This article by Ralph Underwager and Hollida Wakefield examines the misuse of psychological tests in typical forensic settings.



Psychological tests are often used inappropriately and are misinterpreted and overinterpreted in the forensic setting. This harms the person being evaluated and interferes with the cause of justice. It also does a disservice to the reputation of psychologists and the science of psychology. Actual examples of misuse of particular techniques and tests and misinterpretation illustrate what has been done in forensic settings.A forensic evaluation is different from a clinical evaluation. When an evaluation is done in the clinical setting, the conclusions are used to develop a treatment plan. These conclusions form working hypotheses which can be confirmed or rejected during treatment. However, in the forensic setting, a one-time decision is made about the individual - a decision which can markedly affect the person's life.



If tests are misinterpreted in the clinical setting, the treatment plan developed from the evaluation may not be the most effective for the client. However, since treatment plans are generally modified and revised throughout the course of treatment, the mistaken conclusions can be corrected. But, an erroneous decision in the forensic setting can result in immediate and severe consequences, such as losing custody of a child or being jailed. If decisions and recommendations by the psychologist are not based on adequate data, the psychologist is acting both incompetently and unethically.



In addition, conclusions drawn by the psychologist are subject to cross-examination in the adversarial setting. If the conclusions are not based upon adequate data, the psychologist's testimony will be discredited or impeached by a skillful opposing attorney. Therefore, the psychologist should only present conclusions in reports and testimony which can be defended when challenged in cross-examination.



In the course of examining hundreds of reports, we have seen many examples of tests that are misadministered, misinterpreted, overinterpreted, or should never have been given in the particular setting. We are presenting a sample of these to illustrate what should be avoided by any psychologist who does forensic evaluations.



DRAWINGS

Tests such as the House-Tree-Person (HTP) and Kinetic Family Drawings are often overinterpreted and misinterpreted. There is a lack of validity and reliability in the use of drawings as projective assessment devices. In a review of the Draw-A-Person test in the Seventh Mental Measurements Yearbook, Harris (1) notes that there is very little evidence for the use of "signs" as valid indicators of personality characteristics. With children's drawings there is so much variability from drawing to drawing that particular features of any one drawing are too unreliable to say anything about them. The Tenth Mental Measurements Yearbook (2), in reviews by Cundick and Weinberg (p.422-425) continues the consistent finding since the first edition, 1938, that interpretations of drawings (as are often done in forensic evaluations) are unsupported by empirical evidence. Both reviewers note that there are no normative data establishing reliability and validity of the Kinetic Drawing System.



Projective tests generally, and the symbolic interpretation of drawings specifically, should be used only with great caution and with full acknowledgment of their lack of demonstrated validity and reliability. If used, drawings should be interpreted conservatively as a means of generating hypotheses to be explored. If unusual elements are present in the drawings, the client should be asked about them.



Example 1The father, in a divorce and custody dispute, was accused of tying up his three-year-old son with a bicycle chain and then sexually abusing him. Both parents were evaluated by a psychologist. The father was tested and interviewed by the psychologist who left the office, leaving him to finish the drawings. He took them home, finished them with the use of drafting instruments, and brought them to her office the next day.



The psychologist stated that the response style to the projective drawings suggested "obsessive-compulsive tendencies, high defensiveness and an intense need to control ... (and) his rigidly defensive posture does not adequately bind the underlying anxiety and trepidation of doing poorly." However, his Bender is completely normal.



His House-Tree-Person (HTP) drawings are careful and detailed. He clearly had attempted to do as good as job as possible. Given that his understanding was that these drawings would be interpreted to indicate whether or not he was an abuser, his choice to carefully complete them at home demonstrates an understandable effort to comply with the instructions and do the best job he could. None of this was noted in the report. There are no scientific data to support the interpretive comment quoted above. It is meaningless jargon with no connection to an empirical base.



Example 2A four-year-old girl was asked to draw a picture of herself and the family doing something. She instead, according to the school psychologist who was evaluating her, "seemed to be preoccupied with drawing circles within circles which she called 'caves.' Her second representation bore a significant resemblance to male genitalia (when asked what it represented, she reported that it was a ball rolling into a lion's cave)." This was interpreted as being suggestive of sexual abuse and the fact that the child has been subjected to some type of traumatic experience.



When we saw the child, now age five, we tested her and found borderline to low-average intelligence and no ability to draw anything other than scribbled circles. The child clearly had difficulties with visual motor perception and indeed, could not draw, a fact which was ignored by the other evaluator. This example, therefore, illustrates the importance of recognizing the child's developmental level.



Example 3In a similar example with an older child, a 15-year-old boy's drawings of a person were interpreted as "rather primitive for an adolescent of his age and ... suggests that (the boy) has the psychological characteristics of a person who acts out their anger in sexualized ways." But when we tested this boy, we discovered that he was blind in one eye, performed below what was expected for his age on the Porteus and the Bender, and had a performance IQ on the WISC-R of 67. This is why his drawings were "primitive." None of this had been assessed or discussed as a possibility.



Example 4A seven-year-old girl was asked to draw a picture of her family doing something. She drew a picture of herself and her sister with their hands up in the air with the father standing next to them and smiling. The child told the psychologist that she and her sister were "cheering at a show."



The psychologist disregarded what the child told her about the drawing and claimed that this really signified a "helpless posture." She saw it as significant that there were no fingers drawn on the hands and that the hands were large on the father. She asserted that abused children put large hands on the drawings of their perpetrators. She also claimed that the thick lines in the crotch in the picture of the father meant an emphasis on genitals, was probably a penis, and showed anxiety about the father.



She therefore concluded that the girl, who denied the allegations of sexual abuse by the father, had most likely been sexually abused by him and should "be protected from further abuse by him." The behavior of the psychologist in her interpretation is particularly bad because she ignored what the child herself said about the drawing.



Example 5A four-year-old girl's drawing of a tree in the HTP was considered significant because the child, when asked to draw a tree, also drew a cactus. This was interpreted in terms of "unconscious expression of danger and fearfulness." However, the child was not asked if she had a cactus in her yard (this was in Texas).



The child also brought a drawing of a clown's face to the therapist which she had ostensibly drawn while in the waiting room with her parents. The clown was interpreted as being significant because "there is an element of sadness in the clown's eyes." This clown is of much greater sophistication and detail than the child's other drawings. When pressed about this in his deposition, the psychologist acknowledged that the parents probably drew it and she colored it. This example illustrates both problems in administration and in interpretation.



Example 6This was a day care case with allegations of ritualistic satanic abuse complete with costumes, masks, dead animals, sacrificed babies, blood, feces, skeletons, and monsters. These bizarre allegations surfaced during therapy. The therapist who saw two of the children depended heavily upon the children's drawings in forming conclusions about ritualistic, satanic abuse.



The case file included a large stack of drawings over a two-year period - probably over 500 from the two girls. These drawings are typical of the types of scribbles and rudimentary figures drawn by three- and four-year-olds. These had been saved because they were considered significant. In her deposition the psychologist was asked about the drawings in detail. What she believed was significant included:



Shapes that are untypical for three- and four-year-old children

Shapes that are phallic symbols

Jiggly lines that indicate anxiety

Straight mouths that mean people can't say anything.

Jagged mouths that mean anxiety

A mouth that is open and oval shaped

Darkened eyes

Eyeballs that are scribbled around

Eyes that are two different colors

Drawing something and then covering it up

Drawings something and not talking about it

Colors are very important and significant:



Black means the child is frightened or distressed; black is a morbid down color

Red means angry, unless the child is drawing a pretty red flower, when it is healthy

If every thing is the picture is red or red and black, this is very suspicious.

Blue, brown, and orange mean fear, anger, and depression

Pink, red, and green are healthy colors.



There is no empirical evidence to support any of these theories. Also, these were not House-Tree-Person drawings or Kinetic Family Drawings but were simply drawings done in therapy sessions or at home and brought to the therapist by the parent. There was no effort to standardize the administration.



Example 7

This example shows a gross overinterpretation of a Bender given to an adult. Whereas the Bender is a useful screening test for possible organic dysfunction and is an efficient measure of perceptual-motor development in young children, its use as a projective technique for emotional psychopathology is questionable. When used as a personality instrument or projective technique, great caution should be used and it should never be used as the main measure of psychopathology (

3).

In this custody evaluation, the psychologist gave three personality tests, Bender Gestalt, HTP, and TAT, all which were interpreted in the direction of finding extreme psychopathology. MMPIs or other objective testing were not used. The Bender interpretation for the woman is:

There appears to be no visual/motor neurological dysfunction with the Bender Gestalt. Personality interpretation reveals difficulty with dissonant elements of her personality, anxiety, timidity, possible paranoia, and marked ambivalence. She seems emotionally constricted, may lack impulse control, is perfectionistic and obsessive-compulsive, and may manifest dissociation, splitting, or isolation mechanisms. She may feel impotent. In addition she indicates much difficulty with sexuality and aggression. She may have a fear of penetration, anxiety about phallic symbols, or castration anxiety. She may have a desire to return to the womb and/or possible suicidal tendencies. She may have significant problems with ego boundaries.

The HTP and TAT were similarly interpreted as indicating extreme psychopathology and the psychologist concluded that the woman had major weaknesses in areas crucial to parenting and was in need of long-term, intensive, analytically-oriented therapy, and therefore the father should have custody.



Millon Clinical MultiaxIal Inventory (MCMI and MCMI-Il)Practically any computerized Millon Clinical Multiaxial Inventory interpretation can serve as a horrible example when the interpretation is used as part of a forensic (as opposed to a clinical) evaluation and the test is not interpreted accordingly. Very often, what we see is the computerized interpretation of the MCMI-II lifted verbatim and without qualification from the computerized printout which accompanies the test scoring. This is a violation of the ethical standards for psychologists who use computerized test interpretations.

This practice is a particular problem with the MCMI-II, which is normed on and intended to be used for a clinical population. When used for other assessment purposes, the MCMI-II must be interpreted extremely cautiously because of its tendency to overpathologize. The result of using these computerized interpretations therefore greatly exaggerates psychopathology.



problem is not in the test, but in its misuse. The test is normed entirely on clinical samples and is only intended for persons who have psychological symptoms and are being assessed for treatment and evaluation. The manual (4) clearly states that this test is "not a general personality instrument to be used for 'normal' populations or for purposes other than diagnostic screening or clinical assessments." Millon has repeatedly warned against using the inventory with people who are not psychiatric patients because the test norms may not be valid if the subject does not fit the standardizing (psychiatric) group (5).



We do use this test as part of our overall assessment but interpret it cautiously and conservatively with the above in mind. When used in this way, it can provide useful information. Choca, et al. (5) state that there is nothing intrinsically wrong with using the MCMI to test "normal" people as long as the evaluator is aware that the test was designed for and standardized with a psychiatric population. The user will have to make the appropriate adjustments and alter the narratives. The computerized narrative must never be lifted verbatim into the report since it will find serious psychopathology and personality disorders in just about everyone.





RORSCHACH

Few evaluators using the Rorschach acknowledge its limitations. If the Rorschach is used, its limitations should be clearly noted unless the Exner system is used. And then, it is necessary to say what is being scored by the Exner system. But often, idiosyncratic interpretation techniques are used to form conclusions and make recommendations which affect the lives of people.



There is no empirical support for the validity of the Rorschach, except when the Exner system is used. Reviews in the Buros Mental Measurement Yearbook for every year in which this test has been reviewed state that there is no research demonstrating its validity. For example, in the Eighth Mental Measurements Yearbook (6) Peterson concluded: "The general lack of predicted validity for the Rorschach raises serious questions about its continued use in clinical practice."



commenting upon the use of the Rorschach, Dawes (7) writes:



Now that I am no longer a member of the American Psychological Association Ethics Committee, I can express my personal opinion that the use of Rorschach interpretations in establishing an individual's legal status and child custody is the single most unethical practice of my colleagues. It is done, widely. Losing legal rights as a result of responding to what is presented as a "test of imagination," often in the context of "helping" violates what I believe to be a basic ethical principle in this society - that people are judged on the basis of what they do, not on the basis of what they feel, think, or might have a propensity to do. And being judged on an invalid assessment of such thoughts, feelings, and propensities amounts to losing one's civil rights on an essentially random basis.





Example 8

The psychologist in this example interpreted the Rorschach as reflecting:

[a] ... highly defensive stance which is accompanied with blocking, censoring, and inhibition of his underlying affect ... an undercurrent of anxiety, unrequited love, and cloaked sexuality ... difficulty with relating appropriately to others ... latent polymorphous perverse orientation to the environment ... fantasies (that may include) homosexual, bisexual, and exhibitionist feelings ... hostility toward women ...

Examination of the man's actual responses to the Rorschach yields no evidence for interpreting his Rorschach as pathological. Although there is indication of scoring, apparently using the Klopfer or Beck scoring approaches, there is no report of any of the ratios and no attempt to base any of the interpretations upon either a scoring summary or specific responses.



Within the Rorschach literature the actual responses of the client do not warrant these interpretations. They are personal, subjective, and idiosyncratic interpretations. The interpretations assert the reality of inferred unconscious processes going on inside the client. There are no scientific data to support postulation of these intervening variables. The phrase, "latent polymorphous perverse orientation to the environment," is meaningless jargon with no referent in reality.





MMPI

Ziskin (8) notes that the MMPI better fits the forensic requirements for evidence to be believable and understandable than do other assessment methods. The MMPI has years of validation research and the data obtained from it are objective and quantifiable. The MMPI-2 was developed so that the research on the original MMPI is still relevant and usable. In fact, the MMPI-1 profile can be drawn using the table in the back of the MMPI-2 manual.



, MMPIs are often overinterpreted and misinterpreted. Such erroneous interpretations are not simply a matter of a difference of opinion; the horrible examples we have seen result from idiosyncratic interpretations without a basis in the empirical literature. In addition, as with the MCMI-II, sometimes computerized interpretations are used without qualification. Not all computerized MMPI interpretative programs are equally good (9).



Scale 5: Example 9

This profile, in which scale 5 was at 82 and scales 3 and 9 at 70, was seen as "very consistent" with someone who sexually abuses a child. The scale 5 elevation was seen as particularly significant and as reflecting sexual conflict and sexual dissatisfaction. The psychologist testified that this elevation indicates somebody who is in trouble because of their sexual behavior. He denied, under cross-examination, that a high scale 5 can reflect a college education or high degree of education. He asserted the MMPI indicated that the client had a tendency to act out sexually with a child.

is mistake to interpret an elevation on scale 5 as reflecting sexual conflicts or as meaning it is likely that the individual is homosexual or a child molester since there are many factors behind such an elevation. Such an elevation generally reflects an intelligent, imaginative, sensitive, and passive individual with a wide range of interests which do not fit the masculine stereotype. Lachar (10) reports that the college educated frequently obtain elevations in this range.



Fowler (11) points out that scale 5 is a nonpathological scale. Graham (12) notes that scores on scale 5 are related to intelligence, education, and socioeconomic level and that a T-score of 80 is only a moderate elevation for an educated middle-class person. Duckworth (13) states that an elevation on scale 5 suggests a passive person with aesthetic interests and notes that elevations are typical of males with college education. Other MMPI experts report similar characteristics associated with scale 5 elevations. There is no indication in the MMPI literature that child molesters or other sex offenders are more likely to score high on scale 5. (It is of note that the MMPI-2 norms result in much lower scale 5 elevations in males.)



Overinterpretation of the K Scale In Court or Custody Settings

overinterpretation of a high K scale in a court or custody setting is a common error. Any conclusions about defensiveness on the MMPI must be qualified in terms of the testing situation. Elevations on the K scale in persons taking the MMPI in custody and court situations are common and must not be interpreted as signifying defensiveness as a personality characteristic. It is a normal and adaptive response to the situation and must not be overinterpreted. Reports in which there is a K elevation should include the information that persons taking the MMPI as part of a custody or court evaluation commonly have elevations on scale K. Graham (14) notes that if he doesn't see an elevation on K in a custody evaluation, he wonders what is the matter - doesn't the person want the child?



Example 10

This was a divorce and custody evaluation which was complicated by allegations of sexual abuse against the father. The scale K elevation was at 70 in an otherwise within normal limits MMPI and this was interpreted by the psychologist as "clinically significant." He claimed this meant that the client was defensive and was trying to "present himself in the best light psychologically and emotionally." He said that "he was trying to answer the questions in the direction of looking good," and asserted, "Sexually, this kind of thing (an elevation on the K scale) is expected." There were no qualifications in terms of the setting in which the MMPI was taken.



In addition, this was a professionally and occupationally successful man with college education. Such persons routinely have higher K elevations, which indicates good ego strength and competence.



Failure to Recognize the Situational Factor. In a Scale 6 Elevation: Example 11

This man, who had been accused of sexual abuse which he denied, had a scale 6 elevation which was interpreted as indicating high defensiveness, anger, distrust, sexual conflict, poor behavioral controls, and tendencies toward acting out conflicts and impulses. It was labeled "seriously abnormal," a "very pathological profile," "scary" and very unusual and abnormal.



However, an elevation in scale 6 is a common response in persons who have been accused of sexual abuse and who deny the allegations. This is due to the affirmation of such items as: I know who is responsible for most of my troubles, Someone has it in for me, I believe I am being plotted against, I am sure I am being talked about. Rather than reflecting anger, hostility, suspiciously, and paranoia as pathological personality traits, the endorsement of these persecutory items reflects the individual's current reality and is a normal response to the situation.



We have done research on this (15, 16). Ziskin (8) also discusses such situational effects on scales 6 and recommends caution in interpreting scale 6 elevations in such circumstances.



Failure to Use Adolescent Norms for an Adolescent: Example 12

A 15-year-old boy was given an MMPI as part of an evaluation regarding a claim by his sister that he had sexually abused her. Both were adopted minority children who came from troubled backgrounds. The boy stoutly denied the allegations, which arose after he, while babysitting, had put his sister to bed early as punishment for misbehavior.



The boy did not complete the MMPI items, so the psychologist called him and read the items to him over the telephone. The MMPI was then computer scored using the adult norms. The interpretation given by the evaluator was that the MMPI indicated the boy had significant problems with anger management, interpersonal relations, impulsivity, unpredictability, and hostile and sexual acting out. She concluded that he had, in fact, sexually abused his sister and recommended that he be placed in an adolescent perpetrator program. However, when the adolescent norms for the boy's MMPI are used, the only elevation is on scale 3. Scales 4, 8, and 9 are well within normal limits.



The literature on the MMPI indicates that it is standard procedure to use the adolescent norms in order to draw conclusions about pathology in a given adolescence and it is standard practice to plot both profiles. Although adult norms may be used in research since we need to see the contrast between adolescents and adults, the adult norms must not be used forensically. The meaning "disturbed" or "abnormal" can only be established against adolescent norms.



This should no longer be a problem now that the MMPI-A (

17) is available. This MMPI revision is intended for adolescents age 14 to 18 and should be used for this group rather than the MMPI-2.



Departing from Standard Administration Procedures: Example 13

In this custody evaluation, the psychologist sent the MMPIs home to be finished, even after the husband had told him about an earlier MMPI taken by his wife in which she talked to him about what answer to put down on some of the items.



Whereas psychologists may sometimes do this with therapy clients, it is never acceptable for a forensic evaluation where the results of the evaluation are to be presented in the justice system and are to be used in making decisions about people's lives. Ziskin (8) warns against this practice:



The "take home" MMPI should be avoided in the forensic situation ... This practice can lead to questions as to whether the individual took the test in the standard way and whether all of the responses are purely his own, as highlighted by Graham's amusing anecdote about the mental hospital patient who had his ward colleagues assist him by voting on the appropriate answers.





Overinterpretation of the MMPI Supplementary Scales

The supplementary scales must be interpreted cautiously when the basic clinical scales are within normal limits and the interpretations must be on the basis of rules that are based on research.



Example 14

In this custody evaluation, the clinical scales for the father were all well within normal limits but the dominance scale was elevated above 70. The MMPI was therefore interpreted as indicating that the individual had a "highly assertive and domineering style," whose leadership is "characterized by determination, inflexibility, and an almost autocratic control." In his trial testimony, the psychologist said that the client is "a very willful man" who has "not played the game right" and added that "All the time, I suspect what I saw in my tests undercuts that quite a bit, because assertiveness, being aggressive, dominance, can become autocratlcness, and I think that's what has happened."



is a misinterpretation of a dominance scale elevation in an otherwise within normal limits profile. Caldwell (18) says the following about the appropriate interpretation of the Do (Dominance) supplementary scale:



Although based on peer nominations of subjects as strong, confident, influential, unintimidated in face-to-face situations, and showing initiative and leadership ... the title "dominance" may be partially misleading. That is, the scale reflects taking charge of one's own life - or not taking charge - considerably more than bossiness or being overbearing ... Do should be interpreted as taking charge of one's life ... e.g. as self-organizing, making workable plans, and meeting deadlines. This description, was, in fact, quite accurate for this man.





MULTIPHASIC SEX INVENTORY

The Multiphasic Sex Inventory (MSI) (19) is a self-report questionnaire which consists of statements about sexual activities, problems and experiences. It has scales which assess the level of openness about the deviant sexual behaviors. It has been reported to be useful in assessing sex offenders in order to develop treatment plans. It may also be used during treatment to assess progress. However, it is now sometimes being used to assess an individual who denies sexual abuse to determine whether the individual actually is an abuser.



This test is not intended for this purpose.



The manual accompanying the MSI states "[i]t is important to remember that the MSI is not appropriate for use in the legal pursuit of guilt or innocence. The alleged offender must acknowledge culpability in order for the inventory to be used" (19). It must never be used on an individual who denies being a sex offender or as part of an assessment to determine whether someone who denies an alleged sex offense is likely to have actually done it (20).



Example 15

The sexual abuse allegations arose when the child was supposed to be returned from a visitation with the mother (the father had custody). The MSI, which was part of the court-ordered evaluation, was interpreted in terms of a "fake good" response (which means that the respondent either is lying about his sexually deviant interests or does not in fact possess these interests) and it was concluded that the client had an "elevated level of denial" and was not telling the truth.





PENILE PLETHYSMOGRAPH

plethysmograph is a useful technique in developing individualized treatment program for sexual offenders. However, it is an error to use it with someone who denies committing a sexual offense in order to determine the veracity of the denial (21). William R. Farrall, the major manufacturer and provider of plethysmographs and trainer of the use of penile plethysmographs, says that the plethysmograph must never be used in this way because it produces too many false positives - that is, deviant elevations in persons who are not sex offenders (22). The consensus of the experts in the field is that plethysmography is useful in treatment, has limited use in predicting future behavior of known sex offenders, but is of no use in screening a normal population. It cannot be used to determine whether a person who has been accused of sex molestation and is denying it is telling the truth.



Research indicates that normal heterosexual males with no indication of any sexual interest in children frequently respond with some evidence of penile engorgement to the presentation of the stimuli used to present aberrant sexuality, including children. The data also show that responses to the plethysmograph can be manipulated and faked in any direction the subject chooses (23-26).



Example 16

A client was given the penile plethysmograph and it was found that his highest level of arousal was to adult females followed by four-year-old females and 12-year-old females. This was used to support the conclusion that the client was a possible pedophile who therefore had been untruthful in his denial of child sexual abuse.





OTHER "TESTS"

has been much criticism of the use of the anatomical dolls in assessments of children suspected of sexual abuse. The anatomical dolls sometimes are used as a type of test and the behavior of the child in interacting with the dolls is used to draw conclusions about abuse. Two American Psychological Association committees (the Committee of Children, Youth, and Families and the Committee on Psychological Testing and Assessment) (27) determined in a March, 1988 meeting that the dolls "are considered to be a psychological test and are subject to the standards when used to assess individuals and make inferences about their behavior" (28).



have frequently criticized the use of the dolls and the way interactions with the dolls are often interpreted (15, 29-31).



To date, there are no standardized or normative data for the dolls, a fact acknowledged by the APA Council of Representatives in 1991 (32). Nevertheless, a whole paper could be written on horrible examples using the dolls. We have addressed this elsewhere and will not discuss this further here.

, many other techniques are used by psychologists and other evaluators, such as games, puppets, story telling, play observations, projective cards, and play dough (



Example 17

In an evaluation session, a three-year-old girl poked a toy cat with a tinkertoy. Her parents also reported that she tried to poke the cat at home. (The parents gave great attention to this behavior, which, not surprisingly, continued and escalated.)

This was interpreted by the evaluator in terms of reenactment and repetition and was seen as supporting the belief that the child had had a tinkertoy stuck up her genitals by a four-year-old boy at the day care center (this supposedly happened in the lunch room with a teacher present). The poking of the toy cat with the tinkertoy was seen as symbolic for the boy poking her. The evaluator claimed that the child was working through her trauma by repeating her own victimization. The play was interpreted as supporting the reality of the alleged abuse (which was unsubstantiated by child protection).



Example 18

The therapist claimed that she was able to tell whether the alleged events (ritualistic, satanic abuse) actually happened or didn't happen by observing such things as a "white face" or "dark eyes" when the child was talking about the events.



Example 19

The child was described as having the "hardened, drawn, demeanor of an abused child." This was used as evidence that the child had, in fact been abused. (Photographs of the child taken during this period show a normal appearing, attractive child.)



Example 20

A baby was returned to the foster mother following a visit with the parents and was described as having the "smell of sex." An emergency hearing was held in which social services attempted to cut off visits because this "smell of sex" triggered the suspicion that the parents were having sex with their baby. A psychologist agreed that the sex smell was significant and indicated probable abuse on the part of the parents. Fortunately, the parents had been at a church potluck dinner during the entire visit so they were able to disprove, the accusations.





RELEVANT ETHICAL PRINCIPLES

ethical principles for psychologists are relevant to these examples. These are found in both the applicable principles from the Ethical Principles of Psychologists (34) and the revised Ethical Principles of Psychologists and Code of Conduct (35) which will take effect on December 1, 1992.



These principles stress the fact that psychologists bear a heavy social responsibility since their recommendations and actions may alter the lives of others. They therefore must maintain high standards of competence and only provide services for which they are qualified by training and experience. When using psychological testing, they must maintain knowledge of the relevant literature and understand validation problems and test research. When reporting the results of their assessments, they must indicate any reservations they have regarding test validity or reliability because of the circumstances of the assessment or the inappropriateness of the norms for the person tested. They guard against the misuse of assessment results by others.



The American Psychological Association's (36) Standards for Educational and Psychological Testing stresses the necessity for following the standardized procedures for test administration and scoring specified by the test publisher. If any changes in these procedures are made, this should be described in the report, along with appropriate cautions about the possible effects on the validity of the results. Psychologists must not imply that their test interpretations are based upon a empirical evidence of validity unless such evidence exists.



The American Psychological Association's Guidelines for Computer-Based Tests and Interpretations (27) states that computer-generated interpretive reports should be used only in conjunction with professional judgment. The psychologist must determine for each individual the validity of the computerized test report based on the test taker's characteristics along with the context of the testing situation.



CONCLUSIONS

Forensic psychologists have a duty to do a careful assessment and to report their conclusions in a responsible manner since their conclusions can affect the lives of others. The psychologist should only present conclusions which are based on empirical research and which can be adequately defended. If decisions and recommendations by the psychologist are not based on adequate data, the psychologist is acting both incompetently and unethically.



REFERENCES

1. Buros OK (Ed.): The Seventh Mental Measurements Yearbook. High-land Park, NJ, Gryphon Press, 1972 2. Buros OK (Ed.): The Tenth Mental Measurements Yearbook. Highland Park, NJ, Gryphon Press, 1989 3. Whitworth RH: Bender Gestalt Motor Gestalt Test, in Test Critiques, Vol.1. Edited by Keyser DJ, Sweetland RC. Kansas City, MO, Test Corporation of America, 1984 4. Millon T: Manual for the MCMI-II, 2nd Edition. Minneapolis. MN, National Computer Systems, 1987 5. Choca JP, Shanley LA, Van Denburg E: Interpretative Guide to the Millon Clinical Multiaxial Inventory. Washington, DC, American Psychological Association, 1992 6. Buros OK (Ed.): The Eighth Mental Measurements Yearbook. Highland Park, NJ, Gryphon Press, 1978 7. Dawes R: Rational Choice in an Uncertain World. New York, Harcourt Brace Jovanovich, 1988 8. Ziskin J: Clinical Notes on the MMPI. Use of the MMPI in Forensic Settings. Minneapolis, MN, National Computer Systems, 1981 9. Butcher JN (Ed.): Computerized Psychological Assessment: A Practitioner's Guide. New York, Basic Books, Inc., 1987 10. Lachar D: The MMPI: Clinical Assessment and Automated Interpretation. Los Angeles, Western Psychological Services, 1974 11. Fowler R: Workshop on the MMPI. Guadalupe, December 1981 12. Graham J: The MMPI: A Practical Guide. New York, Oxford University Press, 1977 13. Duckworth JC: MMPI Interpretation Manual for Counselors and Clinicians, Second Edition. Muncie, IN, Accelerated Development Inc,, 1979 14. Graham 3: Assessing psychological factors relating to domestic relations. Presentation at The Mental Health Professional as an Expert Witness: A Conference for Psychologists and Psychiatrists, Orlando, Florida, May 20-22, 1988 15. Wakefield H, Underwager R: Accusations of Child Sexual Abuse. Springfield, IL, C.C. Thomas, 1988 16. Wakefield H, Underwager R: Scale 6 elevations in MMPIs of persons accused of child sexual abuse. Presentation at the 23rd Annual Symposium on Recent Developments in the Use of the MMPI, St. Petersburg, Florida, March 1988 17. Butcher IN, Williams CL, Graham JR, Archer RP, Tellegen A, BenPorath YS, Kaemmer B: MMPI-A (Minnesota Multiphasic Personality Inventory-Adolescent): Manual for Administration, Scoring, and Interpretation. Minneapolis, University of Minnesota Press, 1992 18. Caldwell AB: MMPI Supplementary Scale Manual. Los Angeles, Caidwell Reports, 1988 19. Nichols HR, Molinder I: The Multiphasic Sex Inventory Manual (Available from Nichols and Molinder, 437 Bowes Drive, Tacoma, WA 98466), 1984 20. Nichols HR, Molinder I: personal communication, 1990 21. Murphy WD:

Psychophysiological assessment of sexual arousal: uses and misuses. Presented at the Second International Conference on the Treatment of Sex Offenders, Minneapolis, MN, September 22-24, 1991 22. Farrall WR: personal communication, September22, 1991 23. Card RD, Farrall W: Detecting faked penile responses to erotic stimuli: a comparison of stimulus conditions and response measures. Annals of Sex Research 1990; 3:4:381-396 24. Grossman LS, Haywood TW, Cavanaugh JL: Deviant sexual responsiveness on penile plethysmography: pedophiles versus normal controls. Paper presented as part of the paper session titled "Research on Sexual Offenders" at the 97th annual meeting of the American Psychological Association, August 11-15, 1989, New Orleans, Louisiana 25. McAnulty RD, Andrew M: Characteristics of individuals who deny the validity of child molestation allegations. Paper presented at convention of the Association for the Advancement of Behavior Therapy, Washington, DC, November 1989 26. Travin S, Cullen K, Melella JT: The use and abuse of erection measurements: a forensic perspective. Bull American Academy of Psychiatry and the Law 1988; 16:3:235-250 27. Committee on Professional Standards and Committee on Psychological Tests and Assessment: Guidelines for Computer-Based Tests and Interpretations. Washington, DC, American Psychological Association, 1986 28. Landers S: Use of 'detailed dolls" questioned: defense lawyers claim doll use leads to false reports of abuse. The American Psychological Association Monitor 1988; 19:6:24-25 29. Underwager R, Wakefield H: The Real World of Child Interrogations. Springfield, IL, C.C. Thomas, 1990 30. Underwager R, Wakefield H: More effective child interviewing procedures in sexual abuse allegations. Workshop presented at the Seventh Annual Symposium in Forensic Psychology, Newport beach, California, May 2-5, 1991 31. Wakefield H. Underwager R: Evaluating the child witness in sexual abuse cases: interview or inquisition? American Journal of Forensic Psychology 1989; 7:3:43-69 32. APA Council of Representatives: Statement on the use of anatomically detailed dolls in forensic evaluations. Washington, DC, American Psychological Association, 1991 33. Kendall-Tackett KA: (1992). Beyond anatomical dolls: professionals' use of other play therapy techniques. Child Abuse and Neglect 1992; 16:139-142 34. American Psychological Association: Ethical principles of psychologists. American Psychologist 1990; 36:633-638 35. American Psychological Association: Ethical principles of psychologists and code of conduct. American Psychologist 1992; 47:1597-1611 36. American Psychological Association: Standards for Educational and Psychological Testing. Washington, DC, Author, 1985 ABOUT THE AUTHORS

Ralph Underwager, Ph.D. is a licensed consulting psychologist and Hollida Wakefield, M.A. is a licensed psychologist at the Institute for Psychological Therapies in Northfield, Minnesota. They provide treatment to victims, families and perpetrators of child sexual abuse and have consulted or testified in cases of alleged sexual abuse in thirty-six states and several foreign countries. They have presented workshops and seminars on the topic and are the authors of Accusations of Child Sexual Abuse, published by C.C. Thomas in 1988.



This paper was presented at the Eighth Annual Symposium in Forensic Psychology of the American College of Forensic Psychology. held April 9-12,1992 in San Francisco, California.



Copyright 1993 American Journal of Forensic Psychology, Volume 11, Issue 1. The Journal is a publication of the American College of Forensic Psychology, P.O. Box 5670, Balboa Island, California 92862.



Correspondence should be addressed to Ralph Underwager, Institute for Psychological Therapies , 13200 Cannon City Blvd. , Northfield, MN 55057-4405

A forensic evaluation is different from a clinical evaluation. When an evaluation is done in the clinical setting, the conclusions are used to develop a treatment plan. These conclusions form working hypotheses which can be confirmed or rejected during treatment. However, in the forensic setting, a one-time decision is made about the individual - a decision which can markedly affect the person's life.If tests are misinterpreted in the clinical setting, the treatment plan developed from the evaluation may not be the most effective for the client. However, since treatment plans are generally modified and revised throughout the course of treatment, the mistaken conclusions can be corrected. But, an erroneous decision in the forensic setting can result in immediate and severe consequences, such as losing custody of a child or being jailed. If decisions and recommendations by the psychologist are not based on adequate data, the psychologist is acting both incompetently and unethically.In addition, conclusions drawn by the psychologist are subject to cross-examination in the adversarial setting. If the conclusions are not based upon adequate data, the psychologist's testimony will be discredited or impeached by a skillful opposing attorney. Therefore, the psychologist should only present conclusions in reports and testimony which can be defended when challenged in cross-examination.In the course of examining hundreds of reports, we have seen many examples of tests that are misadministered, misinterpreted, overinterpreted, or should never have been given in the particular setting. We are presenting a sample of these to illustrate what should be avoided by any psychologist who does forensic evaluations. Tests such as the House-Tree-Person (HTP) and Kinetic Family Drawings are often overinterpreted and misinterpreted. There is a lack of validity and reliability in the use of drawings as projective assessment devices. In a review of the Draw-A-Person test in the, Harrisnotes that there is very little evidence for the use of "signs" as valid indicators of personality characteristics. With children's drawings there is so much variability from drawing to drawing that particular features of any one drawing are too unreliable to say anything about them. The, in reviews by Cundick and Weinberg (p.422-425) continues the consistent finding since the first edition, 1938, that interpretations of drawings (as are often done in forensic evaluations) are unsupported by empirical evidence. Both reviewers note that there are no normative data establishing reliability and validity of the Kinetic Drawing System.Projective tests generally, and the symbolic interpretation of drawings specifically, should be used only with great caution and with full acknowledgment of their lack of demonstrated validity and reliability. If used, drawings should be interpreted conservatively as a means of generating hypotheses to be explored. If unusual elements are present in the drawings, the client should be asked about them.The father, in a divorce and custody dispute, was accused of tying up his three-year-old son with a bicycle chain and then sexually abusing him. Both parents were evaluated by a psychologist. The father was tested and interviewed by the psychologist who left the office, leaving him to finish the drawings. He took them home, finished them with the use of drafting instruments, and brought them to her office the next day.The psychologist stated that the response style to the projective drawings suggested "obsessive-compulsive tendencies, high defensiveness and an intense need to control ... (and) his rigidly defensive posture does not adequately bind the underlying anxiety and trepidation of doing poorly." However, his Bender is completely normal.His House-Tree-Person (HTP) drawings are careful and detailed. He clearly had attempted to do as good as job as possible. Given that his understanding was that these drawings would be interpreted to indicate whether or not he was an abuser, his choice to carefully complete them at home demonstrates an understandable effort to comply with the instructions and do the best job he could. None of this was noted in the report. There are no scientific data to support the interpretive comment quoted above. It is meaningless jargon with no connection to an empirical base.A four-year-old girl was asked to draw a picture of herself and the family doing something. She instead, according to the school psychologist who was evaluating her, "seemed to be preoccupied with drawing circles within circles which she called 'caves.' Her second representation bore a significant resemblance to male genitalia (when asked what it represented, she reported that it was a ball rolling into a lion's cave)." This was interpreted as being suggestive of sexual abuse and the fact that the child has been subjected to some type of traumatic experience.When we saw the child, now age five, we tested her and found borderline to low-average intelligence and no ability to draw anything other than scribbled circles. The child clearly had difficulties with visual motor perception and indeed, could not draw, a fact which was ignored by the other evaluator. This example, therefore, illustrates the importance of recognizing the child's developmental level.In a similar example with an older child, a 15-year-old boy's drawings of a person were interpreted as "rather primitive for an adolescent of his age and ... suggests that (the boy) has the psychological characteristics of a person who acts out their anger in sexualized ways." But when we tested this boy, we discovered that he was blind in one eye, performed below what was expected for his age on the Porteus and the Bender, and had a performance IQ on the WISC-R of 67. This is why his drawings were "primitive." None of this had been assessed or discussed as a possibility.A seven-year-old girl was asked to draw a picture of her family doing something. She drew a picture of herself and her sister with their hands up in the air with the father standing next to them and smiling. The child told the psychologist that she and her sister were "cheering at a show."The psychologist disregarded what the child told her about the drawing and claimed that this really signified a "helpless posture." She saw it as significant that there were no fingers drawn on the hands and that the hands were large on the father. She asserted that abused children put large hands on the drawings of their perpetrators. She also claimed that the thick lines in the crotch in the picture of the father meant an emphasis on genitals, was probably a penis, and showed anxiety about the father.She therefore concluded that the girl, who denied the allegations of sexual abuse by the father, had most likely been sexually abused by him and should "be protected from further abuse by him." The behavior of the psychologist in her interpretation is particularly bad because she ignored what the child herself said about the drawing.A four-year-old girl's drawing of a tree in the HTP was considered significant because the child, when asked to draw a tree, also drew a cactus. This was interpreted in terms of "unconscious expression of danger and fearfulness." However, the child was not asked if she had a cactus in her yard (this was in Texas).The child also brought a drawing of a clown's face to the therapist which she had ostensibly drawn while in the waiting room with her parents. The clown was interpreted as being significant because "there is an element of sadness in the clown's eyes." This clown is of much greater sophistication and detail than the child's other drawings. When pressed about this in his deposition, the psychologist acknowledged that the parents probably drew it and she colored it. This example illustrates both problems in administration and in interpretation.This was a day care case with allegations of ritualistic satanic abuse complete with costumes, masks, dead animals, sacrificed babies, blood, feces, skeletons, and monsters. These bizarre allegations surfaced during therapy. The therapist who saw two of the children depended heavily upon the children's drawings in forming conclusions about ritualistic, satanic abuse.The case file included a large stack of drawings over a two-year period - probably over 500 from the two girls. These drawings are typical of the types of scribbles and rudimentary figures drawn by three- and four-year-olds. These had been saved because they were considered significant. In her deposition the psychologist was asked about the drawings in detail. What she believed was significant included:There is no empirical evidence to support any of these theories. Also, these were not House-Tree-Person drawings or Kinetic Family Drawings but were simply drawings done in therapy sessions or at home and brought to the therapist by the parent. There was no effort to standardize the administration. This example shows a gross overinterpretation of a Bender given to an adult. Whereas the Bender is a useful screening test for possible organic dysfunction and is an efficient measure of perceptual-motor development in young children, its use as a projective technique for emotional psychopathology is questionable. When used as a personality instrument or projective technique, great caution should be used and it should never be used as the main measure of psychopathologyIn this custody evaluation, the psychologist gave three personality tests, Bender Gestalt, HTP, and TAT, all which were interpreted in the direction of finding extreme psychopathology. MMPIs or other objective testing were not used. The Bender interpretation for the woman is:The HTP and TAT were similarly interpreted as indicating extreme psychopathology and the psychologist concluded that the woman had major weaknesses in areas crucial to parenting and was in need of long-term, intensive, analytically-oriented therapy, and therefore the father should have custody.Practically any computerized Millon Clinical Multiaxial Inventory interpretation can serve as a horrible example when the interpretation is used as part of a forensic (as opposed to a clinical) evaluation and the test is not interpreted accordingly. Very often, what we see is the computerized interpretation of the MCMI-II lifted verbatim and without qualification from the computerized printout which accompanies the test scoring. This is a violation of the ethical standards for psychologists who use computerized test interpretations.This practice is a particular problem with the MCMI-II, which is normed on and intended to be used for a clinical population. When used for other assessment purposes, the MCMI-II must be interpreted extremely cautiously because of its tendency to overpathologize. The result of using these computerized interpretations therefore greatly exaggerates psychopathology. The problem is not in the test, but in its misuse. The test is normed entirely on clinical samples and is only intended for persons who have psychological symptoms and are being assessed for treatment and evaluation. The manualclearly states that this test is "not a general personality instrument to be used for 'normal' populations or for purposes other than diagnostic screening or clinical assessments." Millon has repeatedly warned against using the inventory with people who are not psychiatric patients because the test norms may not be valid if the subject does not fit the standardizing (psychiatric) groupWe do use this test as part of our overall assessment but interpret it cautiously and conservatively with the above in mind. When used in this way, it can provide useful information. Choca, et al.state that there is nothing intrinsically wrong with using the MCMI to test "normal" people as long as the evaluator is aware that the test was designed for and standardized with a psychiatric population. The user will have to make the appropriate adjustments and alter the narratives. The computerized narrative must never be lifted verbatim into the report since it will find serious psychopathology and personality disorders in just about everyone.Few evaluators using the Rorschach acknowledge its limitations. If the Rorschach is used, its limitations should be clearly noted unless the Exner system is used. And then, it is necessary to say what is being scored by the Exner system. But often, idiosyncratic interpretation techniques are used to form conclusions and make recommendations which affect the lives of people. There is no empirical support for the validity of the Rorschach, except when the Exner system is used. Reviews in thefor every year in which this test has been reviewed state that there is no research demonstrating its validity. For example, in the) Peterson concluded: "The general lack of predicted validity for the Rorschach raises serious questions about its continued use in clinical practice." In commenting upon the use of the Rorschach, Daweswrites:The psychologist in this example interpreted the Rorschach as reflecting:Examination of the man's actual responses to the Rorschach yields no evidence for interpreting his Rorschach as pathological. Although there is indication of scoring, apparently using the Klopfer or Beck scoring approaches, there is no report of any of the ratios and no attempt to base any of the interpretations upon either a scoring summary or specific responses.Within the Rorschach literature the actual responses of the client do not warrant these interpretations. They are personal, subjective, and idiosyncratic interpretations. The interpretations assert the reality of inferred unconscious processes going on inside the client. There are no scientific data to support postulation of these intervening variables. The phrase, "latent polymorphous perverse orientation to the environment," is meaningless jargon with no referent in reality.notes that the MMPI better fits the forensic requirements for evidence to be believable and understandable than do other assessment methods. The MMPI has years of validation research and the data obtained from it are objective and quantifiable. The MMPI-2 was developed so that the research on the original MMPI is still relevant and usable. In fact, the MMPI-1 profile can be drawn using the table in the back of the MMPI-2 manual. Nevertheless , MMPIs are often overinterpreted and misinterpreted. Such erroneous interpretations are not simply a matter of a difference of opinion; the horrible examples we have seen result from idiosyncratic interpretations without a basis in the empirical literature. In addition, as with the MCMI-II, sometimes computerized interpretations are used without qualification. Not all computerized MMPI interpretative programs are equally good ().This profile, in which scale 5 was at 82 and scales 3 and 9 at 70, was seen as "very consistent" with someone who sexually abuses a child. The scale 5 elevation was seen as particularly significant and as reflecting sexual conflict and sexual dissatisfaction. The psychologist testified that this elevation indicates somebody who is in trouble because of their sexual behavior. He denied, under cross-examination, that a high scale 5 can reflect a college education or high degree of education. He asserted the MMPI indicated that the client had a tendency to act out sexually with a child. It is mistake to interpret an elevation on scale 5 as reflecting sexual conflicts or as meaning it is likely that the individual is homosexual or a child molester since there are many factors behind such an elevation. Such an elevation generally reflects an intelligent, imaginative, sensitive, and passive individual with a wide range of interests which do not fit the masculine stereotype. Lacharreports that the college educated frequently obtain elevations in this range.Fowlerpoints out that scale 5 is a nonpathological scale. Grahamnotes that scores on scale 5 are related to intelligence, education, and socioeconomic level and that a T-score of 80 is only a moderate elevation for an educated middle-class person. Duckworthstates that an elevation on scale 5 suggests a passive person with aesthetic interests and notes that elevations are typical of males with college education. Other MMPI experts report similar characteristics associated with scale 5 elevations. There is no indication in the MMPI literature that child molesters or other sex offenders are more likely to score high on scale 5. (It is of note that the MMPI-2 norms result in much lower scale 5 elevations in males.) An overinterpretation of a high K scale in a court or custody setting is a common error. Any conclusions about defensiveness on the MMPI must be qualified in terms of the testing situation. Elevations on the K scale in persons taking the MMPI in custody and court situations are common and must not be interpreted as signifying defensiveness as a personality characteristic. It is a normal and adaptive response to the situation and must not be overinterpreted. Reports in which there is a K elevation should include the information that persons taking the MMPI as part of a custody or court evaluation commonly have elevations on scale K. Grahamnotes that if he doesn't see an elevation on K in a custody evaluation, he wonders what is the matter - doesn't the person want the child?This was a divorce and custody evaluation which was complicated by allegations of sexual abuse against the father. The scale K elevation was at 70 in an otherwise within normal limits MMPI and this was interpreted by the psychologist as "clinically significant." He claimed this meant that the client was defensive and was trying to "present himself in the best light psychologically and emotionally." He said that "he was trying to answer the questions in the direction of looking good," and asserted, "Sexually, this kind of thing (an elevation on the K scale) is expected." There were no qualifications in terms of the setting in which the MMPI was taken.In addition, this was a professionally and occupationally successful man with college education. Such persons routinely have higher K elevations, which indicates good ego strength and competence.This man, who had been accused of sexual abuse which he denied, had a scale 6 elevation which was interpreted as indicating high defensiveness, anger, distrust, sexual conflict, poor behavioral controls, and tendencies toward acting out conflicts and impulses. It was labeled "seriously abnormal," a "very pathological profile," "scary" and very unusual and abnormal.However, an elevation in scale 6 is a common response in persons who have been accused of sexual abuse and who deny the allegations. This is due to the affirmation of such items as:Rather than reflecting anger, hostility, suspiciously, and paranoia as pathological personality traits, the endorsement of these persecutory items reflects the individual's current reality and is a normal response to the situation. We have done research on this. Ziskinalso discusses such situational effects on scales 6 and recommends caution in interpreting scale 6 elevations in such circumstances.A 15-year-old boy was given an MMPI as part of an evaluation regarding a claim by his sister that he had sexually abused her. Both were adopted minority children who came from troubled backgrounds. The boy stoutly denied the allegations, which arose after he, while babysitting, had put his sister to bed early as punishment for misbehavior.The boy did not complete the MMPI items, so the psychologist called him and read the items to him over the telephone. The MMPI was then computer scored using the adult norms. The interpretation given by the evaluator was that the MMPI indicated the boy had significant problems with anger management, interpersonal relations, impulsivity, unpredictability, and hostile and sexual acting out. She concluded that he had, in fact, sexually abused his sister and recommended that he be placed in an adolescent perpetrator program. However, when the adolescent norms for the boy's MMPI are used, the only elevation is on scale 3. Scales 4, 8, and 9 are well within normal limits.The literature on the MMPI indicates that it is standard procedure to use the adolescent norms in order to draw conclusions about pathology in a given adolescence and it is standard practice to plot both profiles. Although adult norms may be used in research since we need to see the contrast between adolescents and adults, the adult norms must not be used forensically. The meaning "disturbed" or "abnormal" can only be established against adolescent norms. This should no longer be a problem now that the MMPI-Ais available. This MMPI revision is intended for adolescents age 14 to 18 and should be used for this group rather than the MMPI-2.In this custody evaluation, the psychologist sent the MMPIs home to be finished, even after the husband had told him about an earlier MMPI taken by his wife in which she talked to him about what answer to put down on some of the items.Whereas psychologists may sometimes do this with therapy clients, it is never acceptable for a forensic evaluation where the results of the evaluation are to be presented in the justice system and are to be used in making decisions about people's lives. Ziskinwarns against this practice:The supplementary scales must be interpreted cautiously when the basic clinical scales are within normal limits and the interpretations must be on the basis of rules that are based on research.In this custody evaluation, the clinical scales for the father were all well within normal limits but the dominance scale was elevated above 70. The MMPI was therefore interpreted as indicating that the individual had a "highly assertive and domineering style," whose leadership is "characterized by determination, inflexibility, and an almost autocratic control." In his trial testimony, the psychologist said that the client is "a very willful man" who has "not played the game right" and added that "All the time, I suspect what I saw in my tests undercuts that quite a bit, because assertiveness, being aggressive, dominance, can become autocratlcness, and I think that's what has happened." This is a misinterpretation of a dominance scale elevation in an otherwise within normal limits profile. Caldwellsays the following about the appropriate interpretation of the Do (Dominance) supplementary scale: The Multiphasic Sex Inventory (MSI)is a self-report questionnaire which consists of statements about sexual activities, problems and experiences. It has scales which assess the level of openness about the deviant sexual behaviors. It has been reported to be useful in assessing sex offenders in order to develop treatment plans. It may also be used during treatment to assess progress. However, it is now sometimes being used to assess an individual who denies sexual abuse to determine whether the individual actually is an abuser. This test is not intended for this purpose.The manual accompanying the MSI states "[i]t is important to remember that the MSI is not appropriate for use in the legal pursuit of guilt or innocence. The alleged offender must acknowledge culpability in order for the inventory to be used". It must never be used on an individual who denies being a sex offender or as part of an assessment to determine whether someone who denies an alleged sex offense is likely to have actually done itThe sexual abuse allegations arose when the child was supposed to be returned from a visitation with the mother (the father had custody). The MSI, which was part of the court-ordered evaluation, was interpreted in terms of a "fake good" response (which means that the respondent either is lying about his sexually deviant interests or does not in fact possess these interests) and it was concluded that the client had an "elevated level of denial" and was not telling the truth. The plethysmograph is a useful technique in developing individualized treatment program for sexual offenders. However, it is an error to use it with someone who denies committing a sexual offense in order to determine the veracity of the denial. William R. Farrall, the major manufacturer and provider of plethysmographs and trainer of the use of penile plethysmographs, says that the plethysmograph must never be used in this way because it produces too many false positives - that is, deviant elevations in persons who are not sex offenders. The consensus of the experts in the field is that plethysmography is useful in treatment, has limited use in predicting future behavior of known sex offenders, but is of no use in screening a normal population. It cannot be used to determine whether a person who has been accused of sex molestation and is denying it is telling the truth. Research indicates that normal heterosexual males with no indication of any sexual interest in children frequently respond with some evidence of penile engorgement to the presentation of the stimuli used to present aberrant sexuality, including children. The data also show that responses to the plethysmograph can be manipulated and faked in any direction the subject choosesA client was given the penile plethysmograph and it was found that his highest level of arousal was to adult females followed by four-year-old females and 12-year-old females. This was used to support the conclusion that the client was a possible pedophile who therefore had been untruthful in his denial of child sexual abuse. There has been much criticism of the use of the anatomical dolls in assessments of children suspected of sexual abuse. The anatomical dolls sometimes are used as a type of test and the behavior of the child in interacting with the dolls is used to draw conclusions about abuse. Two American Psychological Association committees (the Committee of Children, Youth, and Families and the Committee on Psychological Testing and Assessment)determined in a March, 1988 meeting that the dolls "are considered to be a psychological test and are subject to the standards when used to assess individuals and make inferences about their behavior" We have frequently criticized the use of the dolls and the way interactions with the dolls are often interpreted ().To date, there are no standardized or normative data for the dolls, a fact acknowledged by the APA Council of Representatives in 1991 (). Nevertheless, a whole paper could be written on horrible examples using the dolls. We have addressed this elsewhere and will not discuss this further here. However , many other techniques are used by psychologists and other evaluators, such as games, puppets, story telling, play observations, projective cards, and play dough ( 33 ). When the psychologist goes beyond these techniques as a way of encouraging the child to talk and uses them as indications or evidence of abuse, they are subject to the same criticisms leveled against the dolls and the drawings.In an evaluation session, a three-year-old girl poked a toy cat with a tinkertoy. Her parents also reported that she tried to poke the cat at home. (The parents gave great attention to this behavior, which, not surprisingly, continued and escalated.)This was interpreted by the evaluator in terms of reenactment and repetition and was seen as supporting the belief that the child had had a tinkertoy stuck up her genitals by a four-year-old boy at the day care center (this supposedly happened in the lunch room with a teacher present). The poking of the toy cat with the tinkertoy was seen as symbolic for the boy poking her. The evaluator claimed that the child was working through her trauma by repeating her own victimization. The play was interpreted as supporting the reality of the alleged abuse (which was unsubstantiated by child protection).The therapist claimed that she was able to tell whether the alleged events (ritualistic, satanic abuse) actually happened or didn't happen by observing such things as a "white face" or "dark eyes" when the child was talking about the events.The child was described as having the "hardened, drawn, demeanor of an abused child." This was used as evidence that the child had, in fact been abused. (Photographs of the child taken during this period show a normal appearing, attractive child.)A baby was returned to the foster mother following a visit with the parents and was described as having the "smell of sex." An emergency hearing was held in which social services attempted to cut off visits because this "smell of sex" triggered the suspicion that the parents were having sex with their baby. A psychologist agreed that the sex smell was significant and indicated probable abuse on the part of the parents. Fortunately, the parents had been at a church potluck dinner during the entire visit so they were able to disprove, the accusations. Several ethical principles for psychologists are relevant to these examples. These are found in both the applicable principles from the Ethical Principles of Psychologistsand the revised Ethical Principles of Psychologists and Code of Conductwhich will take effect on December 1, 1992.These principles stress the fact that psychologists bear a heavy social responsibility since their recommendations and actions may alter the lives of others. They therefore must maintain high standards of competence and only provide services for which they are qualified by training and experience. When using psychological testing, they must maintain knowledge of the relevant literature and understand validation problems and test research. When reporting the results of their assessments, they must indicate any reservations they have regarding test validity or reliability because of the circumstances of the assessment or the inappropriateness of the norms for the person tested. They guard against the misuse of assessment results by others. The American Psychological Association'sStandards for Educational and Psychological Testing stresses the necessity for following the standardized procedures for test administration and scoring specified by the test publisher. If any changes in these procedures are made, this should be described in the report, along with appropriate cautions about the possible effects on the validity of the results. Psychologists must not imply that their test interpretations are based upon a empirical evidence of validity unless such evidence exists.The American Psychological Association's Guidelines for Computer-Based Tests and Interpretationsstates that computer-generated interpretive reports should be used only in conjunction with professional judgment. The psychologist must determine for each individual the validity of the computerized test report based on the test taker's characteristics along with the context of the testing situation.Forensic psychologists have a duty to do a careful assessment and to report their conclusions in a responsible manner since their conclusions can affect the lives of others. The psychologist should only present conclusions which are based on empirical research and which can be adequately defended. If decisions and recommendations by the psychologist are not based on adequate data, the psychologist is acting both incompetently and unethically.Ralph Underwager, Ph.D. is a licensed consulting psychologist and Hollida Wakefield, M.A. is a licensed psychologist at the Institute for Psychological Therapies in Northfield, Minnesota. They provide treatment to victims, families and perpetrators of child sexual abuse and have consulted or testified in cases of alleged sexual abuse in thirty-six states and several foreign countries. They have presented workshops and seminars on the topic and are the authors of Accusations of Child Sexual Abuse, published by C.C. Thomas in 1988.This paper was presented at the Eighth Annual Symposium in Forensic Psychology of the American College of Forensic Psychology. held April 9-12,1992 in San Francisco, California.Copyright 1993 American Journal of Forensic Psychology, Volume 11, Issue 1. The Journal is a publication of the American College of Forensic Psychology, P.O. Box 5670, Balboa Island, California 92862.Correspondence should be addressed to Ralph Underwager, Institute for Psychological Therapies , 13200 Cannon City Blvd. , Northfield, MN 55057-4405