The association between clinicians' initial judgments of feigning and outcomes on symptom validity measures among pretrial forensic psychiatric inpatients.

Research suggests the use of validated symptom validity tests to detect feigning is imperative to increase accuracy over unaided clinical judgment, especially in forensic settings. This study examined performance on the Miller Forensic Assessment of Symptoms (M-FAST) and Structured Interview of Reported Symptoms (SIRS) during 297 assessments of forensic inpatients. The risk of being identified as feigning on the M-FAST or SIRS was similar for those who were referred for evaluation of feigning compared to those who were not, but individuals with malingering designations prior to the evaluation scored significantly higher than those without on the M-FAST and several SIRS subscales. Findings support the importance of utilizing objective methods of data collection.

Therapeutic alliance and treatment outcome in the outpatient treatment of urban adolescents: The role of callous-unemotional traits.

Callous-unemotional (CU) traits designate a unique subset of youth with externalizing psychopathology who have a severe pattern of aggressive behavior and tend to have worse outcomes in treatment. However, little research has addressed how CU traits relate to different components of psychotherapy, such as the therapeutic alliance. The current study examined the role of CU traits in predicting therapeutic alliance in 59 adolescents (M age = 15.3, 51% female, 64% Hispanic American, 15% African American) who were part of a larger randomized naturalistic trial of outpatient behavioral psychotherapy. Multilevel regression analysis further investigated the role of therapeutic alliance in predicting treatment outcome (as measured by self-reported delinquency) and the moderating role of CU traits. Results suggested that regardless of the severity of their externalizing problems, youth with higher levels of CU traits reported more positive ratings of therapeutic alliance. In addition, a positive therapeutic alliance predicted reductions in delinquent behavior, and this association was even stronger for youth higher in CU traits. Our results suggest that CU traits are related to improvement in the formation of the therapeutic alliance among youth with externalizing psychopathology, perhaps because these youth lack many of the social and emotional deficits that other youth with conduct problems possess. Adolescents high in CU traits should not be viewed as untreatable. Indeed, the therapeutic alliance may be an important mechanism for affecting meaningful change in these adolescents' lives. (PsycINFO Database Record