Cognitive Behavior Therapy for Psychosis (CBT-p) as an Adjunct to Competency Restoration

Abstract

ABSTRACT Adjudicative competence evaluations are the most common forensic evaluation to occur in the United States. As a result of these evaluations, pretrial defendants are often found to be incompetent to stand trial and ordered for competency restoration, with psychotic symptoms as a major barrier to competency. Traditional competency restoration services are sometimes insufficient for restoring such defendants to competency within a reasonable period of time. This can lead to a finding that a defendant is unrestorably incompetent to stand trial and potentially a dismissal of charges. However, if not all available interventions are attempted during the course of competency restoration, this may be perceived as a miscarriage of justice for victims. In other cases, defendants with psychotic symptoms may lack insight into their mental illness, and after being successfully restored to competency, become non-adherent with their prescribed medication regimens and decompensate before their cases are resolved. The authors contend that use of Cognitive Behavior Therapy for psychosis (CBT-p) as an adjunct to traditional competency restoration services may be a means of restoring more defendants to competency, and also strengthening the durability of restored competency, when psychotic symptoms are identified as a barrier to adjudicative competence. This makes use of the skill sets of many clinically trained treatment providers working in forensic settings, and is consistent with recent trends of applying empirically-based interventions designed for use with non-forensic patients in forensic contexts. A case example is included to demonstrate the potential application of CBT-p to competency restoration during the course of individualized intervention.