Words of Caution: Recommendations to Consider when Interviewing Patients with a History of Aggression or Violence

This article discusses some of the issues that arise when interviewing individuals who utilize mental health services in forensic settings, given that many patients in this population have significant histories of aggression and/or violence. We identify important considerations for interviewers related to characteristics of the client, interviewer, and setting of the interview. Lastly, some recommendations are offered to forensic mental health professionals who conduct both treatment and assessment-focused interviews. This is the bottom line of a recently published article in the International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health | 2019, Vol. 18, No. 1, 12,20

Interviewing Forensic Mental Health Patients Who have a History of Aggression: Considerations and Suggestions


Andrew Day, Indigenous Education and Research Centre, James Cook University, Queensland, Australia
Michael Daffern, Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia; Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
Ashley Dunne, Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia; Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
Nina Papalia, Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia; Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
Kylie Thomson, Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia


This article discusses issues arising when interviewing men and women in forensic mental health services, noting that many patients in these settings have significant histories of aggression or violence. The differences between interviews conducted for assessment purposes and those that are conducted as part of treatment are noted. We identify some important considerations for interviewers. These relate to characteristics of the client, characteristics of the interviewer, and features of the mental health setting that might impact on the interview. Some practical recommendations are offered to assist forensic mental health practitioners who conduct both types of interview.


Violent; offender, interview, therapeutic alliance

Summary of the Research

“Patients of forensic mental health services are those who have both been diagnosed with a mental disorder and broken the law…it has long been known that many forensic patients are admitted with a history of aggressive and/or violent behavior…and rates of in-patient violence towards staff and patients can be high…The aim of this article is to consider the range of factors that potentially influence the way in which the mental health professional might approach the task of interviewing patients who have a high risk of doing so in the future. Our focus is on interviewing in-patients, although similar considerations will inevitably arise when interviewing forensic patients in the community” (p.12).

“…It is important to note that assessment interviews with mentally disordered patients can differ in important ways from general counseling encounters. For example, the forensic patient’s response style may be characterized by positive impression management motivated by strong external incentives, such as efforts to avoid court proceedings or imprisonment, or to secure a discharge from hospital…Given the disincentives that sometimes exist to open disclosure in the forensic setting, the development of trust is considered particularly important, with feelings of safety also widely considered to be key to therapeutic change in most psychotherapeutic approaches…” (p. 13-14).

“Forensic patients also typically present with a range of co-morbid problems, including substance abuse…and family dysfunction that may distract them from the focus of any interview. It is, however, personality and interpersonal difficulties that are perhaps most commonly identified as challenges to the effective interviewing of violent patients and, in particular, traits of antisocial personality disorder…They are more likely to perceive threat and hostile intent from the interviewer, which may then impact upon their level of engagement, willingness to disclose, and ability to build rapport…In short, the interviewer qualities that are thought to enhance effectiveness include those that lead the patient to view the interviewer as interested, authoritative (not authoritarian), warm and empathic, and tolerant of the patient’s challenges…” (p. 14-15).

Translating Research into Practice

“…Relatedly, there is a particular need to acknowledge that experiences of trauma will often act as a key driver of aggressive and violent behavior. This might involve, for example, the interviewer paying particular attention to how negative life experiences…and associated traumatic experiences might be relevant to the purpose of the interview…Of particular relevance for the interviewer is using the developing understanding of a person’s history to inform judgments about how the patient is experiencing the mental health service and the interview itself…It is already clear that various factors will impact on the quality of the forensic interview. It is possible to group these factors into two key domains that apply to both assessment and treatment interviews; those that related to the patient and those that are relevant to the interviewer…” (p. 14).

“…There can, of course, be an advantage in commencing the initial assessment interview soon after the patient has been admitted to the service…as this may help the mental health professional to better appreciate the nature of the person’s mental health problems, and their relationship with aggression. However, there are also benefits in delaying the initial assessment interview until the more florid symptoms have resolved and the patient’s capacity for reflection and concentration is improved. Ethically, it is also important to wait until the patient has the capacity to consent to the assessment interview” (p.14).

“It is also important to remember that many forensic patients will arrive with traumatic histories and they are, therefore, likely to experience a range of factors that will heighten their sense of threat…and influence their interpersonal engagements…Considering the meaning of these presentations will, therefore, be a key tasks in an effective interview, whether it is for assessment or treatment purposes. Finally, patients will often be very anxious about meeting new staff and it is the interviewer’s responsibility to seek to reduce this anxiety. This may involve considering both strengths and weaknesses, rather than focusing solely on problem behavior, the elucidation of risk factors and/or antisocial personality traits.” (p. 15).

“What follows are four suggestions for how a professional might approach the task of interviewing a forensic patient…A helpful starting point in any interview, after outlining the purpose of the interview and addressing issues of consent, is to summarize what the clinician already knows about the patient and then ask the patient for feedback (points of agreement and disagreement)…Acknowledging information that the clinician already knows also demonstrates openness” (p.16).

“Barber (1991) has proposed a six-step model of what he terms ‘negotiated casework,’ which we suggest provides useful direction to any interviewer who is assessing a forensic patient. Barber starts with the suggestion that the first step is to talk directly about the order or conditions that led to the interview…Then, it is important to identify those aspects of the interview that are non-negotiable and those that can be negotiated…The next step is to make decisions about the way forward, identifying goals and responsibilities, before seeking agreement on criteria for progress and what will happen if the patient fails to comply with aspects of the interview. This approach can help to clarify the boundaries of the interview, as well as the purposes for which information will be used and address concerns about confidentiality” (p.16-17).

“We suggest that interviewers should adopt an affiliatory interpersonal style…This may be particularly difficult to achieve when working with patients who…may evoke both pessimism and rejection. Techniques for engagement that have been reported to be helpful include offering choice, information-giving, preparing people for therapy, goal agreement, treatment contracting, building self-confidence and self-esteem, and feeding back treatment progress, particularly for those with diagnoses of personality disorder….More broadly, violent offenders with high levels of entitlement, grandiosity, and superiority may, on occasion, display behavior that is aggressive…in order to establish or reestablish a sense of self-worth or interpersonal control…The important task for the interviewer here, however, is not to react – but, once again, to use this type of reaction as information that can help conceptualize the patient’s presenting problem and level of risk. Often this will require the support and advice of another professional…” (p.17).

“Given the potential volatility of patients who have a history of violence, it is imperative that interviewers familiarize themselves with the safety procedures of the location in which the interview is taking place. Some important considerations may include carrying a duress alarm, ensuring that the door of the interview room remains unlocked at all times, ensuring other staff are aware of their interview and any potential risks…Careful planning and seeking the advice of other staff who know the patient well and who are familiar with the patient’s present state is prudent. Notwithstanding measures to protect physical safety, it is also important to acknowledge the psychological impact of being in a forensic service where autonomy is limited and the patient is exposed to experiences that may be personally distressing or frustrating” (p.17).

Other Interesting Tidbits for Researchers and Clinicians

“The interpersonal style of the mental health professional may impact alliance and may also impact on the outcome of any interview or therapeutic encounter. [Previous researchers], for example, have reported that sex offenders evaluate their treatment more positively when therapists are perceived as ‘affiliative,’ and weaker when they are previewed as ‘controlling.’ At the same time, there have also ben suggestions that interviewers have to be flexible in their interpersonal approach; adapting their style in line with the interpersonal skills and attachment styles of the patient” (p.14).

“Ross et al. (2008) have also highlighted he possible influence of therapists’ expectations on offender treatment outcomes in correctional settings. They suggest that it might be harmful for clinicians to have too high or low expectations of patients, as they may feel a sense of frustration if their expectations are not met, or be less likely to create opportunities for change if they believe that the likelihood of success is low…preexisting knowledge of certain individual characteristics, such as violence risk level, previous treatment noncompliance or failures, therapy interfering behaviors, and records of negative client labels…can generate negative expectations and judgments, and thus adversely impact the quality of the therapeutic relationship…” (p.15-16).

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Challenging longstanding assumptions about evaluator empathy in forensic evaluations

Evaluators who purposefully use expressive empathy during a psychopathy assessment interview rate evaluees more favorably than evaluators who purposefully avoid expressive empathy. This is the bottom line of a recently published article in Law and Human Behavior. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | Law and Human Behavior | 2019, Vol. 43, No. 1, 56-68

How Does Evaluator Empathy Impact a Forensic Interview?


Lauren M. Vera, Sam Houston State University
Marcus T. Boccaccini, Sam Houston State University
Kelsey Laxton, Sam Houston State University
Claire Bryson, Sam Houston State University
Charlotte Pennington, Sam Houston State University
Brittany Ridge, Sam Houston State University
Daniel C. Murrie, University of Virginia


We used an experimental design to test the key concern that expressive empathy from evaluators during forensic interviews leads to more disclosure of misbehavior (e.g., stealing, breaking the law, manipulating others) from evaluees. In the context of a psychopathy assessment interview, evaluees (N = 94, 100% male, 57.4% Caucasian) interviewed by an evaluator using expressive empathy techniques were no more likely than those interviewed by an evaluator avoiding expressive empathy techniques to admit to past instances of misbehavior (d = .17, 95% CI [-.24, .57]). Instead, the use of expressive empathy techniques seemed to influence evaluator perceptions of the evaluees. Evaluators using expressive empathy rated evaluees as less psychopathic (d = -.52, 95% CI [-.93, -.11]), more conscientious (d = .72, 95% CI [.30, 1.13]), and as having engaged in less impression management (d = -.54, 95% CI [-.95, -.13]) than evaluators avoiding the use of expressive empathy. Put simply, when evaluators expressed empathy, it influenced the evaluator, not the evaluee. These findings suggest the need to expand professional discourse and research on empathy in forensic evaluations to better understand the possible effects of evaluator empathy on both evaluators and evaluees.


empathy, forensic assessment, interview style, psychopathy

Summary of the Research

“Clinicians are often encouraged to reflect empathy—verbally and nonverbally—in assessment and treatment sessions. This practice is supposed to encourage respect, understanding, and rapport between clinician and client. There is, however, considerable debate as to the appropriateness of empathic expressions from evaluators conducting forensic evaluations. Although forensic evaluators are required to inform evaluees about the purpose of the evaluation and limits of confidentiality, an evaluator who expresses empathy might inadvertently lead a defendant to believe that the evaluator is pursuing the defendant’s best interests, as opposed to the interests of defense counsel, the court, or the prosecution. Of particular concern is the possibility that forensic evaluator empathy will lead defendants to reveal potentially prejudicial or disadvantageous information about themselves (e.g., previously unreported criminal behavior, negative attitudes or experiences) and their legal cases. Using more colorful terms, the concern is that evaluators might use empathy as a ‘seductive power’ to create a false sense of therapeutic alliance and ‘induce an inappropriate level of trust in an evaluee’” (p. 56).

“Concerns about the potential misuse of empathy by forensic evaluators have become so well known that many authorities raise the issue of evaluator empathy in forensic evaluation textbooks and manuals. Arguments against the use of empathy typically focus on problems associated with outward expressions of empathy, such as using verbal statements (e.g., ‘That’s understandable,’ ‘It sounds like you felt sad/scared/upset’) and nonverbal behaviors (e.g., head nod, reciprocal facial expression) to communicate a sense of shared understanding or felt awareness We refer to this type of empathy as expressive empathy, although others have referred to it as reflective or therapeutic empathy. The original and strongest argument against using expressive empathy comes from Shuman (1993), who takes the position that the use of expressive empathy is ‘unfair’ and ‘presents a bright ethical line that the ethical examiner should not cross’ because it ‘erroneously implies a therapeutic alliance’” (p. 56-57).

“There appears to be less concern that receptive empathy is problematic for forensic evaluators. Receptive empathy is the mental exercise of attempting to take the evaluee’s perspective. In other words, the attempt to accurately perceive and understand the evaluee’s experiences, thoughts, and emotions. Whereas expressive empathy refers to the evaluator’s outward behavior, receptive empathy refers to an internal process that need not be communicated to the evaluee. Some experts argue that receptive empathy is an inherent piece of conceptualizing another’s mental health problems for the purposes of a forensic evaluation. Even those who take the position that expressive empathy is problematic agree that ‘empathic understanding’ is an important component of forensic assessment” (p. 57).

“The overall goal of the study was to examine whether evaluator empathy would impact the assessment in the ways that those concerned about the use of expressive empathy have warned. If these concerns are accurate, those interviewed by an evaluator using expressive empathy will report higher levels of alliance with the evaluator, engage in less impression management, and be more willing to admit to past instances of misbehavior. Because of this increased disclosure, evaluators who use expressive empathy should rate evaluees as more psychopathic than evaluators who do not use expressive empathy. Arguments against the use of expressive empathy do not focus on the possible effects of using expressive empathy on evaluator accuracy. But if those interviewed by an evaluator using expressive empathy are indeed more open and engage in less impression management than those interviewed by an evaluator avoiding expressive empathy, personality trait ratings assigned by evaluators using expressive empathy should more closely correspond with evaluees’ preinterview self-ratings (i.e., their ratings should be more accurate because evaluees were more open during the interview)” (p. 57).

“The mere possibility that the use of expressive empathy by forensic evaluators might encourage excessive disclosure among evaluees has been concerning enough to drive more than 25 years of professional discourse. Although there are many opinions about the potential misuse of empathy in forensic assessment, and many recommendations from authorities, few empirical studies inform the evaluator-empathy debate. We designed an experiment to test the key concern that expressive empathy from evaluators leads to more disclosure from evaluees, but we found no evidence of the type of increased disclosure about which critics of evaluator empathy have warned” (pg. 64).

“These findings do not mean that the use of expressive empathy had no impact on the evaluation. Differences in evaluator empathy were evident to clinical psychology doctoral student observers during pilot testing and to evaluees during the clinical interviews. Thus, our findings suggest that those arguing for limited empathy in forensic evaluation (e.g., Shuman, 1993) are probably correct in assuming that evaluees feel a stronger sense of compassion, cooperation, and understanding from evaluators using expressive empathy techniques. Our findings simply suggest that this sense of alliance does not necessarily affect evaluee disclosure of antisocial traits and misbehavior” (p. 64).

“The most striking finding of this study was that expressing (or avoiding) empathy seemed to influence evaluator perceptions of the evaluees. Although all four of the evaluators conducted both high-empathy and low-empathy interviews, they rated evaluees as less psychopathic, more conscientious, and more honest (less impression management) after they had conducted interviews using expressive empathy techniques. One way to interpret these findings is that the instruction to use more expressive empathy (offering empathic statements) during the interview may have led to an unintended increase in receptive empathy (taking the evaluee’s perspective)” (p. 64).

Translating Research into Practice

“Although there is already some limited evidence that evaluator traits such as agreeableness and attitudes toward sexual offenders are associated with their assessment results across cases, the current study shows that the same evaluator can view evaluees differently because of a purposeful decision to conduct the evaluation one way as opposed to another (i.e., use expressive empathy vs. not). Although we experimentally manipulated evaluator empathy in this study, it is possible that other factors might shape the degree of empathy that the same evaluator chooses to expresses in different evaluations. These factors might include offense details (e.g., type of crime, heinousness, victim age, number of victims), the purpose of the evaluation (e.g., risk vs. mitigation), evaluee traits (e.g., agreeableness), or something about the evaluee’s background (e.g., similarities or dissimilarities with the evaluee). Evaluators tendencies to vary their level of empathy might also help to explain why evaluators retained by the defense—who may tend to behave more empathically—view evaluees more favorably than those retained by the prosecution—who may tend to act less empathically” (p. 64).

“These findings suggest the need to expand the discourse on empathy in forensic evaluations to better incorporate the possible effects of expressive empathy on evaluators, not just evaluees. Differences in the use of expressive/receptive empathy may help explain some of the recently documented evaluator differences in forensic assessment, including psychopathy measure scoring and competence to stand trial opinions. In addition to studying the possible role of case, offense, and offender characteristics, researchers should study natural variations in evaluator empathy. An evaluator’s tendency to use or avoid empathy may be attributable to his or her interpersonal styles or forensic training. Those with formal forensic training may be more likely to avoid expressive empathy due to their familiarity with arguments against its use” (p. 64).

“Overall, our findings highlight the need for more research on evaluator empathy. They also underscore a broader theme of recent field research addressing forensic evaluations; that is, that evaluators are not uniform, interchangeable ‘instruments,’ but rather a dynamic component of the evaluation, such that—at least to some extent—the outcome of a forensic mental health evaluation may depend on aspects of the evaluator, not just the evaluee” (p. 65).

Other Interesting Tidbits for Researchers and Clinicians

“Several aspects of our study design limit the conclusions that can be drawn from this experimental study of forensic evaluator empathy, including the use of only male layperson evaluees, female doctoral student evaluators, and the nonstandard use of the PCL:SV. Our design choices were influenced by both the resources available for the study (e.g., uncompensated evaluator time, scheduling availability), and concerns about the potential for harm among actively justice- involved participants (e.g., disclosure of previously undocumented criminal behavior), but they limit the generalizability of our findings…Our forensic evaluators were also less experienced than many practicing forensic evaluators. Our doctoral student evaluators had never practiced independently and there is some evidence that PCL scores from more experienced clinicians outperform those from less experienced graduate-student clinicians. Although meta-analytic findings suggest that the association between clinician experience and judgment accuracy is much weaker than many expect, experienced evaluators might better understand how varying their interviewing style could influence their perceptions of evaluees and be less affected by their decision to use a specific level of expressive empathy” (p. 64-65).

“Perhaps the most important question for future research is whether our findings generalize to other samples of evaluators and other forensic evaluation contexts. Concerns about the nonstandard scoring of the PCL:SV (i.e., no collateral records) are ameliorated to some extent by the finding that PCL:SV ratings were correlated with self report psychopathy measure scores (r _ .35 to .44), but the effects we observed using the PCL:SV are still best interpreted as estimates of psychopathic traits, as opposed to true PCL:SV scores. Without an evaluation process that included records, we do not know whether the experimental manipulation of empathy would also influence the way evaluators perceived information in records, as opposed to information presented solely via evaluee” (p. 65).

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Authored by Amanda Beltrani

Amanda Beltrani is a current doctoral student at Fairleigh Dickinson University. Her professional interests include forensic assessments, professional decision making, and cognitive biases.

It’s all relative: Effect of contrast cases on jury members’ decision making

Prosecutors, individuals involved in criminal justice, and general public serving as jury members should be aware of the contrast effects when making judgements in a legal context. This is the bottom line of a recently published article in Psychology, Public Policy, and Law. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | Psychology, Public Policy, and Law | 2019, Vol. 25, No. 1, 30–37

A social judgement? Extralegal contrast effects in hypothetical legal decision making


Max E. Butterfield, Point Loma Nazarene University
Alexandra, N. Bitter, The University of Wyoming


Social judgments in ambiguous situations often rely on heuristics and biases, and legal decision makers are often faced with evidence that does not clearly favor one decision over another. Across two studies, we tested whether one extralegal factor, contrast cases, influenced decision making when judicial factors were held constant. In Study 1, participants (n = 100) evaluated whether an imagined prosecutor had sufficient evidence to send the same three target cases to trial. Before deciding these cases, though, the participants first evaluated cases with either relatively stronger or weaker evidence than the targets. Those in the weak-case comparison group were significantly more likely to send target cases to trial, and they believed the prosecutor had a stronger case. In Study 2, all participants (n = 100) evaluated hypothetical parole applications, but the method was otherwise the same as that used in Study 1. The same contrast-oriented pattern emerged. Participants who first viewed weaker parole applications rated the identical targets as significantly more rehabilitated. Taken together, the results of these two studies suggest that contrast effects may be one extralegal factor involved in shaping individual-level social judgments made in legal contexts such as grand juries and parole boards.


contrast effects, decision making, grand juries, parole boards, heuristics

Summary of the Research

“Objectivity is a cornerstone of the American justice system, and legal decisions are supposed to be based on the strength of available evidence. Research findings do provide at least partial support for the ideal: In many instances, strong cases win and weak cases do not. However, what happens when the strength of evidence does not completely favor one side or the other? A growing body of research has demonstrated that a variety of extralegal factors affect legal decision making. Generally, ambiguous conditions in any domain increase the likelihood that heuristics and biases will influence social judgments, but we were especially curious about how they might affect legal decision making, especially when such processing might be inadvertently or systematically activated in all decision makers involved in a particular case. Among some of the most noteworthy of these are pretrial publicity; the CSI effect; and the race, sex, and gender of the defendant.” (p. 30)

“Our express purpose in the present investigation was to focus on the role of ambiguity in basic social judgments made by individuals. Specifically, we wondered whether contrast cases presented before target cases might be an influence over and above the other extralegal factors that have been more thoroughly documented elsewhere. We hypothesized that making additional cases cognitively accessible to individual evaluators would subtly provide reference points for judging case strength, thereby influencing what otherwise appear to be objective ratings of target cases.” (p. 30)

“Social judgments based on prejudices and stereotypes […] typically rely on systematic processes: Rather than carefully deliberating decisions based on known facts about the individuals being evaluated, mental shortcuts bias and shape inferences instead. Anchoring Effect is but one example of Social Judgment Theory’s emphasis on the importance of reference points in decision making. For many years, in fact, researchers worked to resolve an apparent paradox in which some reference points were observed to create assimilation effects, whereas others lead to contrast effects. Assimilation occurs when target stimuli are evaluated as more similar to an anchor/reference, whereas contrast creates the opposite effect, and evidence has mounted to demonstrating that assimilation and contrast are driven by the features of the references and stimuli that are cognitively accessible at the point of evaluation. […] studies over the years have demonstrated the role of contrast extends beyond physiological and person perception judgments and appears to apply to cognitions across the spectrum of judgment and decision making. However, few studies have specifically explored in depth the ways in which contrast might affect decision making in legal contexts, and although the application is intuitive, empirical investigation has been limited” (p. 31)

“Because the U.S. justice system relies heavily on untrained volunteers for jury service, we believe it is particularly important to determine how social judgment affects legal decision making. Unfortunately, evidence does support the notion of consistent bias in some circumstances, especially in cases where the strength of evidence does not clearly favor one side or another. It is in these cases that jurors may find themselves unable to make decisions based solely facts of the cases they are considering, and they instead rely on intuitions, biases, or mental shortcuts to tip the scales in one direction or another.” (p. 31)

“We specifically wondered whether weak-contrast comparison cases would make target cases appear strong, whereas strong-contrast target cases would make those same target cases appear weak, simply because of the directionally oriented high evaluative contrast created by the cognitive accessibility of the recent comparators. Study 1 was designed to test this hypothesis using a hypothetical grand jury experience. A grand jury setting was chosen for the initial study because, unlike petit juries, they do not reach final case outcome decisions and they can make decisions about multiple cases. Instead, individuals who sit on grand juries decide if the cases they consider have sufficient evidence for a prosecutor to send them to trial, and the jurors are typically exposed to multiple cases in sequence over the course of their time spent serving. Thus, it seemed more ecologically valid to ask participants to consider multiple cases.” (p. 32)

“Similarly, parole boards were chosen as the setting for Study 2 for the same reason: Parole boards in many jurisdictions typically evaluate multiple cases in a sequence, often even multiple in the same sitting. The general hypothesis for both studies was that evaluations of case strength would be higher for participants whose expectations were anchored by weak-contrast comparison cases than for those who were anchored by strong-contrast comparison cases.” (p. 32)

“Across two studies, we demonstrated persistent contrast effects. In Study 1, people who imagined themselves on hypothetical grand juries appeared to anchor their standards for evidentiary evaluations using recent cases they also evaluated. More specifically, target cases were evaluated to have stronger evidence and were more likely to be sent to trial if they were evaluated while embedded with weak cases.” (p. 35)

“Study 2 was a conceptual replication of this effect. There, people who imagined themselves on hypothetical parole boards tended to anchor their evaluations of prisoner rehabilitation using previous cases they had evaluated as well. More specifically, compared to those who viewed strong cases for parole (i.e., better rehabilitation), those who viewed weak cases gave more positive evaluations of the target cases. Taken together, the results of these two studies suggest that contrast effects may be one extralegal factor involved in shaping individual-level social judgments made in legal contexts.” (p. 35)

“Ultimately, the limited capacity of human cognitive architecture has been heavily documented across a wide variety of domains, and the extralegal contrast effects shown here seem to be another example of the wide scope of heuristic processing. Although these thinking errors are commonplace, research and practical evidence in those other domains has shown their effects can be minimized or even avoided altogether under the right circumstances. In order for objectivity to be most effectively achieved across the justice system, then, it may be important to devote further study of contrast effects in a judicial context to more fully understand and limit their influence.” (p. 36)

Translating Research into Practice

“For prosecutors, particularly those involved with grand juries, the results indicate the importance of the order in which they present their cases. In situations where they cannot control the order, steps may need to be taken to minimize the impact of particularly strong or weak contrast cases presented directly before or that may remain salient in jurors’ minds. Prosecutors may also wish to use the effect to their advantage in similar ways, and it will be important for them to be aware of the potential that extralegal contrast could unduly influence juries unfairly. Conversely, individuals involved in criminal defense or parole application should likely do everything in their power to disassociate themselves from cases or people who would elicit contrast in the wrong direction, and similarly seek out instances of positive contrast with which to align themselves.” (p. 36)

“Members of the general public who are called to serve on grand juries should also likely be aware of contrast’s extralegal influence. They have a responsibility to weigh the merits of the cases they evaluate as objectively as possible, and they often do this very well. However, in cases where the evidence is ambiguous, or it is unclear whether the strength of evidence in a case meets standards for trial, it is essential that they be made aware of that contrast effects could be sources of extralegal influence. Similarly, those who serve on parole boards take seriously their responsibility to objectively evaluate whether prisoners are rehabilitated. As a result, it is important for them to be aware of possible contrast effects as well.” (p. 36)

“In general, raising awareness for both grand jury and parole board members would not be complex or costly. Simply providing them with information about the phenomenon may be enough to prevent its effects from taking root. However, awareness alone may not be an effective intervention, and legal professionals involved with grand juries or parole boards may wish to seek additional amelioration methods. For example, it could be useful to provide grand jury and parole board members with a standardized contrast case before each target case they consider, effectively neutralizing prior experiences and allowing for more unbiased evaluations. That being said, the effectiveness of these potential intervention, informational or otherwise, should likely be tested in either a basic or applied setting before they are put into widespread practice.” (p. 36)

Other Interesting Tidbits for Researchers and Clinicians

“Unfortunately, ecologically representative research of this nature is notoriously difficult and costly, and like many past studies we decided to use hypothetical scenarios as a first step to determine whether evidence could first be found for a basic effect. That basic effect, however, should be weighed against the fact that grand jury and parole board decisions typically involve a myriad of group process factors that were not at play in the current study. […] Undoubtedly, though, members of actual grand juries and parole boards can be influenced not just by contrast effects, but also by conversations, social influence attempts, reflection after feedback, situational factors, and a variety of other things. The complexity and nuance added by a complete social environment should not be ignored, and future research on this topic should include more realistic directions, in-person simulations, or actual grand jury or parole board members. Ideally, studies would even include deliberative simulations situated in realistic environments.” (p. 35)

“Because the present research used a very simple design testing only the effects of contrast, it is unclear how much variance in jury or parole decision making can actually be explained by contrast effects relative to other extralegal factors. […] further research may wish to explore the relationship between contrast effects and other extralegal factors that have been the subject of previous research inquiries.” (p. 36)

“Finally, it is still unclear how powerful contrast effects are in relation to judicial factors like strength of evidence, and further study is necessary to determine the factors increase the likelihood of reliance on heuristic processing in legal contexts.” (p. 36)

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Authored by

Kseniya Katsman is a Master’s student in Forensic Psychology program at John Jay College of Criminal Justice. Her interests include forensic application of dialectical behavior therapy, cultural competence in forensic assessment, and risk assessment, specifically suicide risk. She plans to continue her education and pursue a doctoral degree in clinical psychology.

“That Was a Challenging Interview!” A Guide for Interviewing Individuals Given a Diagnosis of a Personality Disorder in Forensic Settings

Histories of complex trauma and insecure attachment are widespread among individuals given a diagnosis of personality disorder in forensic settings and are likely to be underlying factors that contribute to their offending behavior. It is important to bear this in mind when working with this population in order to formulate accurate profiles and engage in a more effective interview process. We present several principles for the effective interviewing of individuals given a diagnosis of personality disorder in forensic settings. This is the bottom line of a recently published article in the International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health | 2019, Vol. 17, No. 4, 338-350

Interviewing people given a diagnosis of personality disorder in forensic settings


Phil Willmot, School of Psychology, University of Lincoln, Lincoln, UK
Sue Evershed, School of Psychology, University of Lincoln, Lincoln, UK


Extensive histories of complex developmental trauma and insecure attachment are widespread among people given a diagnosis of personality disorder in forensic settings, and are likely to be important predisposing factors that contribute to their offending behavior. In working with this population, it is important to bear this in mind, and helpful to formulate clients’ challenging behaviors as a set of learned responses to perceived threat, or as survival strategies. Such an approach not only makes the interviewing process more effective, it also helps to avoid perpetuating destructive patterns of behavior and relationship between forensic clients and people in authority. We present seven principles for effective interviewing with this population: (a) careful preparation; (b) a constant focus on the therapeutic relationship; (c) providing structure and containment; (d) adopting a flexible approach; (e) managing therapy-interfering behaviors; (f) obtaining supervision; and (g) adopting a whole-team approach.


Personality disorder, interviewing, power threat meaning framework

Summary of the Research

“…The consensus statement for people with complex mental health difficulties who are diagnosed with a personality disorder uses the term ‘people given a diagnosis of personality disorder.’ We use the term throughout this article as it is neutral as to the value or legitimacy of the label, while reflecting the fact that a diagnosis has been made, and that it is ‘given’ by others, but not necessarily accepted by the person…While interpersonal dysfunction may be common among people given a diagnosis of personality disorder, the anti-authority attitudes of forensic clients often make relationships with people in authority particularly problematic…” (p.338-339)

“As an alternative to traditional medical diagnostic categories, the Power Threat Meaning Framework (PTMF)…has been developed to enable ‘the construction of non-diagnostic, non-blaming, de-mystifying stories about strength and survival, which re-integrate many behaviors and reactions currently diagnosed as symptoms of mental disorder…’ The PTMF suggests several provisional general patterns of meaning-based threat responses to power…they represent patterns in the meaning of threat and the function of the threat response…Using the PTMF, we propose that, for clinicians working with such individual in forensic settings, personality disorder is best understood as a set of learned responses to perceived threat, or as survival strategies for keeping physically and psychologically safe in interpersonal environments that are seen by the individual as dangerous, hostile, abusive, or neglectful. Common survival strategies in forensic settings include, emotional detachment, hypervigilance to threat, hostility, and aggression…” (p.339-340).

“Perhaps the most obvious difficulty in interviewing this client group is the wide range of challenging or therapy-interfering behaviors with which they can present, both within and outside the session…Schema mode theory…describes these survival behaviors as coping modes and divides them into three categories: avoidant, over-compensatory, and surrender…People given a diagnosis of personality disorder rarely have a single mode of presentation. More often they will switch between several of these, sometimes in quick succession…Once identified, many of these can be offset or minimized by flexible planning, careful presentation of the process, and contracting that is sensitive to the client’s needs” (p.341-342).

Translating Research into Practice

“Arguably, all therapeutic approaches developed specifically for people given a diagnosis of personality disorder stress the importance of the therapeutic relationship. With forensic clients given a diagnosis of personality disorder this can often be the key issue in the success of the intervention…On the basis of their past experiences, clients may approach interviews with the expectation of being rejected, abused, or misled, and may respond in a hostile or defensive manner in anticipation of such treatment. By anticipating such negative responses, the interviewer can guard against responding punitively to the client’s hostility or avoidance. We have found it helpful to preempt such responses by starting the interview process with a discussion of the client’s previous experiences of interviewing, and asking what they found helpful and unhelpful in previous interviews” (p.342).

“As with any therapeutic relationship, the key facilitative conditions of empathy, congruence, and positive regard identified by Rogers (1957) are essential in working with forensic clients given a diagnosis of a personality disorder…Clients are unlikely to relate to an interviewer who feigns views they do not hold or who offers only the professional aspect of themselves. This does not imply the need for boundary breeching, but it does require the interviewer to be ‘real’ or ‘radically genuine’…having a relatively active therapist, a clear structure, and setting limits on unacceptable client behavior are uniquely important in working with people given a diagnosis of personality disorder” (p.342-343).

“Establishing and maintaining motivation and hope are essential if clients are to engage and stay engaged. However, low motivation and feelings of helplessness are common in this client group, with their histories of frequent conflict with authority and disengagement from services. Clinicians need to make extensive use of motivational interviewing techniques…to maintain a commitment to change…At times when motivation is poor, clinicians should maintain a supportive stance and attempt to reinforce motivation by exploring the consequences of maladaptive behavior, rather than adopting a more confrontational and challenging approach which is likely to further damage the therapeutic relationship and increase reactivity” (p.344).

“…Clinical supervision can also offer a restorative function for interviewers, particularly when faced with some of the more distressing an anxiety provoking behaviors…while the observation of personal limits is recommended to prevent frustration and burn out, it is also acknowledged that interviewers’ personal limits may change over time and in the face of competing demands…The process of understanding and accepting personal limits, and observing them but allowing considered extensions is best done within a supervisory context…” (p.346).

“It is inevitable in teams that different team members with different roles and different personalities will trigger different responses in individuals given a diagnosis of personality disorder. Often forensic clients, with insecure attachment patterns and long histories of conflict with authority figures, will tend to dichotomize clinicians into ‘good’…and ‘bad’…and to treat them accordingly. It is important that clinicians recognize that such thinking and behavior is, first and foremost, a transference response…Teams should ensure that their behavior toward the client does not inadvertently reinforce the client’s dichotomous thinking…by ensuring that it is not always the ‘good’ staff who give the client positive feedback and not always the ‘bad staff’ who carry out ‘custodial’ roles…Above all, team members should avoid criticizing their colleagues in front of clients, or appearing to agree with criticism of colleagues by not challenging it. It should be made clear to clients that team decisions are made by the whole team, not by individuals…(p.347).

Other Interesting Tidbits for Researchers and Clinicians

“…Most of the therapeutic models used to make sense of the client’s presenting problems focus on an underpinning structure of maladaptive thoughts, feelings, and behavioral patterns. Without structure, there is a danger that the therapist will simply end up reacting to the client’s shifting and dysfunctional coping behaviors. If this prevents the clinician from discussing difficult or distressing issues, then this risks negatively reinforcing those behaviors. For clients with a history of abuse, structure and predictability can reduce feelings of uncertainty and predictability. It can also enable the clinician to model a relationship in which the client is able to feel contained without feeling controlled or manipulated” (p.343).

“The goals of forensic clients and what they perceive to be the interviewer’s goals may at times be very different. Particularly if the client has previous negative experiences of services, professionals, and authority, his/her own primary goals may be about survival…while their perceptions of the interviewer’s primary goals may be colored by their previous negative experiences…Clients may also be reluctant to give up behaviors that others see as dangerous and dysfunctional, such as self-harm or aggressive behavior, if those behaviors have survival value for them. It is particularly important with this client group to begin a discussion about treatment goals by asking the client what he/she wants to change. Acknowledging that dysfunctional behaviors can have value to the client may enable the client to explore the costs of these behaviors and to consider how they could be modified” (p.344).

Join the Discussion

As always, please join the discussion below if you have thoughts or comments to add!

Authored by Amber Lin

Amber Lin is a volunteer in Dr. Zapf’s research lab at John Jay College of Criminal Justice. She graduated from New York University in 2013 with a B.A. (honors) and is a second year Masters student at Fairleigh Dickinson University. Her research interests include forensic assessment, competency to stand trial, and the refinement of instruments used to assess the psychological states of criminal defendants.

A Cautionary Tale: Issues to Consider when Interviewing Individuals with Autism Spectrum Disorders in Forensic Contexts

Many features associated with Autism Spectrum Disorders (ASD), such as emotional regulation issues or difficulties with social communication, may raise significant issues during formal interviews with individuals with an ASD. This is particularly true in forensic contexts, when individuals with an ASD may be interviewed as a witness, victim or perpetrator of an offense. Using the available literature and clinical experience, this article summarizes some key issues and possible solutions related to conducting forensic interviews with adults who have ASD. This is the bottom line of a recently published article in the International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health| 2018, Vol. 17, No. 4, 310.320

Interviewing individuals with an autism spectrum disorder in forensic settings


David Murphy, Department of Psychology, Broadmoor Hospital, Crowthorne, UK


Autism spectrum disorders (ASD) encompass the neurodevelopmental conditions including autism, atypical autism, high functioning autism, and Asperger’s syndrome. In addition to difficulties with social communication, reciprocal social interaction and within different dimensions of imagination, individuals with an ASD typically present with sensory hypersensitivities, a specific cognitive style and characteristics, emotional regulation issues, as well as other co-morbid neurodevelopmental or psychiatric conditions. All these features can raise significant issues when formally interviewing an individual with an ASD, especially within forensic contexts where individuals may be interviewed as a witness, victim or perpetrator of an offense for a range of reasons. To date, there has been limited discussion in the literature regarding how the difficulties associated with having an ASD and co-morbidities can impact on forensic interviews. Using the available literature and clinical experience this article summarizes some key issues and possible solutions related to conducting forensic interviews with adults who have ASD.


Autism spectrum disorders, forensic interviews, assessments

Summary of the Research

“Autism Spectrum Disorders (ASDs) refer to a broad group of neurodevelopmental disorders including Asperger’s syndrome, high functioning autism, autism, and atypical autism…It is also very common for individuals with an ASD to present with other neurodevelopmental disorders such as attention deficit hyperactivity disorders and intellectual difficulties, as well as neurological issues such as epilepsy and other sensory difficulties related to vision and hearing. For some individuals, comorbid psychiatric disorders including anxiety, obsessive compulsive disorder, psychosis, or a personality disorder may be present, as well as psychopathy for a small few. Indeed, some published literature reviews suggest that individuals with an ASD who commit violent offenses and who are admitted to forensic psychiatric units often display rates of psychiatric co-morbidity” (p.310).

“In some forensic cases, the implications of psychiatric co-morbidity are that it can not only complicate the process of obtaining a reliable diagnosis of an ASD, but it can potentially make understanding the reasons or motives behind an individual’s behavior difficult…While it is generally accepted that the majority of individuals with an ASD are law abiding, individual experiences vary enormously and for some they may be a witness, victim or perpetrator of an offense…there is no evidence to suggest that individuals with an ASD are more likely to offend than so called ‘neurotypical’ individuals…Although there are many reasons why an individual with an ASD may struggle within the CJS…most appear directly related to the associated interpersonal communication difficulties, as well as the thinking styles and sensory hypersensitivities that impact on every day functioning” (p.311-312).

“The aim of this article is to outline some key issues linked to formally interviewing someone with an ASD in a forensic context and offer practical guidance to the interviewer on how to address them…Individuals with an ASD can present with a range of unusual sensory hypersensitivities or hyposensitivities across several sensory areas…While most individuals with an ASD can articulate their distress in response to sensory hypersensitivities, in other circumstances, sensory sensitivity in some individuals with an ASD can result in so-called ‘meltdowns’ where in response to being overwhelmed with sensory stimulation an individual may react either aggressively, shut down, or have difficulty processing information…” (p.313-314).

“In some forensic situations such reactions to sensory overload can potentially be misinterpreted by interviewers such as the police or courts as indications of guilt or a reflection of deliberate antisocial and anti-authoritarian behavior. Avoiding direct eye contact with others has also been described by many individuals with an ASD seen by the author as a way of minimizing sensory overload…While eye contact avoidance may be obvious at the beginning of an interview, other sensory issues may not. Where possible it is therefore very helpful to establish beforehand an individual’s ‘sensory profile’ questionnaire. The information derived from these assessments may allow appropriate environmental adjustments to be made…Failing to consider an individual’s possible sensory hypersensitivities by not creating a ‘low-impact environment’ could restrict an individual’s ability to engage with the interview process and potentially result in high anxiety and distraction, with the result that an individual is less able to provide or retain information” (p.314).

“…Individuals with an ASD can present with a high range of interpersonal communication difficulties and a particular cognitive style (notably being extremely literal in the interpretation and provision of information, as well as experiencing difficulties with central cohesion…). All of these can have a significant impact on an interview and potentially result in the interviewer or observer forming an inaccurate impression of an individual’s understanding or presenting behaviors…If present, such behaviors may also give the false impression to interviewers who are unfamiliar with potential behaviors associated with having an ASD that individuals are not taking an interview seriously, are indifferent, arrogant or even callous. Such presentations may be particularly significant in forensic contexts such as police interviews or courtrooms where jurors or members of the judiciary…may form negative impressions” (p.314-315).

“While the language used and questions put to any individual during an interview can be significant, the language and questions directed at an individual with an ASD may require particular attention and preparation…While the general aim of any interview should be to adopt a clear structure and logical order…there may be a particular need to avoid questions or statements that could be potentially ambiguous in interpretation. Metaphors and sarcasm should also be avoided, as should any non-literal language and those questions that require some form of inference, insinuation, deduction, or abstractive extrapolation” (p.315-316).

Translating Research into Practice

“This article highlights the social communication and reciprocal social interaction difficulties, as well as a range of other cognitive, sensory, and emotional regulation characteristics, associated with having an ASD (most of which are not immediately obvious to an observer) that can make formal interviews potentially difficult…When psychiatric co-morbidity is present or suspected, the potential for misdiagnosis is increased, as is the complexity of assessing culpability and intent. An interviewer should therefore attempt to be familiar with the presenting characteristics associated with several conditions or seek advice from a suitably qualified colleague” (p.316-317).

“…while there are some general difficulties associated with having an ASD, every individual should also be considered unique with regard to their circumstances and specific profile of cognitive, sensory, and emotional characteristics, especially so when there may be co-morbid conditions present. While interviewing training in ASD is an important part of improving ‘outcomes’ of formal interviews and challenging stereotypes of what individuals with an ASD can and cannot do, much also remains to be understood about which assessment and therapeutic approaches best suit individuals with an ASD. For example, there may be particular subgroups of individuals with an ASD who benefit from different interviewing styles and techniques…The potential role of technological aids such as tablets and lap tops in facilitating communication within interviews also remains to be explored…” (p.317-318).

Other Interesting Tidbits for Researchers and Clinicians

“Although general good practice should be that leading questions should also be avoided during interviews…both clinical experience and some studies…suggest adults with an ASD are not especially vulnerable to suggestibility per se when tested using the Gudjonsson Suggestibility Scales 2…it is…questionable as to whether the findings from these studies can be applied to actual forensic cases and especially those with co-morbid psychiatric disorders and other neurodevelopmental disorders. Of interest, but not consistent with clinical experience, is the finding from the adult studies that while individuals with an ASD were no more suggestible than individuals without an ASD, they rated themselves to be significantly more compliant…in the author’s experience with forensic cases there is rarely any particular tendency towards wishing to please the interviewer or necessarily to portray a more socially desirable image” (p.316).

Join the Discussion

As always, please join the discussion below if you have thoughts or comments to add!

Authored by Amber Lin

Amber Lin is a volunteer in Dr. Zapf’s research lab at John Jay College of Criminal Justice. She graduated from New York University in 2013 with a B.A. (honors) and is a second year Masters student at Fairleigh Dickinson University. Her research interests include forensic assessment, competency to stand trial, and the refinement of instruments used to assess the psychological states of criminal defendants.

Letting them speak: Analysis of victim impact statements in capital sentencing proceedings

Victim impact statements are much less instigative than commonly thought, with prosecutors having a great influence over the witness statements. This is the bottom line of a recently published article in Psychology, Public Policy, and Law. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | Psychology, Public Policy, and Law | 2018, Vol. 24, No. 4, 474–488

The heterogeneity of victim impact statements: A content analysis of capital trial sentencing penalty phase transcripts


Bryan Myers, University of North Carolina Wilmington
Narina Nuñez, University of Wyoming
Benjamin Wilkowski, University of Wyoming
Andre Kehn, University of North Dakota
Katherine Dunn, American University


Victim impact statements (VISs) are controversial in capital sentencing proceedings largely due to their questionable relevance to sentencing, the concern that characterizations of the victim may lead to arbitrary sentencing judgments, and the belief that the emotional nature of this evidence may be inflammatory. A sample of 192 capital trial VIS transcripts was analyzed for content as well as a linguistic analysis of emotionality. The findings reveal that these statements are highly varied, including their format, length, and relation between the witness and the victim. Despite a legislative mandate that they address the emotional, financial, and physical suffering experienced by victim survivors, testimony of this nature occurs in a minority of the cases. Most commonly, these statements tend to characterize the victim and their qualities, relay the witness’ shock at first learning of the victim’s death (i.e., trauma narratives), and address the significance of the deceased to the family unit. In approximately one third of the transcripts reviewed, the witness made mention of the defendant, but this rarely included any mention of a desire for vengeance or recommended punishment. Linguistic analysis revealed that emotional content was prevalent throughout the testimony, with sadness emerging as more pervasive than anger. However, the degree of emotional language contained in these statements was not particularly high—and was comparable to that typically encountered in everyday life (e.g., newspapers, novels). Implications, particularly with regard to the potential for VISs to be considered inflammatory, are discussed.


victim impact statements, capital sentencing, content analysis, juror decisions, emotions and judgment

Summary of the Research

“Victim impact statements (VISs) refer to statements given either in writing or orally that detail the impact of the defendant’s crime on victims. In capital trials, this testimony is delivered by victim survivors who have included members of the decedent’s family, but they have also been presented by friends, coworkers and even emergency first responders. VISs are often described as educating the jury concerning both emotional as well as financial hardships that have arisen as a direct consequence of the loss of the victim. […] VISs in capital sentencing proceedings are controversial for a number of reasons, but chief among these issues are their relevance to the sentencing decision and the potential that their emotional nature may interfere with jurors’ capacity to decide in a reasoned and impartial manner.” (p. 474)

“Some early research has indicated that factors surrounding the victim such as their likability has been related to punishment or judgments relevant to sentencing. This pattern has been uncovered in actual trials where less reputable victims promote greater leniency toward the defendant. In studies explicitly examining VISs and victim qualities, we again see evidence that qualities of the victim matter to jurors.” (p. 475)

“Researchers have therefore sought to determine the effects of VISs on sentencing judgments, with a particular focus on whether VISs elicit strong emotions in jurors and whether these emotions are related to sentencing judgments. Early studies in this area failed to uncover a clear pattern suggesting that VISs elicit strong emotions and that these emotions interfere with reasoned decision making. The failure to uncover these effects, however, may have been due in part to a failure to distinguish between emotions of anger and sadness. […] The importance of measuring discrete emotional states finds support in social cognition research on emotions and judgment where repeated findings have emerged that anger and sadness produce differential effects on judgments. […] The research on mood and judgment fail to confirm the broad characterizations voiced by legal commentators who describe all emotions as antithetical to reason.” (p. 476)

“Jury simulation studies that have assessed discrete emotions have tended to produce findings consistent with those in the emotions and judgment literature whereby anger is associated with more punitive responses in jurors. […] The findings thus far provide empirical support to the contention that (a) VISs do elicit emotions in jurors, and (b) anger and not sadness has been linked to sentencing decisions.” (p. 475)

“This empirical evidence addressing the effects of VISs that elicit emotions in jurors is critical to determining whether VISs can be considered inflammatory. However, it is equally important to determine whether emotions such as anger and sadness are typically present in VISs. How typical is emotional content in VISs? In addition, while simulation studies show the importance of victim character on sentencing, it is not clear that character information frequently accompanies VISs. The present content analysis of transcripts of VISs is designed to address these gaps in our information on VISs. Moreover, a content analysis of VISs also affords the opportunity to judge whether simulation research conducted thus far, in general (and not just the research addressing emotionality and character), adequately reflect the VISs jurors typically encounter in actual trials.” (p. 475)

“We examined admissibility status of VISs for all 31 states that currently allow the death penalty, relying on Sanderford (2012) and www.deathpenalty.org as sources. […] Given the wide latitude with regard to the format of VISs, the number of witnesses who may offer testimony, and the general lack of guidance or restrictions surrounding who may testify, the length of their testimony, or the content of the testimony, it is clear that VISs have the potential to vary greatly from case-to-case. It is therefore critical to carefully examine these differences in the administration of VISs and the content of VISs to better establish the degree to which the jury simulation research adequately reflects current practices.” (pp. 476–477)

“In the present study, we obtained trial transcripts from a large number of capital trials (n = 131) which yielded a large number of VIS transcripts (75 cases with 192 VIS statements). One goal of the present investigation was to get a clearer picture of common elements found in VISs in capital sentencing cases. […] A second goal of the present study was to address the degree of emotionality contained within VISs.” (p. 477)

“In addition to some demographic and procedural questions (e.g., gender of witness, relation of witness to victim, VIS length, manner in which the VIS was introduced), the present investigation further identified a number of content areas that are of greatest relevance to the VIS debate: (a) financial harm, (b) physical harm, (c) psychological harm, (d) family significance of victim, (e) victim character, (f) expressed emotions, (g) referencing the defendant, (h) dehumanizing the defendant, (i) describing the crime, and (j) recommended punishment.” (p. 478)

“Analysis of 192 capital trial VIS transcripts revealed substantial variability in the statement content, highlighting the fact that no single study on VISs could adequately represent the information jurors experience in capital trials.” (p. 483)

“With regard to witness characteristics and procedural issues surrounding VIS presentation, the findings revealed that witnesses were nearly three times as likely to be female than male, they were most frequently a parent, and the question-and-answer format occurs approximately 2.5 times more often than the free-narrative format. Surprisingly, the free-narrative format is not more common than a postsentencing VIS delivered to a judge with the jury out of the room.” (p. 483)

“In terms of some commonalities in content, looking across all formats, VISs regularly contain characteristics of the victim, and expressions of the emotional suffering the victim survivors have experienced arises frequently. […] the analysis of the 192 VIS transcripts revealed that any mention of the defendant, including the witness using dehumanizing terms regarding the defendant as well as any recommendations for punishment, are very rare events—happening in less than one in every 10 cases. As a general rule, VISs tended to focus on the qualities of the victim that will be missed, and how the survivors were dealing with their grief. […] none of the content categories differed in frequencies across the sentencing outcomes. In fact, in almost all cases, life and death cases were remarkably similar in the VIS content. The lone exception was the likelihood that the testimony included how the survivor learned of the victim’s death. These narratives were more than twice as likely to arise in death cases than in cases leading to a life sentence, although this difference failed to reach statistical significance.” (pp. 483–484)

“In the present content analysis, mention of the victim and their personal qualities was common. In more than half the transcripts, the description of the victim focused chiefly on how their loss was likely experienced by the surviving family. […] Descriptions of the victim’s reputation in the community, or their social standing, were infrequently present in the VIS testimonies; occurring in less than one in every six transcripts. […] Looking across VIS formats we see that descriptions of the victim characteristics occur significantly less frequently in cases where the jury is not present. Perhaps letting the jury see the victim as more than a “faceless stranger” may be regarded by victim survivors as more pertinent than providing this information before a judge.” (p. 484)

“The data reveals that in approximately two thirds of the cases we reviewed, witnesses sought to convey the emotional suffering they experienced as a result of the crime. The emotional devastation associated with the death of a loved one is frequently conveyed through a description of the experience in which the witness first learned that the victim had been killed. These trauma narratives are relatively descriptive and delivered in a manner that promotes the likelihood that the jury will take their perspective and imagine what it would be like to learn this tragic news. In many cases, this testimony was prompted by the prosecutor, who specifically asked the witness to relay this information. Thus, these trauma narratives were more likely to be present in the question-and-answer VIS format.” (p. 484)

“A linguistic frequency analysis revealed that emotional content regularly occurred throughout VIS testimony, and sadness terms were 44% more prevalent than angry terms in these testimonies. However, the overall level of emotionality in these transcripts indicated that less than 0.5% of all words were angry, and only slightly more than 0.5% were sad. Consequently, concerns that the overall level of emotionality present in VISs is excessive could benefit from some perspective. […] While emotional language does find its way into VIS testimony, the overall level of anger and sadness does not distinguish it from levels present in other contexts encountered in everyday life.” (p. 484)

“With the exception of postsentencing testimony where the witness addresses the court and the defendant, but after the jury has already rendered a sentencing recommendation, a VIS was significantly more likely to contain sad content than angry content. […] The tendency for the prevalence of anger and sadness to vary as a function of whether the testimony is given pre- or postsentencing may be partly a function of the degree to which courts have limited the content of the testimony when presented in front of jurors, and partly a function of who the testimony is directed toward.” (p. 484)

“The relation between sentencing outcome and the degree to which the VIS terms reflect anger and sadness was examined, and there was little evidence in the present study to indicate higher levels of anger are associated with greater frequency of death penalty judgments. Indeed, the zero order correlations suggested that sadness might be a predictor of sentence, and it was positively related to life-sentences. This is inconsistent with the jury simulation research findings, and the small sample of independent cases and our inability to control for a number of important predictors of sentencing would suggest that future research is warranted.” (p. 485)

“In conclusion, the present investigation suggests that jury simulation research on VISs deviate from the “typical” VIS testimony in a variety of ways including the relation between the victim and the witness, the number of witnesses, and the format in which the VIS is presented. The question-and-answer format is most common, and suggests the prosecutors who direct the questioning have great influence on what information the jury hears during a VIS. In most instances, they direct witnesses to convey the emotional toll experienced by the victim survivors in dealing with their loss, and convey to the jury the personal qualities of the deceased. Very rarely do they address the defendant or allow witnesses to vent their anger toward the defendant. Anger is far less prevalent in VIS testimony than is sadness, and when anger is more common, it typically occurs when the jury is not present and therefore not in danger experiencing the prejudicial effects of this testimony.” (p. 486)

Translating Research into Practice

“The findings here suggest a number of changes that would be necessary for simulation research to better represent VISs that occur in actual trials (e.g., witness characteristics, examples of content). However, it is also important to identify areas in which existing policies concerning VISs may be discordant with the research findings, as well as highlighting findings that support existing practices. The chief issue of contention regarding VISs in capital sentencing concerns its relevance to the sentencing process.” (pp. 485–486)

“Whether victim character information should be heard and whether it is appropriate for testimony that is emotional to be present when jurors decide punishment are legal questions that cannot be answered by jury decision making researchers. Instead, the appropriate role here is for psychology to inform the debate by answering relevant empirical questions such as whether victim character information influence how jurors decide punishment, and which specific emotions lead to harsher sanctions. The findings in the present investigation are meant to shed some light on whether the kinds of studies researchers are conducting in the laboratories are reflective of the kinds of VIS evidence typically present in the courtroom.” (p. 486)

“The present findings indicate that while emotional language does populate VIS testimony, sadness is present much more commonly than is anger, which was encountered in less than one half of one percent of all words in the VIS.” (p. 486)

“If courts are concerned about the emotionality of VISs, one practical way to limit the degree to which anger is introduced into the courtroom is through the format by which the VIS is presented. As we noted, free-narrative format is much less common than a question-and-answer format whereby the prosecutor directs the testimony of the witness. Linguistically, anger was most common in the postsentencing format when the jury had already made their sentencing recommendation to the court. Anger was much lower during the penalty phase, with the lowest anger scores occurring for the question-and-answer format. Limiting VISs to this format may be one approach to limit the anger expressed in the testimony, and this format also affords the judge an opportunity to halt proceedings before a witness answers if the question posed by the prosecutor is judged to likely promote an angry response from the witness (e.g., if a prosecutor asked witness if they had something to say to the defendant). Consequently, this format allows victims to speak before the jury, but it does not give them free rein. Limiting this opinion testimony may allow the court to limit the degree of anger present in the VIS.” (p. 486)

“Our present findings suggest that any mention of the defendant is extremely rare, and calls for punishment are rarer still. Less can be said about the potential impact of this information on jurors, as researchers have still not systematically varied the opinions offered for punishment to determine if they do indeed influence sentencing judgments. However, it is perhaps worth noting that a VIS itself typically fails to produce strong effect sizes in simulation studies, and the most reliable effects occur when VISs provoke an anger response in participants. Going forward, systematically studying how statements directed at the defendant that specifically request harsh punishments would better inform decisions regarding the prejudicial effects of this testimony. Importantly, in the present investigation, any comments directed specifically at the defendant occurred vary rarely, and when it did, it was most likely when the jury was not present to hear the testimony.” (p. 486)

Other Interesting Tidbits for Researchers and Clinicians

“The manner in which we structured this content analysis merits attention. A top–down approach to the content analysis (sometimes referred to as directed or deductive) was used in the present investigation. […] This can be contrasted with a bottom–up approach (sometimes referred to as inductive, conventional, or grounded theory) where the materials would first be examined for important themes that arise, without any preconceived notions about the content areas examined. […] it could be argued that our analysis missed some important themes that characterize the nature of VISs in capital sentencing proceedings.” (p. 485)

“For the present investigation, this directed approach focused on the analysis of specific content that would best inform researchers who investigate the effects of VISs on jurors, and that would address issues of contention among legal commenters with regard to the constitutionality of VISs. […] An approach driven by the content of the transcripts rather than the specific a priori factors identified by investigators would likely yield a different picture of what constitutes typical VIS testimony.” (p. 485)

“A second limitation with the present investigation was the sampling method used to obtain VIS transcripts. The sample obtained was not random, but rather was a convenience sample drawn from all death penalty cases tried that year. […] An additional limitation is that while the outcome of the case (life or death) was not discussed as a hypothesis for our study with coders, they were nevertheless not kept blind to the outcome of the case.” (p. 485)

“Our study focused on VISs in death penalty cases that have been tried in the United States. Thus, we cannot speak to VISs that might be presented in noncapital cases or VISs presented in other countries that allow VISs (e.g., Australia, or the United Kingdom). However, with regard to VISs that are presented in death penalty cases, our work may be particularly relevant, given that the United States is the only known country that allows both the death penalty and VISs.” (p. 485)

“Lastly, our analysis of the level of emotionality in VISs fails to address subtle factors that likely play a significant role in how moving testimony may be for a given juror. […] This is an initial attempt at trying to measure the content of VISs, and so we encourage further research that takes alternative approaches to measuring the emotional impact of VISs.” (p. 485)

Join the Discussion

As always, please join the discussion below if you have thoughts or comments to add!

Authored by Kseniya Katsman

Kseniya Katsman is a Master’s student in Forensic Psychology program at John Jay College of Criminal Justice. Her interests include forensic application of dialectical behavior therapy, cultural competence in forensic assessment, and risk assessment, specifically suicide risk. She plans to continue her education and pursue a doctoral degree in clinical psychology.

It’s difficult, but you are doing a great job: The effect of interviewer’s support on child abuse victim’s reluctance in interviews

Interviewer’s support can mitigate child abuse victim’s reluctance, thus increasing the informativeness of the interview. This is the bottom line of a recently published article in Psychology, Public Policy, and Law. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | Psychology, Public Policy, and Law | 2018, Vol. 24, No. 4, 518–527

Support, reluctance, and production in child abuse investigative interviews


Uri Blasbalg, University of Haifa
Irit Hershkowitz, University of Haifa
Yael Karni-Visel, University of Haifa


Child abuse victims are required to participate in stressful forensic investigations but often fail to fully report details about their victimization. Especially in intrafamilial abuse cases, children’s emotional states presumably involve reluctance to report abuse. The current study examined the effects of interviewers’ support on children’s reluctance and production of information when interviewed. The sample comprised 200 interviews of 6- to 14-year-old suspected victims of physical abuse perpetrated by a family member. Interviews followed the NICHD (National Institute of Child Health and Human Development) Revised Protocol (RP), which emphasizes supportive practices. All the cases were corroborated by external evidence, suggesting that the reports of abuse made by the children were valid. Coders identified instances of interviewer support and questioning, as well as indications of reluctance and the production of forensic details by the children. Expressions of reluctance predicted that information was less likely to be provided in that utterance, whereas expressions of support predicted less reluctance and increased informativeness in the following child utterance. Mediation analyses revealed that decreased reluctance partially mediated the effects of support on increased informativeness. The data indicate that support can effectively address children’s reluctance, resulting in increased informativeness and thus confirming expert recommendations that supportive interviews should be considered best practice. The findings also shed light on the underlying mechanism of support, suggesting both direct and indirect effects on children’s informativeness.


forensic interviewing, child physical abuse, reluctance, support, informativeness

Summary of the Research

“Many suspected child abuse victims either do not disclose their abusive experiences at all or else provide limited descriptions when formally interviewed. Recent research has suggested that supportive interviewing can help reduce children’s reluctance and enhance their cooperation during forensic interviews. However, the effects of interviewers’ support with reluctant children during the substantive phase of such interviews, in which children are requested to describe the alleged abusive incidents in detail, remain unexplored. The current study tests the effect of support on (a) children’s reluctance and (b) children’s production of forensically relevant information during the substantive phase of forensic interviews.” (p. 518)

“Reluctance to disclose abuse is associated with factors such as a child’s age, gender, and abuse type and severity, as well as interview practices and relationship to the suspect. The relationship to the suspect was found to have a significant impact on children’s reluctance in investigative interviews, with low disclosure rates (as low as 50%) when intrafamilial abuse is suspected. Children often avoid disclosing abuse by family members, possibly due to their tendency to protect them or to comply with requests for secrecy.” (p. 518)

“Although many children avoid disclosure of intrafamilial abuse, children who do disclose may continue to show reluctance, compromising their forensic testimony. […] Recognizing that children’s reluctance may prevent them from reporting abuse, researchers have explored interviewers’ demeanor in response to children’s reluctance. Several studies have shown that interviewers reacted counterproductively when they encountered reluctance—by asking intrusive questions, being unsupportive, replying negatively, or prematurely engaging in the discussion of sensitive topics related to the suspected abuse, all of which may have aggravated reluctance. The researchers suggested that, when there are signs of reluctance, interviewers should provide support and avoid asking about the possible abuse, because they risk increasing the children’s reluctance” (p. 519)

“Supportive communication involves directing open, welcoming, attentive behavior toward the interviewee to foster a feeling of well-being. However, it is difficult to generalize findings regarding interviewer support, because the operationalization and measurement of support varies considerably. […] The advantageous effects of support on cognitive performance and interview outcomes were first established in analog studies involving nonreluctant children. […] Support was also associated with accurate reporting. […] scholars have revised the Standard NICHD (National Institute of Child Health and Human Development) Investigative Interview Protocol (SP) to promote supportive interviewing. The Revised NICHD Protocol (RP) includes adjustments that emphasize rapport building and support.” (p. 519)

“In sum, previous research has shown that interviewer support (particularly in RP interviews) has advantageous effects on reluctant children. However, direct effects have been identified in only the presubstantive and transitional parts of the interview but not during the substantive phase of forensic interviews, during which details about the abuse are discussed. Accordingly, the current study explored whether support provided in the substantive phase of investigative interviews affected children’s informativeness and whether this effect was mediated by decreased reluctance. The effects of support were tested at the utterance level, using sequential analyses to explore whether specific behaviors (e.g., reluctance or informativeness) were more or less likely to be elicited by other specific behaviors (e.g., interviewer support), thereby elucidating the direction of effects.” (p. 520)

“Two hundred interviews with children (44.0% girls), ages 5.8–13.9 years (M = 9.69, SD = 2.09) who disclosed intrafamilial physical abuse were collected from all regions of Israel. In most cases, children reported multiple (91.0%) rather than single incidents of abuse inflicted by their parents (83.0%) rather than by other family members. Severe abuse using an object or resulting in an injury was reported in about half of the cases (50.1%), whereas hitting was reported in the other half. The interviews were conducted during an 19-month period by specialist forensic interviewers from the Israeli Ministry of Welfare and Social Services. The investigators were intensively trained to use the RP protocol, which emphasizes supportive interviewing. Interviews selected for this study were the first that met the inclusion criteria: The interviews were conducted in an educational setting (to avoid possible intervention of the perpetrator), and the allegations were supported by external evidence (eyewitnesses, 57.5%; visible signs of violence, 10.5%; medical examination, .5%; suspect’s admission, 6.5%; or preinvestigation disclosures to a professional, 25%). Thirty-four percent of the cases were validated in more than one of these ways.” (p. 520)

“In the RP, to enhance children’s emotional comfort, trust, and cooperation, the rapport building precedes (rather than follows) an explanation of the ground rules, and interviewers are encouraged to use supportive statements, such as welcoming the child, showing an interest in the child’s neutral experiences, and exploring the child’s feelings, while reinforcing effort and cooperation (but not content). The RP also encourages the interviewer to respond to reluctance and emotional expressions made by the child with supportive comments throughout the interview and offers an inventory of nonsuggestive yet supportive statements of several different types: expressions focused on building rapport with the child (“Good to meet you,” “I want to know you better,” “Would you like a glass of water?”), emphasis on the interviewer’s trustworthiness (“I am here to listen to you,” “My job is to speak with children”), positive reinforcement of the child’s efforts (“You are telling very clearly,” “Thank you for sharing with me”), emotional support (echoing–acknowledging– exploring the child’s expressions of reluctance and emotions by saying, e.g., “You say you feel embarrassed to speak about [content mentioned]; tell me more about that”), and encouragement (“It’s important that you tell me everything you remember as well as you can”).” (p. 520)

“In the current study, we found that children’s reluctance decreased when interviewers were supportive and that this enabled children to provide more forensically relevant information. The findings add to the understanding in several important ways. First, the inverse nature of the relationships between the reluctance and informativeness of children was reestablished, indicating that reluctance is associated with the production of less forensically relevant information. […] Second, this study went a step further by showing that the association between reluctance and uninformative responding is dynamic and can change from one exchange to the next, during the course of the interview. Our findings showed that, when a child’s reluctance decreased, informativeness tended to increase. In addition, an interaction between decreased reluctance and being asked a question by the interviewer resulted in additional informativeness, suggesting that efforts should be made to reduce reluctance so that questioning can be more effective. […] Third, this study established that responding to expressions of reluctance with support effectively manages reluctance.” (pp. 522–523)

“Fourth, the provision of support not only yielded decreased reluctance but also increased informativeness. […] Our findings suggest that, under supportive conditions, reluctant children can retrieve and report more information and provide more powerful statements than when interviewed nonsupportively. Thus, supportive interviewers may help children to describe their abusive experiences despite their reluctance to talk about their parents’ behavior. Support complemented the positive effects of developmentally appropriate questioning.” (p. 524)

“The present study not only provided important insights into the effect of support but also shed light on the underlying mechanism by which support operates. Some researchers have shown the direct effects of support on cognitive performance, whereas others have claimed that the effects were mediated through emotion regulation. Proponents of the mediation model have suggested that support may help children process and cope with negative emotions, thereby freeing cognitive resources to focus on the interview task, but this hypothesis has not previously been tested in studies using forensic interviews. […] the current study was the first to directly test and confirm a comprehensive mediation model. Specifically, our findings suggest that the effects of support on informativeness are partially mediated by reduced reluctance, that is, that support has both direct and indirect effects on cognitive performance. However, we caution that the mediating factor (reduced reluctance) may be associated with a host of other facilitating factors, including reduced anxiety or distress, increased self-efficacy and confidence, or lessened distractibility.” (p. 524)

“Overall, this study showed that support can effectively reduce reluctance, resulting in increased informativeness by alleged victims of child abuse. […] Furthermore, it substantiates recent claims that a supportive yet nonsuggestive style should be adopted during forensic interviews with alleged victims of child abuse.” (p. 524)

Translating Research into Practice

“Rather than ignoring signs of reluctance or discomfort and continuing to ask questions, a typical yet counterproductive reaction by interviewers, this study revealed effective and evidence-based practices. Addressing the children’s conflicts in an empathic way, discussing their reluctance and negative emotions, conveying the interviewer’s availability and concerns, or encouraging them all alleviated the children’s reluctance. This finding substantiates prior observations that supportive interviewers can help children cope with resistance and overcome mistrust, potentially reducing the stress experienced during a forensic interview.” (p. 523)

“The effect of support on (decreased) reluctance was less when the utterance included both support and a question. This finding is in line with previous recommendations that interviewers should refrain from continuing to ask questions when children express reluctance and should resume questioning only after reluctance has been successfully addressed.” (p. 523)

“Previous research has documented the beneficial effects of support on the reluctance of alleged abuse victims, albeit only in the presubstantive and transitional phases of the interview.[…] The present study showed that providing support during the substantive phase had a beneficial effect on children’s informativeness about the abuse. Reluctance expressed while forensically relevant information is being elicited may threaten the value of the children’s testimony, so the present findings have significant implications for forensic interviewers. Moreover, reluctance expressed when the child is describing specific details about the abuse is presumably more profound than is reluctance expressed while discussing neutral issues, and thus it is reassuring that supportive interviewing remains effective during the substantive phase.” (p. 523)

“Although experts have recommended that interviewers provide support when children are reluctant, field interviewers often fail to do so. Interviewers commonly act counterproductively and tend to be even less supportive and more intrusive with reluctant children, perhaps out of frustration or because it is difficult to master supportive interviewing strategies. Effective supportive interviewers need to constantly identify both explicit and implicit expressions of reluctance and master and use a variety of supportive yet nonsuggestive interventions. Managing reluctance effectively should be recognized as an additional set of skills for forensic interviewers. As the responsibilities of forensic interviewers grow, the needs for their training and supervision should be recognized.” (p. 525)

“The current study highlighted the role of the Revised Protocol, which provides structure to forensic interviews and suggests many possible interventions to target signs of reluctance. However, field interviewers may sometimes avoid working with protocols because they mistakenly perceive them as rigid guidelines that do not permit discretion. Both the Standard and Revised NICHD Protocols are in fact packages of evidence-based practices from which interviewers need to choose the most appropriate techniques for coping effectively with specific challenges. Because supportive interviewing has been deemed best practice, a responsible investigative policy should seek to implement evidence-based supportive protocols such as the Revised NICHD Protocol employed in the current study even though the necessary training may be extensive and costly, because of the need for continuing supervision and quality control. Previous attempts to employ abbreviated training programs or to avoid regular and ongoing supervision have largely failed.” (p. 525)

Other Interesting Tidbits for Researchers and Clinicians

“The correlational nature of the data limits our ability to infer causality and to conclude that support directly affected reluctance or informativeness, rather than the reverse. […] Sequential analyses at the utterance level ignore the other aspects of the interviewer\child interaction during the interview.” (p. 524)

“Although the current study considered the presence or absence of questions, the effect of question types was not investigated. […] In particular, we do not know how support affects the utility of open-ended questions, which typically elicit the most detailed responses.” (p. 524)

“Because the current study explored only the substantive phases of the interviews, it ignored the possible effects of interviewer–child dynamics earlier in the interviews. The RP encourages supportive practices from the very beginning of the interview, and these may have shaped the interviewers’ practices and children’s responses in the substantive phase.” (p. 525)

“Including only externally validated cases may also have biased the findings, especially if evidence known to the interviewers motivated them to make additional efforts to obtain richer forensic statements. In the future, researchers might complement the current findings by comparing validated and nonvalidated cases. Similarly, they might compare the socioemotional dynamics of investigative interviews in different cultures and examine the associations between support and other features of the children’s statements, including their narrative coherence.” (p. 525)

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As always, please join the discussion below if you have thoughts or comments to add!

Authored by Kseniya Katsman

Kseniya Katsman is a Master’s student in Forensic Psychology program at John Jay College of Criminal Justice. Her interests include forensic application of dialectical behavior therapy, cultural competence in forensic assessment, and risk assessment, specifically suicide risk. She plans to continue her education and pursue a doctoral degree in clinical psychology.

Current Treatment Modalities May Not Fully Address the Heterogeneity of Psychopathology in Dual Diagnosis Forensic Inpatient Populations

This study sought to clarify the psychiatric and criminological characteristics among Belgian French-speaker forensic inpatients with low IQ and mental health illnesses (MHI). To this end, we compared a low IQ group with MHI, low IQ group, and control group. Compared to the control group, proportionally more patients in the low IQ and MHI group presented with a psychiatric illness, particularly with a mood disorder, and proportionally fewer presented with a cluster C personality disorder. The findings highlight the heterogeneity of the psychiatric profiles of this subgroup and emphasize the importance of considering these patients’ psychological profiles when formulating their treatment needs. This is the bottom line of a recently published article in the International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health | 2018, Vol. 17, No. 3, 272-284

Forensic Inpatients with Low IQ and Psychiatric Comorbidities: Specificity and Heterogeneity of Psychiatric and Social Profiles


Audrey Vicenzutto, Service de Psychopathologie Legale, Universite de Mons, Mons, Belgium
Xavier Saloppe, Centre de Recherche en Defense Sociale, CRDS, Tournai, Belgium; Laboratoire de sciences Cognitives et affectives (SCALab), CRNS, UMR 9193, Universite de Lille, Villeneuve-d’Ascq, France; Service de psychiatrie, Hopital de Saint-Amand-les-Eaux, Saint-Amand-les-Eaux, France
Claire Ducro, Centre de Recherche en Defense Sociale, CRDS, Tournai, Belgium; Laboratoire de sciences Cognitives et affectives (SCALab), CRNS, UMR 9193, Universite de Lille, Villeneuve-d’Ascq, France
Vanessa Milazzo, Hopital Psychiatrique Securise, Centre Regional Psychiatrique “Les Marronniers”, Tournai, Belgium
Murielle Lindekens
Thierry H. Pham, Service de Psychopathologie Legale, Universite de Mons, Mons, Belgium; Centre de Recherche en Defense Sociale, CRDS, Tournai, Belgium; Centre de Recherche, Institut Philippe-Pinel, Montreal, Canada


While the prevalence of mental disorders in people with intellectual disabilities (ID) is well documented, there is less specific literature in the forensic domain. This study sought to clarify the psychiatric and criminological characteristics among Belgian French-speaker forensic inpatients with low IQ and mental health illnesses. To this end, we compared a low IQ group with mental health illnesses (n.69), low IQ group (n.56), and control group (n.165). Compared with controls, proportionally more inpatients low IQ with Mental Health Illnesses presented a psychiatric illness, particularly a mood disorder, and proportionally fewer presented a cluster C personality disorder. The findings highlight the specificity and heterogeneity of the psychiatric profile of this subgroup of patients. We also demonstrated that forensic patients with ID are not a homogeneous group. This emphasizes the importance of considering in the management of forensic ID patients the specific needs with regard to their psychopathological profile.


Low IQ, psychiatric comorbidities, dual diagnosis, forensic facilities, intellectual disability

Summary of the Research

“While there is no consensus on the definition of Intellectual Disability (ID), the comparison of proposed definitions in North America and Europe agrees that three diagnostic criteria are required: limitations in intellectual functioning, limitations in adaptive behavior, and the occurrence of these difficulties before the age of 18 years…Research indicates that people with intellectual disability are over-represented among prison populations. According to these authors, it is possible that there is a difference in rates of remand detention for similar offenses between offenders with and without ID…Where forensic populations are concerned, few studies have sought to gauge the prevalence of ID in secure psychiatric hospitals…numerous studies have evidenced that these persons are particularly vulnerable within the criminal justice system, particularly because they are at higher risk for physical, sexual, and emotional victimization…In the field of ID, the term dual diagnosis (DD), is used to refer to persons with co-occurring diagnoses, namely, ID and a psychiatric illness…” (p.272-273).

“Researchers have stated that identifying the characteristics specific to persons with DD was key to developing interventions tailored to their needs. It has also been shown that psychiatric disorders, particularly schizophrenia and mood disorders, were associated with prolonged lengths of stay for persons with ID in general psychiatric settings…there is no study on ID and DD among French-speaking forensic inpatient[s] in Belgium. And based on the observation that ID assessment[s], according to the international classifications, are not systematized in clinical practice in this environment, this preliminary study aims to establish the prevalence rate of low IQ with Mental Health Illnesses and, second, to characterize their diagnostic (DSM-IV Axes I and II) and social profile” (p.274-275).

“Regarding the study’s first objective concerning the prevalence of patients with low IQ and Mental Health Illnesses in [a] secure psychiatric hospital, several results emerged worthy of note. First, 41.1% of the sample was composed of patients with an IQ below 70. This rate exceeds by far the numbers reported in the literature…Moreover, the prevalence we observed is far greater than available international figures…Regarding more specifically [the] low IQ MHI group, we observed a prevalence of 22.7% in the forensic population as a whole. Within the subgroup of forensic inpatients with Low IQ, the prevalence was 55.2%” (p.279).

“Regarding the study’s second objective, the results indicated that, all diagnostic categories considered, proportionally more persons from [the] low IQ MHI group presented [with] Axis I disorders compared with the Control group, particularly when it came to mood disorders…Alongside this specificity, a diagnostic heterogeneity emerged among Low IQ with Mental Health Illnesses patients, as reflected in the high prevalence of psychotic disorders, anxiety disorders and addictions in this group. However, the results revealed no significant inter-group differences on these three diagnostic categories…Where personality disorders are concerned, given the specificity of the forensic population, we expected both the Low I! MHI group and the Control group to present a high prevalence of Axis II disorders, especially those in cluster B. While we did observe a high prevalence of cluster A and B disorders in both groups at nearly equivalent levels, a significantly lower proportion of patients from Low IQ MHI group presented with a cluster C disorder” (p.280).

Translating Research into Practice

“…Existing adaptive behavior scales have not been validated in forensic settings. This is critical in that these scales are often of the self-report type. In the legal field, this creates difficulties, mainly related to evaluation issues…Future research should focus on the development of assessment tools in the aim of addressing the limitations mentioned above. A number of French-language scales already exist to assess adaptive behaviors, including the Quebec Scale of Adaptive Behavior. However, to our knowledge, this instrument has never been standardized for forensic purposes” (p.280).

“…While psychiatric disorders are common in the ID population, they are often poorly identified and their evaluation poses a genuine clinical challenge…the more attention is paid to DD, the more the need for adapted means of evaluation and tailored treatment will be recognized. Future research will have to develop tools for assessing psychiatric disorders in this subgroup, but also reflect upon adapting diagnostic criteria to its specificities and developing appropriate training programs for clinicians…we would do well to implement care programs adapted to the specificities of forensic patients with ID with and without a psychiatric comorbidity” (p.281).

Other Interesting Tidbits for Researchers and Clinicians

“While it has been shown that people with ID often have psychosocial difficulties, out analysis of social profile evidenced proportionally more patients in the Low IQ MHI group and the Control group maintained a marital relation, compared with those in the Low IQ group. This raises the question of the different role of the family in the treatment of psychiatric illness versus the management of disabilities. Proportionally more patients in the Low IQ MHI group and in the Control group lived alone prior to admission whereas proportionally more patients in the Low IQ group lived with their family…In the future, it would be interesting to collect information on the life course of these persons” (p.280).

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Authored by Amber Lin

Amber Lin is a volunteer in Dr. Zapf’s research lab at John Jay College of Criminal Justice. She graduated from New York University in 2013 with a B.A. (honors) and is a second year Masters student at Fairleigh Dickinson University. Her research interests include forensic assessment, competency to stand trial, and the refinement of instruments used to assess the psychological states of criminal defendants.

APLS 2019 Presidential Address by Dr. Kevin Douglas

Dr. Kevin Douglas presented his Presidential address–Accomplishments and Aspirations: The Role of Psychology and Law in Fostering Public Good–at the Annual Meeting of the American Psychology-Law Society in Portland, Oregon this March.

American Psychology-Law Society Presidential Address

About Dr. Kevin Douglas

Dr. Kevin Douglas received his law degree (LL.B.) in 2000 from the University of British Columbia, and his B.A., M.A., and Ph.D. in clinical (forensic) psychology from Simon Fraser University. He spent three years on faculty at the University of South Florida in Tampa, and has been on faculty at Simon Fraser University since 2004. He currently is Professor and Associate Chair, Department of Psychology, Simon Fraser University. He is also a Guest Professor of Applied Criminology at Mid-Sweden University, and a Senior Research Advisor at the University of Oslo. He received a Michael Smith Foundation for Health Research Career Scholar Award (2005-2010), and was the recipient of the Saleem Shah Award for Early Career Excellence in Psychology and Law (2005), awarded jointly by the American Psychology-Law Society and the American Academy of Forensic Psychology. Dr. Douglas has authored over 150 journal articles, books, or book chapters. He has given over 150 invited presentations or workshops across 12 countries. His research and professional activities include violence risk assessment and management, the association between various mental and personality disorders (i.e., psychosis; psychopathy) and violence, and dynamic (changeable, treatment-relevant) risk factors, in both youth and adults. He is co-author of the Historical-Clinical-Risk Management-20 (HCR-20) violence risk assessment measure, which has been translated into 20 languages and is the most broadly used violence risk assessment measure around the world (roughly 35 countries) in correctional, forensic, and psychiatric settings. Its purpose is to help guide decisions about violence potential and how to reduce it. Dr. Douglas is lead author on the latest (third) revision of the HCR-20, published in 2013. His work has been funded, to the amount of approximately $5,000,000, by the National Science Foundation in the US, and, in Canada, by the Social Sciences and Humanities Research Council of Canada, Canadian Institutes.

AAFP Distinguished Contributions Award Address by Dr. Stephen Hart

Dr. Stephen Hart was awarded the American Academy of Forensic Psychology’s Distinguish Contributions Award at the Annual Meeting of the American Psychology-Law Society in Portland, Oregon this March. His award address was entitled, Beyond Validity: The Quest for Justice in Violence Risk Assessment.

American Psychology-Law Society Address

About Dr. Stephen Hart

Dr. Stephen D. Hart obtained BA, MA, and PhD degrees in psychology at the University of British Columbia. He has been on faculty in the Department of Psychology at Simon Fraser University since 1990, and has held the rank of Professor since 2001. He also has been a Visiting Professor in the Faculty of Psychology at the University of Bergen in Norway since 2000. His expertise is in the field of clinical-forensic psychology, with a special focus on the assessment of violence risk and psychopathic personality disorder. He has co-authored more than 215 books, chapters, and articles. He has served as editor of two scientific journals; a member of the editorial board of six journals; and ad hoc reviewer for more than 30 journals. He served as executive committee member of several professional organizations, including President of the American Psychology-Law Society and the International Association of Forensic Mental Health Services. He has received various distinctions for his professional work, including the Career Achievement Award from the Society of Clinical Psychology, the Saleem Shah Award for Early Career Research Excellence in Psychology and Law from the American Psychology-Law Society and the American Academy of Forensic Psychology, and the Distinguished Achievement Award from the Association of Threat Assessment Professionals. In Canada, he has been qualified to give expert testimony before various courts, tribunals, and review boards, including the provincial courts of British Columbia and Ontario; the superior courts of Alberta, British Columbia, Manitoba, and Ontario; Federal Court; and the House of Commons Standing Committee on Justice and Legal Affairs.