Systemic Treatment Of Incest: A Therapeutic Handbook

Abstract

810 July 1990 Vol. 41 No. 7 Hospital and Community Psychiatry The book is divided into four major sections: Diagnostic Issues, Psychometric Approaches, Specialized Methods, and Synthesis. The first section discusses the most cornmon clinical diagnoses and situations associated with deception, such as amnesia, posttraumatic stress disorder, sociopathy, and psychosis. A chapter entitled “Children and Deception” is also included. The section on Psychometric Approaches is composed ofthree chapters covering deception as it relates to objective personality inventories such as the MMPI, projective testing, and intellectual and neuropsychological testing. In the third section, Specialized Methods, the usefulness of drugs, the polygraph, hypnosis, and the structured interview in detecting dissimulation are reviewed. Also included is a chapter on sex offenders. The last section offers summaries on clinical methods and research in dissimulation. The book starts slowly with a discussion of methodology and definidons. However, once I was into the third chapter, on malingered psychosis, I began to realize that I had found an impressive guide to assist me in the detection of malingering and deception (read the book to differentiate these terms) and to organize my responses to the attorney who will grill me on cross-examination (which is clearly not the contnibutors’ intent). Each chapter includes, when applicable, descriptions and tables indicating when suspicions should be aroused by the presentation of cmical or test material (the threshold model) and how to arrive at a decision about the presence or absence of deception (the clinical decision model). For example, the threshold ofsuspiciousness for the presence of malingering should be crossed if hallucinations are described as continuous rather than intermittent, vague, or inaudible; are not associated with delusions; are reported in stilted language; are not diminished by various patient strategies; and are always obeyed. In a clinical decision model for establishing a malingered posttraumatic stress disorder, the clinician would try to find an understandable motive to malinger. He or she also would find atleast two of the following criteria present: irregular employment or job dissatisfaction, prior claims for injuries, capacity for recreation but not work, no nightmares or nightmares that are exact repetitions of the trauma, antisocial personality traits, evasiveness or contradictions, and noncooperativeness in the evaluation. The clinician would confirm malingering by either eliciting an admission ofit or by psychometnic evidence on strong connobonative evidence of dissimulation. An extensive reference list and an index follows the very comprehensive summaryofthe book’s contents. The editor, Richard Rogers, is a