Forensic Social Work: Practice and Vision

Loyola University Chicago Loyola eCommons

School of Social Work: Faculty Publications and Other Works Faculty Publications

5-1986

Forensic Social Work: Practice and Vision

Thomas P. Brennan Circuit Court of of Cook County, Chicago

Amy E. Gedrich Circuit Court of Cook County, Chicago

Michael J. Tardy Circuit Court of Cook County, Chicago

Katherine Tyson McCrea Loyola University Chicago, [email protected]

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Recommended Citation Brennan, Thomas P., Amy E. Gedrich, Susan E. Jacoby, Michael J. Tardy, Katherine Tyson McCrea. "Forensic Social Work: Practice and Vision." Social Casework, vol. 67, no. 6 (1986): 340-350.

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Thomas P. Brennan, Amy E. Gedrich, Susan E. Jacoby, Michael J. Tardy, and Katherine B. Tyson Forensic Social Work Practice and Vision Forensic social work can bridge the gap between the criminal justice and mental health systems and serve clients who “fall between the cracks.” The authors describe theoretical and clinical issues, utilizing case examples and the literature to develop a conceptual paradigm for the role of social workers in this area.

Thomas P. Brennan is Assistant Director, Amy E. Ged- social distress. For example, several studies rich and Susan E. Jacoby are Court Caseworkers, and have reported that the rise of criminal be- Michael J. Tardy is District Supervisor, Social Service Department, Circuit Court of Cook County, Chicago, havior by ex-mental patients is the result of Illinois. Katherine B. Tyson is a Psychiatric Social Worker, their release into the community without ade- Olympia Fields Osteopathic Medical Center, Olympia quate resources.’ Some defendants considered Fields, Illinois. “untreatable” within the mental health system, as it exists now, often combine such THE GAP BETWEEN THE criminal justice and problems as substance abuse, indigence, and mental health systems has existed for some chronic, severe psychopathology. They present time; thus twenty years ago, Karl Menninger themselves to mental health personnel as poor lamented and criticized the “cold war between candidates for treatment. In addition, indi- lawyers and psychiatrists.”’ The gap has been viduals who once were able to function fairly created by many factors, among them differ- well may have regressed when deprived of a ences in history, tradition, philosophy, seman- job or adequate social supports. Not recog- tics, and societal mandates. Although to some nizing their difficulties as amenable to treat- extent it is important that the criminal justice ment, they do not seek help but may manifest and mental health systems remain practically their desperation in such minor criminal be- and conceptually distinct, there are times haviors as traffic offenses or shoplifting. when the conflicts between the two systems Finally, the pathology of some patients who persist at great cost to individual and social are receiving treatment may make predicting well-being.2 or forestalling violent behavior difficult, as Many defendants come before the court as with the Vietnam War veteran who becomes a result of actions symptomatic of psycho- violent only during flashbacks. These types of defendants often turn up in handcuffs before a judge who recognizes 1. Karl Menninger, The Crime of Punishment (New York: that, without adequate treatment, they will The Viking Press, 1968). be before the court again, having hurt some- 2. Irving R. Kaufman, “The Insanity Plea on Trial,” New one else or themselves once more. Sentencing York Times Magazine, 8 Aug. 1982, 16-20; Harold A. Levine, “Countertransference Reactions in the Evalua- tion and Treatment of Court-Ordered Patients,” Bulletin of the Menninger Clinic 46 (July 1982):352-62; Ner 3. Marc F. Abramson, “The Criminalization of Mentally Littner, “The True Test of Criminal Responsibility”(Panel Disordered Behavior: Possible Side-Effect of a New presentation to the Illinois Academy of Criminology, Mental Health Law,” Hospital and Community Psychi- Chicago, Illinois, October 20, 1982); and James Pearre atry 23 (April 1972):101-05; and Gary E. Whitmer, “From and Charitey Simmons, “Mentally Ill or Well? Question Hospitals to Jails: The Fate of California’s Deinstitution- Becomes Increasingly Troublesome to Society,” Chicago alized Mentally 111,” American Journal of Orthopsychi- Tribune, 29 Nov. 1976, section 1. atry 50 (January 1980):65-75.

them to jail protects the community tempo- The literature from the fields of social work, rarily. However, jail can result in the defen- criminal justice, and psychiatry is drawn on dant’s suicide‘ or eventual release with the to develop the theoretical base for forensic most antisocial aspects of his or her character social work; case studies are presented to strengthened by the effort to survive incar- demonstrate the varied roles of the forensic ceration. social worker. Such costly results of imprisonment raise a question: Are there other ways of handling Theoretical Perspectives these defendants that will combine the goals of treatment and justice? In “The Development The Social Service Department’s mandate of Forensic Social Work,” Gary Whitmer5 is single-minded-to serve the court. The noted, with hope, that forensic social work workers’ role has two polarized dimensions: can begin to bridge the gap between the crim- a social work function and a law enforcement inal justice and mental health systems and or control function. The polarities of case- can serve clients, such as those just men- work and control are essential and have their tioned, who are “forfeited” by this gap. basis in the department’s budget appropria- Whitmer defined the forfeited client as the tion,* in the criminal statutes: in court, and former long-term hospitalized individual re- in the authors’ experiences. Fulfilling this leased to the community who has “not been mandate, the department integrates the goals passively lost to treatment programs; on the and services of mental health and criminal contrary, mental health professionals have ac- justice. tively struggled with these patients’ problems The ideal of the department is to form a but have acknowledged defeat.”6 The authors worker-defendant relationshiplo and, as a re- of this article define the term somewhat more sult, to facilitate growth so that the defendant broadly, to encompass any individual with an emotional or a mental disorder, or both, who 8. The Cook County Government sponsors the “Protec- has become “lost” in the mental health sys- tion of Persons and Property” program, which funds the Social Service Department through the Judicial Adminis- tem or whose needs cannot be met within tration to provide social casework service. Two goals of this system. They are patients who cannot be the program are most congruent with the department’s goals: to provide maximum security and to assist in treated through current outpatient practices, rehabilitation. See The Annual Appropriation Bill for because they refuse treatment, and who do the fwal year of 1983 approved and adopted February not meet the criterion of dangerousness to 28, 1983, by George W. Dunne, President, Cook County Board of Commissioners. self or to others, and hence cannot be hospitalized. This combination of programmatic, 9. The department’s function is to provide service to court-referred misdemeanor cases. Cases are referred either clinical, and legal factors has helped create because defendants are placed on supervision or sentenced the forfeited client. to conditional discharge, usually for one year. The statutes The goal of this article is to affirm Whit- view supervision and conditional discharge as opportuni- ties for rehabilitation-in the supervision order or con- mer’s presentation and to provide a concep- ditional discharge sentence, the defendant is ordered to tual paradigm for forensic social work by de- report in person to his or her caseworker and to comply with other conditions the court may see as facilitating scribing the major theoretical and clinical rehabilitation. The department’s chief control function aspects of forensic social work as practiced lies in returning cases to court for a hearing if defen- at the Social Service Department’ of the Cir- dants do not cooperate with the court order or are con- victed of another offense. Defendants, whether placed cuit Court of Cook County, State of Illinois. on supervision or sentenced to conditional discharge, are found guilty. If the conditions are fulfilled, the supervision order will not result in a conviction and consequent criminal record. The conditional discharge sentence is a 4. Lindsey Gruson, “The Problems of Mental Illness Are conviction and does result in a criminal record (Illinois Compounded Behind Bars,” New York Times, 23 Jan. Revised Statutes-1981: State Bar Association, Ed., Ch. 1983. 38: 1005-6-3- and Ch. 381005-6.1. St. Paul, MN: West 5. Gary E. Whitmer, “The Development of Forensic Publishing Co., 1982). Social Social Work (May-June 1983):217-22. Work,” 10. Social casework service is the formation of a case- 6. Ibid., p. 217. work relationship within a problem-solving context: the dynamic interaction of feelings and attitudes between 7. Thomas P. Brennan and Violet Park, “The Role of caseworker and defendant. The caseworker’s purpose is the Social Service Departments in the Court System,” to help the defendant make a better, lawful adjustment Judicial Administration Newsletter 7 (February 1977). to his or her environment. The caseworker may provide

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can meet his or her needs legally. It is the is not possible in many correctional agencies.” authors’ belief that, insofar as the goals of The forensic social worker role has two mental health are striven for, the goals of aspects: providing treatment and protecting criminal justice will be fulfilled. In other the community. Although these two aspects words, the authors do not believe that a con- often complement each other, there are times flict between the goals of mental health and when they can be experienced as conflicting the goals of criminal justice is inevitable. The and mutually exclusive. Fbr example, protect- control function in the context of the depart- ing the community can seem opposed to pro- ment is, in part, to monitor: to contact the viding for the client’s welfare, and monitoring defendant or collateral from an outreach can seem opposed to respecting the client’s frame of reference in order to acquire infor- right to Self-determination. The following mation to seek the defendant’s whereabouts, theoretical perspectives define the role of the to help defendants keep appointments, to ac- forensic social worker to recognize and to quire criminal history information to check integrate the goals of criminal justice and new arrests or convictions or both, and to mental health. bring the case to the attention of the court Thomas L. Shaffer“ succinctly conceptual- if the court order is violated. ized the polarity as a difference in training Since the hallmark of the department is to between lawyers and counselors by stating form a relationship with the defendant, the that few lawyers would become good counsel- department necessarily espouses casework as ors and that few counselors would become its ideal. To place the concept casework in good lawyers-“Because a lawyer’s training a broader perspective, it is one of two generic stresses aggression and order and a coun- types of service that have developed in the selor’s training emphasizes acceptance and field of corrections; the other is brokerage!’ understanding.” Lawyers are trained to view Claude T. Mangrum placed casework in the human facts in terms of their relevance, conse- context of “coercive casework in quences, and accuracy. Counselors are trained Casework can be defined essentially as the to assess human facts in relation to feelings, development of a relationship between worker considering their implications for relationships and client, within a problem-solving context, and individual well-being. Shaffer suggested and coordinated with the appropriate use of that the two dimensions-one a thinking di- community resources. Brokerage can be de- mension and the other a feeling dimension- fined as the process of recognizing individual are both necessary and have much to offer needs, matching a community resource to each other. meet those needs, and making a referral. The In terms of style, Louis Tomaino and essential difference is one of depth and em- Arthur SpicaI5 both discussed the role and phasis: casework emphasizes the relationship function of a probation officer and have and direct service; brokerage emphasizes com- based their perspectives on Robert J. Blake munity resources. In the authors’ experiences, and Jane S. Mouton’s managerial grid!6 Spica the casework approach is more effective at helping the client resolve the problems that 13. Brokerage has been the modality used by many de- led to criminal behavior. However, casework partments because personnel are not “equipped by education and experience to provide CaseWoTk counseling. . . ,” because manpower resources are low, and because caseloads are high. See Dell ’Apa, “Advocacy, Brokerage, direct, supportiveanfmtative service or make a referral Community,” p. 38. to an appropriate resource. The treatment plan is based on the defendant’s needs and the caseworker’s skills and 14. Thomas L. Shffa. “Lawvers Counselors. and CW- available time. In addition to sessions in the asmmkefs selors at Law,” Americai Bar Journal 61 (July office, field visits are often conducted with defendants 1975):854-56. and their families or other supportive agencies. 15. Louis Tomaino, “The Five Faces of Probation,” 11. Frank Dell ’Apa, “Advootcy, Brokerage, Community: FedeM1 Probation xxxix (December 1974):42-45; and The ABC’s of Probation and Parole,” Fadem1 Jhbution Arthur Spica, ‘The Correctional Navagram,” Federa/ Pro- xxxx (December 1976). bation xxxix (December 1977):47-51. 12. Claude T. Mangnun, “The Function of Coercive 16. RDbert J. Blake and Jane S Mouton, The Managerid Casework in Corrections,” Fedeml probation xxxv (Sep- Grid Key Orientationfor Achieving Pnniucfion Through tember 1971). Peope (Houston, TX Gulf Publishing Co., 1%).

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contrasted the bureaucratic function with the scribing empathic treatment of “wayward relationship function, stating that the proba- youth,” stated that “psychoanalysis enables tion officer “must satisfy the rules of the the worker to recognize dissocial manifesta- court, the law enforcement agencies, the legal tions as the result of an interplay of psychic profession, the community, and the standards forces, to discover the unconscious motives of the particular agency. On the other hand, of such behavior, and to find means of lead- the needs of the offender, that is the psycho- ing the dissocial back to social logical, physical, social developmental, and He was able to apply psychodynamic prin- rehabilitative needs must be met.” He synthe- ciples to treat the openly resistive, socially sized the bureaucratic and relationship func- deprived clients seen by the forensic social tion through the concept of a “resource in- worker. He also noted that, even in time- tegrator,’’ a worker who establishes a fmbut limited treatment, he could Wess and facili- understanding relationship. tate ego functioning. The challenge to the In The Skilled Helper, Gerard Egan” pre- forensic social worker is to implement the in- sented a model for skills training, developing sights of psychoanalysis within the context of his skill definitions from Robert R. Carkhuff18 the authority of the court. Accurate empathy and confrontation are The resolution of the treatment and control among the skills presented, skills that corre- polarities necessarily has to occur within the spond to the polar functions of the forensic individual worker who comes to integrate social worker’s role. Accumte empathy is both dimensions, recognizing and accepting defined as understanding the frame of refer- the creative tension between them. This calls ence of the client and communicating this for a skilled helper, an artist, a person who understanding in terms of feeling, experience, has the capacity to be both empathic and and behavior. Egan presented empathy as the confrontative depending on the needs of the core skill of his model. He defined confron- client and the community. Figure 1 integrates tation as the various polarities as described by Shaffer, Tomaino, Spica, Blake and Mouton, and responsible unmasking of the discrepancies, distor- Egan2’ tions, games, and smoke screens the client uses to hide both from self-understanding and from Practically, the Social Service Department constructive behavioral change. . .involves challeng- serves the court and, as a result, is not in ing the undeveloped, the underdeveloped, the un- a position to control its intake by informing used, and the misused potentialities. skills, and the court that its caseloads are full. To help resources of the client, with a view to examining structure its resources, the department devel- and understanding these resources and putting oped a classification instrument (caseload them to use in action problems.. . . management assessment). The instrument is Although most counselors understand, use, comprised of thirteen factors (for example, and experience confrontation as opposed to prior arrests, support system, employment empathy, Egan contended that effective con- and residence stability, mental health, sub- frontation is really an extension of empathy. stance abuse) based on the defendant’s needs. Although the psychoanalytic tradition does These factors are believed to predict the de- not speak directly to the dual role of the fendant’s likelihood of reentering the criminal forensic social worker, it contributes valuable justice system. They also relate to the amount insights into the treatment of forfeited and antisocial client^!^ August Aichhorn, in de- Psychoanalytic Quarterly xxi (1952):323-43; August Aichhorn, Waywad Youth. A Psychoanalytic Study of Delinquent Chiwren (New York Meridian Books, 1962); 17. Gerard Egan, The Skilled Helpr: A Model for Sys- and Otto Fenichel, “Perversions and Impulse Neurosis” tematic Helping and Interpersonal Relating (Monterey, and Ybmcter Disodm,” in The P@mana&tic Theory CA: Brooks/Cole Publishing Co., 1976). of Neurosis (New York: Norton, 1945). 18. Robert R. Carkhuff, Helping and Human Rehtions, 20. Aichhorn, Wayward Youth, p. 1. Vol. I: Selections and %inin& Vol. II: Pmctice and Reaaarrh (New York: Holt, Rinehart, and Winston, 1969). 21. Shaffer, “Lawyers, Counselors, and Counselors at Law”; Tomaino, “The Five Faces of Probation’’; Spica, 19. Adelaide M. Johnson and SA. Szurek, “The Genesis “The Correctional Novagram”; Blake and Mouton, The of Antisocial Acting Out in Children and Adults,” Managerial Grid; and Egan, The Skilled Helper.

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of time required for contact, since every de- in once-a-week sessions. So the treatment contract fendant does not require the same amount agreed on was that C and the caseworker were to of time. The instrument thus serves to guide meet every three weeks, with interim inteMews and caseworkers in structuring their time. In addi- phone contacts if needed. The caseworker’s approach tion to this instrument, other forms of assess- with C was ego-supportive and consisted primarily of empathic listening and problem solving. ment, knowledge of resources, and supportive In the course of his two years on supervision, C supervision with goals of case management was able to form a Consistent treatment alliance with and prevention of burn-out are essential tools the worker. His progress was evident in several for caseload management. changes: He was able to join Alcoholics Anonymous, relinquish his addiction to drugs, move away from Case Presentations home and become self-supporting, separate from an abusive lover, and complete his education in data The following case examples illustrate the processing. He decided against a transsexual opera- types of clients referred to forensic social tion: “I want to be a man and function like a man.” workers and the major issues involved in At termination, he planned to take steps to obtain assessment and treatment. further help through a gay counseling organization in his neighborhood. Modification of Daditional Right to Con$Wntialfx Fbtential for Viohee Bwatment Arrangements The consensus of the literature on the pre- Forensic social workers are often called on dictability of violent behavior seems to be that to work with clients who, for various reasons, violence cannot be predicted with any certain- have been unable to profit from a treatment ty.23Yet forensic social workers and other men- alliance with therapists in other settings. Thus tal health professionals are constantly called it becomes essential that the forensic social on to assess clients’ risk to themselves or others. worker assess the client’s potential for utilizing A factor that further complicates the worker’s treatment and arrange the treatment contract plan for acting on an assessment that danger to maximize benefits for the client.22The case is likely is that Illinois law2‘ explicitly states below points up the need to structure treat- that violence must be “imminent.” Clients who ment based on an assessment of the client’s represent relatively constant threats to them- needs and capacity to respond to treatment. selves or others, but who do not threaten “imminent” harm, are protected by their right to Mr. C and the Potential for Psychotic Duns- c~nfidentiality.~~This means that unless the ference. Mr. C, a forty-year-old transvestite, was worker is convinced that the client’s threats of referred for supervision for the charge of prostitu- violence are going to be acted upon “immi- tion. At his intake interview, he showed many signs nently,” the client’s disclosures cannot be of borderline personality disorder, including abuse shared with those threatened, and the worker of alcohol and drugs, financial and emotional de- cannot petition for client hospitalization. For pendence on his mother, profound identity con- example, a court psychiatrist decided against fusion, sadomasochistic sexual acting-out, acute certifying a client of the Social Service De- spells of anxiety and depression, and, in relation- partment and made the following distinction: ships, extreme neediness and fear of abandonment coupled with fears of intimacy. In discussing his 23. Joseph J. Cocozza and Henry J. Steadman, “Pre- previous treatment experience, C related that he diction in Psychiatry: An Example of Misplaced Con- terminated his treatment because his psychiatrist fidence in Experts,” Social problems 25 (February 1978): “wanted to sleep with” him. After more discus- 265-76; Daniel Schmrtz, “Some Problems in Predicting sion, the caseworker’s impression was that C was Dangerousness,” Psychiatric Quarterly 52 (Summer 1980): 79-83; Henry J. steadman, “The Right Not to Be a False describing his experience of a psychotic transfer- Positive: Problems in the Application of the Dangerous- ence and that his capacity to maintain a realistic ness Standard,” Psychiatric Quarterly 52 (Summer treatment alliance would be easily overwhelmed by 1980):84-99, and Saleem A. Shah, “Dangerousness and the paranoid and erotic transferences stimulated Civil Commitment of the Mentally Ill: Some Public Policy Considerations,” American Journal of Psychiatry 132 (May 1975):501-05. 22. Gloria Cunningham, “Social Work and Criminal 24. Illinois Revised Statutes--1981: Ch. 91%, para. 811. Justice: New Directions in Practice,” Federal Probation 44 (March 1980):64-69. 25. Ibid.

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This individual has an alcohol problem. He drinks Domestic Violence Program. Although he consis- to excess, and when he drinks he is prone to violence. tently resisted the worker’s referral for alcohol On occasion he can flare up quite suddenly and act counseling, he became increasingly aware of the out in a violent fashion. . . .[The client is not] an link between his alcohol abuse and his violence. immediate danger to others, but is seen as a chroni- Shortly after referral, B spoke of being ridiculed cally dangerous person. The likelihood of his com- and mentioned the possibility of burning down his mitting significant acts of violence at some time in wife’s and his sister’s house. The workers discussed the future is very high.’6 the threats with their supervisor and concluded that imminent danger was unlikely. B had not planned The forensic social worker who tries to es- a specific time for the arson, and he indicated that tablish a confidential therapeutic alliance with he did not want to harm his children, who were a client continually has to weigh the need to living with his wife. Eight weeks later, B mentioned protect the client and the community from that he had been drinking before the group meet- the client’s violence against the client’s right ing, and that he wanted to “get even” with his to confidentiality and the importance of fos- wife and her boyfriend. The worker’s assessment was that, because Bs threats did not include a tering the client’s trust. The issue is complex, specified action or time frame, imminent danger since many clients’ involvement with the law could not be ascertained with sufficient certainty expresses a need for control they cannot to justify threatening the confidential relationship. themselves provide. If used with respect and Other considerations were that B had ventilated his care, the authority of the court can be in- feelings and had calmed down during the course voked by the forensic social worker to streng- of the meeting and that he had indicated an aware- then the client’s weak motive to get treatment ness of the negative consequences of any violent and to improve impulse control. actions. He had not acted on his earlier threat, Given the complex issues of confidentiality or. to the knowledge of the workers, on any violent and imminent harm, the policy of the Social impulses since the arrest incident. In addition, in- Service Department is that forensic social forming the boyfriend of B’s threats might have led to violent retaliation by the boyfriend. workers seek consultation when faced with However, B did become violent. At the next these decisions. The role of the consultant at group meeting, B indicated that when he left the these times is to help the workers be free previous meeting, he had gotten drunk and had enough of anxiety to determine the client’s stabbed his wife’s boyfriend with an ice pick. At potential for violence realistically. The follow- this meeting, B threatened to kill his wife, her sis- ing case illustrates how the forensic social ter, and her boyfriend. After consultation, Bs wife work team of the Domestic Violence Program was called and the stabbing incident was confirmed. balanced these sensitive issues. It was assessed that there was imminent danger and that B was likely to carry out his threats. Con- Mr. B’s Alcohohm and Violence: Mr. B, a forty- sequently, the worker advised B’s wife, her sister, five-year-old black male, was referred to the and her boyfriend of B’s threats. Domestic Violence Program on a battery charge. Violence was so endemic to B’s environment that When asked about the arrest incident, B indicated no criminal complaint was signed after the stab- that he had hit his common-law wife in the face bing incident, and indeed, no one remarked on with an empty wine bottle when he learned that his violence until he did at the next group meeting. she was seeing another man. B admitted that he To respond to his violence, in addition to con- had been drinking at the time of the incident. He tacting the people B had threatened, the workers and his wife, who had been together for eighteen returned B’s case to court and advised the court years and had five children, separated at the time of the stabbing incident. The workers’ assessment of the arrest. At referral, B was angry, depressed, was that helping B to stop drinking was essential and isolated. He was unemployed, had quit job- to his being able to control his violent behavior. hunting, and seemed to lack any meaningful Therefore, they requested that B be ordered to at- activities. tend alcohol counseling immediately and return to The worker’s initial assessment was that B had court in one month for a status report. The court a serious drinking problem. From the outset, B followed the recommendations. participated regularly in the group sessions of the B was initially very angry at the workers for con- tacting his wife about his threats and for returning 26. From the diagnosis made by court psychiatrist his case to court. He indicated that he felt that Stephen Cann, Psychiatric Institute, Circuit Court of he could no longer be honest in the group and Cook County, State of Illinois, November, 1982. stated, “I thought what we say here is confiden-

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tial.” When the workers explained that they had worker referred to the police narrative of the de- taken his threats very seriously, and informed him fendant’s sexual fondling of his daughter, as re- that they acted in order to assist him in taking ported by his wife. D responded by saying, “If control, he was less angry and seemed relieved. my stepdaughter said I did it, it must be true.” B followed through with the referral for alcohol The use of the arrest report thus elicited some counseling, and after a month he quit drinking. minimal acknowledgment of the incident. The forensic social workers worked closely with the The worker was aware that denial, lack of re- alcoholism counselor. During the last six months sponsibility for the incident, excessive drinking, and of B’s participation in the Domestic Violence Pro- unrealistic expectations of marriage are common gram, he maintained sobriety and continued to at- traits among child sexual abusers. Therefore the tend alcohol counseling. After B completed group treatment alliance was broadened to include Mrs. meetings, he met together with his forensic social D, his thirty-ycar-old wife, to establish a reality workers and the alcohol counselor to discuss his base to effect change in the family. In addition, progress and treatment plan. By termination, B when Mrs. D took her eight-year-old daughter to had stopped making threats, had established new a local hospital for medical attention and subse- relationships in his alcohol counseling pup, and quent courtpwdings, D was referred to a sexual had developed more self-amfidence. He seemed in- abuse offender’s program that met weekly. The vested in fiiding new activities that did not in- formsic social worker coordinated Services with this volve drinking. He was able to see his children agency to monitor D’s treatment progress. again and had begun to seek employment. In bimonthly sessions with the forensic social worker, the couple remained motivated and verbal, Use of Amst Reports and CoUatemh making counseling a productive experience. They With some clients, a forensic social worker were able to talk about the family mores and back- will not be able to act as an effective agent ground, their courtship and decision to many, their for change by seeing a client individually. In present marriage in the light of D’s insecurity and order to work on problems that precipitate jealousy, their needs and expectations for each other, and finally, the issue of D’s alcoholism as the defendant’s acting-out, the forensic social a crucial factor in the sexual acting-out. Commu- worker may need to work with others who are nication patterns and expression of feelings that significantly involved with the client. In those had previously operated at a dysfunctional level cases in which the client’s denial makes an- improved, and husband and wife felt more under- other offense more likely, the sensitive use of stood by each other. D remarked to the worker police reports and the participation of collat- that “you have really touched our lives and made erals can help lessen the client’s defensiveness. a difference in how we deal with each other.” In the following case, the worker was work- However, as the termination date for supervision ing with the defendant and his wife as the approached, D had not openly admitted the inces- state child welfare agency responding to tuous incident in the group or the marital sessions. was The worker also received an additional history the child’s needs. However, the worker kept from the state child welfare agency that indicated herself aware of the child’s progress and care that the supervision charge was the thud such inin order to step in and provide direction cident reported. consequently the forensic social to the family or the agency as needed. In worker conveyed to the client and his wife her this case, the worker did keep the agency plans to return the case to court to ask for a one- informed. year extension of the supervision and treatment order. Mrs. D became angry enough to confront her husband about his denial. Subsequently he was Mr. D’S Thoubled Marriage and Denial of Incest: able to discuss the incest incidents with Mrs. D, Mr. D, a twenty-nine-year-old black employed the forensic social worker, and the group. The male, was referred for supervision for the charge worker returned the case to court with documen- of contributing to the sexual delinquency of a tation from both agencies. A one-year extension child. The court mandated psychologid counseling was granted for continuing treatment, and the D’s and ordered that he would only be permitted to have continued to make steady progress. remain in the family’s apartment with his wife’s permission. The worker saw D individually for the In cases such as incest, in which denial and first two meetings in order to gather a social his- distortion are prevalent, the use of objective tory and gain an understanding of his past percep evidence (social or legal documentation) and tions of the incest incident, as well as his current the involvement of a significant family mem- view of his domestic situation. ber are imperative if treatment is to be suc- D’s denial of his offense was so rigid that the cessful. In this situation, the authority of the

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court was used to foster the client’s motive He began to experknce his alliance with the worker to utilize treatment. as reflecting an autonomous caretaking motive. After four sessions, V requested sessions on a Working Alliance with Invohntaty Clients more frequent, more intensive basis. A The forensic social worker and V agreed to a Mental health practitioners often state that once-a-week treatment contract. At first there was clients who enter treatment under duress of a period during which V reacted to his efforts to a court order cannot form a genuine treat- get help and to his increased involvement with the ment alliance. However, the forensic social forensic social worker by increased anxiety and worker often sees that court-ordered clients confusion about appointment times. However, this can form a treatment alliance, significantly reaction diminished, and he soon was able to keep improve their lives, and derive psychological his appointments regularly and to participate more benefits from treatment. For the alliance to actively in treatment. After a year, V had made significant progress occur, it is essential that the client’s feelings in many areas. He had found stable housing, re- of bemg “coerced” be recognized and worked ceived medical care on a regular basis for his epi- through with the social worker” and that the lepsy, and he admitted to and began to get help client has the experience of making an auton- for his drinking problem. He obtained a divorce omous choice to obtain help. It is essential and started working part-time as a mechanic He that the worker communicate empathy but at was able to experience improved impulse control, the same time help the client to understand saying, “I feel less alone now’’ and “I haven’t got- that if he or she can utilize treatment to con- ten into trouble because I know I have someone trol behaviors, he or she will not be in the to talk with about my problems, instead of just getting mad or doing something stupid that gets painful position of being coerced by the court. me in trouble.” After his court supervision termi- Mr. V’s Motivation for l’keatment: Mr. V, a twenty- nated, V decided to continue treatment sessions eight-year-old white male, was referred for super- with the forensic social worker. vision because of repeated traffic offenses of driving V’s statement illustrates a long-standing without a license. He had a history of juvenile psychoanalytic maxim, “dissocial behavior delinquency and had been severely abused by both parents, who were alcoholics. At his first inter- can be an outlet for repressed emotion.”28 view he was acutely disorganized, his housing and Forensic social workers often see clients whose income were unstable, and he admitted to suffering acting-out is precipitated by loneliness and the from grand mal epilepsy, which was untreated. need to express emotions that have not been During the first session, V was able to verbalize verbalized. As the clients experience a thera- some of his feelings about the counseling being peutic alliance and can articulate their feel- “not my idea,” but rather “the court’s.’’ In subse- ings, their need to act-out often subsides. quent interviews, he was able to see that his re- V’s case also illustrates the importance of porting to and participating in counseling were enough flexibility in agency policy so that the choices he made to act in his own best interests. worker can respond to the treatment needs of defendants after the court order terminates. 27. Judith Gingolani, “Relationship Processes with In- To break off a treatment relationship can be voluntary Clients: Issues and Options” (Paper presented countertherapeutic if significant unfinished at the Illinois Chapter of the National’Association of Social Workers Meeting, October, 1982). Other authors issues remain and if a transfer of therapists have discussed the use of authority in casework, the func- does not seem viable. The department pro- tion of coercion, and the treatment of reluctant or in- vides for these cases through its “consulta- voluntary clients: Nathan Berman, Jack Purves, and Dorothy Cole, “Casework with Law Violators,” Crime tion” policy, so that clients can continue and Delinquency 7 (April 1%1):137-47; Dale G. Hard- working with a caseworker, if necessary, fol- man, “Authority in Casework-A Bread and Butter Theory,” National Probation and Parole Association lowing termination of the court order. Journal v (July 1959):250-54; Dale G. Hardman, “Au- thority Is My Job,” NPPA Journal (July 1957); Roles of the Forensic Social Worker Mangrum, “The Function of Coercive casework in Cor- rections”; Allison D. Murdach, “Bargaining and Persua- Many of the clients the forensic social work- sion with Nonvoluntary Clients,” Social Work 25 (November 1980):458-61; Gerald R. Tracey. “A Social er sees have been diagnosed as “antisocial” Worker’s Perspective on Social Work in Probation.” Crime or labeled “resistant and untreatable” in ear- and Delinquency 7 (April 1%1):131-36; and John Vriend and Wayne W. Dyer, “Counseling the Reluctant Client,” Journal of Counseling Psychologv 20 (May 1973):240-46. 28. Aichhorn, Wayward Youth. p. 5.

Brennan et al.: Forensic Social Work 347 www.familiesinsociety.org

lier contacts with mental health agencies. The ogy of the client became obvious to the forensic clients tend to use defenses of projection and social worker. acting-out, which impedes their ability to ver- Almost immediately, conflicts between F and his balize their feelings and gain insight into family escalated, and it appeared that F was at themselves. Often they are openly paranoid risk of suicide. The forensic social worker referred about the social worker and the prospect of F to the Court Psychiatric Institute, informing the institute of her diagnostic impressions, and F was treatment. Their behavior is almost always of- certified. He was transferred to a long-term state fensive or threatening to society at large, and mental hospital and the forensic social worker yet is ego-syntonic to the client. Because of coordinated Services with Fs therapist with the goal all these factors, the clients often have not of facilitating Fs eventual reintegration into the been able to form a treatment alliance or, community. F’s record and history were collected when they have, they have “fallen through from juvenile probation, The Department of Chil- the cracks” because in other social service dren and Family Services, group homes, and men- programs they were found too difficult or too tal hospitals. unpleasant to work with. When these clients To summarize Fs history, he had been physically come before the court, judges and attorneys and sexually abused by his family and neighbors since early childhood. At twenty, he was function- accurately perceive their needs for mental ally illiterate. A history of pedophilia, suicide health care and thus refer these forfeited attempts, substance abuse, and juvenile crimes clients to forensic social workers.29In work- attested to F’s profound mental disturbance and ing with such clients, the forensic social poor impulse control. Intermittent and brief hos- worker provides services to the court, the pitalizations had culminated in unsuccessful place- community, and the client in many different ments and further arrests or selfdestructive be- ways. haviors. Just before the burglary, Fs case had been In bridging the mental health and criminal reviewed in mental health court. He had been re- justice systems to serve forfeited clients, the leased in the custody of his family, and his case worker often acts as a “transitional object” with the Department of Children and Family Services had been terminated because he was for these clients. If the client’s positive trans- “resistant.” ference is cultivated and some of the client’s During his nine-month hospitalization, F showed basic needs begin to be met, the client can the capacity to respond to psychodynamic treat- begin to have the experience that treatment ment. But within a month of his discharge, F had can be helpful and develop the capacity to run away from the halfway house and was living form a treatment alliance. The alliance with in the streets. After six weeks, he made contact the forensic social worker can then be trans- with the forensic social worker. On investigation, ferred to the appropriate mental health agen- the forensic social worker was informed that F had cy for long-term psychiatric care. The follow- been discharged without funds, food, shelter, or ing case exemplifies the many roles played by supportive services. Although his court case was terminated, F requested services and was seen on the forensic social worker in treating one case a consultation basis, since he had no other sup- over two and one-half years. Proper treatment portive relationship that could provide professional of the case necessitated that the worker be care. able to communicate with professionals in Although housing was arranged, F’s condition mental health and criminal justice while pro- was fragile. Shortly thereafter he was arrested for viding treatment. the charge of indecent liberties with a child. During the police investigation, F became so frightened Mr. E. A Forfeited Client: Mr. F was a twenty- that he admitted to every imaginable aspect of a year-old white male referred following a burglary sexual crime. As a result, he was indicted for five charge. F had broken into a neighbor’s home to Class X felonies and faced a possible prison sen- fix himself dinner after he had been left at home tence of sixty years. by his family for a weekend without funds or food. F’s reaction while awaiting trial was to become Shortly after the sentence to supervision, the severe acutely anxious and suicidal and to provoke violent family conflicts and organic and emotional pathol- attacks from other inmates. The forensic social worker worked with the psychiatric team at the jail and provided crisis intervention treatment. F 29. Whitmer, “The Development of Forensic Social was seen twice weekly throughout his incarcera- Work.” tion pending trial. In addition, the forensic social

348 Social Casework: The Journal of Contemporary Social Work (June 1986) www.familiesinsociety.org

worker contacted a skilled legal aid attorney who in psychotic illness, the most effective and agreed to represent F. Another crucial aspect of efficient means is through the mental health the forensic social worker’s role at this stage was system. The qualified examiner role has de- to provide clinical data to F‘s attorneys, the Court veloped as a way for the forensic social Psychiatric Institute, and a private psychiatrist worker to direct a client to the mental health regarding F‘s condition and his mental competency to stand trial. system using the authority of the local police After several months it became clear that there and the were no signs of physical injury to the complainant Domestic violence and substance abuse are and that the complainant would not testify. After client problems frequently encountered in coIlsultation with the state’s attorneys, Fs attorneys clients by forensic social workers. The depart- gave him a choice: to take the risk of standing ment has begun to provide specialized ser- trial or to plead guilty and accept a conditional vices in the area of domestic violence, a discharge sentence. F eventually decided to plead group treatment program” targeted at the guilty and be sentenced to conditional discharge. male batterer. The staff is increasingly aware The forensic social worker located a residential of the prevalence of alcoholism as a contrib- treatment setting for F. To facilitate the referral process, the caseworker wrote a detailed psycho- uting factor associated with crime, as well as social history that presented the antisocial behavior the lack of treatment facilities for indigent, not as the problem itself, but as a symptom of substance-abusing clients.32 The current goal a mixed personality disorder and a developmental is to increase staff competence in the assess- disorder. With the leverage of the court system to ment and treatment of substance abuse dis- motivate F to adjust to the treatment facility, staff orders. In addition, the department has devel- at the residential treatment facility were willing to oped a specialized program in community interview F. He was accepted for placement. Based service)’ and is contemplating the develop- on the recommendation of the psychiatrist, the ment of special treatment programs in sexual forensic social worker, and the attorneys, and given abuse and theft.)* the assurance that F would reside in a structured setting and continue to participate in psychother- apy, the judge accepted F‘s plea and sentenced him Theory and Practice to four years conditional discharge. The clinical experience of forensic social F was taken to the residential treatment home workers at the Social Service Department of directly from court by his attorneys and the for- the Circuit Court of Cook County has been ensic social worker. The forensic social worker worked with F individually and coordinated services with the staff at the halfway house to facili- 30. Illinois Revised Statutes-1981: Ch. 91 Vz, para. 1-100 tate F’s adjustment. through 6-107. The forensic social worker in Illinois can utilize the Illinois Mental Health and Developmental Dis- abilities Code to route the psychotic defendant to psy- New Directions chiatric treatment by functioning as a qualified examiner. A qualified examiner is a person registered or certified A more assertive, streamlined approach to with the State as a certified social worker [MSW] or as a registered psychiatric nurse [MA], with three years crisis intervention with actively psychotic de- of clinical training and experience in evaluating and treat- fendants and specialized areas of competence ing mental illness. are two new directions in forensic social work 31. Gale A. Dreas, Dorothy Ignatov, and Thomas P. for the department. Brennan, “The Male Batterer: A Model Treatment Pro- gram for the Courts,” Federal Probation xxxxvi A long-standing question in forensic social (December 1982):50-55. work has been how to facilitate the examina- 32. Bradley Googins, “Avoidance of the Alcoholic Client,” tion and commitment of the resistive psychotic Social Work 29 (March 1984):161-66. client to a mental health facility that has the 33. Thomas I? BRM~and Leonard Mason, “Communi- expertise and resources to provide long-term ty Service: A Developing Concept,” Federal Probation care. Protection of the community and the xucxvii (June 1983k49-57. need for in-patient treatment 34, A Retail Theft Program, initiated to provide educa- often has to be weighed against the individ- tion, guidance, and other intervention strategies, is spon- ual’s refusal to accept treatment. Rather than sored by the Behavior Intervention Group, Rush-Presby- terian-St. Luke’s Medical Center. See Charles Mount, seek criminal litigation as the Only solution “County to Expand Successful Shoplifting Counseling to change antisocial behavior that is rooted Program,” Chicago Tribune, 29 Mar. 1984.

Brennan et al.: Forensic Social Work 349 www.familiesinsociety.org

integrated with a broad base of theory to pro- tive clients, forensic social workers can con- vide a conceptual paradigm for the new, tribute to the development of theory and much-needed field of forensic social work. practice in the treatment of mentally ill and The individual forensic social worker, in inte- antisocial clients. Although there are obstacles grating the polarities of empathic casework to the growth and practice of forensic social and the control and authority of the court, work as a clinical specialty, the need to de- implements a practical link between mental velop practical solutions to treat the forfeited health and criminal justice. By helping “for- client is imperative. Forensic social workers feited” clients who fall between the cracks in can begin to bridge the long-standing gap be- the two systems, these workers provide a tween criminal justice and mental health. It preventive and restorative service to a needy is hoped that, with the growth of forensic population of clients who, if left unserved, social work, a bridge can be built between pose grave risks to themselves and to society. criminal justice and mental health that can In the course of working with highly resis- make both treatment and justice possible.

Helping Wives in Dual-Earner Families Clinical Judgments of Poor Clients A Day Treatment Program for Adolescents These important articles and others of equal value will appear in the following issue of the journal. You owe it to yoursetf-and to the people you work with-to keep up with developments in the profession. Read Social Casework: The Journal of Contempomy Social Work. Subscribe now or renew your subscription. Use the coupon below for fast service. Individual Rates: USA and possessions $27 (one year), $51 (two years); Canada $31 (one year), $59 (two years); all other countries $32 (one year), $61 (two years). Institutions and Libraries: USA and possessions $40.50 (one year), $77 (two years); Canada $44.50 (one year), $85 (two years); all other countries $45.50 (one year), $87 (two years).

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350 Social Casework The Journal of Contemporary Social Work (June 1986)