Running head: COMPREHENSIVE EXAM

Psychological Theory and Practice

What assessments could be used to evaluate Ryan?

There are numerous assessments may be used to evaluate Ryan.  The most commonly used assessments to assess the client’s general health and mental status are the Mental Status Exam (MSE), the Minnesota Multiphasic Personality Inventory – 2 (MMPI-2), and the Wechsler Adult Intelligence Scale—Revised (WAIS–R).  With Ryan being accused of violence against his ex-husband the Violence Risk Appraisal Guide (VRAG) would assist his risk of continued violence.  Ryan has admitted to dependency upon alcohol the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) would be used to evaluate his dependency on alcohol.  Ryan has had suicidal thoughts the Scale for Suicide Ideation (SSI) should be used to assesses his risk of suicide.  Because Ryan has been accused of sexually inappropriate interactions with his 16-year-old son the Static-99/99R or STATIC 2002 should be administrated to determine the risk of him offending sexually against his son.  Each of these assessments assists in diagnosing and treating Ryan (Borum & Grisso, 1995).

The MSE combines qualitative observations and standardized assessments to give an overall impression of the client’s mental status at the time of the review as well as previous mental status at the time of the crime.  Prior to the evaluation, the examiner should develop a series of questions based upon the file review.  These questions should be designed to garner responses and assist in determining the truthfulness of those answers.  The examiner providing the assessment looks the behavior of the individual, their grooming, presentations, to determine if there is any mental disorder present the time of the crime or at the current time.  At the beginning of the examination, the examiner notes if the individual is attentive or inattentive, well-groomed or not and if they seem willing to participate in the examination.  As the examinations proceed the examiner will note is the individual is continuing to be complacent in the participation of the examination and if there are any emotional responses either positive or negative.  During the evaluation, the examiner notes the questions asked and possible follow-up questions to enable the examiner to gain a full overview of the individual being examined.  After the examination, the examiner writes up a report.  That report includes details of the crime or event that lead up to the examination, the facts from the file review, the results of the examination, and the examiner’s options of the individual’s mental health at the time of the events and at present day (Sawicki, 2013).

The MMPI – 2 is a personality measurement tool that is widely used to evaluate an individual’s mental health and personality to make recommendations to the courts.  This is a scored assessment and used the individual’s answers, their history, and background to assist in scoring.  There are nine scales where the individual answers a series questions as true or false.  The first scale is the Hypochondriasis (Hs) which focused on non-specific physical symptoms.  This scale looks at an individual’s fear or the belief that an individual has a certain illness rather than an actual illness.  The second scale is Depression (D) which looks at depressive symptoms.  These can include a feeling of hopelessness, sleeplessness, apathy for life and other symptoms.  The third scale is Hysteria (Hy) is divided into two sections.  Section one looks at symptoms in the head arms and legs.  Sections two looks attitudes towards one’s self and others.  The fourth scale is Psychopathic Deviate (Pd) looks at an individual’s overall negative behaviors.  The behaviors looked at include relationships with family, friends, authority figures, and social interactions or lack thereof.  The fifth scale is Masculinity–Femininity (Mf) which looks at areas of interest and if they are stereotypically male or female interests.  The sixth scale is Paranoia (Pa) looks at the paranoia thought process as well as other items such as if someone believes the world is out to get them.  The seventh scale is Psychasthenia (Pt) and looks at the individual’s lack of ability to control their actions, abnormal fears, guilty feelings and other negative irrational feelings.  The eighth scale is Schizophrenia (Sc) which looks at the individuals thought processes, interactions, and difficulties with family and sexual relations.  The last scale is Social Introversion (Si) and looks at if the individual is a social introvert (Butcher, Hass, Greene & Nelson, 2015).

The WAIS–R is an intelligence test and includes three sections verbal, performance and full-scale with half of the scale being verbal and the other half being non-verbal.  The test questions can be multiple choice, true-false, or some other items that can be scored as correct or incorrect.  The examiner should be aware of items that can affect the results of the test such as individuals with test anxiety or other anxiety issues, individuals with ADHD, individuals with learning or behavioral issues and /or reading problems (Kaufman & Harrison, 2013).

The VRAG determines an individual’s risk of reoffending in a violent nature.  This assessment is actuarial in nature and looks the probability that one individual that has a similar crime to others with known outcomes risk or re-offending.  Part of the risk assessment tool contains a victim predictor that looks at prior convictions, violent behaviors and the severity of that behavior to determine the risk that those behaviors will continue in the future (Hilton, Harris, & Rice, 2010).

The ASSIST is a screening tool developed by the World Health Organization (WHO) to determine alcohol and substance related issues.  The assessment tool contains 8 questions designed to be culturally neutral and screens for issues with tobacco products, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives and sleeping pills, hallucinogens, inhalants, opioids and other drugs.  The questions cover what substances the individuals have used other their lifetime, the frequency of the use, the desire to use the substance, any health, social legal or financial issues due to use, if the individual has ever tired or have stopped use for a length of time and has the use caused a hardship in their personal lives (WHO ASSIST Working Group, 2002).  The SSI is a tool designed to determine an individual’ s active or passive suicidal desires and if they have an active plan for suicide.  This will help clinicians to develop a plan to hopefully deter a suicidal and help with suicidal thoughts (Beck, Kovacs, & Weissman, 1979).

The Static-99/99R and STATIC 2002 is an assessment tool designed to determine the risk of an individual committing a sexual offense.  The assessment used information such as has the individual been incarcerated for a sexual offense, number of prior violent arrests as well as types of prior offenses.  If the individual is currently incarcerated the assessment takes into effect all disciplinary actions while incarcerated (Sandler, Freeman and Farrell, 2014).

What are the diagnostic impressions of Ryan?

Based upon the information provided in the case vignette I believe that Ryan has the following based upon the based on all five axes of the DSM-IV-TR.  Axis I Male Hypoactive Sexual Desire, Major Depressive Disorder – Moderate and Alcohol Use Disorder with alternative diagnosis being Pedophilic Disorder and Substance/Medication-Induced Depressive Disorder; Axis II Anti-Social Personality Disorder; Axis III none; Axis IV death of his mother, inability to fully accept his sexuality, strained relationship with his father, preoccupation with sex, excessive alcohol use 3-4 drinks a day, divorce from ex-husband and violation of no-contact order with ex-husband and his adopted sons; Axis V GAF of 50 – 60.

Axis I apply to psychological diagnoses covered by the American Psychological Association (APA).  With Ryan, I believe that he has Male Hypoactive Sexual Desire Disorder 302.71 (F52.0), Major Depressive Disorder – Moderate 296.32 and Alcohol Use Disorder 303.90.  For the diagnosis of Male Hypoactive Sexual Desire Disorder, Ryan self-reports that he has had sexual preoccupations including having sexual contact with other men for money and to be sexually gratified by using “sex apps” to meet other men for casual sex.  The alternative diagnosis of Pedophilic Disorder may not apply as his son is 16, but Ryan is at least 5 years older than his son and is exchanging sexual text messages and watching pornographic movies in front of his children.  Also, Ryan’s file shows no other interest in prepubescent males, therefore, the diagnosis of Pedophilic Disorder is very unlikely unless other information is gathered showing that Ryan has had an interest in the past to prepubescent males.

For the diagnosis of Major Depressive Disorder – Moderate, Ryan reports that the depression was brought on by the death of his mother, he has had a persistent depressed mood, with diminished interest, feelings of worthlessness, diminished the ability to think or concentrate and reoccurring thoughts of death.  Ryan reports that when his mother died he started to feel depressed and started drinking.  He also reports that his father also turned to alcohol to cope with the death of his wife.  Ryan’s psychiatric history reports that he has previously been diagnosed with depression.  Ryan has also been hospitalized for risk of harm to self when he attempted to commit suicide.  The other symptoms could be related to Ryan’s inability to accept his sexuality, his strained relationship with his father and ongoing relationship issues.  For the diagnosis of Alcohol Use Disorder – Mild: Presence Ryan’s current alcohol use resulting in a failure to fulfill major role obligations at work, school or home as he has been drinking most of his life, his continued alcohol use despite having persistent or reoccurring social or interpersonal problems caused or exacerbated by the effects of alcohol, and his recurrent alcohol use in situations in which it is physically hazardous.  As with the depression diagnosis, Ryan’s alcohol use can be associated with the death of his mother, his inability to accept his sexuality, his strained relationship with his father and ongoing relationship issues.  An alternative diagnosis for Major Depressive Disorder – Moderate and Alcohol Use Disorder would be Substance/Medication-Induced Depressive Disorder.  Ryan began drinking and began feeling depressed with the death of his mother.  Because of these factors, the diagnosis of Substance/Medication-Induced Depressive Disorder may be more appropriate based on other factors such as if Ryan is more depressed prior to drinking alcohol or if he is depressed before he drinks alcohol.

Axis II apply to personality disorders or other psychiatric disorders covered by the American Psychological Association (APA).  Per the vignette, Ryan has Anti-Social Personality Disorder 301.7 (F60.2).  Ryan fits this diagnosis with deceitfulness, impulsivity, reckless disregard for the safety of self or others, and lack of remorse.  Ryan is deceitful by having a “secret life of sexual addiction”.  He also has impulsivity and reckless disregard for the safety of self or others with attempted break into his ex-husbands home and violating the no-contact order.  His lack of remorse was clear with his interactions with the denial of doing any wrong by violating the no-contact order.  His belief was that he was in his own home it appears that he believed that the no-contact order did not apply as he was in “his” home.

Axis III is for any additional medical or physical conditions that may or may not be contributing to the mental health issues displayed by the individual.  Ryan reports no medical conditions that could be contributing to his mental illness and does not report any medications that could be causing a mental illness.  While Ryan’s mother did die from cancer there is no file material noted that he may as well have the illness.

Axis IV is any additional environmental or psychosocial factors that may be contributing to the mental illness.  Ryan has many other factors that are contributing to his mental illness including the death of his mother, his excessive alcohol use 3-4 drinks a day, his inability to fully accept his sexuality, his strained relationship with his father, his preoccupation with sex, the divorce from his husband and the violation of no-contact order with ex-husband and his adopted sons.  The death of his mother greatly affected Ryan leading to both his depression and his drinking.  Ryan’s inability to fully accept his sexuality has more than likely contributed to his preoccupation with sex.  His strained relationship with his father because of his sexuality may also be a contributing factor to his preoccupation with sex.  His preoccupation with sex also led to his divorce from his husband.  The no-contact order caused stress in Ryan’s life that he did not deal with causing the violation of the no-contact order.

Axis V or Global Assessment of Function (GAF) looks at how well an individual function in their daily life.  The GAF is a 0 to 100 scale with 0 being they are not capable of looking after their own safety and well-fare and 100 be indicating that they have no issues in that area.  Ryan would have a score of 50 – 60.  Ryan is a threat to the safety of his ex-husband and children.  He violated a no-contact order and attacked his ex-husband with no regard for his safety or well-being.  He also sent sexual text messages to his 16-year-old son who Ryan refers to as having “special needs” and has been abused while in foster care.  Ryan’s son would be a vulnerable person who would be more susceptible to abuse by those factors.  Ryan can care for his own safety and basic hygiene.  Therefore, the score of 50-60 would include those factors.

Legal Theory and Application

How does Ryan’s background, current presentation, and behavior support the diagnosis?

In the vignette for Ryan, there are many factors that affect his overall presentation.  The first appearance of issues started with the death of his mother and progressed with his inability to fully accept his sexuality and his strained relationship with his father.  His sexuality and his issues with that have also lead to a preoccupation with sex and excessive alcohol use.  Both of those factors have led to his current legal issues including his divorce from his husband and the no-contact order with his family.

Ryan reports that his mother died of cancer when he was young and he reported an ongoing depression since her death.  His father began drinking to deal with the death of his wife and Ryan himself reports that alcohol use is a large part of his life.  He reports that he has had questionable sexual contacts for much of his life.  He began having promiscuous sexual contact at the age of 17 and continued that behavior throughout his married life.  He reports that his sexuality caused a rift between his father, but that rift may have already been present since the death of his mother.  His risky sexual contact has also caused a rift with his ex-husband.  Ryan’s risky sexual lifestyle also involves him sending sexual text messages to his son.  Ryan seems to exhibit a lack of empathy and responsibility for his actions.  He does not seek to link any of his own actions to any wrong doing and diminishes the effects of his alcohol use, sexual preoccupation and other actions.

The psychodynamic theory would state that Ryan’s mother was a large influence in his life because the death of his mother set many of Ryan’s issues into play.  Ryan stated he was an unplanned pregnancy this may show that being an unplanned pregnancy may have a bearing on how Ryan viewed himself and affected his self-esteem.  When his mother died, Ryan saw his father turn to alcohol to cope with the loss of his wife which lead to Ryan turning to alcohol as well later in life.  When Ryan came out to his father regarding his sexuality and the results cause the relationship to become strained it, in turn, causes Ryan to have an inability to fully accept his own sexuality.  In being unable to accept his own sexuality Ryan turns to risky and unhealthy sexual lifestyle.  Ryan’s risky sexual lifestyle lead to his divorce and the no-contact order with his family.  The psychodynamic theory would have that Ryan’s unconscious mind is seeking acceptance that he may have received from his mother but not from his father.  Ryan is looking for fatherly acceptance which has led to him seeking that approval from other men in the form of sex (McLeod, 2007).

Social Cognitive Theory states that behavior has three elements, the person, the environment, and the behavior.  Ryan’s case has elements of the person, environment, and behaviors.  For the environment, Ryan has feelings of abandonments after the death of his mother.  His father turned to alcohol and was distant even more so after his disclosure of his sexuality.  For behavior, Ryan may have seen his father lie about his alcohol use and therefore he learned to lie about behaviors that are socially unacceptable.  This would include his preoccupation with sex and his sexual text to his son.  For the environment, Ryan has a conflict with attempting to live a happy married life with a risky sexual life (Huesmann, Dubow, & Boxer, 2009).

Bandura Social Cognitive Theory states that behavior is learned by watching the behavior and the consequences of that behavior.  Ryan watched his father drink and the viewed the consequences of that behavior.  Ryan mentioned no ill effects of his father’s drinking, therefore he views drinking as a non-issue.  Ryan has been involved in questionable sexual behaviors for a majority of his life.  He reports no ill effects of the sexual contact until his divorce and no-contact order.  Ryan may view these as a non-issue as there have been no previous ill effects on his lifestyle.  Ryan may also not view the sexual texts with his son as an issue as at the age of 17 he himself became sexually active.  He may not view his son as an individual with thoughts or feelings but as another anonymous sexual partner.  Ryan may view his son as he was viewed at that age or as others that he has had sexual contact with (Bandura, 1986).

How does Ryan’s actions impact his victim?

In the case of Ryan and the presented vignette, there are numerous victims including Ryan’s ex-husband, his 16-year-old son and other possible victims that Ryan had sexual contact with.  Each of these victims has separate impacts of the abuse suffered and the ongoing lasting effects of that abuse.  The effects of Ryan’s ex-husband would be different than those of his son or anonymous sexual partners.

The first victim is Ryan’s ex-husband, who then likely is an ongoing victim of emotional and physical abuse.  There are reports of ongoing marital conflict and Ryan attacked his ex-husband with a kitchen knife after he attempted to break into the house.  While there were no reports of injuries in this instance there is no report if there were prior instances of physical altercations.  With Ryan’s attitudes towards his violation of the no-contact order, he seemed to believe that the order did not apply to him.  Reports state that he does not trust the system and believes that he has done nothing wrong, these are indicators that Ryan will more than likely continue to violate any no-contact order put into place.  This places his ex-husband at risk for further assault and the possibility of injury.  Ryan’s ex-husband could have trust issues due to the abuse.  Ryan’s risky sexual lifestyle has put his ex-husband at risk of contracting a sexual disease.  Victims of domestic assault usually have on going issues with one individual having the power or control in the relationship and the other having none.  The relationship may start with humiliation, loss of control, intimidation and other forms of emotional abuse.  This is used to assert dominance over one partner.  Abuse can happen to either sex and any type of relationship.  Over time it escalates to physical abuse (Johnston & Campbell, 1993; Kelly & Johnson, 2008).

Ryan’s second victim is his 16-year-old son.  Ryan’s son is special needs and was already abused while in the foster care system.  The nature of the abuse is not known at this time but the child is already considered a vulnerable because of it.  His son is already receiving extensive in and outpatient treatment.  While Ryan denies watching porn, doing other sexually inappropriate behaviors in front of his son or sending sexual texts to him.  The no-contact order and Child Protection Report seem to state otherwise.  Ryan may have been attempting to groom his child to become a sexual victim.  Ryan’s actions put his son at risk for having trust issues and possible other abuses based upon his actions.  Numerous sexual offenders were abused as children because of this fact, they are usually motivated to abuse others.  While Ryan does not report any sexual, physical, or emotional abuse because he began being having a risky sexual lifestyle at the age of 17 it is very likely that at some point he would have been abused by a sexual partner.  Because of this fact, the chances are high that his inappropriate sexual interactions with his son could be in response to that abuse (Faupel, 2015).

Ryan could potentially have additional victims in the form of sexual partners.  Ryan reports that he has had numerous sexual partners throughout his life.  He does not mention the ages of the men he “hooked up” with and many of them could be underage.  Again, Ryan does not report any sexual, physical, or emotional abuse.  There is a possibility that a sexual partner may have abused him.  He states that he began having sex for money at the age of 17.  Many times, sex workers who are assaulted do not report abuse as they are doing an illegal activity.  Ryan may have been abused but ashamed to admit to the abuse.  In turn, Ryan may have been abusing victims for some time but just now being confronted with abuse because his partner saw the sexual test he sent to his son (Faupel, 2015).

What psycho-legal standards may or may not apply to Ryan’s case and why?

There are many psycho-legal standards including competence to stand trial, duty to warn and insanity.  Each of these standards has case law that lays the foundation for current legal cases.  A psychological professional would need to be versed in the definitions of various psycho-legal standards so that when assessing an individual, they can verify that they are citing correct and current legal standards.  In the case of Ryan competency to stand trial and insanity do not apply, but the duty to warn specifically the risk of dangerousness/harm to self or others does.

Competency to stand

During the competency process and evaluation determines if a defendant can stand trial.  A competency to stand trial evaluation looks at the defendant’s ability to understand the charges against them and their ability to assist in their defense.  An attorney, either defense or prosecutor or judge may request an evaluation of an individual based upon their irrational behavior, conduct during the trial or the pre-trial or a prior medical or psychological opinion of the individual’s competency to stand trial.  The incompetent to stand trial follows a process based on state law.  Based upon those factors a judge can order a competency evaluation and appoints an evaluator to the case.  Once the evaluation is completed the evaluator presents their findings to the court in a detailed report.  Based upon that report a judge will make w ruling about the defendant’s competency to stand trial.  If the defendant is found not competent to stand trial, they are sent to a facility to be cared for until they can be competent.  This process varies and the defendant is re-evaluated every few months.  A defendant can request a re-evaluation at any time and once found competent they can be retried for their crimes (Meyer & Weaver, 2006).  In this case, Ryan understands the charges against him and can assist in his defense.  He has also not shown any irrational behavior or conduct during the pre-trial proceedings.  Ryan has no prior medical or psychological opinion of his competency to stand trial.  Therefore, Ryan would be considered competent to stand trial and would not need a competency evaluation.

Caselaw

Dusky v. United States, 362 U.S. 402 (1960)

In the case of Dusky v. United States, Milton Dusky was charged with assisting in the kidnapping and rape of an underage female.  Dusky was diagnosed with schizophrenia at the time of the crime.  Dusky was found competent to stand trial and sentence of 45 years in prison. On his petition to the United States Supreme Court, Dusky requested that his conviction is overturned because he was not competent to stand trial during the court case. The Supreme Court found that while Dusky has some recall of the events that brought him to trial there was no assessment available to determine if he could assist his legal counsel in any significant way or if he fully understands the legal proceedings against him.  Because of these facts, the Supreme Court reversed the conviction and set for Dusky to be re-evaluated to determine if he was competent to stand trial and set a new trial if he was found competent (American Law Institute, 1962).

Drope v. Missouri, 420 U.S. 162 (1975)

Drope was convicted with two others of his wife.  Drope requested that he receive psychiatric treatment and be evaluated prior to trial.  He was denied both and his case was set for trial.  During the trial, his wife testified that Drope had been exhibiting strange behavior and had previously tried to kill her.  Prior to trial Drope tried to commit suicide and was sent to the hospital for treatment.  While he was in hospital his trial proceeded without him.  Despite his motion for a mistrial, which was denied, he was found guilty and sentenced to life in prison.  Drope appealed to the Missouri Supreme Court, which upheld the decision.  Drope then appealed to the United States Supreme Court.  The Supreme Court found that Drope was denied a competency to stand trial evaluation and due process because the trial proceeded without him.  Because of Drope’s behavior prior to trial, to which his wife testified, and his failed suicide attempt there is evidence that he might not have understood the proceeding against him or may not be able to assist in his own defense (American Law Institute, 1962).

Godinez v. Moran 509 U.S. 389

In Godinez v. Moran, Richard Moran shot two individuals and robbed a saloon in Carson City, Nevada.  A few days later he shot his ex-wife and attempted to commit suicide by shooting his-self and trying to slit his wrists.  While hospitalized he called the police and confessed to the crimes.  Prior to trial, two different psychologists found him depressed but competent to stand trial.  During the trial, he dismissed his lawyers and changed his plea from not guilty to guilty.  Moran was found guilty and sentenced to death.  Moran then filed a motion claiming that he was mentally incompetent to defend himself in court.  His motion was denied and he appealed to the Nevada Supreme Court where his appeal was dismissed.  Moran then appealed to the United States Supreme Court which upheld his conviction.  The court reasoned that because Moran was found competent to stand trial he was also competent to dismiss his lawyers and represent himself whether he did an adequate job in his own defense or not (American Law Institute, 1962).

Insanity

In the United States, each state has different standard and guidelines of how the plea of insanity is put forth.  Most but not all states follow the Model Penal Code guidelines.  The first step in evaluating the individual’s sanity is to have a request placed before the court for evaluation.  This request usually comes from the defense attorney, but the judge in the case may also request the evaluation.  The court then hires a psychologist to review all records pertaining to the case, conduct and evaluation.  The psychologist will determine if the individual has a mental illness and if that illness caused the individual to be unable to determine the difference between right and wrong.  The psychologist will also determine if the individual knew that the crime that is accused of was against the law.  The psychologist will also look at if the individual was in control of their actions at the time of the crime.  Once the evaluation is completed the psychologist will submit a report to the court with their recommendation on in the individual knows right from wrong, if they knew their actions were against the law and if they were in control of their actions at the time of the crime (Meyer & Weaver, 2006).  In the case of Ryan, he knew right from wrong, knew his actions were against the law and was in control of his actions, therefore he would not be considered insane.

Caselaw

M’Naughten, 8 Eng. Rep. 718 (1843)

M’Naghten is a landmark case which set the standards for insanity pleas.  In the case, M’Naghten was charged with murder but told the police that he was told to come to London to commit the murder.  The jury found him not guilty but there was no standard to determine if an individual was insane.  The House of Lords met and determined a set of standards to be used in these types of cases.  The standards include that a defendant must have a mental illness, that they did not know the actions were against the law and did not have control of their actions at the time of the crime (American Law Institute, 1962).

Risk of dangerousness/harm to self or others

In the risk of dangerousness, prior to allowing an individual to be set free on bail, the courts must determine if they are at risk of causing others harm.  The judge would look at the file and determine if an evaluation for the risk of dangerousness is needed.  Many times, a judge will deny bail if they view the defendant is a risk to the public or a certain individual.  If the evaluation is required the psychologist would review the file notes, review the individual’s criminal history, conduct an interview and prepare a report for the individual.  The risk of dangerousness can be used to determine if someone who is already incarcerated is a risk to the community or certain individual when released so that the community or the individual can be told of their release.  Another factor that risk of dangerousness evaluations can be used for is in civil commitment cases (Buchanan, Binder, Norko & Swartz, 2011).

In the case presented in the vignette, the risk of dangerousness specifically the risk of harm to self or others, applies.  Ryan has shown disregard to the safety of others in violating the no-contact order, attacking his ex-husband with a kitchen knife, casual sexual encounters and inappropriate sexual texts with his 16-year-old son.  In violating the no-contact order Ryan shows no remorse and almost dismissed the event as a non-issue by stating that he did nothing wrong and was in his own home.  He is a risk of harm to himself with his numerous suicide attempts.

Caselaw

Barefoot v. Estelle 463 U.S. 880 (1983).

In Barefoot v Estelle, Thomas Barefoot was convicted of murder in Texas.  During the sentencing portion of the hearing, the jury had to answer the question if Barefoot would continue to be a threat to society as a whole and may commit additional acts of violence if he were released from prison.  During the trial, two psychiatrists testified that there was a chance that if Barefoot were released he would continue to be a risk to the public.  Barefoot was sentenced to death.  Barefoot appealed his conviction stating that the testimony at his sentencing was unconstitutional, his conviction was upheld.  The case eventually came to the United States Supreme Court which upheld the conviction but stopped his execution.  The Court decided that a decision in a death penalty case could be an important factor in setting a case law in other cases where psychiatric predictions of dangerousness were involved (American Law Institute, 1962).

Assessment, Research and Evaluation

What test or assessments would be used to address psycho-legal issues regarding Ryan’s case?

In the vignette about Ryan, we can rule out that Ryan is competency to stand trial and does not fit the criteria for insanity.  Ryan does qualify for risk of dangerousness specifically with harm to self or others.  In the case, the main cultural concern would be that Ryan is homosexual and has issues with his sexuality.  There are specific tests that would apply to all three psycho-legal standards which include the MSE, MMPI-2, WAIS–R, ASSIST, and SSI.  The MSE looks at the individuals mental, physical and emotional overall health both prior and after the incident.  The report notes the questions asked, the individuals answers and their appearance, mood and how they emotions during the interview.  The MSE is culturally neutral (Sawicki, 2013).  The MMPI – 2 is a personality measurement tool that is widely used to evaluate an individual’s mental health and personality to make recommendations to the courts.  This is a scored assessment and used the individual’s answers, their history, and background to assist in scoring.  The MMPI – 2 notes that demographic, ethnic and cultural variables should be taken into account when scoring the assessment.  The areas that may be affecting by those factors are the Mf, SC and Si scales (Butcher, Hass, Greene & Nelson, 2015).  The WAIS–R is an intelligence test and includes three sections verbal, performance and full-scale with half of the scale being verbal and the other half being non-verbal.  The results of the WASI-R can be affected by test anxiety or other anxiety issues, ADHD, learning or behavioral issues and /or reading problems (Kaufman & Harrison, 2013).  The ASSIST is used to evaluate dependency on alcohol and is designed to be culturally neutral (WHO, 2002).  The SSI is used to assesses the risk of suicide and designed to be culturally neutral (Beck, Kovacs, & Weissman, 1979).

There are specific assessments designed to determine criteria for insanity, competence to stand trial and risk of dangerousness.  Each of these evaluations has been based upon case law and standards set forth national and state standards.  While competency to stand trial and insanity do not apply to the vignette it is very important to understand the tests and standards.

Competency to stand

In competency to stand trial evaluations the assessment that is commonly used is the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), the Evaluation of Competency to Stand Trial-Revised (ECST-R) and the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR).  The MacCAT-CA is an assessment tool has three sections that evaluate understanding, reasoning, and appreciation.  This tool answers all the qualifying portions of the Dusky criteria.  The ECST-R is divided into three sections the factual understanding, rational understanding and consulting with counsel.  The ECST-R answers the criteria set forth in Dusky.  The CAST-MR is also composed of three sections basic legal, skills to assist and understanding.  This assessment is designed for individuals who have mental retardation to assist in determining if they fit the Dusky criteria (Rogers, & Shuman, 2000).

In this case, if the MacCAT-CA, ECST-R or CAST-MR were administered to Ryan they would more than likely show that Ryan was competent to stand trial.   Ryan understands the charges against him, can assist in his defense and has also not shown any irrational behavior or conduct during the pre-trial proceedings.  Ryan also has no prior medical or psychological opinion of his competency to stand trial.  Therefore, Ryan would likely be considered competent to stand trial.

Insanity

Insanity is a legal term and in insanity evaluations, there are many assessments that are commonly used including the M’Naghten test, the American Law Institute’s Model Penal Code Test and the Product test.  The M’Naghten test evaluates an individual to see if they have a mental illness, that they did not know the actions were against the law and did not have control of their actions at the time of the crime (American Law Institute, 1962).  The ALI-MPC looks at similar criteria as the M’Naghten test but has additional criteria to avoid legal criticisms with the M’Naghten test.  The Product test is an open-ended assessment that takes into effect various mental disorders and allows for expert witnesses to testify their findings to the jury (Goldstein, 1967).

In this case, if the M’Naghten test, the American Law Institute’s Model Penal Code Test and the Product test were administered to Ryan he would more than likely be found sane.  Ryan, he knew right from wrong, knew his actions were against the law and was in control of his actions, therefore he would not be considered insane.

Risk of dangerousness/harm to self or others

In risk of dangerousness/harm to self or others evaluations, there are many different types of evaluations that can be used to evaluate an individual including Violence Risk Appraisal Guide (VRAG)and the Static-99/99R and STATIC 2002.  A VRAG looks at the risk of possible reoffending using violence.  The VRAG looks at various items to predict future violence.  The more violence that has been in the client’s past the more likely they are to re-offend.

(Hilton, Harris, & Rice, 2010).  The Static-99/99R and STATIC 2002 determine the risk of individuals committing sexual offenses.  Both the VRGA and Static-99/99R and STATIC 2002 take into effect several factors including age, gender, sexual orientation as well as the past and present behaviors (Buchanan, Binder, Norko & Swartz, 2011).

In the case presented in the vignette, the risk of dangerousness specifically the risk of harm to self or others, applies.  With Ryan being accused of violence against his ex-husband the Violence Risk Appraisal Guide (VRAG) would assist his risk of continued violence.  Because Ryan has been accused of sexually inappropriate interactions with his 16-year-old son the Static-99/99R or STATIC 2002 should be administrated to determine the risk of him offending sexually against his son.  Each of these assessments assists in diagnosing and treating Ryan (Borum & Grisso, 1995).

What research question and testable research hypothesis would apply to Ryan’s case?

The question to be addressed is “What steps could be taken to prevent Ryan from continuing to violate no-contact orders?”  The specific problem is Ryan has already violated one no-contact order what if anything could prevent him from continuing to do so.  The null hypothesis would be “A no-contact order will deter Ryan from continuing to see his ex-husband and children”.  An alternative hypothesis would be “A no-contact order will not deter Ryan from continuing to see his ex-husband and children?”.  The variables in the question are Ryan, his ex-husband and their children, specifically his 16 year-old-son.

The best theory to test the hypothesis would be the idiographic approach which is otherwise known as the qualitative approach. This method uses data gathering to anticipate how individuals may act in certain circumstances (Freedman, 2009).  In Ryan’s case, they hypothesis is that Ryan will continue to violate the no-contact order against him.  To test the validity of the hypothesis a group of like individuals would need to be reviewed.  This could be done by comparing file records of Caucasian males who have violated no-contact orders.  These can be divided into individuals who have violated the no-contact order and those who have not.  Of the individuals who have violated the no-contact order, the group can be reduced further by looking at those who were violent when they violated those orders and those who did not.  If this group is too large it can be reduced even further by dividing the data into age groups.  This data will show the statistical data if a Caucasian male at the age of 61 who used violence when they violated the no-contact order is more or less likely to once again violate the no-contact order.  There are additional factors that can be considered to be more specific on the on the outcome of the hypothesis.  The files could be further decreased by adding in the individual’s sexuality and other arrest elements into the equations.

In researching the hypothesis, the evaluator could use the descriptive method to test the relationship between the variables.  This method looked at each variable as individual not how each variable connects to the other.  This research method would not work well as each of the variables which are Ryan, his ex-husband and his sons are all interconnected and therefore the descriptive method would not work in this case.  Instead, the correlational method could alternatively be used.  That method looks at the relationships between two variables.  In this case, they could look at the relationship between Ryan and his ex-husband or Ryan and his children and see how the variables interact with one another to answer the hypothesis question (Freedman, 2009).

Leadership, Consultation and Ethics

What are the ethical and legal dilemmas related to Ryan’s case?

Per the APA Ethical Principles of Psychologists and Code of Conduct the psychologist assigned to the case must verify that there is no conflict between ethics and law, regulations, organizational demands and should attempt to resolve those conflicts.  They should verify that they have the education and training required prior to providing services.  They should verify that their activities are free of discrimination, sexual harassment, avoid harassment and causing harm as well as avoid having multiple relationships to avoid the appearance of conflict.  A psychologist should also not exploit relationships with employees, work with other professionals and gather informed consent when providing services.

Per the American Psychological Association (APA) in the Specialty Guidelines for Forensic Psychology, there are certain steps that must be taken when evaluating an individual.  When the court asked the psychologist to evaluate the individual they should verify that they have no conflicts of interest.  They should also verify that they have knowledge of the legal system and scientific foundations of the case presented.  As the forensic Professional evaluates Ryan they would need to verify that prior to conducting the interview they verify that Ryan gives his informed consent and understands that the information gathered will be shared with the courts.  If Ryan is court ordered to have the evaluation and Ryan refuses to participate in the evaluation he must be told that the evaluation will continue and all parties involved will be aware of his refusal (APA, 2011).

As a forensic psychologist, the professional role, in this case, would be to consult the court in the risk Ryan poses to his ex-husband and children and will Ryan continue to violate the no-contact order to continue abusing his ex-husband.  The other members that would be involved in this case would be Ryan, his defense attorney, the prosecuting attorney and the judge assigned to the case.  The forensic psychologist would evaluate file materials and conduct a forensic evaluation on Ryan.  After the evaluation is completed on Ryan, a report would be written to the court with copies going to the client, both attorneys, and the judge.  If the judge or either attorney requests the forensic psychologist may be asked to testify in court to their findings and options.

Another issue the psychologist must address is was Ryan attempting to groom his 16-year-old son into a sexual relationship.  Ryan’s ex-husband has placed the charge with the Child Protective Services which had completed their report at the time of the evaluation.  The psychologist should obtain a copy of the report to determine if additional charges of attempted child molestation will be pending against Ryan.  If there are no charges being filed but there is significate evidence that Ryan is in the process of grooming his son there is a duty to report those finding and warn that there is a risk to the safety of the son should Ryan be released.  Ryan would need to be informed about how the information would be used.

In Ryan’s case because he denies the charges against him he may not give his consent to further evaluation.  When first evaluated Ryan was mostly uncooperative and made poor eye contact.  Ryan may not like that the evaluator would be talking to his ex-husband, talking to his 16-year old son and reviewing file material which makes him further hesitant to participate in his evaluation.  Because he does not believe that he has any sexual, alcohol or depression issues he may decline to participate in those evaluations.

Interpersonal Effectiveness

What diversity factors, cultural considerations or other demographics need to reviewed in Ryan’s case?

When rendering a diagnosis for Ryan there are a variety of issues that must be considered.  Ryan is a 61-year -old Caucasian male who identifies as gay.  He does not mention being specifically religious or spiritual in nature.  Ryan does not have any health issues that could affect the case in question he does report that he has an issue with excessive alcohol use but claims that it does not affect his daily living even with reporting to consume 3-4 alcoholic drinks a daily.  Ryan has been previously diagnosed with depression and claims that it does not affect his daily living.  Ryan mentions that he has had a promiscuous sex life, but denies that it affects his daily life.  He does not have any intellectual disabilities and was scored in the high average to superior range.

Ryan’s sexual identity has been a large issue for him.  He reports that he was not entirely comfortable with his sexuality.  He also notes that when he told his father of his sexual preference it created a rift in the relationship.  Because he is uncomfortable with his sexuality he became having risky sexual contact.  The Static-99/99R and STATIC 2002 is looking at past behaviors to determine an individual’s risk of reoffending in a sexual nature.  It also takes into account the age that victimizing began, the number of victims, the current age of the offender, the gender of the offender and if they were violent in their crimes (Sandler, Freeman and Farrell, 2014).  With Ryan being 61 and having no known victims, he would more than likely be considered a low risk for sexual offending on the Static-99/99R or STATIC 2002 testing.  With that being said, because he reports that he has prostituted his-self from an early age if he is found to have underage male victims his score would increase.  If it is found that Ryan was grooming his son to be a sexual partner or if it is found that he has more victims his treatment would need to include a Sexual Offender Treatment.  Many sexual offenders are discovered after they have had many victims.  Also, most sexual offenders against children are from an individual within their family (Waterland & Landon, 2015).  He also uses alcohol to excess which may contribute to his risky sexual contact with other males.  Ryan’s risky sexual endeavors contributed to his divorce.

The MSE would include Ryan’s age, race, gender, sexual orientation and substance abuse. The MSE is culturally neutral as it addressed the individual as a whole at the time of the offense as well as prior health, mental health, legal issues and other issues (Sawicki, 2013).  The MMPI – 2 notes that demographic, ethnic and cultural variables should be taken into account when scoring the assessment.  The areas that may be affecting by those factors are the Mf, SC and Si scales (Butcher, Hass, Greene & Nelson, 2015).  The results of the WASI-R can be affected by test anxiety or other anxiety issues, ADHD, learning or behavioral issues and /or reading problems (Kaufman & Harrison, 2013).  The VRAG is culturally neutral as it looks at past behaviors to determine an individual’s risk of reoffending in a violent nature (Hilton, Harris, & Rice, 2010).  The ASSIST is designed to be culturally neutral (WHO, 2002).  The SSI is also designed to be culturally neutral (Beck, Kovacs, & Weissman, 1979).

References

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Case Law

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Barefoot v. Estelle 463 U.S. 880 (1983).

Dusky v. United States, 362 U.S. 402 (1960).

Drope v. Missouri, 420 U.S. 162 (1975).

In re M’Naughten, 8 Eng. Rep. 718 (1843)

Godinez v. Moran, 509 U.S. 389 (1993).