Letting the referral context shape working hypotheses

Key ideas

Who asked, and for what decision

When a third party requests the service, APA Standard 3.07 asks the psychologist to clarify at the outset the relationship with everyone involved: the psychologist's role, who the client is, the probable uses of the information and any limits on confidentiality.

The psycholegal question

Forensic evaluations are framed around the legal question, such as a particular capacity, and the Specialty Guidelines for Forensic Psychology direct attention to legally relevant factors rather than to a general diagnosis.

Incentives and response style

In a survey of board-certified neuropsychologists, probable malingering or symptom exaggeration was estimated in 29 percent of personal injury and 30 percent of disability cases, but 8 percent of medical cases. Custody litigants, by contrast, often underreport problems on personality inventories.

Validity assessment in every evaluation

The 2021 AACN consensus holds that all clinical and forensic evaluations must address whether test results are valid; the referral context indicates which kind of invalid responding is most to be expected.

Multiple sources

Records from before the referral, collateral interviews and documents test the person's account. The forensic guidelines call for using multiple sources of information and weighing them against one another.

Worked example

A juvenile court orders an evaluation of Dante, 15, who has admitted to a series of car break-ins, to recommend services before the court decides on his disposition. Dante says he was 'just with the wrong people,' and his mother says his behavior changed about two years ago.

1. The court is the client and the report will go to the judge and both attorneys; the psychologist explains this, and what the evaluation is for, to Dante and his mother before starting.
2. The question is what services he needs and what would reduce reoffending, so hypotheses center on factors that bear on it: conduct problems, substance use, peers, supervision at home, trauma and learning problems.
3. Because Dante may minimize problems to win a lighter disposition, the psychologist includes validity indicators and does not rely on his account alone.
4. School, probation and child welfare records and interviews with his mother and a teacher are used to test each hypothesis, including whether the change two years ago followed an identifiable event.

The referral context tells you which hypotheses to test and which sources you need; the data decide among them.