Each morning, I walk the few blocks from my hotel to Dr. Pate's forensic psychology practice in downtown Winchester, Virginia. I read the case file waiting on Dr. Pate's desk and find out what we'll be working with that day. Parental capacity assessment? Evaluation of a sex offender? Competency to stand trial? Or, if it's a slow day, job applicant evaluations for the police department. After my first week, I know what I'll read in the folders--sad stories made even sadder by their homogeneity. Single moms demanding custody of their children despite having no job and no plan, young women who keep going back to the same abusive boyfriend despite having been hospitalized from multiple beatings, middle-aged men and their teenage girlfriends. Alcohol, drugs, and absent fathers feature prominently in nearly every case.
Based on which type of interview Dr. Pate is conducting that day, I prepare the appropriate psychological tests. Before the client arrives for the intake interview, Dr. Pate reminds me, "Pay attention to how the client makes you feel." I greet the client and help him fill out some preliminary paperwork, then guide him to the interview room. I conduct a Mini-Mental Status Exam, asking the client a series of basic questions ("What season is this?") and to perform simple tasks ("Pick up this piece of paper, fold it in half, and hand it to me.") The MMSE allows Dr. Pate to observe the client's state of mind and demeanor, particularly with regards to how some male clients react to a younger woman as an authority figure. I also administer a basic reading test as a rough estimate of his intelligence level.
Dr. Pate begins the interview with the client's personal history (what their childhood was like, what they were like in school, their current relationship with their family) before moving on to an account of the incident at hand, usually an arrest or a domestic disturbance. Most female clients break into tears while recounting the events that led to them sitting in Dr. Pate's office. Often Dr. Pate will have me conduct the drug and alcohol assessment, and so I make my way down the checklist, asking the client not if, but when he first used each substance. During the interview, which lasts for about an hour, I type notes and record the client's responses for later use in Dr. Pate's report. Sometimes I get too wrapped up in the client's story and forget to type notes. Once Dr. Pate has asked all his questions, he invites me to ask any of my own questions, and I try to come up with something halfway intelligent. Twice, Dr. Pate told me I had asked good questions--those were big days for me.
While the client steps outside for a smoke break, Dr. Pate asks me, "What did you notice?" On my first day, I made the rookie mistake of replying with my opinions and not my observations, and Dr. Pate asked me, "Caroline, would that hold up in court?" After that, I answer in facts only: if the client arrived late, if he shook hands and said "Nice to meet you," if she wore pajamas and Crocs, if she laughed nervously when she didn't know words on the reading test, if he slumped in the chair with his arms folded over his chest, if he didn't fill in the paperwork completely. Dr. Pate says, "These are all just points of data. One point might not mean anything--a lot of points mean something." After the client returns, I'll set him up with various psychological tests--a couple of personality assessments and usually a test that's more specific to the current case. While the client completes the tests, I start formatting my notes and observations into Dr. Pate's report template, stopping periodically to email a lawyer, schedule a visit with the jail, or fax something to the court. When he gets antsy, which happens several times a day, we'll walk down to the post office or across the street to the courthouse. While we walk, Dr. Pate extemporizes on military history, pausing to greet every denizen of Winchester by name. Forget the emotionally draining interviews--the toughest questions asked that day will be the ones Dr. Pate fires at me during casual conversation: "Caroline, what are the indicators that someone is psychotic?" "What is mental illness?" "How are men and women different?" "What is love?" (Dr. Pate's answer: love is a superego fantasy.)
When the client has finished testing, I score the assessments and look over them with Dr. Pate. He quizzes me on how to interpret the results. I point out areas in which the client scored either remarkably low or remarkably high, and Dr. Pate asks, "Is this consistent with everything else we've seen? Does it matter in this particular context?" In the afternoons, I busy myself with report-writing and assembling the week's case files while Dr. Pate conducts therapy sessions.
On two afternoons, we go to jail to conduct interviews, one evaluation of a sex offender and one competency to stand trial. On this second occasion, Dr. Pate supervised while I took the lead and tried to disentangle the client's hallucinations (or attempts at malingering?) of his mother's ghost from the official reports of his DUI. Another notable interview was a competency to stand trial evaluation for an elementary student who had assaulted another child on the playground. On my last day, we interviewed a woman whom a referral source suspected of having a shared delusional disorder. Every day of forensic psychology is exhausting, challenging, and emotionally draining. It is also illuminating and emboldening and I love every minute of it. I started this internship with a very limited understanding of what forensic psychology even was, and now leave with a burgeoning career interest in the field.