RATIONAL UNDERSTANDING IN COMPETENCY TO STAND TRIAL: A QUALITITATIVE STUDY AND DEVELOPMENT OF AN ASSESSMENT INSTRUMENT A Dissertation Presented to the Faculty of Antioch University Seattle Seattle, WA In Partial Fulfillment of the Requirements of the Degree Doctor of Psychology By Kenneth C. Cole, Jr. September 2010 RATIONAL UNDERSTANDING IN COMPETENCY TO STAND TRIAL: A QUALITITATIVE STUDY AND DEVELOPMENT OF AN ASSESSMENT INSTRUMENT This dissertation, by Kenneth C. Cole, Jr., has been approved by the committee members signed below who recommend that it be accepted by the faculty of Antioch University Seattle at Seattle, WA, in partial fulfillment of requirements for the degree of DOCTOR OF PSYCHOLOGY Clinical Dissertation Committee: _________________________ Mary Wieneke, Ph.D. Chairperson _________________________ Catherine Koverola, Ph.D. _________________________ Philip Barnard, Ph.D. ________________________ Date. ii © Copyright by Kenneth Cole, Jr., 2010 All Rights Reserved iii 1 ABSTRACT RATIONAL UNDERSTANDING IN COMPETENCY TO STAND TRIAL: A QUALITITATIVE STUDY AND DEVELOPMENT OF AN ASSESSMENT INSTRUMENT KENNETH C. COLE, JR. Antioch University Seattle Seattle, WA Mental competency as a prerequisite for due process was established by the United States Supreme Court‟s Dusky decision (1960). The Court mandated that a defendant must possess reasonable levels of factual and rational understanding in order to competently participate in the adjudication process. The precise definitions of competence were not included in any of the Court‟s decisions regarding the concept of Competency to Stand Trial (CST). The original purpose of this research was to contribute knowledge regarding the psychological dimensions of CST and to suggest definitions of the psychological dimensions of CST and the standardization of the CST evaluation process. However, a review of the existing literature regarding CST revealed a significant omission in the current CST evaluation process. Courts have not adequately defined the dimensions of rational capacity. In addition, CST assessment instruments focus almost exclusively on a defendant‟s factual understanding and take few steps to evaluate the defendant‟s rational capabilities. The research included a qualitative analysis of seven hours of interviews with an incarcerated individual whose CST was in question. That case study was initially designed to analyze for psychological 2 dimensions of CST using a predominant CST assessment instrument. The case study revealed that rational capacities are not a prominent part of current evaluation protocols and the impact of rational incompetence on the CST assessment of defendants is minimal. As a result of these discoveries the focus of the research was modified from a study of a broad-spectrum of psychological dimensions of CST into a study specifically focused on identifying and defining dimensions of rational understanding. In addition, the researcher developed a new CST assessment tool explicitly designed to measure a defendant‟s capacity to rationally understand and participate in the adjudication process - the Cole Rationality Assessment Instrument (C-RAI). A small pilot study of the C-RAI is included. No examples of a similar research approach for exploring the psychological dimensions of CST were found during the review of the literature for this study and no other tools specifically designed to measure rational competencies were located. The electronic version of this dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd. Dedication I dedicate this dissertation work to my family, who has patiently supported me throughout this lengthy process. I especially want to express my feeling of enormous gratitude to my wife Charlette, who was incredibly tolerant and an unwavering source of encouragement and tenacity. iv Acknowledgements I wish to thank my committee members who were more than generous with their expertise and precious time. I would like to gratefully acknowledge Dr. Mary Wieneke, my committee chairwoman for her countless hours of reflection, reading, and limitless patience, and most importantly for her steadfast encouragement to me throughout the entire dissertation process. My sincere thanks go to Dr. Catherine Koverola for agreeing to serve on my committee and for challenging me to produce a meaningful contribution to forensic psychology. I especially want to express my heart-felt gratitude to Dr. Philip Barnard for his encouraging service on my committee, but also for his willingness to be my mentor and role model of professional excellence in the practice of forensic psychology. I also would like to acknowledge the profound impact of Dr. Andy Benjamin upon my entry into the world of forensic psychology at Antioch University Seattle and his continued supportive mentoring since that time. My special thanks to my daughters Corrin and Kaelyn, who helped during final editing of the paper, and for the support and encouragement of my son Joshua and daughter Jacqueline. Finally, I want to acknowledge with deeply felt gratitude the immeasurable influence of my mother and late father upon my life and work. v Table of Contents Page Dedication………………………………………………………….….……….........iv Acknowledgements.………………………………………………….….……….......v List of Tables………………………………………………………….….…..….....vii Introduction……………………………………………………………………….…..1 Purpose………………………………………………………………………………..2 Literature Review……………………………………………………………………..4 Background……………………………………………………………………….….65 Methods…………………………………………………………………………........66 Results …………………………………………………………………..……..…......75 Discussion……………………………………………………………………..…....107 Recommendations for Future Research……………………………………….…....116 References……………………………………………………………………...…...119 Appendix A: Legal References …………………………………………………....126 Appendix B: Definitions of CAI Content Areas and Psychological Dimensions….130 Appendix C: Pilot Study of the Cole Rationality Assessment Inventory (C-RAI)...132 Appendix D: Cole Rationality Assessment Inventory (C-RAI)……………………143 vi List of Tables Page 1. Items from the Competence to Stand Trial Assessment Instrument (CAI)……..76 2. Total Occurrences of 13 Content Areas in Participant Interviews………………77 3. Total Occurrences of Prominent Dimensions in Participant Interviews………...78 4. Results of Pilot Study of the Cole Rational Assessment Inventory (C-RAI)…..137 vii 1 Introduction A fundamental American ideal is that all defendants have the right to a fair trial while participating in an adjudication process. Mental competency as a prerequisite for due process was established by the United States Supreme Court‟s Dusky decision (1960), but the precise definitions of mental competence were not included in any of the Supreme Court decisions regarding the psycholegal concept known as Competency to Stand Trial (herein after referred to as CST) . Thomas Grisso (2003) suggested that the psychological dimensions that make up CST have not been adequately identified and defined and that the forensic evaluations utilized to measure CST have not been administered in a standardized manner. In response to Grisso‟s observations this study set out to explore the psychological dimensions of CST by conducting a case study of one potentially incompetent defendant in the adjudication process. In this way the researcher hoped to contribute useful information to the body of knowledge regarding the psychological dimensions of CST, and to assist in establishing precise definitions of the psychological dimensions of CST and the standardization of the CST evaluation process. During the process of reviewing the existing literature regarding CST (i.e., relevant federal and state case histories, CST evaluation assessment instruments and conceptual models of CST), the researcher discovered a significant omission in the evaluative process of CST. In the United States Supreme Court‟s Dusky decision (1960) the Court directed that defendants must possess two overall psychological capabilities in order to competently stand trial; factual and rational understanding. However, the literature review revealed that federal and state Courts have not clearly or adequately defined the makeup of rational capabilities. In addition, past and current CST assessment instruments focus almost exclusively on the defendant‟s factual understanding and spend