "friends" as to whether she should find a defendant guilty.

With more and more successful appeals of verdicts due to such Internet or social-media interference, according to a Reuters Legal survey, an appeal of any guilty verdict in the four-month Arias trial is a virtual certainty.

But any appeal will not mend the reputations of the expert witnesses called by the defense. As a retired Maricopa County Superior Court judge told Michael Kiefer, the Arizona Republic reporter, "it's the electronic version of a lynch mob."

Sree Sreenivasan, a journalism professor at Columbia University, told Kiefer he had never seen anything like the attack on LaViolette, but that it likely will become "standard operating procedure in prominent cases" -- witness intimidation taken to its logical extreme in a public culture of shaming and vilification.

If so, experts may think long and hard before about accepting referrals in high-profile cases. That, in turn, could have a chilling effect on defendants' rights to a fair trial.

Michael Kiefer's insightful Arizona Republic reports on the social media debacle are HERE, HERE and HERE. A full collection of the live-streamed trial videos is located HERE.

April 10, 2013

Upcoming trainings: Assessment; personal injury; sexual violence; ethics in diagnosis

If you are planning to be in or around Florida, New Jersey, Hawaii or London over the next few months, here are some recommended forensic trainings on the horizon:

April 19 and onwards: Sexual violence workshops (London) 

Building on the success of the 2011 sexual violence workshops sponsored by the British Psychological Society (at which I spoke), Middlesex University is hosting another round of BPS-sponsored workshops on various aspects of sexual violence. Multiple-perpetrator rape is the topic of the first workshop, coming right up on April 19. (Also check out the new book, the first-ever text on this topic.) Next up are a June 27 workshop on "negotiating ethical sexual relationships," a Sept. 17 workshop on "intersectionality and sexual violence," and a fourth workshop on the investigation and prosecution of rape (date yet to be decided). All the workshops will be held at Middlesex University's Hendon Campus. More details are HERE.

April 20: Assessing Emotional Damages in Personal Injury and Employment Discrimination Cases (New Jersey)

William Foote, president of the American Psychology-Law Society (APA Division 41), will be presenting a five-stage model for assessing psychological damages in personal injury and workplace discrimination cases at the spring conference of the New Jersey Psychological Association. To find out more about this all-day training, click HERE.

May 3-5: New Directions in Forensic and Clinical Assessment (Florida)

Many big names in forensic psychology will descend upon Miami for this training sponsored by Division 42 (Psychologists in Independent Practice) of the American Psychological Association. The three-day conference will feature trainings on risk assessment, malingering, trial consultation, the DSM-5, intellectual disability, and much more. Information and registration can be found HERE

July 31: Controversial Psychiatric Diagnoses in Legal Settings (Hawaii) 

Yours truly is the trainer at this all-day continuing education workshop at the American Psychological Association's annual conference, along Honolulu's idyllic Waikiki Beach. I will focus on the scientific and practical limits of psychiatric diagnoses in forensic cases, and provide ethics guidance on how to present diagnostic testimony in court. Details are HERE; I'd love to see you there!

April 7, 2013

Risk screening worthless with juvenile sex offenders, study finds

Boys labeled as 'sexually violent predators' not more dangerous

Juveniles tagged for preventive detention due to their supposedly higher level of sexual violence risk are no more likely to sexually reoffend than adolescents who are not so branded, a new study has found.

Only about 12 percent of youths who were targeted for civil commitment as sexually violent predators (SVP's) but then freed went on to commit a new sex offense. That compares with about 17 percent of youths screened out as lower risk and tracked over the same five-year follow-up period.

Although the two groups had essentially similar rates of sexual and violent reoffending, overall criminal reoffending was almost twice as high among the youths who were NOT petitioned for civil commitment (66 percent versus 35 percent), further calling into question the judgment of the forensic evaluators.

Because of the youths' overall low rates of sexual recidivism, civil detention has no measurable impact on rates of sexual violence by youthful offenders, asserted study author Michael Caldwell, a psychology professor at the University of Wisconsin and an expert on juvenile sex offending.

The study, just published in the journal Sexual Abuse, is one in a growing corpus pointing to flaws in clinical prediction of risk.

It tracked about 200 juvenile delinquents eligible for civil commitment as Sexually Violent Persons (SVP's). The state where the study was conducted was not specified; at least eight of the 20 U.S. states with SVP laws permit civil detention of juveniles, and all allow commitment of adults based on offenses committed as a juvenile.

As they approached the end of their confinement period, the incarcerated juveniles underwent a two-stage screening process. In the first phase, one of a pool of psychologists at the institution evaluated them to determine whether they had a mental disorder that made them "likely" to commit a future act of sexual violence. Just over one in every four boys was found to meet this criterion, thereby triggering a prosecutorial petition for civil commitment.

After the initial probable cause hearing but before the final civil commitment hearing, an evaluator from a different pool of psychologists conducted a second risk assessment. These  psychologists were also employed by the institution but were independent of the treatment team. Astonishingly, the second set of psychologists disagreed with the first in more than nine out of ten cases, screening out 50 of the remaining 54 youths. (Only four youths were civilly committed, and a judge overturned one of these commitments, so ultimately all but three boys from the initial group of 198 could be tracked in the community to see whether or not they actually reoffended.)

Evaluators typically did not rely on actuarial risk scales to reach their opinions, Caldwell noted, and their methods remained something of a mystery. Youths were more likely to be tagged for civil detention at the first stage if they were white, had multiple male victims, and had engaged in multiple instances of sexual misconduct in custody, Caldwell found.

However, no matter what method they used or which factors they considered, the psychologists likely would have had little success in predicting which youths would reoffend. Even "the most carefully developed and thoroughly studied" methods for predicting juvenile recidivism have shown very limited accuracy, Caldwell pointed out. This is mainly due to a combination of youths' rapid social maturation and their very low base rates of recidivism; it is quite hard to successfully predict a rare event.

Indeed, a recent meta-analysis revealed that none of the six most well-known and best-researched instruments for appraising risk among juvenile sex offenders showed consistently accurate results. Studies that did find significant predictive validity for an instrument were typically conducted by that instrument's authors rather than independent researchers, raising questions about their objectivity.

"Juveniles are still developing their personality, cognitions, and moral judgment, processes that reflect considerable plasticity," noted lead author Inge Hempel, a psychology graduate student in the Netherlands, and her colleagues. "There are still many possible developmental pathways, and no one knows what causes persistent sexual offending."

Caldwell agrees with Hempel and her colleagues that experts' inability to accurately predict which juveniles will commit future sex crimes calls into question the ethics of civil commitment.

"From the perspective of public policy, these results raise questions about whether SVP commitment laws, as written, should apply to juveniles adjudicated for sexual offenses," he wrote. "If SVP laws could be reliably applied to high risk juvenile offenders, the benefit of preventing a lifetime of potential victims makes for a compelling case. However, the task of identifying the small subgroup of juveniles adjudicated for sexual offenses who are likely to persist in sexual violence into adulthood is at least extremely difficult, and may be technically infeasible."

* * * * *

The articles are:

Michael Caldwell: Accuracy of Sexually Violent Person Assessments of Juveniles Adjudicated for Sexual Offenses, Sexual Abuse: A Journal of Research and Treatment. Request it from the author HERE.

Inge Hempel, Nicole Buck, Maaike Cima and Hjalmar van Marle: Review of Risk Assessment Instruments for Juvenile Sex Offenders: What is Next? International Journal of Offender Therapy and Comparative Criminology. Request it from the first author HERE.

April 2, 2013

Study links childhood trauma and adult aggression

Call for trauma-focused treatment of offenders

Children who experience abuse, neglect and family dysfunction have a heightened risk of developing health problems such as obesity, drug addiction, depression and heart disease in adulthood. That common-sense notion is widely accepted, and has been proven in a series of studies funded by the US Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. The Kaiser-CDC project has amassed a large database of the life histories and health trajectories of middle-class residents of San Diego, California.

Now, a San Diego psychologist has deployed that project's Adverse Childhood Experiences (ACE) survey to link these negative childhood experiences with adult aggression and criminality, including domestic violence, sexual assault, stalking and child abuse.

In fact, the correlation is additive, the new study found: The more types of adversities a man underwent in childhood, the higher his likelihood of engaging in criminal aggression as an adult.

Men in the study who were referred to outpatient treatment following convictions for domestic violence, sexual offending, nonsexual child abuse or stalking reported about four times as many adverse childhood events as men in the general population. Men convicted of sex offenses and child abuse were especially likely to report being sexually abused as children.

The link between early damage and later aggression explains why treatment programs that focus primarily on criminal acts are not very effective, say psychologist James Reavis of San Diego, California and his colleagues.

"To reduce criminal behavior one must go back to the past in treatment, as Freud admonished us nearly 100 years ago," wrote Reavis and co-authors Jan Looman, Kristina Franco and Briana Rojas in an article slated for the Spring 2013 issue of The Permanente Journal. "Fortunately, evidence exists in support of both attachment-based interventions designed to normalize brain functioning and in the efficacy of psychoanalytic treatment."

Why the link between abuse and aggression?

Cumulative experiences of abuse and neglect disrupt both a child's ability to form secure attachments to others and his ability to regulate his emotions, the researchers posit. Thus, men abused as youngsters tend to either avoid intimacy altogether or are at risk to become violent in intimate relationships, due to a "bleeding out" of their suppressed inner rage.

Not only must treatment of offenders focus on healing their "neurobiological" wounds, the researchers say, but the findings also point to the need for more early childhood interventions to stop child abuse before its victims grow up to victimize others.

Stay tuned: A second article being prepared for publication will explore the link between early adversity and dysregulation in the hypothalamic-pituitary-adrenal axis that modulates stress responses.

The article, "Adverse Childhood Experiences and Adult Criminality: How Long Must We Live before We Possess Our Own Lives?" can be requested from the first author, psychologist James Reavis of San Diego (HERE). The article includes a copy of the ACE questionnaire, which is potentially useful in forensic cases as a means of quantifying experiences of child abuse and neglect.