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The issue of legal mental competency can be a complicated and emotion-packed subject, even under the best of circumstances. This week on Parents Are Hard To Raise… Diane’s special guest, forensic psychologist, Dr. Gianni Pirelli, pulls back the curtain on a common problem, we’d all rather not think about.
Sane or insane competent or not… The answers to these complex legal questions lie at the intersection where the science of psychology and the justice system meet. And that’s where we find this week’s guest expert. Dr. Gianni Pirelli is a board certified forensic psychologist and adjunct professor of forensic psychology at Fairleigh Dickinson University. Montclair State. University and John Jay College of Criminal Justice.
His research has been featured in USA Today, Psychology Today and cited in briefs to the New York Court of Appeals and the United States Supreme Court.
Dr. Perelli currently serves as the editor of the State Psychological Association’s Journal, The New Jersey Psychologist and as an editorial board member for a leading forensic psychology journal law on human behavior. He is the author of three textbooks including The Ethical Practice of Forensic Psychology published by Oxford University Press.
Parents Are Hard To Raise S02 E66 Transcripts
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Announcer: [00:00:38] The issue of legal mental competency can be a complicated and emotion packed subject, even under the best of circumstances.
[00:00:46] This week on parents to raise Diane’s special guest forensic psychologist Dr. Gianni Pirelli pulls back the curtain on a common problem. We’d all rather not think about.
Diane: [00:01:09] Welcome to Parents Are Hard to Raise helping families grow old together without losing their minds. I’m elder care expert Diane Berardi.
[00:01:18] Sane or insane competent or not. The answers to these complex legal questions lie at the intersection where the science of psychology and the justice system meet. And that’s where we find this week’s guest expert.
[00:01:31] Dr. Gianni Pirelli is a board certified forensic psychologist and adjunct professor of forensic psychology at Fairleigh Dickinson University, Montclair State University and John Jay College of Criminal Justice. His research has been featured in USA Today, Psychology Today, and cited in briefs to the New York Court of Appeals and the United States Supreme Court. Dr. Perelli currently serves as the editor of the State Psychological Association’s Journal, The New Jersey Psychologist, and as an editorial board member for a leading forensic psychology journal law on human behavior. He is the author of three textbooks including The Ethical Practice of Forensic Psychology published by Oxford University Press. Dr. Pirelli… Welcome to Parents Are Hard to Raise.
Dr. Pirelli: [00:02:19] Thank you so much.
Diane: [00:02:21] Wow, you had such a wonderful backround there. I was getting tongue tied.
Dr. Pirelli: [00:02:26] Thank you.
Diane: [00:02:28] So, of course I know everyone… All our listeners are saying, what does a forensic psychologist do?
[00:02:35] Right. I often ask myself.
Diane: [00:02:37] We think it’s CSI.
Dr. Pirelli: [00:02:39] Exactly. Well it’s funny you say that, because a lot of times I’m talking to intro to psychology undergraduate students trying to explain to them the same thing, because they’re kind of interested and oh! They think it’s CSI as well.
[00:02:53] And that’s obviously very, very minimal aspect of the field. Criminal profiling is usually more law enforcement. Forensic psychologist is somebody who applies clinical psychology to the law, essentially. And it’s really a specialty area. It’s been recognized for about 15 years by the American Psychological Association and someone like myself conducts evaluations for civil, criminal and legal matters, as well as administrative matters.
[00:03:29] So basically a forensic psychologist like me in the context of the issues that you talk about we can be brought in on cases when there’s questions about parental or parent’s capacity to make decisions or their ability to make decisions. So we call those guardianship evaluations.
Diane: [00:03:51] I’m thinking, we as children, we have so many different concerns today because our parents… People are living longer. And we have the prevalence of dementia patients rights, blended families, intergenerational transfer of wealth, informed consent. So we have so many issues and we’re looking… We we look for help because there’s a point where you don’t know what to do.
[00:04:22] Most of us have a relative who we think, jeez, they’re beginning to make decisions that may be inconsistent with how they usually…their thought process was, or their core values and they’re exhibiting behaviors that have caused us to QUESTION… Well, can they live independently? what. Can they drive a car safely or are they making sound financial decisions. So in that respect would we be able to just call you for something like that?
Dr. Pirelli: [00:04:57] Yes so. So there’s a couple of different ways that someone can can get in touch with us. One is directly, and we would speak to them in terms of determining where they’re at in the process because it may just be a time of initial assessment a maybe a time of therapeutic interventions individual therapy or it may be a time where it’s seriously time to consider getting attorney and filing formally for guardianship. And I’m not an attorney but if we deal these all the time so I would just generally say… .
[00:05:30] You have limited guardianships where someone might, you can assist the parent making decisions and then there’s full guardianship usually. Again every jurisdiction is different. But what’s important is it goes back to what is a forensic psychologist. Most people will just say right let’s just go to our general medical doctor right. And a lot of times that’s fine. A lot of times general medical doctors or even psychiatrists can do these types of guardianship cases where they basically fill out a form and there’s an easy transfer. But we tend to get called in when we really need to evaluate it further. When we do psychological testing. We do functional testing meaning, we’re literally asking the person to look into a phone book although that’s getting outdated. But things like that. Like one of the best subtests… Actually, one of the things we do is we put these candies but they’re supposed to mimic pills in a bottle and then we set a timer for five minutes from now, then we continue with other tasks, and then the timer goes off…
[00:06:39] Like, what are you supposed to do now? Like, I don’t know. So we try to give it very practical, real world Functional Testing, to understand where the person is, so that we can then speak to medical, financial legal, decisions.
[00:06:55] Because you’ve made number one, be in a family situation where there’s a disagreement. So, the one sibling thinks no they don’t need any help the other sibling thinks that they do. Or, that could come about later. And if you don’t get somebody who has some expertise with respect to legal matters, then later on they’re going to say well you influenced them to sign off on that.
[00:07:25] And so we, were basically hired and experts and foreshadowing that, thinking ahead doing all the proper procedures now so that we address any questions that might come up later that our procedures are sound. So in a jurisdiction like New Jersey, a state like New Jersey, you still need a medical doctor. But you can also get a license psychologist. And oftentimes, in my experience, as a psychologist like us, forensic psychologist, that’s those are the ones that are going to give you the three, four, five page reports that are more detailed. Versus filling out a form.
[00:08:02] Because we’re just used to going to our medical doctors to thought forms for Social Security and disability. And that’s again that’s fine. I’m not knocking that. That can be good. But you might be in a situation where say what we want to know really more and we want there to be actual testing… To lay it out.
Diane: [00:08:21] Yeah, because we have a lot of children they don’t live in the same area as their parents. And if there’s two parents in the home a lot of times they cover for each other. When you call… Everything’s fine. When you think it’s OK and then you find people come to visit you come for a holiday or whatever and you’re like oh my gosh… Mom, is dad like that all the time? He doesn’t seem to be remembering or… you see mail piled up. Or he’s not paying the bills or you go for a ride with him and he gets lost or he shouldn’t be driving he’s not acting in the right way.
[00:09:05] So, driving is a big issue. And people say, how do I get the keys away? What do I do? So these are things. I guess…
Dr. Pirelli: [00:09:18] Absolutely. And the key is, what you’re talking about again is kind of compensating. As families we tend to compensate. We see this even from a cultural perspective. The 10 year old child is translating in a different language for the parent.
[00:09:35] But that type of family dynamic carries through, most of our families and through most of our lives. So a lot of times, I’ll have a woman call me and 50 year old woman who say I want I need my mother evaluated but can I sit in on the evaluation. I’ll say, no! Because, what’ll happen is it’ll be like you asked the person what’s your birthday and they say “come on my Ma… you know it’s in January.”
[00:10:00] OK well…I Can no longer evaluate that. There goes that item. And so it’s very difficult for people like your listeners and all of us really to not kind of chime in and jump in. Because actually, and this applies to everyone, when you do cognitive testing. It’s stressful. So in other words, if I do personality testing, where I tell someone, oh fill out a questionnaire and I want to know your views on different things so I can get a sense of your personality.
[00:10:29] It’s a lot less threatening and stressful. Because there’s really no obvious right or wrong answer. But when you ask someone, what is two plus two? And they can’t answer it. They know they don’t know the answer. And that is stressful. And as stressful as a family member to watch that.
[00:10:45] So what we do is family members, a lot of times, we try to save that person. Like you said, it’s kind of save face… Everything’s fine… And compensate.
[00:10:54] But, that’s why again, when we do these types of assessments, we really need to bring the person and see them independently, so that we can get an independent evaluation of how they’re functioning. And that’s really important.
[00:11:11] I’ve had a number of cases where someone has come to me and they say, oh we think everything is fine. But they’ve sat in on every previous assessment with other doctors. And then you see them independently, and things are… Not good.
Diane: [00:11:27] We’ll be back with Dr. Gianni Pirelli after the break.
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Announcer: [00:13:38] You’re listening to parents are hard to raise. Now thanks to you…. The number one elder care talk show on planet earth.
[00:13:47] Listen to this and other episodes on iTunes Google Play and on demand using the iHeart Radio app.
Diane: [00:14:05] And we’re back…. And I want to welcome our new listeners from Kansas… Wichita, Liberal, Scott City. From West Virginia, Charleston, St. Alban’s, Summersville. From Idaho, Pocatello, Twin Falls. From San Juan Puerto Rico. Marigot St. Martin. I love Marigot Saint-Martin and from Milan Italy.
[00:14:30] And I’m back with our special guest Dr Gianni Pirelli, forensic psychologist.
[00:14:36] So, we were talking about, if someone calls and wants to bring in a parent who feels that maybe they shouldn’t be driving, or they’re not they shouldn’t be living alone et cetera. So, I guess could you take us through what…
Dr. Pirelli: [00:14:50] Sure. Sure.
[00:14:52] So, again if you want to if you want to get in contact with us specifically, if you’re in our area, you can look at GPirelli.com G P I R E L L I .COM My name is Gianni Pirelli. But honestly, I know you have listeners everywhere, you can call us anytime. We’re happy to talk to you. So please reach out or send an email. You don’t have to feel like your next door at all.
[00:15:17] But, specifically how we would do these evaluations, is we look at it to see if there’s any records available, any medical records we would review. We would also then do obviously an interview with the person in question wether it’s your mom dad, whomever. And also testing with them as I said. And so, that usually blocks off a few hours of time, depending on how well they’re functioning or not.
[00:15:43] Now we also go to nursing homes and hospitals and so forth if they can’t travel. So that’s something that we can do. And we also do an interview with you.
[00:15:55] So, what you’re doing as a forensic evaluator in this case, is you’re looking at the records, you’re interviewing the person, you’re doing testing, you’re talking to family. You look at all that data you put it together and you put it into a report.
[00:16:10] The overall question… The main referral question is, What is that person’s capacity to make decisions? And capacity is another word for competency or another word for fitness… Their ability to make certain types of decisions.
[00:16:25] So what does that mean? That’s a legal term. How do we break that down clinically and what does that mean to us?
[00:16:31] We really think of it in terms of their ability to make a choice… To express a choice. I want this or I want that. Also, their understanding, appreciation, and reasoning abilities. So what does that mean?
[00:16:45] Let’s look at that… I don’t want to take my. I do want to take my medication. Let’s say, I don’t want to take my medication. I understand what it is… Like in other words they’re able to give you a factual understanding. This is the name of my medication this is what it does.
[00:17:01] I appreciate… That the second one. So understanding, [00:17:05] appreciate… [0.5] I appreciate the effects and the potential side effects, the benefits and side effects… in general.
[00:17:13] And then the final part is the reasoning. In my specific situation, is it good for me or not and here’s why. So remember it’s expressing a choice. Showing the ability to understand, factually, what something is. Appreciating the information around it. And then reasoning through it. You Know, being able to weigh that decision.
[00:17:37] And if you think of that, you can apply that to a lot of different types of decisions… Medications, medical procedures…Like You said, driving. I haven’t actually been specifically asked to handle driving. I mean I think medical doctors probably wind up getting that before comes to my desk. But any type of decision… Because competency or capacity is assumed…
[00:18:03] We all walk around everyday and make decisions. But here’s what we have to remember….
[00:18:08] We’re allowed to make poor decisions. We’re not allowed to make incompetent ones. So in other words, a lot of us don’t eat healthy perhaps, or maybe we smoke cigarettes, or we do different things that are not really maybe good choices in terms of health. But they’re competent. You’re allowed to legally make “bad choices.” You’re just not allowed to legally make incompetent ones.
[00:18:33] And so that’s where psychologists like like me comes in a forensic psychologist who tries to evaluate… Is the decision making process clear? It’s a little bit less about. It’s a lot less about what exactly is their choice. Right. Some people may elect to be conscientious objectors to medication or for religious reasons are have you. And that’s why you have to remember, someone may say they don’t want something. In and of itself that doesn’t mean that that’s a incompetent decision. They might provide you with a very rational explanation of why they don’t want it. I don’t want that… .
[00:19:18] I had a case where grandma’s 85 years old. And they could do surgery on her nose… she had polyps… But the risk of this surgery was such that she said she didn’t want to have that procedure.
[00:19:35] Now, the fact that she didn’t want the procedure, in and of itself, doesn’t tell you anything about Decision-Making.
[00:19:42] If I… Let’s use the extremes. If I go to her and say, why don’t you want this procedure. And she says I don’t want this procedure because I’m going to live to 150 anyway. I’m saying like real delusion. Well… Then that’s irrational. Right? But if she says I don’t want this procedure because it can hurt me, and there’s risks. You know… She doesn’t have to be articulate, she dosen’t have to be a doctor. She dosen’t have to explain those terms…
[00:20:07] But as as a as a doctor like me, we’re looking for the thought process behind the decision.
[00:20:13] And so that’s what you’re going to see differently between a forensic psychologist versus maybe a general practitioner. There’s no offense to general practitioners. I know you’re all out there and in fact you are my referral source as well if someone comes to your door and it’s a grayer area situation. You’re going to want to call forensic evaluator to to kind of try to pick apart the exact type of decision making and do the testing and so forth that’s needed to look into it a little closer.
Diane: [00:20:44] Right. Because you’re really delving into more… I know, like my mother will say, she goes to her doctor every year. And she goes… She asks me the same three questions… She’s like… And I know what she’s going to ask me. She wants to see if I remember things… I can remember Apple… and she lists them. She goes… “I tell all my friends who go to the same doctor, these are the questions she’s gonna ask. you Get.
Dr. Pirelli: [00:21:07] Right. Well that’s the thing. I’m happy you said that. Because what happens with memory, first of all, there’s about 25 different types of memory or more. Now we’re not neuropsychologist we’re not going to break it down to the minuscule level. We want to understand how the memory impacts the decision making. That’s where the forensic piece comes in. But, here’s the thing people that they know certain things, like their name, are those three questions you said. It’s just… It’s not that you are aware of it from a process standpoint in their mind. It’s just memorized.
Diane: [00:21:40] Right.
Dr. Pirelli: [00:21:40] And so what you’re doing, as an evaluator like me is… You’re trying to get away from the memorization. And to the ability to actually make decisions that are more again functional level because again people compensate. Like I said it’s not uncommon to see certain people, older people, be very funny and joke like… Oh,so when were you born? “I was born a hundred years before you were.” Now, on a day to day basis they get away with that. Oh, isn’t she so funny…
[00:22:14] As an evaluator, I don’t let her get away with that. I say OK. That’s so funny. But I really need to know your date of birth or something like that. And so that’s what’s critically important, is when you go to a…
[00:22:27] And even the medical doctor who works with that personal time might… I’m not saying that they’re gonna be duped… But they might also fall into that dynamic because they have such a rapport with the person. When you get an independent third party as an evaluator, especialty forensic person, we take really kind of a colder approach in terms of not that we’re going to be cold to you on a personal level but from the evaluation standpoint, we’re going to push further. And we’re not going to just accept those kind of jokes or different things. We really want to understand what the person’s abilities are.
[00:23:05] And so, yes just that’s something to think about. If you want to. Not that you should do your own… I can’t give you a home kit or something… But you want to be thinking about in terms of if you want to sort of get a sense as different questions.
[00:23:21] Now… You don’t want to upset the person. If you are caring for or you have a loved one or know someone who has dementia and who is literally struggling. No. Then you want to do the opposite. You want to not ask them those types of stressful questions. Because actually families tend to do that…
[00:23:39] Which is… Why we tend to say, “Oh you do remember me? What’s my name? And the person’s struggling. And that actually can really stress them out. So that’s the irony. When it’s time for the evaluation with the doctor, we help them and we give them all the comfort stuff. But then when we’re at home we’re like… “Oh, do you remember what year Maria was born? And the person is very stressed out.
[00:24:01] And so I’d actually recommend the opposite. Which is, if your loved one is struggling with memory care related issues. If you look at the research and the suggestions around that it’s always about keeping the person on a routine. Asking them routine questions. Don’t ask them very difficult questions. Let the evaluator do that, to get a sense of where they’re at. But you as a caretaker, as a loved one, try to keep them as comfortable as possible. It’s such a common thing. I mean I just see it every day. When you see people and they say, “oh… do you remember me or what your name, or… do you remember we went to the party. And it can be very stressful.
[00:24:44] So remember what I said about cognitive abilities, your memory, your ability to think through things. It’s very stressful, because even people who are advanced with dementia and so forth, it’s now called Neurocognitive Disorder by the way, but we still call it dementia, sometimes. They have some insight into knowing what they don’t know.
Diane: [00:25:07] Right.
Dr. Pirelli: [00:25:07] So it’s kind of an interesting thing… The human mind in that way. It’s it’s protective in some ways, but other ways insight tends to hang around for a long time and that can be very stressful.
Diane: [00:25:23] And we use children, because we’re dealing with so many different things, and our lives are busy… We might be working, we have a parent,we’re not in the area or whatever. And you.. The caregivers are so stressed. So it’s kind of… I think that’s part of it too. Of course… “You remember.” When we try to just…this isn’t so. You can see sometimes, people, that kind of want to shake their loved one and go, “No you remember!”.
[00:25:55] Right. It’s For our own sake. Yeah. And it’s understandable, I mean like you said, the caretaker experiences a lot of stress as well. And so you really need to remember that. But but I think it’s also important to realize that… Forget about aging populations for a minute… And let’s just talk about everybody. The push is about mindfulness, living in the moment.
[00:26:20] Right. That’s that’s why you see these days when we look at mental health, physical health. “Live in the moment, mindfulness also… Remember that concept applies at all ages and it should apply. So I know you want to go down memory lane with mom and dad. I appreciate that. And I feel bad if you can’t do that. But remember that you could stay in the moment, as much as possible… You can have a really nice experience without the stress.
Diane: [00:26:47] Thank you. And Dr. Pirelli. Tell us again how we can get in touch.
Dr. Pirelli: [00:26:51] Sure. It’s just GPirelli.com G P I R E L L I dot com. Thank you.
Diane: [00:26:57] Thank you.
[00:26:58] I hope this episode helped you with something you may be dealing with at this moment. Please keep emailing your questions and comments and share as much detail as you can. Because listeners just like to come here each week for insight and inspiration. And your story can also help someone else. Please email me at Diane@parentsarehardtoraise.org Or [00:27:17] just click the green button on our home page. [2.2] [00:27:19] If you found something helpful in this episode, subscribe to our show and iHeart Radio iTunes or your favorite podcast app.
[00:27:26] And I’d be so grateful if you’d share this episode with your family co-workers and friends. Episode number 66. Parents are hard to raise is a CounterThink Media production. The music used in this broadcast was managed by Cosmo Music New York, New York. Our New York producer is Joshua Green, our broadcast engineer is Well Gambino. And from our London studios… The Melodious voice of our announcer Miss Dolly D.
[00:27:50] Thank you so much for listening. And I look forward to reading your comments and can’t wait till we meet up again on the next episode of parents are hard to raise. Till then…
[00:28:00] May you forget everything you don’t want to remember and remember everything you don’t want to forget.
[00:28:05] See you again next week.