Forensic Clinical Interviewing: Toward Best Practice

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International Journal of Forensic Mental Health

ISSN: 1499-9013 (Print) 1932-9903 (Online) Journal homepage: http://www.tandfonline.com/loi/ufmh20

Forensic Clinical Interviewing: Toward Best Practice Caroline Logan To cite this article: Caroline Logan (2018): Forensic Clinical Interviewing: Toward Best Practice, International Journal of Forensic Mental Health, DOI: 10.1080/14999013.2018.1519615 To link to this article: https://doi.org/10.1080/14999013.2018.1519615

Published online: 02 Dec 2018.

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INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH https://doi.org/10.1080/14999013.2018.1519615

Forensic Clinical Interviewing: Toward Best Practice Caroline Logan Greater Manchester Mental Health NHS Foundation Trust, and University of Manchester, Manchester, United Kingdom ABSTRACT

This two-part special issue of the International Journal of Forensic Mental Health is dedicated to the practice of forensic clinical interviewing, that is, the nature and application of specialist clinical interviewing skills with clients in forensic settings. The rationale for its preparation is concern about the neglect of this area of practice in the empirical and clinical literatures. While there is a substantial evidence base for the techniques applied by investigative and forensic interviewers (e.g., police officers, social workers), little of this work has been prepared or adapted for the use of clinicians (e.g., psychologists, psychiatrists, nurses) engaging with individuals managed by forensic mental health services, prisons, and probation. This article sets the scene for the special issue. First, it examines what is meant by the term “interview,” the information gathering opportunity on which so many clinicians rely to inform their clinical judgment. Second, forensic clinical interviewing is examined; what does this term mean, and to what range of activities does it refer? Third, the key points in the article to follow in the special issue are discussed. This article concludes with a rationale for clinicians to exercise more deliberation on their interviews, and a plea for more research.

Introduction This special issue of the International Journal of Forensic Mental Health is dedicated to highlighting and delineating the practice of forensic clinical interviewing, that is, the nature and application of specialist clinical interviewing skills with clients in forensic settings. The rationale for compiling this collection of articles on the subject is because of concern about the neglect of this area of practice in the literature, both in terms of empirical research and clinical guidance. That is, there is a substantial evidence base for the skills, techniques, and strategies applied by investigative or forensic interviewers (e.g., police officers, social workers) in situations in which information is being sought usually from suspects or victims in relation to possible crimes committed by or against them (e.g., Bull, 2014; Bull, Valentine, & Williamson, 2009; O’Donohue & Fanetti, 2016; Walsh, Oxburgh, Redlich, & Myklebust, 2016). However, very little of this work has been prepared or adapted for the use of clinicians—psychologists, psychiatrists, nurses, and so on—engaging with usually already convicted individuals detained in and managed by forensic mental health services, prisons, and probation facilities. Also, there is a substantial literature on the skills, techniques, and CONTACT Caroline Logan [email protected] Hospital, Bury New Road, Prestwich, Manchester M25 3BL, UK ß 2018 International Association of Forensic Mental Health Services

KEYWORDS

Forensic clinical interviewing; investigative interviewing; forensic interviewing; clinical interviewing

strategies applied by practitioners in clinical situations in which information is being sought from clients about their presenting problems (i.e., their emotions, thinking processes, attitudes, and behaviors; e.g., MacKinnon, Michels, & Buckley, 2016; Morrison, 2014; Shea, 2017; Sommers-Flanagan & SommersFlanagan, 2014; Villatte, Villatte, & Hayes, 2016). However, little of this work has been written or adapted for use by clinicians working with legally detained clients who, for whatever reason, may be unforthcoming about how they feel and how they may choose to express and satisfy their psychological needs. Therefore, the purpose of this special issue is to both highlight forensic clinical interviewing as a dedicated area of clinical concern and endeavor, and to begin to characterize some of its key practice elements and processes. Does this quite specific, even rather narrow area of practice really require this level of attention? This introductory article in the special issue will argue that it does. As will become clear, the basis for that argument is that the paucity of literature on the subject of forensic clinical interviewing, both empirical research and practice guidelines, puts clinicians at risk of poor technique in information gathering. And if the

Edenfield Centre, Greater Manchester Mental Health NHS Foundation Trust, Prestwich

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information is poor on which practitioners rely, for example, to prepare and implement compulsorily administered treatment plans or to make recommendations to courts resulting in restrictions to a person’s liberty, then there is the potential for those treatment plans to be inadequate and for the recommendations made to be in some way in error (e.g., attributing characteristics to the client that in fact originate in the clinician’s poor interviewing technique). Presently, it is unclear where clinicians working in forensic settings turn to for guidance in relation to commonplace challenges in their interviewing practice. For example, what particular skills are useful and how may they be applied differently when interviewing a client of the same compared to the opposite gender as the interviewer, or the same versus a different culture, or from a different age group as the interviewer? Also, where might practitioners go for guidance in the event that they are required to interview an older adult with a history of personality disorder, or a working age woman on the autism spectrum, or a male adolescent with a history of sexual offending involving a pattern of psychological coercion to which the interviewer will likely be subject, or an aggressive and distrustful military veteran? And how confident are practitioners that they can adapt their existing skills to each of these and any number of other scenarios in turn and still gain the information they require to create valid, accountable, and helpful clinical judgments for the benefit of the agencies requesting them? This special issue brings together what is known now about the specialist skills, techniques, and strategies used in common clinical interviewing scenarios by practitioners working in secure hospitals, prisons, and community-based agencies tasked with understanding the behavior of people in their care who have a history of harming others and who use the face-to-face interview as a central means of information gathering. The articles to come will attempt to outline the general requirements of these engagements in terms of beginning, sustaining, and concluding interviews that meet the objectives of the clinician— and keep any distress experienced by the client as a result of the process to a minimum. Collectively, the articles will describe a range of skills, techniques, and strategies that their authors rely upon in their respective fields to collect the maximum amount of information of relevance whilst maintaining an open, respectful, and supportive stance with the client. And each article in turn will address the ethics of extracting by good interview technique information from clients who may not be motivated to provide it and who

may unable to foresee the consequences of their most revealing responses. This introduction to the special issue sets the scene for all the articles to come—in essence, it will outline the guidance given to each of its contributors. First, this article will consider in detail what exactly is meant by the term “interview,” the information gathering opportunity on which so many practitioners rely to inform their clinical judgment. Second, this introduction will elaborate in more detail the subject of the special issue, namely forensic clinical interviewing; exactly what does this term mean, and to what range of activities does it refer that differentiates it from clinical interviewing and investigative or forensic interviewing? Third, the range of articles in the special issue will be summarized and their key practice points highlighted. Finally, the aricle will conclude with a rationale for clinicians to exercise more deliberation on their interview technique, and a plea for an increase in research into interviewing in the forensic clinical field.

The interview: a definition The origins of the word “interview” are French—it derives from entrevue, which is a combination of words meaning “between” (entre) and “to see” (voir), making the combined word mean “meeting” or, in effect, ‘to see each other’ (Thompson, Fowler, & Fowler, 1995; for a historical overview, see also Platt, 2002 and Oxburgh, Fahsing, Haworth, & Blair, 2016). In current parlance, the word interview suggests formality (an intentional coming together of at least two people), purpose (namely, information-gathering), and turn taking (to facilitate an exchange, of question and answer). There is the expectation in an interview that one party (the interviewer) will lead with questions prepared in advance, and the other (the interviewee) will respond in the moment (although sometimes, with preparation) with the information sought, which may then be scrutinized, queried, and explored in a calm and fluid exchange. The interview ends when the both questions and follow-up enquiries have been exhausted and the sought-after information obtained, or when one or both participants require a break. Interviews are to be compared and contrasted with meetings for the purpose of informing a person of some fact (e.g., their duties that day, which is an activity more like a briefing) or providing that person with goods, which might include clinical interventions (e.g., a health-related treatment, such as a session of cognitive behavioral therapy), although there may be

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some processes and tasks in common across all of these forms of face-to-face encounter. Interviews that take place in mental health-related settings between a practitioner and a client are likely to attend to a number of core interpersonal processes, which will include but not be limited to the following (e.g., Shea, 2017): (i) forming an effective working relationship with the client, which will feature aspects of empathy and compassion, and be regarded as an investment in that person’s future engagement with mental health services; (ii) understanding the nature, origins, and context of the mental health problems experienced by the client (e.g., via a mental state examination, or a more formal diagnostic evaluation); (iii) identifying any short-term risks associated with those mental health problems in that individual (e.g., risk of suicide or self-neglect in someone with depressed mood, or relapse in a person with a history of substance abuse); (iv) understanding the relationships between problems and risk (e.g., how the experience of long-term child abuse may have led to chronic post-traumatic stress disorder, a diagnosis of personality disorder in adulthood, and the use of selfharm to manage emotion dysregulation); and (v) preparing for the subsequent delivery of interventions. Such interviews may also be referred to as appointments, meetings, consultations, (formal) discussions, examinations, or sessions. The literature available to guide practitioners in these activities is largely founded on the experience of expert or scholar practitioners in the field (e.g., Rosengren, 2017; Shea, 2007, 2017; Villatte et al., 2016). Interviews that have a more investigative focus, such as those carried out by police officers or social workers with suspects or victims in criminal investigations, and which may include some aspects of the work of practitioners involved in legal proceedings, such as expert witness testimony in relation to the question of criminal responsibility or risk management via the restrictions imposed by, for example, dangerous offender or sexually violent predator proceedings, attend to a slightly different range of interpersonal processes. In such interviews, interviewers will focus on at least the following activities: (i) forming a relationship with the client, which is likely to be short-term in duration and intense in nature, applying specific techniques such as rapport-building or a conversational approach, in order to encourage valid selfdisclosure on the part of the interviewee; (ii) creating the appropriate legal context in which to raise with the interviewee a pre-determined range of topics about the precise matter at hand (e.g., the incident

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under investigation, past behavior), and to seek and to explore their knowledge and intentions in relation to it; (iii) anticipating, understanding, and managing resistance on the part of the interviewee to the disclosure of such information, including detecting and addressing deception through challenge; and (iv) identifying any other matter of legal significance to either the incident under investigation or any other relevant legal matter (e.g., Walsh, Oxburgh, et al., 2016). Investigative or forensic interviews may also be referred to using terms such as interrogation or crossexamination, but also less technically, as elicitation or debriefing. Therefore, the focus of such interviews tends to be on a very specific incident or matter and on the interviewee’s role and purpose in its occurrence (e.g., Bull, 2014). In contrast, the focus of clinical interviews tends to be on a potentially lifelong range or pattern of experiences and perceptions, as well as on their causes and future manifestations and options for collaborative and managed change (e.g., Villatte et al., 2016). The empirical evidence available to guide investigators in their forensic interviewing practice is substantial, especially for the specific practice of law enforcement personnel, much of it empirically grounded, undertaken by dedicated researchers, and of very high quality—as it should be given the potential legal standing of the information so obtained. The proposal presented by this special issue is that practitioners working in forensic mental health facilities, prisons, and in probation services require a hybrid of clinical and forensic interviewing skills, strategies, and techniques. This article will attempt to outline what such a hybrid skill-set could look like. Further, how can forensic clinical interviewing be applied in an evidence-based and legally defensible way in situations in which the quality of the information so retrieved may have a lasting impact on the lives of interviewees and those with whom they interact? The answer to this question is more the subject for the articles to follow, although their main points will be synthesized toward the end of this introduction.

Forensic clinical interviewing: a definition As proposed at the start of this article, forensic clinical interviewing is the application by mental health practitioners of specialist clinical interviewing skills with clients in forensic settings who are detained or their activities are restricted by law. Such clients may have little choice in the matter of engaging with practitioners for this purpose, and the information they

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provide on such subjects as their experience of the symptoms of mental disorder, past offending behavior, and future risk, must be probed, verified, and frequently challenged. Therefore, at its most general, the term forensic clinical interviewing refers to face-toface meetings with clients (or patients or service users) in order to discuss matters relevant to the reason for their detention in a secure facility or the restrictions legally imposed upon them. Such encounters are intended to encourage them to yield the most relevant of the information they have and using it to inform and justify subsequent clinical and legal decision-making. Mental health practitioners, for example, psychologists, psychiatrists, nurses, social workers, and occupational therapists, apply the skills, techniques, and strategies inherent in the practice of forensic clinical interviewing, adapting their practice to the purpose of the interview and the presentation of the client. Their clients may be male or female, and they may be young, of working age, or older adults. Further, their clients may be from the same cultural background as the interviewer or from any number of other cultural settings such that linguistic including sign language translators are required to enable the interview to take place. Clinical interviewing As part of their basic professional training, clinicians of all types are given some level of input on undertaking clinical interviews with clients in mental health settings (e.g., Sommers-Flanagan & SommersFlanagan, 2014). In the main, they will be given training on a combination of the content to cover in mental health interviews of different types and the process of conducting the interview (Shea, Green, Barney, Cole, Lapetina, & Baker, 2007). With respect to content, topics would include initiating the interview (also consent, capacity and confidentiality), the presenting problem and its history, the client’s medical, personal, and social history, their family history of mental disorder, and screening questions for different conditions (e.g., depression, suicidal ideation), potentially including a mental status examination (e.g., Morrison, 2014; Shea, 2017). In respect of the process of the interview, training will usually cover key tasks such as initiating openings, engagement, and empathy, building and maintaining rapport, understanding verbal and non-verbal communication, questioning style, the art of listening, addressing sensitive subjects, understanding and managing hesitancy or resistance (e.g., as being due to lack of awareness, or shame, or

fear of judgment), possible sources of bias, confrontation, and challenge, closing the interview, interviewing informants, interviewing with interpreters and translators, and turning interview information into a narrative report (Morrison, 2014; Shea, 2017). Training in conducting clinical interviews in mental health settings will usually be delivered through a combination of direct observations of a skilled and experienced (often more senior) colleague, also role-playing, scrutiny of recordings of interviews (the student’s own, and those of experienced others such as tutors or experts in the field), and long-term facilic supervision (that is, supervision on how the interviewer structures and controls time-limited interviews while gathering essential data; Shea & Barney, 2015; Shea et al., 2007). The availability of guidance on the adaptation of such skills and strategies to the forensic mental health arena appears limited and professional development in that area seems largely dependent on the availability of good quality and relevant training and clinical supervision from a capable forensic practitioner (e.g., Logan, 2013). Investigative and forensic interviewing As summarized previously, there are some important differences between the disciplines of, on the one hand, clinical interviewing, and on the other, investigative and forensic interviewing. In contrast to clinical interviewing, investigative and forensic interviewing may be characterized by the following essential features. First, because of the legal weight that interviewobtained information may have in a criminal case and because of the very specific focus of such interviews, investigators undertaking such interviews can be trained to a very high level in most (although not all) jurisdictions (e.g., Smets & Rispens, 2014; Walsh, Oxburgh, et al., 2016). For example, in the UK, police are trained in applying the PEACE model to their investigative interviews with crime suspects: that is, planning and preparation, engage and explain, account, closure, and evaluation (for an overview, Clarke & Milne, 2016), and in accordance with a fivetiered structure of applied interviewing skills (e.g., Griffiths & Milne, 2006). This extensive training program is intended to ensure the development and maintenance of a high level of professional interviewing expertise in police officers, especially detectives, thus enabling sound and legally defensible practice in suspect interviewing to be both carried out and evidenced (Poyser & Milne, 2015). By comparison, following post-graduate clinical training, clinicians

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attend to the development of their very diverse interview practice in specific areas rather than overall (e.g., motivational interviewing, Arkowitz, Miller, & Rollnick, 2015; interviewing sexual offenders, Wilcox, Donathy, Gray, & Baim, 2017; interviewing in relation to child sexual abuse, O’Donohue & Fanetti, 2016; interviewing in relation to risk assessment, Logan, 2013; interviewing people with psychopathic traits, Cooke & Logan, 2018). However, many hone their generalist interviewing skills, which may include their bad habits, largely through working experience. Second, practice in investigative and forensic interviewing—and training—is underpinned by a substantial and still growing body of international research (e.g., Walsh, Oxburgh, et al., 2016). This impressive evidence base provides a firm foundation for legally defensible practice and has enabled the delineation of key skills, strategies, and techniques for use in undertaking controlled, precise and targeted, efficient and effective interviews. Given the usually narrow focus of investigative and forensic interviews (the interviewee’s role in the alleged offence, the victim’s experience with the alleged perpetrator), these “tools” are fit for purpose where sensitively administered in sequence. For example, studies have been carried out into overarching interview strategies such as PEACE (Milne & Bull, 1999; Walsh & Bull, 2015), the use of the cognitive interview (Rivard, Fisher, Robertson, & Hirn Mueller, 2014) and the conversational approach in interviews (Clarke & Milne, 2001; Clifford & George, 1996; Shepherd & Griffiths, 2013), as well as the applications of more specific investigative techniques, for example, developing the working alliance between interviewer and interviewee (Vanderhallen & Vervaeke, 2014), the use of rapport (Abbe & Brandon, 2013), the strategic use of evidence (Hartwig, Granhag, & Luke, 2014), and the application of the Scharff technique (Oleszkiewicz, Granhag, & Kleinman, 2017). By somewhat stark comparison, empirical research into clinical interviewing skills, techniques, and strategies is modest at best leaving clinicians at the mercy of interviewing practice as art rather than science (Barney & Shea, 2007). Clinicians may regard a more dynamic, responsive interview style as preferable to one that is comprised of a sequence of techniques bolted together by an investigator seeking revelations, and certainly one that is in keeping with the development of empathy and rapport and the clear communication of a compassionate stance toward improved mental health. However, in the absence of a sound empirical base to clinical interviewing practice, its quality is hard to estimate and its

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defensibility a challenge to prove, which is a potentially problematic situation in the forensic context. Third, while formal interviews of any kind are often uncomfortable experiences for interviewees, it is invariably the case that investigative interviews are more demanding than most, especially when the interviewee is a suspect (e.g., Vanderhallen & Vervaeke, 2014). In investigative interviews, for example, there is a significant power differential between interviewer (usually a police officer) and interviewee (the suspect, the defendant). Therefore, it is expected that engagement will be an issue, and that the veracity of the information provided will have to be tested and challenged; deceit is to be prepared for. Indeed, a significant body of research and guidance is available to investigators to assist in the detection of deception using cognitive approaches embodied within an organized and strategic interview (e.g., Brandon, Wells, & Seale, 2018; Granhag & Hartwig, 2015; Vrij, 2014; Vrij, Fisher, Blank, Leal, & Mann, 2016). In clinical interviews, while it can be demanding for clients to discuss troubling experiences, current and past, the power differential is less pronounced between interviewer (e.g., psychologist) and interviewee (e.g., client), and the expectation that relief will follow from the revelations made and accepted by the interviewer is a powerful encouragement to truth-telling. In the main, interviewees in clinical interviews engage in such encounters voluntarily, often willingly, and deception is not thought to be a routine occurrence. Where distortions are detected in client selfreport (e.g., symptoms are exaggerated or minimized), these are more likely to be attributed to the psychological forces or processes that brought them into the consultation in the first place (e.g., psychosis, personality disorder) rather than the deliberate desire to deceive (Shea, 2017). Consequently, the need to challenge clients about the accuracy of their account is a less frequent feature of clinical interviews, while it is invariably an element of the forensic equivalent (e.g., Clarke & Milne, 2016; Soukara, Bull, Vrij, Turner, & Cherryman, 2009). Fourth, while clinical interviews tend to be rather private affairs—an interviewing practitioner and a client, talking face-to-face in a quiet and private room, the content recorded in note form, and eventually in a letter or report for the information of the referrer— investigative and forensic interviews are generally more public affairs (for a description incorporating the PEACE approach, see Oxburgh et al., 2016). Investigators often interview in pairs, taking turns to lead on key topics or with quite specific roles (e.g.,

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monitoring the suspect’s responses). In investigative interviews under caution, additional people may be in the room also such as a legal representative and in some cases, an appropriate adult or a translator too. In addition, the interview may be monitored downstream by an interview advisor or senior colleague with the capacity to comment on progress—or the lack of it—during breaks in the proceedings, something of which the interviewee will be aware. Finally, interviews are recorded and the contents of these recordings may be used as evidence in the case eventually made against the interviewee. Therefore, the highest level of the investigative interview—that in an active investigation—is a demanding experience for both interviewers and interviewee, with significant pressure likely to be experienced by all (Vanderhallen & Vervaeke, 2014). However, there are in all likelihood more similarities than differences between the two fields of interviewing endeavor. Now more than ever, the quality of the working alliance between interviewer and interviewee is acknowledged as the key means by which both parties can feel sufficiently at ease as to facilitate the interview process and the detection of both deceptive and distorted accounts (Shea, 2017; Vanderhallen & Vervaeke, 2014). However, as with all things, the devil is in the detail and rapport building and empathic responding, and the range of other conversational facilics, together lend themselves to more rather than less conversation, and it is in the detail of an interviewee’s account that opportunities lie to understand and detect information relevant to the reason for the encounter (Vrij, Meissner, Fisher, Kassin, Morgan, & Kleinman, 2017). Further, both clinical and forensic interviews emphasize a structured or strategic approach toward clear objectives via a sequence of stages from general to specific (e.g., understanding the nature and origins of the client’s presenting problem, appraising the suspect’s role in the crime under investigation; e.g., Brandon et al., 2018). And, notwithstanding the involvement of clinicians in the development of deeply concerning interview (interrogation) practices (for an example, Mitchell & Harlow, 2016), now more than ever, ethical considerations in all areas are prominent and acknowledged (e.g., O’Mara, 2015; Walsh, Redlich, Oxburgh, & Myklebust, 2016). Forensic clinical interviewing If forensic clinical interviewing is a hybrid of practice in its neighboring fields, what does it entail that sets it

apart from both that has the potential to define it as a distinct area of practice? Clinicians in forensic settings are, first and foremost, clinicians—they have evolved professionally to embody the kind of interview practice described above. However, that form of practice requires some adjustment to become optimal for use in the range of forensic scenarios encountered by the clinicians engaging with them. To begin with, the context of interviews in forensic settings is different and somewhat at odds to that in more conventional mental health services. Meloy (2005) and Melton, Petrila, Poythress, Slobogin, Otto, Mossman, and Condie (2017) outlined a number of those differences in some detail. First, Meloy and Melton and colleagues highlight the coercive or involuntary context in which such forensic clinical interviews frequently take place. Clients often have little real choice but to see a mental health practitioner, such as for a probing risk assessment, a psychiatric evaluation for court proceedings, or for the treatment for a disorder they may not believe they have or is relevant to their offending behavior; “complete voluntariness should never be assumed” (Meloy, 2005, p. 422). Clients can refuse to attend such interviews, or limit their engagement once they do, but to do so would invariably be held to be against their interests. Thus, their decision to so engage is not freely made and the consequences of their participation for their self-esteem and their liberty can be significant and long lasting. A second observation relates to the absence of any degree of confidentiality in forensic clinical interviews (Meloy, 2005). Contrary to interviews in traditional mental health settings, where the confidentiality of proceedings is an entitlement—unless, of course, where a past crime is reported or future criminal behavior is discussed—everything covered in a forensic interview, and both the client’s behavior and that of the clinician, has the potential to become known to others (for example, other members of the client’s clinical or legal teams) or be discussed in legal proceedings (e.g., mental health tribunals, Parole Board hearings); that is, it is legally admissible evidence. Therefore, the sanctity of the clinical consultation does not exist in the forensic arena and every personal detail revealed can and will be subject to the scrutiny of any number of individuals unknown to the client. The extent to which this impedes openness and influences distortion—including deception—in the psychological information sought is unknown. Third, it is beholden on clinicians to assume that clients in forensic interviews will to some degree and

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for a variety of reasons distort their self-report (Melton et al., 2017); “the conscious distortion of information provided [by the client] during the evaluation … must be assumed to exist in all forensic interviews until it is disproven” (Meloy, 2005, p. 428). Some clients may deliberately distort their accounts because it is their intention to deceive the interviewer, perhaps in order to present themselves in a more favorable light, thus securing a more sympathetic evaluation—and a lighter sentence or earlier release. Alternatively, the self-report of other clients may be influenced by their disorders and it is beholden on the clinician to determine this influence and distinguish it from more intentional misrepresentations. Forth, in forensic contexts, the opinion of clinicians is most likely to be challenged and contested, resulting in them having to account here more than in any other setting for their assessment procedure—including their interview methods—their diagnoses and formulations, and their recommendations (Meloy, 2005). Meloy warns that the risk of narcissistic insult is especially high for clinicians working in forensic settings because of the frequency with which their opinion is challenged (see also Watts & Morgan, 1994). How this risk plays out in the nature and the quality of the clinical opinions expressed is presently unknown. Finally, the client of forensic clinical interviews is rarely the interviewee (Meloy, 2005; Melton et al., 2017). Instead, the client, the key stakeholder in proceedings and the one with the largest investment in the outcome of the meeting, is usually a legal body such as a mental health tribunal or the Parole Board (see also Hart, 2001). Exactly how this variation from general mental health practice influences the clinical opinion and the recommendations subsequently made by the forensic clinical practitioner is also unknown, although concerns have been expressed that expert opinion can vary predictably by the side to which the expert is allied (Murrie & Boccaccini, 2015 for a description of “adversarial allegiance”). Two additional issues are worthy of consideration in a discussion about how clinical interviewing in forensic settings differs from interviewing in nonforensic settings. The first issue is that practitioners are often required to conduct forensic clinical interviews in environments that are not conducive to the establishment of a rapport (Melton et al., 2017). Instead, interviews are often carried out in noisy visit halls, or in interview rooms with poor soundproofing, or within line of sight or earshot or in the actual presence of escorting staff (e.g., prison officers, nursing staff), or through hatches in otherwise locked doors.

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Such interviews may also be conducted at some speed, or with time constraints imposed by legal proceedings, constraints that would only occasionally impact on clinical interviews. While restrictive or time constrained conditions are often precautionary and for the safety of the interviewer, they can be a barrier to rapport-building and a potential inhibitor to the skilled and nuanced use of an assortment of techniques to build engagement and nurture detailed and honest reporting. The second additional issue is that clients in forensic services have the capacity to generate strong feelings in interviewers, regardless of their degree of experience or preparation. Perhaps because of the specific mental health problems of clients (e.g., severe personality disorder or psychopathy) or due to the nature of their offending behavior (e.g., sexual offences against children), or maybe because of the techniques the client relies on to manage or control the practitioner’s opinion about him or her (e.g., simulation, dissimulation; for an example, Newbury & Johnson, 2006) or as a result of their condition limiting the application of the techniques on which the clinician relies (e.g., the client is on the autism spectrum and empathy is problematic establish and use to promote engagement), interviews may not yield the kind of information clinicians hoped for. In addition, interviewers can be adversely affected by the material revealed by their clients, which has the potential to impact on their mental health in the long term (e.g., Greenall & Marselle, 2007; Powell, Guadagno, & Cassematis, 2013). Consequently, both a high level of flexibility and a broad range of skill and resilience are demanded of forensic clinicians. In its absence, there is a risk that strong personal reactions become unfavorable judgments about the client, which are more a reflection of the practitioner’s frustration and limited skill than the interviewee’s state of mind. Therefore, clinicians working in forensic settings have to make a number of important adjustments to their practice in order to facilitate the requirements of the context in which they conduct their interviews with their clients (Melton et al., 2017). Clinicians unprepared to make such adjustments are at risk of being misled by their interviewees, criticized by their actual clients, and personally affected by the material they hear. And yet the guidance available to clinicians on making such adjustments, while sustaining a high level and quality of professional practice, is minimal. The articles in this special issue of the International Journal of Forensic Mental Health, and in a further and more detailed publication to follow (Logan, in

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preparation), aim to address something of this shortfall. The investigative and forensic interviewing fields will be important guides to the development of practice in the clinical arena.

This special issue on forensic clinical interviewing This special issue will be published in this journal two parts, the first eight articles in this last issue of 2018 and the remaining articles in the first issue of 2019. All articles have different aspects of clinical interviewing practices in forensic settings. Specifically, the articles address common or especially challenging forensic clinical interview scenarios in order to highlight both how traditional clinical interviewing skills and techniques require adjustment in order to accommodate the forensic context, and the potential application of investigative interviewing skills and techniques in clinical settings. A wide range of clinical and forensic specialists has written the articles to follow, and each offers a scholarly account of practice in important areas of expertise. The areas—or interview scenarios—addressed include gender-, age-, and culturally ware interviewing, interviewees with challenging conditions and experiences (e.g., personality disorder, autism spectrum disorder), and offending behavior (e.g., a history or violence including terrorism offences), as well as common tasks in interviewing practice (e.g., overcoming resistance, identifying anomalies in disclosure, training and mentoring). This body of work endeavors to demonstrate the skill and versatility of forensic clinical interviewing practice, and in its totality, at least three important points about current and future practice may be highlighted. Forensic clinical interviewing: the best of both worlds As suggested above and in Melton et al. (2017), the traditional—and separate—disciplines of clinical and forensic interviewing differ in their focus (e.g., the client’s long-standing complex psychological problem; the client’s role in a specific criminal act), method (e.g., a trusting relationship is built over time between two essentially willing participants; a brief but intense engagement between at least two participants where the willingness of the client to engage is generally limited), and outcome (e.g., the information gathered is used to prepare a formulation, which guides supportive interventions; the information gathered may be used in evidence against the client). Forensic clinical

interviewing, the hybrid of those two disciplines, provides an opportunity to bring together the strengths of both. In this special issue, a number of articles make this point clearly. For example, in their comprehensive article, Place and Meloy examine lessons learned in the investigative interviewing field about the phrasing of questions and queries and how the choice of words used and how the message is delivered can have a significant impact on the interviewee’s willingness to engage and, ultimately, the volume and quality of the information they provide. There may be nothing in their article that will come as a surprise to the reader, the deliberate and intentional selection of words and the manner of their delivery speaks to the nuanced management of resistance in interviews where the power differential between interviewer and interviewee may be influential and the engagement of the client in an open discussion is the challenge at hand. In clinical interviews in forensic settings, where complex topics require careful and detailed exploration—topics such as the nature and existence of deviant sexual arousal, the risk of reoffending, and attitudes toward treatment and supervision, all subjects with a direct bearing on risk management including interventions – engagement and client openness are key. Therefore, word choice matters. In his similarly detailed article, Shepherd provides a tour de force on the detection of anomalies in the self-reported accounts of individuals motivated to withhold information; that is, when a client engages with an interviewer but their engagement appears incomplete, how can one detect such incomplete engagement and understand its meaning in relation to the reason for the interview? Shepherd uses conversational rules—and their breach—as his guide to the detection of anomalies and he offers a very comprehensive guide to understanding what anomalies look like and what they may mean for the underlying truth of the matter. However, the guidance he offers presupposes that the client is participating in the interview process, that he or she is talking with the interviewer sufficiently for that person to detect where topics are being incompletely covered, withheld, or distorted in order to conceal some concern of the interviewee’s. This requirement compounds our interest in resistance and in Place and Meloy’s discussion of methods to overcome and manage it. It is only in enduring conversations that the opportunities to detect “hot spots” are truly available, that is, topics of significance that the individual appears reluctant to discuss in detail (Vrij et al., 2017). Together, these two articles provide a highly granular map of the

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interview structure and content allowing more of the landscape to be exposed and negotiated. However, Wells and Brandon take a structured approach to interview management to a more considered level. Wells and Brandon address interviewing from a similar investigative angle, but they take a broader view of the structure of the interview as a whole rather than its detailed component parts. The emphasis of their article is on the importance of interview planning, the dynamic engagement process, and the value of the particular technique of sense-making, that is, taking a view of the dynamics of the interview and the interviewee’s engagement with it as a whole rather than its component parts. These are familiar tasks for clinicians, especially the latter. However, in their detailed description, including an illustrative case, they offer forensic clinicians a model of a robust form of investigative practice that is also transparent and accountable. A central tenet of their article is that the application of science-based methods of interviewing significantly increases the amount and detail of valid information elicited in interviews with clients who are to at least some degree, reluctant to engage. This is an important message and one yet to be properly assimilated into the clinical—and forensic clinical—interviewing fields. The melding of the focus and discipline of the investigative and forensic interviewing fields with the nuanced and dynamic practice of clinicians working with complex presentations has the potential to create effective interview performance. For example, in Murphy, an approach is proposed to the productive interviewing of clients in forensic mental health settings who have an autism spectrum condition. The guidance available to clinicians on interviewing this client group in forensic settings is modest at best and this article, in addition to that by al-Attar, represent a significant contribution to improving our understanding. Al-Attar’s article is especially detailed, as she examines the potential impact of an autism spectrum condition on a range of aspects of the individual’s presentation—notably, in the context of interviews in relation to terrorism offences—and how failing to appreciate the role of autism can lead the interviewer to quite different and potentially more negative assumptions about the underlying drivers of the client’s behavior. Similarly, the impact of personality disorder on interview performance is examined by Wilmott and Evershed, by Daffern, Thomson, Dunne, Papalia and Day, and by Ramsden. Wilmott and Evershed provide general guidance for competent clinical interviewing

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with clients with personality disorder who are resident in high secure forensic mental health facilities. In contrast, Daffern and colleagues focus in the transition from information-gathering interviews (such as for risk assessments) to those engagements that have a more therapeutic focus. Although interviews are interventions in their own right, the differences between engagements that are primarily information gathering in purpose and those whose function is to negotiate change are the focus here. Subsequently, Ramsden looks specifically at understanding and managing clients with antisocial personality disorder in interviews. She addresses the very prominent issue of trust with individuals more inclined than most to question the word and actions of those whose power over them they may resent and offers guidance on understanding its importance to such clients and managing its achievement. Finally, a range of articles discuss the very particular requirements of gender-based interviewing (Motz), culturally sensitive interviewing (Rosenfeld & BarberRioja), and age-relevant interviewing (McCuish, Hanniball & Corrado), each making the point about how much personal interview style has to be understood in order to apply it sensitively and responsively to the diverse experiences faced by clinicians in forensic settings. And a selection of work addressed the interviewing requirements of client groups with specific presentations that have the potential to impact on how interviews are conducted; for example, interviewing sexual offenders who may use grooming behaviors as much on interviewers as on their victims (Hoberman). Therefore, the article contained in this special issue flag key areas and practices of which forensic clinicians need to be aware in order to conduct both productive clinical interviews, but also ones that can withstand scrutiny at the highest legal level. One desire in bringing all of these articles together here was to highlight this requirement and raise the awareness of both practitioners and researchers to practice in this field. Toward a better understanding of complex interviewees A second message of this special issue is that competent interviewing yields not only more information for the use of the interviewer but more opportunities to understand the interviewee’s experience and stance with respect to the challenges they face; knowledgeable and curious practitioners are essential to the

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interview process and nowhere more so than in a forensic clinical context where the complexity of problems and the need for understanding is especially marked. Understanding is critical to the forensic clinician intent on making observations about the individual with a view to doing or recommending positive and proportionate responses to what they see in the context in which they practice. Therefore, an approach to interviews that goes beyond the facts of the interviewee’s past behavior (e.g., what was your role in this criminal act?) to its drivers and evolution over time (e.g., help me understand why you have come to see violence is a way of solving your problems?) has the potential to inform the clinician’s formulation of the client, which has in turn the potential to direct a bespoke and proportionate package of measures in response, from direct interventions to more general risk management strategies (Logan, 2013). Further, doing so in a conversational way rather than in the form of a highly structured (investigative) interview offers more opportunities for breadth of meaningful coverage as well as depth (Nordgaard, Sass, & Parnas, 2013; Shepherd & Griffiths, 2013): “psychopathology … requires an in-depth study of experience and subjectivity” (Nordgaard et al., 2013, p. 355). As an example of this practice, al-Attar in her article on interviewing violent extremists who are on the autism spectrum takes the approach that the best way of eliciting information from such a person, maintaining that openness, and preparing a sensitive and manageable risk management plan, is for the interviewer to have a good understanding of how and why people on the spectrum present as they do. Such awareness is likely to lead to the more sensitive application of interview strategies, more thoughtful enquiries, and encouraging responses. Al-Attar argues that such an approach is more likely to manage the real potential for interviewers to evoke an adverse reaction in the client because of a clumsy and insensitive approach, an outcome that reflects as much on the interviewer as on the interviewee but of which they may not be so aware. Ramsden makes a similar point in respect of engaging in interviews with people who have antisocial personality disorder, skilled interviews improve one’s understanding of the client. Daffern et al. address the point directly in their article about transitioning to treatment where those interventions are based on a formulation derived from the application of interview technique that is sensitive to the psychological problems experienced by the client. Interviewers of any kind—forensic, clinical, or a hybrid of the two—are not neutral or without

influence in their engagement with the client (see also Lilienfeld, 2016). Interviews are dynamics between the two people in the room—or more, in the event that there are also appropriate adults or advocates, lawyers or translators present. Each person is responding to all others present, and interviews in such settings are far more than the asking of questions and the recording of responses (see Spitzer, 1983). It is therefore not without justification that Shea (2017) describes clinical interviews as akin to a “delicate dance” between or among its participants (p. 2). It is an understandingbased approach on the part of the interviewer that appears to offer the real possibility of a resonant and productive engagement. Developing the evidence base for forensic clinical interviewing A final point worth highlighting in the articles of this special issue is that more attention should be paid to the training and preparation of clinicians to interview clients in forensic settings—when they undertake evaluations for the courts, tribunals, and Parole Board hearings, when they begin their assessments of clients new to their facilities or for the purpose of peer review or expert assessment, and when they supervise early career colleagues to whom the resistance or distortions offered by clients may still be perplexing and frustrating. In their contribution, Davies and Nagi address this requirement directly, with particular focus on the interview process (i.e., its structure, the roles of each of its participants, and effective communication within such as with the use of empathic statements), its content or tasks (i.e., the questions asked and how they fit into an overall strategy for interviewing a particular client linked directly to the purpose of the interview), interpersonal skills (i.e., the range of techniques and methods that interviewers use to nurture interview engagement, the working relationship between interviewer and interviewee, and relevant information flow), and personal style (i.e., the way individual interviewers deploy their own characteristics, such as their tone of voice, their physical presence, and method of enquiry, to nurture the interview). Furthermore, Davies and Nagi discuss how these features of interviews link to its purpose, its context, the interviewee’s experience and expectations, and the training and supervision available to the interviewer, in addition to wider considerations such as ethics, consent and confidentiality, quality assurance, and the role and influence of other interested parties. The comprehensive training and professional

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development framework proposed by Davies and Nagi offers a basis for enhancing existing training and supervised practice for forensic clinical interviewers, and also a basis for determining the quality of their work against the one or several purposes for which the interview was intended. To date, no other such framework has been proposed in relation to interview practice in the forensic mental health arena. This article, along with all the others in this special issue, is a step in the direction of more evidence-based and accountable practice.

Moving forward: toward best practice in forensic clinical interviewing The present article has described the context of this two-part special issue and the articles to follow, which taken together offer a more detailed understanding of forensic clinical interviewing in key areas of practice in the field. The purpose of this special issue is to raise awareness about this very important aspect of the work of clinicians in forensic settings, and to provide an account of some of the more relevant skills, strategies, and techniques, which may be useful or are already used in commonly occurring scenarios in practice. Little of what is discussed in the pages to follow will be new to the experienced interviewer or even unexpected in the novice. However, their delineation and collection here is intended to achieve two outcomes. First, it is to encourage practitioners to exercise more deliberate choice in the use of such practices in the complex and dynamic context to which they may best be applied, akin to what Shea (2017) refers to as intentional interviewing. That is, in the dynamic dance of the interview between practitioner and client (Shea, 2017), we wish to encourage interviewers to exercise good care in their selection and deliberate application of practice techniques— akin to dancing a managed foxtrot or a quickstep in which the interviewer carefully and lightly leads the interviewee, rather than a more freestyle disco arrangement in which the plan or process is potentially vague and therefore unstable (Duckworth & Kedward, 1978). It is only through the articulation of each skill and technique, and their combination in a strategic approach to the task at hand, that progress in this field of practice will be made, because it is only then that research on its component parts can be undertaken and practitioners can derive better and evidence-based means by which to determine the quality of their practice.

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And so the second desired outcome is to provide justification for more research to underpin interview process and technique in forensic clinical interviewing practice. For example, because men and women manage their social relationships quite differently (Adshead, 2011; Paris, 2007; Rosenfield, 2000), there is a need for a much better understanding of how male interviewers approach male clients compared to female clients and, in turn, how female interviewers approach female clients as opposed to male clients. Such awareness could assist interviewers of both genders to maximize their understanding of the dynamic between them and their clients and encourage better and more controlled interview management (Cooke & Logan, 2018). Also, how can interview skills and techniques optimal to one forensic clinical scenario best be combined with those from another? For example, how does one carry out a clinical interview in a forensic setting with a woman on the autism spectrum compared to a man with the same condition, or how does one best interview a young person as opposed to a working age adult who demonstrates significant features of resistance (see McCuish et al.; Place & Meloy)? Empirical research on such detailed practice requirements is to be encouraged. On behalf of all the contributors to this two-part special issue, these articles are offered as a guide to best practice in forensic clinical interviewing now, to be built upon and evolved in the years to come.

ORCID Caroline Logan

http://orcid.org/0000-0001-8810-8072

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