Informing Patients of Dual-Role Pitfalls

The dual role of psychotherapist and forensic evaluator cannot always be avoided, such as when the psychiatrist practices in a small town or rural area. But before any significant exchange of information occurs, patients should be informed about potential pitfalls, said forensic psychiatrist Thomas Gutheil, M.D., at APA's 1998 annual meeting in Toronto. Gutheil is codirector of the Program in Psychiatry and Law at Harvard Medical School and Massachusetts Mental Health Center and a corecipient of the Manfred S. Guttmacher Award.

Gutheil suggested using the following statements with patients:

• "Even though you are meeting with a psychiatrist, this exchange is not confidential because it involves a legal matter. Information coming from this interview might appear in a report, a deposition, or even in court at some point."



• "I have been retained by [fill in the blank, for example, your attorney, the prosecution], but I can perform my duty only if I am objective. Thus, my testimony may help your case, hurt your case, or have no visible effect on it. We will not know that until later in the proceedings."



• "You don't have to answer these questions, but I am required to note that fact. "



• "You can consult with your attorney as needed."



• "Do you understand these instructions?" If not, the evaluator can repeat the instructions, request a psychiatric examination, provide written documents, or recommend other interventions, said Gutheil.