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Forensic Neuropsychology in the Real World

Published online by Cambridge University Press:  22 March 2006

Leah Ellenberg
Affiliation:
Clinical Associate Professor of Pediatrics, University of Southern California School of Medicine, Los Angeles, California.
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Extract

Forensic Neuropsychology Casebook. Robert L. Heilbronner (Ed.). 2005. New York: The Guilford Press. 370 pp., $50.00 (HB).

The chapters in Forensic Neuropsychology Casebook read like a collection of short stories. An experienced forensic neuropsychologist authors each chapter and each case is presented from a personal point of view, a viewpoint generally not found in mainstream textbooks. The case background, test results, and legal proceedings are described along with the neuropsychologist's thoughts, feelings, insights, and lessons learned. The practitioners and topics were well chosen to display the diversity of forensic neuropsychology. Included are adult, pediatric, civil, and criminal cases. Besides the more common cases such as traumatic brain injury, medical malpractice, and workers' compensation, more esoteric topics are covered such as electrical injury, sexual consent capacity in an Alzheimer's patient, and competence to confess.

Type
BOOK REVIEWS
Copyright
© 2006 The International Neuropsychological Society

The chapters in Forensic Neuropsychology Casebook read like a collection of short stories. An experienced forensic neuropsychologist authors each chapter and each case is presented from a personal point of view, a viewpoint generally not found in mainstream textbooks. The case background, test results, and legal proceedings are described along with the neuropsychologist's thoughts, feelings, insights, and lessons learned. The practitioners and topics were well chosen to display the diversity of forensic neuropsychology. Included are adult, pediatric, civil, and criminal cases. Besides the more common cases such as traumatic brain injury, medical malpractice, and workers' compensation, more esoteric topics are covered such as electrical injury, sexual consent capacity in an Alzheimer's patient, and competence to confess.

Different authors were confronted repeatedly with many of the same issues despite the wide variety of cases. They are those issues with which all forensic psychology practitioners must grapple. Frequently mentioned were the differences between clinical and forensic cases regarding the nature of “client.” In the former, the client is the one being examined, while in the latter, the client is generally the person or entity requesting the evaluation, for example, the attorney or the court.

The referral questions in the legal cases varied widely, but typical clinical questions such as “What are the neuropsychological deficits?” or “What is the best course of treatment?” were never asked. Almost all authors addressed the importance of assessment of motivation and many mentioned the value of collateral sources of data. Ethical issues were raised in most chapters, including the importance of obtaining informed consent and maintaining the position of a scientist rather than an advocate. Michael F. Martelli, for example, provides a valuable list of recommendations for promoting objectivity. The adversarial nature of the legal process as opposed to the truth-seeking nature of clinical neuropsychological evaluations was a recurrent theme, along with the importance of resisting pressure from the attorney who made the referral and from opposing counsel. Lynn Bennett Blackburn views the deposition process as a chance to practice psychotherapy skills, working to understand the attorneys' “construction of reality, while helping them to accept a more accurate construction—mine.”

Harrowing tales of cross examination abound, with admonition to be up to date on the current literature on neuropsychological testing in general, the specific areas relevant to the case at hand, and the cultural and ethnic issues pertinent to conducting assessments and interpreting results. The final three chapters were the responses of three prominent forensic neuropsychologists (Jerry J. Sweet, Manfred F. Greiffenstein, and Paul R. Lees-Haley) to the same eleven questions with their answers reflecting different responses to the same common practice dilemmas.

I found this book to be highly entertaining. The cases were fascinating and many of the authors wrote with style and wit. Paul L. Craig, for example, in describing his thoughts on a journey to a remote Native Alaskan village muses, “I wonder how many other neuropsychologists are going to work today in a dog sled pulled behind a snow machine across a frozen arctic sea?” Kristie J. Nies, described a woman whose circumstances were very difficult before the incident that gave rise to the lawsuit and notes that “the canvas of [her] life was the tragic context on which she interpreted the additional brushstrokes of the injury.” The format of allowing practitioners to discuss cases from their respective points of view provided insights into the unique process each one used to examine the findings and reach their conclusions.

Forensic Neuropsychology Casebook will serve as a very useful adjunct to a standard forensic neuropsychology textbook for the novice as well as the experienced clinician. It provides a window into the practice of forensic neuropsychology as it exists in the real world and fosters a process of self-examination that may increase a practitioner's competence and ethical purity. Besides, it's a good read.