The patient–psychologist relationship and informed consent in neuropsychological evaluations

Abstract

Objective: To discuss specific issues regarding consent for neuropsychological evaluation and the patient–psychologist relationship within the context of the Ethics Code of the American Psychological Association and relevant literature.

Method: The author makes recommendations based on the Ethics Code and published sources. This article is advisory and does not prescribe ethical practice.

Conclusions: The presence or absence of a patient–psychologist relationship is an essential consideration. The consent process varies, depending on the absence or existence of a patient–psychologist relationship and the type of evaluation. Circumstances when the examiner has the option of establishing a patient–psychologist relationship and guidelines regarding multiple relationships affecting legal testimony by treating providers are considered. Differences in the consent process between clinical and forensic evaluations, and the need for tailoring the consent process for the specific type of clinical or forensic evaluation, are emphasized. Specific provisions that can be included in consent forms in clinical and forensic evaluations, the rationale for their inclusion, and the benefits of consent to both the examiner and the examinee are considered. Circumstances are defined that dictate the need for assent rather than consent. The consent process is discussed in relation to evaluations of fitness for duty and civil capacity. Mandatory reporting of impaired drivers in some jurisdictions, fee agreements, and other issues are considered. Guidance is provided on role limitations in legal testimony by a clinical evaluator that addresses conflicting recommendations now in the literature.

Keywords:

• Ethics
• consent
• patient–psychologist relationship
• neuropsychological evaluations

Acknowledgments

The reviewers and the associate editor made many constructive suggestions. David Bush and Christopher Grote provided comments on an initial draft. Harrison Fulop made style recommendations. Portions of this paper were based on a presentation at the American Academy of Clinical Neuropsychology meeting, Chicago, 2016 by Laurence M. Binder and A. John McSweeny.

Disclosure statement

The author performs forensic evaluations.

Notes

1 The 2017 revision of the Code of Ethics clarified the 2002 version regarding interrogation techniques and made no changes to sections discussed here.