Q: I've been ordered to undergo a forensic psychological examination. What does that mean, exactly? How is that different from any other kind of psychological examination?
A: To begin with, there are a few major differences between a forensic exam for legal purposes and a clinical exam for treatment purposes.
If you voluntarily go to a psychologist for help, the fiduciary relationship that exists is between you and your doctor, and the purpose of any formal evaluation is to diagnose and effectively treat your disorder or help you with your problem. The content of the examination and any additional treatment records are confidential, and you are free to terminate the evaluation or treatment process at any time.
In the forensic setting, the fiduciary relationship is between the psychologist and the court, or the attorneys involved in the case. The purpose of the exam is to assess the aspects of your mental status that are relevant to the case in question, not necessarily to help treat your problem, although the examining psychologist may make treatment recommendations as part of his or her conclusions. The results of the exam typically go to the attorney who ordered it, although your attorney will probably get a copy of the report that he or she may then share with you. You are still free to terminate the examination, but there may be legal consequences for doing so. In some cases, either or both attorneys may arrange for the forensic psychological examination to be transcribed and/or videotaped.
In a few cases, if you have been seeing a psychotherapist in treatment, or have done so in the past, those records may be subpoenaed for the purposes of your case. While this may not seem "fair," the law allows that if you choose to put your mental state at issue in pursuing a claim of injury (in a civil case) or exculpation (in a criminal case), all parties have a right to review other factors that might affect that mental status. In rare cases, the treating clinician may even be called to testify, although courts are generally reluctant to violate doctor-patient confidentiality, except in extreme cases.
The exact procedures and measures utilized in the psychological exam will depend of the specific referral question. Virtually all forensic psychological exams begin with the doctor reviewing relevant records of the case, to provide a background for the examination. A good portion of the exam will involve you sitting face-to-face with the psychologist, while he or she asks a set of questions relating to the circumstances of the present case, your medical, academic, and employment history, any current signs and symptoms you may be experiencing, and a set of mental status exam questions to assess your orientation, memory, reasoning, and emotional state.
Depending on the nature of the exam, you may be administered several psychological tests, some requiring direct interaction with the examiner, others consisting of questionnaires and checklists. This can range from only a few standardized measures in a child custody or fitness-for-duty evaluation, to an extensive, hours-long battery of cognitive tests in a neuropsychological evaluation for personal injury or criminal responsibility determinations. The complete examination may therefore take a couple of hours, or extend over days.
The best advice to prospective examinees is: Be honest. This applies to answering questions, as well as performing to the best of your ability on psychological tests. In my experience, nothing - I mean nothing - poisons a case more than the suspicion that you may be lying, malingering, or trying to manipulate the findings.
Finally, even in an adversarial forensic setting, you have the right to be treated with reasonable respect and courtesy. No psychological examination should ever be conducted in a needlessly offensive or hostile atmosphere. Patients who feel they have been treated too brusquely should report this to their attorney, as it may affect the interpretation of the examination results.
© 2005, Laurence Miller, PhD. All rights reserved. This article may not be reproduced in whole or in part without the express written consent of Dr. Miller.