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Am J Psychiatry 1997; 154:448-456
Copyright © 1997 by American Psychiatric Association
On wearing two hats: role conflict in serving as both psychotherapist and expert witness
LH Strasburger, TG Gutheil and A Brodsky
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
OBJECTIVE: This article explores the clinical, legal, and ethical problems
that typically occur when a psychotherapist serves as both a treating
clinician and forensic evaluator (or expert witness) in the same case.
METHOD: The professional literature, ethics codes, opinion surveys, and the
changing economic and institutional contexts of psychotherapy are reviewed
in order to identify obstacles to widespread recognition of this
straightforward ethical issue. The processes of psychotherapy and forensic
evaluation are then analyzed so as to reveal fundamental incompatibilities
between the psychotherapist's clinical and legal functions. RESULTS:
Attempting to treat and evaluate the same person typically creates an
irreconcilable role conflict. This role conflict manifests itself in
different conceptions of truth and causation, different forms of alliance,
different types of assessment, and different ethical guidelines.
CONCLUSIONS: Although circumstances sometimes compel a practitioner to
assume the dual role of treater and evaluator, the problems that surround
this practice argue for its avoidance whenever possible.
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