Evaluator empathy in risk assessment interviews.

OBJECTIVE: Should forensic evaluators convey empathy during forensic assessments? Opponents contend that empathy causes harm by leading evaluees to disclose potentially incriminating information, but proponents hold that empathy is crucial for establishing rapport and conveying respect. This study provides a comprehensive examination of experienced forensic evaluators' use of empathy in forensic assessment. HYPOTHESES: The study was exploratory and not hypothesis-driven, but we expected to find identifiable subgroups of evaluators who differed in their use of empathy in the context of a risk assessment interview. We also expected that evaluator subgroups would differ in their attitudes and practices regarding empathy and that higher levels of empathy may be associated with more favorable views of evaluees. METHOD: Experienced forensic evaluators (N = 200) assumed the role of interviewer in a written parole risk assessment interview and chose questions (high or low empathy) they would ask the evaluee if they were conducting the interview. Evaluators also provided ratings of their perceptions of the evaluee and responded to questions regarding their attitudes toward, and use of, empathy in forensic assessment. RESULTS: Latent class analysis results indicated that most evaluators fell into low- (46.0%) or moderate- (43.0%) empathy subgroups, with few falling into a high-empathy subgroup (11.0%). Higher levels of empathy in the interview were associated with attitudes and practices supporting empathy use and higher self-reported understanding of the evaluee, but not with opinions of the evaluee's risk or suitability for parole. CONCLUSIONS: These findings of clear differences in evaluator empathy add to the growing body of research documenting the extent to which forensic evaluators differ in their evaluation styles and tendencies. Although there was support for both very low and very high levels of empathy, support for very high levels of empathy was uncommon. Most evaluators opted for low to moderate empathy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Identifying the Contributions of Maternal Factors and Early Childhood Externalizing Behavior on Adolescent Delinquency.

We examined whether childhood externalizing group subtypes were uniquely related to maternal depression and victimization and whether these subtypes differentially predicted adolescent delinquency. Data were drawn from the Longitudinal Study on Child Abuse and Neglect (LONGSCAN) consortium (N = 1091; 51.3% female, 52.2% African American). Latent class analysis indicated three groups at age 4 (titled "well-adjusted," "hyperactive/oppositional," and "aggressive/rule-breaking"). Caregiver victimization and depression significantly predicted group membership such that aggressive/rule-breaking group had higher levels of maternal depression and victimization although the well-adjusted group had higher levels of maternal victimization relative to the hyperactive/oppositional group. Further, membership in higher externalizing groups at age four is associated with greater risk of adolescent delinquency at age 16. These findings underscore the need to address maternal risk factors in the treatment of childhood disruptive behavior and provide evidence of the continuity of disruptive behaviors from early childhood to adolescence.

Rater experience and the predictive validity of Psychopathy Checklist: Youth Version scores.

We compared the predictive validity of Psychopathy Checklist: Youth Version (PCL:YV) scores assigned by a licensed clinician to scores assigned by a graduate student across a sample of 82 juvenile offenders. Although both raters completed in-depth training and practice scoring cases, the graduate student had no prior clinical experience. The raters showed a high level of agreement in their scoring for 11 reliability check cases (intraclass correlation coefficient, ICCA,1 = .90 for PCL:YV Total score), but the scores assigned by the licensed clinician were better predictors of post-release recidivism (area under the curve, AUC = .77) than those assigned by the graduate student (AUC = .45). There was more variability in the scores assigned by the licensed clinician than those assigned by the graduate student, suggesting that more experienced clinicians' willingness to assign both high and low scores may help explain rater differences in predictive validity.

How does evaluator empathy impact a forensic interview?

We used an experimental design to test the key concern that expressive empathy from evaluators during forensic interviews leads to more disclosure of misbehavior (e.g., stealing, breaking the law, manipulating others) from evaluees. In the context of a psychopathy assessment interview, evaluees (N = 94, 100% male, 57.4% Caucasian) interviewed by an evaluator using expressive empathy techniques were no more likely than those interviewed by an evaluator avoiding expressive empathy techniques to admit to past instances of misbehavior (d = .17, 95% CI [-.24, .57]). Instead, the use of expressive empathy techniques seemed to influence evaluator perceptions of the evaluees. Evaluators using expressive empathy rated evaluees as less psychopathic (d = -.52, 95% CI [-.93, -.11]), more conscientious (d = .72, 95% CI [.30, 1.13]), and as having engaged in less impression management (d = -.54, 95% CI [-.95, -.13]) than evaluators avoiding the use of expressive empathy. Put simply, when evaluators expressed empathy, it influenced the evaluator, not the evaluee. These findings suggest the need to expand professional discourse and research on empathy in forensic evaluations to better understand the possible effects of evaluator empathy on both evaluators and evaluees. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Does the Convergent Validity of the PAI Antisocial Features Scale Depend on Offender Response Style?

Researchers have recently questioned the utility of the response style indicators included on many self-report measures of personality and psychopathology. We examined whether the size of convergent validity coefficients for Personality Assessment Inventory (PAI) Antisocial Features (ANT) scores depends on PAI validity scale scores. Using PAI and Psychopathy Checklist-Revised (PCL-R) scores from 477 offenders evaluated for civil commitment as sexually violent predators, we found that PAI Positive Impression (PIM), Negative Impression (NIM), Malingering Index (MAL), Defensiveness Index (DEF), and Infrequency (INF) scores moderated the association between ANT and PCL-R scores. The association between ANT and PCL-R scores decreased as offenders overstated psychopathology (i.e., higher NIM or MAL scores) or exhibited increasing disengagement (i.e., higher INF scores). However, the association between ANT and PCL-R scores increased as offenders engaged in defensive reporting (i.e., higher PIM or DEF scores). The interaction effects were most common for ANT-E (Egocentricity), and to a lesser extent ANT-A (Antisocial Behaviors). PAI discriminant function validity indexes did not exhibit moderating effects on ANT and PCL-R scores. There was no evidence of validity scale suppression effects. These findings provide support for the potential role of some PAI response style measures for ANT scale interpretation in forensic settings.

Personality Assessment Inventory Scores as Predictors of Evaluation Referrals, Evaluator Opinions, and Commitment Decisions in Sexually Violent Predator Cases.

We used data from more than 1,500 offenders to examine the association between Personality Assessment Inventory (PAI; Morey, 1991 ) scores and progress through the sexually violent predator (SVP) screening, evaluation, and commitment process. There was no clear association between PAI scores and referrals for full evaluations, but PAI scores were small to moderate predictors of evaluator opinions and diagnoses among offenders who underwent full evaluations. Higher Antisocial Features (ANT) scores were associated with diagnoses of antisocial personality disorder, but this association was moderated by offender response style. ANT scores were more strongly associated with antisocial personality disorder diagnoses among those responding defensively (d = .71) than among those responding openly (d = .48). The mean ANT score among defensive responders diagnosed with antisocial personality disorder was about 55T, suggesting that even moderate ANT scale elevations could indicate a clinically significant level of antisocial traits among some offenders.

Psychopathy Checklist-Revised Use and Reporting Practices in Sexually Violent Predator Evaluations.

We surveyed evaluators who conduct sexually violent predator evaluations ( N = 95) regarding the frequency with which they use the Psychopathy Checklist-Revised (PCL-R), their rationale for use, and scoring practices. Findings suggest that evaluators use the PCL-R in sexually violent predator cases because of its perceived versatility, providing information about both mental disorder and risk. Several findings suggested gaps between research and routine practice. For example, relatively few evaluators reported providing the factor and facet scores that may be the strongest predictors of future offending, and many assessed the combination of PCL-R scores and sexual deviance using deviance measures (e.g., paraphilia diagnoses) that have not been examined in available studies. There was evidence of adversarial allegiance in PCL-R score interpretation, as well as a "bias blind spot" in PCL-R and other risk measure (Static-99R) scoring; evaluators tended to acknowledge the possibility of bias in other evaluators but not in themselves. Findings suggest the need for evaluators to carefully consider the extent to which their practices are consistent with emerging research and to be attuned to the possibility that working in adversarial settings may influence their scoring and interpretation practices.

Jurors report that risk measure scores matter in sexually violent predator trials, but that other factors matter more.

After deliberating to a verdict, jurors (N = 462) from 40 sexually violent predator (SVP) trials completed a questionnaire asking them to rate the extent to which risk measure scores, diagnoses, expert witness testimony, and offender characteristics described during the trials influenced their commitment decisions. Jurors reported that offenders' sexual offending history, failure to change, and lack of remorse had the strongest influence on their commitment decisions. They reported that testimony about risk instrument scores (e.g., Static-99) and psychopathy had less influence on their decisions, but those who did report being influenced by instrument results were especially likely to view the offender as being at a high risk for reoffending. Overall, findings suggest that SVP jurors view risk measure results as important, but not as important as other offender, offense, and testimony characteristics, including some that have limited relevance to recidivism risk. Thus, findings also suggest that experts may need to better educate jurors regarding factors that do and do not relate to recidivism risk.

Rater differences in psychopathy measure scoring and predictive validity.

Although field studies reveal that some forensic evaluators tend to assign higher psychopathy measure scores to sexual offenders than others, the extent to which these findings apply to psychopathy measure scoring in other contexts is unclear. And no study has examined the impact of evaluator differences in scoring on predictive validity. We used data from the MacArthur Violence Risk Assessment Study to examine whether there were rater differences in psychopathy measure scoring and predictive effects among trained raters in a rigorous research context. The proportion of variance in Psychopathy Checklist: Screening Version (Hart, Cox, & Hare, 1995) scores attributable to raters was larger for Part 1 (14%) than Part 2 (4%) scores. The association between Facet 4 scores and future violence was stronger among evaluators who assigned higher and more variable Facet 4 scores, but there were no similar effects for other PCL:SV scores. Although there was only limited evidence for an association between PCL:SV scoring tendencies and predictive validity, findings show that mean differences in scoring have implications for score interpretation, with the cut score that indicates a high level of risk being lower when it comes from a rater who assigns relatively low scores compared to a rater who assigns relatively high scores. These findings suggest that evaluators should carefully consider their own psychopathy measure scoring tendencies across cases and the extent to which these tendencies are consistent with the normative sample scores that form the basis of their psychopathy measure score interpretations.

Static-99R reporting practices in sexually violent predator cases: Does norm selection reflect adversarial allegiance?

We surveyed experts (N = 109) who conduct sexually violent predator (SVP) evaluations to obtain information about their Static-99R score reporting and interpretation practices. Although most evaluators reported providing at least 1 normative sample recidivism rate estimate, there were few other areas of consensus. Instead, reporting practices differed depending on the side for which evaluators typically performed evaluations. Defense evaluators were more likely to endorse reporting practices that convey the lowest possible level of risk (e.g., routine sample recidivism rates, 5-year recidivism rates) and the highest level of uncertainty (e.g., confidence intervals, classification accuracy), whereas prosecution evaluators were more likely to endorse practices suggesting the highest possible level of risk (e.g., high risk/need sample recidivism rates, 10-year recidivism rates). Reporting practices from state-agency evaluators tended to be more consistent with those of prosecution evaluators than defense evaluators, although state-agency evaluators were more likely than other evaluators to report that it was at least somewhat difficult to choose an appropriate normative comparison group. Overall, findings provide evidence for adversarial allegiance in Static-99R score reporting and interpretation practices.

Jurors' views on the value and objectivity of mental health experts testifying in sexually violent predator trials.

Although psychologists and psychiatrists often testify in court, we know relatively little about the extent to which jurors value the testimony they hear from these experts. We surveyed 161 jurors who rendered opinions in 14 sex offender civil commitment trials after hearing testimony from psychologists and psychiatrists serving as expert witnesses. Most jurors reported that the experts they heard testify were honest, and they tended to attribute disagreements among experts to case complexity, as opposed to adversarial allegiance or bias. Most reported that hearing from the experts helped them make better decisions and that experts using risk assessment instruments could make more accurate predictions than those who did not. Jurors were, however, more skeptical about the ability of experts to accurately predict recidivism when they heard testimony from both prosecution and defense experts. Findings suggest that jurors value risk assessment testimony from experts, but that experts must think carefully about how to best make risk assessment instrument results accessible to jurors.

Evaluator differences in Psychopathy Checklist-Revised factor and facet scores.

Recent research suggests that the reliability of some measures used in forensic assessments--such as Hare's (2003) Psychopathy Checklist-Revised (PCL-R)--tends to be weaker when applied in the field, as compared with formal research studies. Specifically, some of the score variability in the field is attributable to evaluators themselves, rather than the offenders they evaluate. We studied evaluator differences in PCL-R scoring among 558 offenders (14 evaluators) and found evidence of large evaluator differences in scoring for each PCL-R factor and facet, even after controlling for offenders' self-reported antisocial traits. There was less evidence of evaluator differences when we limited analyses to the 11 evaluators who reported having completed a PCL-R training workshop. Findings provide indirect but positive support for the benefits of PCL-R training, but also suggest that evaluator differences may be evident to some extent in many field settings, even among trained evaluators.

How likely is "likely to reoffend" in sex offender civil commitment trials?

Many sexually violent predator (SVP) laws are ambiguous regarding the degree of reoffense risk that would indicate that an offender is sufficiently "likely to reoffend" to justify civil commitment. We review how SVP statutes operationalize likelihood of reoffending. We then examine what likelihood of recidivism actual SVP jurors considered to indicate that an offender was likely to reoffend. Real jurors (N = 153) from 14 actual SVP hearings completed a questionnaire after deliberating to a verdict. Most jurors (81.7%) considered a 15% estimated chance of recidivism to mean that the respondent was "likely" to reoffend, and many (53.6%) even considered a 1% chance to indicate likely reoffense. Jurors who heard lower risk estimates in trials were more likely to report that a low chance of recidivism (as low as 1%) indicated an offender was likely to reoffend. Results suggest that jurors view risk more in terms of the severity of potential harm than in terms of strict statistical probability. Results also suggest that when laws give jurors discretion to define tolerable risk, jurors consider even a statistically low degree of risk intolerable.

Same score, different message: perceptions of offender risk depend on Static-99R risk communication format.

The popular Static-99R allows evaluators to convey results in terms of risk category (e.g., low, moderate, high), relative risk (compared with other sexual offenders), or normative sample recidivism rate formats (e.g., 30% reoffended in 5 years). But we do not know whether judges and jurors draw similar conclusions about the same Static-99R score when findings are communicated using different formats. Community members reporting for jury duty (N = 211) read a tutorial on the Static-99R and a description of a sexual offender and his crimes. We varied his Static-99R score (1 or 6) and risk communication format (categorical, relative risk, or recidivism rate). Participants rated the high-scoring offender as higher risk than the low-scoring offender in the categorical communication condition, but not in the relative risk or recidivism rate conditions. Moreover, risk ratings of the high-scoring offender were notably higher in the categorical communication condition than the relative risk and recidivism rate conditions. Participants who read about a low Static-99R score tended to report that Static-99R results were unimportant and difficult to understand, especially when risk was communicated using categorical or relative risk formats. Overall, results suggest that laypersons are more receptive to risk results indicating high risk than low risk and more receptive to risk communication messages that provide an interpretative label (e.g., high risk) than those that provide statistical results.

Are forensic experts biased by the side that retained them?

How objective are forensic experts when they are retained by one of the opposing sides in an adversarial legal proceeding? Despite long-standing concerns from within the legal system, little is known about whether experts can provide opinions unbiased by the side that retained them. In this experiment, we paid 108 forensic psychologists and psychiatrists to review the same offender case files, but deceived some to believe that they were consulting for the defense and some to believe that they were consulting for the prosecution. Participants scored each offender on two commonly used, well-researched risk-assessment instruments. Those who believed they were working for the prosecution tended to assign higher risk scores to offenders, whereas those who believed they were working for the defense tended to assign lower risk scores to the same offenders; the effect sizes (d) ranged up to 0.85. The results provide strong evidence of an allegiance effect among some forensic experts in adversarial legal proceedings.

How reliable are forensic evaluations of legal sanity?

When different clinicians evaluate the same criminal defendant's legal sanity, do they reach the same conclusion? Because Hawaii law requires multiple, independent evaluations when questions about legal sanity arise, Hawaii allows for the first contemporary study of the reliability of legal sanity opinions in routine practice in the United States. We examined 483 evaluation reports, addressing 165 criminal defendants, in which up to three forensic psychiatrists or psychologists offered independent opinions on a defendant's legal sanity. Evaluators reached unanimous agreement regarding legal sanity in only 55.1% of cases. Evaluators tended to disagree more often when a defendant was under the influence of drugs or alcohol at the time of the offense. But evaluators tended to agree more often when they agreed about diagnosing a psychotic disorder, or when the defendant had been psychiatrically hospitalized shortly before the offense. In court, judges followed the majority opinion among evaluators in 91% of cases. But when judges disagreed with the majority opinion, they usually did so to find defendants legally sane, rather than insane. Overall, this study indicates that reliability among practicing forensic evaluators addressing legal sanity may be poorer than the field has tended to assume. Although agreement appears more likely in some cases than others, the frequent disagreements suggest a need for improved training and practice.

Are self-report measures of adaptive functioning appropriate for those high in psychopathic traits?

There is ongoing debate about the methods that evaluators should use to assess the adaptive functioning of an individual in an Atkins claim, including the appropriateness of using self-report measures and extent to which adaptive functioning measures are valid for persons with a history of violent offending. This study examined whether offenders' self-report adaptive functioning scores tended to decrease as their level of psychopathic traits increased. Eighty-five male felony probationers completed the self-report version of the Adaptive Behavior Assessment System - II (ABAS-II: Harrison & Oakland, 2003), the Psychopathic Personality Inventory - Revised (PPI-R: Lilienfeld & Widows, 2005), and a brief intelligence screening measure. ABAS-II composite scores were negatively correlated with PPI-R Self-Centered Impulsivity and Coldheartedness scores, but positively correlated with Fearless Dominance scores. These relationships appeared to be due, in part, to over-reporting symptoms of impairment across measures, suggesting that scores on self-report adaptive functioning measures may be especially susceptible to feigning.

Field reliability of competence to stand trial opinions: How often do evaluators agree, and what do judges decide when evaluators disagree?

Despite many studies that examine the reliability of competence to stand trial (CST) evaluations, few shed light on "field reliability," or agreement among forensic evaluators in routine practice. We reviewed 216 cases from Hawaii, which requires three separate evaluations from independent clinicians for each felony defendant referred for CST evaluation. Results revealed moderate agreement. In 71% of initial CST evaluations, all evaluators agreed about a defendant's competence or incompetence (kappa = .65). Agreement was somewhat lower (61%, kappa = .57) in re-evaluations of defendants who were originally found incompetent and sent for restoration services. We also examined the decisions judges made about a defendant's CST. When evaluators disagreed, judges tended to make decisions consistent with the majority opinion. But when judges disagreed with the majority opinion, they more often did so to find a defendant incompetent than competent, suggesting a generally conservative approach. Overall, results reveal moderate agreement among independent evaluators in routine practice. But we discuss the potential for standardized training and methodology to further improve the field reliability of CST evaluations.

When experts disagreed, who was correct? A comparison of PCL-R scores from independent raters and opposing forensic experts.

Researchers recently found that Psychopathy Checklist-Revised (PCL-R; Hare, 2003) scores reported by state experts were much higher than those reported by defense experts in sexually violent predator cases pursued for civil commitment (Murrie, Boccaccini, Johnson, & Janke, 2008), which raised the question of which scores were more accurate. In this study, two independent raters rescored the PCL-R from file review for 44 offenders from that sample who had opposing evaluator scores (allegiance cases) and 44 who had state expert, but not defense expert, scores (comparison cases). The independent raters agreed with one another in their scoring of the allegiance and comparison cases (Intraclass Correlation Coefficient [ICC] ICCA,1 = .95), but they disagreed with both state (ICCA,1 = .29) and defense (ICCA,1 = .14) experts in the allegiance cases. Agreement was stronger between state experts and independent raters for the comparison cases (ICCA,1 = .63), but the independent raters assigned significantly higher PCL-R scores than experts for both the allegiance and comparison cases. These findings suggest that offenders who were selected for rescoring by the defense may have been more difficult to score. Findings also raise questions about the extent to which PCL-R scores based on correctional file review only are comparable to those based on file and interview.

Do PCL-R scores from state or defense experts best predict future misconduct among civilly committed sex offenders?

In a recent study of sex offender civil commitment proceedings, Murrie et al. (Psychol Public Policy Law 15:19-53, 2009) found that state-retained experts consistently assigned higher PCL-R total scores than defense-retained experts for the same offenders (Cohen's d > .83). This finding raises an important question about the validity of these discrepant scores: Which type of score, state or defense evaluator, provides the most useful information about risk? We examined the ability of PCL-R total scores from state and defense evaluators to predict future misconduct among civilly committed sex offenders (N = 38). For comparison, we also examined predictive validity when two state experts evaluated the same offender (N = 32). Agreement between evaluators was low for cases with opposing experts (ICCA,1 = .43 to .52) and for cases with two state experts (ICCA,1 = .40). Nevertheless, scores from state and defense experts demonstrated similar levels of predictive validity (AUC values in the .70 range), although scores from different types of state evaluators (corrections-contracted vs. prosecution-retained) did not. The finding of mean differences between opposing evaluator scores, but similar levels of predictive validity, suggests that scores from opposing experts in SVP cases may need to be interpreted differently depending on who assigned them. Findings have important implications for understanding how rater disagreement may relate to predictive validity.