Assessing Negative Response Bias in Competency to Stand Trial Evaluations

It is axiomatic in a forensic mental health evaluation that an evaluee's responses may be distorted in some way, either over- or under-reporting symptoms. In the context of criminal cases, the former is more frequently encountered. Dr. Rubenzer's new volume offers a wealth of information for those conducting various types of evaluations, including assessments of competency to stand trial.

This book is quite thorough. In the first chapter, various estimates of the frequency of malingering in competency to stand trial evaluations are reviewed, followed by discussion of implications from the findings. This is the primary area in which I disagree with Dr. Rubenzer. He writes, “This book takes the position that response-style assessment is the primary differential diagnostic and assessment skill of the competency to stand trial examiner,” and recommends “that any defendant presenting with deficits sufficient to warrant a finding of incompetence (or serious doubt about competency) be assessed for negative response bias” (pp 5–6). In my view, this is an extreme stance. Cognitive neuroscience has shown that even highly educated and well-motivated individuals are disturbingly prone to unintentional bias.¹ Given rates of malingering estimated at 20 to 25 percent in competency to stand trial evaluations, it is necessary to maintain an appropriate level of vigilance. An unduly heightened level of suspicion, however, easily leaves the clinician vulnerable to confirmatory biases,² including forgetting that three quarters or more of evaluees are probably not feigning or exaggerating symptoms. Dr. Rubenzer and I have discussed this difference of professional opinion, and we have agreed to disagree.

Chapter 2 discusses challenges involved in conducting competency to stand trial evaluations. Although some of this will be familiar to experienced clinicians, there is a useful discussion of signs that have been identified as indicating feigning or exaggeration of symptoms. Chapters 3 through 6 are, in many respects, the core of this volume. Each presents a review of instruments pertaining to specific relevant topics, respectively: tests for directly assessing competency to stand trial, measures of feigned or exaggerated psychopathology, feigned cognitive impairment, and the few tests intended to identify feigned incompetence.

In Chapter 7, some of the obstacles involved in combining data from multiple response style measures are reviewed. This is followed in Chapter 8 with a consideration of challenges in assessing specific categories of defendants, including those claiming amnesia, with dissociative symptoms, and with intellectual disabilities. Chapter 9 is a review of challenges in report writing and offering testimony. In the course of preparing this volume, Dr. Rubenzer conducted an extensive survey of forensic practitioners covering various practice areas, and these data are presented in Chapter 10. The final chapter considers implications of some of the author's conclusions for judicial and other governmental agencies. Dr. Rubenzer makes suggestions for practitioners and of potential topics worthy of future research.

It is perhaps unfortunate that the release of Dr. Rubenzer's book coincided closely with the publication of the most recent edition of the seminal volume on the topic of deceptive responding, Clinical Assessment of Malingering and Deception, Fourth Edition.³ Although it could be argued that the latter text obviates the need for Dr. Rubenzer's book, he has provided a concise and detailed review of many of the most pertinent instruments for the detection of feigned or exaggerated symptomatology in forensic examination. Much of the same information is spread across multiple locations within the broader coverage provided in the Rogers and Bender text.³ Indeed, information on the M-FAST is presented in seven different chapters of the latter book, the TOMM in twelve chapters, and the SIRS in fully half of the 30 chapters. I find Dr. Rubenzer's contribution quite useful, and I recommend it for every forensic clinician's bookshelf.

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