About Allen Associates

In our experience there is generally a good understanding amongst lawyers about what psychiatrists and psychologists do and how they can help the legal process.  However in some cases it can be difficult to know whether a psychiatrist or a psychologist is the right expert and we thought a little background might help, though we are always happy to discuss individual cases with you.

About Psychiatry and Psychiatrists

Psychiatry is a medical specialty; just like, for example, orthopaedics or paediatrics.  Psychiatrists are doctors who, after medical school, will have trained for at least 6 years, to specialise in one or more of the many subspecialties of psychiatry. Psychiatrists can thus be experts in mental illness, substance and alcohol misuse, personality disorders and a range of other miscellaneous conditions such as sexual deviancy. The expertise will differ between psychiatrists, depending on experience and training.

Although psychiatrists have a good understanding of psychological processes and there is considerable overlap with the skills which psychologists have, they approach their work in a different way to psychologists, relying primarily on clinical observation skills. This is absolutely fundamental to an understanding of the way in which they work and often leads to misunderstandings. Although there are some questionnaires which a range of professionals use, the overwhelming majority of psychiatrists are not trained in or qualified to use the specialist psychological tools used by psychologists.

For a psychiatrist, like any other doctor, the process by which they view patients or clients is divided into History and Examination. The History is the account of the person’s symptoms, supplemented by a series of questions under agreed headings such as Family and Social History. The Examination for psychiatrists can include a limited Physical Examination but always consists of a Mental State Examination, again under recognised subheadings, such as mood, perception and cognition.

It is important to understand two things about the Mental State Examination; firstly, much of it is done concurrently with the taking of the History. Psychiatrists are adept at watching out for both the form and the content of what people are saying. Secondly, although perhaps not as scientific as a blood pressure reading, it represents psychiatry’s take on objectivity – it is not representative of the psychiatrist’s opinion per se.

Psychiatrists, being doctors, often prescribe medication. This is because their core expertise lies in the area of treating disorders and those which respond to medication – mostly, those disorders termed ‘illnesses’ are usually left to psychiatrists to treat. But psychiatrists are perhaps better thought of as being the leader of the orchestra. Because psychiatrists are trained in diagnosis, they are usually the first person a patient sees for an assessment. They then decide on a treatment plan which will very often include being seen by other members of the broader team, which includes psychologists, nurses and occupational therapists.

There are numerous subspecialties in psychiatry which are important in considering expertise. The main differentiation is by age, with child and adolescent, adult and elderly psychiatrists being the main three. However, learning disability psychiatrists specialise in people with low IQ, classically under 70, meaning that unless IQ is known in advance (and this is assessed by psychologists), there can be issues with expertise. Forensic psychiatrists specialise in seeing people involved in the criminal justice system – usually those with more severe offending behaviour. Clearly, there is some overlap between these specialties and the boundaries are sufficiently ‘fuzzy’ for this not to be an issue in many cases, but it is always helpful, if there is doubt, for a psychiatrist to review a case in advance to see whether it might better be dealt with by a colleague from a different specialty.

One of the main issues which confuses people is the problem of psychological versus psychiatric injury or distress. Psychiatrists essentially deal with the abnormal and a psychiatric condition, by definition, is one which falls outside the norm. Hence, it is completely possible for someone to be incredibly distressed by something which has happened to them but to have no psychiatric condition at all. This is because, in simple terms, ‘normal people would react in the same way’. The classic example, which people can easily relate to, is bereavement, but there are many other examples which are less intuitively understandable.

About Psychology and Psychologists

Psychology is a very wide discipline and starts from an academic background which covers many different aspects of human and indeed, animal functioning. In terms of careers, many psychologists will have an undergraduate qualification in psychology with the vast majority having undergone further training, experience and gained postgraduate qualifications in the areas they are expert in.

Psychologists work in many areas of life, for example, in education, business and therapeutically. Psychologists who work therapeutically are known as clinical psychologists but, even within clinical psychology, there are subspecialties and some psychologists are expert in one or more of one of these. There are child psychologists, forensic psychologists, neuropsychologists and counselling psychologists amongst many other categories.

Furthermore, other practitioners such as nurses are trained in aspects of psychotherapeutic work so they can do, for example, cognitive behavioural therapy or outcome-focused therapy. To confuse the matter further, there are other people who work in a ‘talking therapy’mode. These include counsellors and psychotherapists. Sometimes, these people are also psychologists, but not always!

Psychologists, psychotherapists and counsellors will sometimes assess people directly and sometimes receive referrals from psychiatrists. It can be difficult, as a patient, to know whom you need to see and getting a clear ‘diagnosis’ and having treatment options properly explained is vital. The term diagnosis is essentially a medical one so not all practitioners relate to it. Other terms such as formulation are sometimes used, but clearly there has to be some shared understanding of what the problem is before something can be done to help.

Some psychologists will use ‘tools’. This is a specific term referring to a series of questions which are then expertly interpreted by the psychologist. ‘Raw data’ from these tools can be misleading for the lay person if not properly interpreted by the psychologist. One of the best known types of tool is that for assessing IQ. This is a good example of a complex area which needs a lot of explanation to understand it properly.

The majority of people who encounter psychologists in a therapeutic setting will be seeing them for help with a problem which they have identified and/or which has been elucidated by a professional. Treatment is usually multiple, consisting of a number of sessions lasting from 50 to 60 minutes and proceeding on a weekly basis until there has been some agreed resolution to the identified problem. People are mostly expected to practise techniques or reflect on the sessions in between appointments and much of the ‘work’ is done by the person outside the session.

About the limits of expertise

Whilst you are clearly the experts on the law, we have to be able to delineate our expertise.  This applies particularly in the field of psychiatry, where there are many subspecialties.  Nowhere is this more important than in the area of intellectual disability, where knowing the IQ in advance can sometimes determine which expert to see.

We always encourage you to discuss questions you want answered.  In most cases there is no issue but, particularly in some criminal cases there can be a tendency to rely heavily on counsel’s perception of what a psychiatrist can determine.  Occasionally this is complimentary but inaccurate.  One must always have in mind the fact that psychiatrists derive their expertise from seeing and treating patients.  It therefore follows that there are limits to their familiarity with other aspects of your case.

A particular area of concern is the criminal defence of automatism.  This is a very rare finding indeed in clinical practice, yet a very common request from criminal solicitors.  If alcohol or drugs are involved we strongly encourage you to discuss this first with the psychiatrist.  If a sleep automatism is being considered it is important to understand that if the psychiatrist feels that there is evidence to support this concept, further studies from a sleep specialist (a non-clinician) will almost always be required.

Neither psychiatrists nor psychologists derive their expertise from looking at artefacts of any kind.  It is inherently unlikely that we would be able to consider some written, photographic or video material as primary evidence of mental disorder, though they can always be considered alongside other material.