Caroline Logan

Forensic Case Formulation

Formulation is the process or product of gathering and integrating diverse information to develop a concise account of the nature and etiology of the problems affecting a persons mental health to guide idiographic treatment design and other decision-making. Formulation is a core competency in mental health practice, including forensic mental health; however, there is no agreement concerning the details of how it should be done or how to evaluate it, either generally or more specifically with respect to forensic mental health. The purpose of this paper is to raise specific issues in the practice and evaluation of forensic case formulation, and so enhance the profile of this important area of work. In this paper, we (1) define case formulation and describe its key features, (2) specify criteria for evaluating case formulation, and (3) address challenges in forensic practice, with suggestions for advancing practice through research. We conclude with a proposed research agenda that we hope will encourage and promote activity in this important area.

Explicating the Construct of Psychopathy: Development and Validation of a Conceptual Model, the Comprehensive Assessment of Psychopathic Personality (CAPP)

Psychopathic personality disorder (PPD) has important clinical and forensic implications. But much more effort has been devoted to assessing or diagnosing PPD than to explicating or defining it. In the first part of this paper, we describe the development of a conceptual model or “concept map” of PPD. Based on a systematic review of descriptions of PPD in the clinical and research literature, as well as consultation with subject matter experts, we identified key features of the disorder and translated them into 33 symptoms, presented as natural language (i.e., non-technical) trait descriptive adjectives or adjectival phrases. Each symptom in turn was defined by three synonymous adjectives or adjectival phrases. The 33 symptoms were grouped rationally to reflect six domains of personality functioning. In the second part of the paper, we discuss research completed and in progress intended to validate the CAPP conceptual model.

The Comprehensive Assessment of Psychopathic Personality (CAPP): content validation using prototypical analysis.

The Comprehensive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie, 2004) is a new personality-based model and clinical assessment of psychopathy. This study was the first to examine the content validity of the English-language CAPP. Content validation is a crucial part of the development and refinement of any new instrument. Prototypical analysis was used to evaluate the representativeness of CAPP symptoms to the psychopathy construct in adults. Symptoms were rated by international mental health professionals (N = 132). Findings support good content validity of the CAPP, with most symptoms rated as highly representative of psychopathy. Domains relating to interpersonal style were particularly prototypical. Confirmatory factor analyses further suggested that CAPP domains are highly unidimensional. However, some CAPP symptoms may be weaker items in the model and further refinement is needed.

Assessment of Psychopathy: Inter-correlations between Psychopathy Checklist Revised, Comprehensive Assessment of Psychopathic Personality – Institutional Rating Scale, and Self-Report of Psychopathy Scale–III

The aim of the present study was to investigate the inter-correlation between three different instruments for the assessment of psychopathic personality disorder. Eighty male inmates at Bergen prison (Norway) participated in the study. All the participants were assessed for psychopathy using the Psychopathy Checklist Revised (PCL-R; Hare, 1991), the Comprehensive Assessment of Psychopathic Personality – Institutional Rating Scale (CAPP-IRS; Cooke, Hart, & Logan, 2004), and the questionnaire Self-Report of Psychopathy Scale–III (SRP-III; Paulhus, Neumann, & Hare, in press). The correlational analysis revealed significant correlations between all the instruments, but substantial diverges were also found. CAPP-IRS and PCL-R showed high inter-correlations and, hence, seem to tap into the same underlying construct. The CAPP-IRS seems, however to have a higher affect focus in all its domains. Our finding of lower correlation between the SRP-III and the other two clinical tools may suggest a limitation in the instrument to uncover the full range of the psychopathic construct. Especially the interpersonal and affective segments seemed to be missed.

The HCR-20 Version 3: A Case Study in Risk Formulation

The third edition of the HCR-20 (HCR-20V3, Douglas, Hart, Webster, et al., 2013) consolidates essential recent thinking about risk assessment and management using the structured professional judgement approach. As with the preceding Risk for Sexual Violence Protocol (Hart, Kropp, Laws et al., 2003), risk factors for violence are now assessed for their relevance as well as presence, scenario planning has a central place in anticipating the nature, severity, imminence and likelihood of future harm, and risk management strategies must incorporate a combination of treatment, supervision, monitoring and victim safety planning interventions and recommendations. However, the key process now proposed for linking the assessment and overall management of risk is risk formulation—the act of understanding the underlying mechanism of an individuals harm potential in order to develop sensitive and proportionate hypotheses to facilitate change (embodied within the risk management plan). In this paper, the process of risk formulation is described and illustrated with a case study—Paul. A brief report of the risk assessment, formulation and management recommendations for Paul illustrate the key features of what is recommended in the new version of this internationally renowned violence risk guide. However, empirical research into risk formulation remains outstanding.

Sexual Violence Risk Assessment: An Investigation of the Interrater Reliability of Professional Judgments Made Using the Risk for Sexual Violence Protocol

The RSVP is a set of structured professional judgment guidelines for assessing risk of sexual violence. We investigated the interrater reliability (IRR) of judgments made using the RSVP in a multidisciplinary forensic-clinical context. Raters were 28 forensic mental health and intellectual disability professionals with diverse training and experience. They used the RSVP to evaluate six case vignettes that varied with respect to offense characteristics, clinical complexity, and level of risk. The IRR of ratings for individual risk factors was generally fair. There was a good level of interrater reliability on Summary Judgments and Supervision Recommendations. Interrater reliability was highest when used by professionals who were highly trained in forensic risk assessment. On average, professionals with lower levels of specialist training agreed less with their colleagues and experts, and provided higher estimations of sexual violence risk. Lower levels of agreement were found in cases with moderate levels of complexity and risk. The RSVP can be used to make judgments of risk with adequate levels of interrater reliability. However, this is dependent on the training and expertise of professionals who use the tool. Methodological strengths and limitations are considered, followed by a discussion of implications for training, practice, and future research.

Working in partnership: making it happen for high risk personality disordered offenders

Purpose – The implementation of the Offender Personality Disorder (OPD) strategy requires partnership between NHS providers and custodial and community-based practitioners in the National Offender Management Service (NOMS). What this partnership looks like is dependent on the nature and resources of involved services. However, what it is meant to achieve – reduced reoffending, a more knowledgeable workforce, and a more engaged client group – is clearer. It is fundamental to the OPD strategy that these outcomes are delivered through partnership so as to minimise harmful transitions between services, and to effectively share the expertise required for the holistic case management of personality disordered (PD) offenders. The paper aims to discuss these issues. Design/methodology/approach – The implementation of the OPD strategy is ongoing, and data will be forthcoming in due course that will allow for the empirical test of the hypothesis that working together is better than working separately. However, with...

Understanding, Treating and Managing Psychopathy: Moving On

This special issue of the International Journal of Forensic Mental Health Services is dedicated to the work presented and discussed at the 2nd Bergen Conference on the Treatment of Psychopathy, which took place in Norway between November 14 and 17, 2011. This conference had three objectives. First, it proposed to examine conceptual issues in our understanding of psychopathy and the relationship between this disorder and other disorders of personality. Second, the conference would consider a range of issues relevant to the engagement in treatment of individuals with psychopathy. Finally, the conference would review key programs established for the purpose of addressing the treatment of psychopathic clients. The 1st Bergen Conference on the Treatment of Psychopathy took place in November 2004, and there was a real sense in which the subsequent and much larger meeting in 2011 reviewed the very considerable progress made in the preceding eight years in all three of these areas of endeavour. All 19 keynote and plenary speakers in the 2nd Bergen Conference were selected and invited by the Scientific Advisory Board for the meeting. The Board consisted of Stephen Hart of Simon Fraser University and the University of Bergen, David Cooke of Glasgow Caledonian University and also the University of Bergen, Siri Nome and Helge Andreas Hoff of the Centre for Research and Education in Forensic Psychiatry at Haukeland University Hospital in Bergen, Tom Palmstierna of the Karolinska Institute, and Corine de Ruiter of Maastricht University. Caroline Logan, of Greater Manchester West Mental Health NHS Foundation Trust and the University of Manchester, was the Chair of the Board. In addition to speakers, poster presentations addressing the conference objectives were also accepted from researchers and practitioners in Canada, the United States, Great Britain, Nor-

Risk Formulation: The New Frontier in Risk Assessment and Management

This chapter focuses on the structured professional judgement (SPJ) approach to the clinical risk assessment and management of men and women whose sexual behaviour is harmful to others. The SPJ approach promotes the use of clinical guidelines—such as the Risk for Sexual Violence Protocol to help practitioners appraise the relevance of risk factors to the individual client and to create an understanding of that person’s risk potential, on the basis of which comprehensive and proportionate risk management plans can be prepared, implemented, evaluated, and repeatedly updated towards managed risk. This chapter makes the case that the most important part of the clinical risk assessment and management process using the SPJ approach is risk formulation—the process of generating an understanding of harmful behaviour that directly links assessment findings to management actions.

La femme fatale: the female psychopath in fiction and clinical practice

Purpose – Literature and legend features many dangerous female characters. However, in fiction (and in film), it is the male psychopath who dominates. In the scientific literature, research into psychopathy in men also dominates. Studies of the nature and treatment of this severe personality disorder in women are sparse and little is known or agreed about its presentation in this group. Consequently, psychopathy is not routinely assessed in women and the harmful potential of some can be overlooked leading to failures in the management of risk, especially towards partners and children. The purpose of this paper is to explore how psychopathic women manifest the traits of their disorder compared to men.Design/methodology/approach – This paper focuses on the representation of women in fiction who appear to demonstrate psychopathic traits. Several relevant works of fiction will be identified but three texts are described in detail and their female characters and storylines explored.Findings – Gender difference...