The Med-Legal Psych Professor - Cross-Examining Psych Doctors, Tip #101

If you are reading this, chances are that you are an attorney or an insurance professional who has an education, training and experience in those areas.  Further, chances are that you do not have education, training or extensive experience as an expert in psychology or psychiatry.  As such, you are probably relatively inexperienced about the intricacies of psychological diagnoses and psychological or psychiatric treatment, which puts you at a disadvantage when deciding the best route to take when handling psych reports that are not in your favor.  No need to worry any longer.  You can access an array of information that will be useful to you in reading psych reports and cross-examining psych doctors who have produced reports not in your favor.  Simply subscribe to the Med-Legal Psych Professor blog where you will find over 100 tips with information about psych reports and taking a psych doctor’s testimony.

Absence of MCMI-III Scores - Cross-Examining Psych Doctors, Tip #100

     The Millon Clinical Multiaxial Inventory-III (MCMI-III) is the most recent revision of that test.  It contains four scales capable of providing information about the validity of the test-taker’s responses.  The data from the four validity scales assess:  (1) “Validity” - Did the individual understand and attend to the content of the questions? (2) “Debasement” - Did the individual attempt to portray him or herself as having more troublesome emotional and personal difficulties than exist? (3) “Desirability” - Did the individual attempt to portray him or herself as being more morally virtuous, socially attractive and more emotionally well composed than they are? and, (4) “Disclosure” - Was the individual inclined to be frank and self-revealing or more likely to be secretive?  The MCMI-III is similar to the MMPI-2 in that the test can only be interpreted to provide information about the individual’s psychological status if their validity scale scores indicate they completed the test in an honest and straightforward manner.  However, when the doctor’s report lacks the actual MCMI-III scores the reader of their report does not know if the test-taker completed the test in an honest and straightforward manner or attempted to distort their true presentation.  Thus, when you encounter a psych report that is devoid of the patient’s MCMI-III validity scale scores, you should ask the psych doctor on cross-examination if there is anything in their report that would allow the reader of that document to confirm the conclusions they drew from the patient’s MCMI-III.

The MMPI F(P) Scale - Cross-Examining Psych Doctors, Tip #99

     The Minnesota Multiphasic Personality Inventory (MMPI) is the gold standard of psychological test batteries used for medical-legal purposes.  The MMPI-2 is the 1989 revision of the original MMPI that dates back more than 70 years and has many proponents who depend on the test’s validity scales to provide information about the individual’s test-taking attitudes and credibility.  The MMPI-2 is also the most commonly used version of the MMPI by psychologists and psychiatrists.  With regard to the MMPI-2, every validity and clinical scale performance is described with a T-Score.  All T-Scores on the validity scales and the clinical scales on the MMPI-2 have a mean of 50 and a standard deviation of 10. In this regard, it should be noted that it is well known and universally accepted that T-Scores of 65 or larger are clinically significant or interpretable. In this regard, the F(P) Scale is one of the validity scales of the MMPI-2. Scores 65 or higher on the F(P) Scale are characteristic of individuals who are “overreporting psychopathology” and attempting to portray themselves as having symptoms that do not exist. 

The MMPI F(P) Scale - Cross-Examining Psych Doctors, Tip #98

     The Minnesota Multiphasic Personality Inventory (MMPI) is the gold standard of psychological test batteries used for medical-legal purposes.  The MMPI-2 is the 1989 revision of the original MMPI that dates back more than 70 years and has many proponents who depend on the test’s validity scales to provide information about the individual’s test-taking attitudes and credibility.  The MMPI-2 is also the most commonly used version of the MMPI by psychologists and psychiatrists.  With regard to the MMPI-2, every validity and clinical scale performance is described with a T-Score.  All T-Scores on the validity scales and the clinical scales on the MMPI-2 have a mean of 50 and a standard deviation of 10. In this regard, it should be noted that it is well known and universally accepted that T-Scores of 65 or larger are clinically significant or interpretable. In this regard, the F(P) Scale is one of the validity scales of the MMPI-2. Scores 65 or higher on the F(P) Scale are characteristic of individuals who are “overreporting psychopathology” and attempting to portray themselves as having symptoms that do not exist. 

Use of The Oswestry Pain Questionnaire - Cross-Examining Psych Doctors, Tip #98

     The Oswestry Pain Questionnaire (OPQ) is a 10-item questionnaire that asks an individual to describe their behavior on ten different variables:  Pain Intensity, Personal Care, Lifting, Walking, Sitting, Standing, Sleeping, Sex Life, Social Life, and Traveling.  In each of the above noted areas, the test-taker is asked to choose one of the following categories for themselves:  “I can tolerate the pain I have without having to use pain killers,” “the pain is bad but I manage without taking pain killers,” “pain killers give complete relief from pain,” “pain killers give very little relief from pain,” and “pain killers have no effect on the pain and I do not use them.”  Clearly, the OPQ is a self-report questionnaire that has no validity scales for assessing the individual’s test-taking attitudes or credibility, rendering it useless in a medical-legal context.   

Neuropsychological Medical-Legal Evaluations - Cross-Examining Psych Doctors, Tip #97

Neuropsychology is both an academic discipline and one of the applied medical arts, often called clinical neuropsychology.  Neuropsychologists are psychologists who have taken postdoctoral training in the area of neuropsychology.  In the forensic cases they are typically given referrals by neurologists who depend on their psychological testing to assess neurological decrements not revealed by the neurologist’s tools.  While neuropsychological testing can provide the neurologist with valuable information about a patient’s neurological condition, to use those testing results to support the conclusion of a “neuropsychological injury” is to open the door to a double recovery for a single neurological injury. 

Read the Apricot™ and Apply the Advice - Cross-Examining Psych Doctors, Tip #96

     I’ve been writing Apricots for about eight years.  Apricots™ are work-product privileged reports designed to help attorneys cross-examine mental health professionals such as forensic psychologists, forensic psychiatrists, psychotherapists, social workers etc.  An Apricot™ describes all of the substantial flaws in a psych report in jargon-free, non-technical language. An Apricot™ also provides a list of questions and techniques that will help get those flaws on the record despite what might be the doctor’s evasive or non-co-operative behavior.  In this regard, any attorney who has commissioned an Apricot™ is strongly urged to read it’s complete contents and to apply the advice I’ve given in the Apricot™ for the best possible outcomes with the case.  I intentionally put strong emphasis on reading the contents and apply the advice.  For instance, you’ll find in the contents of my Apricots™ the recommendation that you focus your questioning on the weakest part of the doctor’s report, which is their diagnosis.  If you don’t take this advice and pursue a different line of questioning on cross-examination you’ve wasted the your client’s money that paid for the Apricot™!

Deviating from DSM Terminology - Cross-Examining Psych Doctors, Tip #95

     The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a variety of mental disorders with a wide variation of modifiers or specifiers that may be applied to the specific disorder diagnosed.  In addition to modifiers and specifiers, diagnostic codes are also required in association with the diagnosis.  According to page 1 of the DSM-IV-TR and page 23 of the DSM-5, diagnostic codes are essential for increased specificity in identifying the intended diagnosis.  Unfortunately, some psych doctors choose to deviate from DSM terminology and create their own diagnosis by adding modifiers or specifiers that are not outlined or permitted by the DSM.  Further, for some unknown reason, some psych doctors decline to provide a diagnostic code or, even worse, provide diagnostic codes that do not match their verbal diagnosis which results in a situation where their diagnosis is ambiguous.  In situations where the doctor has created diagnostic uncertainty, during their deposition you should ask the doctor where in their report they provided the information about their diagnosis as required by the DSM.