  Dr. L evaluates sex offenders for the state. They are convicted rapists, sadists, pedophiles, exhibitionists and voyeurs, some reformed, some still dangerous. In the court room, Dr. L’s professional opinion of their likelihood to re-offend can put them in a hospital or free them back into society. We had initially planned to photograph Dr. L at work. But getting access to the prisons and courts where she spends most of her work time turned out to be a hard ask. So, we met at the library instead. We walked around and took photos of Dr. L and then sat down at a local cafe, drank tea, and talked. I won’t describe Dr. L physically and we did not photograph her face. Dr. L works with a population that is in many cases dangerous and she has previously been assaulted by a patient. This is our conversation, edited for flow and clarity. Where are you from and how did you become interested in psychology? I was born and raised in [a former USSR republic]. I remember that from around the age of 12 I wanted to leave to another country. I don’t know why – I wasn’t sure if it was going to be America, Israel, France, England. It was around the time that I also had the realization you could leave USSR – some of my family members were leaving. I didn’t make any concrete plans at that age - I went on with my education, finishing college. How do you make a child read when they’re a teenager? You tell them a book is forbidden by the government. My father was at a flea market in a small town one day and picked up a book by Sigmund Freud. He told me it had previously been forbidden in the Soviet Union, so I was very curious. I remember that it was a combination of different works by Freud including Little Hans, a case study about a 5-year-old boy with a phobia of horses. I fell in love with this book. It was at that same age that I was making decisions about what to do next and what to study. At the time, my understanding of what I read was enough to comprehend the concept of psychoanalysis and how some of the things we do and think are dictated by our subconscious and our ego. So, I applied and was accepted to college and then Graduate school, where I studied psychology. After graduation, I realized that there were not many options in the USSR for making a living as a Psychologist – probably your best one was to marry rich. There were only a few practicing psychologists– mostly the ones who had been wealthy enough to study abroad. It wasn’t like it is here now, where you Google "psychoanalysts" and see if they have a spot to see you tomorrow. It was a dangerous and difficult time in USSR. People struggled with money. Most of my friends didn’t have the opportunity to work in the field they had studied, even the brightest most talented ones. I left my country. It was 1998 when I came to the US as a student. Coincidentally, a guy that I was in love with was coming here too. We made an agreement that if we were both able to move here, we would get married; so, we did. It was not a good marriage. He was not a good person. He was misogynistic and narcissistic. Eventually I left him and re-married years later. Do you think this experience had any bearing on your decision to pursue forensic psychology and specifically your choice to work with the types of people you work with? No - I don't. I don’t think that this had any bearing on the type of psychology I am focusing on now. But what I will say is that negative experiences in the past have made me the person I am today. Every one of us goes through certain difficulties in life. It was a long time after all that happened that I made the move towards forensic work. So, how was it that you started doing forensic work? My first degree was in clinical psychology – I did not know anybody that did forensic work at the time and I found it fascinating. I found it interesting. I was watching all those criminal shows and reading books about the FBI. But it all existed somewhere on another planet. At the time I was working in a hospital, seeing patients, I was looking for a new job and I saw that there was an advert – they needed people to evaluate sex offenders, to go into prisons, testify in court. I thought I’d go and see what it was all about, I didn’t think they’d be interested in hiring me because I didn’t have any experience in this type of work but thought I wouldn’t be losing anything by going – it was exciting. Why do you think they hired you? There were not many people who had specific experience in the field. They would take a clinician who had a license and a doctorate degree and teach them how to do the job and give them opportunities to grow in this field. I went for the interview and thought it was amazing – I really liked the people who interviewed me. I asked them questions about the job and thought it was really cool. I remember that after the interview, I had a 4 hour drive back home and spent the drive thinking “This is so so amazing - I want them to choose me! I wish I could have been better! Damn... they probably won’t choose me”. It was a few months before I heard back from them and although I didn’t know it at the time it was just because the budget wasn’t approved. They said “Hey, we’d like to offer you the job”. It was a total shock to me. I was so excited – I got this huge rush of blood to my face. I called my husband – “oh my God, oh my God, oh my God, you HAVE NO idea what just happened!" He was really supportive. How did your wider circle react to you getting this position? My parents were supportive in the sense that they wanted me to succeed. But they mostly didn't and still don’t understand what I do. Psychology in my country has a very different reputation – not a very positive one. My mother thinks it’s something close to shamanism. People don’t want to talk about sex crimes. It makes people uncomfortable. Some of my friends who are attorneys or doctors understand more and express some respect for it but I don't think that even they fully grasp it. You talked a little bit about watching those shows that we all watch – Law & Order SVU, Criminal Minds...how does your work compare to what we see on TV? On TV shows it looks much more glamorous and much fairer than the real process is. I don’t remember who said it, but there is a great quote by – I think it was Mark Twain. He said that a lie or a fiction has to have certain bounds because it needs to seem believable. Truth has no bounds because it can be less believable than fiction. (The actual quote is “Truth is stranger than fiction, but it is because Fiction is obliged to stick to possibilities; Truth isn't.”) The real stories are much more gruesome and much sadder than in the movies. And besides, movies show impossible situations where the good guys always win. The truth is always far more complicated. So, going back to when you first started, how were you trained for the work? I was already a fairly seasoned clinician when I started, so I knew about these types of diagnoses. I’d already worked with patients who had committed these type of offences- both sexual and non-sexual. It wasn’t completely new. I’d also worked with people with severe mental illness. But in terms of training for the specific job - I had to read a ton of articles, watch other people testify in court, read a lot of their reports, participate in case discussions to get an idea of how the process goes and how to evaluate patients and draw conclusions. Do you remember your first court testimony and how it went? I’ve had many court testimonies. Some went well, some didn’t. I am always anxious when there’s a jury sitting in the court room – I have to think about a lot of different things, like trying to explain my point of view in the normal language, without psychobabble, and in a way, that will help them see where I’m coming from, at least theoretically. I also need to appear in a way that doesn’t scare the jury and allows them to find me credible. For example, I tend to clench by jaw when I am cold, which makes me appear angry even though I am not. These are the types of things I just don’t think about when I'm sitting in my office writing reports. I also have had to develop an understanding of where the judge is coming from, or really consideration for the fact that they might be sitting in the court room all day long hearing a lot of cases – I need to be cognizant of all of those elements when I’m testifying. Before you testify, if we go back to the evaluations you do, is there a data led framework you follow? Is it a science or is there an element of interpretation and art to it? We try to take out subjectivity as much as possible– our evaluation of a person has to be based on science. I have to be up to date on the latest research. I then base my evaluation on what the research points to. We are dealing with peoples’ lives, so we have a responsibility to be very thoughtful. There are cases when my interview with a person can be very unpleasant, I can feel annoyed, I can feel frustrated. I might think that the person I’m interviewing is not a nice person. But I have to remember that that doesn’t necessarily make them likely to re-offend – I have to take myself and my feelings out of the equation. Likewise, sometimes an individual is very nice during a casual interaction, and I start to imagine them being a nice neighbor, a good dad or husband, but again- this means very little – it’s not about my subjective experience of a person, it’s about what the science says about them. Are there cases that aren’t so well understood in the literature, where you have very little data to go off? What do you do if you're looking at something largely unknown? I have to consult my colleagues. Thankfully I’m not alone, there’s a whole department of smart and experienced people working with me. One example I can think of is when a colleague had to evaluate a female sex offender. The research is mostly based on men, so it is not necessarily applicable to the population of women. We do our best to extrapolate scientific data but, in the end, you have to tell the judge – “there is not much data here.” And, in the end it’s not my decision – it’s that of the court. About female sex offenders- why do you think there isn’t a lot of research or data out there on female sex offenders? There are probably many explanations as to why we don’t see as many female sex offenders. The first might be the fact that crimes go unreported. Thinking about my cultural background, in my culture it would be stigmatizing for a male to report that he has been assaulted sexually by a woman. For example, recently, I was speaking to a colleague in my home country and described a prominent case in the US where a teacher had sexually exploited a student who was 13 or 14 years old. My colleague’s reaction was “What’s there to report? You’d brag about an encounter like that”. Thankfully, at least in the United States, this attitude is changing – but this is definitely still a prominent mentality and a way of thinking. Another reason might be that there are certain disorders that are just rarely recorded in females, say pedophilia or sadism, also exhibitionism or voyeurism. Some disorders are more common among females some are less common. And of course, underlying both of the above is the fact that we might not even have the accurate data on female sex offenders due to social reasons. Since we're talking about women, how has your job changed in light of the “Me Too” movement? It hasn’t really affected my work yet. Maybe people will start reporting sexual offences more often, then perhaps we will have a larger population to work with. 20 years ago, this work wasn’t really being done to the same extent it’s being done now. I like it when judges ask questions, – it makes me very hopeful. Perhaps that will happen more often now. But really, I think the “Me Too” movement may affect people in different ways. Some people have certainly become more aware and more sensitive – they have started to consider their actions more. On the other hand, other people have probably become more dismissive, particularly with certain types of incidents. I’m sure this must influence the jury too – because they may start questioning the credibility of a witness, who is making a complaint about something that happened years ago. What do you think the future has in store for your profession? I hope that psychology as a whole will become a more respected field in the next 10 years – there’s a lot of research and talk now about how emotional experiences change people's health, lives, their disease outcomes. There is a recognition now that psychological treatment can really help change things for the better. At a broader level -it also depends on politics, I guess. If insurance stops reimbursing for some services – those services will become less accessible to people. And in terms of forensic psychology specifically– I think if correctly applied, science can help predict better outcomes. If you think about forensic psychology 50 years ago and forensic psychology now – our evaluations now are based on large amounts of empirical data. When I testify and when I read my colleague's reports– I see assessments based on proven facts rather than speculation. That’s how you can tell the quality of someone’s work. How do you take care of your own mental health when you’re seeing so much darkness on a day to day basis? I do step away from this when I can, but I wish I could step away from it more. For example, this weekend I have to work because I testify on Monday. I spend time with my family and with my friends - they are NOT involved in this line of work. They remind me of life outside this. I also do sometimes accept non-forensic patients for psycho-therapy – and that gives me a better sense of reality, it makes me feel that I can help people. And of course, spending time with my child helps return me to the normal world. Of course, there have also been cases that were particularly difficult for me to work on because of how gruesome they have been or because crimes were committed against a child who is the exact same age and gender as my child. I try to move away from this and take my mind out of this situation – meditation or working out help. I am usually able to separate my personal life from my work. What would you tell somebody who’s entering this field now? I would tell them the truth (unless they’ve already invested in their education….!). It’s emotionally draining work. It’s difficult to see progress- or if you see it, it’s tiny progress over months and years. That’s the sad truth about it. It also changes you, it makes you much more sensitive. But it makes you a better parent if you have kids, a better partner/spouse if you have a family. It also helps you recognize what the people in your life are about. When will you stop doing what you’re doing? When I stop believing that the legal process has any fairness to it. I don’t see myself ever retiring, ideally in my older age I’d just work fewer hours – take fewer referrals. I don’t see myself ever stopping. I like what I do. I do sporadically participate in different research-based projects. I’m writing a book chapter with a friend and a colleague, I teach – I forgot to mention that. I teach 2 classes once a week – one focuses on neuro-psychology, another of psychopathology – what mental illness looks like – how to diagnose it and how to treat it. I guess, I'll never stop. 
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