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Psychological Injury and Law hrtpsildcizeg/10.1007/s12207-020-09384-9 Ethical and Professional Considerations in the Forensic Assessment of Complex Trauma and Dissociation Lisa M. Rocchio _ Received: 30 September 2019 / Accepted 27 May 2020 iO Springer Science+Business Media, LLC, pan of Sponger Nature 2020 Abstract Empirical research spanning the past three decades has consistently upheld that traumatic experiences are prevalent (Gold, Psychological Trauma Theory Research Practice and Policy, 5(1), 114-124, 2008: Kilpatrick et al. Journal of Traumatic Stress• 26(5), 537-547. 2013: Resnick, Kilpatrick. Dansky, Saunders. & Best Journal ofClinical and Consulting Psychology 61(6), 984-991, 1993). Therefore. the likelihood of encountering an individual who has experienced significant trauma within forensic settings is high (Dalenberg. Straus. & Ardill, 2017). Further, forensic psychologists are frequently called upon to assess the impact ofsuch traumatic events and to opine about their connection to a specific psycho-legal issue such as damages in a civil case or the presence of extreme emotional disturbance or mitigating factors in criminal matters. Childhood trauma that has occuned repeatedly and cumulatively, particularly within the context of family relationships, has been referred to as complex trauma. Complex trauma has been shown to result in significant difficulties in a broad range of capabilities such as affect regulation. dissociation, identity development. relational capacities, and somatic distress (Courtois and Fond 2009). The author delineates core ethical principles and challenges encountered in forensic assessment both generally and more specifically in the forensic assessment ofcomplex trauma and dissociation. She also details practical strategies for responding to those challenges. In addition, the author identifies essential skills needed for competency in this arena and outlines professional considerations that arise when working with this population. Keywords Ethics • Trauma Complex trauma - Dissociation Forensic • Civil litigation - Personal injury Psychologists, mental health professionals. researchers. and oftrauma exposure, it is very likely that forensic psychologists public policy makers are becoming increasingly aware that will find themselves involved in civil or criminal matters in- exposure to traumatic events is not a rare occurrence and is volving the assessment of an individual who has experienced related to a number of trauma-related disorders (Gold. 2008). at least one significant traumatic event. Although ethical prac- For example, a national study utilizing a large sample ofadults tice is critical in all aspects of forensic practice. evaluating residing in the USA found that 89.7% had experienced at least individuals who have experienced complex trauma can pres- one DSM-5 Criterion A traumatic event and that many had ent some unique difficulties that are important for psycholo- experienced more than one type of trauma (Kilpatrick et al., gists to understand. This paper will address those ethical con- 2013). Another study found that 69% of a sample of over siderations that are critical for any forensic evaluation, as well 4000 US women reported having experienced a traumatic as discuss how repeated trauma can increase the complexity of event over the course of their lifetime (Resnick et al.. 1993). forensic practice. While prevalence rates in community samples are high, stud- ies of clinical populations have found significantly higher prevalence rates (Mauritz, Goossens. Draijer• & van Roles of Forensic Psychologists Achterberg• 2013; Shi, 2013). Given the high prevalence rates Forensic psychologists can and frequently do perfonn varied roles at the point of intersection between psychology and the Lisa M. Rocchio law, and there is a myriad of ways in which a forensic psy- Irocchiorldrlisarocdtio.com chologist can be called upon to provide specialized expertise Lisa M. Rocdtio. Ph.D. & Associates. Inc.. 1524 Atwood Avenue. in the areas of trauma, complex trauma, and dissociation. A Suite 222. Johnston 02919. RI. USA forensic evaluator will conduct an independent psychological Published online: OR June 2020 Springer 3502-027 Page 1 of 11 EFIA_00001638 EFTA00156979 Psychol. Inj and Law evaluation in order to obtain information in response to a forensic psychologist has in a particular matter, it is critical specific psycho-legal question (Dalenberg et al.. 2017). The that they adhere to ethical principles and standards ofpractice. evaluator may then be asked to prepare a written report and /or They must be prepared to respond professionally to the pro- to provide testimony about that evaluation and their expert fessional challenges that may arise in the context of a forensic opinions. For example. in civil contexts, they may be asked evaluation generally and a forensic evaluation involving trau- to evaluate a plaintiffwho has alleged compensable injury as a ma, complex trauma. and/or dissociation more specifically. result ofa traumatic event or series ofevents. In this example, the evaluator may be asked to assess the individual's prior level of functioning, the impact of the traumatic events, and Ethical and Professional Considerations the extent of halm, or damages incurred as a result (Foote & Lareau. 2013). Forensic evaluators may also be asked to de- When working as forensic psychologists. as in all areas of tennine the time at which an individual reasonably knew or professional work, psychologists are expected to conform should have known about a connection between a traumatic their behavior to the APA Ethics Code, the most recent ver- event or events and any alleged resulting injuries. In criminal sion of which was developed in 2002 and revised in 2010 and cases, forensic evaluators may be called upon to assess an 2017 (American Psychological Association [APA). 2017). individual's state of mind at the time of an alleged offense While the APA Ethics Code applies to all psychology special- and to opine about the possible impact of traumatic events ty areas, including Forensic Psychology (Bush. Connell, & on that person's state of mind. At sentencing hearings, foren- Denney, 2020). certain sections of the code may be relevant sic psychologists could be asked to evaluate an individual's for forensic practice, generally. and forensic assessment in- history to identify any potential traumatic events that could be volving complex trauma, more specifically. The Code is com- used as mitigating factors. posed of an Introduction, a Preamble. General Principles A-E, In both civil and criminal matters, psychological experts and specific Ethical Standards. The Preamble and General may also be retained to provide scientific framework testimo- Principles of the Code, in contrast to the Standards. are aspi- ny about relevant psychological issues without having evalu- rational in nature. "Their intent is to guide and inspire psy- ated an individual client. This is often referred to as providing chologists toward the very highest ethical ideals of the profes- "general scientific testimony" about topics within an individ- sion- (APA. 2017. p. 3). The General Principles are not meant ual's general area of scientific expertise. For example, an ex- to be obligatory in nature but rather provide an overall context pert witness who has not performed an evaluation of an indi- for ethical behavior. The second section of the Code consists vidual may be asked to assist the trier of fact by presenting of specific standards for ethical behavior which are "enforce- scientific data pertaining to issues such as the prevalence of able rules for conduct as psychologists" (APA. 2017, p. 3). trauma, the psychological and physical consequences of trau- In addition to the APA Ethics Code. Forensic Psychologists ma. traumatic memory. dissociation, grooming behavior, or can seek guidance from the APA Specialty Guidelines for issues related to predictions of risk and/or dangerousness Forensic Practice (APA. 2013). These guidelines were original- (Brand et al.. 2016; Frankel. 2009). They may also provide ly developed and published in 1991 and have been revised and valuable information about ways in which an individual's ex- updated along with continuing developments in the field (APA. periences oftraumatic events may influence their participation 1991. 2013). The Guidelines specifically state 'The goals of with the legal system or may influence the ways in which they these Specialty Guidelines for Forensic Psychology ('the tell their story. The role of the evaluatingexpert and the expert Guidelines') are to improve the quality of forensic psycholog- providing scientific framework testimony is to provide inde- ical services: enhance the practice of forensic psychology; en- pendent scientific information about specific topics to the trier courage a high level of quality in professional practice: and of fact that fulls within an area of the witness's demonstrated encourage forensic practitioners to acknowledge and respect area of expertise (American Psychological Association. the rights of those they serve" (APA. 2013. p. II). Although (APA). 2013; Melton et al., 2018). the Guidelines are informed by the APA Ethics Code, they are In other instances, forensic psychologists are hired as con- advisory in nature. and are aspirational in intent. They are not sultants to work with attorneys as part of their legal team, and meant to be used as standards, nor are they intended to be in those circumstances. there is no expectation that the psy- mandatory or exhaustive. chologist will conduct an evaluation or provide expert testi- In addition to the APA Ethics Code and Specialty mony. Rather, the psychologist works to assist the attorneys Guidelines for Forensic Psychology, forensic psychologists with their presentation and execution of their client's case. should also take into account the information, guidelines. (Datenberg et al.. 2017). They may be called upon to assist and standards that have been developed, adopted. or endorsed the attorney with understanding the scientific literature related by scientific and professional organizations within their areas to trauma exposure or to help the attorney to make sense of a of specialization (Bush et al.. 2020). For example. within the traumatized individual's behaviors. Irrespective of the role the areas of forensic assessment of complex trauma, forensic 4;3 Springer 3502-027 Page 2 of 11 EFIA_00001639 EFTA00156980 Psychol. Inj and Law psychologists should be thoroughly familiar with the relevant Brand, Schielke. & Brains, 2017a: Dalenberg et al.. 2017). guidelines related to complex trauma and PTSD (Cloitre et al.. Minimally, forensic psychologists engaged in this work will 2012; International Society for the Study of Trauma and need to be well versed in the scientific literature pertaining to Dissociation [1SSTD], 2011). matters related to following content amts. Many of the ethical issues inherent in a forensic evaluation involving complex trauma and dissociation are common to Prevalence and Incidence of Traumatic Stress Although the forensic psychological practice. In the following sections. incidence of traumatic events is high. the prevalence of these ethical challenges and professional considerations and Posttraumatic Stress Disorder following a traumatic event is the specific applicable sections of the APA Ethics Code and relatively low. For example, Kilpatrick and colleagues found the corresponding section of the Specialty Guidelines will be that lifetime, past 12-month, and past 6-month prevalence of reviewed. Wherever appropriate, specific applications to the PTSD was 8.3%. 4.7%. and 3.8% respectively (2013). In spite forensic assessment of complex trauma and dissociation will of the relatively low incidence of PTSD among trauma survi- be highlighted and explored. vors, individuals who have experienced traumatic events are likely to be overrepresented within forensic settings. For ex- Competence ample, Dalenberg et al. (2017) contacted two large law firms in California in 2016 and found that the attorneys estimated When initially contacted by an attorney, the forensic psychol- that over 80% of law suits included allegations of trauma. ogist must clarify the referral question to determine if the Claims of emotional injury involving pain and suffering can questions asked fall within the evaluator's areas of expertise be raised in cases involving harassment, discrimination, rape and if an evaluation is likely to be able to determine the an- and sexual assault, personal injury, and disability. In these swers to the questions posed. When undertaking an examina- cases, forensic psychologists are frequently called upon to tion, it is incumbent upon the evaluator to ensure they have the assess the impact and emotional damage resulting from a spe- requisite skills, training, and level of competence to conduct cific traumatic event or events and may need to opine about the evaluation and provide answers to the relevant psycho- the relative impact and sequelae of a number of traumatic legal questions. Standard 2.01 (a) of the APA Ethics Code events that have occurred over the course of an individual's states "Psychologists provide services, teach, and conduct re- lifetime. It is also important to understand that many of the search with populations and in areas only within the bound- prevalence studies do not evaluate the frequency with which a aries of their competence, based on their education, training. particular trauma happened. with many repotting the number supervised experience, consultation. study. or professional ex- of categories rather than how many instances of a particular perience" (APA. 2017). Guideline 2.01 of the Specialty trauma are present (see Bailey & Brown this issue). Guidelines similarly emphasizes the need for assessing one's competence: Revictimization Given that childhood victimization has been found to increase vulnerability for subsequent When determining one's competence to provide ser- rev ictimization (Classen, Palesh, & Agganval, 2005; vices in a particular matter, forensic practitioners may Widom, Czaja, & Dutton, 2008), forensic psychologists consider a variety of factors including the relative com- may also be asked to assess the impact of traumatic plexity and specialized nature of the service, relevant events that have occurred during adulthood when there training and experience, the preparation and study they is also a prior history of other traumatic events (See are able to devote to the matter, and the opportunity for Brown, this issue, for further discussion.). They may consultation with a professional of established compe- also need to address the sequelae of traumatic events tence in the subject matter in question. (APA. 2013. p. that have occurred during childhood and draw conclu- 9). sions about ways in which those traumatic events have impacted the individual's life trajectory. Within the Few mental health practitioners have received systematic criminal arena, forensic psychologists may be called up- training in the assessment and treatment of trauma and its ef- on to assess the impact of traumatic events on an indi- fects, and even fewer have received training in the area of vidual's state of mind at the time a crime occurred or to complex trauma and dissociation (Brand. 2016). Within the help to explain their behavior during of following the specialized areas of trauma. complex trauma, and dissociation, commission of an alleged criminal act. They may also forensic psychologists should therefore seek out relevant train- be asked to elaborate upon the presence of traumatic ing and supervision in the area of trauma psychology and have events as mitigating factors to be taken into account expertise in the psychological assessment of complex trauma. during sentencing. However, it is important to note that dissociation. and its effects as well as training and expertise in much of the research has been completed on single- the area of forensic psychology more generally (Brand. 2016; incident trauma survivors and, therefore. may not well cl Springer 3502-027 Page 3 of 11 EFIA_00001640 EFTA00156981 Psychol. Inj.and Law represent individuals with repeated and/or ongoing trau- Psychiatric Association [APA], 2013, p. 291). It is often con- ma exposure. ceptualized as an adaptive response designed to assist with coping with trauma when physical escape is not possible Complex Trauma Complex trauma is trauma involving harm (Daknberg et al.. 2012). Although dissociation can be present or abandonment by caregivers that occurs during a develop- in a variety of clinical presentations. such as somatic, sub- mentally vulnerable time period in an individual's life, espe- stance use, and psychotic disorders, it is most commonly re- cially during childhood, and that involves repetitive or lated to trauma (Bailey, Boyer. & Brand, 2018: Lyssenko prolonged exposure to multiple traumatic stressors that is per- et al., 2018). Dissociative disorders are more prevalent than petrated by caregivers over a prolonged period (Counois & is commonly realized (See Bailey et al., 2018: Bailey & Ford. 2013). Exposure to this type ofrepeated trauma has been Brand, 2017; Loewenstein. 2018). In his recent review. shown to increase the likelihood of chronic and complex is- Loewenstein (2018) found prevalence rates in the general sues. as well as significantly increased risk for further victim- population ranging from 9.1 to 18.3% and prevalence rates ization (Briere, Age. & Dietrich, 2016; Briere. Kaltman. & in clinical populations ranging from 4.6 to 48% across diverse Greene, 2008; Cloitre et al.. 2011: Courtois & Ford. 2013: samples. Given that dissociation has been associated with a Herman, 1992). The proposed clinical syndrome describing range of functional impairments, as well as poor prognosis the constellation of difficulties experienced by adults who and lower quality of life, it is particularly important that fo- were severely and repeatedly traumatized during childhood rensic evaluators involved in the assessment of trauma also is referred to as complex posttraumatic stress disorder assess for dissociative symptoms (Brand. Schielke, & Brams, (cPTSD) (Courtois, 2008: Herman. 1992). A study of the 2017a: Brand, Schielke, Brains, & DiComo, 2017b; Frankel, prevalence of complex PTSD as defined in the ICD-1I found 2009). Assessment of complex trauma and dissociation in a prevalence rates of 0.6% in a representative community sam- forensic context is a highly specialized area that requires ex- ple of US adults and 13% in a sample ofUS trauma exposed pertise and training in both forensic psychology and trauma military veterans (Wolf et al.. 2015). psychology (Brand, 2016; Dalenberg et al., 2017). Authors have conceptualized cPTSD as "involving patho- Unfortunately. there is an overall lack of training and educa- logical dissociation; emotion dysregulation; somatization, and tion about trauma and dissociation, and the information is altered core schemas about the self. relationships. and sustain- often missing or inaccurate in many psychology textbooks ing beliefs (i.e.. morality, spirituality) in the aftermath of ex- and training programs (Commis & Gold, 2009). posure to traumatic interpersonal victimization" (van Dijke, Ford. Frank. & van der Hart, 2015. p. 429). In their book on Cultural Competence Within the context of complex trauma the treatment of complex trauma. Courtois and Ford describe and cPTSD, issues pertaining to cultural competency and di- the ways that complex trauma can result in major changes in versity must be attended to. particularly when the examiner the following "seven key domains of an individual's develop- and evaluee are from different ethnic. socioeconomic, and/or ment: emotional regulation, memory. attention, and con- racial backgrounds. Principle E ofthe APA Ethics Code states sciousness, self-perception. perceptions of the perpetrator, re- that: lationships with others, somatic symptoms and/or medical problems, and sense of meaning in self, others, and the world" Psychologists respect the dignity and worth of all peo- (Courtois & Ford, 2013. In a literature review. Bailey and ple.... Psychologists are aware of and respect cultural. Brand (2017) have further delineated the connections among individual and role differences, including those based on and between childhood traumatic events and the development age. gender. gender identity. race, ethnicity. culture. na- ofenduring and severe sequake, including cPTSD and disso- tional origin, religion, sexual orientation, disability, lan- ciation. It is critical that forensic evaluators are aware of the guage. and socioeconomic status, and consider these connection between trauma and dissociation because individ- factors when working with members of such groups. uals who have been diagnosed with cPTSD have been found Psychologists try to eliminate the effect on their work to experience trauma-related dissociation with more severity of biases based on those factor... (APA, 2017, p. 4). and frequency than other populations (Brand, Schielke, Brains. & DiComo. 2017b: Hyland, Shevlin, Fyvie, Cloitre, When evaluatinga trauma survivor. the evaluator must also & Karatzias. 2019). attend to the ways in which that individual's cultural back- ground is impacted by and impacts their experiences of the Dissociation Dissociation is defined in the Diagnostic and alleged traumatic events and their interactions with the legal Statistical Manual of Mental Disorders (5th ed) as "a disrup- system. As outlined by Brown. "Responding to trauma in a tion and/or discontinuity in the normal integration of con- culturally competent manner requires the psychotherapist to sciousness, memory, identity, emotion, perception. body rep- understand how those added meanings that derive from con- resentation, motor control, and behavior" (American text and identity make each instance of trauma unique- Springer 3502-027 Page 4 of 11 EFIA_00001641 EFTA00156982 Psychol. Inj and Law (Brown, 2008. p. 4). In addition, various aspects of identity when forensic psychologists are asked to assume a clinical can increase the likelihood of experiencing a traumatic event role after the conclusion of the legal matter (Durgin 2019; and developing dissociative symptoms, particularly when an Melton et al.. 2018). individual identifies with a group that is relatively The importance of paying attention to potential role con- disempowered within the dominant culture (Bailey et al., flicts is similarly emphasized in APA Ethics Code Standard 2018). Sensitivity and understanding are similarly required 3.05: "A psychologist refrains from entering into a multiple in a forensic context, especially when there is a need to delin- relationship if the multiple relationship could reasonably be eate the specific impact and potential harm experienced as a expected to impair the psychologist's objectivity, competence. result of a traumatic event. Forensic psychologists must also or effectiveness in performing his or her functions as a psy- be aware of the power imbalance inherent in the relationship chologist" (APA, 2017, p. 6). Similarly. Guideline 4.02 of the between psychologist and evaluee and the ways in which that Specialty Guidelines for Forensic Psychologists, states that "A power imbalance may impact the evaluee's behavior and state multiple relationship occurs when a forensic practitioner is in ofmind throughout the evaluation (Bailey et al., 2018) a professional role with a person and, at the same time or at a subsequent time, is in a different role with the same person" Potential Role Conflicts (APA, 2013, p. 11). Guideline 4.02.01 further states that "Providing forensic and therapeutic psychological services As described earlier, forensic psychologists can take on a va- to the same individual or closed related individuals involves riety ofroles when working within the legal system. including multiple relationships that may impair objectivity and/or cause evaluators, scientific framework experts providing general exploitation or other harm" (APA, 2013, p. 11). scientific testimony. and consultants (Bush et al., 2020; When conducting any forensic evaluation, it is Gottlieb & Coleman 2012). While both types of testifying essential to clarify the forensic psychologist's role in the experts, evaluators and scientific framework experts, speak case and to determine "who is the client?' Unlike in clin- with attorneys and educate them about trauma and dissocia- ical settings, the person being evaluated in a forensic eval- tion. their role is to provide independent and scientifically uation is not the client and is not the individual (or agen- informed information rather than advocacy. They should be cy) to whom the psychologist owes the primary responsi- free of conflicts, and their opinions should not vary depending bility. One must therefore first ascertain who the individ- upon the retaining party. In contrast a forensic psychologist ual client is. In most civil evaluations, the client will be an hired as a consultant may be retained to work with the legal attorney, either for the defense or for the plaintiff. team to assist with their preparation and execution of their side However, the client could also be the court, in cases of of the case, and there is no expectation that they will evaluate a court-ordered evaluation. At the time of the initial con- the individual or provide testimony. In their capacity as foren- tact with the retaining party, the forensic psychologist sic consultants, they may work with the legal team to assist should also determine who is involved in the case in order them in their understanding of the psycho -legal issues and in to identify any potential conflicts (Foote & Lareau, 2013). evaluating opposing expert depositions and reports. They may Ethics Code Standard 3.06 also clarifies obligations relat- also assist with legal strategy such as jury selection and prep- ed to conflict of interest and Standard 3.07 deals with aration of questions for deposition or direct or cross examina- third-party requests for services (APA, 2017). Ensuring tion of witnesses. However, in this role, they do not provide that the role of the evaluator is clearly explained is even expert witness testimony or conduct evaluations. They are more critical when evaluating a trauma survivor because considered a member of the legal advocacy team and do not they frequently present difficulties with establishing trust, have the same expectations ofindependence and objectivity as particularly when a power differential is present (Courtois those providing expert testimony. and Ford 2009). It is also critical to understand the distinctions between The interpersonal nature of complex trauma and the inher- clinical and forensic roles (Greenberg & Shuman, 1997). In ent violations of trust and safety involved make it particularly their influential article. Greenberg and Shuman enumerate ten important that forensic psychologists evaluating complex specific differences between clinical and forensic roles and trauma and dissociation maintain clear and consistent bound- outline the numerous ethical difficulties and conflicts that in- aries and be wary of potential role conflicts in their work in terfere with the ability ofa clinician's ability to offer a forensic order to avoid doing further harm (Dalenberg et al., 2017). In opinion about their client. They highlight the necessity of addition, the evaluator may need to clarify these critical dis- respecting these role differences and argue convincingly that tinctions between therapist and expert and the problems asso- ignoring the role conflict jeopardizes both the therapeutic and ciated with role conflicts with attorneys; in this writer's expe- forensic endeavors for the patient as well as the rights of all rience, attorneys often mistakenly believe that a therapist is the involved parties. Since this article's publication, there has also "best" person to testify on behalf of their clients and benefit been increased awareness of the ethical challenges presented from education about why these roles should not be blurred. 4 Springer 3502-027 Page 5 of 11 EFIA_00001642 EFTA00156983 Psychol. Inj.and Law Legal and Jurisdictional Issues Similarly. the Ethics Code Standard 3.07 states that "When psychologists agree to provide services to a person or entity at In addition to identifying potential conflicts, psycholo- the request ofa third patty. psychologists attempt to clarify at gists need to be certain that they are able to practice in the outset of the service the nature of the relationship withal the jurisdiction of the case. Licensure laws vary from individuals or organizations involved" (APA, 2017. p. 6). The state to state, as do the requirements and permissions engagement agreement should specifically address the com- related to temporary practice and the issue of practicing ponents of the evaluation, the fee agreement. and the forensic psychology in states where one is not licensed timeframe. Specialty Guidelines 5.01 and 5.02 specifically is controversial (Heilbrun, Grisso, & Goldstein, 2009). deal with determination of fees and the need to clarify with While many states do allow for limited temporary prac- the client the likely cost of services, respectively (APA, 2013, tice, a significant minority of states do not (Tucillo, p. 12). The attorney should also be given guidance regarding DeFilippis, Denney, & Dsurney, 2002). Standard the anticipated total time required for the evaluation and for 2.01(f) of the Ethics Code requires that "When assum- writing a report. if needed. ing forensic roles, psychologists are or become reason- Clients who are severely traumatized and experiencing able familiar with the judicial or administrative rules symptoms of dissociation may require a longer period governing their roles" (APA, 2017, p. 5). Similarly, of time in order to adequately review their histories. In partic- Specialty Guideline 2.04 states: ular, clients who have experienced multiple episodes of trau- ma beginning in early childhood will likely have more com- Forensic practitioners recognize the importance of plex and lengthier relevant background information that will obtaining a fundamental and reasonable level ofknowl- need to be reviewed and potentially documented in a report. In edge and understanding of the legal and professional addition, given the potentially triggering nature of the infor- standards, laws. rules and precedents that govern their mation being reviewed, when possible. evaluees may benefit participation in legal proceedings and that guide the im- from multiple. shorter appointments rather than one long pact of their services on service recipients (APA, 2013, meeting for the evaluation. The complex nature of these eval- P. 9). uations can therefore add significantly to the time required for an evaluation of complex trauma and dissociation, and this Given the specialized nature of the forensic assessment of will need to be explicitly discussed with the retaining party trauma and dissociation, and the relative lack of training in this prior to the evaluation. area. psychologists who have that specialization may find Although the Ethics Code does not specifically refer to the themselves contacted by attorneys from multiple jurisdictions. issue of payment on a contingent basis, Specialty Guideline It is therefore imperative that practicing forensic psychologists 5.02 specifies that "Because of the threat to impartiality pre- are aware of the laws that apply in the jurisdictions in which sented by acceptance of contingent fees and associated legal they intend to practice: however, information regarding tem- prohibitions, forensic practitioners strive to avoid providing porary practice can be vague and difficult to obtain (Shuman, professional services on the basis of contingent fees- (APA. Cunningham. Connell, & Reid. 2003). It is therefore recom- 2013, p. 12). mended that the forensic evaluator contact the licensing board The specifics of the engagement agreement should also of the state in which they intend to conduct an evaluation if take into account the relevant legal requirements per the laws they are not licensed in that jurisdiction. in the specific jurisdiction. for example, federal law generally requires production ofa report as do evaluations conducted of Fees and Engagement Agreement plaintiffs by forensic examiners retained by defense counsel (Melton et al.. 2018). The specific terms of the engagement agreement between the hiring party (generally the attorney) and the psychologist Multiple Sources of Information should be clearly delineated, ideally, in writing. Guideline 4.01 of the Specialty Guidelines states that: In keeping with Forensic Guideline 9.02 which states that "Forensic practitioners ordinarily avoid relying solely on one At the initiation ofany request for service, forensic prac- source of data, and corroborate important data whenever feasi- titioners seek to clarify the nature of the relationship and ble" (APA. 2013, p. 15). a comprehensive forensic mental the services to be provided including the role of the health assessment (FMHA) requires multiple sources of infor- forensic practitioner... which person or entity is the mation (Heilbrun et al.. 2009). The psychologist should make it client; the probable uses of the services provided or in- clear to the retaining party at the outset of the evaluation that formation obtained; and any limitations to privacy, con- they will require access to all documents pertaining to the case fidentiality, or privilege (APA, 2013, p. II). and will need to conduct collateral interviews as pan of the 4!I Springer 3502-027 Page 6 of 11 EFIA_00001643 EFTA00156984 Psychol. Inj. and taw evaluation. The evaluator should not only take care to thor- confidentiality, and the differences between a forensic evalu- oughly review all documents provided but will also need to ation and treatment. The process should also delineate clearly request specific other documents. For example, when evaluat- how the information will be utilized and to whom it will be ing damages following a traumatic event or series ofevents. the provided. evaluator will need to review independent sources of infomta- Standard 4 of the Ethics Code specifies the obligation of tion regarding the individuals' prior and current level of func- psychologists to - take reasonable precautions to protect con- tioning (Foote & Lareau. 2013). Such documentation may in- fidential intonation- and to discuss with persons "the rele- clude. but is not limited to. school records, employment records vant limits ofconfidentiality" and the "foreseeable uses of the and performance evaluations, any prior psychological testing. information generated" (APA. 2017. p. 7). This informed con- psychotherapy and medical records, arrest and prison records. sent process should also be repeated when conducting any and possibly records related to involvement with foster care or collateral interviews, as it is essential that any person with the state's department of children, youth, and families. whom the forensic evaluator interacts understand the purpose The evaluator will also need to identify individuals who of the interview and the limits of confidentiality. have potentially useful information with whom to conduct When evaluating individuals who have experienced com- collateral interviews. Specialty Guideline 8.03 states that plex trauma, and who may be exhibiting symptoms of disso- "Forensic practitioners strive to access information or records ciation. it is particularly important to keep in mind that issues from collateral sources with the consent of the relevant attor- related to informed consent may need to be addressed fre- ney or the relevant party..." (APA. 2013. p. 14). In matters quently over the course of the evaluation. In addition, forensic involving the assessment of complex trauma, these individ- psychologists will need to take into account the pacing of the uals will typically include those who have known the evaluee evaluation, and ensure that the individual being evaluated over a long period of time, ideally before. during, and atter the understands the nature of the questions that will be asked. alleged incidents, as well as individuals who can provide in- and the information that will be discussed. Further, the formation about the individuals previous and current levels of evaluee should be prepared for the potential difficulty of the functioning and performance (Foote & Lareau. 2013). These evaluation, given the need to disclose trauma-related informa- individuals may include parents. siblings, other family mem- tion in a time-limited setting (flalenberg et al.. 2017). bers, friends, coworkers, supervisors. therapists. and mentors. among others. The individuals contacted for collateral inter- Use of Appropriate Assessment Tools views should be asked about their observations of the evaluee's performance, functioning and symptoms, as well The APA Ethics Code and Specialty Guidelines for Forensic as any other relevant information they are able to provide Psychology both include statements emphasizing the impor- (Foote & Lareau. 2013). However, particularly when tance of using assessment tools that are appropriate for interviewing family members, it is also critical to understand assessing the matter at hand. Standard 9.01 emphasizes the that some of these individuals may be perpetrators of past or need to base opinions "on information and techniques suffi- ongoing trauma, even if the evaluee is not willing to discuss cient to substantiate their findings, and Standard 2.04 states this with the examiner. that "Psychologists' work is based upon established scientific and professional knowledge of the discipline" (APA, 2017, Informed Consent and Limits of Confidentiality pp. 12, 09). Specialty Guideline 9.01 states that "Forensic practitioners strive to utilize appropriate methods and proce- Once the evaluator has reviewed relevant documents and dis- dures in their work" (APA. 2013. p. 14), and Specialty covery materials. upon meeting with the evaluee, it is essential Guideline 10.02 states that "Forensic practitioners use assess- to obtain informed consent. The APA Ethics code 3.10(c) ment procedures in the manner and for the purposes that are specifies that psychologists must obtain informed consent appropriate in light of the research on or evidence of their and that when services are court ordered or otherwise mandat- usefulness and proper application" (APA. 2013, p. 15). ed. -psychologists inform the individual of the nature of the In the case of the forensic assessment of complex trauma anticipated services, including whether the services are court and dissociation, the evaluator generally includes assessment ordered or mandated and any limits of confidentiality. before tools that are global measures of personality and potentially proceeding." Standard 3.10(d) further specifies that consent cognitive functioning, as well as assessment tools that are must be appropriately documented (APA. 2017, p. 7). trauma specific (Brand, Schielke, Brams, & DiComo. Standard 9.03 clarifies issues pertaining to the informed con- 2017b: Brown. 2009; Dalenberg et al.. 2017). When using sent process in assessments (APA, 2017. p. 13). Consent general measures of personality, such as the PAI or the should be obtained in writing and it is essential that the indi- MMPI, the psychologist must be well versed in the ways in vidual being evaluated understand fully the process of the which trauma survivors respond to these measures. both on evaluation, the role of the evaluator, the limits of validity and on clinical scales (Brand et al.. in press; Brand. Springer 3502-027 Page 7 of 11 EFIA_00001644 EFTA00156985 Psychol. Inj. and Law Schielke, Brains, & DiComo. 20176; Brown. 2009: Eakin, This recommendation is consistent with the Ethics Code Weathers, Benson. Anderson. & Fundetburk. 2005; Lange, Standard 6.01 regarding documentation of professional work Sullivan. & Scott, 2010). In accordance with Ethical and records maintenance (APA, 2017. p. 9), and with Standards 9.08 and 9.09, tests utilized should be current, and Specialty Guideline 10.06 which states that "Forensic practi- if test scoring and interpretation services are utilized, the psy- tioners are encouraged to recognize the importance of chologist must ensure that the interpretations are based upon documenting all data they consider with enough detail and accurate data and norms that have been validated for use quality to allow for reasonable judicial scrutiny and adequate with the population being evaluated (APA, 2017). discover by all parties" (APA, 2013. p. 16). The evaluator will In addition to the use of general measures, a competent and also likely be required to provide a copy of their entire file to ethical forensic evaluation of trauma and dissociation will need the court and to the opposing attorneys. to include measures that specifically evaluate these Finally, when preparing and copying the record, attention traumatic experiences and symptoms (Brand. Schielke, should be given to the maintenance of test security in accor- Brains. & DiComo. 20176; Brown, 2009; Dalenberg et al., dance with Ethics Code Standard 9.11 which specifies the 2017; Foote & Lareau. 2013; Frankel. 2009). Careful selection need for maintaining test security (APA, 2017). as well as of these trauma-specific measures will assist the evaluator in any copyright regulations pertaining to the test materials being using measures appropriately named and validated and those replicated. that have demonstrated efficacy in evaluating trauma-related symptomatology. Several of these, such as the TS1-2. also con- Impact of Trauma Exposure on the Individual Being tain validity measures. All instruments utilized should of course Evaluated and the Evaluator be carefully and properly scored using appropriate norms. In any forensic evaluation, where there may be external mo- Additional areas for consideration that are specific to a foren- tivation to either exaggerate or minimize symptoms and psy- sic evaluation involving the assessment of complex trauma chopathology. it is essential that the possibility of malingering and dissociation include awareness of ways in which the and overall response style both be carefully evaluated (Heilbrun evaluee's individual history and experiences may impact them a al.. 2009; Melton et al.. 2018). There have been many articles throughout the course of the evaluation (Brand. Schielke. & written about the assessment of malingering in trauma survi- Brains. 2017a: Brand. Schielke. Brains. & DiComo. 20176; vors. and it is essential that the evaluator ensure that they are Dalenberg et al.. 2017). For example, victims of complex using measures that have been appropriately named and vali- trauma may have significant difficulties with trust and with dated in traumatized populations (Brand, Schielke, Brains. & feelings of shame. and may rely upon coping strategies such DiComo. 20176; Brand. Tursich, Tzall. & Loewenstein, 2014; as minimization, denial, or avoidance, that could significantly Brown, 2009; Rogers. Payne. Correa, Gillard. & Ross, 2009). impact their responses during the evaluation (Dalenberg et al.. In addition, it is critical that forensic evaluators be aware of 2017). ways in which the responses of complex trauma survivors can The very nature ofa forensic evaluation requires review of appear to be exaggerated or feigned (Brown. 2009). a great deal of potentially traumatic information over a very brief period. often only 1-2 days. This type of intense expo- Record Keeping sure can be potentially overwhelming for the individual being evaluated. As a result. the evaluator needs to pay attention to Over the course of the evaluation. the evaluator should take the pacing of the evaluation and may need to offer frequent care to keep careful and accurate records. They will need to breaks. In addition, the evaluator needs to pay attention to the make note of both what is observed throughout the evaluation ways in which the individual being evaluated in responding to and what is reported by the evaluee. and these behavioral questions and to the degree to which they are present and observations should be accurately labelled as such (Brand, grounded. They will need to work to help the individual being Schielke. Brams, & DiComo. 20176: Dalenberg et al.. 2017; evaluated remain within a window ofaffect tolerance, in order Foote & Lareau. 2013: Heilbrun et al.. 2009; Melton et al., to maximize the quality and accuracy of the data being gath- 2018). In addition, it is critical that the evaluator retain a copy ered (Brand. Schielke, & Brams, 2017a: Brand. Schielke. of the engagement agreement with the attorney. carefully and Brains. & DiComo, 20176). This may seemingly put the fo- thoroughly document everything reviewed as part of the eval- rensic evaluator at odds with the role of the forensic evaluator uation, and maintain a complete record ofall testing and notes as an objective investigator, and the evaluator must take care taken dining the evaluation. not to blur their role between forensic evaluator and treating Brand and colleagues (Brand. Schielke. & Brains, 2017a) clinician. However, a competent forensic assessment will re- and Brown (2009) provide guidance on the importance of quire use of both clinical and assessment skills, particularly recording observations, particularly when assessing an indi- when evaluating a survivor of complex trauma. In many cir- vidual who has experienced complex trauma and dissociation. cumstances. the evaluee may be in therapy. and it is prudent to cal Springer 3502-027 Page 8 of 11 EFIA_00001645 EFTA00156986 Psychol. Inj. and law request that the therapist be "on call" and available to the survivor is trying to communicate. Considering the risks of individual to assist them with issues related to safety. stabili- vicarious traumatization and their potential negative impact on zation. and distress tolerance during and following the evalu- the psychologist and on the forensic evaluation, it is impera- ation. In those circumstances where the evaluee is incarcerat- tive that the forensic evaluator engage in self-care. Clinician ed, it is helpful to consider that overt distress can make some- self-care can include things such as diet, exercise, sleep, and one a target and ensure that there is sufficient time to help the time off, as well as consultation and personal therapy individual regulate before returning to their cell. (Frankel, 2017: Saakvitne & Pearlman. 1996). It is also important to be aware ofand to communicate with the retaining attorney the ways that the trauma survivor's ex- Report Writing and Testimony periences may impact their interactions with the legal system as well as their response to the demands of the evaluation and Following the completion of the evaluation, the forensic psy- to testifying. For example. individuals with cPTSD may be chologist will typically provide feedback to the retaining party very hesitant to discuss or even to disclose their experiences to and may then be required or asked to prepare a written report. their attorneys. and their use psychological defenses such as The report should carefully describe the assessment process minimization, compartmentalization. or denial may make it and the bases for the conclusions made. As highlighted by more difficult for their attorneys to successfully advocate on Brand and colleagues (Brand, Schielke. & Brains. 2017a; their behalf. In addition, difficulties with emotional regulation Brand, Schielke. Brains, & DiComo. 20176), in the context and management of impulses. as well as engagement in high- of the forensic assessment of complex trauma and dissocia- risk behaviors such as self-injury or substance use. may also tion. it is particularly important that the forensic psychologist interfere with their interactions with the legal system (Brand. be prepared to present accurate information in a manner that is Schielke, & Brams. 2017a; Brand, Schielke. Brams, & both readily comprehensible and evidence-based. The psy- DiComo, 20176). Judges and juries may have difficulty un- chologist should also be prepared to dispel myths and correct derstanding the apparent lack of emotional response of an mis-information, and to present all information in a scientifi- individual who is testifying about their experiences, and the cally informed manner. testifying forensic expert will need to clearly explain the indi- In accordance with Ethical Standard 9.01(a)"Psychologists vidual's behavior in a way that helps the triers of fact make base the opinions contained in their recommendations. re- sense of what they are seeing. ports. and diagnostic or evaluative statements, including fo- In addition to attending to the impact of the evaluation on rensic testimony on information and techniques sufficient to the individual being evaluated, a significant component of substantiate their findings" (APA, 2017. pp. 12-13). The eval- competency for the forensic evaluation of complex trauma uator should be certain to limit their conclusions to those re- involves an awareness of how the demands and content of sults supported by the evaluation, and not go beyond the data the evaluation will impact the evaluator. Standard 2.06(a) when explaining assessment results. As specified in Specialty and 2.06(6) of the Ethics Code state that psychologists should Guideline 11.02. care should also be taken to carefully "dis- not initiate professional activities when they know or should tinguish observations, inferences, and conclusions. Forensic know that their personal problems will interfere with perfor- practitioners are encouraged to explain the relationship be- mance and that when experiencing personal problems with the tween their expert opinions and the legal issues and facts of potential to interfere with competency. they - take appropriate the case at hand" (APA. 2013. p. 16). measures such as obtaining professional consultation or assis- The evaluator may also experience pressure from the tance and determine whether they should limit suspend, or retaining attorney to add or to withhold statements that the terminate their work-related duties" (APA. 2017, p. 5). attorney sees as potentially damaging or disadvantageous to The nature ofa forensic assessment of complex trauma and their client. This is especially true when the plaintiff has a long its effects is such that the evaluator will be exposed to explicit and extensive history of complex trauma, and the attorney is details about traumatic events and their effects in a relatively concerned that discussion of the individual's past trauma briefperiod oftime. In addition, the evaluator will not have the could be harmful to the case. It is critical that the forensic benefits of eliciting the information in the context of a thera- psychologist make it clear to the attorney that all relevant peutic relationship that occurs over time, which may increase history will need to be explored and disclosed. and that the vulnerability to vicarious traumatization. Vicarious traumati- psychologist's role is to provide an independent evaluation, zation. which is distinct from burnout and compassion fatigue. not an advocacy report The psychologist should be guided by can produce in the evaluator (or therapist) the same symptoms the Ethical principle B of Fidelity and Responsibility as well experienced by the trauma survivor (Pearlman & Saakvitne, as Principle C: Integrity in adhering to the standard 5.01 re- 1995: Saakvitne & Pearlman. 1996). Similarly. Dalenberg gaiding the avoidance of false or deceptive statements (APA, (2000) addresses the impact of countertransference on the 2017). In addition, Specialty Guidelines 11.01 and 11.04 pro- therapist's ability to hear and understand what the trauma vide guidance regarding accuracy. fairness and avoidance of 4:i Springer 3502-027 Page 9 of 11 EFIA_00001646 EFTA00156987 Psychol. Inj and Law deception and comprehensive and accurate presentation of American Psychological Association. (2017). Ethical principles of psy- chologists and code of conduct. Retrieved from htips://ww.v.apa. opinions in reports respectively (American Psychological orglethkseode/ Association, 2013). Bailey. T. D.. Boyer. S. M.. & Brand. B. L (2018). Dissociative disor- ders. In D. L. Segal (Ed.). Diagnostic interviewing. New York: Springer. Bailey. T. D.. & Brand. B. L (2017). Traumatic dissociation: Theory. Conclusions research. and unman. Clinical Psychology: Science and Practice. 24(2). 170-185. https://doi.orgl10.1I I I tcpsp.12195. This ankle has highlighted key ethical and professional consid- Brand. B. L. (2016). The necessity of clinical training in trauma and dissociation. Journal ofAnxiety and Depression. 5(4). htips://doi. erations in a forensic psychological evaluation generally and org/I0A 172,2167.1044.1000251. more specifically in the assessment of complex trauma and dis- Brand. B. L.. Chasson, G. S.. Palermo. C. A.. Donato. F. M.. Rhodes, K. sociation. In particular. the recognition of trauma psychology and P.. & Voorhees. E. F. (in press). Truth is in the details: A comparison forensic psychology as specialized areas of practice has been ofMNIPI.2 item endorsements by patients with dissociative identity emphasized. Therefore, forensic practitioners who wish to eval- disorder patients versus simulators. The Journal of the American Academy ofPs3rbiatry and the Law. uate victims ofcomplex trauma and trauma specialists who wish Brand. B. L.. Sar. V.. Stavropoulos. P.. Kruger. C.. Korzekwa. M.. to become involved with forensic practice both will require spe- Martinez-Taboas. A.. & Middleton. W. (2016). Separating fact from cialized training. education, and professional consultation. as fiction: An empirical examination of six myths about dissociative well as ongoing continuing education in order to maintain the identity disorder. Hanurd Review ofPsychiatry. 24(4). 257-270. Impsitdoi.org/10.1097.01RP.00000000000C0100. requisite competencies. Forensic practitioners need to remain Brand. B. L.. Schielke, H. J.. & Branca. J. S. (2017a). Assisting the courts aware of the relevant laws and regulations governing the juris- in understanding and connecting with experiences ofdisconnection: dictions in which they intend to practice and remain aware of Addressing trauma-related dissociation as a forensic psychologist. potential role conflicts. In addition the need for cultural compe- pan I. Psychological Injury and Law. 10(4). 283-297. htips://doi. tency as well as an ongoing awareness of ways that exposure to org/10.1007/s12207-017-93648. Brand. B. L. Schielkc, H. J.. Branca. 1. S.. & DiComo. R. A. (2017b). trauma will impact the individual being evaluated and their par- Assessing trauma-related dissociation in forensic contexts: ticipation in the legal system as well as the forensic psychologist Addressing trauma-related dissociation as a forensic psychologist. are essential. Forensic psychologists should rely upon evidence- pan II. Psychological kitty and Law. 10(4). 298-312. htips://doi. based and trauma-informed assessment tools and make use of org/I0.1007/s12207-017-9305-7. multiple data sources when conducting evaluations. Knowledge Brand. B. L., Tursich. M., Tzall. D.. & Loewenstein. R. J. (2014). Utility of the SIRS-2 in distinguishing genuine kmsimulated dissociative and comfort with the appropriate use of measures specific to identity disorder. Psychological Thauma Theory Reseatth Practice trauma and dissociation as well as awareness of the ways in and Polity. 6(4). 308-317. which complex trauma survivors that respond to broad-based Briar. J.. Agee. E.. & Dietrich A.(2016). Cumulative trauma and current measures are also essential. An evaluator who attends to these positraumatic stns disorder status in general population and inmate samples. Psychobglosl Trauma. 8(4). 439a. https://cloiorg/10. ethical and professional considerations can contribute greatly to 1037/m10000107. the field of forensic psychology. As concluded by Dalenberg Mitre. J.. Kaltman. S.. & Greene. R. (2008). Accumulated childhood et al.. 'Taking into account the devastating consequences that trauma and symptom complexity. Journal of Traumatic Stress. trauma can produce. as well as the resilience of the human spirit 21(2). 223-226. lums://cloi.org110.1002/rts. the forensic evaluator can help the court come to a just and Brown. L S. (2008). Cullum!competence in trauma therapy: Beyond the flashback. Washington. DC: American Psychological Association. balanced solution in civil and criminal matters- (2017. p. 556). Brown. L. S. (2009). True drama or true trauma? Forensic trauma assess- ment and the challenge of detecting malingering. In P. F. Dell & J. Compliance with Ethical Standards A.O'Neil (Eds.). Dissociation and the dicsociathe divorders: DS4f- V and beyond (pp. 585-594). New York: Roinkdge. Conflict of Interest The author declares that she has no conflicts of Bush. S. S.. Connell. M. A.. & Denney. R. L. (2020). Ethicalpractice in interest. forensic psychology: A guide for mental health pnufessionab (2nd oi). Washington. D.C.: American Psychological Association. (in press). Classen. C. C.. Palesh. O. G.. & Aggarwal. R. (2005). Sexual References rev ictimization: A review of the empirical literature. Trauma Violence Abuse. 6(2). 103-129. hitps://doLorg/10.1177/ 1524838005275087. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders DSM-5 (5th oi). Washington D.C.: Cloitre. M.. Counois, C. A.. Charuvastra. A.. Campezza. R., Stolbach. B. American Psychiatric Press. C.. & Green. B. L. (2011). Treatment of complex PTSD: Results of the ISTSS expert clinician survey on best practices. Journal of American Psychological Association. (1991). Specialty guidelines for Traumatic Stress. 24(6). 615-627 Retrieved from http://proxygu. forensic psychologists. Law and Human Behavior. 15. 655-665. researchpon.unid.cdurlogin?insu&url=http://search.cbscohost. American Psychological Association. (2013). Specialty guidelines for c 0m/togin.a sp x ?di reet =true&db=psyh& AN=20 1 1 -2984 8- forensic psychology. American Psychologist 68(1). 7-19. hops:// 00161sitctehost.live marylene.cloitreenyumcorg. doiorg/10.1037/a0029889. 4%3 Springer 3502-027 Page 10 of 11 EFIA_0000 (647 EFTA00156988 Psychol. Inj. and Law Cloitre. Counois. C. A.. Ford. J. D.. Green. B. L.. Alexander. P.. traumatic events and PTSD prevalence using DSM-IV and DSM-5 Brier°, J..... Van der Hart. 0. (2012). The ISTSS expert consensus criteria. Journal of Traumatic Stress. 26(5). 537-547. https://doi. treatment guidelines for complex PTSD in adults. org/10.1002/ts.21848. Ccurtois. C. A. (3:108). Complex trauma. complex reactioatc Assessment and Lange. R. T.. Sullivan. IC A.. & Scon.C. (2010). Comparison ofMMPI-2 trauma P.9thological TharmallworyResecuth PmcticearadPoliac and PAI validity indicators to detect feigned depression and PTSD I ). 86-I®. haps://dolorg/10.1037/1942-9681.S.1.86. symptom reporting. Psychiatry Research. 176(2-3). 229-235. Conjs. C. A.. & Ford. J. D. (2013). herantaa of complex trauma: A htips://dolorg/10.1016.5.psychres.2009.03.004. supernal. telatioachip-based approach. New York: Guilford Press. Loewenstein. R. J. (2018). Dissociation debates: Everything you know is Counois. C. A.. & Ford. J. D. (Eds.). (2009). Treating complex traumatic wiring. Dialogues in Clinical Neuroscience. 20(3). 229-242. stress disorders: An evidence-based guide. New York: Guilford Lyssenko. L.. Schmid. C.. Bocichacker, L.. Vondalin, R.. Bohus. M.. & Press. Kleindienst. N. (2018). Dissociation in psychiatric disorders: A Cone. C. A. & Gold. S. N. (2009). The need fee inclusion ofpsychological meta-analysis of studies using the dissociative experiences scale. trauma n the proceed/mai cuniculunt A call to aetko. Ps)rhoknzical American Journal ofPsychiatry. 175(1). 37-46. https:ildoi.org/10. Tanana Theory Research Practice andPolio; /(1). 3-23. I176/applajp.2017.1701CO25. Dalcnberg. C. J. (2000). Counteriransference and the treatment of Mauritz. M. W.. Goossens, P. J.. Dauer. N.. & van Achterberg. T. trauma. Washington. D.C.: American Psychological Association. (2013). Prevalence of interpersonal trauma exposure and trauma- Dalenberg. C. J.. Brand. B. L.. Cleaves. D. H.. Dorahy. M. J.. related disorders in severe mental illness. European Journal of Loewenstein. R. J.. Cardona. E.. et al. (2012). Evaluation of the Pnychotraumatology. 4.4. hnps://doi.orgil0.34021aptAi0.19985. evidence for the trauma and fantasy models of dissociation. Melton. G. B.. Pctrila. J.. Poythress. N. G.. Slobogin. C.. Otto. R. K.. Psychological Bulletin. 138(3). 550-588. httpsg/doi.org/10.1037/ Mossman. D.. & Condia L. (2018). Psychological evaluations for a0027447. the courts: A handbook for mental health professional and lawyers Dalcnberg. C. J.. Straus. E.. & Ardill. M. (2017). Forensic psychology in (4th cd.). New Yak: The Guilford Press. the context of trauma. In APA handbook oftrauma psychology (pp. Pearlman. L A.. & Saalaitne. K. W. (1995). Trauma and the therapist: 543-563). Washington. D.C.: American Psychological Association. Counterrransference and vicarious traumatizationinpsychotherapy Drogin. E. Y. (2019). Ethical conflicts in psychology (5th cd.). Washington. D.C.: American Psychological Association. with incest sus-Ways. Ncw York: W W Norton & Ca. Eakin. D. E.. Weathers. F. W.. Benson. T. B.. Anderson. C. F.. & Resnick. H.S.. Kilpatrick. D. G.. Dansky. B. S.. Saunders. B. E.. & Best. Funderburk. B. (2005). Detection of feigned posttrawnatic stress C. L. (1993). Prevalence of civilian trauma and PTSD in a represen- disorder. A comparison of the MMPI-2 and PAL Journal of tative national sample of women. Journal of Clinical and Psychopathology and Behavioral Assessment. 28(3). 145-155. Consulting Psychology. 61(6). 984-991. haps://dolorg(10.1007410862-005-9006-5. Rogers. R.. Payne. J. W.. Correa. A. A. Gillard. N. D.. & Ross. C. A. Foote. W. E.. & Lanai. C. R. (2013). Psychological evaltiarion of emo- (2009). A study of the SIRS with severely traumatized patients. tional damages in tort cams. In Handbook ofpsycholoszy: Forensic Journal ofPersona°. Assessment. 91(5). 429-438. hups://doLorgi psychology (Vol. II. Ind ed.. pp. 172-200). Hoboken: Wiley. 10.1080'00223890903087745. Frankel. A. S. (2009). Dissociation and the dissociative disorders: Saakvitne. K. W.. & Pearlman. L. A. (1996). harufanning the pain: A Clinical and forensic assessment with adults. In P. F. Dell & J. A. workbook on vicarious traumatization. New York. NY. US: W W O'Neil (Eds.). Dissociation and the dissociative disorders: DS14-V Norton & Co.. and beyond. New York: Taylor & Francis Grine. Shi. L (2013). Childhood abuse and neglect in an outpatient clinical Frankel. A. S. (2017). Legal and ethical considerations in working with sample: Prevalence and impact. American Journal of Family trauma survivors: Risk management principles for clinicians. In Therapy. 41(3). 198-211. APA handbook oftrauma psychologw Foundations in knowledge. Shuman. D. W.. Cunningham. M. D.. CcenelL M. A.. & Reid. W. H. Vol. 1 (pp. 547-558). Washington. DC. US: American (2003). Interstate forensic psychology consultations: A call for re- Psychological Association. form and proposal of a model rule. Professional Psychology: Gold. S. N. (2008). The relevance of trauma to general clinical practice. Research and Natio-. 34(3). 233-239. Psychologkal Thauma Theory Research Practice and Policy. S(1). Tucillo. J. A.. DeFilippis. N. A.. Denney. R. L. & Delaney. J. (2002). 114-124. hupsg/doiorg/10.1037/1942-9681.S.1.114. Liens:use requirements for intajurisdicrional forensic evaluations. Gottlieb. M. C.. & Coleman. A. (2012). Ethical challenges in forensic Professional Psychology: Research and Practice. 33(4). 377-383. psychology practice. In APA handbook ofethics in psychology. Vol van Dijke. A. Ford. J. D.. Frank. L. E.. & van der Hart. 0. (2015). 2: Practice. teaching. andresearch (pp. 91-123). Washington. DC. Association of childhood complex trauma and dissociation with US: American Psychological Association. complex PTSD symptoms in adulthood. Journal of hauma & Greenberg. S. A.. & Shuman. D. W. (1997). Irreconcilable conflict be- Dissociation. 9732(Junc). 150423133122002. hups://doi.org/10. tween therapeutic and forensic roles. Professional Psychology: 108035299732.2015.1016253. Research and Practice. 28.50-57. Widom. C. S.. Czaja. S. J.. & Dutton. M. A. (2008). Childhood victim- Heilbrun. IC. Citisso. T.. & Golds:tit A.M. (2009). Foundations offorauic ization and lifetime revictimiation. Child Abuse & Neglect. 32(8). mentalhod& assessment. Nov York: Oxford University Press. 785-796. hups://doiorg110.10164.chiabu.2007.12.006. Hennan. J. L. (1992). Trauma and recoway. New York: Basic Books. Wolf. E. J.. Miller. M. W.. Kilpatrick. D.. Resnick. H. S.. Badow. C. L.. Hyland. P.. Shevlin. M.. Fyvie. C.. Cloitre. M., & ICarattias. T. (2019). Marx. B. P.. Keane. T. M.. Rosen. R. C.. & Friedman. M. J. (2015). The relationship between ICD-I I PTSD, complex PTSD and disso- ICD- I 1 complex PTSD in US national and veteran samples: ciative experiences. Journal Of Trauma & Dissociation. No Prevalence and structural associations with PTSD. Clinical Pagination Specified-No Pagination Specified. 21.62-72. hups:// Psychological Science: A Journal of the Association for doi.org/10.108035299732.2019.1675113. Psychological Science. 3(2). 215-229. hnps://doi.orgil 0.11771 International Society for the Study ofDissociation. (201l). Guidelines for 2167702614545480. treating dissociative identitydisorderin adults. third revision. Jowled of Trauma & Dissociation. 12(2). 115-187. Kilpatrick. D. G.. Resnick. H. S.. Milani. M. E.. Miller. M. W.. Keyes. Publisher's Note Springer Nature remains neutral with regard to jurisdic- K. M.. & Friedman. M. J. (2013). National estimates ofexposure to tional clan in published maps and institutional affiliations. Springer 3502-027 Page 11 of 11 EFIA_00001648 EFTA00156989