Stress and Eyewitness Memory

bundet

S STORY MODEL FOR JUROR DECISION MAKING Learning Verdict Options Rendering a Verdict Research Investigating the Story Model STRESS AND EYEWITNESS MEMORY STRUCTURED ASSESSMENT OF VIOLENCE RISK IN YOUTH (SAVRY) Psychometric Properties STRUCTURED INTERVIEW OF REPORTED SYMPTOMS (SIRS) Description and Development Reliability Validity Forensic Applications Future Directions SUBSTANCE ABUSE AND INTIMATE PARTNER VIOLENCE Substance Abuse as a Risk Marker for IPV Explanations for the Association Between Substance Abuse and IPV Implications for Research and Practice SUBSTANCE ABUSE TREATMENT Substance Abuse Treatment and the Criminal Justice System Typical Care at Treatment Facilities Evidence-Based Treatment SUBSTANCE USE DISORDERS Impact of Substance Use Disorders Biopsychosocial Model Diagnosis of Substance Use Disorders SUICIDE ASSESSMENT AND PREVENTION IN PRISONS Research and Theory Risk Factors Suicide Prevention SUICIDE ASSESSMENT MANUAL FOR INMATES (SAMI) SUICIDE BY COP SUPERMAX PRISONS Conditions of Supermax Confinement Population of Supermax Prisons Effects of Supermax Confinement Legal Regulation T TENDER YEARS DOCTRINE History of Child Custody Law Current Research on the Tender Years Doctrine TERMINATION OF PARENTAL RIGHTS Legal and Regulatory Standards Forensic Assessment in Context Ethical Standards and Guidelines for Practice Child Maltreatment Parenting and Child Development Forensic Assessment in Care and Protection Matters TERRORISM The State of Research TESTAMENTARY CAPACITY Legal Elements of TC Insane Delusion and TC Undue Influence Attorney Observations of TC Consultation Regarding TC Contemporaneous Clinical Evaluation of TC Retrospective Evaluation of TC Research on TC TEST OF MEMORY MALINGERING (TOMM) Development and Validation Interpreting the TOMM THERAPEUTIC COMMUNITIES FOR TREATMENT OF SUBSTANCE ABUSE Substance Abuse Treatment Within Therapeutic Communities Research on Therapeutic Communities THERAPEUTIC JURISPRUDENCE Therapeutic Jurisprudence: An Overview The Development of Therapeutic Jurisprudence Practical Implications International Appeal The Future of Therapeutic Jurisprudence TRAINING OF EYEWITNESSES TRANSFER TO ADULT COURT See WAIVER CRIMINAL COURT TRANSLATED TESTIMONY Perceptions of Translated Testimony Impact on Jurors’ and Juries’ Decisions Explanations of the Impact of Language Implications for the Law TREATMENT AND RELEASE OF INSANITY ACQUITTEES The Role of the Physician Treatment Public Policy on the Rights of the Insane Public Sentiment and the Insanity Defense Treatment and Release of Insanity Acquittees Contemporary Issues and Developments TRIAL CONSULTANT TRAINING Academic Preparation On-the-Job Training Continuing Education Certification of Trial Consultants knowledge. For example, an episode may consist of ini- tiating events that led the defendant to a certain mental state, which then led the defendant to create goals or to have certain motivations, which then resulted in the defendant acting in a particular way. Jurors may get some of the information to complete the episode from trial evidence and may have to infer some of the episode elements based on their knowledge of the world. Episodes are hierarchically organized, in that each com- ponent of any given episode may be broken down into its own individual episode. The highest level episodes are the most important in explaining the actions that occurred; thus, the story model accounts for the weight jurors assign to different pieces of evidence. One of the greatest strengths of the story model is that it accounts for jurors’ unique experiences and indi- cates when they add those unique experiences and pieces of knowledge into the decision-making process. Witnesses do not often have the opportunity to explain why particular events happened or how they personally reacted to a particular sequence of events. So, jurors fill in those blanks with inferences based on their own per- sonal knowledge of similar events. In addition, jurors’ expectations about what makes a complete story are important to help them determine when important pieces of information are missing or when an inference about human behavior or how someone might act in a particular situation needs to be made. Jurors then can make this inference based on their personal knowledge. The story model accounts for differences in stories between jurors by accounting for the different world experiences and expectations jurors bring to the story construction process. C C e e r r t t a a i i n n t t y y P P r r i i n n c c i i p p l l e e s s Three certainty principles govern whether a juror will find a particular story acceptable, and following acceptability, how much confidence a juror will have in a particular story. The first two—coverage and coher- ence—contribute to whether a story will be accepted and, if accepted, how much confidence the juror will have in the story. The third principle, uniqueness, con- tributes solely to the juror’s confidence in the story. Coverage refers to the amount of evidence accounted for by a particular story. The more coverage a story has, the more likely the juror is to deem the story acceptable and, if accepted, the more confidence the juror will have in that story. Conversely, the less evi- dence the story accounts for, the less likely it is to be accepted by jurors. If accepted, jurors are likely to have less confidence in the story compared with if the story had a high level of coverage. If a story has low cover- age and, therefore, the juror has a low amount of confi- dence in the story, the juror would also have a low level of confidence in the final decision based on that story. The second principle is coherence. A story’s coher- ence is determined by a combination of three variables: consistency, plausibility, and completeness. To be con- sistent, a story must contain no internal contradictions or contradictions with pieces of evidence the juror believes are true. To be plausible, the story constructed must be similar to the juror’s knowledge of what typi- cally happens in these situations. That is, a story must not contradict the juror’s knowledge about the world in general. Last, to be complete, the story must contain all the parts of what a juror believes makes up a story. The more consistent, plausible, and complete the story, the higher the coherence of the story. If a story is deemed coherent, the juror is more likely to think that the story is an acceptable account of the events in question and the more likely the juror is to be confident in the story. The story model posits that jurors can construct more than one story, but one story usually emerges as the best explanation of events. However, what hap- pens when jurors create more than one story and each of the stories is high in both coverage and coherence? According to the story model, this compromises the last certainty principle, the uniqueness of the story. If jurors construct more than one acceptable story, they are less likely to believe either story, and the confi- dence in both stories goes down. Learning Verdict Options In the second stage of the story model, jurors learn which verdict options are available to them. Generally, the different verdict options along with the definition of what constitutes each verdict option are given to the jurors in the judicial instructions at the end of the trial. The combination of this one-trial learning task with the difficulty of legal language makes this task difficult for jurors. In fact, research has demonstrated that jurors generally do not comprehend the majority of judicial instructions presented to them. In addition, jurors also have preconceived notions of what constitutes various crimes. Those preconceived notions, accurate or inac- curate, may interfere with jurors’ understandings of the verdict options in the case. Story Model for Juror Decision Making ———767 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 767 Rendering a Verdict In this last stage of the story model, jurors map their accepted story onto each of the verdict categories to determine which verdict category best matches the accepted story. This mapping sequence is intentional on the part of jurors and is difficult because they are map- ping their accepted story onto unfamiliar, newly learned concepts. However, jurors are somewhat aided in this process by the structure of the verdict options. Typically, verdict options consist of elements that closely mimic the episodic structure that jurors used when creating the story. For example, the verdict definition of first-degree murder includes an element of identification (identify- ing the person who committed the crime), mental state (that person intentionally killed the victim), circum- stances (the victim gave no provocation and the murder was premeditated), and actions (the killing was inten- tional and unlawful). These correspond to the elements that make up an episode in a story. Once the jurors have chosen which verdict cate- gory best matches the story, jurors apply the judge’s procedural instructions to make a decision in the case. For example, in a criminal case, if the best-fit verdict option exceeds the jurors’ threshold for reasonable doubt on each of the elements of that verdict option, then the juror is likely to choose that verdict. If not, the juror does not choose that verdict option. If no match of verdict option and story exceeds this thresh- old, then the juror defaults to a verdict of not guilty. In addition, the goodness of fit, or the jurors’ confidence in a verdict category-story match, will affect whether the juror is likely to choose that verdict. If the good- ness of fit is low, the juror is less likely to be confident in that verdict than if the goodness of fit is high. Research Investigating the Story Model The initial study in the development of the story model was designed to provide a picture of how jurors processed evidence and established that jurors created narrative structures to explain and account for evidence. Further research demonstrated that the actual creation of the narrative was a spontaneous act of the juror and that the story is actually a mediator in the verdict deci- sion. That is, jurors heard the evidence, created a story, and then the story caused the jurors to choose a partic- ular verdict. Last, the researchers also conducted a study demonstrating that the story model was a more complete and accurate explanation of juror decisions compared with more traditional models of decision making. Other researchers have also applied the story model of juror decision making to successfully explain jurors’ decisions in rape trials, civil cases, and sexual harassment cases. In sum, the story model of juror decision making is an explanatory model of decision making that asserts that jurors actively create a narrative (in the form of multiple episodes) to organize trial evidence. In creating the story, jurors use evidence presented at trial and their own knowledge of both real-world events and the elements that make up a story. To determine whether a story is acceptable, jurors use the certainty principles of coverage and coherence. Coverage and coherence, combined with the story’s uniqueness, also contribute to the juror’s sub- sequent confidence in a story. The second stage of the story model is the stage in which jurors learn the verdict options available to them, and this happens during judi- cial instructions at the end the trial. Jurors’ preconceived notions about certain crimes may also affect the way in which they perceive the verdict categories. In the last stage, jurors map their chosen stories onto the various verdict categories and apply the standard of proof given to them by the judge. If the match exceeds the standard of proof, then the juror chooses that verdict. If not, the juror defaults to a not-guilty verdict. Last, research has generally demonstrated support for the story model of juror decision making in a variety of cases. Lora M. Levett See also Juries and Judges’ Instructions; Jury Deliberation; Pretrial Publicity, Impact on Juries; Sexual Harassment, Jury Evaluation of Further Readings Huntley, J. E., & Costanzo, M. (2003). Sexual harassment stories: Testing a story-mediated model of juror decision-making in civil litigation. Law and Human Behavior, 27, 29–51. Olsen-Fulero, L., & Fulero, S. M. (1997). Commonsense rape judgments: An empathy-complexity theory of rape juror story making. Psychology, Public Policy, and Law, 3, 402–427. Pennington, N., & Hastie, R. (1992). Explaining the evidence: Tests of the story model for juror decision making. Journal of Personality and Social Psychology, 62, 189–206. Pennington, N., & Hastie, R. (1993). The story model for juror decision making. In R. Hastie (Ed.), Inside the juror: The psychology of juror decision making (pp. 192–221). New York: Cambridge University Press. 768 ———Story Model for Juror Decision Making S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 768 S TRESS AND E YEWITNESS M EMORY Stress exerts complex effects on eyewitness memory. On the whole, it has a negative effect, but this can be quite variable depending on the level of stress and the aspect of the witnessed event that one is trying to remember. Stress operates similarly in affecting per- son recognition (i.e., lineup performance) and recall of event details. The effects of stress on eyewitness memory and identification are of interest because of the fact that per- sons witnessing a crime, especially a violent crime, commonly (though not always) experience stress. “Stress” is itself a rather vague term that has been inter- preted differently by various commentators, but gener- ally, it can be taken to denote a negative emotional state associated with both physiological changes and a sub- jective set of cognitions. The physiological experience of stress is associated with increased arousal, marked by increases in heart rate, blood pressure, and muscle tone. The subjective experience typically includes some perception of threat and feelings of anxiety. People often assume that a high level of emotion, positive or negative, will facilitate memory; however, it is also possible that intense emotion, especially the high level of stress associated with witnessing a crime, would lead to decrements in memory for details of the crime itself and for the ability to recog- nize the persons involved. Early studies investigating the effects of stress on memory yielded inconsistent findings. Some researchers found that accuracy suf- fered when witnesses were under stress, others found that it was unaffected, and a minority of researchers reported improvements in accuracy. This ambiguity can be explained, in part, by variations in the degree of stress. The Yerkes-Dodson law proposes that the relationship between arousal and performance can be plotted as an inverted U , where with moderate increases in arousal, performance is improved but with too much arousal performance declines. This the- ory was subscribed to by many researchers, and ini- tially, it was thought to provide an explanation for the seemingly contradictory pattern of research findings. The studies that found improvements may have elicited an optimal level of stress or arousal, whereas those studies that had found decrements had exceeded that optimal level of stress. However, this explanation proved inadequate as the body of research grew because of the difficulty in comparing degrees of stress and also because of findings indicating that stress is not a unidimensional construct, as proposed by the Yerkes-Dodson law, but instead has multiple components (e.g., physiological, affective, cognitive, behavioral, etc.). An alternative explanation is that with higher levels of emotional stress, the observer’s attention becomes narrower and more focused. As a result, memory for central and closely attended-to details improves, while memory for more peripheral details declines. This distinction between central and periph- eral details also helps explain some of the inconsistent findings, where stress sometimes helps but at other times impairs memory. Research reviews and meta-analyses of the topic reveal that, taken as a whole, stress has more of a negative than a positive impact on eyewitness mem- ory in terms of both identification of the perpetrator and recall of event details. Eyewitnesses in high- stress situations are less likely to be able to correctly identify a perpetrator from a lineup, and recall of details associated with the witnessed crime is less likely to be accurate. The type of lineup adminis- tered and the type of recall appear to moderate the effect of stress on accuracy. High-stress situations disproportionately affect eyewitness identification accuracy, such that the likelihood of an accurate identification is reduced when the target person (i.e., perpetrator) is present in the lineup, but the effect on target-absent lineups is negligible. In other words, when the target person is present in the lineup, wit- nesses are more likely to select someone other than the target (i.e., a foil—namely, an innocent person in a police lineup) or incorrectly report that the target is not present in the lineup, thus rejecting the lineup. In contrast, when the target is absent, the likelihood that a witness will correctly reject the lineup is virtually unaffected. In eyewitness studies, witnesses are typically asked to report information in one of two ways: narrative or interrogative. With narrative or free recall, witnesses are asked to report what they recall and can choose what information to report. The interrogative type of recall requires a witness to answer specific questions about various details of the witnessed event. High- stress situations produce a greater decline in accuracy for interrogative recall than for narrative recall. One possible explanation for this difference is that with narrative recall, witnesses are free to choose what information to report and may opt not to report details of which they are not certain. Stress and Eyewitness Memory ———769 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 769 These findings extend partly to children as well. Child eyewitnesses perform worse when under stress, but it is unclear whether stress has a disproportionately negative effect on children. Stress effects can also be complicated by the presence of a particularly arousing, eye-catching aspect of the event, such as gore or a weapon. Research on stress and memory also suffers from methodological complications. There are limits to the amount of stress that one can ethically induce in an experimental situation, and even with highly arousing materials, research participants are usually not person- ally threatened by the witnessed event; that is, they are bystanders rather than victims or potential victims, which is likely to influence not only their stress level but also their behavior, degree of attention, and so forth. Some innovative research designs have attempted to overcome this limitation by studying victims/witnesses of real crimes or individuals undergoing stressful med- ical procedures. In conclusion, it is hard to generalize about the effects of stress on eyewitness memory. The findings are somewhat mixed, and the explanation for stress effects on memory is far from clear, making general- ization difficult. More research is necessary to resolve this uncertainty. However, it is clear that, overall, high levels of stress harm eyewitness memory in more ways than they help it. Ani A. Aharonian and Brian H. Bornstein See also Children’s Testimony; Lineup Size and Bias; Weapon Focus Further Readings Deffenbacher, K. A., Bornstein, B. H., Penrod, S. D., & McGorty, E. K. (2004). A meta-analytic review of the effects of high stress on eyewitness memory. Law and Human Behavior, 28, 687–706. Peters, D. P. (1997). Stress, arousal, and children’s eyewitness memory. In N. L. Stein, P. A. Ornstein, B. Tversky, & C. Brainerd (Eds.), Memory for everyday and emotional events (pp. 351–370). Mahwah, NJ: Lawrence Erlbaum. Reisberg, D., & Heuer, F. (2006). The influence of emotion on memory in forensic settings. In M. Toglia, J. D. Read, D. F. Ross, & R. C. L. Lindsay (Eds.), Handbook of eyewitness psychology: Vol. 1. Memory for events (pp. 81–116) . Mahwah, NJ: Lawrence Erlbaum. S TRUCTURED A SSESSMENT OF V IOLENCE R ISK IN Y OUTH (SAVRY) The Structured Assessment of Violence Risk in Youth (SAVRY), developed by Randy Borum, Patrick Bartel, and Adelle Forth, is a risk assessment instrument designed to structure appraisals of violence risk and risk management plans for adolescents. Such assess- ments are routinely required by juvenile and criminal courts and at nearly every juncture of the juvenile jus- tice system. In the SAVRY, one’s risk for serious vio- lence is viewed as the result of dynamic and reciprocal interplay between factors that increase and factors that decrease the likelihood of violence in the developing juvenile over time. Its central objective is to facilitate assessments that are systematic, empirically grounded, developmentally informed, treatment oriented, flexible, and practical. The SAVRY is based on the “structured professional judgment” (SPJ) risk assessment framework, and is designed for use with adolescents between the approx- imate ages of 12 and 18 who have been detained or referred for an assessment of violence risk. Evaluators systematically assess predetermined risk factors that are empirically associated with violence, consider the applicability of each risk factor to a particular exami- nee, and classify each factor’s severity. The ultimate determination of an examinee’s overall level of vio- lence risk is based on the examiner’s professional judg- ment as informed by a systematic appraisal of relevant factors. In this way, the SPJ model draws on the strengths of both the clinical and actuarial (formula- driven) approaches to decision making and attempts to minimize their respective drawbacks. The SAVRY protocol is composed of 6 items defin- ing protective factors and 24 items defining risk factors. Items are coded on the basis of reliable, available infor- mation. Information should be obtained from multiple sources, including an interview with the youth and a review of records (e.g., police or probation reports and mental health and social service records). Risk items are divided into three categories: historical, individual , and social/contextual, and each is coded for severity according to a three-level coding structure (high, mod- erate, or low). Protective factors are coded as present or 770 ———Structured Assessment of Violence Risk in Youth (SAVRY) S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 770 absent. The coding form also includes a section for list- ing “additional risk factors” and “additional protective factors” because the SAVRY is not exhaustive in iden- tifying all potential risk and protective factors for any given individual. If these additional factors are present, they should be documented and weighed in final deci- sions of risk. Though the SAVRY is sufficiently flexible to accommodate varying styles of risk communication, the coding form prompts evaluators to make a final summary risk rating of low, moderate, or high. The ultimate risk rating is not based on cutting scores (SAVRY items are not assigned numeric values) or a specific formula. Evaluators exercise their profes- sional judgment to determine the nature and degree of the juvenile’s risk for violence after carefully weigh- ing the relevant risk and protective factors. Psychometric Properties One of the primary indices used in SAVRY research (not in practice) is the “SAVRY Risk Total.” This is calculated by transposing item ratings of low, moder- ate, and high to numerical values of 0, 1, and 2, respec- tively, and summing the values. The summary risk rating is similarly transposed for statistical analysis. Reliability and Internal Consistency. The internal consistency (alpha coefficient) of the SAVRY Risk Total has been shown to fall in the range of .82 to .84. Interrater reliability for the SAVRY Risk Total has ranged between .74 and .97, with an unweighted aver- age of .84. Interrater reliability coefficients for the Summary Risk Rating have ranged between .72 and .85, with an unweighted average of .78. Validity. The concurrent validity of the SAVRY has been examined in relation to the Youth Level of Service/Case Management Inventory (YLS/CMI) and the Hare Psychopathy Checklist: Youth Version (PCL:YV) . In the initial validation study, the SAVRY Risk Total correlated significantly with both instru- ments among offenders and in community samples (e.g., .89 with YLS/CMI and .78 with PCL:YV among offenders). The SAVRY protective domain was nega- tively correlated with both the other measures. Across five studies, correlations between the SAVRY Risk Total and the PCL:YV Total Score have ranged from .48 to .74, with an unweighted average of .67. Although the correlations are significant, indicating that the SAVRY shares variance with other measures, it also possesses independent predictive power. With regard to criterion validity, studies have found significant correlations between SAVRY scores and var- ious measures of violence in juvenile justice and high- risk community-dwelling populations. In the initial validation sample, SAVRY Total Risk scores were all significantly related to behavioral measures of institu- tional aggressive behavior (.40) and aggressive conduct disorder symptoms (.52). The SAVRY has also demon- strated incremental (criterion) validity (or predictive power) beyond the YLSI and the PCL:YV. Results of hierarchical regression analyses showed that adding the SAVRY improved the power of the YLSI and the PCL:YV in predicting both institutional aggressive behavior and serious aggressive conduct disorder symp- toms. The SAVRY also accounted for a large proportion of the explained variance in each type of violence. Using receiver operating characteristic (ROC) analysis, which measures predictive accuracy in terms of relative improvement over chance, we found that areas under the curve (AUCs) for the total score aver- age about .74 to .80 across studies. Interestingly, the examiner judgments (summary risk rating), not made on the basis of any cutting score, consistently perform as well as, and often better than, the linear combina- tion of the scores themselves. For example, using ROC analysis, an unpublished master’s thesis at Simon Fraser University reported an AUC of .70 for the SAVRY total score, but the AUC for the SAVRY Summary Risk Rating was .89. This finding has been evident in research on other SPJ tools as well and pro- vides some of the first empirical evidence that clinical judgments—properly structured and based on sound assessments—can achieve levels of accuracy that rival that of any other known predictors, while maintaining latitude for case-specific analysis. Additional research is needed and is under way to clarify the SAVRY’s applicability in different coun- tries, across genders, and with various ethnic groups. Randy Borum, Patrick Bartel, and Adelle Forth See also Hare Psychopathy Checklist: Youth Version (PCL:YV); Juvenile Offenders, Risk Factors; Risk Assessment Approaches Structured Assessment of Violence Risk in Youth (SAVRY) ———771 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 771 Further Readings Borum, R., Bartel, P., & Forth, A. (2006). Manual for the Structured Assessment for Violence Risk in Youth (SAVRY). Odessa, FL: Psychological Assessment Resources. Borum, R., & Douglas, K. (2003). New directions in violence risk assessment . Psychiatric Times, 20 (3), 102–103. Borum, R., & Verhaagen, D. (2006). A practical guide to assessing and managing violence risk in juveniles. New York: Guilford Press. S TRUCTURED I NTERVIEW OF R EPORTED S YMPTOMS (SIRS) The Structured Interview of Reported Symptoms (SIRS) is a fully structured interview that is designed to assess feigned mental disorders and related response styles. Each of its eight primary scales was constructed to evaluate well-established detection strategies for differentiating between malingered and genuine psychopathology. These primary scales con- sist of Rare Symptoms (RS), Symptom Combinations (SC), Improbable and Absurd Symptoms (IA), Blatant Symptoms (BL), Subtle Symptoms (SU), Selectivity of Symptoms (SEL), Severity of Symptoms (SEV), and Reported Versus Observed Symptoms (RO). Description and Development The initial development of the SIRS was based on an exhaustive review of potential detection strategies for feigned mental disorders. SIRS scales were developed based on the likely effectiveness of the underlying detection strategy and the adaptability of each strategy to interview-based assessments. Final item selection was based on independent judgments by eight experts in malingering and was subsequently refined to improve scale homogeneity. The SIRS is composed of 173 items that are organized by eight primary and five supplementary scales. The original validation of the SIRS combined sam- ples from multiple studies to form four groups: 100 inpatients and outpatients, 97 controls from commu- nity, correctional, and college settings, 170 simulators including coached and uncoached participants, and 36 likely malingerers from forensic settings. Subsequent validation research has included clinical and correc- tional samples with an additional 255 participants. Reliability Internal consistencies (alpha coefficients) for SIRS primary scales were excellent: They ranged from .77 to .92, with a mean alpha of .86. The reliability of indi- vidual scores was examined via standard errors of measurement (SEM). The SEMs were low for both clinical and control samples, indicating high reliability for individual scores. A central issue for the SIRS was its interrater reliability. These estimates were impres- sive, ranging from .89 to 1.00. The median reliability was .99, which represents almost perfect agreement. Validity SIRS validation relied on a combination of simulation designs and known-group comparisons. The simula- tion design capitalizes on internal validity in its use of analog research with clinical comparison samples. In contrast, known-group comparisons provide unmatched external validity in their use of individuals from actual clinical-forensic settings who were inde- pendently evaluated as malingering by established experts. For the assessment of malingering, conver- gent results from simulation and known-group studies provided the strongest evidence of SIRS validity. A major focal point of the SIRS is its discriminant validity. The critical issue is whether each of the primary scales systematically differentiates between genuine and feigned psychopathology. Combining across studies, effect sizes can be computed for the critical distinctions (a) simulators versus clinical honest and (b) suspected malingerers versus clinical honest. For simulators, Cohen’s d’s were very large: They ranged from 1.40 (SU) to 2.31 (RS) with an average d of 1.74. Cohen’s d’ s were also very large for suspected malingerers but showed less variability: 1.20 (IA) to 1.98 (SEL). The average effect size for malingerers was identical to that of simulators ( d = 1.74). These combined data provide very strong evidence of discriminant validity. Convergent validity was evaluated by comparing the SIRS with other measures of feigned mental disorders. The SIRS evidenced robust correlations with MMPI–2 validity scales. For example, the SIRS primary scales are strongly correlated with Scale F ( r’s from .71 to .80). As also expected, they are negatively correlated with Scale K ( Mr =− .35), a measure of defensiveness. Construct validity was examined via discriminant analysis and factor analysis. A two-stage, stepwise discriminant analysis with a canonical correlation of 772 ———Structured Interview of Reported Symptoms (SIRS) S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 772 .79 demonstrated the usefulness of SIRS primary scales for the accurate differentiation of feigned from clinical honest profiles. A high level of accuracy was main- tained across calibration and cross-validation samples. Recently, a confirmatory factor analysis yielded strong support for a two-factor model of the SIRS (i.e., spuri- ous presentations and plausible presentations) that was theoretically relevant to the assessment of malingering. Forensic Applications The SIRS is widely accepted as one of the best-vali- dated measures of feigned mental disorders in clinical and forensic settings. Its classification of malingering in forensic settings is highly accurate. These classifications are based on either (a) three or more primary scales in the probable feigning range or (b) one or more primary scales in the definite feigning range. The probable feign- ing range was established so that it would include most feigners (typically > 75%) but very few genuine patients ( < 10%). By using the established criterion ( > 3 scales in the probable feigning range), very few genuine patients were misclassified as feigners (i.e., 2.1% at 3 scales; 0.0% at > 4 scales). Scales in the definite feigning range are set very high to minimize false positives. Research by other investigators generally confirms the accuracy of the SIRS and its low false-positive rates. Ongoing research suggests that the SIRS pro- vides useful data for civil-forensic applications such as disability evaluations. As a caution, the initial data indicate that its cut scores may not be useful for a sub- set of inpatients with dissociative disorders and multi- ple traumas beginning before adulthood. Future Directions Research is currently under way for validating a Spanish-language SIRS. The SIRS was independently translated by three bilingual psychologists. The com- posite translation was back-translated by an indepen- dent bilingual psychologist; minor discrepancies were found for only 11.0% of the SIRS items. A revised Spanish SIRS was subjected to further translations and reviews. With the Spanish SIRS established, the com- parability of the Spanish and English SIRS is currently being tested with bilingual Hispanic patients. Richard Rogers See also Forensic Assessment; Malingering Further Readings Rogers, R. (Ed.). (1997). Clinical assessment of malingering and deception (2nd ed.). New York: Guilford Press. Rogers, R., Bagby, R. M., & Dickens, S. E. (1992). Structured Interview of Reported Symptoms (SIRS) and professional manual. Odessa, FL: Psychological Assessment Resources. Rogers, R., Jackson, R. L., Sewell, K. W., & Salekin, K. L. (2005). Detection strategies for malingering: A confirmatory factor analysis of the SIRS. Criminal Justice and Behavior, 32, 511–525. Rogers, R., & Shuman, D. W. (2005). Fundamentals of forensic practice: Mental health and criminal law. New York: Springer. S UBSTANCE A BUSE AND I NTIMATE P ARTNER V IOLENCE Research indicates that substance abuse is a risk marker for intimate partner violence (IPV). This entry reviews the evidence for this association, possible explanations for it, and implications for theory and practice for professionals who work in this area. Substance Abuse as a Risk Marker for IPV Studies using a variety of passive-observational research designs have established that substance abuse is a risk indicator for IPV. For example, population-based studies as well as studies of clinic- or court-referred groups, have examined rates of substance abuse in people with and without a history of IPV victimization, IPV perpetration, or IPV recidivism (i.e., repeated IPV following an initial incident). According to narrative and meta-analytic reviews of these studies, the associa- tion between substance abuse and IPV is moderate or even moderate-to-large in magnitude. About 20% to 50% of all incidents of IPV occur when one or both partners have consumed and are under the influence of alcohol or illegal drugs. Substance abuse increases the odds of IPV perpetration or victimization by a factor of about 2 to 4. The association tends to be strongest when (a) the substances of abuse are alcohol, cocaine (in var- ious forms), or heroin; (b) substance abuse is defined in terms of problematic patterns of use, rather than fre- quency of use or amount consumed; © IPV is defined Substance Abuse and Intimate Partner Violence ———773 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 773 in terms of moderate or severe violence, rather than minor violence; and (d) substance abuse and IPV are defined in terms of a broad time frame (e.g., lifetime) rather than a narrow time frame (e.g., past year). The association does not appear to be influenced by the legal status of the intimate relationship (married vs. cohabiting vs. dating), the sexual orientation of the inti- mate partners (heterosexual vs. same sex), or the gen- der of the perpetrator and victim. Explanations for the Association Between Substance Abuse and IPV There are several possible explanations for the observed association between substance abuse and IPV. First, the association may be false—the result of perpe- trators attempting to avoid moral and legal culpability by claiming that they were intoxicated at the time they committed IPV. But the substance abuse/IPV associa- tion is observed even in studies that relied solely on vic- tims to provide information and even in studies where substance abuse was measured months or even years prior to the first occurrence of IPV. Second, the association may be artifactual—the result of some third factor that is causally related to both substance abuse and IPV. Potential third factors could include mental disorder in the perpetrator (e.g., antiso- cial personality disorder or psychopathy) or severe con- flict in the victim-perpetrator relationship (e.g., recent separation or divorce). But studies that attempted to con- trol for potential third factors have found that they accounted for only a small part of the association. Third, IPV may be a cause of (i.e., have a causal influence on) substance abuse. Longitudinal research supports this view, at least in part. People who experi- ence IPV increase their use of alcohol or illegal drugs, which in turn leads to increased risk for (repeated) IPV. Fourth, substance abuse may be a cause of IPV. The same longitudinal research that found that IPV increases substance abuse has also found that substance abuse increases risk for IPV, even when the substance abuse came months or years before the IPV. For example, substance abuse as a young adolescent predicts IPV as a young adult, and premarital sub- stance abuse predicts IPV after marriage. In addition, treatment outcome research has found that reductions in substance abuse are associated with subsequent reductions in risk for IPV. In summary, the association between substance abuse and IPV appears to be bidirectional in nature: Substance abuse is both a cause and a consequence of IPV. With respect to substance abuse as a cause of IPV, theory and research suggest that several direct or proximal and indi- rect or distal causal mechanisms may exist. Putative direct mechanisms focus on the psychopharmacological or psychological effects of substance abuse. Intoxication and withdrawal may impair cognitive functions, leading to reduced inhibitions against violence (e.g., underesti- mation of negative consequences, overestimation of pos- itive consequences, failure to consider alternatives to violence) or misperception of social cues (e.g., misattri- bution of hostile intent in others). Putative indirect mech- anisms focus on the destabilizing effects of substance abuse on social adjustment. For example, the short- and long-term consequences of substance abuse—such as problems with employment, finances, health, and family arguments about drinking patterns or the consequence of drinking on employment, finances, and relationships with family or friends—cause conflict between partners in intimate relationships, which in turn increases the risk that IPV will occur. Similarly, the consequence of sub- stance abuse may impair one partner’s ability to cope with conflictual or aggressive behavior by the other part- ner (through the use of strategies such as de-escalation, deterrence, or escape), thus increasing vulnerability to victimization and, ultimately, the risk that IPV will occur. Implications for Research and Practice It is clear that substance abuse is neither a necessary nor a sufficient causal factor for IPV but rather one of many contributory causal factors. Currently, researchers are trying to further understand the vari- ous causal mechanisms that may exist and how sub- stance abuse interacts with other causal risk factors to cause IPV. Professionals who work in the field of IPV need to be aware that substance abuse increases risk for IPV, and treating substance abuse mitigates risk. For these reasons, substance abuse is included as a risk factor in several IPV risk assessment procedures, including the Danger Assessment Instrument (DA) and the Spousal Assault Risk Assessment (SARA) Guide, and many intervention programs for perpetrators and vic- tims of IPV focus in part on decreasing substance abuse. The challenge for professionals is to determine what role substance abuse plays (i.e., which causal mecha- nisms are relevant) in a given case and then deliver appropriate services. Stephen D. Hart 774 ———Substance Abuse and Intimate Partner Violence S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 774 See also Danger Assessment Instrument (DA); Intimate Partner Violence; Spousal Assault Risk Assessment (SARA); Substance Use Disorders Further Readings Klostermann, K. C., & Fals-Stewart, W. (2006). Intimate partner violence and alcohol use: Exploring the role of drinking in partner violence and its implications for intervention. Aggression and Violent Behavior, 11, 587–597. Stith, S. M., & Smith, D. B., Penna, C. E., Ward, D. B., & Tritt, D. (2004). Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review. Aggression and Violent Behavior, 10, 65–98. S UBSTANCE A BUSE T REATMENT A number of different methods are used to treat sub- stance abuse. The most common method often used by treatment facilities is 12-step counseling, although little is known about its effectiveness. Treatment modalities include inpatient, day treatment, and outpatient care, usually followed by aftercare. Twelve Step Facilitation Therapy has been scientifically validated but is rarely adopted for use in 12-step treatment facilities. Motivational interviewing has been determined to be an effective means to motivate clients to seek therapy and change substance use and can be particularly effec- tive with unmotivated clients. Numerous cognitive- behavioral therapies have been effective as interventions in substance use disorders. Relapse prevention therapy is the most widely used cognitive-behavioral approach. Twelve-step counseling, cognitive-behavioral therapy, therapeutic communities, and even Vipassana medita- tion have been used in jails and prisons to intervene in substance use disorders and recidivism. Substance Abuse Treatment and the Criminal Justice System Evidence exists that quality substance abuse treatment can lead to lower recidivism and relapse rates among substance users in the criminal justice system. In addi- tion, court-ordered treatment has been found to be extremely cost-effective when compared with incarcer- ation as an alternative. Many jurisdictions now have drug courts that generally offer treatment as an alterna- tive to imprisonment, but the type of treatment available to participants varies widely across the country. Traffic courts often include mandated treatment courses for DUI offenders, but the evidence that these programs change drinking and driving behavior is inconsistent, perhaps because the content of these courses vary widely across jurisdictions. Treatment outcomes are often used by mental health courts, probation officers, and parole boards as evidence to determine the success of rehabilitation efforts. Typical Care at Treatment Facilities The prevailing model of treatment in the United States uses 12-step counseling (often referred to as the Minnesota Model). Although many of these programs have abstinence as a requirement for entry into the facility and as a goal for treatment, researchers find that many clients do not remain abstinent but will reduce their substance use. Although most treatment centers use a similar model, the quality and content of the 12- step counseling across treatment facilities is not consis- tent. In addition, the 12-step counseling provided by many treatment centers has not been tested under con- trolled conditions to determine if it is in fact effective. Addiction counselors are certified by state boards. The process often requires documentation of counselor education in Minnesota Model principles and an exam- ination of counseling skills by peers. Although some addiction counselors have undergraduate and graduate degrees, many states do not require these credentials for a counselor to be certified. Addiction counselors often have personal experiences in 12-step recovery. T T r r e e a a t t m m e e n n t t M M o o d d a a l l i i t t i i e e s s Treatment modalities vary. Treatment can be con- ducted in inpatient or outpatient settings. In the past, most treatment was provided in 28-day inpatient stays, until research showed that outpatient care is just as effective as inpatient care for most clients. Since those findings, the insurance industry has pushed the treat- ment toward a predominantly outpatient model. People with substance use disorders and co-occurring severe mental disorders (such a debilitating depression or psy- choses) may benefit more from the structured environ- ment of an inpatient stay. Day treatment also is available in some communities to provide structured treatment and care during business hours (clients return home dur- ing the evening). Many treatment facilities provide med- ical care, family programs, and sometimes nutrition and fitness programs. Counseling format varies between Substance Abuse Treatment ———775 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 775 individual sessions with a primary counselor to group sessions with peers and counselors. In addition to inpa- tient and outpatient services, treatment centers generally provide aftercare to provide ongoing support to clients who have completed treatment. S S u u p p p p o o r r t t G G r r o o u u p p s s Treatment providers generally encourage support group participation as an adjunct to therapy. Support groups vary in terms of philosophies. Twelve-step groups operate under the assumption that substance use disorders are chronic incurable diseases that require a lifetime of working the 12 steps to facilitate abstinence. Other groups such as Rational Recovery understand substance use disorders as a problem of disordered thinking and behavior that can be changed permanently with aid of the group and the Rational Recovery Program (based on the work of Albert Ellis). Moderation Management is an example of a support group that works with individuals who do not necessar- ily have abstinence as a goal but, instead, want to reduce substance use. Each program seems to be successful for participants when program philosophies closely match the values and worldview of the participants. Evidence-Based Treatment Researchers have developed and tested a great variety of therapies that have proved effective as interventions in substance use disorders. To provide quality and consistent care for psychological disorders, including substance use, the therapy used has to have two char- acteristics. The first is demonstration that the treat- ment has worked better than nothing at all by comparing outcomes in a particular therapy with a no- therapy or care-as-usual control group. The second important characteristic is conducting therapy using a manual. Manualized therapy promotes adherence to the scientifically validated treatment protocol to pre- vent drift. The following sections review therapies that have been tested under controlled conditions or have manuals or guidelines available for use by physi- cians/therapists to provide best practices to clients. B B i i o o p p s s y y c c h h o o s s o o c c i i a a l l M M o o d d e e l l Research supports a biopsychosocial model for addictive behaviors. Successful models of treatment incorporate biological (physiological), psychological, and social (environmental) interventions to modify biopsychosocial processes associated with substance misuse. For example, physiological (biological) treat- ment methods typically involve pharmacological means. There is evidence that certain medications may be helpful to promote treatment success among clients with alcohol use disorders. Disulfiram (Antabuse) has been used as a disincentive to alcohol use among people at high risk for relapse but with mixed results. Disulfiram blocks metabolism of alcohol and causes clients to become violently ill when they drink, which sometimes persuades clients to remain abstinent when they are tempted to drink. However, clients have been known to drink when on disulfiram, and client compli- ance for taking the medication is a problem. Naltrexone and acamprosate have been shown in some studies to help reduce cravings and improve treatment outcomes. Methadone has been used as a safe substitute for heroin. For clients with co-occurring mental disorders, such as depression, bipolar disorders, and schizophrenia, psy- chiatric medications can help reduce substance use. Many clients believe that substance use helps with psy- chiatric symptoms. When prescribed medications func- tion to control psychiatric symptoms, it may reduce the desire to self-medicate with illicit substances. P P s s y y c c h h o o l l o o g g i i c c a a l l T T h h e e r r a a p p i i e e s s Several types of psychological therapies have been found to be efficacious for the treatment of substance use disorders. Twelve Step Facilitation Therapy has been found to be efficacious in treating substance use disorders. This is a 12-session therapy that includes a manual to promote consistency in the delivery of the treatment. The therapy incorporates principles from 12-step programs (such as Alcoholics Anonymous and Narcotics Anonymous). Although Twelve Step Facilitation Therapy has been found to be an effective treatment under controlled conditions, many treat- ment centers across the country do not use this ther- apy, even though the manual is readily available from the National Institute of Alcohol Abuse and Alcoholism. Use of this therapy manual would likely increase quality and consistency of care in treatment centers dedicated to the 12-step model. Cognitive-behavioral therapy, which involves the use of scientifically developed and tested cognitive and behavioral modification methods to change behavior, has been found to be an effective means to intervene in substance use disorders. Many psychologists use 776 ———Substance Abuse Treatment S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 776 cognitive-behavioral therapy in individual psychother- apy with clients who have substance use disorders. As its name would suggest, cognitive-behavioral therapy includes change strategies described subsequently that target cognitions and behavior chains associated with substance use patterns in clients. Cognitive change strategies challenge and modify beliefs about substance use behavior. For example, beliefs about substance use influence motivation to change behavior, which in turn predicts whether a client will take steps to change behavior. Client motiva- tion levels vary widely in treatment; so assuming that a client is ready to change is unreasonable. In addition, client motivation changes over time so that one minute he or she can appear committed and then uncommitted the next. Ambivalence about change is normal, espe- cially early in therapy, and reflects the reality that clients are weighing beliefs about the pros of substance use against the cons. The Transtheoretical Stages of Change Model, a widely used model to understand addictive behavior change, indicates that commitment to change will occur when clients resolve their ambiva- lence in favor of resolve to take action. Motivational interviewing and motivational enhance- ment therapy have been found to be very helpful to enhance motivation to change among clients. Motivational interviewing is a scientifically validated therapy that uses strategic methods to help clients to explore and resolve their ambivalence about continued substance use and that enhances motivation to change. Research has found that use of motivational interview- ing can be very effective to encourage reductions in sub- stance use and can be used effectively in conjunction with other therapies. Motivational enhancement therapy is a scientifically tested therapy conducted over four ses- sions and includes the use of motivational interviewing along with other change strategies. Motivational inter- viewing seems to be especially effective with clients uncommitted to therapy. Other beliefs associated with substance use include expectancies and self-efficacy. Expectancies are beliefs that people have about the expected outcomes of sub- stance use, and they have been found to be a good pre- dictor of substance use pre- and posttreatment. The research suggests that interventions that increase nega- tive expectancies and decrease positive expectancies may be helpful to improve treatment outcomes. Therapists use various cognitive strategies to accom- plish this goal. Self-efficacy, or confidence and compe- tence in being able to negotiate particular situations without substance use, is another consistent predictor of treatment outcome. Therapists teach, rehearse, and reinforce new skills to cope effectively with high-risk situations to establish competence and to develop con- fidence in appropriately using the skills to enhance self- efficacy so as to avoid substance use in those situations. Several behavior modification strategies have been found to be effective to foster change. Aversion therapy pairs substance use with aversive agents to discourage the use of the substance. Typical methods are pairing the smell or taste of the substance with electric shock or an emetic agent to condition avoidance of substance use. Studies have found that aversion therapy can result in successful outcomes initially, but those posttreatment gains may be lost over the long term without concurrent use of relapse prevention (see below). Contingency management strategies have been used successfully to encourage positive outcomes in treatment. Contingency management modifies client behavior by providing incentives to successfully engage and complete tar- geted tasks in therapy. Incentives have been used to increase attendance and participation in sessions as well as promote reduction targets or cessation of sub- stance use. However, contingency management is not widely used, perhaps because of the costs involved with incentive-based care. Coping skills therapy has been supported by sci- ence as well. New skills are taught to aid clients to cope effectively and solve problems without the use of substances. Therapists may also teach anger manage- ment, daily life management, assertiveness training, and relaxation methods (including meditation) to increase the repertoire of skills available to clients. Relapse prevention methods developed in the cogni- tive-behavioral model have been shown to be highly successful to reduce the severity and duration of relapse events when they occur. Relapse prevention teaches clients that relapse is normative rather than a failure and can be used to identify and correct prob- lems in posttreatment behavior. Relapse prevention also teaches substance refusal skills, develops and rehearses plans to cope with relapses, and uses cogni- tive and behavioral modifications previously men- tioned in this section. In addition to one-on-one methods with clients, cognitive-behavioral interven- tions that target couples, family relationships, schools, and other peer groups have been associated with changes in substance use. Arthur W. Blume Substance Abuse Treatment ———777 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 777 See also Drug Courts; Substance Use Disorders; Therapeutic Communities for Treatment of Substance Abuse Further Readings Blume, A. W. (2005). Treating drug problems (Treating Addictions Series, Vol. 1, R. H. Coombs & W. A. Howatt, Eds.). New York: Wiley. Kadden, R., Carroll, K., Donovan, D., Cooney, N., Monti, P., Abrams, D., et al. (1999). Cognitive-behavioral coping skills therapy manual (Project MATCH Monograph Series, Vol. 3, M. E. Mattson, Ed.). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). New York: Guilford Press. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing (2nd ed.). New York: Guilford Press. Nowinski, J., Baker, S., & Carroll, K. (1995). Twelve Step Facilitation Therapy manual (Project MATCH Monograph Series, Vol. 2, M. E. Mattson, Ed.). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. S UBSTANCE U SE DISORDERS Substance use disorders are defined as the use of a sub- stance that results in persistent and sometimes perva- sive aversive consequences. Substance use disorders have profound economic and public health impacts in the United States. Researchers have identified impor- tant biological, psychological, and social factors that predict the development and resolution of substance use disorders. Biological processes related to substance use include physiological reactivity, changes, and adap- tations. Psychological processes associated with sub- stance use include conditioning, observational learning, beliefs about substance use, and emotions that cue sub- stance use. Social relationships and environmental stressors also have been found to influence the course of substance use. Diagnostic criteria have been estab- lished to define severity and to specify the course of the disorder. Substance use disorders are thought by some to be chronic and progressive, but research on the nat- ural course of these disorders disputes those beliefs. Impact of Substance Use Disorders The total costs of abuse of alcohol and abuse of other drugs including tobacco to the American economy has been estimated by the federal government to be more than $400 billion annually. The two most common substances of abuse are tobacco and alcohol. Conservative estimates indicate that about 20% of the population in the United States abuses tobacco, and between 8% and 13% of the population abuses alco- hol. Men are more likely to abuse substances than women. Treatment often results in positive outcomes. Substance abuse has been associated with the five leading causes of death in the United States in 2004: heart disease, cancers, strokes, chronic lower respira- tory illnesses, and unintentional injuries. Some ethnic minority groups may be at high risk for substance use problems. For example, liver diseases often associated with alcohol abuse were the sixth leading cause of death for Hispanics and Native Americans. In con- trast, liver diseases are not in the 10 leading causes of death for either Whites or Blacks. However, it is also worth noting that there is often wide variation in sub- stance use within demographic groups. Interestingly, Native Americans also have the highest abstention rate from alcohol when compared with any other eth- nic group. In the United States, the recent trend is greater abuse of prescription medications and methampheta- mines. Abuse of substances not traditionally classified as psychoactive, such as steroids and erectile dysfunc- tion medications, has been commonly seen over the recent years. Although these substances often are not listed among traditional drugs of abuse, they can become problematic for users. Substance abuse is strongly associated with legal consequences. In addition to violation of controlled sub- stance statutes, substance abuse has been associated with domestic violence and other violent crimes such as suicide, property damage, vehicular offenses, and sexual perpetration. In the United States, crime-related costs of substance abuse have been projected to be around $100 billion annually, and conservative estimates have indi- cated that at least 1 million people have substance abuse problems. Substance abuse is also a major contributing factor to traffic a

bundet

nd workplace accidents. Extreme substance-related toxicity can contribute to psychotic symptoms, although sometimes those symptoms pre- ceded the substance use and were masked. Biopsychosocial Model Researchers use a biopsychosocial model to understand addictive processes. Biological processes that have been identified include physiological reactivity to the 778 ———Substance Use Disorders S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 778 ingestion of substances, physiological changes due to acute or chronic use of substances, and physiological adaptations to the level of exposure to the substances. Physiological reactivity occurs in response to the sub- stance and results in metabolic changes in the body. Sub- stances activate the pleasure-reward system in the brain, which often results in euphoria. Acute or chronic sub- stance abuse can cause neurotoxicity and damage to vital organs. Commonly experienced cognitive impairments include difficulties with short-term and working mem- ory; problems with executive cognitive functions related to decision making, problem solving, impulse control, and abstraction; and, in some cases, difficulties with bal- ance and motor functions. Existing evidence suggests that some physiological changes are reversible, including cognitive impairment, after a period of abstinence. Psychological processes include behavioral, cogni- tive, and emotional responses to substance use. Behavioral processes operate according to learning prin- ciples. Classical conditioning in substance abuse occurs when particular stimuli are paired or associated with substance use. In substance abuse research, these stim- uli are often referred to as cues or triggers. Substance use may occur at an automatic level when cues trigger sub- stance use so quickly that the individual may be momen- tarily unaware of actions. Common triggers or cues include places, situations, things, physical senses (sen- sations, sights, sounds, smells, and tastes), emotions, or events that become paired with substance use and may trigger cravings or desires to use. Operant conditioning operates when substance use is reinforced or punished. Positive reinforcement is conceptualized as a consequence following a behavior that is rewarding or pleasurable and makes it likely that the behavior will be repeated. Substance use can have rewarding properties that positively reinforce the behaviors related to substance use. In addition, sub- stance use can be negatively reinforced. Negative rein- forcement occurs when an aversive consequence is lifted or withdrawn, which in effect reduces an aversive experience. Because the aversive consequence is with- drawn or reduced, it makes it more likely that the behavior will be repeated. An example of this process is when someone uses substances because it has reduced pain or discomfort previously (negatively reinforced) as opposed to using substances because it has caused euphoria in the past (positive reinforcement). An excel- lent and common example of substance use being neg- atively reinforced among users is when they described using substances to “self-medicate” symptoms. The behavior described as self-medication alludes to a history where the substance use may have caused aver- sive symptoms to subside. Research has demonstrated that punishment can effectively stop or reduce sub- stance use over the short term but that for long-term changes to occur punishment must be followed by learning new behavior and having that reinforced. Substance abuse is difficult to change because it is reinforced on a variable schedule. Since substances are sometimes reinforcing and sometimes not, the user cannot predict when substance use will be rein- forcing and continues using substances in the hope that the next event will be reinforcing. Variable rein- forcement is one process that contributes to the transi- tion from recreational use to substance abuse. Observational learning also is a powerful predictor of substance use. Youths and young adults are very much influenced by observing and then modeling the behaviors of significant others in their lives. Before adolescence, youths tend to model the substance use behavior of their parents. Researchers have noted that substance abuse tends to be intergenerational in family systems. The assumption for many years was that this intergeneration “transmission” of substance abuse must be genetic. However, recent research has identified that at least part of the intergenerational phenomenon in family systems appears to be learned behavior, princi- pally from observing and modeling parents who misuse substances. As youths move into the teen years and early adulthood, peer groups tend to influence sub- stance use more than parents. In addition, researchers have found that adolescents and young adults tend to overestimate the substance use of peers and at the same time underestimate their own substance use. Cognitive factors related to addictive processes include expectancies about substance use, motivation to change, and self-efficacy. Expectancies are beliefs about the expected effects of substance use. Expectancies can develop through personal experience or observational learning. As an example of the latter, to sell their prod- ucts advertisers of alcohol beverages often advertise that alcohol makes people sexy or socially attractive, beliefs that are assumed by youths who observe the advertise- ments. Positive expectancies refer to beliefs that sub- stance use will provide a desirable outcome, whereas negative expectancies refer to beliefs that substance use will lead to an undesirable outcome. Positive expectan- cies have been found to predict continued and some- times increased substance use, whereas negative expectancies have been linked to reductions. Motivation to change determines whether a user will consider and ultimately change substance use. Substance Use Disorders ———779 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 779 Decisions to change often follow a process known as the decisional balance, where a user considers the pros and cons for change. Ambivalence is quite normal for some- one contemplating change. If a user decides that the pros for change outweigh the cons, then she or he likely will be more committed to changing behavior and seeking help. Self-efficacy also has been found to predict sub- stance abuse. Self-efficacy is a term from social learning theory that describes, in the case of substance abuse, whether a person has competence and confidence to negotiate a specific situation without use of substances. Lower self-efficacy in a situation predicts poorer sub- stance use outcomes in that situation. Cognitive impairment is of concern when a user has engaged in extreme or chronic substance abuse. Perceptual problems result from acute intoxication. One phenomenon, substance use myopia, refers to how cognitive processes become impaired as intoxication increases, literally narrowing a person’s ability to see or accurately perceive events occurring around him or her. During substance use myopia, clients are vulnerable to impulsive, disinhibited, and risky behavior because per- ception of risk is impaired. As an example, substance- induced myopia leads to poor judgment, such as believing that it is safe to drive under the influence of substances. Emotions and moods also have been associated with substance abuse. Many users report links between emotional events and substance use behavior, and relapses have been linked to extreme emotions (positive or negative). Users often use substances to manage emotions and moods but also report that sub- stance use contributes to loss of emotional control. Research has established that chronic substance use may disrupt emotional expression and contribute to substance induced dysphoria. Social and environmental factors linked to addictive processes may include relationship stressors and envi- ronmental stressors such as unemployment and poverty. Some researchers believe that a major function of sub- stance misuse is in tension reduction. Changes in rela- tionship interactions and environmental conditions have been linked to changes in substance use. Youths are espe- cially vulnerable to changes in the environment and sub- stance abuse in that age group can be influenced heavily (both positively and negatively) by such changes. Diagnosis of Substance Use Disorders Misuse of substances can be diagnosed by means of structured clinical interviews that assess for criteria specified by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). The most com- monly used interviews are the Structured Clinical Interview for DSM-IV (SCID) and the Diagnostic Interview Schedule (DIS). Substance misuse is classi- fied as either substance abuse or dependence for a sin- gle substance or for multiple substances. DSM-IV diagnostic categories also include “specifiers” that denote abuse with or without physiological depen- dence and “course specifiers” that define the course of the disorder, including early full remission, early par- tial remission, sustained full remission, sustained par- tial remission, on agonist therapy (such as methadone), or in a controlled environment (where access is restricted). DSM-IV diagnoses conceptualize substance abuse as a chronic condition subject to periods of remission. However, researchers have found evidence that a sub- group of people diagnosed with alcohol dependence, for example, show evidence of controlled moderate drinking without problems later in life. In addition, other research shows that the course of substance abuse does not necessarily worsen with time nor do users need to hit the bottom to want help. Substance use diagnoses for adolescents have been found to be very unstable. Many adolescents meeting DSM-IV cri- teria for substance abuse or dependence experience a “maturing out” process as they age and go on to adult lives free of substance-related problems. Therefore, substance use diagnoses for adolescents should be interpreted with caution. Arthur W. Blume See also Substance Abuse Treatment; Therapeutic Communities for Treatment of Substance Abuse Further Readings DiClemente, C. C. (2003). Addiction and change: How addictions develop and addicted people recover. New York: Guilford Press. Donovan, D. M., & Alan Marlatt, G. (Eds.). (2005). Assessment of addictive behaviors (2nd ed.). New York: Guilford Press. McCrady, B. S., & Epstein, E. E. (Eds.). (1999). Addictions: A comprehensive guidebook. New York: Oxford University Press. Miller, W. R., & Carroll, K. M. (2006). Rethinking substance abuse: What the science shows, and what we should do about it. New York: Guilford Press. 780 ———Substance Use Disorders S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 780 S UICIDE A SSESSMENT AND P REVENTION IN P RISONS Prisoner suicide assessment and prevention is an area of active research and clinical involvement. Indeed, it is an important component of the forensic psychologist’s clinical responsibilities due to the disproportionately high incidence of prison suicide as compared with the general population. This high incidence is a consistent phenomenon across countries. In some countries, this translates into suicide being a major cause of death among prisoners. To address the topic of suicide assess- ment and prevention, first the research challenges in conducting prisoner suicide research and the relevant theory in conceptualizing the process of prisoner suici- dality are briefly summarized. A review of relevant risk factors as evidenced by research are categorized into several domains and described. These domains include demographic factors, historical factors, criminality fac- tors, and clinical factors. Following a review of risk fac- tors, suicide prevention within the prison setting is summarized. Research and Theory In an effort to better understand and assess (i.e., predict) prisoner suicide, a large body of research has investi- gated the risk factors related to prisoner suicide. However, there are some intrinsic challenges in the prediction of suicide generally, and there are some methodological weaknesses in prisoner suicide research specifically. The major challenge in predicting suicide is that it is a relatively rare event (i.e., has a low base rate). Statistically, it is more difficult to predict a rare event than a frequent event. This creates significant challenges for researchers in designing good-quality predictive studies. For example, because suicide is a relatively infrequent event, a researcher would need to have a very large number of subjects at the beginning of a study for there to be a sufficient sample size of even- tual suicides for analyses. For individual clinicians, this difficulty in predicting rare events creates the higher risk of false positives (i.e., predicting suicide where none occurs). False negatives (a suicide occurs when it was predicted that no suicide would occur) literally have life and death implications and represent what most clinicians and staff members want to avoid. Some particular methodological weaknesses in pris- oner suicide research include samples consisting of mixed populations of prisoners (e.g., remanded and sentenced prisoners), lack of control or comparison groups of nonsuicide or nonattempter prisoners, and reliance on descriptive studies, which generates diffi- culties in establishing a causal relationship between risk factors and outcome. Of note is that, in recent years, researchers have made efforts to address these methodological problems. There have been efforts to design more comparative studies, to use more sophisti- cated statistical analyses (e.g., logistic regression), and to even undertake matched control studies. This is a welcome shift in the research approach to prisoner sui- cide. Indeed, given the plethora of descriptive studies generated over the last 25 to 30 years, there are limita- tions in the value added by purely descriptive studies of prisoner suicide at this time. Designing more method- ologically sound studies will more meaningfully build on current knowledge. Overall, despite the challenges presented by researching prisoner suicidality, identifying relevant risk factors has facilitated the development of suicide assessment protocols and scales. Prior to reviewing rel- evant risk factors, it is important to note that, as useful as individual risk factors are, there has been a major contribution by researchers who have offered valuable conceptualizations of the suicidal process as one that occurs over time and is affected by multiple factors. In particular, Marti Heikkinen and colleagues have pro- vided one of the most well-developed models. Their process model of suicide consists of risk factors, pre- cipitating factors, vulnerability factors, and protective factors that contribute to the process of suicidality. In this model, the suicidal process is viewed as dynamic and affected by several categories of risk factors (i.e., biological, psychological, social, cultural). At the same time, the individual’s vulnerability and protective fac- tors affect risk. For instance, a prisoner who has diffi- culty in coping with various areas of his life will likely experience greater risk. A prisoner with a strong social support system would likely experience some protec- tion against risk. Finally, the model includes precipitat- ing factors such as stressors and external events that contribute to triggering suicidality (e.g., loss of support, negative decision regarding release). Risk Factors Research on prisoner suicidality reveals several domains of risk factors that are relevant to suicide assessment. These general domains include demo- graphic factors, historical factors, criminality factors, and clinical factors. Suicide Assessment and Prevention in Prisons ———781 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 781 D D e e m m o o g g r r a a p p h h i i c c F F a a c c t t o o r r s s During the last couple of decades, predominantly descriptive research has linked prisoner’s age with suicidal risk. Generally, the research has suggested that younger age groups (e.g., approximately under the age of 30 years) are overrepresented in suicide completer samples. However, a couple of recent and more methodologically sound research studies have challenged this conclusion, suggesting that either no relationship exists or that older age (i.e., 40 years and above) is predictive of prisoner suicide. More research will be required to clarify predictive relationships between age and prisoner suicide. A relatively new result provided by one of these recent studies was identifying homelessness as a predictive factor. It is worth mentioning that many descriptive studies have examined marital status as a correlate of prisoner sui- cide. These results have been equivocal and not uni- formly supported by the recent better-quality research. H H i i s s t t o o r r i i c c a a l l F F a a c c t t o o r r s s The research has been fairly convincing that both the presence of a psychiatric history (typically broadly defined in prisoner suicide research) and a history of substance abuse are connected to an increased risk of prisoner suicidality. Recent research using the matched control methodology and/or logistic regres- sion analyses has supported these predictive relation- ships. Some research suggests that recent psychiatric contact or intervention may possess additional predic- tive power. Results from the larger body of suicide research have revealed the increased risk generated by a family history of suicide. In particular, a genetic component has been attributed as partly responsible for the relationship. Individuals with first-degree rela- tives (i.e., parents, siblings) who committed suicide are at greater risk for committing suicide. This risk becomes more elevated if the relative suffered from a mood disorder (i.e., depression, bipolar disorder). Given this research, it is important to consider this factor in assessing prisoner suicidality. C C r r i i m m i i n n a a l l i i t t y y F F a a c c t t o o r r s s Several criminality factors are linked with greater risk of prisoner suicidality. These include sentence length, time served in sentence, security level, crimi- nal history, and institutional adjustment. In terms of a prisoner’s sentence length, generally prisoners with lengthier sentences are disproportionately represented among prisoner suicides. In particular, those prisoners with life or indefinite sentences may be at higher risk. The amount of time served in one’s sentence is also linked to prisoner suicide but not as definitively as sen- tence length. Generally, prisoners who commit suicide do so earlier in their sentences (within approximately the first 2 years of being sentenced). A prisoner’s secu- rity level appears to be relevant to suicidal risk. A lim- ited amount of recent research, some of which has used logistic regression, has revealed an overrepresentation of higher security prisoners (i.e., maximum security level) among suicide completers and attempters. Recent more methodologically sound research has indi- cated that several characteristics of prisoner criminal history are linked with suicidal risk. In one study, sui- cide attempters were more likely to have current con- victions for homicide, break and enter, or robbery. Consistent with that result were two studies that found having a current violent offense was more predictive of suicide completers. In addition, prisoners with a history of prior criminal involvement (variously defined as prior offense, prior incarceration) were more likely to attempt or commit suicide. One study found that sui- cide completers and attempts were more likely to have had breach of trust offenses (i.e., escapes, violations of parole or probation). Finally, limited recent research using comparison groups and logistic regression found that both suicide completers and attempters had demonstrated negative institutional adjustment (e.g., institutional violence, contraband violations, substance abuse incidents, escape, requests for protective cus- tody). Prisoners with a history of contraband-related incidents were three times more likely to attempt sui- cide. Those with a disciplinary history were 19 times more likely to engage in a suicide attempt. Both suicide completers and attempters participated in correctional programs less than nonattempters. C C l l i i n n i i c c a a l l F F a a c c t t o o r r s s In addition to assessing the risk factors characteris- tic of suicidal prisoners, there is a fundamental role for the assessment of relevant generic clinical factors as part of the suicide assessment. In other words, a good assessment of prisoner suicidality is predicated on con- ducting a competent clinical assessment. In fact, there are several salient clinical factors that require particular attention. Clinical domains and factors important to the 782 ———Suicide Assessment and Prevention in Prisons S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 782 suicide assessment are described. The work of John and Rita Sommers-Flanagan has been used to lend some structure to the description of clinical factors. In addi- tion, where relevant, prisoner suicide research related to that factor is summarized. The overarching clinical fac- tors include the presenting problem, depression, suici- dal ideation suicidal intent, suicidal plan, self-control, vulnerability, and coping. Presenting Problem Similar to a suicide assessment with a nonforensic client, the initial goal is to attempt to establish rapport and determine the nature of the presenting problem. Determining the prisoner’s level of distress and cop- ing efforts will provide some indication of how to pace the remainder of the assessment. Identifying the precipitating factors and current stressor(s) provides some contextual and situational information. Depression There is a strong relationship between depression and suicidality as well as between depression and hopelessness. If a user combines alcohol and depres- sion, then risk will further elevate. Therefore, it is important to determine the presence of depressive symptomatology. The diagnostic criteria and sympto- matology of depression are not detailed here. Rather, relevant domains of functioning are reviewed as a means of suggesting some structure for the assess- ment process. These include emotional, physical, cog- nitive, behavioral, and social domains. The emotional domain primarily refers to determin- ing the presence of depressed mood and related factors such as frequency, intensity, and duration. Of particular concern is the presence of hopelessness. Research has established hopelessness as a strong predictive factor of suicide generally. Available research investigating this factor in prison populations has confirmed the predic- tive relevance of hopelessness. An additional emotional factor that warrants attention is the occurrence of a sud- den and unexplained change in the individual’s mood and/or functioning. This is a salient clinical sign that has traditionally been interpreted as an indication of increased risk. Experts in suicide assessment suggest that the improvement may result from the individual making a decision about ending his or her emotional pain or result from an alleviation of mental illness. The suggested dynamic is that either of these occurrences reduces ambivalence, brightens moods, and frees up energy to act (and possibly carry out a plan for suicide). The physical domain refers to determining the presence of physical symptomatology indicative of depression. Relevant factors include appetite, weight, sleep, energy level, concentration, psychomotor func- tioning, and self-care. The cognitive domain involves assessing whether cognitive functioning is intact. For example, there may be the presence of thought distortions, disorga- nized thought, impaired judgment, or event psychotic symptoms. Research has also pointed to the relation- ship between depression and the presence of negative thinking about oneself, the world, and the future (referred to as the cognitive triad). The behavioral domain refers to behavioral symp- toms of depression that can be observed. These may include decreased pleasure in one’s usual activities, decreased physical activity, restlessness, poor concen- tration, and poor problem solving. Changes in self- care and other negative behavior may be present. The social domain refers to interpersonal and social functioning. Some examples can include social withdrawal, rejecting support, interpersonal conflict, and decline in social skills. Suicide Ideation and Suicidal Intent Suicidal ideation and suicidal intent are related to increased risk for suicide. Ideation does not necessar- ily result in high risk. Expressing suicidal intent gen- erally presents a greater risk than ideation. Inquiring directly about ideation and intent is important. Questions regarding frequency, duration, and intensity can provide additional information. In addition, col- lateral information and/or behavioral observations can be useful. If the prisoner commits or contracts, it is suggested that the commitment be made for both self- harm and suicide rather than assuming the commit- ment for one act will generalize to the other. Suicide Plan Having a suicide plan can present a serious level of risk. Determining the details is crucial. Relevant domains of functioning to assess include prior suicide attempts, specificity, lethality, availability, and proximity. A history of prior suicide attempts increases the risk for suicide. A suicide attempt within the past year ele- vates risk even further. Obtaining details about the prior Suicide Assessment and Prevention in Prisons ———783 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 783 attempts can help identify any patterns or past precipi- tants that may be relevant to the current situation. Specificity of the suicide plan needs to be deter- mined. Generally, the more detailed (i.e., high speci- ficity) a plan, the greater the risk of suicide. Lethality of a suicide plan is defined as the amount of time that passes between initiating the suicidal act and dying. High lethality is a plan that results in a quick death (e.g., hanging) and translates into high risk. In addition to the lethality presented by a specific method, there is also an impact resulting from how the method will be used. Research on prison suicide has revealed that hanging, a very lethal method, is the pri- mary method of committing suicide. Self-Control By examining a prisoner’s behavioral history (e.g., history of impulse control difficulties) and obtaining information about previous suicide attempts, the pris- oner’s degree of self-control can be assessed. Another factor affecting self-control is the use of alcohol or substances. Coping and Vulnerability A prisoner’s poor ability to cope is a risk factor of suicide. Research has identified a component of the prison population that is particularly vulnerable and poor copers. These individuals tend to have difficulty coping across time and situations. Psychosocial isolation (e.g., emotional and social support) increases the likelihood of suicide. The pris- oner’s access to emotional and social support resources should be assessed. Physical isolation of suicidal prisoners can have a detrimental effect. Research addressing this issue had revealed that placing suicidal prisoners in some form of isolation (e.g., constant observation) is quite detrimental and can actually contribute to increased suicidal risk. Suicide Prevention Suicide prevention is typically conceptualized as an institutional or organizational approach to preventing prisoner suicides. Among the preventive strategies, there can be policies and procedures that specify the manage- ment of identified suicidal prisoners (e.g., type, fre- quency, and/or location of observations; mental health referrals). More broadly, there can be policies, proce- dures, and programs designed to improve identification of suicidal prisoners. Screening for suicidal risk at intake can be a valuable preventive strategy. During the last decade, there has been an appreciable amount of research directed toward developing effective screening instruments. Some scales are designed to be adminis- tered by nonclinical frontline staff at intake (e.g., correc- tional staff), while other scales require mental health training to administer. Some screening instruments have been designed for specific settings (e.g., remand centers vs. prisons), while other scales have been designed for use across a variety of settings. Implementing a screen- ing instrument can be influenced by human resource and cost factors. A brief scale that requires no mental health training to administer is typically less resource intensive than a scale that may require clinically trained staff (e.g., nurse) to administer. However, the administrative costs must be weighed against the effectiveness of the scale to accurately identify prisoners as potential suicide risks. An important component of suicide prevention pro- grams includes training programs for prison staff. These programs can vary in scope. Some training pro- grams target improved knowledge about the indicators of suicidality, while others target skill building in detec- tion and basic intervention. Indeed, some institutions or jurisdictions have developed programs that provide training to prisoners in an effort to improve knowledge and/or provide skills that facilitate detection and peer support. Yet another suicide prevention strategy can involve changes to the physical environment that essen- tially decrease opportunity for a suicidal prisoner. For example, changes in cell location (e.g., observation cell) may improve visibility of a suicidal prisoner. Improvements to the physical structure of a cell may include installing tamper-proof fixtures and eliminating structures that provide opportunities to implement a suicide plan (e.g., a noose attached to a pipe). Overall, research supports the conclusion that sui- cide prevention programs can reduce the incidence of prisoner suicides. Wider implementation of suicide prevention policies, procedures, and programs is nec- essary to further advance prevention efforts. Indeed, more comprehensive suicide prevention programs would also be beneficial. Natalie H. Polvi See also Critical Incidents; Extreme Emotional Disturbance; Forensic Assessment; Jail Screening Assessment Tool 784 ———Suicide Assessment and Prevention in Prisons S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 784 (JSAT); Mood Disorders; Personality Disorders; Posttraumatic Stress Disorder (PTSD); Substance Use Disorders Further Readings Bonner, R. L. (2000). Correctional suicide prevention in the year 2000 and beyond. Suicide and Life-Threatening Behavior, 30, 370–376. Daigle, M., Labelle, R., & Cote, G. (2006). Further evidence of the validity of the Suicide Risk Assessment Scale for prisoners. International Journal of Law and Psychiatry, 29, 343–354. Hayes, L. M. (2007). Jail suicide/mental health update. National Institute of Corrections. Retrieved April 12, 2007, from http://www.nicic.org/Library/000001 Heikkinen, M., Aro., H., & Lonnqvist, J. (1993). Life events and social support in suicide. Suicide and Life- Threatening Behavior, 23, 343–358. Liebling, A. (1995). Vulnerability and prison suicide. British Journal of Criminology, 35, 73–187. Polvi, N. H. (1997). Assessing risk of suicide in correctional settings. In C. D. Webster & M. A. Jackson (Eds.), Impulsivity: Theory, assessment, and treatment (pp. 278–301). New York: Guilford Press. Sommers-Flanagan, J., & Sommers-Flanagan, R. (1995). Intake interviewing with suicidal patients: A systematic approach. Professional Psychology: Research and Practice, 26, 41–47. S UICIDE A SSESSMENT M ANUAL FOR INMATES (SAMI) The Suicide Assessment Manual for Inmates (SAMI) is a new instrument designed to assess risk for suicide attempts among individuals admitted to a pretrial remand center or jail. The SAMI is a 20-item clinical checklist of risk factors derived from the suicide research literature. Initial research on the SAMI has focused on its factor structure and predictive validity. Suicide is the leading cause of death of inmates in jail facilities. Research on suicide prevalence rates indicates that the rate of suicide in an incarcerated pop- ulation is higher than that in the general population, with some estimates indicating the prevalence to be as much as nine times higher in incarcerated populations. In addition, the prevalence of suicide may be higher in a population of remanded (pretrial) offenders than in a population of sentenced offenders. Suicide is a low base rate behavior; therefore, it is difficult to predict which individuals will attempt to commit suicide. It is, however, important to be able to identify those inmates who are at an increased risk for suicide on admission to a correctional facility so that they may be classified and housed accordingly. Structured clinical guidelines are useful in attempt- ing to determine which individuals are at an increased risk for suicide. The SAMI was developed to provide a framework of important variables that should be assessed for each individual admitted to a pretrial remand center or jail to determine that individual’s risk for suicide within the next 24 hours. The SAMI is a clinical checklist of risk factors for institutional sui- cide attempts. It consists of 20 items that were identi- fied by a review of the literature on suicide in general as well as suicide in jails and prisons. The purpose of the SAMI is to guide evaluators through important information and variables that should be assessed to determine an inmate’s risk for institutional suicide. The SAMI was developed for use as a way to structure professional judgment in the assessment of institu- tional suicide risk. Each of the 20 items contained in the SAMI can be rated on a 3-point scale, with a score of 0 being asso- ciated with low risk, a score of 1 being associated with moderate risk, and a score of 2 being associated with high risk with respect to the particular item. It is important to note, however, that like many instru- ments developed to structure professional judgment, the item scores on the SAMI are not to be added but, rather, are to be considered within the full context of the individual, the institution, and the circumstances. Both the self-report of the inmate as well as the obser- vations and professional judgment of the evaluator are to be considered for each item. Extensive and thorough literature reviews have iden- tified numerous variables that are associated with risk for suicide in general as well as in jails and prisons, including age; sex; marital status; history of drug or alcohol abuse; psychiatric history; history of suicide attempts; history of institutional suicide attempts; family history of suicide; arrest history; history of impulsive behavior; high-profile crime or position of respect within the community; current intoxication; concern about major life problems; feelings of hope- lessness or excessive guilt; presence of psychotic symp- toms or thought disorder; symptoms of depression, Suicide Assessment Manual for Inmates (SAMI) ———785 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 785 stress, and coping; social support; recent significant loss; suicidal ideation; suicidal intent; and suicide plan. The SAMI includes an assessment of each of these variables, with the exception of age and sex given the low variability on these factors since the vast majority of jail inmates are males in their 20s and 30s. The SAMI is a new instrument, and research exam- ining its reliability and validity is limited. Results of a preliminary study in which the SAMI was administered to 138 pretrial defendants indicate acceptable levels of interrater reliability. In addition, this research indicates that scores on the SAMI items are related to institu- tional category of risk for suicide (low, medium, high), need for mental health services, and need for monitor- ing within the pretrial facility. Factor analysis of the SAMI items identifies six factors: affective disturbance, suicide history, current cognitive state, current situa- tional variables, impulsivity, and support and coping. The first three factors (affective disturbance, suicide history, and current cognitive state) are strongly associ- ated with institutional category of risk for suicide, need for mental health services, and need for monitoring within the institution. The sixth factor, support and cop- ing, is also strongly associated with need for mental health services. Regression analyses with the SAMI have indicated that Factors 1 and 2 (affective distur- bance and suicide history) are predictive of referral to mental health services within the institution, whereas Factors 2 and 3 (suicide history and current cognitive state) are predictive of category of institutional suicide risk. Further research investigating the predictive utility of the SAMI is currently underway. Patricia A. Zapf See also Suicide Assessment and Prevention in Prisons Further Readings Zapf, P. A. (2006). Suicide assessment manual for inmates. Burnaby, BC: Mental Health, Law, and Policy Institute. S UICIDE BY C OP Suicide by cop (SbC) is a phenomenon confronted by police officers in which suicidal individuals behave in such a way as to force officers to use lethal force against them. Research findings have found common characteristics and behaviors among SbC subjects. The phenomenon is recognized sufficiently that there are a number of court decisions that are relevant to incidents that are defined as SbC. Finally, police offi- cers often suffer psychologically after their involve- ment in SbC incidents. Their suffering must be addressed if they are not to have long-term effects. Suicide requires an active decision to kill oneself. Such action may conflict with religious ideology, or the subject may fear societal stigma. Suicidal individuals also may fear pain and believe that the police officers’ training in lethal force will ensure their instant death. Some of these individuals have a desire to die in a high- profile “blaze of glory.” Often, the decision of individ- uals to induce the police to use lethal force against them is impulsive. Emotionally distraught and under the influence of alcohol, many individuals form a cloudy decision to die only when the police arrive in response to a precipitating event such as a domestic dispute. Due to some of these conditions, suicidal subjects may become SbC subjects, inducing officers to kill them. As with other suicidal behavior, the subject fre- quently is ambivalent about death. If the police can delay a confrontation, SbC subjects often are open to negotiation, especially if they become sober. Unfortunately, as found by studies conducted by the author, SbC subjects often place officers in situations in which they cannot get themselves or the victims in a safe place, so must shoot the SbC subjects. Also similar to other forms of suicide attempts, the behav- ior that often accompanies an SbC incident is an endeavor to cope with stressful life events by self- destructive behaviors. SbC subjects primarily are male, White, and more than 25 years old. They often have a mental illness his- tory, including mood and personality disorders. Alcohol is used in a majority of the recorded SbC inci- dents, with a number of the individuals having a history of alcohol abuse. Subjects under the influence of alco- hol overcome their inhibitions and are more impulsive and lethal. Often, anger and aggression are indicated by a number of past assault or domestic violence com- plaints, homicidal pre-incident conversations, and negotiation conversations that include injury to others. Precipitating events to the SbC incidents often include the termination of a relationship and/or other family problems. SbC subjects have been known to attempt to use the incident as a means to coerce a sig- nificant other to remain in a relationship or for revenge against a significant other. Unlike other suicide victims, 786 ———Suicide by Cop S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 786 SbC subjects usually have significant others in their lives, although these others are often part of the prob- lem. Outstanding criminal warrants on the SbC subject also are prevalent. They may state that they would rather die than return to prison. Although early research in SbC focused on prepa- ration by SbC subjects, more recent research done by the author has found that about half of the SbC inci- dents are impulsive rather than planned. About half of the SbC subjects, who she studied, had made some sort of statement or had a change in behavior that could be interpreted as presuicidal. These behaviors included writing and leaving a note, telling a therapist or significant other of what they were considering, and giving away possessions. Prior suicide attempts overall were not very prevalent; however, those who had attempted suicide in the past were more likely to be successful in their attempts in inducing police offi- cers to shoot them. The courts have not decided predominantly in favor or against police officers in all SbC cases; how- ever, the courts have agreed that only the facts known by the officers at the time of the incident are relevant to the case. Intentions or motives of the SbC subjects discovered later are not directly related. The degree of danger that the officer or another person is in is judged at what is known by the officer at the time of the inci- dent. Officers are granted qualified immunity unless they violate established law. The plaintiff has the bur- den to prove that the officers committed a constitu- tional violation. Although the courts should consider only what the officer would have known at the time of the incident, it is useful to conduct a psychological autopsy to investi- gate what the individual’s state of mind was at the time of the SbC incident. Such information will give officers a better understanding of the subject’s motivation, plan, and pathology. It can help also in officers’ psychologi- cal debriefings. Information for a psychological autopsy often is obtained from the subject’s friends, family, and co-workers, as well as from any notes left by the subject, recent high-risk behavior, the giving away of personal property, and actions or statements that suggest preoccupation with death and/or suicide. Officers who are involved in the SbC incident, espe- cially the officer(s) who actually shoot the subject, are quite likely to suffer psychological traumatic stress dis- order. Often, the subject does not actually have a loaded or real gun, although it appears real at the time of the incident. The officer may feel manipulated by the subject and is unprepared for the emotional and physi- ological reactions that follow the shooting. The officer also is often not given the opportunity to verbalize or emotionally ventilate his or her emotions. It is critical that police agencies require officers to see a therapist if they are involved in shootings or other violent incidents. Vivian B. Lord See also Critical Incidents; Police Psychology; Psychological Autopsies Further Readings Hutson, H. R., Anglin, D., Yarbrough, J., Hardaway, K., Russell, M., Strote, J., et al. (1998). Suicide by cop. Annals of Emergency Medicine, 32, 665–669. Lord, V. B. (2004). Suicide by cop: Inducing officers to shoot. Flushing, NY: Looseleaf Law. Parent, R. B., & Verdun-Jones, S. (1998). Victim precipitated homicide: Police use of deadly force in British Columbia. Policing: An International Journal of Police Strategies and Management, 21, 432–448. S UPERMAX P RISONS Super-maximum secure or “supermax” prisons are used to hold those prisoners whom prison authorities regard as the most problematic in the prison system. These facilities merge the 19th-century practice of long-term solitary confinement with 21st-century tech- nology in ways that subject prisoners to unparalleled levels of isolation, surveillance, and control, usually for long duration, with the potential to inflict significant amounts of psychological harm. Despite a range of aca- demic studies documenting the serious and potentially long-lasting psychological harm it may inflict, and sev- eral judicial opinions criticizing the risks it entails and significantly limiting its use, the supermax prison form persists. This entry describes the conditions in which prisoners in supermax confinement are held, character- istics of the supermax population, effects on prisoners of supermax confinement, and the current legal status of supermax prisons. Although different prison systems employ different terminology to refer to supermax-like conditions (e.g., “control unit,” “special management unit,” “security housing unit,” or “close management”), these units have enough distinctive features in common to be analyzed as Supermax Prisons ———787 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 787 a separate penal form. Their use has continued to increase over the past several decades, and there are now tens of thousands of prisoners in supermax-type con- finement throughout the United States. Conditions of Supermax Confinement Conditions in supermax confinement are marked by the totality of the isolation, the intended duration of the confinement, the reasons for which it is imposed, and the technological sophistication with which it is achieved. Supermax facilities house prisoners in vir- tual isolation and subject them to almost complete idleness for extremely long periods of time. These prisoners rarely leave their cells and are typically given at most 1 hour a day of out-of-cell time. They eat all their meals alone in the cells, and typically, no group or social activity of any kind is permitted. In most of these units, prisoners are escorted outside their cells or beyond their housing units only after they first have been placed in restraints—chained while still inside their cells (through a food port or tray slot on the cell door)—and sometimes tethered to a leash that is held by an escort officer. Prisoners in supermax confinement are rarely if ever in the presence of another person (including physicians and psychotherapists) without being in some form of physical restraints (e.g., ankle chains, belly or waist chains, handcuffs). They also often incur severe restrictions on the nature and amounts of personal property they may possess and have limited access to the prison library, legal materials, and can- teen. Their brief periods of outdoor exercise or “yard time” typically take place in caged-in or cement- walled areas that are so constraining they are often referred to as “dog runs.” In some units, prisoners get no more than a glimpse of overhead sky or whatever terrain can be seen through the tight security screens that surround their exercise pens. Supermax prisoners often are monitored by camera and converse with staff through intercoms rather than through more direct and routine interactions. In newer facilities, computerized locking and tracking systems allow most of their movement to be regulated with a minimum of human contact (or none at all). Some super- max units conduct visits through videoconferencing equipment rather than in person, which means that pris- oners are denied immediate face-to-face interaction (let alone physical contact), even with loved ones who may have traveled great distances to see them. In addition to “video visits,” some facilities employ “telemedicine” and “telepsychiatry” procedures in which prisoners’ medical and psychological needs are addressed by staff members who “examine” and “interact” with them over television screens from locations many miles away. As noted, supermax prisons routinely keep prison- ers in this near-total isolation and restraint for extremely long periods of time. Unlike punitive segre- gation in which prisoners typically are isolated for rel- atively brief periods of time for specific disciplinary infractions, supermax prisoners may be kept under these conditions for years on end. In addition, many correctional systems impose supermax confinement as part of a long-term strategy of correctional man- agement and control rather than as an immediate sanc- tion for discrete rule violations. Population of Supermax Prisons Supermax prisons are usually justified by reference to the alleged dangerousness of the prisoners who are housed there—the “worst of the worst,” as correc- tional administrators often characterize them. Thus, the increased use of this distinctive prison form is linked to the contention that an especially dangerous or “new breed” of disruptive prisoner now inhabits the modern maximum security prison. In fact, there is little or no empirical support for these contentions. Instead, many prisoners appear to be placed in super- max less for what they have done than who they are judged to be (e.g., “dangerous,” “a threat,” or, espe- cially, a member of a “disruptive” group). In many states, a large group (sometimes the major- ity) of supermax prisoners has been given “indetermi- nate” terms, usually on the basis of having been officially labeled by prison officials as gang members. An indeterminate supermax term often means that these prisoners will serve their entire prison sentences in iso- lation unless they “debrief” by providing incriminating information about other alleged gang members. These practices have resulted in a significant overrepresenta- tion of racial and ethnic minorities in supermax prisons and what analysts have described as an “overclassifica- tion” of the prisoners who end up in these units. In addition, the percentage of mentally ill prisoners in supermax appears to be much higher than in the general prison population. Thus, researchers estimate that approximately 30% of supermax prisoners suffer from “severe mental disorders.” This overrepresentation of the 788 ———Supermax Prisons S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 788 mentally ill likely results from the fact that some men- tally disturbed prisoners engage in disruptive behavior that prison officials punish rather than treat. It also may indicate that supermax conditions themselves are severe enough to exacerbate and perhaps even create psycho- logical disturbances in persons subjected to them. Effects of Supermax Confinement Numerous empirical studies have documented the harmful psychological consequences of living in supermax facilities. The evidence is substantial and comes from personal accounts, descriptive studies, and systematic research on solitary and supermax- type confinement conducted over a period of many decades by researchers from several different conti- nents with diverse backgrounds and a wide range of professional expertise. Direct studies of prison isolation have documented an extremely broad range of harmful psychological reactions, including potentially damaging symptoms and problematic behaviors such as negative attitudes and affect; insomnia, anxiety, withdrawal, hypersensi- tivity, ruminations, cognitive dysfunction, hallucina- tions, loss of control, irritability, aggression; and rage, paranoia, feelings of hopelessness, lethargy, depression, a sense of impending emotional breakdown, self- mutilation, and suicidal ideation and behavior. Self- mutilation and suicide are also more prevalent in iso- lated prison housing—the hallmark of supermax confinement, as are deteriorating mental and physical health (beyond self-injury); other-directed violence, such as stabbings, attacks on staff, and property destruc- tion; and collective violence. In fact, many of the nega- tive effects of solitary confinement are analogous to the acute reactions suffered by torture and trauma victims, including posttraumatic stress disorder. Some researchers have estimated the prevalence rates of these adverse symptoms among prisoners who are confined in supermax-type conditions. One study found that three-fourths or more of a representative sample of supermax prisoners reported suffering from ruminations or intrusive thoughts; an oversensitivity to external stimuli; irrational anger and irritability; confused thought processes; difficulties with attention and often with memory; and a tendency to withdraw socially, to become introspective, and to avoid social contact. An only slightly lower percentage of prisoners in the same study reported a constellation of symptoms that appeared to be related to developing mood or emotional disorders—concerns over emotional flatness or losing the ability to feel, swings in emotional responding, and feelings of depression or sadness that did not go away. Finally, sizable minorities of supermax prisoners reported symptoms that are typically only associated with more extreme forms of psychopathology—hallucinations, per- ceptual distortions, and thoughts of suicide. In addition to these specific symptoms, many super- max prisoners undergo other kinds of significant and potentially damaging transformations during their iso- lated confinement. Because they are so tightly and completely controlled, they may lose the ability to ini- tiate or to control their own behavior or to organize their personal lives. Because individual identity is socially constructed and maintained, the virtually com- plete loss of genuine forms of social contact and the absence of any routine and recurring opportunities to ground thoughts and feelings in a recognizable human context leads to an undermining of the sense of self. For other prisoners, total social isolation leads, paradoxi- cally, to social withdrawal. That is, some prisoners recede even more deeply into themselves than the sheer physical isolation of supermax requires. Legal Regulation Because supermax prisons are of relatively recent ori- gin, their constitutionality—the question of whether the conditions of confinement in this new prison form represent “cruel and unusual punishment”—has been tested in only a few important legal cases. The first of these cases, Madrid v. Gomez (1995), addressed con- ditions of confinement in California’s Pelican Bay Security Housing Unit. Although the judge found that overall conditions in the supermax units were harsher than they needed to be, he concluded that he lacked any constitutional basis to close the prison or even to require significant modifications in many of its gen- eral conditions. Instead, he barred certain categories of prisoners from being sent there because of the ten- dency of the facility to literally make them mentally ill or to significantly exacerbate preexisting mental ill- ness. However, he also emphasized that the record before him had pertained to prisoners who had been in supermax for no more than a few years and that longer-term exposure might lead to a different result. The constitutionality of supermax confinement has been tested in federal courts in several other states (notably in Texas and Wisconsin), with largely similar results—a strongly worded condemnation of the Supermax Prisons ———789 S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 789 harshness of the conditions, exclusionary orders that exempted certain categories of prisoners from such confinement, but a concession that there was no legal basis to order that the supermax prisons be closed. The legal threshold for finding conditions of confine- ment unconstitutional has been set especially high in the United States over the past several decades. Supermax prisons per se continue to come very close to this thresh- old and, in the case of mentally ill prisoners, were found to have crossed it. As the empirical record about the psy- chological effects of this kind of confinement continues to be augmented, and the consequences of long-term confinement in these units becomes clearer, other courts may reach different and perhaps even more sweeping conclusions about the legality of supermax. Craig Haney See also Prison Overcrowding Further Readings Haney, C. (2003). Mental health issues in long-term solitary and “supermax” confinement. Crime & Delinquency, 49, 124–156. Haney, C., & Lynch, M. (1997). Regulating prisons of the future: The psychological consequences of solitary and supermax confinement. New York University Review of Law and Social Change, 23, 477–570. King, R. (2000). The rise and rise of supermax: An American solution in search of a problem? Punishment and Society, 1, 163–186. Kurki, L., & Morris, N. (2001). The purposes, practices, and problems of supermax prisons. Crime and Justice, 28, 385–424. Madrid v. Gomez, 889 F. Supp. 1146 (1995). Riveland, C. (1999). Supermax prisons: Overview and general considerations. Washington, DC: U.S. Department of Justice. 790 ———Supermax Prisons S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 790 791 T ENDER Y EARS D OCTRINE The tender years doctrine, or the practice of awarding infants and young children to mothers in custody dis- putes, was employed in most state courts from the late 19th century until the 1960s. The tender years doctrine is based on the idea that mothers have superior, “nat- ural” nurturing abilities and a biological connection to their infants. In the 1970s, most states abolished the tender years doctrine and replaced it with a gender- neutral “best interests of the child” standard. However, some current research claims that a maternal prefer- ence, especially in custody disputes over infants, con- tinues to exist in practice in lower-level courts. History of Child Custody Law Historically, fluctuations in child custody law have reflected societal changes in beliefs about parenthood. Until the mid- to late 1800s, fathers had sole rights to custody, reflecting the notion that women and children were considered the property of the male head of the household. The father’s absolute claim to custody also reflected the view of children at the time: In the primar- ily agrarian economy of the early 19th century, children were seen as economic assets. This agrarian economy shifted to an industrial one in the mid- to late 19th cen- tury, which made children less economically valuable and also necessitated the separation of home and work. With the emergence of separate spheres, men worked outside of the home, and women had responsibility for the home. At this time, the law shifted to a “tender years” doctrine. The tender years doctrine emphasized mothers’ biological superiority as a parent and gave a legal preference to mothers in custody matters. In the past few decades, most states have replaced the tender years doctrine with a best interests of the child doctrine, under which both mothers and fathers are con- sidered equally. This shift in custody law reflected more widespread changes to gender-neutral legal language. For example, in Watts v. Watts (1973), a New York family court stated that “application of the ‘tender years presumption’ would deprive [the father] of his right to equal protection of the law under the Fourteenth Amendment to the United States Constitution.” Adopting the “best interests” standard also coincided with increasing public acceptance of the notion that fathers are able to care for children as well as mothers. In 1986, in Pusey v. Pusey , a Utah appeals court held that a maternal preference “lacks validity because it is unnecessary and perpetuates outdated stereotypes.” At the same time, psychological research was used in legal proceedings to bolster the idea that mothers or fathers could be good caregivers to young children. Research on father-child interactions supported this idea, as did studies claiming that preserving the child’s relationship to its “psychological parent”—the adult most responsible for and connected to the child—was paramount. This psychological research was used to discredit the tender years doctrine and to endorse the best interests of the child policy. Current Research on the Tender Years Doctrine Despite the shift to a more gender-neutral custody standard, the consideration of tender years is not a relic T T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 791 of the past. As recently as 1989, a Florida appeals court, in DeCamp v. Hein , applied a maternal prefer- ence in the case of a child of tender years. And until 1997, the Tennessee child custody statute allowed judges to consider the sex of the parents in the case of a child of tender years. Thus, some scholars argue that judges in the lower courts have not “caught up” with this change in the law. Even if the tender years doctrine is not endorsed in statutory or case law, trial court judges may subscribe

bundet

to it. A recent study examined both judges’ views of the tender years doctrine and whether their views were con- sistent with contested custody rulings. In face-to-face interviews, judges were asked directly about the tender years doctrine and also asked to assess a hypothetical custody case involving an infant. Despite the current gender-neutral custody policy, over half the judges inter- viewed expressed some support for the tender years doctrine. These views of the tender years doctrine were explained, in large part, by the gender of the judges and, relatedly, by their gender role attitudes; female judges reported more egalitarian views and were less likely to support the tender years doctrine than male judges. When comparing judges’ views of the tender years doc- trine with their decisions in custody disputes, judges’ accounts were generally consistent with their rulings in contested custody disputes. Judges who endorsed the tender years doctrine were more likely to award custody of infants and young children to mothers than judges who did not endorse the tender years doctrine. This research suggests that although state appellate courts and legislatures have abolished the tender years doctrine, practice in lower courts may continue to per- petuate some vestiges of the tender years doctrine. So despite greater legal and cultural acceptance of the idea that fathers and mothers are equally qualified to raise children, there are complex processes at work in the legal system that may perpetuate traditional notions of motherhood and fatherhood. Julie E. Artis See also Child Custody Evaluations; Divorce and Child Custody Further Readings Artis, J. E. (2004). Judging the best interests of the child: Judges’ accounts of the tender years doctrine. Law & Society Review, 38, 769–786. DeCamp v. Hein , 541 So.2d 708, 710 (Fla. App. 1989). Mason, M. A. (1994). From fathers’ property to children’s rights: The history of child custody in the United States. New York: Columbia University Press. Pusey v. Pusey , 728 P.2d 117 (Utah 1986). Watts v. Watts , 77 Misc.2d 178, 350 N.Y.S.2d 285 (1973). T ERMINATION OF P ARENTAL R IGHTS When families fail to care for and protect children, states have the authority, when granted legal jurisdiction by the court, to initiate family services and to provide sub- stitute care for the children. The prevailing legal stan- dard for the care and protection of children is the best interest standard. The state is expected to act in the best interest of the child. Termination of parental rights is a legal action initiated in state family or juvenile court by the state’s child protective services department. It typi- cally follows a series of care and protection hearings and interventions designed to protect children within the confines of child welfare laws and regulations promot- ing child safety, family life, and parental rights. Cases of severe maltreatment, defined by statute, may move immediately to termination of parental rights without the provision of family services. Less serious care and protection cases are resolved without a termination hearing. When the conditions for family reunification remain unsuitable, a termination hearing is initiated according to state statutes, child protective service regu- lations, and codified timelines. The content of termina- tion statutes varies across state jurisdictions (in some instances, federal statutes apply). Common thresholds for state jurisdiction and subsequent termination of parental rights include serious harm or the threat of seri- ous harm to a child due to a caregiver’s physical abuse, sexual abuse, or physical and emotional neglect of the child. Some statutes contain other criteria, such as the amount of time the child has been in substitute place- ment and the child’s attachment to substitute caregivers after a defined period of time in their custody. Termination of parental rights is a legal action and a subsection of child and family law and psychology. In termination proceedings, the attorney’s role depends on whom the attorney represents. The child protective services agency’s attorney, employed by the state, rep- resents the interests of the state in the care and protec- tion of children. When facing a termination hearing, parents in states allowing indigent funding are 792 ———Termination of Parental Rights T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 792 provided with attorneys. In other states, parents must hire attorneys privately. Usually, each caregiver has his or her own attorney. Children may be provided their own attorneys to represent their expressed interests and guardians ad litem to represent their best interests as determined by substituted judgment. The role of the psychologist, as a forensic evaluator or consultant, depends on the referral source and the referral ques- tion(s). The psychologist is retained by the court, the state, or one of the attorneys for the parent(s) or child. Evaluations are requested for five main reasons: (1) to assess the caregiver’s need for interventions after the state assumes jurisdiction; (2) to evaluate the risk of harm, if any, the caregiver poses to the child; (3) to assess the child’s level of functioning and intervention needs; (4) to assess the caregiver’s amenability to interventions; and (5) to determine the caregiver’s par- ticipation and progress in recommended interventions. Referral questions may be comprehensive, involving the evaluation of multiple family members; or they may be limited to a specific feature of the case. A properly qualified forensic psychologist has knowledge of jurisdictional legal and regulatory care and protection standards. The acceptance of a referral takes place within the legal context. The referral ques- tion is framed in a manner that respects parents’ rights, the rights of children, the socioeconomic and cultural dynamics of the case, and the role and purview of the judicial finder of fact. Psychologists consult ethical standards and guidelines for practice, and they have a strong foundation in theories and research relevant to child maltreatment, parenting, child development, parental risk of harm through violence and neglect, parental mental illness and substance abuse, parental intellectual functioning, and parental poverty. They use the forensic assessment report and court testimony as communication mechanisms addressed to all parties relevant to the case. Legal and Regulatory Standards Societal responses to child maltreatment take many shapes, with the legal system representing the most for- mal mechanism of response. The nature and breadth of state jurisdiction in child care and protection matters are found in legal definitions of child maltreatment and in legal and regulatory procedures for identifying, investigating, intervening in, and making judicial deci- sions about family reunification or separation. Broad constitutional rights serve as the legal basis for family privacy, parental rights, and children’s rights. Federal regulations influence developments and changes in state statutes, with the most recent guidance found in the Adoption and Safe Families Act of 1997. Child- abuse-reporting requirements and statutes influence the frequency and nature of cases entering the child protec- tive services system. Procedural laws and regulations govern the sequence of hearings and the structure and process of service provision as cases move through the system. The confluence of these sources of laws and procedures provides a framework for the relative judi- cial weight given to state jurisdiction, family privacy, parental rights, and children’s interests in their protec- tion from harm or the threat of harm. From a legal per- spective, children are neither fully independent nor fully dependent legal actors in actions taken by the state over the competence of their caregivers. A typical case in which a termination hearing is eventuated moves through the following phases: an anonymous report of maltreatment by a mandated or a nonmandated reporter; an initial screening of the com- plaint by the local or regional child protective services agency representatives; an investigation of the allega- tions in the complaint; an emergency evidentiary hear- ing and removal of the children from the custody of the caregivers; an evidentiary hearing over whether the emergency removal will stand or will be overturned; placement of the children in substitute care; provision of relevant services to the caregivers and the children; periodic reviews and hearings relevant to the continued need for state intervention and service provision; and a final evidentiary hearing that leads to an outcome of a reunification plan, permanent substitute care, or termi- nation of parental rights. Only the most serious and pro- tracted cases reach termination. If their rights are terminated, parents occasionally are allowed posttermi- nation contact with their children under carefully spec- ified and limited circumstances. More commonly, ties are severed, and posttermination contact is disallowed. Forensic Assessment in Context Referrals for forensic assessment in the context of care and protection matters are made to assist the court in gathering data relevant to the case. Referrals may orig- inate directly from the court by prior agreement of all involved parties, through an ex parte motion by the attorney for one parent or a joint motion by the attor- neys for both parents, from a representative or an attor- ney for the child protective services agency, through Termination of Parental Rights ———793 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 793 a regional child protection agency’s contracted relation- ship with specific consultants/evaluators, or through an ex parte motion by the attorney for the child. Ex parte motions are those that occur in front of the judge with- out the knowledge of the other parties to the case. They preserve attorney–client privilege until the report is introduced into evidence. Motions may or may not be requested in this private fashion. The use of exparte motions gives the attorney the option of quash- ing results unfavorable to the client’s case. The disad- vantage is the difficulty of retaining attorney–client confidentiality and protecting the evaluation results under the attorney work product rule because of the eventual need for the evaluator to contact multiple par- ties to conduct a thorough evaluation that would typify most referral questions in care and protection matters. Referral questions cover a range of topics. The evaluator might be asked to assess the child’s psycho- logical well-being in the aftermath of maltreatment or threats of maltreatment, to determine what services should be offered to the child and/or the caregiver to promote child well-being and safety, the amenability of the caregiver to interventions designed to reduce the risk of harm to the child, the psychological impact on the child of a return to the custody of the caregiver, the psychological impact on the child of permanent substitute care or parental rights termination, and the child’s attachment to substitute caregivers. Ethical Standards and Guidelines for Practice Psychologists and other mental health professionals seek the relevant education, professional training, postdoctoral training, and continuing education. They turn to ethical standards and principles to guide their practice. Professional organizations develop guidelines for practice. Guidelines have been written specifically for the subspecialty of forensic assessment and consul- tation in care and protection matters. Guidelines rele- vant to cultural competence are particularly important because of the broad diversity of families that come to the attention of the care and protection system. Advocacy organizations for child welfare sometimes develop their own suggested practice guidelines. Child Maltreatment Legal definitions of child maltreatment are drawn from statutes, child protective service regulations, and case law. Social science definitions and nosologies of child maltreatment may not be fully consistent with the legal standards because of differing classification schemes and thresholds for maltreatment. Research on the etiol- ogy and impact of child maltreatment is complicated by differences in the definitions of maltreatment, differing standards for quantifying the scope and impact of mal- treatment, and differing classification and diagnostic schemes. Theories of child maltreatment are drawn from sociobiology, the emerging field of genetics and human behavior, the psychology of human attachment, and the psychology of the inner life of the individual. Such theories may also take into account violence in the individual and society, parental attribution style, parental intellectual and social support resources, the impact of mental illness and substance abuse on parent- ing, intergenerational transmission or desistance of child maltreatment (i.e., whether parents who were vic- timized by child abuse become abusers or set about making sure they do not become abusers), social isola- tion, youthful parenting, and macrosocial issues such as neighborhood quality or the stress of parental impover- ishment. Scholars are careful to point out that parents may parent competently even when they face multiple challenges. Parental factors such as mental illness, parental substance abuse, or intellectual limitations must be linked directly to the maltreatment to be con- sidered legally relevant. Parental violence and neglect involve multiple complex factors that result in child maltreatment by some but not all parents. Research usefully illustrates the features that are common in cases of child maltreatment, but none of the features or combinations of features is isomorphic with maltreat- ment per se. Although much is known about the factors that predict child maltreatment, the relative weight of individual factors is less clear. Cumulative risk and chronicity of risk are not well researched, in part because of the inherent ethical and methodological challenges of conducting relevant empirical research in applied settings. Parenting and Child Development Theories of parenting and child development provide a framework for considering multiple styles of parent- ing, multiple forms of family structure, and child development trajectories. Theory serves as an organiz- ing framework for understanding the inner life of individuals, family dynamics, the social biological 794 ———Termination of Parental Rights T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 794 context, and the cultural context of cases. It facilitates the use of logic and reasoning in the integration of evaluation data. Research provides a basis for under- standing family relationships, understanding the family system from the child’s perspective, recom- mending relevant interventions, understanding and interpreting parental risk of harm, and placing para- meters around interpretations and recommendations based on limitations in the state of the science. A forensic assessment report with legal utility has pro- bative value based on the science of psychology as it is applied to and interpreted within specific legal standards. Forensic Assessment in Care and Protection Matters Evaluation methodology and forensic assessment reports in care and protection matters vary with the breadth and comprehensiveness of the referral ques- tions(s). A typical evaluation involves an interview with the caregiver(s), an interview with the child, caregiver- child observations, collateral information, relevant records, and psychological assessment and/or risk assessment measures when indicated. Multimodal assessment is the most optimal approach. Focus is placed on hypothesized factors that potentiated family distress and child maltreatment, the viability and treat- ment utility of the service plan, whether conditions have changed or have been adequately addressed, and whether positive changes might be stable over time. Evaluation methodology might alternatively focus on the child’s attachment to substitute caregivers and the child’s readiness for adoption. Depending on the refer- ral question, the interpretation section of a report might address the parent’s level of functioning; the strength and quality of the parent-child relationship; child mal- treatment risk and the mediators of risk; parental amenability to treatment; accommodations that might contribute to parental amenability to treatment; the expected intervention outcome for a parent or a child; specific changes (or lack thereof) in a parental condi- tion, such as mental illness or substance abuse; support services that would allow a parent with intellectual lim- itations to parent adequately; the description of a partic- ular child’s special needs and their bearing on the child’s parenting needs; and the matter of whether a positive intervention outcome might be expected within statutory time limits. Meaningful reports and testimony answer the referral question(s) with scientific integrity, within the parameters of the legal standards and con- text, in a tone respectful of all parties to the case and the judiciary, and with appropriate caveats. Lois Oberlander Condie See also Child Maltreatment; Children’s Testimony, Evaluation by Juries; Child Sexual Abuse; Sex Offender Assessment; Sex Offender Treatment; Substance Abuse Treatment; Substance Use Disorders Further Readings American Psychological Association, Committee on Professional Practice and Standards. (1988). Guidelines for psychological evaluations in child protection matters. Washington, DC: Author. Belsky, J. (1993). Etiology of child maltreatment: A developmental-ecological analysis. Psychological Bulletin, 114, 413–434. Condie, L. (2003). Parenting evaluations for the court (Perspectives in Law and Psychology, Vol. 18, R. Roesch, Ed.). New York: Kluwer-Plenum. Dubowitz, H. (1999). The families of neglected children. In M. E. Lamb (Ed.), Parenting and child development in “nontraditional” families (pp. 327–345). Mahwah, NJ: Lawrence Erlbaum. Goldstein, R. D. (1999). Child abuse and neglect: Cases and materials. St. Paul, MN: West. T ERRORISM Terrorism, like many other horrific types of violence, has begged in the minds of many for a psychological explanation. The research and systematic analysis that has been done on the topic, however, show that neither mental illness nor a simple “lack of conscience” are significant primary causes of terrorism. There is no known “terrorist personality.” The pathways and influences that lead certain individuals to become ter- rorists are quite diverse. Psychological research and systematic analysis, however, can help illuminate the processes by which people and groups come to adopt extremist ideologies and subsequently use those ideas to justify violent actions. Since the attacks on the United States on September 11, 2001, leaders in the U.S. intelligence, diplomatic, and law enforcement communities have concurred that terrorism currently poses the most serious threat Terrorism ———795 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 795 to American national security. Understanding the causes, motivations, and determinants of terrorist behavior poses an enormous challenge in countering that threat, leading to a heightened interest in the “psychology of terrorism.” This entry focuses on the psychological dimensions of terrorist behavior, de- emphasizes the analysis of sociologically based expla- nations (sometimes referred to as root causes ) or macrolevel economic and political theories, and does not address the psychological effects of terrorism. After decades of social science research, no single theory of aggression has gained ascendance as an explanatory model for all types of violence. Terrorism is a distinct form of violence, although the basic ques- tion of how best to define terrorism has itself been a vexing problem. For heuristic purposes, though, most agree that terrorism would include acts of violence (as opposed to threats or more general coercion) inten- tionally perpetrated on civilian noncombatants with the goal of furthering some ideological, religious, or political objective. Issues of intent, tactics, motive, ideology, and legit- imacy of targets all add complexity and plurality to the construction of terrorism as a form of violence and challenge the emergence of a unifying explanatory theory. Commenting on the search for a master expla- nation of terrorism generally, Walter Laqueur has insightfully observed that there exist “many ter- rorisms” and that the factors that cause, sustain, or weaken them may vary greatly for different groups in different contexts at different points in time. From a psychological perspective, the psychiatrist Jerrold Post believes that there is not one terrorist psychology, but multiple terrorist psychologies. Psychological theory and research on terrorism has evolved considerably since the 1960s. The earliest line of work was drawn principally from psychoanalytic theory and tended to focus on narcissism and hostility toward parents as explanatory variables. More recent explanations have moved away from this approach. A summary of the more contemporary body of profes- sional literature on the psychology of terrorism is out- lined below and framed around a series of functional questions. How and why do people enter, remain in, and leave ter- rorist organizations? Research on terrorists and violent extremists who adhere to a broad range of ideologies shows that the pathways to, and motives for, terrorism are quite varied and diverse. Among the key psycholog- ical factors in understanding whether, how, and which individuals in a given environment enter the process of becoming a terrorist are motive and vulnerability. By definition, motive is an emotion, desire, physiological need, or similar impulse that acts as an incitement to action, and vulnerability refers to susceptibility or liability to succumb, as to persuasion or temptation. Regarding motive, researchers have begun to distinguish between the reasons for joining, remaining in, and leav- ing terrorist organizations, finding that motivations may be different at each stage and not even necessarily related to each other. Regarding vulnerability, there do appear to be some common vulnerabilities and per- ceptions among those who turn to terrorism—perceived injustice, need for identity, and need for belonging, though certainly there are persons who share these per- ceptions but do not become terrorists. In 2006, at Pennsylvania State University, an Advanced Research Workshop was convened of pro- fessionals who study the psychology of terrorism. The common “risk factors” for terrorism identified by the participants of the workshop included the following: • Perceptions of isolation or alienation from general society • Perceptions of individual or group humiliation, injus- tice, shame, or dishonor • Social isolation • Need for identity and desire to belong • Sense of disillusionment with the available alternatives • Ideology that legitimizes terrorism • Role models and heroes • Sense of being or identifying with victims Promising areas of inquiry have focused on com- mon stages and processes in adopting extremist ide- ologies rather than on the content of the motive or justification per se. Three contemporary theories describing the adoption of extremist ideologies include Randy Borum’s generic four-stage terrorist mindset model, which attempts to explain how griev- ances and vulnerabilities are transformed into hatred of a target group and how hatred is transformed—for some—into a justification or impetus for violence. Also recently introduced is Ali Moghaddam’s stair- case to terrorism model, in which he describes a con- vergent (i.e., fewer people proceed to each successive stage), five-step progression that transforms the per- sonal experience of adversity into violent terrorist action. Using a more socially based framework in a study of people affiliating with Al-Muhajiroun in the 796 ———Terrorism T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 796 United Kingdom, Quintan Wiktorowicz outlines a four-part, developmental process based on social movement theory. Although each model was devel- oped independently, and almost contemporaneously, the consistency of the major themes across the three models is quite striking. To what extent is psychopathology relevant for under- standing or preventing terrorism? Research on the psychology of terrorism has been nearly unanimous in its conclusion that mental illness and abnormality are typically not critical factors in explaining terrorist behavior. Studies have found that the prevalence of mental illness among samples of incarcerated terrorists is as low as or lower than in the general population. Moreover, although terrorists often commit heinous acts, they would rarely be considered classic psy- chopaths. Terrorists typically have some connection to principles or ideology as well as to other people (including other terrorists) who share them. Psychopaths, however, do not form such connections, nor would they be likely to sacrifice themselves (including dying) for a cause. To what extent is individual personality relevant for understanding or preventing terrorism? There is no terrorist personality “type,” nor is there any accurate profile—psychologically or otherwise—of the terror- ist. Moreover, personality traits alone tend not to be very good predictors of behavior. Becoming a terrorist is probably best regarded as a process rather than as a single decision. That process is affected not only by the individual psychological characteristics, but also by situational factors, recent experiences, associations with others, and the ambient political environment and influence of people’s constituencies. The quest to understand terrorism principally by studying the per- sonality traits of terrorists is likely to be an unproduc- tive area for further investigation and inquiry. To what extent are an individual’s life experiences rel- evant for understanding or preventing terrorism? Certain life experiences tend to be commonly found among terrorists. Histories of childhood abuse and trauma appear to be widespread. In addition, themes of perceived injustice and humiliation often are promi- nent in terrorist biographies and personal histories. None of these contribute much to a causal explanation of terrorism but may be seen as markers of vulnerabil- ity, possible sources of motivation, or mechanisms for acquiring or hardening one’s militant ideology. What is the role of ideology in terrorist behavior? Ideology is often defined as a common and broadly agreed on set of rules to which an individual subscribes, which help regulate and determine behavior. Ideologies that support terrorism, while quite diverse, appear to have three common structural characteristics: They pro- vide a set of beliefs that guide and justify a series of behavioral mandates; those beliefs are inviolable and must be neither questionable nor questioned; and the behaviors are goal directed and seen as serving some cause or meaningful objective. Culture is a critical fac- tor in the development of ideology, but its impact on terrorist ideologies specifically has not been exten- sively studied. Ideology guides and controls behavior, perhaps by providing a set of behavioral contingencies that link immediate behavior and actions to long-term positive outcomes and rewards, or it may best be viewed as a form of rule-following behavior. What distinguishes extremists who act violently from those who do not? Not all extremist ideologies facilitate violence, nor are all extremists violent. One potentially useful distinction to consider is the direction of activity—that is, whether the focus is more on promo- tion of a cause or destruction of those who oppose it. Even within destruction-oriented extremism, it usually takes more than ideology to compel violent action. Psychological and social influences must erode the powerful, naturally occurring barriers that inhibit wide- spread human killing. The two main avenues of assault on those barriers are outside-in (i.e., effects of the group or social environment) and inside-out (i.e., making an internal cognitive adjustment about how to perceive the environment or situation). What are the vulnerabilities of terrorist groups? Terrorist groups, like all social collectives, have cer- tain vulnerabilities in their existence. Some come from within the organization, and some operate from outside. Internal vulnerabilities include internal mis- trust, boredom/inactivity, competition for power, and major disagreements. Some of the more common external vulnerabilities include external support, con- stituencies, and intergroup conflict. How do terrorist organizations form, function, and fail? Surprisingly little research or analysis has been conducted on the stages and cycles of terrorist groups’ organizational development and functioning. In partic- ular, there has been little systematic inquiry on the process of terrorist recruitment, despite the fact that Terrorism ———797 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 797 thwarting tomorrow’s terrorists is at least as critical as understanding extremists of the past and the present. There are three tentative conclusions on extremist recruitment: (1) terrorists focus their recruitment where sentiments about perceived deprivation are deepest and most pervasive, (2) social networks and interpersonal relationships provide critical connections for recruit- ment into terrorist organizations, and (3) effective ter- rorist recruiters either identify in or impart on the prospect a sense of urgency and imminence in “closing the deal.” Though some anecdotal reports exist on how some specific individuals came to join a terrorist group, there has been little serious scientific or systematic study of recruitment and radicalization processes. From extremist group research based on organiza- tional behavior principles, it does seem clear that the group must be able to maintain both cohesion and loy- alty. Effective leaders of terrorist organizations must be able to maintain a collective belief system, estab- lish and maintain organizational routines, control the flow of communication, manipulate incentives (and purposive goals) for followers, deflect conflict to external targets, and keep the action going. The State of Research Social science researchers in the field of terrorism studies are nearly unanimous in their conclusion that its research largely lacks substance and rigor. Several fundamental problems remain unresolved: There still is no agreed-on definition of terrorism, most of the existing research is not empirical or based on any data, and the existing research is largely inapplicable to operational considera- tions. Future endeavors designed to inform counterter- rorism operations should be operationally informed, maintain a behavior-based focus, and derive interpreta- tions from analyses of incident-related behaviors. In addition, to further the basic social science of ter- rorist behavior, NATO’s Advanced Research Workshop posed the following as “high-priority” research objec- tives for the future: • A more rigorous, specific understanding of social and political movements that are not involved in vio- lence, in order to understand what leads some organi- zations toward violence • More primary research—better access to and more interviews with activists and terrorists • Better triangulation of data obtained from these sources Furthering psychological and other behavioral sci- ence research on terrorism will, it is hoped, enhance international security and prevent acts of violence toward innocent civilians. Randy Borum See also Criminal Behavior, Theories of Further Readings Borum, R. (2003). Understanding the terrorist mindset [Electronic version]. FBI Law Enforcement Bulletin, 72 (7), 7–10. Retrieved from http://www.fbi.gov/ publications/leb/2003/july03leb.pdf Borum, R. (2004). Psychology of terrorism. Tampa: University of South Florida. Retrieved from http://www.ncjrs.gov/pdffiles1/nij/grants/208552.pdf Borum, R. (2004). Psychology of terrorism: Annotated bibliography. Tampa: University of South Florida. Retrieved from http://www.ncjrs.gov/pdffiles1/nij/ grants/208551.pdf Moghaddam, F. (2005). The staircase to terrorism: Psychological exploration. American Psychologist, 60, 161–170. T ESTAMENTARY C APACITY Under Anglo-American law, the right of testation refers to the freedom to choose how one’s property and other possessions will be disposed of following one’s death. For a will to be valid, the testator (the person making the will) must have testamentary capacity (TC) at the time that the will is executed. TC is thus a legal con- struct that represents the level of mental capacity nec- essary to execute a valid will. If TC is absent, then the will is void and fails. For reasons of public policy, courts have traditionally applied a low legal threshold for finding TC. Conceptually, TC falls within the broader concept of financial capacity , but for reasons of history and tradi- tion, TC continues to receive distinct attention within the legal system. Each state jurisdiction, through its statutes and case law, sets forth the legal elements or criteria for TC. The absence of one or more of these ele- ments of TC can serve as grounds for a court to invali- date a will. A will can also fail if the testator has an insane delusion that specifically and materially affects the testator’s creation or amendment of a will. Finally, a will is often challenged on the conceptually separate 798 ———Testamentary Capacity T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 798 ground that it was the product of undue influence on the testator exerted by a family member or a third party. As TC represents a legal construct closely associ- ated with the testator’s mental status, clinicians are often asked to evaluate TC and offer clinical testimony in legal proceedings. Such evaluations are sometimes conducted contemporaneously with a will’s execution but more often occur retrospectively following the incapacity or death of a testator and probating of the will. In recent years, there has been an increase in will contests in the probate courts, with associated claims of impaired TC and also undue influence. There is currently relatively little literature on TC. Several papers addressing the general clinical guide- lines for assessing TC and undue influence exist. However, there is a great need for conceptual and empirical work in this area. Legal Elements of TC Although the requirements for TC vary across states, four criteria must generally be met. A testator must have (a) knowledge of what a will is, (b) knowledge of the class of individuals that represents the testator’s potential heirs (“natural objects of one’s bounty”), © knowledge of the nature and extent of his or her assets, and (d) a general plan of distribution of assets to his or her heirs. The absence of one or more of these elements can serve as grounds for a court to invalidate a will due to lack of TC. However, the way in which courts weigh the legal elements of TC in determining the validity of a will varies across states. Some states require that the testator meet only one of the criteria for a will to be valid. Other states require that the testator not only must understand a will and demonstrate memory of all property and potential heirs but also must hold this information in mind while developing a plan for dis- position of assets. Accordingly, the reader is strongly encouraged to review the relevant law on TC specific to his or her state jurisdiction. Insane Delusion and TC Even when the legal elements of TC are present, a will can fail due to an insane delusion. Specifically, some states require that the testator be free of delusions and hallucinations that result in the testator devising prop- erty in a way that he or she would not have done in the absence of the delusions and hallucinations. A psychi- atric disorder with delusions and other symptomatology is not by itself sufficient to invalidate the will. It must be shown that the delusion specifically and materially affected the testator’s creation or amendment of a will. In other words, the will must be the direct product of the insane delusion. Undue Influence A will can also fail on the separate ground that it was the product of undue influence. Although undue influ- ence is conceptually distinct from TC, these two legal issues very often co-occur and intertwine when wills are contested. Under the law, undue influence exists in those situations where the will is the product of manip- ulation, persuasion, or coercion exerted by the “influ- encer” (e.g., family member, friend, neighbor, caregiver) and is not truly the volitional act of the testator. It com- monly occurs in relationships where the testator has a special trust in or reliance on the influencer and where dependency has been increased through the influencer’s use of isolation and manipulation. In some instances, the testator may be subjected to explicit threats and intimidation by the influencer. Conceptually, undue influence assumes some preserved level of TC in the testator, which, however, is supplanted by the wishes and actions of the influencer. For this reason, undue influence should be considered conceptually distinct from TC, albeit closely linked to it. Clinicians need to understand both TC and undue influence when con- ducting evaluations in this area. Attorney Observations of TC Typically, issues of TC may first arise in the context of a testator’s interactions with his or her attorney. During the course of the client interview, an attorney may observe signs of diminished TC, such as an inability to recall the names of family members or to appreciate the full value of different assets. Variability in a client’s state of mind and a lack of consistency between the client’s current choices and his or her long-term values and previously stated wishes can also raise red flags. From a professional standpoint, attorneys must be sen- sitive to indicators of diminished TC in their clients and, where necessary, take steps to protect their client’s best interests. In many instances, this may involve seek- ing consultation from a clinician. Clinical consultation regarding TC can substan- tially inform the way in which attorneys and judges understand and determine the legal issues of TC. The role of clinicians in cases of TC includes informal Testamentary Capacity ———799 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 799 consulting with attorneys about clients with question- able capacity, contemporaneous clinical evaluations of TC prior to will execution, and retrospective evalu- ations of TC in cases involving a now-deceased or incompetent testator. Consultation Regarding TC An attorney may choose to consult with a clinician prior to, or instead of, seeking a formal clinical assessment. In this situation, the clinician provides an informal opinion regarding TC based solely on client observation and the information provided by the attorney. The clinician may also identify concerns or issues that the attorney may have overlooked, as well as suggest strategies for enhancing TC. Clinical consultation may assuage an attorney’s con- cern regarding a client’s TC or justify pursuing a formal clinical evaluation of TC. Contemporaneous Clinical Evaluation of TC In certain circumstances, the testator, a family mem- ber, or his or her attorney may request that a clinician assess the testator’s TC prior to will execution. Two scenarios are common in such a referral. The attorney may have concerns about TC and desire clinical expertise and input on the issue before proceeding fur- ther. Alternatively, in cases of ongoing or anticipated family conflict, the attorney may seek to preempt a future will contest by having an assessment of TC conducted as part of the will execution. Contemporaneous evaluations of TC are multifac- eted and involve (a) collecting relevant data regard- ing the testa tor’s assets, potential heirs, and general cognitive and everyday functioning from collateral sources (i.e., a spouse, other family members, and friends); (b) conducting a comprehensive mental sta- tus examination of the testator to identify cognitive and psychiatric impairments that may interfere with TC; and © completing a thorough clinical interview of the testator to assess TC according to the above legal criteria. Spar and Garb have proposed a valuable semistructured interview approach that clinicians can use to assess TC. Because the validity of a will is dependent on the testator’s TC at the specific time that the will is executed, clinicians should conduct evalua- tions of TC as close to the time of will execution as possible. Retrospective Evaluation of TC Although contemporaneous assessment of TC is highly desirable, retrospective evaluations probably repre- sent the majority of these forensic assessments. Retrospective evaluations arise after the death or incompetency of a testator, when potential heirs or other parties contest a will on the grounds that the tes- tator lacked TC at the time the will was executed. Retrospective evaluations of TC are based on a thor- ough record review and information obtained from the testator’s family, friends, business associates, and other involved professionals (often through deposition testi- mony). Primary attention is given to gathering evidence of mental status and neurobehavioral and everyday functional skills as close as possible to the date the will was executed. Relevant personal records include the testator’s business records, checkbook and other finan- cial documents, and personal documents (e.g., letters, diaries, family films, or videos). Medical records can yield particularly useful information, including mental status, behavioral observations, diagnosis, level of impairment, dementia stage (if applicable), and psy- chological test results. Clinicians may also find it ben- eficial to interview the testator’s surviving family, friends, business associates, and other involved profes- sionals regarding the testator’s cognitive and functional abilities at the time the will was executed. Ultimately, the clinician must assemble all of this information and retrospectively determine whether or not the testator clinically had TC at the prior relevant legal time point(s). In some cases, it may not be pos- sible to render such a judgment if there is insufficient evidence of the testator’s cognitive, emotional, and functional abilities contemporaneous with the prior will execution. With respect to both contemporaneous and retro- spective forensic evaluations of TC, it is important to emphasize that the clinician’s opinions regarding TC represent clinical judgments that the court may con- sider and weigh in arriving at a dispositive legal judg- ment of TC. Research on TC TC as a civil competency represents a key knowledge gap in forensic science. There is relatively little pub- lished research on TC. Several good articles exist that provide general clinical guidelines and tips for assess- ment of TC and undue influence. However, there has 800 ———Testamentary Capacity T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 800 been an absence of conceptual and empirical research in this area. Specifically, there is a need for cognitive and neuropsychological models of TC, assessment instrument development, and empirical clinical studies. Daniel C. Marson and Katina R. Hebert See also Competency, Foundational and Decisional; Financial Capacity; Financial Capacity Instrument (FCI); Forensic Assessment; Guardianship; Psychological Autopsies Further Readings American Bar Association Commission on Law and Aging & American Psychological Association. (2005). Assessment of older adults with diminished capacity: A handbook for lawyers. Washington, DC: Authors. Greiffenstein, M. F. (1996, May). The neuropsychological autopsy. Michigan Bar Journal, 424–425. Marson, D. C., Huthwaite, J., & Hebert, K. (2004). Testamentary capacity and undue influence in the elderly: A jurisprudent therapy perspective. Law and Psychology Review, 28, 1–96. Spar, J. E., & Garb, A. (1992). Assessing competency to make a will. American Journal of Psychiatry, 149, 169–174. Spar, J. E., Hankin, M., & Stodden, A. (1995). Assessing mental capacity and susceptibility to undue influence. Behavioral Sciences and the Law, 13, 391–403. Walsh, A. C., Brown, B. B., Kaye, K., & Grigsby, J. (1997). Mental capacity: Legal and medical aspects of assessment and treatment (2nd ed.). Deerfield, IL: Clark, Boardman, & Callaghan. T EST OF M EMORY M ALINGERING (TOMM) The issue of malingering is becoming increasingly important in the field of forensic psychology, particu- larly in cases involving traumatic brain injury, where alleged memory impairment is often used to seek per- sonal compensation or as a defense against prosecu- tion for various types of crimes. The Test of Memory Malingering (TOMM) was developed by the author to provide an objective, criterion-based test that is able to discriminate between individuals with bona fide memory impairment and those with feigned symp- toms of impaired memory. The acronym TOMM was selected to emphasize that the test was developed with a definite, preconceived notion—to determine whether or not an individual is feigning or malinger- ing a memory impairment. Thus, the TOMM should not be viewed as a malingering test per se. The TOMM consists of two learning trials and a retention trial. The learning trials consist of a learning phase and a test phase. The study portion of each learn- ing trial contains 50 line-drawn pictures (targets), each presented for 3 seconds with a 1-second interval between pictures. The same 50 pictures are used on each learning trial. However, they are presented in a dif- ferent order on the second trial. During the test phase, each target is paired with a new line drawing (distrac- tor). The position of the target is counterbalanced for the top and bottom positions. The person is required to select the correct picture (i.e., target) from each panel. For each answer, the examiner provides feedback about the correctness of the response. A delayed retention trial, consisting only of the test phase, is administered approximately 15 to 20 minutes after completion of the two learning trials. The TOMM is available in a com- puterized as well as a paper-and-pencil format. Development and Validation The TOMM was initially validated with 475 community- dwelling adults ranging in age from 17 to 84 years and 187 neuropsychological assessments from patients clas- sified as follows: no cognitive impairment ( n = 13), cog- nitive impairment ( n = 42), aphasia ( n = 21), traumatic brain injury (TBI) ( n = 45), depression ( n = 26), and dementia ( n = 40). Inspection of the distribution of cor- rect responses for the cognitively intact participants and the clinical patients showed that most nondemented indi- viduals achieved a perfect score on Trial 2 and the reten- tion trial. Moreover, rarely did a nondemented patient obtain a score lower than 45. In view of these results, the criterion score of 45 on Trial 2 or on the retention trial was selected. That is, any score lower than 45 should raise concern that an individual is not putting forth the maximum effort and is likely malingering. The criterion score correctly classified 100% of the community- dwelling participants and 95% of the nondemented clin- ical patients (cognitively impaired = 90%; aphasia = 95%; TBI = 98%; depressed = 100%; and dementia = 73%). Thus, the only clinical sample with a relatively Test of Memory Malingering (TOMM) ———801 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 801 low sensitivity score was the dementia group. Even these individuals still obtained a score of greater than 92% on Trial 2. The finding that the scores on the TOMM were less than 95% for the dementia group is not particularly negative since it is unlikely that feigning memory impair- ment is a major issue when dementia patients undergo neuropsychological assessment. It should be noted that “below-chance” perfor- mance ( < 18 correct at the 95% confidence level) also can be used as a statistical decision rule. However, experience has shown that malingerers or individuals simulating malingerers do not ordinarily obtain below- chance scores on the TOMM on any trial. Of course, if they do, the decision rule can be applied. Five experiments using different types of partici- pants and different types of experimental designs pro- vide evidence that the TOMM readily differentiated between malingering and nonmalingering individuals and show that the TOMM is a useful psychometric test for detecting exaggerated or deliberately faked memory impairment. In this context, it should be noted that the TOMM meets all the guidelines established in Daubert v. Merrell Dow Pharmaceuticals (1993) to define the generally accepted standards for judges to use in deter- mining the scientific admissibility of evidence, particu- larly when presented by expert witnesses. Interpreting the TOMM Interpretation of the TOMM should never be made solely on the basis of the TOMM score that a patient achieves. It depends on many factors, starting with the basic conceptual issues on how malingering is defined. The TOMM does not measure a general trait called “malingering.” In forensic assessments, the TOMM is not an appropriate test to evaluate whether or not a per- son is faking a psychiatric disorder any more than it would be appropriate to use it to determine if a person is faking a back injury. Moreover, the interpretation of the TOMM should not be used to identify a “malingerer” but rather to indicate that a person is putting forth less than the maximum effort. Although individuals malinger, malingering cannot be legitimately viewed as a personality trait. Malingering in one situation does not necessarily mean that the person will always malinger or, in fact, will ever malinger again. In many, if not most, instances, individuals with TBI who malinger are “good” people caught in “bad” situations. It must also be remembered that malingering is not an all-or-none phenomenon but that it exists in different degrees, ranging from minor exaggeration of existing symptoms to flagrant faking of nonexistent symptoms. Tom N. Tombaugh See also Forensic Assessment; Malingering Further Readings Daubert v. Merrell Dow Pharmaceuticals, 509 U.S. 579 (1993). Lynch, W. J. (2004). Determination of effort level, exaggeration, and malingering in neurocognitive assessment. Journal of Heat Trauma Rehabilitation, 19, 277–283. Multi-Health Systems. (2006). Test of Memory Malingering (TOMM). Research monograph: Summary application in clinical and research settings. Toronto, ON, Canada: Author. Tombaugh, T. N. (1996). The Test of Memory Malingering (TOMM) . Toronto, ON, Canada: Multi-Health Systems. Tombaugh, T. N. (2002). The Test of Memory Malingering (TOMM) in forensic psychology. Journal of Forensic Neuropsychology, 2, 69–96. Vallabhajosula, B., & VanGorp, W. G. (2001). Post-Daubert admissibility of scientific evidence on malingering of cognitive deficits. Journal of the American Academy of Psychiatry and the Law, 29, 207–215. T HERAPEUTIC C OMMUNITIES FOR T REATMENT OF S UBSTANCE A BUSE Therapeutic communities use interpersonal interactions within a structured community milieu to treat substance abuse. They have shown promising outcomes, espe- cially among people with substance use disorders who require a highly structured environment to succeed. Therapeutic communities are used frequently in correc- tional institutions to treat inmates with severe substance use disorders and who exhibit antisocial behavior. Positive outcomes have been found for many partici- pants, such as reduced substance use and recidivism after release from incarceration. Since therapeutic com- munities focus on communal processes to facilitate change, this treatment may not be an effective means to individualize care. In addition, the communities may not be helpful for autonomous, high-functioning indi- viduals or people with severe co-occurring psychiatric 802 ———Therapeutic Communities for Treatment of Substance Abuse T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 802 disorders. However, these communities have func- tioned well in correctional settings and seem to be well designed to serve the needs of inmates with severe sub- stance use disorders who are motivated to change their behavior. Substance Abuse Treatment Within Therapeutic Communities Therapeutic communities are commonly used in cor- rectional institutions to treat substance use disorders and other life problems. Therapeutic communities operate under the assumption that substance use is a consequence of a dysfunctional lifestyle that requires a holistic treatment solution to facilitate change. Holistic healing occurs within a highly structured peer milieu that seeks righteous living without substance use. In therapeutic communities, the interpersonal interactions within the context of communal living are considered to be the mechanism for treating substance use. The community models appropriate behavior for individual members, serves to correct the behaviors of individuals when they are inappropriate, and shapes changes in individuals. The historical roots of thera- peutic communities for substance abuse can be traced to the Synanon community. Therapeutic communities often include group work and may provide opportunities to participate in 12-step support groups. However, therapeutic communities differ from traditional treatment in that they view engaging in everyday life activities within the context of the community as a critical part of the healing process. For example, treatment involves engaging in work activities that benefit the community. In correc- tional institutions, staff and senior community mem- bers assume mentorship roles for the junior members of the community. They often function as closed com- munities, operating as independently of their surround- ings as possible, and frequently require junior members of the group to limit exposure to events out- side the community until they reach a certain level of maturity in the program. Emphasis is placed on the importance of social relationships and reciprocal social support among par- ticipants and staff in the therapeutic community which can contribute to persistence in treatment engagement and better treatment results. Encouraging friends and family to participate in treatment also has been used to enhance social support with positive results among therapeutic community participants. Following treatment, participants often report improved relations with friends and family. Research on Therapeutic Communities Data concerning the efficacy of therapeutic communi- ties are somewhat sparse, and interpretation of results is complicated by the lack of a standardized model, which makes comparisons across sites difficult. Therapeutic communities can work well for people who have severe substance use problems and would benefit greatly from treatment in a highly structured environment. Researchers examining the efficacy of therapeutic communities in the United States and Europe have found evidence that inmates, homeless people, adolescents, older adults, and certain ethnic minority groups may benefit from participation. Positive outcomes have included lower levels of dis- tress, drug and alcohol use, and criminal involvement among participants. In addition, there is evidence that participation may enhance self-esteem, promote the taking of prescribed medications as directed, lead to gainful employment, and increase social and coping skills. Relapse prevention strategies and aftercare have been used to improve the efficacy of therapeutic communities’ intervention in substance use disorders. Evidence suggests a positive relationship between the length of association with therapeutic communi- ties and successful outcomes after treatment. Motivation to participate in therapy and change cur- rent behavior patterns commonly is related to better treatment retention and less drug use after treatment. Participants in therapeutic communities often report greater motivation to change and higher satisfaction with treatment than people in other types of substance abuse treatment. However, these results may be con- founded with self-selection biases since members choose to join these communities and participation requires a high degree of commitment. Differential treatment outcomes associated with gen- der have been found. Because of these differences, some researchers have suggested that it may be helpful to use gender-specific treatment strategies. Women commonly enter therapeutic communities with lower levels of social functioning than men. They may exhibit evidence of greater psychological distress, often including suici- dality and trauma histories, which need to be addressed in treatment. After participation in therapeutic commu- nities, many women experience less victimization by Therapeutic Communities for Treatment of Substance Abuse ———803 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 803 their partners and are less likely to engage in risky sexual behaviors, including trading sex for money. Participants who are higher functioning and do not require highly structured care may not benefit from therapeutic communities. In addition, research sug- gests that people with severe mental health disorders may not have positive outcomes in therapeutic com- munities. Participants with greater psychological dis- tress and more mental health symptoms when they enter the therapeutic communities seem to be more likely to drop out. Participants in need of limited social and environmental stimulation may find it difficult to tolerate the intense social interactions encouraged in this treatment model. Tailoring treatment to the needs of individuals with greater mental health symptoms would likely increase the chance of a successful out- come. One of the criticisms of the therapeutic commu- nity model in general has been that it does not account for individual differences or needs in treatment. However, the therapeutic community model meets the needs of inmates with severe substance use disorders in correctional settings such as jails, prisons, and half- way houses by providing a highly structured and safe community dedicated to staying substance free. Arthur W. Blume and Michelle R. Resor See also Substance Abuse Treatment; Substance Use Disorders Further Readings Broekaert, E. (2001). Therapeutic communities for drug users: Description and overview. In B. Rawlings & R. Yates (Eds.), Therapeutic communities for the treatment of drug users (pp. 29–42). London: Jessica Kingsley. De Leon, G. (1999). The therapeutic community treatment model. In B. S. McCrady & E. E. Epstein (Eds.), Addictions: A comprehensive guidebook (pp. 306–327). New York: Oxford University Press. T HERAPEUTIC J URISPRUDENCE Therapeutic jurisprudence (TJ) is an interdisciplinary approach to the study and practice of law and the role of legal actors. It aims to focus on the often underappre- ciated aspect of the law and legal actors’ role in produc- ing therapeutic or antitherapeutic consequences. It is a normative framework that advocates the use of the social sciences to inform the processes and outcomes of legal interactions and procedures. It does not suggest that therapeutic concerns should override other impor- tant elements of the legal system (such as due process or justice concerns), but it does suggest that the thera- peutic consequences of the law and legal actors be con- sidered and systematically studied. TJ has become a highly influential framework for thinking about the law and the way legal actors interact with their clients. The influence of TJ has recently begun to move from the conceptual to the empirical. Social science researchers are now beginning to empirically test the conceptual assumptions of the therapeutic framework. This is ushering in a new and exciting wave of TJ scholarship, for now, the TJ scholars are using not only the insights of the social sciences to develop law and legal processes but also the methods of the social sciences to test those insights. The near future of TJ scholarship promises to be an exciting and fruitful one for the development of law and legal processes. This entry examines this newly emergent and impor- tant aspect of the intersections between law and psy- chology (and the wider social sciences). It provides an overview of the concept,

bundet

a brief history of its develop- ment, a review of the practical implications of the framework, and an overview of its international appeal. Therapeutic Jurisprudence: An Overview TJ is, at its most basic, a therapeutic perspective of the legal system. It aims to use the knowledge and exper- tise of the social sciences–including psychology, criminology, social work, and others—to study the therapeutic and antitherapeutic aspects of the law and the wider legal system. TJ suggests that, whether one likes or acknowledges it or not, the law and the way legal actors interact with people have therapeutic con- sequences; thus, when the opportunity arises, legal actors should attempt to maximize the therapeutic potential (or at least minimize the antitherapeutic potential) of the legal interaction, providing that legal safeguards such as due process and justice considera- tions are not compromised. TJ is not a paternalistic framework and does not call for increased state intervention or coercion. Therapeutic jurisprudence simply suggests that the therapeutic potential of the law and legal actors be recognized, sys- tematically studied, and, when appropriate, acted on. 804 ———Therapeutic Jurisprudence T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 804 It suggests that all things being equal, the law should be constructed in such a way as to enhance the therapeutic potential of the law and legal actors. TJ does not suggest that therapeutic ends should trump other considerations of the law. The law often serves other purposes that are equally valuable or more valuable than therapeutic ones. The TJ framework sug- gests that to achieve truly effective and humane law reform, policymakers should strive for a solution where these values converge. However, where these values conflict, TJ does not itself resolve the conflict, but it does sharpen and enrich the discussion. The Development of Therapeutic Jurisprudence I I n n i i t t i i a a l l O O r r i i g g i i n n s s : : T T h h e e L L a a w w a a n n d d M M e e n n t t a a l l H H e e a a l l t t h h TJ began in the area of mental health law. It aimed to systematically study the previously neglected aspect of the law’s therapeutic or antitherapeutic effects in relation to mental health law, in order to minimize the antitherapeutic effects and highlight the need for fur- ther analysis on therapeutic grounds. The first explo- ration of the framework occurred in 1987, when David Wexler delivered a paper to the National Institute of Mental Health in the United States. The impetus for the development of TJ was a reaction to the antipsychiatry perspective that had developed in the late 1970s and through the 1980s in mental health law. TJ suggested that psychiatry, and indeed the wider disciplines of the social sciences, had valuable insights to offer to the field of law and mental health and that the law and the legal profession should attempt to use those insights where appropriate. T T h h e e S S p p r r e e a a d d A A c c r r o o s s s s t t h h e e D D i i s s c c i i p p l l i i n n e e o o f f L L a a w w Through the early part of the 1990s, David Wexler, Bruce Winick, and a growing group of legal scholars in the mental health field sought to investigate the scope of TJ and its application to not only mental health law but other areas of the law as well. The interdisciplinary scope and easy applicability of its mission statement— to enhance the therapeutic potential of the law and legal actors—made the framework appealing to a num- ber of different areas of the legal system. By 1996, TJ had expanded to include legal arenas such as correctional law, criminal law, family and juvenile law, sexual orientation law, disability law, health law, personal injury and tort law, law of evidence, labor arbitration law, contracts and commercial law, and the legal profession, as well as theoretical explorations and empirical examinations of the concept. The wide scope of the TJ framework quickly made it a valuable resource for the future development of legal areas and law reform. Toward the end of the millennium, the concept became thought of in conjunction with a number of other legal developments of the comprehensive law movement, including preventive law, collaborative law, and prob- lem-solving courts. The convergence between these practical applications of the legal system and the princi- ples of TJ has seen the concept move from a theoretical (and largely academic) enterprise into a collaborative form of scholarship with truly practical implications. Practical Implications The move from theory to practice has thoroughly enriched the scope and application of the TJ frame- work. This entry will now highlight some of these. P P r r o o b b l l e e m m - - S S o o l l v v i i n n g g C C o o u u r r t t s s In an important joint resolution in the United States, the Conference of Chief Justices and the Conference of State Court Administrators endorsed the continued use and expansion of problem-solving courts (such as drug treatment courts, mental health courts, and domestic violence courts) and made specific reference to the courts’ use of the principles of TJ. Although TJ and problem-solving courts (which emerged in Miami in 1989 with the first Drug Treatment Court) developed around the same time, their development was indepen- dent of each other, and for almost a decade, they each continued to show significant development within the U.S. legal system. However, in the mid-1990s, Judges Peggy Hora and William Schma began collaborating with David Wexler and Bruce Winick, speaking at con- ferences, and writing about the applicability of the TJ framework to the problem-solving (specifically, drug treatment) court phenomenon. Since then, the two con- cepts have developed a symbiotic relationship, and most problem-solving courts acknowledge the influence of the principles of TJ in their day-to-day work. G G e e n n e e r r a a l l C C r r i i m m i i n n a a l l J J u u r r i i s s d d i i c c t t i i o o n n Recently, scholars and, perhaps more significantly, judges and court administrators have begun to apply Therapeutic Jurisprudence ———805 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 805 and implement the principles of TJ in courts of general jurisdiction. An excellent example is a manual pro- duced by Canada’s National Judicial Institute. The manual uses TJ principles to inform judges how they might use probation as a behavioral contract. Also, with the implementation of insights such as relapse preven- tion planning, scheduled periodic review hearings, and early termination of probation after successful proba- tionary sentences, the insights of TJ have added to the tools of judges in Canadian criminal courtrooms. In England, TJ principles have guided the way judges act even when handing down a custodial sentence. There, instead of simply sending the offender to custody with- out an explanation of the purpose of or reason for the custodial sentence, a community court judge completes a “Statement of Reasons,” which explains the rationale behind the incarceration, and sends a follow-up letter to further explain the need for the custodial sentence. In this case, the judicial officer takes care to condemn the act and not the person. Such practices use the psycho- logical principles of procedural justice to inform their functions, and it is hoped that these practices increase the defendant’s sense of fair treatment and potentially facilitate future compliance with the law. C C i i v v i i l l L L a a w w Besides its focus on criminal law, TJ continues to grow in the area of its origin—mental health law, prin- cipally through the work of Bruce Winick, Michael Perlin, Kate Diesfeld, and Ian Freckelton. There have also been important developments in family law and child protection law. Scholars such as Daniel Shuman and Katherine Lippel have looked at topics such as compensation in tort law and procedural justice ele- ments in workers’ compensation. L L a a w w y y e e r r i i n n g g TJ influences the processes of the courtroom and urges an expanded rehabilitative role for criminal lawyers. TJ also influences the way lawyers undertake their roles in their offices. The TJ perspective suggests that lawyers work with their clients to achieve outcomes that are good from a therapeutic standpoint as well as a legal one. It also encourages lawyers to explain the potential consequences of pursuing certain forms of action. For example, when combined with preventive law, TJ asks the lawyers not only to identify legal “soft spots” (potential legal problem areas) but also to identify psycholegal soft spots—areas where legal interventions may lead to antitherapeutic consequences regardless of the legal outcomes. TJ suggests that lawyers should dis- cuss these potential soft spots with the client prior to any legal intervention to ensure that the client has a full understanding of the potential for therapeutic harm. L L e e g g a a l l E E d d u u c c a a t t i i o o n n TJ has now established itself in the curricula of many law schools as well as a number of social sci- ence courses. The concept is also gaining prominence in clinical legal education. International Appeal The wide appeal of TJ has seen it spread from its birth- place in the United States to a number of countries, including Australia, Canada, New Zealand, England, Pakistan, Scotland, Puerto Rico, South Africa, India, Vanuatu, Spain, Israel, Italy, Sweden, and Argentina. Publications now appear in English, Spanish, French, Italian, Japanese, Swedish, Hebrew, and Urdu. Indeed, at the Third International Conference on Therapeutic Jurisprudence, held in Perth, Western Australia, about nine countries were represented. The Future of Therapeutic Jurisprudence The wide-ranging appeal and international growth of TJ have seen the concept move from the theoretical to the practical, with a growing number of justice sys- tems around the world implementing the ideas and principles of the concept in new and exciting ways. The next chapter in the development of TJ will pro- vide researchers, policymakers, and those involved in the justice system with an excellent platform to think about the way we see the law, legal actors, and the jus- tice system in the future. Glenn Took and David B. Wexler See also Alternative Dispute Resolution; Civil Commitment; Domestic Violence Courts; Drug Courts; Forcible Medication; Mental Health Courts; Mental Health Law; Patient’s Rights; Procedural Justice Further Readings International Network on Therapeutic Jurisprudence. (2006). Welcome. Available at http://www .therapeuticjurisprudence.org 806 ———Therapeutic Jurisprudence T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 806 Stolle, D. P., Wexler, D. B., & Winick, B. J. (Eds.). (2000). Practicing therapeutic jurisprudence: Law as a helping profession. Durham, NC: Carolina Academic Press. Wexler, D. B. (1990). Therapeutic jurisprudence: The law as a therapeutic agent. Durham, NC: Carolina Academic Press. Wexler, D. B., & Winick, B. J. (Eds.). (1996). Law in a therapeutic key: Developments in therapeutic jurisprudence. Durham, NC: Carolina Academic Press. Winick, B. J., & Wexler, D. B. (Eds.). (2003). Judging in a therapeutic key: Therapeutic jurisprudence and the courts. Durham, NC: Carolina Academic Press. T RAINING OF E YEWITNESSES The ability to accurately recognize others is important to everyone, particularly because important social, personal, physical, and economic resources are uniquely associated with individual persons. The recognition training that most people experience comes with everyday social interaction, containing the incentives within their social environment. The ecol- ogy of personal recognition and the social-cognitive processes through which it develops have hardly been studied, and the social conditions under which some persons might become more accurate recognizers than others are largely unknown. Attempts to improve face recognition through short-term training focused on changing the attributes of faces that participants attend to or use in encoding facial information have largely proved ineffective. There are social environments in which higher recognition performance levels would be very valuable. These are most commonly environments in which indi- viduals to be recognized or identified have committed some crime and need to be apprehended. For example, persons at risk as victims due to their employment (bank tellers, convenience store clerks) might benefit from being capable of high recognition performance levels. Law enforcement, military, or intelligence per- sonnel likewise would benefit from higher levels of recognition capability than the general public. For this reason, developing effective training in face recognition has real practical utility. Unfortunately, the available evidence is not encouraging: There is little evidence that persons of any occupational group are reliably bet- ter or worse at recognizing faces than others. Research conducted with law enforcement officers suggests that they are no better than other citizens in face recognition accuracy; however, officers have been shown to per- form better at recalling the details of an event. Research on face recognition training also has theo- retical utility because of the need to better understand the basic cognitive and social psychological processes that form the basis for training. While face recognition processes have been shown to involve both featural and holistic components, few studies have been directed at using these aspects of face recognition to improve recognition. We know that elaborated or inferential pro- cessing of faces leads to higher levels of recognition performance, and it appears that such processing is the default mode. Instructing participants to attend nar- rowly to specific features causes their recognition per- formance to suffer. Some studies show that attempts to change or refine the facial information research partic- ipants extract at the point of encoding can lead to reduced recognition performance. This may result from attempting to substitute new memory strategies based on relatively short training experiences for encoding and recognition strategies that are based on a lifetime of practice. There is growing evidence that we develop selective processing of faces very early in life and that this processing is selective for our own “race” (or that which is experienced early). A deficit in face recognition accuracy has been shown when people attempt to recognize faces of other “races.” Known as the cross-race effect, studies have consistently shown the deficit in recognition across a variety of races, ethnicities, and nationalities. A few studies have attempted to train individuals in order to improve their ability to make accurate cross-race identi- fications; however, the studies have shown limited suc- cess, demonstrating that training effects are at best temporary and inconsistent. The methods used to train in face recognition have varied immensely since the early 1970s. For instance, one of the first training studies administered electrical shock following an incorrect recognition judgment. After only 1 hour of training, the shock feedback improved recognition performance. Effects of training over longer intervals were not exam- ined. Another study trained participants to focus on crit- ical facial features that were believed to differ between White and Black faces. Once again, participants showed immediate improvement in their face recognition abil- ity; however, these effects diminished after the passage of 1 week. More recent research has focused on “feature-critical training” using INDSCAL (INdividual Differences SCALing software) analyses of the phys- iognomic differences between certain races. Results suggested that such training improved cross-race face Training of Eyewitnesses ———807 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 807 recognition; however, once again there was no indica- tion of the persistence of the improvement or whether the improvement could be generalized across faces within that race. It is unclear at this juncture whether or not systematic training can, or ever will, reduce or elim- inate the cross-race effect. Natural experience (or the lack thereof) appears to be the basis for the cross-race effect, and studies of the effects of changing environments over a period of years (e.g., residential school experience) support this, as do studies of the effects of high levels of interest in sports where many of the outstanding performers are of a “racial” group contrasting with the “racial” group mem- bership of many fans. Fans investing large amounts of time in watching the sport and who have a high level of detailed knowledge about the players show a reduced level of the cross-race effect. It is thought that social incentives and penalties exist for successful recognition and recognition errors or omissions, respectively. As good an idea as this might be, manipulating incentives as a training technique has not been studied. Given the general failure in training individuals to improve their recognition of faces, a current move- ment among researchers has involved developing computer-based recognition algorithms. A number of procedures have been developed to use information from facial images to match one instance of a person to another of the same individual, under different con- ditions. Great progress has been made in this line of research, and it has now been shown that face recog- nition algorithms can be superior to human face recognition even under previously troublesome condi- tions, such as differences in illumination and shadow between the two photos to be matched. In addition, fusing the use of computer-image-processing algo- rithms with human similarity judgments leads to near- perfect recognition. Nevertheless, the problem of extracting accurate identifications from human mem- ory remains. While human judgments have led to improvements in computer-based face recognition, computer-based support systems using genetic algo- rithms have been shown to provide effective assis- tance in human recognition. Overall, training the human cognitive system to achieve higher levels of face recognition performance is an important goal, with only modest advances hav- ing been achieved. Roy S. Malpass, Kyle J. Susa, and Christian A. Meissner See also Cross-Race Effect in Eyewitness Identification; Expert Psychological Testimony on Eyewitness Identification; Police as Eyewitnesses Further Readings Malpass, R. S. (1981). Training in face recognition. In G. M. Davies, H. D. Ellis, & J. W. Shepherd (Eds.), Perceiving and remembering faces (pp. 271–285). London: Academic Press. O’Toole, A. J., Abdi, H., Jiang, F., & Phillips, P. J. (2006). Fusing individual algorithms and humans improves face recognition accuracy. In G. Bebis, R. Boyle, D. Koracin, B. Parvin, P. Remagnino, A. Nefian, et al. (Eds.), Advances in visual computing (pp. 447–456). Berlin: Springer-Verlag. O’Toole, A. J., Abdi, H., Jiang, F., & Phillips, P. J. (in press). Fusing face recognition algorithms and humans. IEEE: Transactions on Systems, Man and Cybernetics. T RANSFER TO ADULT COURT See W AIVER TO CRIMINAL COURT T RANSLATED T ESTIMONY As society becomes increasingly more diverse cultur- ally and linguistically, translated testimony will become a more frequent component of the American justice system. Due to the complex nature of the trans- lation process, errors and misunderstandings of inter- preted testimony are nearly unavoidable and can affect jurors’ perceptions of a trial. Misjudgments may occur due to the inadvertent influences of the court interpreter or jurors’ biased perceptions of a defen- dant’s translated testimony. Psychological theories related to individuals’ social identity and the human propensity to categorize other people as members of one’s in-group or out-group may provide a framework for understanding the potential biasing nature of trans- lated testimony. The implications for law and policy provided by research pertaining to translated testi- mony are vital for the fair and impartial treatment of all people within the U.S. justice system. From the perspective of courts in the United States, the official language of courtroom proceedings is 808 ———Translated Testimony T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 808 English. When a trial participant does not speak or understand English, court interpreters are used. The court interpreter’s task is to completely, impartially, and accurately reiterate in English the utterances of a trial participant that originate in a speaker’s native language. The interpreter also renders the utterances that originate in English into the native language so that the non- English-speaking witness or defendant can understand the proceedings as well. The number of monolingual and minimally bilin- gual non-English-speaking individuals who come in contact with the U.S. criminal justice system is increasing. According to the 2005 Annual Report of the Director of the Administrator’s Office of the United States Courts, the number of cases requiring the use of court interpreters increased by 1.5% in 2005, with the Spanish language involved in 94% of these cases. The 2000 U.S. Census indicated that the percentage of Spanish speakers living in the United States increased by 3.2% since 1990; additionally, 10% of the Spanish-speaking population was monolin- gual. This rise in the monolingual Spanish-speaking population has created a need for Spanish-English interpreters, in particular in the United States. Perceptions of Translated Testimony Linguistic minority speakers are at a disadvantage in the courtroom. Early research demonstrated that English- speaking individuals perceive unaccented English more favorably than either Black vernacular English or Mexican American accented English. Thus, if linguistic minority witnesses and defendants choose to communi- cate in English during the court proceedings, they may be perceived less favorably by the jury because of their accented or limited English. Providing translated testi- mony to counter the linguistic minority speaker’s lim- ited English does not remove this bias. Furthermore, the court interpreter’s translation of tes- timony can shape jurors’ views of speakers in the court- room due to linguistic alterations in the translation process. Interpreters tend to lengthen testimony by using uncontracted versions of words and altering fragmented speech into a more narrative form. For example, in Spanish-to-English translation, English interpreters often add hedges such as “ …uh,…w ell, an d…um” into the speaker’s testimony. These added hedges may reflect the interpreter’s own performance deficiencies in the translated language; however, such additions to tes- timony cause the jurors to perceive the witness, not the interpreter, less favorably. Finally, linguistic minority defendants and wit- nesses are forced to rely on the interpreter to under- stand the courtroom proceedings. During translation, interpreters may inadvertently alter an attorney’s intended meaning during questioning by weakening the force of leading questions or including additional words. For example, if an interpreter adds words such as “well” or “now” to the beginning of an attorney’s question during cross-examination, the witness may view the attorney as confrontational. Such alterations in the structure of the questions can influence the wit- ness’s perception of the attorney and understanding of the questions, thus altering the resulting testimony. Impact on Jurors’ and Juries’ Decisions The fact that interpreted testimony per se may influ- ence the outcome of criminal cases has been demon- strated as well. Empirically derived data reveal that jurors see criminal defendants who testify in a lan- guage other than English with the assistance of an English interpreter more negatively than defendants who testify in English. For example, data collected in Texas courts in the 1990s showed that criminal defen- dants who testified in Spanish with interpretation into English were at significantly greater risk of conviction than were similarly situated defendants who testified in English. That is, the negative perceptions of non- English speakers were converted into a predisposition to vote for conviction of the defendant. This occurred even when people who themselves were Spanish speakers served on the juries that convicted. More recent experimental data collected in the same jurisdictions suggested that the language of a defendant’s testimony continues to have an impact on jurors’ judgments about the guilt of defendants but that now the direction of the outcome has changed. That is, jurors serving on cases where defendants tes- tify in Spanish with English interpretation are less likely to be conviction prone, other things being equal, than jurors serving on cases with equivalently situated defendants who testify in English. However, this effect seems to be diminished when jurors deliberate, when the language of defendants’ testimony does not appear to influence juries’ decisions. An important Translated Testimony ———809 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 809 additional finding from this research is that the jurors’ own language use influences both voting preference prior to deliberations and jury verdicts after delibera- tions. Spanish-English bilinguals seem to be more lenient in general than are monolingual English speakers. Explanations of the Impact of Language One theoretical explanation proposed for these results follows social identity theory. This theory postulates that individuals are motivated to maintain a positive social identity. In addition, it is presumed that humans have a universal and natural tendency to categorize other people as members of the categorizer’s in-group or members of some other out-group. One can use a vari- ety of strategies to maintain a positive self-image, but important strategies relate to the way we interact with and reward those we see as in-group or out-group mem- bers. One can, for example, increase one’s own positive self-image by perceiving members of one’s in-group more favorably than members of out-groups and by dif- ferentially rewarding those who are in-group members. In a legal context, leniency would be expected from those jurors who perceive themselves to be most similar to the defendant. Spanish-speaking jurors would be expected to perceive Spanish-speaking defendants as more similar to themselves than would English mono- linguals and thus would be expected to act more favor- ably toward Spanish-speaking defendants. Similarly, English monolingual jurors should be more lenient, other things being equal, with English-speaking defen- dants and more punitive with Spanish speakers. The empirical data from the studies conducted to date do not support this logic, however. Rather, Spanish-speaking jurors are more lenient toward defendants in general, no matter what the defendants’ language of testimony. In addition, regardless of their own language use, jurors treat Spanish-speaking defendants more leniently. An alternative hypothesis is that jurors should be motivated to see themselves, and be seen by others, as different from those who are accused of crimes. Other things being equal, they should be predisposed to con- vict defendants to clarify the fact that they are differ- ent from that person. By testifying in a language other than the manda- tory language of the proceedings (i.e., English), a Spanish-speaking defendant also may be seen as an out-group member by all the jurors. To serve as a juror, an individual must be able to read and write the English language. Therefore, by testifying in Spanish, the defendant is demonstrating that he or she is dis- tinctly different in this regard. While out-group members may be treated more punitively than in-group members, this punitive treat- ment may not be manifest in the bilingual courtroom. Indeed, quite the opposite may occur. The commission of a crime is what society would define as deviant behavior. Violations of norms result in negative sanc- tions (e.g., convictions and imprisonment), but this also is contingent on the observers’ (e.g., the jurors) recog- nition that the person who violated the norms was able to conform to the expectancies in the first place. When they testify in Spanish, defendants may be perceived as foreigners in a system that they do not understand. Jurors may be sympathetic toward the Spanish-speaking defendants because they see them as individuals who do not understand the situation in which they find themselves. This speculation suggests a new line of inquiry to pursue empirically. That is, if a defendant is seen as a “stranger” to the system, jurors may heighten their standard for the burden of proof and require the prosecution to justify the convic- tion of an individual who does not completely under- stand the consequences of his or her actions. Community attitudes also may explain the results of the research outcomes to date. Recall that the impact of jurors’ language use has been shown to be greater than that of the defendant’s language of testi- mony. It may be that jurors’ views of the American judicial system are critical in providing a context for their decisions. So, for example, it may be that more people who serve as jurors today hold more negative attitudes regarding law enforcement and the courts than those who served as jurors in the past, producing a more lenient outcome for defendants. Implications for the Law Court interpretation plays a pivotal role in the provision of justice to linguistic minorities in the United States. Future empirical research concerning court interpreters and the impact of translated testimony on jurors will provide useful information for the legal system and allow for unbiased due process for all defendants. It is vital that standards remain consistent concern- ing the availability of a translator in all cases involving 810 ———Translated Testimony T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 810 linguistic minorities. The establishment of state and federal training and certification procedures ensures that courts handle such cases in a consistent and impar- tial manner. Furthermore, programs allowing for con- tract interpreters and telephone interpreting in districts where no certified interpreters are available are impor- tant steps to facilitate due process for all defendants. In addition to training court interpreters consistently, training for legal professionals such as judges and attorneys may allow for a better understanding of the special challenges associated with such cases. This type of training will generate greater awareness of the rights of defendants and the responsibilities of feder- ally certified interpreters. The fact that jurors are prepared to treat defen- dants who testify in the official language of trials (English) differently from those who do not is dis- turbing. Regardless of the quality of the interpreta- tion, the fact that interpretation is provided at all seems to be an influential factor in the outcome of cases. At a minimum, courts may need to provide additional instruction to jurors to set aside their beliefs about those who do not testify in English. If jurors are instructed that the language of testimony is not to be included in consideration of the mean- ing and importance of facts presented in evidence, they may be able to hold their predilections in abeyance, and equal treatment can be given to all defendants. Brooke A. Smith, Larissa A. Schmersal, and Harmon M. Hosch See also Procedural Justice; Race, Impact on Juries; Sentencing Decisions Further Readings Berk-Seligson, S. (1990). The bilingual courtroom. Chicago: University of Chicago Press. Hovland, D. L. (1993). Errors in interpretation: Why plain error is not plain. Law and Inequality: A Journal of Theory and Practice, 11, 473–503. Laster, K., & Taylor, V. (1999). Interpreters and the legal system. Leichhardt, New South Wales, Australia: Federation Press. Stephan, C. W., & Stephan, W. G. (1986). Habla ingles? The effects of language translation on simulated juror decisions. Journal of Applied Social Psychology, 16, 577–589. T REATMENT AND R ELEASE OF INSANITY A CQUITTEES For more than one and a half centuries, from the first insanity defense commitment of John Hadfield in England in 1800 through the mid-1960s, insane defendants (those not guilty by reason of insanity, or NGRIs) were automatically and indefinitely com- mitted to a secure psychiatric facility until the state determined that they could be released. Until the mid-1960s, most were never released regardless of their crime. Treatment for NGRIs then and today mirrors the standard psychiatric treatment of the time—ranging from simple confinement in pretreat- ment eras to increasingly more sophisticated inter- ventions such as those available starting in the 1950s. Today, most people found that NGRIs in the United States and elsewhere have a major mental disorder such as schizophrenia or bipolar disorder, and their treatments are at least initially as inpa- tients in a public psychiatric hospital. Due to legal changes from the 1970s onward, states that take cus- tody of this population must also provide them with medical and mental health care whether they are inside or outside the hospital. The Role of the Physician Mental illness has for centuries been considered a mit- igating circumstance in criminal behavior. Beginning in England in 1760, physicians specializing in mad- ness have testified before the court that an individual’s criminal responsibility could be diminished due to mental state. While such testimony was not an insanity defense per se, the early role of the physician as a court expert established medicine’s domain, which contin- ues today in many criminal trials throughout the world. Few defendants are found not criminally responsible without psychiatric testimony, confirming the long- held view that mental disorder is a medical illness and that responsibility for treatment lies with the medical profession. Today, while psychologists and social workers are included in evaluation, treatment planning, and service delivery, it remains the physician’s respon- sibility to decide whether a defendant is mentally ill, to prescribe medications—the treatment of choice, and to recommend the confinement or release of an insane defendant. Treatment and Release of Insanity Acquittees ———811 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 811 Treatment Treatment for NGRIs is delivered primarily by the public mental system. The first public mental hospi- tals in the United States were built after the 1830s, and there was no distinction between patients committed by family and those brought in by law enforcement. Insanity was used interchangeably to refer to all patients who were believed to be unable to make deci- sions due to mental illness. As suspicions rose about the use of civil commitment for inappropriate motives, such as acquiring family wealth or obtaining a divorce, the laws were changed in the late 1800s to require hearings prior to civil commitment, at which time the patient could object. These concerns were not directed at the legally insane patients. The concern with unfair commitments was short-lived as many states began allowing unrestricted, streamlined emer- gency commitments, as is still the case today. It was not until the judicial activism of the U.S. federal bench starting in the 1950s that civil commitment laws began to change, but these early federal deci- sions did not extend to NGRIs. This population of patients was committed for life and was not covered by the new, stringent civil commitment laws. Treatment continued unscrutinized in hospitals, and insanity acquittees could expect to spend their lives confined to the state hospital. Public Policy on the Rights of the Insane This period of complete neglect of the legal and treat- ment interests of the insane extended until 1966, when the U.S. Supreme Court ruled that convicted and hos- pitalized defendants were to be held to civil commit- ment standards. This holding was extended to NGRIs on the grounds that they had been denied equal pro- tection due to lack of review of their automatic, indef- inite commitment to maximum-security hospitals. The next year, the Court held that sex offenders were entitled to a hearing before being transferred from prison to a hospital after serving their sentence. The following year, the D.C. Court of Appeals held that insanity defendants were to be given the same proce- dural protections as other patients. In case after case, federal courts decided in favor of both NGRIs and convicted defendants with mental illness, requiring states to prove why continued commitment was nec- essary. As these new commitment laws were written, most states had the burden of proving that persons found NGRIs were mentally ill, dangerous, and in need of hospitalization. If treatments were not being provided, the state failed to meet the burden. Hearings were now required to review the continued hospital- ization of all patients. Prosecutors opposed to an insanity defense in a particular case were put in the awkward position of first arguing at trial that the individual’s mental disor- der was not so severe as to require an insanity verdict and then following this with the argument that the mental disorder was so severe that the person acquit- ted should be involuntarily committed. Not surpris- ingly, many insane patients no longer met the criteria for commitment and were released. The lack of treat- ment and supervision they encountered is legend, and beginning in the late 1960s, states began releas- ing NGRIs who no longer met the criteria for commitment—mental illness and dangerousness. At the same time, the costs of inpatient mental health care continued to rise due in part to “right to treat- ment” cases. For myriad reasons, such as the lack of resources, the belief that treatment would be ineffec- tive, and fear, there was considerable community resistance to treating this forensic population. The relatively unsupervised release of insanity defendants who had, in many cases, been hospitalized for decades caused fear and concern among the gen- eral public. Complicating the issue, a number of states had notorious cases in which a former NGRI commit- ted a particularly heinous crime, leading to a reconsid- eration of the release procedures of insanity defendants. States began to make the release proce- dures more stringent, placing more responsibility on the defendant. The landslide of legislative change accelerated with the 1983 insanity acquittal of John Hinckley for his attempted assassination of President Ronald Reagan (and serious injuries to other victims). Following this widely publicized case, most states tightened their insanity defense laws, shifting the bur- den of proof to the defendant; changing the test for insanity from the American Law Institute’s guidelines back to the more restrictive M’Naghten test; adopting guilty but mentally ill statutes; abolishing the affirma- tive insanity defense; and creating new, less defen- dant-friendly release procedures. Whether such legal reforms created the intended outcomes has been the subject of extensive research. While Hinckley did not start the retrenchment movement, his acquittal completed it. 812 ———Treatment and Release of Insanity Acquittees T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 812 Public Sentiment and the Insanity Defense Research conducted from the 1960s through the 1980s reveals that the public views NGRIs as more danger- ous than ordinary inmates, consistent with other research on public views of persons with mental ill- ness as being dangerous. Therefore, little public senti- ment exists to attend to the rights of NGRIs. Even when faced with overwhelming expert testimony that a defendant’s mental illness is so severe that he or she could not have known right from wrong, juries more often than not find a defendant guilty, perhaps hoping that they will receive treatment in prison. When asked following the trial why they rejected the insanity defense, jurors often state that although they do not dispute the evidence of psychosis, they are fearful that the individual will be released from the hospital. As public opinion shifted away from reform favor- ing defendants’ rights, the courts turned away from defendants as well. What followed from 1983 to the present could be summarized as a refinement of pro- cedures and laws regarding the insanity defense, within a context where standard psychiatric treatment is constitutionally required for NGRIs. In 1983, the Supreme Court ruled that an insanity acquittal for any crime is a presumption of dangerousness for purposes of commitment. In 1992, the Court held that NGRIs must be released if they no longer meet commitment criteria. An exception is made for convicted sex offenders, who can be involuntarily committed to a psychiatric hospital following completion of their sen- tence until their “mental abnormality” is cured. The implication of the Court’s ruling is that sex offenders can be treated by mental health professionals, even though there is lack of evidence for the efficacy of these treatments. Treatment and Release of Insanity Acquittees One effect of the documented reduction of insanity defense cases from the 1960s through to the present is the change in the NGRI population, affecting treat- ment needs in both the hospital and the community. While some defendants might have been able to “fake” psychosis in the early decades, this grew less likely as the fields of forensic psychiatry and psychol- ogy developed and specialized training became required. Both civil patients and NGRIs have always been prescribed treatments that are thought to be med- ically appropriate and necessary. Earlier interventions including psychosurgery and electroconvulsive treat- ment were invasive and performed by physicians While both interventions are still sparingly used today, the most common treatment for all mental ill- ness is medication; like earlier treatments, it is fixed within the professional domain of licensed medical doctors. For inpatients and outpatients alike, some psychosocial treatments have always been available, although the only common treatment is psychotropic medication. In terms of treatment options in public facilities, there is little difference among patients due to their commitment status. Nearly all jurisdictions maintain maximum-security hospitals, and most NGRIs begin their commitment in these types of facilities but are eventually transferred to less secure, less costly facilities. In some states, these transfers require multi- ple approvals, but the degree of real oversight is unknown. Most often, security changes are made with internal review boards. Outright release or conditional release of NGRIs is supervised to a greater extent than transfers, and the release process varies in complexity and criteria. Some states require extensive, multitiered reviews, while others allow the committing judge to grant the release. A few states have convened special- ized boards to oversee all NGRI release decisions and supervision. If placed on conditional release, NGRIs are required to adhere to the prescribed treatment and can face revocation if they violate the terms of their release. Failure to adhere to treatment, along with psy- chiatric deterioration, is the most common reason for revocation, not re-offending. Contemporary Issues and Developments Today, defense attorneys and defendants alike will not necessarily opt for an insanity defense for a relatively minor offense, even if the defendant meets the criteria for an acquittal. So, while the court decisions of the 1960s resulted in the release of many long-term patients, this trend away from commitment was short-lived. The insanity defense fell into disfavor among defense attor- neys, in large part due to closer scrutiny of defendants and stricter release procedures leading to a long period of hospitalization, and among the public, due to per- ceived fears of this population. There was a parallel influx of nonviolent persons with mental illness into the Treatment and Release of Insanity Acquittees ———813 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 813 communities and the criminal justice system. Whereas between 1966 and 1983 the insanity defense was a viable defense for a wide range of defendants with con- cern about unusually long commitment, the new laws discourage its use for less serious offenders. The insan- ity defense with its expected long-term commitment is an attractive defense only for serious offenders who are facing long incarcerations if convicted. This leaves a large portion of persons with mental illness who are being cared for in the community finding themselves in minor scrapes with the criminal justice system. Two major law and mental health initiatives of the late 20th and early 21st centuries are outpatient commit- ment and mental health courts, both of which are out- growths of the real and the perceived influx of nonviolent persons with mental illness into the commu- nities and the criminal justice system. Outpatient com- mitment is not a new concept, but it has only recently been widely implemented. It is a form of leverage of persons who have a history of treatment noncompli- ance—accept treatment or be hospitalized. In some states, it is also a form of leverage of the legislature to provide resources for mental health treatment. Most of the early mental health courts accepted only nonviolent misdemeanants. Revisions of these courts and the newer courts began to accept felons as well, but these may be limited to nonviolent offenders. Mental health courts are a form of criminal justice system diversion for defen- dants with mental illness. It is unknown at this point the degree to which these diversion programs are taking the place of the insanity defense. It is well documented that there is a measured increase in psychotic disorders among jail inmates and the convicted prison population. While this may be due in part to better diagnostic work in jails and prisons, it is unlikely that this accounts for all of the increase. These observed changes parallel the decline in the use and success of the insanity defense. Persons with mental illness who in prior decades were acquitted and provided treatment in mental health facil- ities are perhaps now receiving treatment in branches of the criminal justice system—outpatient commitment, jail diversion programs, mental health courts, and jails and prisons. How states respond to the increased demand for psychiatric treatment both in and outside the criminal justice facilities is evolving. Some states have extensive “inpatient” and “community” mental health services throughout their prison system. Ironically, these states are often the same states that provide extensive community mental health services in general. At the same time, some states fail to meet the demand at all levels and fail to recognize that good treatment is good security. Lisa Callahan See also Conditional Release Programs; Criminal Responsibility, Assessment of; Criminal Responsibility, Defenses and Standards; Insanity Defense Reform Act (IDRA) Further Readings Eigen, J. P. (1995). Witnessing insanity: Madness and mad- doctors in the English court. New Haven, CT: Yale University Press. Moran, R. (1985). The modern foundation for the insanity defense: The cases of James Hadfield (1800) and Daniel McNaughtan (1843). Law & Society Review, 19, 602–631. Steadman, H. J., McGreevy, M. A., Morrissey, J. P., Callahan, L. A., Robbins, P. C., & Cirincione, C. (1993). Before and after Hinckley: Evaluating insanity defense reform. New York: Guilford Press. Zapf, P. A., Golding, S. L., & Roesch, R. (2006). Criminal responsibility and the insanity defense. In I. B. Weiner & A. K. Hess (Eds.), The handbook of forensic psychology (3rd ed., pp. 332–363). Hoboken, NJ: Wiley. T RIAL C ONSULTANT TRAINING The nature and scope of trial consultant training reflect the array of services that are offered to clients, such as jury research, presentation strategies, and assistance with exhibits. There are no standard acade- mic or professional requirements for trial consultants. Their training varies considerably across the profes- sion, but it tends to involve a relevant academic back- ground, some on-the-job training, and continuing education. Graduate training in the social sciences tends to be quite valuable, typically more than a back- ground in law. However, on-the-job training helps provide competencies and strengthen skills that are difficult to obtain in any other way. Continuing educa- tion helps trial consultants remain up-to-date on valu- able developments in the industry and advances in methodological, technological, and statistical areas. Trial consultants provide either a narrow or a wide range of services to their clients, who are usually attorneys but can also include insurers, corporations, or individuals. These services generally include case 814 ———Trial Consultant Training T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 814 consultation and trial strategy, witness preparation, jury-related services, or presentation and technology- related services. Trial consultants who specialize in trial strategy often have a foundation in social psy- chology and communication and a solid understand- ing of law and legal procedure. Those who specialize in witness preparation may have a background in the- ater, communication, or counseling. Consultants who specialize in jury-related services such as jury selec- tion or community attitude surveys typically have experience with social science research methodology and statistics as well as a foundation in social psychol- ogy. Finally, trial consultants who specialize in pre- sentation and technology-related services tend to have a foundation in graphic art and communication. Of course, there are trial consultants who offer the full gamut of services. Thus, trial consultant training is quite diverse, reflecting the umbrella of services that consultants may provide and tapping into a range of disciplines. Academic Preparation Most successful trial consultants have graduate degrees in the social sciences, with a doctoral degree in psy- chology (particularly clinical psychology or psychol- ogy and law) being quite prevalent. In these types of academic programs, students acquire valuable skills in research design and methodology as well as in qualita- tive and quantitative data analysis. Graduate programs in the social sciences, particularly psychology, typically provide students with a solid theoretical background as well as research experience. These are particularly important for consultants who provide jury-related ser- vices such as mock trials and community attitude sur- veys. Analytical and communication skills are also valuable skills that can be honed in graduate programs in the social sciences, although other types of training, such as law school, can provide these as well. Some trial consultants assist their clients with mediations and arbitrations, so an understanding of the theories and applications relating to negotiations and conflict man- agement is often helpful. There is no clear academic path for individuals interested in trial consulting. Currently, there are no known academic programs that are dedicated to train- ing future trial consultants. Appropriate academic preparation depends on the types of services that the individual plans to offer. For example, a person inter- ested in focusing on graphics or demonstratives (e.g., developing day-in-the life videos of someone with a serious disability, designing illustrations to be used at trial) would need different training from someone who is more interested in conducting jury research in the form of posttrial interviews. In 2007, several uni- versities offered masters and doctoral programs in psychology and law, forensic psychology, or related disciplines (e.g., Florida International University, John Jay College of Criminal Justice, and some other institutions offer relevant courses). A few of these pro- grams offer a combined J.D./Ph.D. degree (e.g., University of Nebraska at Lincoln), although it is not clear whether the dual degree constitutes a superior academic path for those interested in trial consulting. It is important to note that familiarity with the law and legal procedure is crucial, regardless of the nature or scope of the services provided. Attorney clients do not expect trial consultants to be legal scholars, but they do expect a functional knowledge of the law and a solid understanding of legal procedure. A careful read of relevant texts as well as in-court observations of proceedings is strongly advised. The level of academic training that trial consultants should have depends on the level of responsibility and the type of work. For example, a master’s degree in the social sciences should suffice for someone working as an associate or assistant to a more senior trial consul- tant. A doctoral degree in psychology or the social sci- ences provides valuable academic preparation for more senior-level positions, as well as the type of credentials that attorney clients often value. It is not clear whether graduate training of any form would be necessary for someone working in graphics or presentation-focused aspects of trial consulting. Proficiency in the appropri- ate software and graphic arts coupled with a back- ground in communications should be adequate. On-the-Job Training Most trial consultants tend to acquire hands-on train- ing by working for a consulting firm. This experience provides an invaluable opportunity to learn about the profession, the business, and the clients. Working with more experienced consultants can help individuals learn about best practices and gather their own sense of what works best. Moreover, many seasoned trial consultants have considerable insight into how jurors respond to certain types of arguments or evidence, particularly if they have worked on a particular type of case for a long time (e.g., medical malpractice cases). Trial Consultant Training ———815 T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 815 Someone who acquires training under the tutelage of a consultant who has built a practice around certain types of cases would likely acquire specialized knowl- edge in that area, which is probably difficult to obtain in other ways. It is in the courtroom that novice trial consultants often obtain considerable insight into courtroom dynamics, trial strategy, appropriate behavior, and the idiosyncrasies corresponding to some state and fed- eral courts. By observing hearings and trials from start to finish, a novice trial consultant who is working as part of a trial team acquires know-how that is proba- bly difficult to obtain in any other way. On-the-job training can also help individuals learn about the business of trial consulting, including how to market and sell trial consulting services as well as meet the needs of clients. Such hands-on experience helps consultants provide answers to clients’ ques- tions. For example, a client may wonder whether jurors will understand the testimony of a scientific or technical expert in a complex civil case. A trial con- sultant might suggest some witness preparation to help the expert deliver the information clearly and convincingly in a way that fits with the themes of the case and to prepare the witness for cross-examination. The consultant might also recommend some demon- stratives or exhibits to help the witness convey com- plex information clearly and help jurors use the testimony and evidence as intended. Additionally, sur- rogate jury research might test, among other things, the extent to which mock jurors understood the expert’s message and incorporated that evidence into their decision-making process. Of course, clients do not always have unlimited resources, so successful trial consultants learn to devise solutions that meet the needs and fit within the constraints that clients bring to the table. Trial consultants must also successfully manage clients. Understanding client needs and managing the complex interpersonal dynamics and political issues that can emerge when working among attorney clients, corporate clients, support staff, and others is important. Depending on their practice, trial consul- tants often find themselves working with multiple clients, such as corporate defendants and insurers, who do not always share the same goals. These are the types of situations that test consultants’ skills in diplo- macy, conflict management, communication, and crit- ical thinking. As another example illustrating the importance of understanding client needs and politics, trial lawyers sometimes hire trial consultants only to be able to blame them for providing bad advice if the verdict is unfavorable. Such practices are probably uncommon but reflect the importance of being able to understand the trial consultant’s role in a particular situation. Generally, trial consultants tend to acquire and hone many of these competencies through hands-on experience. Finally, some successful trial consultants have built their practice entirely on their experience and have no relevant academic credentials. These consultants pre- sent a compelling argument when they point to their repeat clients, who are pleased with the level of ser- vices they provide. However, it is likely that in the future, trial consultants who acquired their knowledge and skills exclusively on the job will face increasing challenges in providing cogent answers to questions about statistics and methodology from increasingly sophisticated clients. Continuing Education Trial consultants need to update their skill set and remain up-to-date with current best practices and developments in the field and changes in the law. Clients are becoming increasingly sophisticated with regard to social science and technology, so trial consul- tants are additionally motivated to keep up with profes- sional developments. For continuing education, trial consultants in the United States typically turn to the American Society of Trial Consultants (ASTC). Every year, the ASTC organizes a conference where trial consultants can take “Trial Consulting 101” and can discuss emerging trends and findings with seasoned experts. Other related professional organizations include the American Psychology-Law Society and the Law and Society Association. The annual meetings of these organizations sometimes provide useful informa- tion about scientific findings that are relevant to trial consultants (typically relating to jury behavior). Certification of Trial Consultants The ASTC has considered the merits and drawbacks of certification for trial consultants. Considering the diverse nature of the services as well as the swift changes that technological advances can bring, the cur- rent state of the profession in the United States excludes any professional certification or state licensing. 816 ———Trial Consultant Training T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 816