The child as a witness

The increasing participation of children in judicial proceedings raises two central issues: the competency of the child as a witness and the effects on the child of testifying about a traumatic experience. After discussing these issues, the authors present the recommendations of forensic child psychiatrists on how to improve the judicial process to elicit more accurate testimony from child witnesses--for example, by videotaping a child's testimony to avoid repeated interrogations, using anatomically correct dolls and pictures to allow the child to recount events through displacement, and using one skilled interviewer throughout the proceeding to allow rapport to develop between interviewer and child. They then discuss the role of the child psychiatrist in court proceedings involving child witnesses.     

Neurologist as expert witness.

Prevailing liberal rules of evidence permit qualified medical and scientific experts to offer opinions designed to help courts decide issues to which their expertise relates. The opinions can be based on direct examinations, review of data assembled by others and data or inferences of a type relied on by other experts in the field. Application of these rules is illustrated through analysis of expert testimony in litigation involving a neurologic syndrome allegedly caused by an immunization and in a case involving controversy over the extent and outcome of major brain injury. Concerns about misuse of expert medical and scientific testimony in litigation are addressed. The article closes with a consideration of approaches designed to improve the reliability of expert testimony.     

The psychiatrist as expert witness

This article discusses the two different types of legal situations involving participation by psychiatrists--clinical testimony and forensic expert testimony--and presents guidelines and ethical considerations for the psychiatrist participating in the criminal justice system.     

The therapist as representative payee

The effects of the therapist's assuming control of the patient's finances through representative payeeship is discussed. The authors use case examples from an urban outpatient community mental health center to illustrate administrative issues, ethical conflicts, and transference and countertransference manifestations of payeeship. They favor an approach whereby the institution is formally the payee and a clinician is designated to manage a patient's account. For most patients for whom a clinician assumed payeeship, compliance with treatment increased, the number and length of hospitalizations decreased, and housing arrangements improved. Although designating the therapist as payee has a significant impact on the therapeutic relationship, in most cases the patient is so impaired that the benefits outweight the liabilities.     

Psychotherapy as civics: the patient therapist as citizens

The field of psychotherapy has failed to live up to its promise to be a force in the continued development of democracy by aligning itself with medicine and psychiatry. Psychotherapists must recognize that those with whom they work and disseminate information to are inevitably citizens and that they are redefining citizens as mental patients. By utilizing psychiatric diagnoses, which are in effect, moral labels, psychotherapy unwittingly helps create authoritarian political structures by convincing their patients and the public that they are essentially inferior and can do nothing to change that condition. A series of recommendations are made that suggest ways for psychotherapy to free itself from institutional psychiatry and medicine and build its own "house."     

Peer with intellectual disabilities as a mindfulness-based anger and aggression management therapist

A young man with intellectual disabilities (ID) and mental illness, who had previously been taught to successfully manage his aggressive behavior by using Meditation on the Soles of the Feet, reported that he shared his mindfulness practice with his peers with ID. When requested by his peers, and without any training as a therapist, he began to teach this procedure to his peers for controlling their anger and aggressive behavior. We tracked the anger and aggressive behavior of three of the individuals he taught and the fidelity of his teaching of the procedure. According to self and staff reports, anger and aggressive behavior of the three individuals decreased to very low levels within five months of initiating training and remained at very low levels for the two years during which informal data were collected. The fidelity of his teaching the procedure was high, if one allows for his idiosyncratic teaching methods. These findings suggest that individuals with mild ID, who have mastered an effective mindfulness-based strategy to control their aggressive behavior, may be able to teach their peers the same strategy to successfully control their anger and aggressive behavior to a level that is acceptable for community living.     

The chief resident as reluctant staff therapist.

The author discusses the interactional process between the chief resident and ward staff, with reference to Bion's theory of group functioning. He concludes that the primary task of the chief resident is to serve as psychotherapist to the staff, and that this in not a chosen role but derives from the staff's wish for such a leader.     

The child victim as witness in sexual abuse proceedings

The psychiatrist working with a child witness in a sexual abuse case is at an intrinsic disadvantage. Most of the activities take place in a legal system where the psychiatrist may feel like a stranger in a strange land. Further, a major area of concern to the courts is cognitive development and memory, which unlike phenomenology, dynamics, and therapeutics, are somewhat remote from the psychiatrist's core expertise. It is not surprising, then, that the stress associated with the role of child advocate or expert witness often produces anxiety for the psychiatrist or may result in a frank avoidance of forensic tasks. This paper is intended to militate against such a reaction by familiarizing the psychiatrist with the salient issues of the sexually abused child as a witness.