Power imbalances in therapeutic and forensic relationships

Abstract

This article examines the ways that power imbalances affect relationships in the forensic mental disability system and between therapists and their clients. It considers the impact o f the "dual loyalty" dilemma on forensic relationships, the manner in which courts deal with this dilemma, and suggests several points of commonality that arise around such power conflicts. It also examines recent litigation involving therapeutic relationships, and attempts to extract doctrinal threads from these cases. Finally, it recommends that, in order for the judicial system to attempt to correct any of the underlying imbalances, courts and jurors must openly come to grips with the psychodynamic issues that underlie these imbalances.

Character Motivations in the Representation of Mental Health Professionals in Popular Film

“…The importance of power can be seen symbolically in certain forms of psychoanalysis in which the analyst self-consciously assumes an authoritative role (Shapiro, 2000) and can be seen legally in the powers granted to directors of mental health facilities. Viewing power-mad MHPCs as entirely unrealistic may not be prudent, as the most common areas of litigation in treatment settings are all related to violations of power (Perlin, 1996). This reality is why some authors (Aveline, 1996) have suggested 92 YOUNG, BOESTER, WHITT, AND STEVENS that therapists-in-training be explicitly taught about power issues in order to better recognize and correct potential abuses.…”

“Where the home in the valley meets the damp dirty prison”: A human rights perspective on therapeutic jurisprudence and the role of forensic psychologists in correctional settings

“…The forensic relationship is not an equal one; the power lies with the psychologist. In corrections, absolute confidentiality does not exist with opportunities for the psychologist to inappropriately disclose offender information or for the psychologist to be obliged to disclose information for community protection (Perlin, 1991b). Q: Do you warn your client of the limits to confidentiality, in writing, when you establish the therapeutic relationship?…”

“…As will be demonstrated, these dual roles become anti-therapeutic in coercive environments if community rights trump offender rights. The dual role experienced by forensic psychologists provides a power imbalance exploitable for unethical purposes such as: failing to represent multiple interests and weigh community, social, and political values (i.e., a normative judgment that community rights outweigh offender rights); causing harm to the offender (an extreme case being assessing competence for execution); applying empathy skills to elicit information the offender may not wish to disclose; and avoiding legal protections regarding justice and fairness (see Perlin, 1991b). From a human rights perspective, duty-bearers are obliged to actively meet, or to at least not actively restrain, the human rights of rights-holders such as offenders (Ward & Birgden, 2007).…”

Be Afraid, Be Very Afraid: A Note of Contrition to Court Report Writers and Requestors

“…Autonomy is further respected and non-maleficence promoted if the health assessor is vigilant about ensuring that the focus of the report remains on the question or questions that the court have specified in the ordering of the report (Evans, 2005). In reality, however, defendants (many of them with extensive mental health difficulties and experience of marginalization and stigmatization) may either lack full comprehension of the process or lack the ability to assert their voice in a courtroom (Livingston, Rossiter, & Verdun-Jones, 2011;Perlin, 1991).…”

“…Does the health assessor, being an agent of the court, divulge all information obtained in its entirety to the court, knowing that some of it could incriminate the defendant? The fact that doctors and psychologists writing reports utilize skills originally developed for helping people, and are thus skilled at extracting information from the mentally ill, belligerent and taciturn, adds to the complexity of this ethical dilemma (Perlin, 1991).…”