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Deception in clinical settings summary (literature)
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Deception in clinical settingsWeek 1
Chapter 1: An introduction to response styles (p3-17)
Complete and accurate self-disclosure is rare in the context of a psychotherapeutic relationship.
Despite imagining positive gains from personal disclosure, many clients elected not to be fully
forthcoming about deeply personal issues. Deceptions in therapy are not relegated to undisclosed
personal issues. Many clients minimized their distress and symptoms severity, pretend to like
comments/suggestions, overstate the effectiveness of therapy and pretend to do homework.
Therapists also vary in their numbers and types of self-disclosures.
Deceptions routinely occur in personal relationships, including intimate relationships. Beyond
therapy and relationships, deceptions commonly occur in the workplace, including the concealments
of mental disorders, this can be due to public stigma or concerns about potential damage to their
careers. A study showed that decisions about response styles (disclose or deceive) are often rational
and multidetermined and these decisions are often individualized responses to interpersonal
variables or situational demands. It is a misconception that response styles are inflexible
characteristics of certain individuals.
Decisions to deceive or disclose are part of relationships across a spectrum of social contexts. Most
individuals engage in a variety of response styles that reflect their personal goals in a particular
setting. Clients in an evaluative context may experience internal (e.g., disorders, intentional goals or
identity) and external influences on their self-reporting.
In the context of clinical assessments, mental health professionals should consider what level of
deception should be documented in their reports (e.g., (in)consequential deceptions). The
inconsequential deceptions should be considered carefully; two extreme alternatives are presented:
1. Taint hypothesis: any evidence of nongenuine responding is likely to signal a broader but
presently undetected dissimulation. Therefore, practitioners should document any observed,
even if isolated, deceptions.
2. Beyond-reasonable-doubt standard: only conclusive evidence of a response style, such as
feigning, should be reported.
In forensic practice, determinations of malingering are perceived as playing a decisive role in legal
outcomes. Mental health professionals must decide what evidence of response styles should be
included in clinical and forensic reports. Their decisions are influenced by at least two dimensions:
Accuracy vs completeness of their conclusion
Use versus misuse of clinical findings by others
Fundamentals of response styles
Nonspecific terms
Practitioners and researchers seek precision in the description of response styles. A very common
error is the overspecification of response styles. Clinicians try to determine which specific response
style best fits the clinical data, which often leads to the specification of a response style, even when
the data are inconclusive, or conflicting. A two-step
approach is recommended. This approach asks practitioners
to make an explicit decision between nonspecific or general
descriptions and specific response styles. Conclusions about
specific response styles are more helpful to clinicians than
nonspecific descriptions. Therefore, nonspecific
,descriptions are considered first to reduce the tendency of overreaching data when conclusions
about specific response styles cannot be demonstrated. Nonspecific terms are defined and
accompanied with a brief commentary:
Unreliability: accuracy of the reported information. It makes no assumption about the
individual’s intent or the reasons for inaccurate data.
Nondisclosure: withholding of information. It makes no assumptions about intentionality.
Self-disclosure: how much individuals reveal about themselves.
Deception: any consequential attempts by individuals to distort of misrepresent their self-
reporting. It often includes deceit and nondisclosure.
Dissimulation: a wide range of deliberate distortions or misrepresentations of psychological
symptoms.
Overstated psychology
There are three terms to categorize overstated pathology:
1. Malingering: intentional production of false or grossly exaggerated physical or psychological
symptoms, motivated by external incentives.
The presence of minor exaggerations or isolated symptoms does not qualify as malingering.
2. Factitious presentations: intentional production or feigning of symptoms that is motivated
by the desire to assume a sick role.
The deceptive behavior is evident in the absence of obvious external rewards. It requires
some unspecified internal motivation, it doesn’t preclude external incentives. Internal and
external motivations can often co-occur.
3. Feigning: the deliberate fabrication or gross exaggeration of psychological or physical
symptoms, without any assumptions about its goals.
Measures of response styles have not been validated to assess an individual’s specific
motivations. Psychological tests can thus be used to establish feigning but not malingering.
There are three terms that should be avoided in clinical and forensic practice:
1. Suboptimal effort (incomplete or submaximal effort): this term lacks precision and may be
applied to nearly any client or professional. The effort of an individual may be affected by
internal and external factors.
2. Overreporting (self-unfavorable reporting): unexpectedly high level of item endorsement.
The term lacks clarity with respect to its content and it has been used to describe both
deliberate and unintentional acts.
3. Secondary gain: its inherent problem for practice stems from the presence of conflicting
meanings (e.g, from a psychodynamic, behavioral, and forensic perspective).
Mental health professionals should use professional language that is clearly defined. Ambiguous
terminology leads to confusion and errors.
Simulated adjustment
Three terms are used to describe specific response styles that are associated with simulated
adjustment:
1. Defensiveness (polar opposite of malingering): deliberate denial or gross minimization of
physical and/or psychological symptoms.
2. Social desirability: the pervasive tendency for certain individuals to present themselves in
the most favorable manner relative to social norms and mores. It involves the denial of
negative characteristics and the attribution of positive qualities.
3. Impression management: deliberate efforts to control others’ perceptions of an individuals;
its purpose may range from maximizing social outcomes to the portrayal of a desired
identity. It is more situationally driven than social desirability.
Other response styles
, There are four other response styles:
1. Irrelevant responding: the individual does not become psychologically engaged in the
assessment process. The given responses are not related to the content of the inquiry. It can
reflect intentional disinterest or carelessness. Examples are the repetitive selection of the
same option or an alternating response pattern.
2. Random responding: is a subset of irrelevant responding and is based entirely on chance
factors.
3. Acquiescent responding (yea-saying)
4. Disacquiescent responding (nay-saying)
5. Role assumption: individuals assume the role or character of another person in responding
to psychological measures.
6. Hybrid responding: an individual’s use of more than one response style in a particular
situation.
Domains of dissimulation
Response styles are almost never pervasive. A framework for understanding and assessing response
styles is the concept of domains. Three broad domains encompass most attempts at dissimulation:
1. Feigned mental disorders
2. Feigned cognitive abilities
3. Feigned medical complaints/symptoms
These domains are important to assessment of response styles.
Common misconceptions about malingering
There are common misconceptions about malingering:
Malingering is rare
Malingering is a static response style. On the contrary, most efforts at malingering are
related to specific objectives in a particular context.
Malingering is an antisocial act by an antisocial person
Deception is evidence of malingering
Malingering is similar to the iceberg phenomenon. This misconception is based on the theory
that any evidence of malingering is sufficient for its classification. The misconception involves
that any observable feigning, similar to the visible tip of an iceberg, represents a pervasive
pattern of malingering.
Malingering precludes genuine disorders
Syndrome-specific feigning scales measure syndrome-specific malingering
Malingering has stable base rates.
Clinical and research models
Motivational basis of response styles
Most response styles are conceptualized as deliberate efforts, which makes individual motivations a
central concern. The motivational basis for response styles (i.e., explanatory models) has
implications for practice. Selection of a particular response style is based on the options available and
the desired outcome (predicted utility). The category of simulated adjustment (i.e., defensiveness,
impression management, and social desirability) is the most used form of response styles. Predicted
utilities may focus on others or is self-focused.
The prevailing model of malingering relies on expected utility.
- Adaptational model: malingerers attempt to engage in a cost-benefit analysis in choosing to
feign psychological impairment.
- Pathogenic model: an underlying disorder motivated the malingered presentation. The
malingerers, in an ineffectual effort to control their genuine impairment, voluntarily produce
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