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Why Retain a Forensic Psychiatrist as Opposed to the Treating Psychiatrist

This issue involves what has been referred to as “dual agency.” There has been numerous articles published in the professional literature regarding “dual agency”, for example, “On Wearing Two Hats: Role conflict in serving as both psychotherapist and expert witness; (Strasburger et al; American Journal of Psychiatry 154:4, April 1997.) The treating mental health professional had best avoid also filling the role of the forensic expert. They of course may testify as a fact witness. Sometimes the dual role is unavoidable such as the need to rendering an opinion regarding the patient’s functioning in social security cases, causation and impairment in Workers’ Compensation cases, and perhaps in rural areas where there is only available mental health professional. Mental health providers in correctional settings by virtue of their employment automatically have a dual allegiance for their employer and to their patient. However, individual treatment providers who are not in that situation owe their allegiance and duty to their patient. There is no question that this is the way it should be. However, they cannot have both a duty to render an unbiased opinion to their patient and a duty to the court. The ethics of a forensic psychiatrist include adhering to the principle of honesty and striving for objectivity. Since the treatment provider has developed a relationship with their patient and owes a duty to their patient, it is virtually impossible to be objective. This is one of the issues that presents difficulty in fulfilling both roles. Among other additional problems are the source of information gathered by the treater as opposed to the forensic examiner, the difference between a clinical and a forensic evaluation and the possibility of the provider losing their patient if the opinion given is not what the patient wants to hear. Many knowledgeable treatment providers will refuse to render a legal opinion regarding their patient and will refer to the forensic evaluator.