Richard Sostowski, M.D., D.F.A.P.A.

Forensic

Psychiatrist

My Approach to Forensic Psychiatry

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After thirty years of experience in psychiatry, I believe that my success in forensic psychiatry is a direct result of my decision to keep intact my various professional identities such as psychiatrist, psychoanalyst, Chairman of Psychiatry, Associate Professor of Psychiatry and, of course, forensic psychiatrist! I have never aspired to do medical-legal work on a full time basis.

Many attorneys tell me that they look for experts who are still involved, at least part time, in the day to day practice of clinical psychiatry. This makes sense to me. The legal system is more likely to put faith in a doctor who has experience "down in the trenches." This is an apt metaphor because the atmosphere is not always friendly and can be downright nasty.

When I am retained on a new case, the unspoken expectation of the attorney is that my opinion will be based on the application of forensic principles to the most complete and accurate database that I can obtain from a frequently less than cooperative interviewee in a limited amount of time. The interview may be audiotaped or videotaped. A paralegal or an associate, from the office of the opposing attorney, may be allowed to sit in and even interrupt the flow of my evaluation. The interviewee has probably been well prepped by his attorney who may have copies of some of my previous reports and depositions. This is an adversarial situation that requires superb skills in conducting the diagnostic psychiatric interview and the ability not "to lose one's cool." This is not an arena for the amateur!

A forensic psychiatrist could, for example, know everything that there is to know about medical malpractice. Although this could advance her academic career and make her a great teacher and researcher, without interview skills to match, she would be a liability to the side that retained her on some high profile case.

Research in the neurosciences is beginning to answer questions about the role of the brain in mental illness. Since I completed my psychoanalytic training, psychiatry has changed its image from a dying yet arrogant analytic cult to arguably the most intellectual and scientific medical specialty. Unfortunately, most of the new research data has not had impact on day-to-day clinical practice.

Notwithstanding the current emphasis on evidence based research, I believe that it is the expertise in the art of the psychodynamic (used synonomously here with psychoanalytic) diagnostic interview in combination with DSM-IV descriptive psychiatry that is still the mandatory skill set required to be a first rate practicing forensic psychiatrist. For all of its shortcomings, the psychodynamic approach has allowed me to get into the "skin" of another human being and share their experience of the world, even if it is only for a short period of time.

The development of skills in forensic interviewing requires time, the opportunity to work in different settings and with different diagnostic categories and, perhaps most importantly, the personal experience of living through some traumatic event. It is inconceivable to me that one could be effective in this work without the first-hand experience of a serious accident, the death of someone close to us, an intolerable work environment or some other life changing event.

Although it may sound a bit like philosophy or theology 101, I believe that I am constantly becoming a forensic psychiatrist. This is not unlike the constant evolution in technique experienced by those of us who still believe that the time, money and energy invested in psychotherapy are worth it.

I welcome comments from other forensic professionals and the attorneys who retain us.

You can contact me either by calling my office at 908.766.5466 or via email at rich@forensicpsychnj.com