Treating therapist as police interrogator

For all you psychologists, here's a quick ethics vignette:

You live and work in a small town, population 13,000. Like many psychologists, you have a diverse practice. You treat patients at a local mental health clinic. You serve on professional boards. You work part-time as a consultant to the local sheriff's department.

One day, the sheriff asks you to come down and help with some interrogations in a cold case of sexual assault and murder. Among the suspects being questioned are Deb and Ada, two young women you treated in your private practice.

What do you do?

If you are Wayne R. Price, Ph.D. of Beatrice, Nebraska, you see no problem in interrogating the young women despite having been their therapist:

"What I find, I find. It makes no difference to me," Price testified at a pretrial hearing. "When I have an emotional involvement or vested interest and can't do it objectively, I will say so."

Price's role in helping elicit confessions from two of his former patients is in the spotlight now, almost two decades later, because of new DNA evidence pointing to a different killer. The so-called Beatrice Six case has set a record for the number of people exonerated by DNA evidence in a single case.

The five suspects who confessed fit the pattern of false confession cases: Suggestible young people with psychiatric or cognitive problems who used alcohol or drugs, were easily confused, and were worn down by aggressive questioning.

False confessions like this are not nearly as unusual as many people still think. According to the Innocence Project, they have been found in about one-fourth of DNA exonerations.

What is unusual in the Beatrice Six case is the psychologist's role. A psychologist playing the dual roles of trusted therapist and criminal interrogator "would have had a powerful place of trust and persuasion over suspects," the Omaha World-Herald cites confession experts as stating.

The Six did not become formal suspects until four years after the 1985 murder of Helen Wilson. The ball got rolling when a hard-partying 23-year-old named Tom Winslow was in jail for an unrelated crime, the beating of a motel clerk during a robbery. Police approached him with an offer he couldn't refuse: "Help us solve our murder case, and we'll get you out of jail on bond."

Winslow claims police called him a liar and threatened him with the electric chair if he did not confess. He said police fed him information and "suggested he was blocking out memories of a horrific crime due to the cloud of alcohol or drug abuse," according to reporter Paul Hammel, who has followed the case for the World-Herald.

Earlier this month, authorities announced that the DNA found at the crime scene matched an Oklahoma City man, Bruce Smith, who had since died. In light of that evidence, the state is seeking pardons for the Beatrice Six.

Joseph White, a 26-year-old drifter from Alabama, was the only one of the Six who refused to confess. A jury deliberated for only a few hours before convicting him anyway, largely on the testimony of co-defendants who received reduced charges in exchange.

One of White's attorney's, Toney Redman, recalled arguing in court that those testifying were "so weak-minded" that their stories could not be trusted.

"I'm fully convinced now that the police, if they wanted to, could get any borderline personality person, who has alcohol and drug issues, and scare them to death and get them to confess to anything," he told the World-Herald.

Two of the three who testified against White - Ada JoAnn Taylor and Deb Shelden - were former patients of Dr. Price. Their accounts reportedly changed over time, partly after Dr. Price encouraged them to recollect more details.

Taylor, diagnosed by Price with a personality disorder, initially said she couldn't recall much because she had memory problems. After police insisted she was at the scene of the murder, she eventually changed her story. She also told investigators she communicated telepathically with a friend and had five former lives and an imaginary twin. She took a plea deal and was paroled in November.

Shelden, the other former patient of Price's, initially told interrogators she didn't recall the details of the assault on her grand-aunt until months later, when she began having nightmares. She said Dr. Price helped her to remember the details. Shelden was paroled after serving 10 years in prison.

Although Dr. Price - now executive director of Blue Valley Behavioral Health in Beatrice - doesn't see a problem with his dual roles in the Beatrice Six case, many other psychologists might.

Beneficence and Nonmaleficence is the very first principle of the American Psychological Association's Ethics Code, advising us to to "benefit those with whom [we] work and take care to do no harm." Another principle, Justice, cautions psychologists to "exercise reasonable judgment and take precautions" to avoid participating in unjust practices. A third principle, Respect for People's Rights and Dignity, discusses the duty to safeguard people's confidentiality and self-determination, especially when their "vulnerabilities [might] impair autonomous decision making."

The dangers of multiple relationships are specifically addressed in Section 3.05 of the Ethics Code. Psychologists are forbidden from engaging in dual relationships that "risk exploitation or harm to the person with whom the professional relationship exists."

The Forensic Psychology Specialty Guidelines, published two years after Dr. Price's involvement in the Beatrice Six interrogations, also caution against engaging in dual relationships that might cause harm: "Forensic psychologists recognize potential conflicts of interest in dual relationships with parties to a legal proceeding, and they seek to minimize their effects. Forensic psychologists avoid providing professional services to parties in a legal proceeding with whom they have personal or professional relationships that are inconsistent with the anticipated relationship."

It's hard to see how providing someone with confidential psychological therapy would not be inconsistent with later becoming that person's police interrogator.

If you have other thoughts on the ethical contours of this case, I encourage you to comment.

Omaha World-Herald coverage of the Beatrice Six case is here, here, and here.

A classic article on dual roles in forensic psychology is: Greenberg, S.A. & Shuman, D.W. (1997). Irreconcilable Conflict Between Therapeutic & Forensic Roles. Professional Psychology: Research & Practice, 28, 50-57.

Spitzer update on DSM-V transparency

The latest on the controversy

Robert Spitzer, MD, chair of the DSM-III and DSM-III-R workgroups, has issued an update on efforts to reduce the secrecy surrounding the American Psychiatric Association's DSM-V revision process:

"As those of you who have followed this issue know, APA leadership has been resistant to improving the transparency of the revision process. At the outset, all DSM-V Task Force and Workgroup members were required to sign a confidentiality agreement that prohibited them from discussing anything about the DSM-V revision process.... Requests to APA leadership to see minutes of Task Force and Workgroup meetings were refused on the grounds that releasing minutes would compromise the revision process by inhibiting free discussions among Workgroup members. It also was argued that making minutes of meetings and conference calls would jeopardize APA's intellectual property rights. How this would happen has never been explained....

"Pressure on APA leadership to increase transparency culminated in the drafting of an Action Paper by some members of the APA Assembly. The paper called for the posting of the minutes to the DSM-V workgroup and task force meetings on the DSM-V web site....

"Although clearly a move in the right direction, I believe that these reports fall far short of providing the requisite transparency. The Workgroup reports are quite variable in terms of the amount of detail they provide regarding possible directions for change in the DSM-V....

"Full transparency of the process will only be satisfied by posting the minutes of all DSM-V conference calls and meetings so that the process of the deliberations is evident to all . Anything less is an invitation to critics of psychiatric diagnosis to raise questions about the scientific credibility of DSM-V. That is exactly what Christopher Lane, a harsh critic of the DSMs, did in an Op-Ed piece for the LA Times.

"One of the oft-repeated DSM-V talking points is that the process is 'open and transparent.' To be truly transparent, the nuts and bolts of the DSM-V process needs to be open for outside scrutiny. When it comes to the crucial issue of transparency, even the appearance of impropriety must be avoided. Rather than appearing open and transparent, current APA policy continues to give the appearance that APA has something to hide about how it is developing DSM-V. It remains likely that unwanted media attention will fall on the DSM process until full transparency is achieved."

The only Task Force report posted so far is here. Progress reports from the individual workgroups are posted here.

My readers will be especially interested in the report from the Sexual and Gender Identity Disorders workgroup, which will make recommendations for the highly controversial Paraphilias section of the DSM. The brief report is very vague and really doesn't say much. Rumor has it that the workgroup may be considering adding a new diagnosis for nonsadistic rapists, a highly controversial proposal that was rejected the last time around but would help government experts at civil commitment proceedings. With the continuing secrecy surrounding the process there is no way to know for sure what the workgroup is up to; we'll just have to stay tuned.

Robert Spitzer can be reached via email at Spitzer8@verizon.net.

Blogging jurors

Blogs take on a direction of their own. I have written far more about the DSM-V and sex offender issues than I ever thought I would when I started this blog 19 months ago. There's just a lot to say on those fronts.

Similarly, when jury consultant and trial lawyer Anne Reed started her excellent jury blog, Deliberations, she did not envision how many posts she would write about jurors who blog. But she has. And when she is quoted, interviewed, or asked to speak, social networking is the number one topic of interest.

I have a long list of topics that I never get around to, and blogging jurors is one that keeps going to the back burner. Since I haven't gotten around to writing about it yet, I've decided to point my readers to Anne Reed and let her tell you all about this interesting topic that trial lawyers in particular need to pay more attention to:

So here come two more online jurors this week, frightening lawyers everywhere. There's the Facebook juror in England who put a poll on Facebook to help her decide guilt or innocence. And there's the blogging juror here who knows she can't write about the case, but thinks that "doesn't mean I can't give people a a glimpse of the people I am dealing with," and so gives a great sketch of each person in the courtroom. ("The lead defense lawyer. When he is trying to make a point when questioning a witness he beats his hand on the jury box. "So you *wham* are telling me *wham* that blah blah blah blah blah BLAH! *WHAM*" ) The Facebook juror was dismissed; the word-sketch artist is still sitting, as far as we know.

Reed's advice to attorneys?

This is going to happen to you. It's going to happen to you. It's going to happen to you.

Four things to add to your trial task list:

1. Ask. Ask jurors in voir dire whether they write on line and if so where. If you get a "yes" to that question, you have several tools: (1) the judge can strongly impress on that particular witness that she is to write nothing about the trial, not even character sketches; (2) the lawyers can keep an eye on the juror's site during the trial; and (3) if there's time, you can jump on the juror's site before the jury is chosen to see if it contains anything of concern.

2. Look. Simply running searches by jurors' names -- before the jury is seated if possible, after if not -- you can find non-anonymous blogs, of which there are many.

3. Watch. Even if you've asked and looked, you can still have jurors writing about your trial that you didn't know about, on anonymous sites they did not disclose. If you have enough people, assign someone to set up standing searches to try to catch these, using terms the juror might choose -- the location of the court, and the type of case it is. It also makes sense to check on-line comments to news stories about the case, where you have the staffing to do it.

4. Relax. It's possible that none of these techniques will find the Facebook juror or the sketch artist on your trial. Does that mean we're in a frightening new world with intolerable new rules? I don't think so. Remember that in the old days, both jurors probably would have had talked about the case in the same way, but in conversations with their friends, not on line -- and you wouldn't have found out about those either. If anything, it's easier, not harder, to find chatty jurors than it was when they simply talked.

Click here to see her full post, with links to an entire series on blogging jurors and to her very practical Trial Lawyer's Guide To Social Networking Sites, which does the work for you inquisitive types by linking to all of the major (and many of the minor) social networking sites.

I hope all of you have a nice Thanksgiving holiday!

Photo credit: VintFalken (Creative Commons license)

More on the DSM-V controversy

"The new mental disorders?"

Inspired by last week's op-ed in the L.A. Times, Atlanta Journal-Constitution staff writer Richard Halickshas has a new piece questioning some of the strange new diagnoses being proposed for the DSM-V:

Sex addiction. Internet addiction. Compulsive buying disorder. All of these and more could become officially recognized mental disorders in the next few years. The American Psychiatric Association is creating the fifth edition of its Diagnostic and Statistical Manual, or DSM-V, which defines mental disorders and adds new ones with each edition.

Christopher Lane, author of the book "Shyness: How Normal Behavior Became an Illness," complained last week that the new DSM, due out in 2011, is being put together in secret, a charge that DSM's editors denied.

In "Wrangling Over Psychiatry’s Bible," published in the Los Angeles Times, Lane also warned that the creation of new disorders where none currently exists may be "little more than a pretext for prescribing profitable drugs."

Here's a look at selected new ailments under consideration by the committees of experts writing DSM-V.

Sex addiction

Real, says Dr. Patrick Carnes, a leading researcher in the field. It's a "compulsive behavior that completely dominates the addict's life. Sex becomes the organizing principle of addicts' lives."

Not real, says Seattle therapist Roger Libby. Slate.com quotes Libby: "You cannot be addicted to yourself. You have to have a substance external to yourself like alcohol or drugs to be addicted."

Caffeine withdrawal disorder

Real, say Johns Hopkins University researchers. Withdrawing from the world's most-used drug causes headache, fatigue, irritability, depression, difficulty concentrating, even flulike symptoms.

Not real? Few seem to argue against this. It's in DSM-IV as a trial diagnosis and is up for official diagnosis designation in DSM-V.

Parental Alienation Syndrome

Real, says paskids.com: [PAS] "arises primarily in the context of child-custody disputes. Its primary manifestation is the child’s campaign of denigration against a parent, a campaign that has no justification."

Not real, says the National Organization for Women: "Parental alienation really is a dangerous and cleverly marketed legal strategy that has caused much harm to victims of abuse, especially women and children during and post-divorce."

Internet addiction

Real, says Dr. Jerald Block, writing in the American Journal of Psychiatry: "Internet addiction appears to be a common disorder that merits inclusion in DSM-V… . [It] consists of at least three subtypes: excessive gaming, sexual preoccupations and email/text messaging."

Not real, argues thelastpsychiatrist.com. "Internet addiction belongs in DSM-V… . And then let's rename the DSM The Book of Fantastikal Magickal Pixies and incorporate it into the Monster Manual."

As you see in the above coverage, the APA denies the charge by Lane and others, including none other than DSM-III Task Force Chairman Robert Spitzer, that the DSM-V revision process is occurring in secrecy.

But, as Spitzer points out in a letter to Psychiatric News, the secrecy is spelled out quite clearly in the contract that all DSM-V task force members must sign:

"I will not, during the term of this appointment or after, divulge, furnish, or make accessible to anyone or use in any way... any Confidential Information. I understand that 'Confidential Information' includes all Work Product, unpublished manuscripts and drafts and other pre-publication materials, group discussions, internal correspondence, information about the development process and any other written or unwritten information, in any form, that emanates from or relates to my work with the APA task force or work group."

The Atlanta Journal-Constitution article is online here. Spitzer's letter about the secrecy is here. My previous post on the DSM makeover controversy is here.

Locking the courthouse doors

I recently blogged about how the current economic crisis is affecting public defender services, creating a potentially unconstitutional situation in which indigent clients cannot get adequate legal help.

Now, at least one county is proposing to curtail essential court services in order to balance the budget.

That is also unconstitutional, says the presiding judge.

The judge of the King County (Seattle), Washington court, the state's largest court, is taking the unusual step of going public. In an opinion piece in the Seattle Times, he reminds the public of the county's duty to adequately fund not only the courts but also the prosecutor and the public defender -- "There is only so much that can be cut before the administration of justice is undermined."

Presiding Judge Bruce Hilyer also pointed out the penny-wise, pound-foolish nature of the wild budget slashing occurring these days.

For example, Seattle's Drug Court is a nationally recognized model that brings in $3.7 million biannually from the state. That money will be forfeited if the Drug Court shuts down. Taxpayers will also lose in the long run if more drug offenders are incarcerated rather than rehabilitated.

In responding to the county proposal to close the court for 10 working days next year, Judge Hilyer delivers a basic civics lesson:

A core principle of our system of government is three branches, each with authority independent of the other. The legislative branch sets policy, the executive branch implements it and the independent judiciary protects the rule of law and the rights of the individual against the other powers of the state…. The drafters of our state constitution foresaw the risk that one branch of government might force closure on another branch. To prevent this, our constitution provides that the superior court "shall always be open, except on nonjudicial days," which are weekends and holidays. …. Apart from weekends and holidays, the courts may be closed only in physical emergencies like snowstorms, floods or earthquakes….

King County faces some very hard choices. But no matter what they are, we cannot afford to suspend our citizens' access to justice by closing our courts.

The full article, "King County Superior Court cannot be closed," is online here.

"The sausage-making of psychiatric care"

"The less you know about how mental health is defined, the better. Or perhaps it's the other way around."

In case you missed English professor Christopher Lane's excellent opinion piece in the L.A. Times last week, the Minneapolis Star Tribune ran it this Sunday. As the American Psychiatric Association gears up for DSM-V, we all need to keep it real when it comes to psychiatric diagnosis. Let's hope this media spotlight will encourage the APA to increase the transparency of the process and make sure only legitimate diagnoses get added to the manual.

The Star Tribune op-ed is online here.