Clinician's Corner: Forensic Evaluations and the PAI

Mark Ruiz, PhD, ABPP, is a licensed psychologist at the James A. Haley Veterans' Hospital and coauthor of the Personality Assessment Inventory Interpretive Report for Correctional Settings (PAI-CS). He specializes in competency to stand trial, mental state at the time of offense, violence and sexual recidivism risk assessment, and sentencing mitigation. In today's blog, PAR Project Director Sierra Iwanicki, PhD, talks to him about the use of the Personality Assessment Inventory (PAI) in forensic evaluations, how he became drawn to the field, and where he thinks forensic psychology is going in the future.

How did you become involved in forensic evaluations?

It happened by accident. During my undergraduate and graduate training, I had brief experiences working with juvenile and adult offenders. I took some workshops about competency and sanity evaluations through the University of South Florida. Following the workshops, some opportunities to do court-ordered evaluations opened in the county I was in and it took off from there.

Why is it helpful to include a measure of personality in these evaluations?

Psychological testing that can address multiple clinical issues in an objective manner adds credibility to any evaluation. Judges, juries, and law enforcement often are not reassured when a clinician makes an opinion based solely on the words that came out of the client's mouth. Because he told me so is not typically a persuasive argument. Psychological testing backed by science tends to be well received in the court of law.

Describe your use of the PAI in forensic evaluations.

I typically use the PAI in risk assessment and sentencing mitigation evaluations. The evidence-based validity scales are important for gauging the client's approach to the evaluation. The PAI's broad coverage of mental health and substance use disorders is also helpful in clarifying the diagnostic picture. Additionally, the well-validated Antisocial Features (ANT) and Aggression (AGG) scales are central to opinions of future risk for reoffending and violence.

What makes the PAI unique from other instruments?

The PAI's ability to measure personality pathology and substance use independently is critical in many forensic evaluations. The growing body of research validating the use of various PAI scales, most notably Negative Impression Management (NIM) and Antisocial Features (ANT), is helpful in generating persuasive opinions in the forensic setting.

How do you see the field of forensic psychology changing in the next 10 years?

The COVID-19 pandemic has placed an emphasis on telehealth. As such, technologies to ensure the availability and integrity of psychological testing will be very important. Forensic clinicians who typically work in correctional or criminal justice settings are hampered by a lack of access to facilities and an inability to do face-to-face encounters due to the infection control protocols in place. Even in situations where access is available, many clients do not have the know-how or computer access to take a psychological test remotely. Having the capacity to administer tests via telehealth and to ensure the validity of the results will be crucial for forensic psychology.

What advice would you give to anyone interested in pursuing forensic psychology?

Forensic psychology is like scotch—you must have a taste for it. Attorneys play by a different set of rules than mental health professionals, with the main goal of the legal system being to sharpen conflict to resolve a particular issue. Unconditional positive regard is not often practiced in the courtroom. Psychologists are not typically comfortable with the baseline level of hostility and conflict present in the courtroom.  However, the role of the legal system is to resolve conflicts in pursuit of justice; any psychologist interested in stepping into that forum should be ready for the culture that comes with it.

What is one thing we can glean from psychological science to improve mental health outcomes during the current collective pandemic crisis?

I think psychology has emphasized the importance of human connection, something that has taken a big hit with the social distancing and protective protocols that come with our response to the pandemic. Efforts to maintain connections during this time are more crucial than ever, particularly for the elderly and for vulnerable populations that have been isolated for extended periods of time.