Article Figures & Data
Figures
- Figure 1.
Defense Mechanisms in the Forensic Population–Adapted from Protter and Travin.22
- Figure 2.
Four Types of Countertransference Response Sets–Adapted from Protter and Travin.22
Tables
Level I (pathological) Delusional projection: delusions about external reality, usually of a persecutory type; includes the perception of one's own feelings in others and then acting on the perception
Denial: denial of external reality
Distortion: reshaping external reality to accommodate inner needs
Level II (immature) Projection: attributing one's own feelings to others
Schizoid fantasy: tendency to use fantasy to resolve conflict; may be associated with global avoidance of interpersonal intimacy
Hypochondriasis: transformation of reproach or aggressive impulses toward others into complaints of pain and somatic illness
Passive-aggressive behavior: indirect expression of aggression toward others through passivity and masochism
Acting out: direct expression of an unconscious impulse or wish in order to avoid awareness of affect that accompanies it
Level III (neurotic) Intellectualization: thinking about instinctual wishes in affectively bland terms, paying attention to irrelevant detail to avoid expression of inner feelings
Repression: an unconscious process in which the expression and perception of instincts and feelings are prevented
Displacement: redirection of feelings toward a less cared for person or situation than those arousing feelings
Reaction formation: enacting behavior or exhibiting affect that opposes an impulse
Dissociation: temporary, drastic modification of personal identity to avoid emotional distress
Level IV (mature) Altruism: vicarious gratification of impulses through service to others
Humor: expression of feelings without personal discomfort and unpleasant effect on others
Suppression: conscious diversion of attention from conflict
Anticipation: goal-directed planning for future inner discomfort
Sublimation: modification and direction of acknowledged impulses toward more appropriate activities
Procedures Goals Relevant General and Psychodynamic Concepts and Questions Preparation for a case Initial consult with attorney(s), court-system Determine basic nature of the case and medico-legal question Determination of qualifications to provide forensic assistance Request all appropriate documentation and collateral data Determine whether referral to another forensic specialist is warranted Discuss fee arrangement Countertransference: examine initial reactions to the case Bias: given initial reactions, is impartiality feasible or would personal vulnerabilities and opinions impede objectivity? Data collection Interview with the evaluee Obtain a full psychiatric database Transference: how is the evaluee interacting? How does his current interactional style reflect his developmental history? Does he appear forthcoming or withholding? Interview with any collateral sources where appropriate Ensure that sufficient data are available to answer medicolegal question Countertransference: what is my emotional response to the evaluee (anger, empathy, fear)? Is this a response to projected emotions, or is it idiosyncratic? Do I feel safe? Do I have unusually strong positive or negative feelings toward an evaluee? Is my interview with the evaluee deviating from my baseline or characteristic approach? Review documentation and request additional information if warranted Developmental history: does the evaluee's narrative contain past loss, abuse, or psychological trauma? If so, how do these factors affect risk assessment? Characteristics of the ego: strengths and weaknesses, defense mechanisms, relationship to superego Quality of object relations: family and intimate relations Characteristics of the self: self-esteem and self-cohesiveness, self-boundaries Data analysis Analysis of interview data Ensure that focus remains on legal point in question Countertransference: does the gathered data reflect a balanced approach to the case? Did I gather or include information that might disconfirm my impression of an evaluee? Seek supervision if needed Forensic report Synthesis of the data Provide a logical, integrated and objective assessment Determine whether recommendations and clinical impressions reflect all data obtained during an interview Discuss findings with consulting attorney Ensure availability for expert testimony Identify and acknowledge possible discrepancies or conflicting information that might alter report conclusions Forensic testimony Presentation of the data Assist the trier of fact in applying psychiatric expertise to a legal question Determine whether a psychodynamic understanding of the case at hand assists the trier of fact in explaining a defendant's behavior Provide formulation of the offense in a clear and coherent manner, without use of jargon Educate court about relevant mental health concerns, including psychodynamic concepts, if relevant Understand limitations and challenges of presenting psychodynamic concepts in court Anticipate challenges to testimony in cross-examination; acknowledge limitations of data Countertransference: internal response to attorneys, judge and other court personnel in the courtroom; screen for signs of overinvestment in the case (e.g. remaining in court after testimony is complete)
