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When you sue someone, you are called the plaintiff. Your abuser becomes a defendant. First be warned that when you decide to sue your abuser, your experience as a plaintiff may be painful and challenging. As adversaries in a lawsuit, both you and your abuser have certain legal rights. Your attorney has the right to depose your abuser, that is question your abuser under oath. Similarly, the defendant's attorney has the right to depose you under oath to find out anything possible about you to be able to cast doubt on your description of what occurred and on your character. It is your attorney's responsibility to convince the court that your claim is a true account of what happened and that you have been damaged by the actions of the defendant. To do this, your lawyer may call on the services of a forensic expert, usually a psychiatrist or psychologist, to interview you, to carry out a formal evaluation of your mental health, and to describe the damage that has been done to you. The forensic expert is not your doctor or treater, and you are not a "patient." For these purposes, you will be described as a "client." It is the responsibility of the forensic expert to review all of your medical and mental health notes and any other material deemed relevant. It is important to know that, in many places, such records may be accessible to the defense. The forensic expert may also be deposed by the defendant's attorney or called on by your attorney to testify in court. It is a requirement of ethical practice that the forensic expert begin the first interview by telling you what you are agreeing to when you participate in the interview. Here is what I would tell a new "client": "I am Dr. James Beck, and I am a forensic psychiatrist. I am meeting with you because your attorney has hired me to help you with your case against Dr. X. That means I am working for you, not for the other side. I will share with you and your attorney what I learn through our interview. In some places, it is legal for the other side to demand to see my notes and even call me to testify as to what I know. In addition, if I am concerned that you or anyone else is at risk of serious harm, I will do whatever I can to keep everyone safe. It is important for you to know that I am not your physician, and you are not my patient. I am here to do a limited job, that is to evaluate you as part of your lawsuit. I will be taking notes during the interview. Is that all clear?" Occasionally clients may ask a question to clarify my introduction. That is usually enough for me to conclude that the client understands what needs to be understood in order to be interviewed. When occasionally I have questioned whether clients have understood, I have asked them to tell me, in their own words, what I have said. The forensic interview is fundamentally different than a clinical interview in which you are a patient. When you are a patient, the clinician may ask a few questions to get you started, but usually the clinician lets you tell your story at your own rate. Not so here. Here the forensic expert wants information and will ask for it directly. I begin forensic interviews by acknowledging the difficulty for the client and then ask questions that allow me to know more about the client's history going back as far as the client is willing to go. This often includes stories of vulnerability and early emotional abuse that may or may not have included sexual abuse. Events that led the patient into therapy are often difficulties with or failure of important intimate relationships. This failure, in the context of the sense of vulnerability, creates a person at risk of exploitation by an unscrupulous other, in this case the clinician. Telling one's story to a person who is truly listening and who appears to be sympathetic provides some comfort. I go on to ask, "Could you tell me please about what happened that made you decide to sue?" This allows a discussion of what is involved in making a complaint and the people important in the process. In turn, this leads to the discussion of the abusive relationship. You will get to tell your story, but it will be in response to direct questions that will elicit concrete information, much like what a good journalist wants to know: who, where, when, how long, how often and why. Good forensic experts will do their best to be supportive but within the context of looking for answers. The forensic expert wants not only the facts but also what your experiences have meant to you. The careful forensic expert will ask you how this experience has affected you, e.g., whether you have symptoms of a mental disorder; changes in your personal relationships; changes in your ability to function in your social roles, at work or home; changes in your ability to trust your judgments of others; about substance abuse; and so on. Be prepared that such questioning may stir considerable anxiety, guilt, shame and self reproach. Some clients I have evaluated have told me they will never trust anyone in a position of power and authority again. Many are reluctant to begin therapy with someone new. Underlying this are beliefs that they cannot trust their own social sense. They trusted the therapist - and look what they got. Fearing that they are unable to rely on their social judgments, they can become very isolated. If you feel uncomfortable about going for a forensic interview, consider bringing a friend for support. Your friend cannot be present during the actual interview without, as a result, becoming a witness who can then be deposed by the defendant's lawyer; but knowing that you have a good friend in the waiting room who will be with you after the interview can be a great comfort. The written report: After I review the written records and interview the client, I write a report for your attorney. Here is one from a hypothetical client. The examples are all composites.
The Problem and the Database. You referred your client, Ms. C, to me for a forensic psychiatric evaluation. You asked for my opinion if there is evidence that your client was damaged as a result of her experience with Dr. X. Further, is there evidence that the conduct of Dr. X with your client fell below the standard of care. I interviewed your client in my office in Cambridge, Massachusetts for a total of four hours in two interviews on days 1 and day 2, 20XX I began the interview by reviewing the basic ground rules: the relationship of the interview to the legal context; who I am working for; limits on confidentiality including a specific statement on the circumstances under which I will disclose; voluntariness of the client's participation both in whole and as far as answering any particular question. I included a statement that I am not the person's physician but rather am conducting the interview in the context of the specific legal question in order to assist you in representing your client. Lastly I included a statement that I will be taking close to verbatim notes on my laptop during the interview. Opinion: Ms C was badly damaged as a result of her 'treatment by Dr. X. The damage includes but is not limited to symptoms of anxiety and depression described below. She meets criteria for severe major depression and for post traumatic stress disorder. Exacerbation of Crohn's disease is part of the damage. Further, as a result of this experience, her abilities to function at work and as a wife and mother have been severely damaged. The conduct of Dr. X fell far below the professional standard for therapists with his professional training practicing in his community at the time he 'treated' Ms. C. Conclusions: I hold these opinions to a reasonable medical certainty. They are based on my work in this case and on over 35 years' experience as a clinical, teaching, and forensic psychiatrist. In particular, I have served as an expert in over 200 cases involving allegations of psychological harm, as an expert for either plaintiffs or defendants, including more than a dozen cases involving allegations of sexual abuse by a therapist of a client or patient.
A detailed history would be inserted here Observations of Ms. C. Ms. C was on time for the interview. She came accompanied by her long time-friend, Ms. D. Ms. C. is a 42 year old woman who looks her stated age. She was neatly and appropriately dressed for the interview. Her hygiene was good, but her grooming was questionable. She wore heavy eye shadow, and her hair was not well combed. She answered questions appropriately but at times in a halting manner. She spoke in a low voice, and she showed limited emotion, giving the impression that she was attempting to hide how she felt. As the interview progressed, she opened up more. She was appropriately angry as she described her experience with Dr. X, and she cried appropriately as she discussed the changes she has experienced since the 'treatment' Her thought is formally intact. She told her story in a clear, connected narrative, responding appropriately to my questions. I saw no evidence of psychosis. Her insight and judgment were good, and she had a clear understanding that her difficulties had either begun or gotten much worse since her 'treatment' with Dr. X. Discussion. Ms. C. is open in acknowledging that she sought treatment for a depression that had been present for six months. She had been taking Zoloft for three months but thought it had not done much except stifle my sexuality. She had difficulties in her marriage, but she and her husband were able to discuss them. She thought she had been a good mother to Josh, age 12, and Carolyn, age 9. She was doing her job adequately as a copy writer in an advertising firm. Her boss had commended her work on several campaigns. All this changed dramatically after her relationship with Dr. X became sexual. She felt very guilty, and was unable to tell her husband what was troubling her. She began to withdraw from him and increasingly could hardly talk to him at all. Their sexual relationship ended. She was able to provide for the children physically, but emotionally she felt she was hardly present. She had been a good cook, but now she was increasingly relying on frozen dinners, pizza, and take out to feed her family. Her husband had been initially sympathetic, but as her ability to communicate deteriorated, he became increasingly irritable. They had begun to have nasty fights for the first time. She had been a member of a women's group for several years, but she had begun to miss meetings and had to drag herself to go. Her work deteriorated. She had difficulty concentrating and missed several deadlines. Her boss had spoken to her several times about how the quality of her work seemed to have deteriorated. Recently Ms. C had been warned that improvement was necessary. She stopped going to the gym. Her sleep was fragmented: She had difficulty falling asleep due to constantly reviewing what had gone on with Dr. X and to self-reproach about what she had done. She woke often at midnight and often also in the early morning. She had little appetite, did not enjoy what she ate, and had lost 15 pounds. She had recurrent nightmares in which she was trapped in some vague but threatening situation that she was unable to get out of. She would wake up perspiring heavily. Her husband complained that the sheets were "drenched." As noted above, her concentration was poor, and this showed itself also as she failed to give Josh needed help with his homework. She found herself increasingly reluctant to keep appointments with her PCP for her Crohn's disease. She noted increasing abdominal cramping pain and diarrhea. She drove out of her way to avoid taking the street where Dr. X had his office. She denied any thoughts of ending her life but acknowledged that increasingly her life felt like a burden. In summary we have here a classic picture of a woman who had been functioning well prior to her treatment with Dr. X but who now is experiencing a serious depression as well as PTSD. All of this is clearly a direct result of Dr. Xs having taken advantage of her in this unethical, unprofessional way. Thank you very much for the opportunity to evaluate this unfortunate woman. If I can be of any further assistance, please free to call on me. Forensic interviews may take place at any point during the legal action. At the outset, the forensic expert's evaluation may be used to establish the value of the litigation, i.e., how much to ask for as a settlement amount. In my experience, three or four hours of interviews spread over two days is enough time for me to do my job. That said, from conversations with other forensic clinicians and from the review of other forensic reports, I may take more or less time than many forensic experts. Additionally, forensic interviews carried out in preparation for going to court take longer, while such interviews for the purposes of demand letters take less. Finally, beware of the forensic "expert" who demands an exorbitant payment up front rather than working for a carefully documented hourly fee. Every forensic interview, review, and report will have different demand in detail and time required. James C Beck To return to the list of Essays, click here. |
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