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Hey folks, welcome back to [00:01:00] The Testing Psychologist. Glad to be here as always. Today, I am particularly excited about this conversation because we have a returned guest, Dr. Brenna Tindall. She’s been on two or three times before.
She is a psychologist licensed in Colorado, Hawaii, Oklahoma, Wyoming, and South Dakota. She is certified by the Domestic Violence Offender Management Board and the Sex Offender Management Board to complete court-ordered evaluations. She is also a Certified Addiction Specialist and a Board Certified Clinical Sexologist.
She works as a blind expert in criminal trials, completes various types of evaluations, consults on legal cases, and works on Domestic Relations cases as well as civil lawsuits.
Brenna is here to share her perspective largely from the forensic world on the wide variety of approaches to assessment that she has seen and the implications thereof. So [00:02:00] she comes from a perspective where the evaluation results can become a matter of life or death in these trials. She has observed and found many different approaches to the evaluation process, some better than others.
So our conversation today just gets into some of the more common “errors” that might show up in an evaluation along with ideas to stay on top of best practices. This episode is not meant to scare you by any means. It’s just a reminder of the incredible weight that we have as evaluating clinicians and some of the ways to make sure to stay on top of your game.
Now, speaking of staying on top of your game, at least business-wise, I am recruiting for the next cohorts of The Testing Psychologist mastermind groups. Those will start in January 2025. There are cohorts for beginner, intermediate, and [00:03:00] advanced practice owners. So if you are a business owner and want some support and accountability, these groups might be for you. You can check out more information and schedule a pre-group screening call at thetestingpsychologist.com/consulting.
But for now, let’s get to my conversation with Dr. Brenna Tindall.
Brenna, hey, welcome back.
Dr. Tindall: Thank you. Thanks for having me.
Dr. Sharp: I am very glad to have you. I’m always glad to chat with you. You’ve always got interesting things on your mind to share with us and tales from the forensic world. I’ll start with the question I always start with, which is why this topic in particular is important [00:04:00] and why reach out about it now.
Dr. Tindall: As you pointed out, I’m in the field of forensic or criminal psychology and, the standard of making sure that you’re crossing T’s, dotting I’s, is honestly higher than a lot of the other areas. It should be high everywhere, but when you’re held to the fire when you’re sitting on the stand or having other people critique your reports or whatnot, it’s just something that becomes a much more prominent issue than in regular day-to-day practice where sometimes if there’s ever aberrant ethics questions that come up in normal clinical practice, they’re all based around some of our basic like duty to warn or confidentiality. And so the field that I work in, it comes out a lot more.
For me, [00:05:00] I’ve had issues where people have grieved my license in the past. I’ve had to deal with some of those things and look at them. None of them have been founded, thankfully but just staying on top of my game. You and I were talking that I feel like that those of us in this field in particular sometimes forget the level of responsibility that we have with the amount of power that is handed over to us by the court system.
I’ve spoken about this before on your podcast as well as another one, which is that the world of the criminal, the domestic relation, the civil worlds have all come down to expert versus expert, and it has become even more important to me to make sure that what we’re sharing, what we’re doing as a profession is reflected ethically and professionally, because every time we do something, the ripple effect on someone’s life and a family’s life is something you can’t measure.
[00:06:00] Dr. Sharp: That’s well said. It’s funny, I was wrestling with the title of this podcast and I still don’t know what we’re going to call it, but ripple effect is one, and professional responsibility is one. Just getting at this idea that the work that we do is super important.I think it can be easy to forget that sometimes, we are literally altering people’s lives with the work that we do, and at the same time, we do it day in and day out, and there are things that maybe slip through the cracks consciously or unconsciously. We have a lot of responsibility to do the best work that we can.
You’re coming from the forensic realm which is super high pressure, but even for those of us in normal private practice, we’re making diagnoses and recommendations that set people on a trajectory for years sometimes and help them develop identities and ways to [00:07:00] think about the world. We have a lot of power
Dr. Tindall: I do think that maybe my humility sometimes can get in the way of me understanding the power that’s being handed to me, because I want to think I’m not that important, what I do is not going to have something that significantly.
I know when we had talked before I said I think even people who work in the non-forensic normal world need to have this always reminder that things that they’re doing, like you said, in an assessment, for example, if they’re putting down a diagnosis or whatever, me on the other end of it as a forensic psychologist, I’ll be getting records.
For example, I have a case. The guy’s 30-something and he’s facing life in prison for something. I have tirelessly worked to get all of his records from his childhood, from his school, all of these different things. I don’t think sometimes people understand when they’re taking therapy notes or they’re writing assessments, how important it is to get that [00:08:00] information accurately, because then I might be using it or other people might be using it in a case to either provide some mitigation or to help figure out should they go into a court-ordered treatment program that has providers that work with intellectual disabilities.
The risk assessments I do, some of them are normed on people that have normal intelligence, some are not. And so you have to do different risk assessments for people that have an intellectual disability. So if people are being, I don’t want to say frivolous, but not as careful as they need to be, there’s a lot of impact on it. I think when you’re in your little office with your shingle, I’ve been there myself, it’s hard to remember.
I think that I didn’t really realize that the burden of proof was higher in forensics until I took my licensing exam in South Dakota. It was on a Zoom panel with this group of people that were on the board there. It was mostly jurisprudence questions, but there were actually clinical situations.
[00:09:00] It was funny because after a little bit, they were like, listen, we’re good. We don’t even know these things you’re telling us because I was like, well, with this case, you have to think about this, you might want to consult and there’s this dynamic. Actually, there’s a legal statute that says this. They were laughing and they finally were like, you’re good. We got it. We don’t even know the answer to those questions.Clearly, because of what you do, it’s a different space and so I think that me myself realizing that anything I say because of the credibility I’ve worked really hard to try to get in this field is taken way more seriously than you can imagine. So even in phone calls, I have to be very careful because people will go and say, Dr. Tindall said this, she said this.
And so every email I write, even a text message, every phone call, it has to be very careful about what I’m saying, because if I just make an offhanded comment and they use that and just drop it in conversation [00:10:00] in a legal case, it could be a problem.
So I think the first part of my point in doing something like this is to say, this is a learning process for me. I’m not here to say, oh, everybody’s unethical and I’m perfect; it’s more that because of the field I’m in and because I’ve worked very closely with my lawyer for my practice and making sure that I’m covering my bases and also figuring out other ways to cross-reference and check myself because I’m just recognizing the burden of responsibility I carry when I go into court and say something about research, that everyone’s going to believe that everything I say is absolutely true because I’m an expert being endorsed on the stand and that is very important to me.
Dr. Sharp: I’m right with you. That humility thing is a good point to bring up. I struggle with that too. I would imagine a lot of people out there also wrestle with that. It is tough to step into that expertise and [00:11:00] acknowledge or own, hey, everybody’s going to take this really seriously. I’m maybe more important than I want to give myself credit or people are going to see me as more of an expert than I think I am.
I’ve seen that, it sounds similar to your experience, born out many times over the years now, just doing it long enough where folks will come back and they’ll say, you said this back in when 2012 in this report, when we talked, or whatever it may be. People really hang on to things that we say.
In forensic realm, high pressure I suppose, but it’s even as simple for me as remembering that a lot of people read these reports. So if we’re evaluating a kid, that’s going to at least go to the parents, probably go to the school, probably go to other providers working with that kid for the next however many years. The kid [00:12:00] themself is going to read the report at some point probably about their own evaluation. And so keeping that in mind, looking through that lens, it sounds paranoid but it also makes a lot of sense
Dr. Tindall: I raised a review with the release to get an evaluation that your office had done a while ago. I think the individual is 15 or 14 now. I think that your office had done it when they were nine or something, and it’s really important for the current situation.
I think what people don’t realize in a normal clinical practice is that particular evaluation, let’s just say hypothetically, had been because that person was in the court system and gotten arrested and it was needing to have because of one reason or another, maybe it would have prevented the said juvenile from going to jail because it showed X, Y or Z.
So that’s where it’s this [00:13:00] crossover where even people that don’t do criminal work or forensic work, it does cross over because I am definitely the person that’s always getting those records. Prosecutors are pulling records. They’re subpoenaing therapists.
The point of all of this comes down to this case I recently did. It’s a civil lawsuit. The question at hand was teasing out the PTSD diagnosis to such an extreme minute fashion that I don’t even think there’s an answer to it about does PTSD present like this or this?
And it’s like, how do you get this answer when we live in a world of ambiguity? The DSM-5, it’s great as a guide but at the same time, we know it’s changing all the time and when new changes happen, they don’t go into effect for a while. So you get clinicians who are using the DSM-5-TR, but then there’s research out there that’s more current that is probably going to change that particular diagnosis and the next thing.
And so I [00:14:00] think the world of forensics requires that we’re on the very cutting edge of what research is coming out. I have to be up on a literature review as much as I possibly can, because if I’m getting old information in court trial or whatever, in a deposition for a civil lawsuit, it can impact things a lot.
You and I were talking about there is not a good guide or rule book for a lot of the situations that you might encounter or I might encounter because we have these ethics code that we follow. And then there’s forensic guidelines that are aspirational. You can’t get a straight answer from just about anybody.
I’ve called the Colorado Psychological Association line that they have where they can give some feedback about ethical questions but in my case, most of the time that I call, they’re so great, but they’re like, man, that’s even more than we even know.
And so then I’ve had to figure out, oh, you can actually call [00:15:00] your malpractice insurance. They have legal counsel because it’s in their benefit to make sure they’re advising you. Every practice should probably have some mental health legal counsel on retainer because of the things that come up.
Dr. Sharp: Agreed.
Dr. Tindall: You get the duty to warn. I have been told by many lawyers that that burden always goes against the clinicians in court trials. I remember this one lawyer called me and he said, hey, I just want to tell you, I just finished this trial from this psychologist and I want to tell you heads up, you need to report more often than you think you do and you need to say something more often, even if you think it’s this finite, it has to be immediate, it has to be whatever.
And it got me a little bit jarred with that. And so whenever I have that now, I definitely consult with my lawyer, but it’s a little frightening when you’re like, well, we’ve been taught that here’s the data that we have to decide about releases of information, this is how we do about duty to warn or suicide checks but in reality, that may [00:16:00] not necessarily hold up in a court of law if we’re under hot water for something that may have happened.
Dr. Sharp: Sure. I want to get into some specific situations that you have seen over the years that we might need to be aware of because you occupy an interesting role that not many of us formally occupy and that is you are hired sometimes to go through other reports and pick them apart. Is that right?
Dr. Tindall: They call them rebuttal experts. In general, I try to stay away from the expert and the only time I ever have agreed to do them is when I feel like there is such a significant issue with it that it’s impacting somebody’s life in an unalterable way. For example, custody being taken away from somebody. [00:17:00] I try not to do it because I think it’s hard enough to do what we do that they should be frivolities.
What’s a little bit tricky, though, Jeremy, is that in my field, and I’ve talked to my lawyer about this because normally when we have an ethical concern about somebody, the idea is to try to go to the person informally and say, hey, here’s the situation.
What I found out most recently was, I had a scenario where I was reading somebody else’s evaluations because there were some concerns that they weren’t done properly, I’ll go into that a little bit more but I said to my lawyer, I was like, listen, I feel like out of professional courtesy, I would like to contact this person first and be like, hey, listen, this was wrong. Maybe this is not what was supposed to happen based upon this.
Unfortunately, because of the way that I was hired as a privileged work product for an attorney, for a client, I had to produce the report that laid these out first, and then the next step would have been to contact her. It’s almost like it’s too late at that point because they’ve received the report with the [00:18:00] criticisms.
I want to make it very clear, I do not think that I’m perfect. I know I have had people do rebuttals on my reports as well, which is always hard to get feedback about things that you do. I try to put measures in place to prevent that in terms of consulting. I have a whole stable of people that I consider experts in different areas that I consult with, that I get releases so they can read my reports. And so for me, I’m always like consult, make sure people are reviewing your work, running questions by experts to make sure that that’s the right course of action.
I definitely don’t like to do the rebuttal stuff, but if it’s egregious, I feel like it’s important for somebody to be a gatekeeper and say, you just ruined somebody’s life because you did not do what you needed to do properly. So I think that’s a little bit harder to do.
It’s also required me to be up on the ethics code to a finite degree as well as all the [00:19:00] jurisprudence issues. I’m licensed in five states now. And so having to take those jurisprudence exams in each state too, is also this huge reminder of what the law is and that there’s so much ambiguity in it as well. And then there’s the forensic guidelines too. So it’s cross-referencing what are our ethics codes say. And then what do the forensic guidelines suggest?
And then on top of that, some of us are in the forensic world, we have other certifications. So we have the Sex Offender Management Board and they have rules and guidelines, then we have the Domestic Violence Management Board rules and guidelines. I’m a certified addiction specialist through DORA, so I have those rules and guidelines.
It gets a little tricky because whose fidelity is most important? So I can get a sanction from the Sex Offender Management Board for writing about something that I’m required to do as a psychologist, but it may not be in compliance with their particular like view on the matter. It is a tricky thing to say what certification holds the highest burden [00:20:00] when we’re doing and making ethical considerations. And that’s really hard.
Dr. Sharp: That’s a great point. Just as a quick sidebar, I always forget you do so many things, but you’ve got all these different certifications and licenses and so forth. Have you gotten a good answer on how to navigate that? When one regulatory board trumps another and how you rank order each one?
Dr. Tindall: I just sent an email or called my lawyer, Kari Hershey, who’s amazing and asked her to help tease through it because ultimately once she gives me the advice on what to do, there’s a bit of protection I have because my legal counsel is telling me to do this. In the past, I had a duty to warn because of a situation where someone had told me that the next cop they came upon, they were going to shoot and kill and then die by caught by suicide.
So think about [00:21:00] that. I don’t know when they’re going to get pulled over. They could go their whole rest of their life without having contact with the police officer potentially but it was a pretty direct threat. If it was like, oh, if I get sentenced to prison, then I’m just going to right there kill the judge, when that happens, it’s like, what is the what’s the confidentiality there?
I consulted with, I don’t even know how many people. I spent an entire day asking around. You may have even been one of the people I called. I called the Colorado Psychological Association line, I called my malpractice insurance, I had to wait till later to talk to my lawyer, and everyone had a different opinion about whether I had to make a call and do something about it.
Ultimately, my lawyer, she always says, I’d rather make the call if it’s on the border and then defend you on the stand for confidentiality as opposed to having to defend you because someone got murdered and you didn’t do anything about it. So that burden of doing no harm, which it says in the APA ethics code about professionals [00:22:00] will do their best to resolve when there’s those conflicts between maybe the law, for example, a legal statute, and then what the ethics code says.
And so at the end of the day, my lawyer said, this is what I want you to do. I do think this is enough for you to report it, but I’m going to write out the statement and put it in an email that this is what you were to say when you call the police specifically, you were to say that I’ve advised you to call, and then if something happens, it falls back on me.
It was very specific in terms of how she wanted me to word it so that it wasn’t giving up too much confidential information. She wanted me to call the attorney for the client to give them a heads up. They weren’t too happy about that. My duty was, whether they’re upset or not, I had to follow the advice of my lawyer.
I think that that’s something that’s pretty important to have in these scenarios. It certainly helps if I say, oh, I called Dr. so and so, I called this line and they all had my back, but at the end of the day, you know as well as I do, there’s only so much protection from that.
Dr. Sharp: Of [00:23:00] course. I do want to talk about some specific scenarios. I appreciate that you are owning that this is not meant to be, we talked about this, a slap on the wrist for folks or anything like that, or a finger-wagging situation.
I think we’ve all probably been in situations where folks have taken issue with some of the work that we’ve done and nobody’s immune to that, but maybe we start if you’re willing with some of those stories. You said that your license has been grieved before. I’m curious what some of those things might have been and then we can go into some other situations that you’ve seen as far as work that may have been a little off base.
Dr. Tindall: No, I have no problem. In some respects, it’s good to have people file complaints against you because it makes you go back, look, [00:24:00] double check and make sure that the things that maybe are being said aren’t actually true or whatnot. To be honest, the three grievances I’ve had have come from professionals. Knock on wood, I’ve never been grieved by a patient.
In the criminal forensic world, there’s a lot of competition. And so at least my lawyer’s assertion was there. There were some components of trying to file things against people to get them in trouble for competitive reasons. I’m not giving that opinion myself. I’m just saying that there was some discussion about that.
The very first time it was a disgruntled employee who we could not advance in certification and got upset. In the process of doing the grievance, they put confidential information in the grievance and it became apparent that it was just to get back at me.
So the [00:25:00] accusation, there wasn’t anything of merit in there. Luckily it was dropped. It definitely was jarring for me as a professional. I don’t know if you’ve ever been grieved, but for anyone who ever has, it’s your whole life. You’ve worked your whole life to become a doctor.
I’ll never forget it. It’s like your whole identity is challenged about who am I if I’m not a doctor or doing this work. And so I think that was good. The allegations were I wasn’t doing supervision properly, or that I was using tests that were outdated or something. And so it’s good to double check those things. I had measures in place that were able to show that that was not true.
Then the second one, I had testified in a criminal trial. I had co-written a report with another very awesome psychologist. Half the grievance was about her testing. The person said that the Rorschach scoring had been done wrong but [00:26:00] that person didn’t do Rorschach and so they didn’t know there were two scoring systems. And that coding scoring had been done wrong.
And so it was a funny thing because the grievance was against me, but 90% of it was about the testing. One of the complaints was that it was not appropriate to have two psychologists doing an evaluation. And so in that case, I reached out to the assessment professor in a doctoral program and asked him, I said, is there any issue with this? And he said, two brains are better than one.
I have a general rule, I like somebody else to do the testing so that I’m not confirming a hypothesis. It keeps it a little bit cleaner for me because when the stakes are so high and maybe I’m going in with a hypothesis that this person, I think they had an intellectual disability, it could taint testing in some respects. And so I have somebody else do it. It was in my office at the time, and then I analyze it as well and [00:27:00] then integrate it.
And then the other issue was that I had called Harlow’s Monkey studies. It was about trauma bonding. When I was testifying, I’d said something that he was engaging in animal abuse of some sort. And that was true. I was like, he put it monkeys in a pit of despair and didn’t let them have attention. I think that that’s abuse.
So those were the items. The funniest part of this grievance was that she’d reached out via email and said, “Hey, I have these concerns.” I was like, great, that’s fine. Let’s meet for coffee to talk about them. Never heard back from her but then the grievance said, “I reached out to Dr. Tindall to talk about these complaints, but her response was, let’s have coffee to talk about them. I just thought that was a sign she wasn’t willing to take my feedback. So I went ahead and filed it.”
Dr. Sharp: Oh.
Dr. Tindall: I don’t know what the appropriate response would have been. Do you have any ideas? I don’t know.
Dr. Sharp: Good question. I don’t [00:28:00] think so. I probably would have said the same thing.
Dr. Tindall: Licensed to go out for a drink instead or I’m not sure.
Dr. Sharp: Right. It should have been happy hour.
Dr. Tindall: So that one luckily went away. The third one was from, there was a facility that was not treating a kid very well and everybody that was involved wanted my input, and to talk to the kid, and it was confirmed.
So in coordination with the prosecutor, the guardian in light of the probation officer, we went to the judge to talk about our concerns about this particular kid. The judge wholeheartedly agreed and pulled the kid from the facility.
The biggest thing was that they hadn’t made a report of sexual abuse that he had disclosed, which is a big deal in my mind. Once the kid was pulled, and I knew when it happened, I knew that they were going to file something and they did.
[00:29:00] They made some assertions of things, which were absolutely false. Luckily, I had the prosecutor, I had multiple people write letters to DORA with my lawyer’s help that said, look, we all were in line with this. This is what happened. It seemed like these grievances against me were more on the expert versus expert situation.But that being said, they jar me. They are very jarring, but in some respects, then I’m like, okay, it’s a good reminder to check and balance yourself. I’m always afraid that’s going to happen because you never know. It’s very easy to misspell a word or something.
And like I said, you don’t normally in most situations, if you’re writing a report I would imagine, hire somebody to rip it apart or to google you and find out anything online that they might use to prove that something you’ve done is not okay. And so that’s where it’s like, okay, I’m [00:30:00] very appreciative of that level because I think it keeps me up on my game and it keeps my work product as good as possible, but there are these issues that come up repeatedly that you’re like, there’s not a good answer to this.
You asked for specific examples, one of them in particular that comes to mind was somebody had done an evaluation, it was in a custody situation, but on the father and on the mother at the same time. I don’t mean a child family investigation or parental responsibility but an evaluation to determine stuff like domestic violence, anger management, and whatnot. The court had specifically ordered domestic violence valuations for both parties.
I personally don’t think it’s the right thing. I’m not saying it’s unethical, but I don’t think it’s appropriate in that setting for one person to do both evaluations, and that is what occurred, but from the outset, they called one a victim assessment and the other an [00:31:00] offender assessment. And neither one had been charged with anything.
And so from the get-go and tell me if I’m wrong, it seems like that’s deciding innocence or guilt when both were ordered to do the same thing. As a professional, it may not seem like that when I’m like, oh, this seems like this person’s being more victimized than this person. It’s not our job to make that determination and then do separate testing in my mind.
I’m not going to go with my opinion. I consulted with a thousand people on this. There were some people that said, oh, it’s actually a legal statute that you’re not supposed to evaluate two people in the same scenario. I couldn’t find a legal statute related to that.
I think the ethics code talks about multiple relationships and making sure there’s no subjectivity in that and they’re doing no harm, there’s no multiple relationships, et cetera. You tell me what you think, what’s your opinion? I’m curious if you think it’s okay in a scenario, especially where there’s custody on the table and it’s contentious to do an evaluation [00:32:00] on both parties involved.
Dr. Sharp: I’m not an expert in this area, but outside the context of a CFI, a PRE or something like that, I have seen it done in those cases for sure but just as a normal independent evaluator. There’s the layer of evaluating two people from the same family that can get really tricky. We’ve seen that get tricky, but then the bigger thing for me is the bias that seems to have been present from the beginning and not starting from a blank slate as we hope to do.
Dr. Tindall: I don’t know that it was mal-intentioned or anything, I think that it goes back to this idea that with the power that the court system gives mental health professionals, doctors have to be so careful because maybe that person didn’t understand that the impacts could be somebody losing custody of their kid because we have so much clout [00:33:00] and it is; they rely on experts now to make these determinations.
They could impact a trial one way or the other. They could impact the course of someone’s life. I personally don’t think that’s the way it should be. It shouldn’t be just one person’s opinion, one person’s report that shifts things that dramatically. It’s a little bit frightening, but it’s the best I think that we have at this point.
For me, I feel really bad and I feel really guilty for having to point these things out because it does come off as me being, I know better. It’s why I take such care when I do it. I can’t even tell you how many people I consulted with or had, with permission from client and lawyer, to have review even my write-up to make sure that I was on board. I don’t want to ever do something that’s not in line.
When I’m doing some rebuttal report, I am very objective. I cite the ethics code. I cite the law. I do not make any emotional things in there. I’m very specific. And so there were some assessments that were used that were outdated or [00:34:00] that weren’t done completely accurately.
There’s one, it’s like the danger assessment and it’s supposed to be in tandem of this self-report in interview part, but then it’s supposed to be accompanied by a 12-month log of data points that the person’s supposed to keep. I’ve now seen it twice given and then used to say, oh, this person’s a high risk or they’re whatever without doing this 12 month of like of data points from said client. That’s a big difference. It’s just this little discrete 20 questions, I think it’s 20.
Or someone using the MCMI-III instead of the most recent version, and then the court was using that MCMI-III in the write-up about it to make some big decisions about what it said about the client. And so I just feel like if people respect that you know what you’re talking about and you’re doing an outdated assessment, it’s going to feed false information.
So I definitely think the assessment use is important. I see people use risk [00:35:00] assessments on clients that they’re not normed on. The risk assessments, they’re not normed on women, for example. Both of domestic violence and sex offense, there’s nothing normed on women. I still see people score them on women and it just overestimates the risk and doesn’t speak to what the research says.
And then the other part of it is citing research that’s old and inaccurate. It’s just that comes up a lot. And that research is something that impels people to make decisions. And so if people are not doing a really good literature review, asking other people for resources, or reaching out to experts who are the ones doing it, you can really mislead people. Do you agree?
Dr. Sharp: Oh, 100%. I don’t want to say that I’m immune to this. I’ll keep coming back to that theme like these are all mistakes that are easy to make.
I think we’ve all probably had the experience where we read that one article or that set of articles in graduate school and they stuck with you, [00:36:00] and you go back to that. It’s just a good reminder that we have to stay on top of our game and be deliberate about the decisions that we make.
This whole discussion makes me think a lot about cognitive dissonance and the motivation or awareness around some of these decisions for folks. I’m curious, this is a total philosophical question, but I’m curious for you, do you get the sense that folks are deliberately practicing in a way that may not be totally up to date, or right in line with the standards, or is it slipping through the cracks, falling into old patterns and not changing?
Have you been able to figure out any reason for some of these?
Let’s take a break to hear [00:37:00] from a featured partner.
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Dr. Tindall: I never want to believe that anyone is doing something like that maliciously. There was just this CFI person though that, I don’t know if they got charged or something, because I think that they didn’t even have a [00:39:00] psychology license and had been misrepresenting themselves. That’s an extreme example. It’s ridiculous.
There was a facility that was shut down in Denver. I think it was shut down or they closed, but there were two people that were running it. They were pretending to be doctors. They were literally making medication changes and stuff. That sounds outrageous, come on, but those might be more on the fringe.
To answer your question, I would say the first part is that back to how I started this, which is, I don’t think people understand the impact of their actions and that what we do carries more weight than we think it does. And not always, but it could, even if you’re in non-forensic settings. I can’t tell you how many therapists I have to call that have done normal therapy with people that they’re trying to get records.
In other states, if there’s a victim, a lot of times they’re able to get all the alleged victim who’s accusing people, their mental health records. Colorado disallows it almost always. I don’t think I’ve ever seen that approved, but if you’re writing up notes of somebody who’s [00:40:00] been reporting in the past one thing or another, those could be subpoenaed.
Understanding that the privilege we have in people’s trust in doing this work, that there is a high level of responsibility that requires higher checks and balances than we all use sometimes. The second thing is that we are all overloaded and it is difficult.
Who has the time except for people that are required to do it? I suppose you just make time to be up on every single research. I still can’t, but I sure try because there’s nothing that terrifies me more than going into court and citing inaccurate information that is inaccurate and influences jurors in the wrong direction or getting ripped on the stand because I’m using old research that’s not true. That’s also pretty horrifying.
I think people are busy and it’s hard to take good progress notes. I see treatment records all the time for guys that are discharged from [00:41:00] court-ordered therapies or probation records and you can see the errors of like, oh, this data point here was not entered accurate to here.
I don’t think it’s intentional. I think everyone just gets busy and it’s really hard to be perfect. Unfortunately, the consequences are much braver in the forensic world.
I think the lack of oversight sometimes and having a lawyer on staff or having people to consult with instead of worrying alone is, a phrase I remember someone using, where instead of asking every other people for their opinion or getting some feedback from other people, we can start to just do things the way we’ve always done them or the way that we think is best. And that’s never a good idea in our field, to be honest.
I think it’s just not paying careful attention to details most of the time, and that requires a lot of work to make sure that you’re up on the most recent standards. There [00:42:00] were some changes not too long ago in the releasing of test data for the APA guidelines. It comes up all the time in the world I work, which is asking professionals for their raw data. And it’s this line of like, wait, where does that fall?
Somebody that I know well sent me five different attachments on that topic because they happen to be in the know about it. I had to read through all those and be like, okay, hang on a second, but wait, is this situation apply here? Now it does, but they might have to have a court order.
You ask five different people, they’ll give you five different answers on whether the person has to release the test data to another psychologist in particular situations or not and then what stuff is released or not. I’ve seen professionals release an entire raw report and answers on an MCMI to a probation officer as part of a discharge letter for therapy.
Dr. Sharp: I feel like that’s one of the most common examples. I’ve seen personality testing results released to [00:43:00] any number of people. That seems very common.
Dr. Tindall: I think Jeremy, that there’s a simple way to do this. I had the opportunity last week to talk to probably two of the most brilliant men I know that are experts. Dr. Steven Berkowitz is a neuroscientist. He’s at CU and he runs some clinic. And then Dr. Lish is at CU Health. He’s just brilliant.
I always have to get permission for this in terms of clients to maybe let them review my work or whatever but Dr. Lish had told me some advice, which was great. He’s been doing this longer and he said, listen, there were two things in your report, it felt like your statements were too absolutist.
I can’t remember necessarily what they were now, but in my field and maybe even in normal practice, instead of saying, this is absolutely the worst type of abuse that somebody could suffer, is it? Do you know that for sure? Do we really know that this type of abuse is more egregious than this particular? How are you measuring [00:44:00] that? Et cetera.
When we make statements that are so absolute, I don’t think that we should be doing that really. I think there has to be a lot of, it may, it might, possibly and who’s saying the information; is the client saying it, or are you saying it? Did you get it from a report or did you get it from some research?
And so it’s making sure that you’re attributing information to the right source, but also not making statements like this person is going to kill this person in a report. You better have some pretty good data points to bag that one up. Do you absolutely know with certainty that that’s going to happen? And so I do think one level of protection, it was such good feedback from him, is to tamper your statements and it’s not being wishy-washy, but we don’t know.
One of the things is looking at somebody that had said, this is absolutely PTSD, absolutely meets the criteria, et cetera. Maybe they do, but I don’t [00:45:00] really know because we don’t really know sometimes how trauma manifests, especially if it’s three years after a traumatic event. I’ve asked many people about it, but a statement that was made with sexual abuse impacts people more than any other type of abuse.
To be honest, the research does not support that but I don’t know if it’s also true either, because we may get new research coming out in the future that says the opposite, but for the time being, the most recent literature does not say sexual abuse impacts somebody’s brain the most, especially depending on developmental period.
So I think the fault is making the statements absolute and saying, in my opinion, the damage I’ve seen in working with, I’m using example, that you can tamper that and saying that a little bit differently. So I’m trying to be very careful about saying, in my opinion, it seems like this.
Dr. Berkowitz, I saw him at a training. He does a lot of work on that trauma and the brain, adverse childhood experiences and whatnot, and protective factors. He said, when I’m on the stand and I’m [00:46:00] asked, Dr. Berkowitz, are you certain? He says, “The only thing about which I’m certain is that I’m uncertain.”
I think that’s true for all of us. When you give advice in the therapist session, or you write up recommendations, it’s your best estimation based upon data points you have and research we know, but it’s always changing daily.
Dr. Sharp: I cannot agree more. I feel like that’s one thing as time has gone on and I’ve done this longer is it is inevitable that circumstances are going to change. I’m talking about testing; we’re doing our best with what I think of as a snapshot in time.
Even with supposed neurodevelopmental concerns like autism, ADHD, intellectual disability, and whatnot, we’re getting kids, young adults, or adults at a specific period in time and things might change next week, things might change in 4 years, circumstances, environments. It’s [00:47:00] really hard to be certain. I’ve gotten a lot more comfortable saying, I think this is pretty close but let’s see, it might change, and that’s a tough place to get to.
Dr. Tindall: It may. It’s my best guess, get a second opinion if you want. It is unfortunate because when you get somebody saying, I don’t think that was done right. I think you should do it this way. I know it casts a doubt maybe even on other people about our profession, how could I get such an extreme response here from this?
And even in this PTSD example, I’m saying, I’m like, “I’m not saying that the said person is wrong. That’s absolutely not what I’m saying. I’m saying, they’re wrong in saying that they absolutely know.” There’s a big difference.
They could be right about their sign of designation of a diagnosis. That may be possible, but to make absolute things that you absolutely know that in the interim from the traumatic event, the person’s had multiple other traumatic events in my mind, that saying the [00:48:00] current PTSD diagnosis is absolutely related to the other event A, B, or C, I don’t think we know.
So for me, I’m learning to say that as well, which is, I don’t actually know, but here’s my best guess. To give you an example, in the brain research area, we have for so long, and I testify about trauma and memory a lot, I would say quite a bit. And so we have heretofore thought that when we’re remembering traumatic stuff, the hippocampus is activated, and that part of it is where it’s controlled.
There was a study, it came out in November 2023. Luckily I saw it right before I testified in January 2024. They had done this study, maybe they’ll disprove it, but they had people recount sad stories, some other traumatic stories from childhood, different parts of their life. Brain scans show activation of the hippocampus, what they expected.
But then they had military veterans recall traumatic events from [00:49:00] war, combat, whatever. It didn’t activate the hippocampus. It activated another part of the brain. That’s significant. It changes everything if that’s repeated about what we know about trauma and how we retain it, what protective factors affect, so there’s this stuff that it’s like you can’t say with any absolute certainty that one thing is true because you don’t know if there’s research out there that is looking at something and finding something the opposite.
I remember in graduate school, I did research at the veterans’ administration hospital in Denver with Dr. Mike Meshes, such a great guy. We ran water maze experiments on albino rats. He was feeding them blueberries because his hypothesis at the time was that blueberries impacted their memory and whatever. The results came out as he expected, but then I lost touch with him, moved on.
I recently saw a publication that said that they found that blueberries improve the memories of blah, blah, blah. They use studies on rats. I’m thinking to [00:50:00] myself, that was in 2005. Did it take that long to publish his research or what happened? It’s interesting to me. If I had gone on the stand and then said blueberries help improve memory, clearly, it took this much time to prove that hypothesis.
Anyway, hopefully, this stuff is helping him stay on the topic or whatnot, but the general theme I would like to relate is that do the very best you can to go look at the ethics code and see what your fidelity is in a particular situation about getting releases signed by certain people or releasing information, how much to release, and then if that’s still ambiguous, which it is always, the ethics code is a bit ambiguous, then go and consult with other professionals.
Everybody should have some people that they are on speed dial to ask questions. There was this one person that used to call me pain in the butt because I would call them all the time and be [00:51:00] like, what do I do?
Dr. Sharp: That was your name in their context.
Dr. Tindall: And I’m like, I’m totally good. Yes. I want to keep doing that. I’m sure I still make mistakes and still do things. I try my best not to, but I think the biggest thing is just checking with people because in my history, I’ve checked with 10 different people on a particular ambiguous question and I get 10 different answers.
Dr. Sharp: But you checked, that’s the important thing, even if it’s …
Dr. Tindall: It’s documentation. There’s a bit of saying it and that sucks when it’s covering your ass, which I would never want that to be the main reason.
Dr. Sharp: There is this part of the process that we could maybe talk more about. And for me, I keep thinking, how does someone get from a place where, let’s give them the benefit of the doubt, they are thinking that they’re doing the right thing? They have the best intentions. And then at some point, there’s a [00:52:00] rationalization or a decision-making process where they have to work through something to say yes, this is the right thing to do. I am doing the right thing in this case.
I think most people are trying to do the right thing. That cognitive dissonance component and how we rationalize our own behavior, that process feels really important. Have you read that book, Mistakes Were Made (But Not by Me)?
Dr. Tindall: No.
Dr. Sharp: It’s pretty good. It’s Carol Tavris and Elliot Aronson, two super prominent social psychologists. It’s probably 20 years old now, but I think they updated it maybe in the last 10 years. Anyway, that book was …
Dr. Tindall: It’s old research, Dr. Sharp.
Dr. Sharp: It’s old research. Listen, there’s an updated version.
Dr. Tindall: That’s when it happened. It’s like, no, that’s wrong. I’m not listening to you.
Dr. Sharp: Maybe I’m [00:53:00] standing on a sandcastle here, who knows? It’s interesting. It was really good for me to read that book to just have some awareness of the mental gymnastics we will go through just on individual personal level to justify our actions.
They have this great example or image of everybody starts at the top of a pyramid and in terms of what is the right approach, but as soon as somebody takes one step off to either side, they are sliding down the sides of the pyramid and then end up in completely different places in terms of justification or decision making and rationalization for their actions.
So it’s like we all start from this place of wanting to do the “right thing”, “best thing”, “good thing”, or whatever it may be, but then we take one step in a different direction and end up in a different place.
[00:54:00] Dr. Tindall: Most people don’t have checks and balances because if you’re just doing a normal clinical practice, let’s say you’ve got your degree and everything else, and you’re doing things, I have the benefit of having to be on the stand and having a prosecutor or a defense lawyer, someone attack my work.There’s something that’s also very good about that because I have to be on my game. They’ll read it line by line and go through it line by line. If there’s an error, a typo or whatever, you get ripped for it. There’s nothing like that. That’s something you don’t forget, so I recognize that’s a privilege.
In reality, mental health professionals are not required to do that much continuous education or that much oversight for their licenses. And so that’s the problem is you run out of time in the day to get all this stuff. It’s like everybody should have to undergo supervision always.
I do like that about the Domestic Violence Management Board. They require you to have ongoing [00:55:00] consultant, that you’re working with another equivalent professional, that you have it. The Sex Offender Management Board has much stricter renewal requirements in terms of how much of education you have to get in each specific area. I think that’s a really positive thing.
I wonder to your question, by the way, I’m going to use that expression, the sandcastle, because I think it’s exactly what Dr Berkowitz was saying. The only thing about which I’m certain is I’m uncertain, because you are, you’re standing up there, but the sandcastle. It’s good for now but the waves come in, the tide comes in, someone kicks it, it’s going to change. And that’s the equivalent of new research or things about a case or something you don’t really know.
I also think that there’s vicarious trauma in our field. It doesn’t matter if you work with offenders or you’re working with children, it can get overwhelming for people. We know that people already have pre-trauma risk factors and then when they’re experiencing [00:56:00] stress from work and they have a traumatic case or somebody with suicide on their caseload, we’re not encouraged to raise our hand and say, ma’am, we’re impaired, we’re not doing very well right now. It’s seen as a sign of weakness.
And so I think that people continue to practice when they’re under great amounts of stress. I’ve done it myself. So maybe the cognitive dissonance comes more easily then, or we’re just not as aware of it because we’re in a cloud. If you know you’re going through a divorce, but you’re also working this many hours or then someone dies in your life.
I was talking to a friend. It’s not funny. It’s a good example. They work for Fortune 500 company. Unfortunately, her husband has been on hospice. I was like, oh, how’s work been going? She said, “They’ve been really flexible, letting me work remotely.”
I said, “Has it been going well?” And she said, “Well, I figured it was going to fall out at some point.” And she said, “I think last week it was, I was on the phone with a lot of important people and I basically [00:57:00] called someone an idiot.” And she’s like, “My boss was like, you know what? I think it’s time for you to step away.”
It’s a funny example where people don’t realize the things that are showing up that might indicate some impairment or some cumulative career traumatic stress. I think that probably contributes. I do know there’s an overload in terms of the volume of people that everyone has on their caseloads. And so I think that that’s it. I hate to be the person, so I was like, oh, you’re doing this inaccurately. I’ve had it done to my stuff, but I think when there are instances, if it’s causing harm, it’s a problem.
Here’s another example you asked, someone did a report or something that was called a contextual analysis of the situation. What does contextual mean, Jeremy? What does contextual mean to you?
Dr. Sharp: Environmental factors, external factors.
Dr. Tindall: The whole picture. So it was an ironic [00:58:00] title for said paper, because the contextual analysis only talked to one person in the situation. It was a domestic violence situation again, and it was only off of the self-report of the person. And that particular person was one that had their own charges. The other person didn’t, but only off of the self-report was that person doing it but they said, this is a contextual analysis.
Honestly, I was basic and my rebuttal is like, listen, the contextual analysis by definition is this. So it’s not really contextual analysis when you only have one person’s opinion about the scenario. You don’t have any records in there. You haven’t talked to the other party.
It’s okay if you want to say, based upon my interactions with this one person, if I had to make a decision on this information alone, here’s my opinion. That’s different. But to make a global statement about, I’ve looked at this entire situation and I haven’t, and then to make a finite statement about what someone’s going to do or [00:59:00] what the risk or who should have custody, in my mind, I forget what the word is for that.
Dr. Sharp: It’s not good.
Dr. Tindall: It’s not good. I try to have people check and balance my work. I know I’ve called you on occasion and I’ve called people that have worked for you in different areas to get that advice. I think the thing I’ve learned more recently is to tone down my absolute statements and that can be true for anyone doing therapy or evaluations is to say might or may, or in my best estimation, but to talk about that maybe this isn’t 100% accurate.
Dr. Sharp: That’s reasonable. I love that. It’s very concrete and relatively easy for us to do. It sounds like you’ve built a pretty strong network of folks to check in with, and you have this natural built-in check and balance of being on the stand so [01:00:00] often and having to keep yourself accountable. Do you have any recommendations for folks who maybe aren’t testifying so frequently to stay sharp? Any other strategies or ways that you’ve built this into your practice to stay on top of things?
Dr. Tindall: I think it’s building that network. If people can call that Colorado, I wish I had the number or whatever. I can try to get it to you and you can put it on the website or something. There’s a number that you can call and there’s psychologists or whatever that have, or I don’t know how they get chosen or whatever, but they’ll call you back and you can run your problem by them and they’ll give you some feedback.
Like I said, most people’s malpractice insurance, you can call their legal line and ask them, because they have a vested interest in giving you advice because then that’s a little bit protective because they obviously don’t want to have to use their money to defend you. So I think that’s good.
Even from the podcast that we’ve done together and the [01:01:00] one I did for Dr Vienna, I’ve gotten calls from people. I had a call recently from someone in California asking if I could talk to them about juvenile assessments.
I was so happy to hear from them because they said, listen, I’m relatively new doing this. There was a need for it. They asked the judge. I did get asked for to do it, but I’m a little not up to speed on what’s the most recent assessments I should be doing for juveniles or how do you best recommend to do in an evaluation of a juvenile in the court system or whatever. I love that. It’s awesome.
And so I’m always open to taking those emails or phone calls from people myself. I had most of the answers for her, but then I referred her to somebody else also to talk to, to get some other information. And so reaching out to people that you’ve been looking on the directory on Psychology Today and expert in let’s pretend it’s an issue with the transgender client.
I’ve had cases where I’ve had to do evaluations in situations. So I reach out to two experts that specialize in that area to [01:02:00] make sure I’m using the right terminology, that I’m conceptualizing it the proper way. And so I think it’s just if you don’t have anybody you know personally, it’s to be able just to google somebody and then reach out.
My experience is that people are a lot more receptive. Dr Berkowitz is this amazing, he’s so busy. I was blown away that he got back to me and agreed to have a phone call so I could ask him about this trauma, what his opinion was before I testified.
I’ve reached out to Karl Aquino, who was on this podcast. He’s up in British Columbia and talks about virtuous victimhood. So I think to encourage people that if they read something or if they can google and see who’s an expert in that area, and let me reach out to them and ask their advice.
Dr. Sharp: I love that. It’s easy to practice on a silo put our heads down and get busy, do what we do and years can go by, and that’s dangerous.
Dr. Tindall: One more thing I was going to say to your question, you said the cognitive [01:03:00] dissonance. I honestly feel like the way that people can guard themselves the most is to always ask this question, which is, how is what I am saying going to impact other people’s lives? It has to.
It doesn’t matter what area we’re in, if you are in doing couples therapy and you make a strong opinion or recommendation to the couple that makes them, if you say, oh, I think your husband’s a douchebag or something, whatever it is, even on the side. My point is you can’t do that because it can impact somebody significantly.
One of my sisters had told me, this therapist had sent a text message to her and said something like you’re borderline. I saw the text message. They’ve been doing couples therapy and she was meeting with her husband on the side without including her, and then send her a text that said you’re borderline and you’re going to need lifelong therapy.
Come on, that was not in the state. [01:04:00] That’s ridiculous. That’s a very glaring example of what not to do. But it’s like, if she had thought through, I’m sending a text message to someone informing them that I think they have a personality disorder. It obviously sent my sister in a tailspin, and it could have been really damaging. That could send someone over the top.
If you’re writing something absolute to the court that then makes them pull custody from somebody but you’re not 100% certain of that opinion, you should probably say you’re not 100% certain because I feel like we have to take ownership of the power that we have in today’s current age.
I think that people that maybe don’t work in the forensic world don’t understand how important their opinions are to people, that there is no guidance for decisions. And so everyone’s relying on mental health professionals. We cannot be saying things willy-nilly. We can’t be offering opinions about politics or religion to our clients, in my opinion.
We have so much influence [01:05:00] over people in this vulnerable position that we have to guard ourselves against saying things that could impact their opinion one way or the other because it carries more weight than if we’re just at a table having drinks with somebody. When we’re in a professional setting context, everything we do and everything we say has to be with that intention in mind, because they will say, I just talked to this doctor and she said this, and that’s just not okay, in my opinion.
Dr. Sharp: That’s fair. Maybe that’s a nice place to start to close, it’s coming back to what we’ve talked about in the beginning, just this idea that we do have a lot of power and sometimes we can get in our own way with that, and be too humble, but it’s almost like a call to own the responsibility and the power that we do have in this work and step into that and make sure to do well.
Dr. Tindall: Empower from what is assigned to us. I don’t want to leave this thinking like, oh, we’re so important and we’re so [01:06:00] powerful because I don’t agree with that. We have been given a lot of power by people in general.
If they’re in a vulnerable spot, they go in, they don’t know credentialing stuff. They’re like, oh, you’re a doctor. You must know what you’re talking about. Most people just come in, whatever you tell me, I’m going to do. And so they’ll follow it 100%.
And so I think that’s where it’s just recognizing that the court system, the school system, the civil litigation, it gives experts like us a lot of power. It has become, I will tell you, expert versus expert that make these decisions based upon the information they share, and so it’s just that recognition that maybe we shouldn’t have all that power.
I don’t think we should but the court system, civil, domestic relations, legal is giving that power to us. And so I think we have to recognize that it is [01:07:00] something we have to handle with care. It’s impossible for any one person to stay up on everything and that’s why reach out to an expert.
More often than not, when someone calls and asks my opinion, I’m like, this is what I think. I probably should ask a neuropsychologist. That’s more of their area. Let me connect you with them. I’ll put you on an email and they’ll help you.
I don’t think I’ve ever had anybody tell me no. When I get someone like Dr. Berkowitz or Dr. Lish agreeing to have a conversation on an afternoon just to help me out, I feel like it speaks highly of people that are willing to reach out, especially, when they’re that important.
I am opening it up if people have questions and they are about a particular thing, or I can provide some guidance on who I’ve reached out to, to help on certain situations, feel free to give them my email. I’m more than happy to respond to that because I feel a really strong responsibility to make sure that I try as best as I can to stay up on things.
Dr. Sharp: I really appreciate that. I’ll make sure to put your information in the show notes and let people know, reach out if they have questions. You have a lot of [01:08:00] experience. You’ve seen a lot of different things. I know that’s valuable for folks.
Dr. Tindall: Getting grieved certainly helps you stay up on your game too. I’m sure it’ll happen again. It just is what it is. It’s the nature of the work I do. I’m proud of the fact that I haven’t had anybody I’ve worked with a client or patient do that knock on wood but I think it’s good for professionals to point out other people’s mistakes so you can get better.
Dr. Sharp: Well said. It’s always fun to talk to you, Brenna. Thanks for coming on again.
All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.
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