| No longer is it possible to assess and/or
| |
| | problems that have been derived from
|
| treat a mental health population without
| |
| | statistical models (actuarial tools)
|
| also interfacing with forensic issues
| |
| | should be part of the evaluation since
|
| such as legal infractions, Courts,
| |
| | clinical assessment of risk of future
|
| violence, sexual behavior problems,
| |
| | dangerousness is only a little better
|
| delinquency, crime, Not Guilty by Reason
| |
| | than chance. While risk assessments are
|
| of Insanity, substance abuse, and others.
| |
| | not perfect, they are better than
|
| The training and approaches to the
| |
| | clinical judgment in this area.How are
|
| mental health population is different
| |
| | Interventions Different?Major Mental
|
| than that for a forensic population. So
| |
| | Illnesses, while often chronic, can often
|
| what is to be done, if a person has both
| |
| | be very effectively treated with
|
| issues? We must be cross trained for
| |
| | medication and therapy. At the higher
|
| dually affected clients.How Are the
| |
| | functioning end of the continuum, therapy
|
| Populations DifferentA Mental Health
| |
| | can be supportive, psychotherapeutic,
|
| population is comprised primarily Axis I
| |
| | family, or cognitive behavioral.
|
| disorders, such as Bipolar Disorder,
| |
| | Therapists are trained to accept what the
|
| Schizophrenia, Major Depression, PTSD,
| |
| | client presents and start where the
|
| and Anxiety Disorders. Daily functioning
| |
| | client is functioning and how the client
|
| is on a continuum. Recovery is quick for
| |
| | sees the world. The clients are usually
|
| some and slow for others and is also on a
| |
| | self-motivated and seek therapy
|
| continuum. Well controlled intermittent,
| |
| | voluntarily. They accept responsibility
|
| mild to moderate episodes of a mood or
| |
| | for their behaviors and for making
|
| anxiety disorder will not necessarily
| |
| | changes in their lives. Use of a
|
| interfere with daily functioning.
| |
| | strengths model is often very effective.
|
| Someone with severe, chronic
| |
| | Many people recover fully and lead quite
|
| Schizophrenia or Mood Disorder requiring
| |
| | "normal," non-disrupted lives. When
|
| periodic hospitalizations and extensive
| |
| | someone is on the lower end of the
|
| community support, will have impairment
| |
| | continuum, with major disruption in every
|
| in daily functioning. Goals for these
| |
| | day functioning (work and family),despite
|
| folks are often pro-social and involve
| |
| | medication and therapy, major supports
|
| being an active member of society. A
| |
| | for housing, jobs, and activities of
|
| therapist can be fairly sure that the
| |
| | daily living and medication are needed
|
| mental health client without forensic
| |
| | for a very long time, perhaps a life
|
| issues will be relatively honest in his
| |
| | time. However, their life goals are
|
| or her interactions and the therapist can
| |
| | often still pro-social. Serlf-directed
|
| take most of what he/she says at face
| |
| | care works well with the mental health
|
| value. An emphasis on a strengths model
| |
| | population without Axis II diagnoses.In
|
| works well when no personality disorder
| |
| | the area of intervention, different
|
| is involved.A forensic population can be
| |
| | approaches are needed for the forensic
|
| defined as having personality disorders,
| |
| | population. Some level of social and
|
| interpersonal difficulties, behavioral
| |
| | family dysfunction is generally
|
| problems, multiple problems and life long
| |
| | intergenerational and lifelong. These
|
| courses of various levels of dysfunction
| |
| | clients are often Court ordered to an
|
| or difficulty. Again, this population
| |
| | assessment or therapy or they are having
|
| fills the full spectrum of effective
| |
| | significant problems at work or within
|
| daily functioning. However, social
| |
| | the family causing others to seek
|
| functioning is often the most severe
| |
| | assessment or therapy for them. They do
|
| impairment. There are issues of trust,
| |
| | not always accept responsibility for
|
| appropriate relationships, ego centrism,
| |
| | their actions or for changing. There are
|
| moral development, honesty, manipulation,
| |
| | skill deficits that need to be addressed,
|
| and danger to self and others. They
| |
| | such as social skills, anger management,
|
| often have a negative view of themselves
| |
| | and problem solving. You cannot take
|
| and others, especially authority figures.
| |
| | what these clients say at face value.
|
| Moral development is often delayed
| |
| | Third party information is always needed.
|
| leaving them at the egocentric stage of
| |
| | This is because you need to trust
|
| development. This means that what serves
| |
| | someone in order to be honest with them
|
| the self is what matters and empathy for
| |
| | and most of these folks have been abused,
|
| others and the ability to have an honest
| |
| | neglected, or exposed to domestic
|
| relationship with another person may not
| |
| | violence and a suspicious arm's length
|
| yet have developed. Their goals are
| |
| | treatment of others is a coping strategy
|
| often self-serving.The capacity to
| |
| | that is difficult to give up.This
|
| understand the importance of the best
| |
| | population often has multiple problems so
|
| interest of the group through laws and
| |
| | that Multi-systemic Therapy that
|
| rules that we voluntarily follow, may not
| |
| | approaches many areas that need to be
|
| be well understood. Many, if not most,
| |
| | addressed is often effective (treating
|
| have histories of childhood abuse,
| |
| | the whole person). Group work and trauma
|
| neglect, or exposure to domestic
| |
| | therapies are also good tools.
|
| violence. The assessment and
| |
| | Self-directed therapy may not be
|
| interventions with this population is
| |
| | effective because of the need to protect
|
| necessarily different that those for a
| |
| | oneself from what may appear to be an
|
| people with no Axis II disorder or trait.
| |
| | unsafe world. Nurturing, setting good
|
| The people with forensic issues do not
| |
| | boundaries, and structure are essential
|
| always tell the truth because of their
| |
| | in this work. Motivational interviewing
|
| lack of trust in relationships. The
| |
| | and stages of change can be very helpful.
|
| therapist cannot take what he/she says at
| |
| | When clients have issues in the mental
|
| face value. The therapist must separate
| |
| | health and forensic arenas, both
|
| the sincere from the manipulative moves
| |
| | approaches must be used to the extent
|
| for self-gain. The internal boundaries
| |
| | possible.ConclusionsClients in a mental
|
| are such that they need the therapist to
| |
| | health setting range from the single
|
| put external boundaries into place for
| |
| | diagnosis of a major mental Illness to
|
| them. Information must be checked with
| |
| | the dual diagnosis of a major mental
|
| other sources of information.How
| |
| | illness and a personality disorder and/or
|
| Assessment Tools DifferIn a mental health
| |
| | forensic/legal issue. The approaches to
|
| population, assessment can quite
| |
| | these dissimilar populations is unique
|
| effectively be done through instruments
| |
| | when clients are dually diagnosed, both
|
| such as the MMPI-A, BASC, and MACI. These
| |
| | approaches are needed. Assessments and
|
| self-report tools are quite sufficient
| |
| | treatment for a mental health population
|
| for this population and will elucidate
| |
| | can be self-directed and strengths
|
| psychological dynamics and mental
| |
| | based.However, the approach for the
|
| illness, if present. Self-report is not
| |
| | forensic population cannot be
|
| as much of an issue as it is in the
| |
| | self-directed because the client's goals
|
| forensic population, where third party
| |
| | are often antisocial and by definition
|
| verification is more important. However
| |
| | counter to the best interests of society.
|
| when a youth has multiple problems, both
| |
| | The therapist or evaluator cannot accept
|
| mental health and forensic, a combination
| |
| | everything the client says at face value
|
| of tools is preferred.Forensic evaluation
| |
| | because not being honest is part of the
|
| tools rely less on self-report because of
| |
| | disorder that the therapist is treating.
|
| the trust issues and because it is not
| |
| | Motivational interviewing seems to blend
|
| always in the client's best interest to
| |
| | the views of traditional mental health
|
| be completely truthful. Self-report
| |
| | and forensics in a way that is beneficial
|
| assessment instruments can be used, but
| |
| | for the client and society.Dr. Kathryn
|
| third party and official reports should
| |
| | Seifert has over 30 years experience in
|
| also be used in the evaluation phase of a
| |
| | mental health, addictions, and criminal
|
| forensic assessment. Courts are
| |
| | justice work. She has authored the CARE
|
| concerned with public safety, therefore,
| |
| | and numerous articles. Dr. Seifert has
|
| the need for tools that assess future
| |
| | lectured internationally on youth and
|
| risk of dangerousness to others. Risk of
| |
| | family violence and trauma.
|
| future aggression and sexual behavior
| |
| |
|
