Clinicians In the Dual Role: Navigating the Demands of Therapeutic Support and Legal Advocacy

Clinicians providing both mental health services and completing a forensic evaluation for an individual seeking asylum can face the notable challenges of a dual relationship, which can be both problematic and highly discouraged (Mercado et al., 2022; Paul & Wortzel, 2015). Though legal advocates and clinicians approach dual role complications differently, limited data are available on these differences. This qualitative study explores differing perspectives of each profession regarding the dual role in immigration legal processes.

Focus groups and interviews with immigration lawyers (n=22) and forensic mental health evaluators (n=19) were held in 2025 and 2026 to explore the role, value and best practices of clinicians in immigration court. Convenience and snowball sampling strategies were utilized, with recruitment taking place via email. Transcribed data was analyzed using inductive thematic analysis methods (Braun & Clarke, 2006). Research team members reviewed transcripts and discussed, resolved discrepancies for, and finalized emergent themes.

Themes identified distinct approaches between clinicians and attorneys regarding mental health expertise in the dual role. For attorneys, the central theme was Relationship over Objectivity. Attorneys found the reports and testimony from clinicians with an ongoing treating relationship to their immigrant client to “hold more water” for judges than the insights of one-off forensic evaluators, who met with their client twice to formulate a declaration producing what they felt was just “boilerplate” language rather than professional insight tailored to their client’s history of persecution, which could offer insight into client longer-term mental health trajectories and demonstrate evidence of client proactivity in treatment.

However, themes from clinicians of 1. Undermining Professional Credibility and 2. Ethical Understanding for Authentic Evaluation, highlighted division in their dual role perspectives. Some clinicians, such as doctors, psychiatrists and psychologists rejected any consideration of a dual role and articulated how it undermined perceptions of professionalism, ethical expectations, and objectivity, “I'm not a therapist, right, I'm an evaluator, this is my role”. Clinicians from social work, counseling, and other similar professions were more comfortable entertaining dual roles, “I think that with enough integrity and self-awareness, hopefully you can maintain an objectivity that feels ethical,” highlighting the strength of insight that comes with longer client relationships, and sometimes framed it as more ethical to provide evaluations after deeper understanding of client’s symptoms, story, and circumstances; providing professional evaluations necessitated having "the full picture of the client's psychological challenges” and an “expert look into that person” that only emerged in an ongoing relationship.

These findings underscore the drastically divergent values of the legal and mental health professions, and highlight the different professions’ focus on function (effective evidence that produces the intended outcome) versus process (whether dual role obligations muddy the objectivity and credibility of clinicians). The schism between various professions dis/comfort with the dual role also invites the necessity of future research, to assess how professional vantage points toward individual ailments versus whole-person approaches can shape ethical practice in this area of vital mental health advocacy.