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Robert D. Hare, Ph.D.
In a recent civil commitment hearing in the United States the District Attorney's Office decided not to introduce a psychologist's testimony concerning her PCL-R assessment, because of the belief that she was not qualified to use the instrument. The grounds for this belief are not clear, but apparently included some concerns raised by the Public Defender's Office about the adequacy of the psychologist's training in the use of the PCL-R. The implication seemed to be that in order for clinicians to be qualified to use the PCL-R they must have participated in the training program offered by my organization, Darkstone Research Group.
This particular case is similar to many others in which I am asked to evaluate a clinician's qualifications and competence with respect to the PCL-R assessment of psychopathy. However, in all but the most egregious cases I would be on shaky grounds if I did so. I have no professional or legal authority to determine who can and cannot use the PCL-R, or to provide judgments about the adequacy of specific clinicians and their assessments. In North America the education, professional training, and clinical/forensic experience required to purchase and use psychological instruments, including the PCL-R and its derivatives, the Psychopathy Checklist: Screening Version (PCL: SV) and the Psychopathy Checklist: Youth Version (PCL: YV), are determined by the test publishers, professional standards (e.g., the American Psychological Association's Standards for Educational and Psychological Testing), and by state (U.S.A.) or provincial (Canada) licensing or regulatory boards. As long as clinicians meet relevant professional and regulatory standards, have sufficient forensic experience, are legally permitted to conduct psychological assessments, and are familiar with the clinical and research literature on psychopathy, they would meet the technical requirements for use of the PCL-R.
Beyond this, it is the responsibility of clinicians to do what they can to ensure that they have the appropriate level of training and experience for the purpose at hand, and that they adhere to the appropriate professional and ethical guidelines and standards. They also should be familiar with the relevant research literature and be prepared to have their assessments subjected to scrutiny and examination. Many clinicians feel more comfortable if they have received or been exposed to specialized training in the use of a particular instrument. This may be especially true with respect to the PCL-R. As indicated in the PCL-R Manual, such training can be provided within institutions by individuals who are themselves experienced in the administration, scoring, and interpretation of the PCL-R. The Manual also recommends that a clinician should complete five to ten practice assessments and achieve an acceptable level of interrater reliability before using the PCL-R for forensic purposes. Some institutions have set their own standards for in-house PCL-R training, and most of the clinicians who participate in this training should have little difficulty in conducting reliable PCL-R assessments.
In large part, the issue of qualifications necessary to use the PCL-R is the result of the prominent role it plays in assessments of risk for violence and suitability for treatment, and because such assessments potentially have serious implications for both the individual concerned and for the public. PCL-R evaluations therefore are subjected to scrutiny by prosecutors and defense counsel that is more intense than it is with most other psychological instruments. This is particularly so with respect to the increasing use of the PCL-R in civil commitment proceedings in the United States, dangerous offender hearings in Canada, and severe dangerous personality disorder evaluations in the United Kingdom. In discussing its use in sexual predator evaluations, for example, Campbell (2000) commented, "Though it is more an objective procedure than not, there are elements of clinical judgment involved in using the PCL-R. Consequently, appropriate usage of the PCL-R appears to require specific training" (p. 125). He went on to say that psychologists who use the PCL-R (as part of a risk assessment tool) are at risk for violating the American Psychological Association's (1992) ethical standards associated with "boundaries of competence" if they have not had "specific PCL-R training" (p. 125).
In 1994, at the urging of the Association for the Treatment of Sexual Abusers (ATSA), Darkstone began to offer a formal training program for the administration, scoring, and interpretation of the PCL-R (see Hare, 1998). The Darkstone program (more specifically, the Hare PCL-R Training Program) now consists of basic and advanced workshops, and an optional post-workshop segment in which participants score, and receive feedback on, a set of videotaped case studies. The program provides prospective users with standardized training experiences, as well as some indication of the extent to which they are able to match our criterion scores for the videotaped case studies. The goal is to have international standards for the use of the PCL-R and its derivatives.
Completion of the Darkstone program indicates that the participants have received formal training in the use of the PCL-R; it does not guarantee that they are competent clinicians or that they will use the training in a professional and reliable manner. These are issues that can be monitored and evaluated by local licensing boards and through cross-examination by informed prosecutors or defense attorneys. In this regard, it is significant that both prosecuting and defense attorneys are beginning to sit in on PCL-R workshops, with a view to learning as much as they can about the PCL-R and the construct it measures. This means that expert witnesses increasingly will be subjected to intensive examination of their knowledge of the literature on psychopathy and on their ability to justify their scoring and interpretation of the PCL-R. In my view, this a good thing, but it means that clinicians will have to ensure that they are well prepared. The Darkstone program is helpful here because it ensures that all participants are exposed to the same set of training and evaluation procedures and standards for use of the PCL-R and its derivatives. Increasingly, administrators and the jurisdictions they represent wish to ensure that their clinicians meet the Darkstone standards, and it is not uncommon for me to receive requests for lists of those who have participated in the Darkstone program. As I've indicated above, however, it is not the only way in which clinicians and researchers can prepare themselves to conduct competent PCL-R assessments.
Campbell, T.W. (2000). Sexual predator evaluations and phrenology: Considering issues of evidentiary reliability. Behavioral Sciences and the Law, 18, 111-130.
Hare, R.D. (1998). The Hare PCL-R: Some issues concerning its use and misuse. Legal and Criminological Psychology, 3, 99-119.
August 22, 2000