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Psychological Injury and Law httosildciorg/10.1007/s12207-020-09386-7 Evaluating the Effects of Repeated Psychological Injury: an Introduction to the Special Issue Tyson D Bailey' • Lisa Rocchio 2 Springer Science+Business Media, LLC, part of Springer Nature 2020 Trauma-informed forensic psychology is an intersection of equilibrium or stasis" (p. 4). Although one event can be suf- two specialized practice areas, both requiring advanced ficient to create lasting distress, the effects are exponentially knowledge and a continually evolving understanding of psy- magnified when the trauma is repeated (particularly in child- chological and legal constructs (Dalenberg, Straus. & Ardill, hood), involves a betrayal of a trusted relationship, and/or a 2017; Frankel, 2009: Frankel & Dalenberg. 2006). In essence, persistent sense of anticipation about the impending abuse functioning effectively in the psycholegal world requires one (Ford & Courtois, 2020: Ten•, 1991). In addition, those indi- to maintain a bicultural stance that navigates systems that are viduals who have experienced complex trauma are also at not always compatible. Given the high prevalence of traumat- increased likelihood of interactions with the legal system. ic events (see articles in this section for review), forensic prac- Given these considerations, forensic evaluators are encour- titioners are quite likely to be asked to evaluate individuals aged to understand the literature for individuals with complex who have experienced trauma and its effects, whether or not it trauma on their likely biopsychosocial outcomes, diagnoses, is known to the person requesting the evaluation. Further. and performance on various assessment measures commonly experiencing trauma increases the risk of myriad problematic used in practice. It is also critical to understand that effective outcomes, including involvement in the legal system forensic evaluations rely on multi-measure and multi-source (Dalenberg et al.. 2017). Unfortunately, encounters with the corroboration and include measures that are specifically legal system do not follow a trauma-informed process. nor are nonned on trauma exposed populations. they meant to be therapeutic. Even when one experiences a Given the complexity of cumulative trauma exposure hoped-for outcome, such as a Suction in sentence, drop in (Briere, Dietrich. & Semple. 2016: Briere, Kaltman, & charges. or a monetary award, the legal process frequently Greene, 2008). survivors of repeated interpersonal trauma exacerbates symptoms. In a forensic context, where a motiva- may appear to be feigning or exaggerating symptoms on com- tion might exist to misrepresent levels of psychological dis- mon psychological measures, even when they are not (Brown, tress, the issue of malingering or feigning symptoms must be 2009). For example. research has demonstrated how a history carefully considered and assessed. Therefore, the assessment ofcomplex trauma and dissociation can result in elevations of ofresponse style necessitates a careful and thorough approach the validity scales ofcommon personality measures, as well as to each evaluation (Brown, 2009; Dalenberg et al.. 2017). stand-alone symptom validity measures (see Brand. Schielke, particularly when complex posttraumatic presentations are & Brams. 2017; Brand• Schielke, Brains, & DiComo, 2017b present. for a review in forensic evalutions). Unfortunately, training Ford and Courtois (2020) define traumatic stressors as programs do not regularly provide information on complex those "events, experiences, and exposure—that greatly exceed posuraumatic reactions and many textbooks inaccurately de- the individual's capacity to control, cope with or withstand scribe dissociation and the effects of repeated trauma (Brand, and that compromise the individual's psychophysiological 2016: Kissee, Isaacson, & Miller-Perrin, 2014: Simiola, Smothers, Thompson. & Cook, 2018; Wilgus, Packer, Lile- King, Miller-Perrin. & Brand, 2015). Tyson D Bailey TysoneDrTysonBailey.com Private Practice. 19221 36th Ave W. Ste 208. Brief Case Example Lynnwood. WA 98036. USA Private Practice. 1524 Atwood Avenue. Suite 222. Shortly after becoming licensed, the first author conducted a Johnston. RI 02919. USA forensic evaluation in which a person had been diagnosed Published online: 20 June 2020 421 Springer 3502-026 Page I of 4 EFTA_00001634 EFTA00156975  Psychol. Inj. and Law with a personality disorder not otherwise specified by a pre- dissociation. Given the ubiquity of trauma. particularly within vious forensic evaluator. The results of this decision led the the legal system. it is important for forensic evaluators to have prosecutor to seek the maximum penalty for alleged offense. a fine understanding of the science, application, and debate When reviewing the other psychologist's report and data. within the field. which utilized two common personality measures, a semi- A central point in the special issue relates to the trauma structured interview, and limited record review, it became victim's assessment process. It is critical to note that forensic apparent that the examiner did not ask about trauma history evaluations need multi-source and multi-measure corrobora- at any point during the interview. Upon reexamination, the tion: much like an effective study. a single point of data is of first author learned that the individual had been repeatedly limited utility. Comprehensive forensic evaluations therefore traumatized, and that the trauma included experiences of sex- require review of external data sources, collateral interviews, ual and emotional abuse as a child with multiple familial per- psychological testing utilizing measures that assess for re- petrators. Utilizing trauma-informed measures and proce- sponse style and malingering, and a clinical interview. For dures, the data supported the diagnoses of chronic PTSD example, behaviors reported or observed during the evalua- (complex PTSD was not yet in the diagnostic nosology) and tion that may be associated with a traumatic or dissociative dissociative disorder NOS, rather than a personality disorder. response will need to be considered in light of all of the data. Further, while discussing his experiences during the previ- Without additional supporting information, a single observa- ous evaluation, the evaluee described becoming triggered dur- tion or report is not considered sufficient information upon ing the interview and repotted that there were no efforts made which to draw a conclusion within a forensic setting. to help him to manage or reduce his distress. His description Within the seven articles contained in this section. the au- of the experience had the markers of depersonalization and thors explore a variety of issues relevant to performing derealization, which was consistent with the results of the trauma-informed forensic psychological evaluations. Bailey assessment measures. In addition, the previous report and Brown (2020) provide an overview of key diagnostic contained no statements suggesting that the previous psychol- challenges associated with complex trauma, complex post- ogist recognized the behavioral indicators of potential intro- traumatic stress disorder, and dissociation within a forensic sive or dissociative symptoms or the potential relevance of a setting. They provide valuable information that is critical for trauma history to the individual's psychological functioning the forensic evaluator to take into account when assessing an and mental status. The report instead strongly asserted that individual who has experienced trauma. Rocchio (2020) re- these behavioral indicators supported the personality disorder views ethical and professional considerations and potential diagnosis despite only having a single. moderate relevant ele- pitfalls for forensic psychologists. She addresses psycholo- vation in the assessment data. When his test results were com- gists working in various forensic roles such as conducting pared to research that has been conducted with severely trau- forensic evaluations, providing scientific framework testimo- matized samples. the evaluee's scores and responses, includ- ny, or consulting with attorneys. She also highlights the spe- ing those on a stand-alone measure of symptom feigning. cific applications to trauma-informed forensic evaluations. resulted in valid profiles. Unfortunately, cases like these are Brown (2020) addresses the complexity ofevaluating a sexual common in both authors' experiences, and it is our hope that harassment plaintiff who has a history of complex trauma the scholarly works in this special section increase the under- exposure. She discusses the concept of reasonableness in standing of complex posttraumatic reactions in forensic terms of the sexual harassment claim and highlights populations. important considerations for therapists who have a client involved in a lawsuit claiming emotional injury. Dalenberg. Brand, Loewenstein, Frewen, and Spiegel (2020) provide a The Current Issue final response to a series of articles in the present joumal discussing the forensic applications of complex trauma litera- This special section is intended to provide an overview of key ture. In their response. they highlight critical areas of agree- ethical, practical. and assessment issues that are imperative to ment as well as recommendations for future scientific work on consider when contemplating forensic practice with this com- the issue. plex trauma population. Our goal is to provide evidence-based Abu-Rus, Thompson. Naish. and Dalenberg (2020) pro- information that will be useful both for the forensic practition- vide preliminary information on the development of a validity er wanting additional training in the area of complex trauma scale for the Dissociative Experiences Scale, a screening mea- and dissociation and for the trauma practitioner seeking con- sure commonly used to assess dissociative symptoms. tinuing education in the area of forensic practice. The infor- Ellickson-Larew, Escarfullert, and Wolf (2020) provide an mation also should be widely disseminated in the legal sys- overview of the dissociative subtype of posttraumatic stress tem, for example, to prosecuting attorneys and to judges who disorder, including evaluation strategies and recommenda- might have to deal with cases of complex PTSD and tions for future editions of the diagnostic and statistical 4 Springer 3502-026 Page 2 of 4 EFIA_00001635 EFTA00156976 Psychol. Inj. and Law manual of mental disorders (DSMs). Finally. Loewenstein's to the commonplace nature ofunspeakable acts perpetrated on (2020) article provides a comprehensive case study of an others. Although the number of professional organizations evaluee in a criminal case who experienced severe dissocia- directly dedicated to the study of trauma and its sequelae cre- tion and also malingered some aspects of her presentation. ates significantly more difficulty with collective amnesia, This article provides a clear example of the extensive process there continues to be debates about the extent and effects of a trauma-informed forensic evaluator utilized to determine trauma, particularly in cases that involve complex posurau- whether a client who met criteria for dissociative identity dis- matic or dissociative symptoms. It is our hope that special order was competent to stand trial and could bear legal respon- sections like these increase the scientific discourse, particular- sibility for her actions. ly within trauma-informed forensic psychology. It is also crit- ical to note that if a person has trauma (single incident or complex) and postuaumatic reactions, they can also be held Future Directions and Conclusions criminally responsible, engage in feigning. be deceptive in their responses, or affect any of the other important issues Although significant gains have been made in understanding evaluators will encounter in the forensic realm. In the end. complex posttraumatic reactions, more research and scientific forensic evaluators must focus on providing an opinion that discourse is needed. It is imperative that individuals who have is consistent with the data, to a reasonable degree of psycho- experienced complex trauma are included in research studies logical certainty, and the triers of fact will determine what to assist forensic evaluators in understanding assessment mea- evidence is the most informative for their decision-making sure responses. possible treatment recommendations, and ef- process. Psychologists have a crucial role in this regard in fective strategies for gathering information in a trauma- providing probative rather than prejudicial information to the informed manner. While maintaining objectivity has been court, and especially for cases that are hard to disentangle held as the standard within forensic psychology, it is critical psychologically and legally, such as in cases of complex trau- to understand that it is not possible to be completely free of ma. dissociation, and PTSD. as presented in depth in the pres- bias (Gowensmith & McCallum, 2019; Sue. 2010). ent special issue. Interestingly, research has shown that forensic evaluators of- ten conceptualize themselves as immune to the effects of bias but readily identify their colleagues as having significant problems (Neal & Brodsky. 2016). This is not to say there is not a distinct role that evaluators inhabit in a forensic setting: References however, despite the systemic pressures on the forensic eval- uator, it is possible to clearly communicate one's role, provide Abu-Rus. A.. Thompson. K. 1, Haiti. B.. & Dalcnberg. C. J.. (2020) Development of a validity teak for the dissociative experience an opinion that is consistent with the data (even if it is not scale-revised: Atypicality, structure, and inconsistency. favorable to the referring party. to the evaluee. as the case may Psychological Injury and Law. be), and maintain an empathic stance (Mulay. Mivshek, Bailey. T. D. & Brown, L S. (2020). Complex trauma: Missed and Kaufman. & Waugh. 2018). misdiagnosis in forensic evaluations. Psychological Injury and Law. With the inclusion of complex PTSD in the International Brand. B. L. (2016). The necessity of clinical training in trauma and dissociation Journal ofAnxiety and Depression. 5(4). hups://doi. Classification of Diseases-II (ICD-11: World Health org/10A17212167-1044.1000251. Organization. 2018). it is anticipated that research exploring Brand. B. L.. Schielke. H. J.. & Brains.). S. (2017). Assisting the courts the unique phenomenology. assessment results, and treatment in understanding and connecting with experiences ofdisconnection: of repeated, inescapable trauma will increase in the corning Addressing trauma-related dissociation as a forensic psychologist. pan 1. Psychologinsl Injury and Law. 10(4). 283-297. hups://doi. years. We encourage researchers to design studies that do not org/10.1007/s12207-017-9304-8. exclude chronically traumatized samples and look beyond Brand. B. L. Schielke. H. J.. Bran J. S.. & DiComo. R. A. (2017). how many categories of trauma have been experienced. 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