Purpose of this blog

This blog helps you understand something about the world of forensic psychiatry. This area of medicine combines knowledge of the legal system with psychiatric training. Examples include evaluating child custody disputes, assessing allegations of sexual abuse, evaluating children and adults charged with crimes, serving as an expert witness in civil suits, evaluating medical malpractice cases - to name a few.

While I cannot help you with advice concerning a particular case unless I am retained, we can discuss many topics here, and even generate some controversy. Welcome!

Comments

[Dr Stephen E. Doyne]

It's been a few years since this blog was established, but I hope it's not too late to thank you for creating it. As is obvious from some of the comments, forensic psychology is poorly understood by many. Hopefully, blogs like this can help clear up some of the confusion.

[Stephen Herman, M.D.]

Good question. The forensic psychiatrist uses
his/her training, knowledge and experience with families in crisis to
make an assessment of the family and provide recommendations to the
court. Can the psychiatrist be fooled? Yes, but not as much as you
think. When I began this work over 25 years ago, I saw each parent only
3 times. Now, I see each parent about 8 times. Over that period - which
usually lasts about 2 or 3 months - I get to know the parent pretty
well. There are also collateral sources: therapists, teachers, doctors,
etc. who provide further information. If there is an allegation that a
parent uses drugs and that parent refuses, I will spring a test on
the person and insist on an immediate test. So, there are ways to
uncover pertinent information. The key, I believe, is to spend enough
time with the family to get to know everyone.

[SB in NY]

I am confused about this area of forensic psychiatry. If two parents are fighting for custody and hire a forensic psychiatrist, that psychiatrist makes a recommendation. If one parent's actions clearly put into question her mental stability, but she interviews well and can easily manipulate various situations, how can you be assured to have a fair decision?

[family therapy]

I recently came across your blog and have been reading about family therapy. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

[child custody agreement]

I recently came across your blog and have been reading about child custody agreement. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

[Stephen P. Herman, M.D.]

In Illinois, a 604(b) evaluation is a court-ordered custody study. This should be done by a mental health professional well-versed in child psychology/psychiatry and who knows the proper way to undertake such an evaluation. The person is neutral and sees everyone in the family and . All of the professionals you mentioned may not have been appointed by the court to conduct such a comprehensive project. I emphasize that the person doing this study must be highly qualified. There are certain procedures to be followed when doing such an evaluation. Most mental health professionals have not been trained in this area.

[Janet Barry]

Dear Dr. Herman:
With all of your recent exposure, I hope you still have time to read this. I have been struggling with a 2 1/2 year divorce from an emotionally and physically (to children only) abusive husband. No matter how many professionals (6 to be exact - Guardian ad Litum, DCFS, LCSW, Court appointed intervener and police detectives), the courts still will not remove the children from my ex-husband until they get a 604(b) evaluation.

I am having a hard time understanding what this evaluation will entail and what it will determine. Do you have any resources I can research to understand what is going to happen?

I would so much appreciate any help you could give me.

Sincerely,
Janet in Chicago

[Stephen P. Herman, M.D.]

Today, January 22, 2008, an internist called me because she wanted some guidance regarding her friend's custody dispute. The friend is undergoing an evaluation, along with her husband and the children. The internist wanted to know how she could help her friend. I told her to be supportive but STAY OUT OF THE CUSTODY BATTLE. The doctor did not know much about custody disputes. She wanted to be there for her friend - maybe write an affidavit of support, etc.

I told the doctor that her comments about her friend would not be given much weight by the court. A friend is a friend. When I evaluate custody disputes, I do not seek out friends, college roommates, etc. because I know they cannot be objective. Besides, the doctor could get sucked into the legalities of the matter, much to her chagrin.

Most people are naive about how custody evaluations work. Most doctors do not understand either - even psychiatrists not trained in forensics. That's ok, but the smart person knows what she doesn't know. What do you think?

[Stephen P. Herman, M.D.]

Dear Ms Cardi:
Thanks for your comments.In no other field of child psychiatry do people have opinions or conclusions not based upon fact but upon their own personal feelings - as they do regarding child custody disputes. And this goes for judges, too! Unfortunately, even the literature is often not very helpful, because every family operates by a different set of dynamics, and the researchers' data might be skewed depending on the population they studied.

I completely agree with you that joint custody can work even if a parent - at least initially - is against it. There ought not be a knee-jerk reaction that says, well, this parent says no joint custody so that's the end of the discussion.

The literature does show that J.C. works best when parents have similar moral/ethical values, when they are able to tolerate (at least to some extent) their differing parenting styles, and when neither parent suffers from a serious psychiatric and/or substance abuse problem.

What would make for a better prognosis for the family that you described would be for them to agree on an ongoing mental health professional who can meet with them as needed to help them work out disagreements when they occur. Sometimes this is called a parenting coordinator (buzz word for today!), but the point is that over time, an experienced professional can help and reduce the likelihood that an agreement will fall apart.

There is an article in Family Process, 2007 March (79-91) that discusses how family therapy can help in high conflict divorces involving children. Emery, et al, have written much over the years on joint custody and they have an article in the Journal of Consulting and Cinical Psychology 2001 April (323-32) that suggests early mediation (and that word can be open to different interpretations) can result in a better outcome - at least after 12 years. Simons, in a study of high-conflict divorces suggests that mental health intervention can make a positive impact. That article is in the Bulltein of the Am. Acad. of Psychiatry and the Law 1990 18(1) 85-97.

And, yes, being able to email each other can help. I think that can help reduce tensions between parents.

[Dawn Cardi]

I am interested in whether there is any evidenced based studies of the impact various types of parenting time arrangements have on children.

So much of what the judges, law guardians, and attorney's decide has no real basis in fact, but is anecdotal or their personal opinions. For example, the general claim is that if two people are not speaking they cannot have joint custody. I did a very contentious case which settled with one week with each parent, joint decision-making and only e-mail contact and it is working beautifully.

I would like to read any studies which exist in the literature. Please post