Attorneys' Attitudes Toward Coaching Forensic Clients on the MMPI-2: Replication and Extension of Attorney Survey by Wetter and Corrigan (1995).

In this study we replicated and extended Wetter and Corrigan's (1995) commonly cited convenience survey of attorneys and law students regarding their attitudes toward coaching litigants prior to forensic psychological testing. We conducted a target survey of attorneys practicing in specialty areas of law where it is common to enlist psychological testing as part of legal proceedings (family law, juvenile law, personal injury, criminal law, social security/disability, workman's compensation). The estimated prevalence of attorneys who endorse providing their clients with information about the presence of MMPI-2 validity scales is 53%, with a 95% confidence interval of ±7%. Compared with Wetter and Corrigan's results of 63%, this represents a slightly lower estimate of attorneys who indicate a positive attitude toward coaching their clients on the presence and purpose of validity scales. More than 70% of attorneys, in both surveys, believe they should provide general advice and preparation for psychological testing to their clients. Survey results were further analyzed as a function of attorney age, years in practice, and specialty area. Implications are discussed in relation to future research and the practice of forensic psychological evaluations.

What Does "Couple" Mean in Couple Therapy Outcome Research? A Systematic Review of the Implicit and Explicit, Inclusion and Exclusion of Gender and Sexual Minority Individuals and Identities.

This study systematically reviewed extant couple therapy outcome studies (k = 111) through December 2018 to evaluate for implicit or explicit, inclusion or exclusion of gender and/or sexual minority individuals and identities. We evaluated sampling, participant demographic reporting, and language used in each manuscript for any reference or consideration given to participants' sexual and/or gender identity. Results indicate that couples have been historically presumed to be heterosexual and cisgender male or female without reported assessment. More recent inclusion and consideration of sexual minority individuals is limited and absent for nonmonosexual and gender minority individuals. These findings are contextualized in supplementary analyses of other sociocultural characteristics (e.g., race, age, length together). Suggestions are provided for affirmative consideration of the plurality of individuals' sexual and gender identities. Implications are discussed for research, training and practice of couple therapy with sexual and/or gender minority couples.

Detecting Feigning in Adolescents on the Personality Assessment Inventory-Adolescent Form.

Much of the research on identifying feigning in psychological assessment has focused on adults with less attention to adolescents. The purpose of the present study is to expand the limited literature on detecting feigning in adolescents using the Personality Assessment Inventory - Adolescent. The study included 114 nonclinical adolescents (ages 15 to 18) recruited from high schools in the Midwest who were randomly assigned to experimental groups: honest nonclinical, uncoached feigning, and coached feigning. 50 randomly selected individuals with depression from the PAI-A clinical standardization sample were included as the honest clinical group. Sample demographics included a mean age of 16.64 years; 51.2% young men, 48.2% young women; 85.4% Caucasian, 6.7% African American, 5.5% Hispanic, and 2.4% Asian. 80% of feigning profiles reported clinical levels of depression. MANOVA results showed strong support for the Rogers Discriminant Function (RDF; d range = 1.85-2.05). The Negative Impression Management (NIM) scale also demonstrated promise (d range = 0.77-1.08), while the smallest effects for detecting feigning were found for the Malingering Index (d range = 0.58-0.70). The negative distortion indices showed good utility in differentiating between groups. Cut-scores and pragmatic implications are presented.

Psychological masquerade embedded in a cluster of related clinical errors: Real practice, real solutions, and their scientific underpinnings.

In this paper, we discuss the need for medical rule outs in over 50% of DSM­5 diagnoses and the risk for mental health practitioners to engage in a clinical judgment error called psychological masquerade (Taylor, 2007). We use the specific example of thyroid dysfunction as a relevant rule out when a client presents with symptoms consistent with an affective disorder. A real clinical example is provided and discussed to illustrate how the first author invoked psychological masquerade resulting in clinical decision-making errors during the treatment of a mother participating in family therapy. Solutions for this specific case and more generally for psychological masquerade are provided and discussed in the context of theory and research on mental health clinical decision-making.

Microaggressions: Clinical errors with sexual minority clients.

Sexual minority (SM) individuals live in a heterosexist society that denigrates their sexual orientation identity. The stigma and prejudice they regularly encounter is hypothesized to lead to their significantly increased risk for developing mental health disorders. Because of these factors, therapists should be diligent to create an affirming and supportive therapeutic environment but this is often not the case. SM clients frequently report experiencing sexual orientation microaggressions in therapy, such as heteronormative statements, a disregard for their sexual orientation identity, and an assumption that their presenting issues are rooted in their sexual orientation identity. These microaggressions should be viewed as bias manifested as clinical errors because of how they weaken therapeutic alliance, decrease the effectiveness of treatment, decrease utilization intent, and cultivate feelings of shame, anger, and misunderstanding. This article provides empirically supported findings regarding common SM clinical errors and microaggressions, a clinical example of such biases with corrective examples along with the author's personal reactions, and more general strategies for avoiding microaggressive errors with SM clients. Implications for practice, training, and research are discussed. (PsycINFO Database Record

Clinical errors and therapist discomfort with client disclosure of troublesome pornography use: Implications for clinical practice and error reduction.

Mental health professionals are increasingly aware of the need for competence in the treatment of clients with pornography-related concerns. However, while researchers have recently sought to explore efficacious treatments for pornography-related concerns, few explorations of potential clinical judgment issues have occurred. Due to the sensitive, and at times uncomfortable, nature of client disclosures of sexual concerns within therapy, therapists are required to manage their own discomfort while retaining fidelity to treatment. The present paper explores clinician examples of judgment errors that may result from feelings of discomfort, and specifically from client use of pornography. Issues of potential bias, bias management techniques, and therapeutic implications are discussed. (PsycINFO Database Record

A meta-analysis of confidence and judgment accuracy in clinical decision making.

The overconfidence bias occurs when clinicians overestimate the accuracy of their clinical judgments. This bias is thought to be robust leading to an almost universal recommendation by clinical judgment scholars for clinicians to temper their confidence in clinical decision making. An extension of the Meta-Analysis of Clinical Judgment (Spengler et al., 2009) project, the authors synthesized over 40 years of research from 36 studies, from 1970 to 2011, in which the confidence ratings of 1,485 clinicians were assessed in relation to the accuracy of their judgments about mental health (e.g., diagnostic decision making, violence risk assessment, prediction of treatment failure) or psychological issues (e.g., personality assessment). Using a random effects model a small but statistically significant effect (r = .15; CI = .06, .24) was found showing that confidence is better calibrated with accuracy than previously assumed. Approximately 50% of the total variance between studies was due to heterogeneity and not to chance. Mixed effects and meta-regression moderator analyses revealed that confidence is calibrated with accuracy least when there are repeated judgments, and more when there are higher base rate problems, when decisions are made with written materials, and for earlier published studies. Sensitivity analyses indicate a bias toward publishing smaller sample studies with smaller or negative confidence-accuracy effects. Implications for clinical judgment research and for counseling psychology training and practice are discussed.

A comprehensive meta-reanalysis of the robustness of the experience-accuracy effect in clinical judgment.

Experience is one of the most commonly studied variables in clinical judgment research. In a meta-analysis of research from 1970 to 1996 of judgments made by 4,607 participants from 74 studies, Spengler, White, Ægisdóttir, Maugherman, Anderson, et al. (2009) found an experience-accuracy fixed effect of d = .121 (95% CI [.06, .18]), indicating that with more experience, counseling and other psychologists obtain only modest gains in decision-making accuracy. We sought to conduct a more rigorous assessment of the experience-accuracy effect by synthesizing 40 years of research from 1970 to 2010, assessing the same and additional moderators, including subgroup analyses of extremes of experience, and conducting a sensitivity analysis. The judgments formed by 11,584 clinicians from 113 studies resulted in a random effects d of .146 (95% CI [.08, .21]), reflecting the robustness of only a small impact of experience on decision-making accuracy. The sensitivity analysis revealed that the effect is consistent across analysis and methodological considerations. Mixed effects metaregression revealed no statistically significant relation between 40 years of time and the experience-accuracy effect. A cumulative meta-analysis indicated that the experience-accuracy effect stabilized in the literature in the year 1999, after the accumulation of 82 studies, with no appreciable change since. We assessed a broader range of experience comparing no experience to some experience and comparing nonexperts with experts, and for differences as a function of decision making based on psychological tests; however, these and most other moderators were not significant. Implications are discussed for clinical decision-making research, training, and practice.

Introduction: Reprioritizing the role of science in a realistic version of the scientist-practitioner model.

This series of articles attempts to redefine and reprioritize the role of science in search for a clinically meaningful and realistic version of the scientist-practitioner (S-P) model. To this end, science is discussed as both research-driven practice and clinically meaningful research, keeping practitioners and their needs in the center of attention. In this process, common problems in the actualization of the S-P model are discussed, and potential solutions are offered.

How psychotherapy integration can complement the scientist-practitioner model.

This article aims to integrate the two separate bodies of literature in Psychotherapy Integration (PI) and the Scientist-Practitioner (S-P) model. Based on an examination and synthesis of the main ideas from the two fields, it illustrates that, although developed separately, these movements are compatible and they complement each other. After describing the historical, empirical, and conceptual relationship of the two movements, the implications of this relationship for psychotherapy are outlined and recommendations are offered. PI is conceptualized as a key ingredient in the optimal expression of the S-P model, which can address several difficulties in the actualization of the model.