Selective Recall of Mental Health Professionals
At LitigatorsHandbook.com we know that the expectations of mental health professionals can lead them to believe that symptoms consistent with their diagnostic impressions were exhibited in an interview; when in fact, they were not. Conversely, they are also less likely to recall symptoms that were actually present during an interview but inconsistent with their diagnostic impressions.
These effects of selective memory were dramatically demonstrated in a 1979 experiment using college students. The students read a story about a woman who exhibited both introverted and extroverted traits. Two days later, half of the students were asked to assess how well this woman would do in a sales position ‑ a presumably extroverted career. The remaining students were asked to assess her suitability as a librarian ‑ a presumably introverted career. Those students asked to assess how the woman would function as a salesperson interpreted more storyline facts as instances of her extroversion. Those students asked to assess how the woman would function as a librarian interpreted more storyline facts as instances of her introversion.
When confronted with evidence demonstrating the wholesale unreliability of their clinical judgment, mental health professionals protest vehemently. They insist they accurately remember how they question their patients, and how those patients respond to their questions. The relevant research, however, does not support such claims[1]. A 1981 study videotaped psychiatric trainees interviewing patients. The supervisory sessions of these trainees were also videotaped. Reviewing the videotapes revealed that the psychiatric trainees overlooked 50% of the important issues transpiring during their interviews. Furthermore, another 50% of what these trainees did report to their supervisors was also distorted. These data suggest that the total accuracy with which a typical interview is recalled approximates 25% (.50 x .50 = .25).
Experienced mental health professionals can be expected to protest the above study, insisting it is not applicable to them. They would likely claim that their years of professional experience enable them to avoid such errors. However, the relevant research does not support these claims either. Instead, the data demonstrate that experienced interviewers do not accurately recall their own behavior during interviews[2]. We at LitigatorsHandbook.com understand this is not particularly surprising considering how these professionals pay more attention to what their patients say than paying attention to themselves.
When asked exactly how they worded the questions they asked patients, mental health professionals cannot reply accurately. The relevant research demonstrates that our verbatim memory for conversational dialogue fades within seconds[3]. People then compensate for faded verbatim memories by using gap‑filling strategies[4]. In other words, they fill in their memory gaps with what seems plausible[5]. Nevertheless, they genuinely think they possess verbatim recall for what was said.
At LitigatorsHandbook.com we teach that the diagnostic impressions of mental health professionals can also lead them into selective recall of their interviews[6]. After reaching a diagnostic impression, for example, mental health professionals often incorrectly recall the patient exhibiting some symptom if that symptom is consistent with their diagnostic impression. Conversely, they also find it difficult to recall symptoms actually exhibited by the patient, but inconsistent with their diagnostic impressions. This kind of selective recall is known as “confirmatory bias,” defined as “... the tendency to seek supportive data for one's hypotheses and to underweight or disregard non-supportive data.”[7]
Cross‑examination Related to Selective Recall
1. Dr. X, in your previous testimony, you claimed that you were not influenced by any preconceived expectations you brought into your evaluation of Mr. Smith ‑‑ Correct?
2. And you previously claimed that you were not predisposed to overlook Mr. Smith's normal characteristics ‑‑ Correct?
3. And you previously claimed that you did not resort to asking Mr. Smith biased, one‑sided questions ‑‑ Correct?
4. All of your claims assume that you can accurately remember what you asked Mr. Smith, and how he responded ‑‑ Correct?
5. In evaluating Mr. Smith, did you videotape or audiotape your interviews with him? [It is exceedingly rare for mental health professionals to electronically record their evaluative interviews]
6. Without a videotape or audiotape, therefore, we cannot know what transpired between you and Mr. Smith ‑‑ Correct?
7. Our verbatim memory for conversational dialogue fades within seconds ‑‑ Correct?
8. After a few minutes elapse, we may recall the theme of a conversation but not the exact words ‑‑ Correct?
9. And would you agree that is why we have this court reporter ‑ diligently taking down every word spoken in this proceeding ‑ because our verbatim memories for spoken dialogue are pretty poor ‑‑ Correct?
[USE THE 22 FOUNDATIONAL QUESTIONS FROM PREVIOUS POSTS IF YOU HAVE NOT YET DONE SO]
10. The American Journal of Psychiatry is a generally recognized and accepted, peer‑reviewed journal in your field ‑‑ Correct?
11. And a 1981 article by Muslin and his colleagues published in the American Journal of Psychiatry ‑ titled “The Fate of The Clinical Interview: An Observational Study” ‑ could be relevant to your opinions in this case ‑‑ Correct?
12. Concerning this research, I’d like to ask you this hypothetical question which involves these four steps:
[Consider printing these four steps on a piece of paper you can hand to the witness]
(1) Psychiatric trainees were videotaped interviewing patients
(2) Subsequent to their interviewing these patients, the trainees’ supervisory sessions with their supervisors were also videotaped
(3) When reporting their interviews to their supervisors, the trainees overlooked 50% of the important issues transpiring during their interviews
(4) And another 50% of what these trainees did report to their supervisors was also distorted
Now my question: - .5 x .5 = .25 ‑‑ Correct?
13. Therefore, the sum accuracy of a non-recorded interview is approximately 25% ‑‑ Correct?
14. You have not published any data in a peer‑reviewed journal necessitating that we reconsider the findings of this 1981 study ‑‑ Correct?
15. You cannot cite any data published in a peer‑reviewed journal necessitating that we reconsider the findings of this 1981 study ‑‑ Correct?
16. Without other data necessitating reconsideration of the 1981 findings of Muslin and his colleagues, those results ‑ published in a peer‑reviewed journal ‑ should be regarded as generally recognized and accepted ‑‑ Correct?
17. In other words, your profession generally recognizes and accepts that the sum accuracy of a non-recorded interview approximates 25% ‑‑ Correct?
18. And experienced mental health professionals also do not accurately recall their own behavior during interviews ‑‑ Correct?
19. They cannot accurately recall their own statements because they pay more attention to whom they are interviewing than to themselves ‑‑ Correct?
20. And the relevant research demonstrates that people compensate for faded verbatim memories by using gap filling strategies ‑‑ Correct?
21. In other words, we fill in our memory gaps with what seems plausible ‑‑ Correct?
22. But what seems plausible does not necessarily correspond with what actually occurred in an interview ‑‑ Correct?
23. For example, the relevant research demonstrates how mental health professionals incorrectly recall symptoms exhibited by patients ‑‑ Correct?
24. You can mistakenly recall a patient exhibiting some symptom ‑ when in fact the patient did not exhibit the symptom ‑ if the symptom is consistent with your diagnostic impression ‑‑ Correct?
25. And conversely, you can overlook some symptom actually exhibited by the patient if that symptom is inconsistent with your diagnostic impression ‑‑ Correct?
26. And this kind of selective recall is known as “confirmatory bias” ‑‑ Correct?’
27. And confirmatory bias has been defined as “... the tendency to seek supportive data for one's hypotheses and to underweight or disregard non-supportive data” ‑‑ Correct?
28. Without a videotape or audiotape of your interview, therefore, we can only rely on your best guesses as to what occurred ‑‑ Correct?
[1]. Muslin, H.L., Thurnblad, R.J., Meschel, G. (1981). The fate of the clinical interview: An observational study. American Journal of Psychiatry, 138, 823-825.
[2]. Truax, C.B. (1966). Reinforcement and non-reinforcement in Rogerian psychotherapy. Journal of Abnormal Psychology, 71, 1-9.
[3]. Rayner, K. & Pollatsek, A. (1989). The psychology of reading. Englewood Cliffs, NJ: Prentice-Hall.
[4]. Roediger, H.L. III & McDermott, K.B. (1995). Creating false memories: Remembering words not presented in lists. Journal of Experimental Psychology: Learning, Memory and Cognition, 21, 803-814.
[5]. Barclay, C.R. & Wellman, H.M. (1986). Accuracies and inaccuracies in autobiographical memories. Journal of Memory and Language, 25, 93-103.
[6]. Arkes, H.R. & Harkness, A.R. (1980). Effect of making a diagnosis on subsequent recognition of symptoms. Journal of Experimental Psychology, 6, 99-105.
[7]. Faust, D. (1989). Data integration in legal evaluations: Can clinicians deliver on their premises? Behavioral Sciences & the Law, 7, 469-483 (p. 475).
