Managing the communication channel. Discursive representations of clinical communication in forensic psychiatric reports


  • Dariusz Galasiński University of Wroclaw, Poland
  • Justyna Ziółkowska University of Social Sciences and Humanities, Poland



clinical communication, discourse analysis, forensic reports, psychiatry


Background: Forensic reports require clinicians’ presence as an agent in court-ordered forensic assessment.Aim: We focus on discursive representations of clinical communication in forensic psychiatric reports.Methods: We perform a critical discourse analysis of 142 forensic assessment reports for 33 patients detained and hospitalized on forensic wards in three hospitals in the southwest of Poland. Results: Clinical communication is constructed as controlled by the clinician. All references to patients’ communication are anchored in interpretation by the clinician. While the speaking patient is explicitly constructed as a communicator, the clinician her/himself is only very rarely represented as personally communicating, invoking an impersonal voice of institutional medicine. Discussion: Our study offers insight into the role of communication is forensic psychiatry as serving the clinician to construct an institutionally useful account of the patient. In contrast to psychiatry’s pronouncements, communication is not a means for a clinical dialogue, but for an institutional monologue. Conclusion: The results of our qualitative study are useful as do not only examine how things are done in forensic psychiatry, but also what it means in its context.


Anspach, R. R. (1988). Notes on the sociology of medical discourse: The language of case presentation. Journal of Health and Social Behavior, 29(4), 357–375.

Appelbaum, K. L. (2010). Commentary: The art of forensic report writing. Journal of the American Academy of Psychiatry and the Law Online, 38(1), 43–45.

Austin, J. L. (1962). How to Do Things with Words. Clarendon Press.

Barker, C., Galasiński, D. (2001). Cultural Studies and Discourse Analysis: a dialogue on language and identity. Sage.

Barnao, M., Ward, T., & Casey, S. (2015). Looking beyond the illness: Forensic service users’ perceptions of rehabilitation. Journal of Interpersonal Violence, 30(6), 1025–1045.

Bogdanowicz, E., & Hajdukiewicz, D. (1997). Opinie sądowo-psychiatryczne wydane po obserwacjach szpitalnych w Polsce w latach 1995–1996 – ocena poprawności pod względem formalnym. Postępy Psychiatrii i Neurologii, 6, 461–469.

Caldas-Coulthard, C. R. (1994). On reporting reporting: the representation of speech in factual and factional narratives. In M. Coulthard (Ed.), Advances in written text analysis (pp. 295–308). Routledge.

Ciszewski, L. (1995). Ogólna charakterystyka pacjentów wobec których stosuje się w szpitalach psychiatrycznych w Polsce środek zabezpieczający. Doniesienie wstępne. Postępy Psychiatrii i Neurologii, 4, 149–156.

Cook, G. (1992). The Discourse of Advertising. Routledge.

Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., Vu, H. T., Powe, N. R., Nelson, C., & Ford, D. E. (1999). Race, gender, and partnership in the patient-physician relationship. JAMA, 282(6), 583–589.

Coulmas, F. (ed.) (1986). Direct and Indirect Speech. Mouton de Gruyter.

Fairclough, N. (1992). Discourse and social change. Polity Press.

Fairclough, N. (1995a). Critical Discourse Analysis. Longman.

Fairclough, N. (1995b). Media Discourse. Edward Arnold.

Fairclough, N. (2003). Analysing Discourse. Routledge.

Galasiński, D., & Ziółkowska, J. (2013). Managing information: Misrepresentation in the patient’s notes. Qualitative inquiry, 19(8), 589–599.

Gierowski, K., & Paprzycki, L. (2013). Niepoczytalność i psychiatryczne środki zabezpieczające. Zagadnienia prawno-materialne, procesowe, psychiatryczne i psychologiczne. C.H. Beck.

Glancy, G. D., Ash, P., Bath, E. P., Buchanan, A., Fedoroff, P., Frierson, R. L., ... & Zonana, H. V. (2015). AAPL practice guideline for the forensic assessment. The journal of the American Academy of Psychiatry and the Law, 43(2 Suppl), S3–S53.

Gray-Little, B., & Kaplan, D. A. (1998). Interpretation of psychological tests in clinical and forensic evaluations. In J. H. Sandoval, C. L. Frisby, K. F. Geisinger, J. D. Scheuneman, & J. R. Grenier (Eds.), Test interpretation and diversity: Achieving equity in assessment (p. 141–178). American Psychological Association.

Greenfield, D. P., & Gottschalk, J. A. (2008). Writing forensic reports: A guide for mental health professionals (1st ed.). Springer.

Griffith, E. E. H., Stankovic, A., & Baranoski, M. (2010). Conceptualizing the forensic psychiatry report as performative narrative. The Journal of the American Academy of Psychiatry and the Law, 38(1), 32–42.

Grisso, T. (2006). Evaluating competencies: Forensic assessments and instruments (Vol. 16). Kluwer Academic/Plenum Publisher.

Haidet, P., & Paterniti, D. A. (2003). Building a history rather than taking one: A perspective on information sharing during the medical interview. Archives of internal medicine, 163(10), 1134–1140.

Hajdukiewicz, D. (2006). Ultima ratio stosowania środków zabezpieczających związanych z umieszczeniem w szpitalu psychiatrycznym. Psychiatria Polska, 4, 645–646.

Hajdukiewicz, D. (2016). Zagadnienia psychiatrii sądowej cz.1. Podstawy prawne i medyczne. Instytut Psychiatrii i Neurologii.

Halliday, M.A.K. (1994). An introduction to functional grammar (2nd edition). Edward Arnold.

Hartley, J. (1988). Understanding News. Routledge.

Heitzman, J., Markiewicz, I., & Gosek, P. (2019). Complementary Model of Long-Care in Poland as a Result of the Political Transformation, Law Reform and Service Changes in Forensic Psychiatry. In B. Völlm & P. Braun (Eds.), Long-Term Forensic Psychiatric Care (pp. 287–300). Springer.

Hettema, P. (2019). Ethical Aspects of Long-Stay Forensic Psychiatric Care. In B. Völlm & P. Braun (Eds.), Long-Term Forensic Psychiatric Care. Clinical, Ethical and Legal Challenges. (pp. 47–62). Springer.

Hodge, R. I. V., & Kress, G. R. (1993). Language as ideology. London: Routledge.

Holt, E. (2016). Indirect reported speech in interaction. In A. Capone, F. Kiefer & F. Lo Piparo (Eds.), Indirect Reports and Pragmatics. Interdisciplinary Studies (pp. 167–187). Springer.

Jarema, M. (2007). Zalecenia konsultanta krajowego w dziedzinie psychiatrii w sprawie struktury opinii sądowo-psychiatrycznej w sprawach karnych i cywilnych. Instytut Psychiatrii i Neurologii.

Kacperska, I., Heitzman, J., Bąk, T., Leśko, A. W., & Opio, M. (2016). Reliability of repeated forensic evaluations of legal sanity. International Journal of Law and Psychiatry, 44, 24–29.

Karlińska, A. (2021). Textual strategies of forensic psychiatrists. A corpus-based analysis of how the language of psychiatry is reconciled with the language of law in polish forensic psychiatric opinions. International Journal of Law and Psychiatry, 74, 101652.

Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(4), e94207.

Livingston, J. D., Nijdam-Jones, A., & Brink, J. (2012). A tale of two cultures: Examining patient-centered care in a forensic mental health hospital. Journal of Forensic Psychiatry & Psychology, 23(3), 345–360.

MacKinnon, R. A., Michels, R., & Buckley, P. J. (2015). The psychiatric interview in clinical practice. American Psychiatric Publishing.

McCabe, R., Healey, P. G., Priebe, S., Lavelle, M., Dodwell, D., Laugharne, R., ... & Bremner, S. (2013). Shared understanding in psychiatrist–patient communication: Association with treatment adherence in schizophrenia. Patient Education and Counseling, 93(1), 73–79.

Mellor, D., Davison, T., McCabe, M., George, K., Moore, K., & Ski, C. (2006). Satisfaction with general practitioner treatment of depression among residents of aged care facilities. Journal of Aging and Health, 18, 435–457.

Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook. Sage.

Mossman, D., Noffsinger, S. G., Ash, P., Frierson, R. L., Gerbasi, J., Hackett, M., ... & Zonana, H. V. (2007). AAPL practice guideline for the forensic psychiatric evaluation of competence to stand trial. Journal of the American Academy of Psychiatry and the Law Online, 35(Supplement 4), 3–72.

Ng, L.L. (2016). Forging steel from fire: emerging as a forensic psychiatrist. Academic Psychiatry, 14, 1-2.

O’Grady, J. C. (2002). Psychiatric evidence and sentencing: ethical dilemmas. Criminal Behaviour and Mental Health: CBMH, 12(3), 179–184.

O’Grady, J. C. (2004). Report writing for the criminal court. Psychiatry, 3, 34–36.

Pennebaker, J. W. (2011). The secret life of pronouns: What our words say about us. Bloomsbury Press.

Pouncey, C. L., & Lukens, J. M. (2010). Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry. Theoretical medicine and bioethics, 31(1), 93–105.

Pridmore, S. (2000). The psychiatric interview: A Guide to History Taking and the Mental State Examination. Harwood Academic Publishers.

Priebe, S., Dimic, S., Wildgrube, C., Jankovic, J., Cushing, A., & McCabe, R. (2011). Good communication in psychiatry–a conceptual review. European Psychiatry, 26(7), 403–407.

Pyrcak, M. (2010). Opinie sądowo-psychiatryczne przy orzekaniu środka zabezpieczającego z art. 94 k.k. – analiza pod względem formalnym. Internetowy Przegląd Prawniczy TBSP UJ, 1(4), 65–74.

Resnick, P. J., & Soliman, S. (2011). Draftsmanship. In A. Buchanan, & M. A. Norko (Eds.), The Psychiatric Report: Principles and Practice of Forensic Writing (pp. 81–92). Cambridge University Press.

Riedl, D., & Schüßler, G. (2017). The influence of doctor-patient communication on health outcomes: a systematic review. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 63(2), 131–150.

Ruzikowska, A., Tarczyńska, K., & Walaczyna-Leśko, A. (2009). Internacja – i co dalej? Postępy Psychiatrii i Neurologii, 18(3), 307–310.

Searle, J. R. (1969). Speech Acts. Cambridge University Press.

Silva, J. A., Weinstock, R., & Leong, G. B. (2003). Forensic psychiatric report writing. In R. Rosner (Ed.), Principles and practice of forensic psychiatry (2nd ed., pp. 31–36). Arnold.

Stanghellini, G. (2007). The grammar of the psychiatric interview. Psychopathology, 40(2), 69–74.

Stivers, T., Heritage, J., Barnes, R. K., McCabe, R., Thompson, L., & Toerien, M. (2018). Treatment Recommendations as Actions. Health Communication, 17, 1–10.

Stone, A.A. (1984). The ethical boundaries of forensic psychiatry: a view from the ivory tower. The Bulletin of American Academy of Psychiatry and the Law, 12, 209–19.

Sullivan, H.S. (1970). MD The Psychiatric Interview. W. W. Norton.

Titscher, S., Meyer, M., Wodak, R., & Vetter, E. (2000). Methods of text and discourse analysis. Sage.

Van Leeuwen, T., & Wodak, R. (1999). Legitimizing immigration control: A discourse-historical analysis. Discourse Studies, 1(1),83–118.

Verschueren, J. (1980). On speech act verbs. John Benjamins Publishing.

Völlm, B. A., Clarke, M., Herrando, V. T., Seppänen, A. O., Gosek, P., Heitzman, J., & Bulten, E. (2018). European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders. European Psychiatry, 51, 58–73

Wettstein, R. M. (2010). Commentary: Conceptualizing the forensic psychiatry report. The Journal of the American Academy of Psychiatry and the Law, 38(1), 46–48.

Wierzbicka, A. (1987). English speech act verbs: A semantic dictionary. Academic Press.

Ziółkowska, J. (2009). Doświadczenie choroby a kryteria diagnostyczne. Analiza dyskursu wywiadów psychiatrycznych z pacjentami ze wstępnymi diagnozami zaburzeń depresyjnych. Unpublished PhD thesis, Szkoła Wyższa Psychologii Społecznej, Wydział Zamiejscowy we Wrocławiu.




How to Cite

Galasiński, D., & Ziółkowska, J. (2022). Managing the communication channel. Discursive representations of clinical communication in forensic psychiatric reports: Array. Qualitative Health Communication, 1(1), 134–150.