Book Review
Forensic Psychiatry
Mastering Forensic Psychiatric
Practice: Advanced Strategies for the Expert Witness. Thomas G Gutheil, Robert I Simon. Washington (DC): American Psychiatric Publishing; 2002. 150 p. US$30.95.
Reviewer
rating*: Very Good
Review by: Paul Ian Steinberg, MD, FRCPC
Edmonton, Alberta
This slim text is a follow-up to Gutheil’s previous works in similar format, The Psychiatrist as Expert Witness and The Psychiatrist in Court, which have previously been reviewed in this journal (1). In this book, the authors describe the expert witness’s task not only as witness but also as consultant, businessperson, teacher, advocate, and performer. They review the ethical tensions facing the expert witness, and in a basic and thoughtful way, they describe the strategies attorneys employ when confronting experts.
The second part of this text deals with practical matters, including practical aspects of the forensic examination. For example, the authors emphasize the importance of repeatedly reminding the examinee of the forensic nature of the examination and offer a model consent form. They describe a seduction hypothesis—a dilemma wherein the empathic expert elicits inappropriate trust from the examinee, who slips into a clinical attitude and is, as a result, insufficiently self-protective. The authors also discuss “critogenic factors,” that is, stresses and injuries that litigation provokes in litigants, together with the constraints that may be put on examinations. Boundary issues and case preparation with attorneys are dealt with. Helpful guidance regarding pursuing a forensic career in an ethical manner is offered, again with detailed treatment of the practical aspects. A chapter is devoted to fee agreements and finances in forensic practice. In it, the authors discuss the intrinsic and extrinsic value of money, as well as the use of fee agreements, and offer guidelines for a model fee agreement. However, these seemed to me to be overly inclusive, given the relationship I have had with lawyers. Although the authors caution one not to be adversarial, many of the guidelines in their model agreement could be thus construed.
Part 3 of the book is devoted to problem areas in attorney–expert relations; it begins by describing the pressures attorneys exert on the expert witness. The authors offer early warning signs that an attorney may assume a coercive attitude. They discuss experts’ vulnerability to attorney pressures and provide helpful examples. A chapter is devoted to the “phantom” expert, whose name is used without consent as a legal strategy. I am not familiar with this problem, which may reflect the possibly more aggressive nature of the US legal system. A chapter on forensic countertransference describes early signs of compromised objectivity. The authors describe examinee-centred and attorney-centred countertransference but use a rather restricted definition. A section on problems with deposition and trial testimony begins with personal questions on examination. A chapter on “telling tales out of court” discusses experts’ disclosures about opposing experts.
Many chapters are partly or wholly based on the authors’ surveys of forensic experts in areas where little literature or evidence exists. The undertaking of these pilot studies is an impressive beginning, but they involve small samples from which limited conclusions can be drawn (which the authors acknowledge). A chapter on preparing psychiatric or psychological testimony for court describes the development of common law as illustrated by 3 American cases in which rulings regarding admissibility of evidence were reversed on the basis of developing guidelines of admissibility. The final section of the book is devoted to ethical issues. As does the whole book, this chapter raises worthwhile questions and offers examples with thoughtful discussion. Although well written, this chapter in particular is frustratingly brief. I would have welcomed lengthier case examples and a more in-depth discussion.
At many points in this book, the authors apply psychodynamic principles in a nonpsychotherapeutic venue, which is refreshing. The chapters are short, punchy, and to the point. They are easy to read and attractively formatted. My major disappointment with this work is that it is a little too light. I would have been happy to have a book that demanded more of me and offered more of an intellectual challenge. The book is written clearly, is jargon-free, and provides many helpful references. The authors are clearly experts in the field and have written much on the subject. They emphasize throughout the need to strive for objectivity and honesty, which involves an ongoing tension inherent in forensic work. I recommend this book highly for any psychiatrist interested in becoming involved in forensic psychiatric practice.
References
1. Steinberg PI. The psychiatrist in court: a survival guide. The psychiatrist as expert witness [book review]. Can J Psychiatry 1999;44:600.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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