Irreconcilable conflict between therapeutic and forensic roles.

Abstract

Despite being contrary to good patient care and existing clinical and forensic practice guidelines, some therapists nevertheless engage in dual clinical and forensic roles. Perhaps because an injured litigant seeking treatment is required to engage in 2 distinct roles (litigant and patient), care providers may be tempted to meet both sets of that person's needs. Through the presentation of 10 principles that underlie why combining these roles is conflicting and problematical, the authors stress the importance of avoiding such conflicts, avoiding the threat to the efficacy of therapy, avoiding the threat to the accuracy of judicial determinations, and avoiding deception when providing testimony. With increasing frequency, psychologists, psychiatrists, and other mental health professionals are participating as forensic experts in litigation on behalf of their patients. Factors such as tightened insurance reimbursement rules, a growing market for forensic mental health professionals, and zealous patient advocacy by therapists have combined to induce many therapists, including those who once zealously avoided the judicial system, to appear, often willingly, as forensic expert witnesses on behalf of their patients. Although therapists’ concerns for their patients and for their own employment is understandable, this practice constitutes engaging in dual-role relationships and often leads to bad results for patients, courts, and clinicians. Although there are explicit ethical precepts about psychologists and psychiatrists engaging in these conflicting roles, they have not eliminated this conduct. One important factor contributing to this continued conduct is that psychologists and psychiatrists have not understood why these ethical precepts exist and how they affect the behavior of even the most competent therapists. When the reasons for the ethical precepts are understood, it is clear why no psychologist, psychiatrist, or other mental health professional is immune from the concerns that underlie them.