High Road ABA: Clinical Data Discussion

Discussion of Twelve Clinical Data Points in the High Road Single-Case ABA Data

C.A. Childress, Psy.D. (2019)

Parent-Child Relationship Rating Scale (PC-RRS)

Affection (Aff):  Attachment networks – blue line

Cooperation (Co):  Emotional regulation – gold line

Social Involvement (SI):  Arousal and mood regulation – silver line

Slide1

High Road Workshop Data

The PC-RSS data from the two-days of the High Road workshop represent a truly remarkable rocket into a joyful, healthy, and happy child by the end of the 2-day workshop.  The exit level data points are in the superior range.  The child’s affection is 5.5, his emotional system is 6, and his mood is 6.   He is immensely happy.

Of note is that this is a 2-day High Road workshop.  Typically, Ms. Pruter’s High Road recovery workshops are 4-days.  The actual recovery of the parent-child bond typically occurs sometime during the second day of the workshop, and then there are two additional days of recovery stabilization, structured through the workshop protocol, that takes place following the recovery of the parent-child bond of love and affection. 

The data from the workshop reflects a typical half-way point of the workshop; the recovery point.  Based on the data from the High Road workshop, the recovery of healthy child development occurs in the context of a very happy child.  Affection and attachment bonding networks are glowing wonderfully warm and positive, emotional systems are happy and alive, and mood is wonderful. The child is relaxed and happy during the recovery of healthy authenticity.  This data provides a remarkable insight into the recovery process from complex trauma.  Seeking additional information from Ms. Pruter about this recovery process and how she accomplishes such relaxed joy in the child is recommended.

In the interpretation of the follow-up clinical care data for this initial ABA with the High Road protocol, it is important to note that the typical High Road workshop is an integrated intervention of 4-days, and the protocol is structured for a 4-day recovery.  The additional two days of the High Road recovery workshop are important.  That Ms. Pruter conducted the recovery in two-days was a feature of her response to trauma and the needs of the case for immediate response when the child became available for her workshop.

The child’s supremely relaxed happiness reflected in the day-2 recovery data from the High Road workshop is a product of the workshop, it is not the actual set points of the child’s regulation systems.  They might become his set points if the child spent enough time with Ms. Pruter, but two days is not likely to alter the regulation set points of his nervous system created by three-years of continual psychological child abuse by his pathologically narcissistic father. Once the workshop is over, the child will (if recovered) return to his established neurological set points for these three regulatory systems (attachment; emotions; arousal-mood).

If the child’s ratings on the PC-RRS from the workshop are merely a product of the workshop, then the child’s functioning will collapse into disorganization and chaos once the recovery workshop ends.  The initial data into the clinical care period reflects the stable set-points for the three regulatory networks (attachment systems, emotional systems, arousal-mood systems).   She recovered the child’s authenticity.

(1)  Set-Point for Social Involvement

It is reasonable to expect a drop in functioning evidenced on the PC-RRS data from the end of the HR workshop to entry into my clinical care a week and a half later as a natural function of his return to his established regulatory set-points, and this expected drop to set-points is reflected in the data.  The entry points into my clinical care reflect the set-points for these three regulatory systems of the brain: attachment systems (Aff-3), emotional systems (Co-4), and arousal-mood systems (SI-6). 

Of first note is the separation of the SI system from the other two.  The SI (arousal-mood) system is two points higher than the next regulatory system, and is in the upper-range of regulation – a 6.  This suggests anxiety, and likely sustained anxiety/stress, that has elevated the set-point for this regulatory system.  The elevated set point also suggests that the child may use better-than-average social skills as an avenue for acquiring nurture, and as a vehicle for anxiety regulation.

A 6 set-point for SI regulation is too high.  The child’s nervous system is in a chronic up-regulated state from the years of trauma exposure.  The down regulatory systems of the brain are the sadness emotional networks.  The 6 set-point of SI suggests inadequate counter-regulation from the down-regulatory systems of sadness.  The child has unprocessed sadness.  Sadness is metabolized through the attachment networks.  The next clinical focus becomes the attachment system.

(2)  Set-Point for Attachment

The set-point for the attachment networks upon entry into follow-up clinical care is 3.  This is in the normal-range, but the Aff ratings also took the largest drop from the second day of High Road recovery to the stabilization.   This may reflect the absence of the final two days of the workshop protocol.  I have reviewed the protocol, and I understand how it achieves its effectiveness.  The final two days are important regulatory stabilization days for the newly activated attachment networks.  The 3 as a set-point for the attachment networks likely reflects the absence of the final two days of the workshop. 

The entry set-points into follow-up recovery care represent the half-way set-points in these regulatory systems achieved by the High Road workshop, a snap-shot of the regulatory networks set-points at the time recovery of authenticity occurs.  Of note in this regard is the higher regulatory set-point for emotional regulation systems (Co:4) than attachment systems (Aff:3).  I have some hypotheses as to why this set-point configuration would occur at the mid-way point of the workshop. 

Notice in the workshop data how Co (emotional networks) aligns with SI (the anxiety of trauma), in the context of a meteoric rise in affectionate bonding (Aff; attachment networks), I would offer the suggestion that during the recovery process the emotional systems lay on the trauma networks, and the trauma networks receive the elevated glow of attachment bonding (love) from the attachment networks of the child’s brain.  It is my professional opinion that we are watching the extraction of complex trauma – not healing – extraction of damage to the neurological networks of the brain.

In healthy child structures, the set-point for attachment networks (Aff) is above the set-point for the protest behavior (Co), and the two systems are entrained.  In the entry data into clinical care, the set-point hierarchy is inverted, and the two systems are not entrained.  Based on the speed by which clinical intervention achieved both a reversal of attachment and emotional set-points and entrainment of the two systems, it is likely that this early disruption represents the missing two final days of the High Road workshop. 

Additional entry data from clinical care following the full 4-day recovery workshop would be extremely helpful in interpreting this 2-day workshop data.  The recovery of attachment bonding with the full 4-day workshop protocol is anticipated to be more robust.

(3)  Co-2 Tiffy with Sad

My active clinical intervention does not begin until data point (5).  At the first Co drop to 2, I had not applied any clinical interventions of note.  In my first session I had done some stabilization, but it was mostly entry work.  My second session was with the mother (that released the ratings from their High Road stabilization). 

One interpretation of entry level stability is that both mother and child were afraid to do anything.  The recovery was great and they didn’t want to do anything to mess it up (reflecting the missing two days of the High Road workshop that are designed to address this “deer-in-the-headlights” experience).  Once I became involved as a support to mother, she became more comfortable with the recovery, and as she became relaxed the child became relaxed, and this is reflected in the release of ratings.  Everybody relaxed.

Follow the Co line once my intervention releases the ratings from their High Road stability.  Notice the drop to the Co-2, with a simultaneous drop in Aff to 3 and SI to 4.   The drop in Co represents a protest behavior display, something hurt, or there is a growth occurring.  The drop in Aff along with the drop in SI indicates sadness (down regulation of SI and lowered affectional warmth; the child is sad).  The drop is to a 2 (not a 1), so it’s a tiff of protest behavior rather than a fight of conflict.

This Co-2 drop occurred three days before my next session with the mother and child, and the first active session of my therapy.  Given the history of conflict in this relationship, a drop to 2 in Co is of note for recovery stability.  I had not yet had time to become an active stabilizing agent for the relationship, I had unlocked the stability of Dorcy’s recovery, and Dorcy only had 2-days of her workshop protocol rather than the structured and standard 4-day recovery protocol.   The mother-child bond may be fragile, and a Co-2 may collapse the recovery achieved by the 2-day workshop.  I took no direct steps, but I monitored the following day’s ratings to see if my active intervention was required.

The next day, the Co rose two points, to 4.  They had resolved their interaction without the need for my intervention.  Attachment bonding remained stable at its set-point of 3, and SI took a 2-point hop to its set-point of 6, indicating the absence of sadness.  The Co-2 tiffy with sad had been fully and successfully resolved.  We discussed the incident in session and it involved miscommunication and he became frustrated (and used inappropriate language).  A normal-range parent-child conflict, resolved entirely normally.  We developed communication and problems solving skills in our session.

This data point, Co-2 tiffy with sad, represents an important data point in the High Road ABA recovery profile.  It is the data point that indicates the degree of stability to the recovery achieved by the High Road workshop.  It is entirely stable.

(4)  Dyssynchrony

Before leaving the High Road stabilization phase of the data to enter my clinical care sessions, the variability in the three systems is notable.  The attachment system does not vary with the other two, and there is seeming synchrony of the emotional networks (Co) with the trauma impact (SI; arousal-anxiety), which is not the desired synchrony.  The nervous system of the child his healthy, but it is not yet organized. 

The focus of my first therapy session was to impact the stability of the attachment recovery.  I hoped to raise the set-point on attachment networks to 4 (with rises into 5), I wanted to reverse the set-points for Aff and Co (attachment higher than protest), and I wanted to entrain the emotional system (protest behavior; Co) with the attachment networks (Aff).  My intervention in session 1 was on the attachment networks as the ground to organizing the regulatory systems.

(5)  Session 1: 7-Spike SI

My first therapy session is indicated by the spike in SI to 7, the arousal system became very active with the material from my first session.  Note also the rise in Aff to 4 and the 4-point rise in Co (loss of protest, increased emotional flexibility and cooperation).  He liked my session.  The rise in Aff and spiking of SI (arousal-mood) suggest he was happy, and the 4-point rise in Co indicates he was relaxed.  He liked my first session.

On the following day, Aff continued to rise to 5, SI continued to spike at 7, and Co dropped one point on rebound to 5.  He continues to be happy and relaxed, and attachment bonding is increased from my session.

(6)  Consolidation V

Two days after my session, his nervous systems consolidate the gains from the intervention, with a rebound (bounce-back) of Aff to 4, Co to 3, and SI to 5.  A nice tight synchrony of all three regulatory systems is evidenced, and in a healthy order of set-points, attachment (Aff-4) above protest (Co-3).  This V shape of three systems represents the consolidation of the therapy intervention from two days previously.  Consolidation occurs on the down-regulatory networks.  Then watch what happens.

(7)  Integration Triad

The following day, three days after the therapy session, all three regulatory networks converge on a 5 rating, high-normal.  This is an integration of the therapy intervention from three days ago.  Integration occurs on the up-regulatory networks.  The consolidation V to the integration triad is magnificent.  Then watch what happens.

(8)  Synchrony: Attachment and Protest

Once the three lines converge in integration, where did the blue line go?  Attachment (Aff) and emotional regulation (Co) are perfectly synchronized for the next four days, even on a one day bounce they remain synchronized.  The correlation of the Aff and Co ratings before the three-line integration point is r=.60, following the three-line integration point the correlation of Aff and Co is r=.94.  The two systems achieved synchrony at that three-line integration following the three-line V consolidation, and remained in complete synchrony until the intervention of my second session.

(9)  Set-Point Stability

I had introduced organizing disruption followed by consolidation and integration by the intervention of my first session, and the regulatory systems stabilized into new set-points following their consolidation and integration from the therapy intervention.  The new stabilization set-point for SI across 3 days was 5, one point lower than it’s entry at 6, and now in the normal-range.  The new stabilization set-points for Aff and Co combined appear to be in the 4-5 range, a 1-point increase for attachment regulation from the entry levels.  All three regulatory systems are within one point or less of each other.

(10)  Session 2:  Something to Consider

The stability of synchrony achieved between Aff and Co at the integration point continues for five days following the integration, with my interventions in session 2 becoming the disruptive agent.  Session 2 of my therapy produced another immediate spike to 7 in SI, his arousal level was high.

Aff dropped by one point, and Co dropped by two, breaking their synchrony, with Aff settling on a set-point (3) one point higher than Co which dropped in the Co-2 range of “protest behavior.”  I had given him something to ponder, not verbally, but in the process of our session, as I wove our session I gave him an issue to consider.  

You can see the impact.  His stress level went up (SI-7), his emotions became more inflexible, he’s processing something (Co-2), and he didn’t like what he was processing (drop in Aff).  What happened?

He figured it out.  The next day was a 3-point rise in Aff, to a 6.  The last time there was a 6 in Aff was the three-line integration.  Now, again, Aff and Co rejoin in synchrony at 6.  The only missing component of a three-system integration is that arousal-mood is too high at 7.  He’s too happy about what he figured out.  That makes me smile.

Notice the nice V drop of entrainment in this “considering” episode, between the attachment system and emotional system (protest behavior system).  We want protest contained within the attachment networks.  Co-2 drops represent minor breach-and-repair sequences of self-individuation in a social context.  The issue is not minor disagreements, it’s how we handle them.  If we bring problematic things to the breach, the minor breach can turn into a major one.

Occasional Co-2 drops are healthy individuation, especially in an adolescent-age child.  But we want protest behavior contained within the context of healthy attachment bonds.  We want the set point for Aff to be higher than for Co, we want them entrained, and we want Aff to always remain in the normal-range or above (3-5, with occasional elevations into 6 and 7). 

The entrainment Vs of Aff and Co at data points (6), (10), and (12) all reflect the desired Aff over Co organizational structure (protest behavior guided by and within the context of attachment), with Aff remaining 3 or above (normal and healthy attachment bonding), and no Co-1 (no severely painful breach for the child).

(11)  Two-Day 7-Spikes

I find those two-day 7-spikes in SI from my sessions interesting.  On the first session they reflect the child’s happiness and relaxation as Aff moves up consistently and Co spikes to 7 and only drops one point to a 6 the following days  He felt much more relaxed following my first session of active intervention.  The second day of the SI-7 means he continued to be very social with his mother, likely his gregariousness was because he was just a relaxed and happy guy.  He’s a great guy.

The second session 7-spikes on the SI scale are different.  The first one is an increase in arousal (stress) because of the – thing – I gave him to consider in our session.  You can see his Aff drops one and his Co drops two.  He’s not happy about that thing I gave him to consider.  He’s pondering it, that’s the arousal SI-7.  It’s troubling him, that’s the drop in Aff and Co.

He figured it out.  The next day, that bounce up for Aff of 3 points and Co 4 points is his figuring it out.   That’s an impressive impact.  He’s happy and relaxed.  Good for him that he’s figuring things out.

The 7-spike in SI on the day following our session is because he’s happy again.  The SI scale measures social involvement. He was socializing a lot with his mom.  On the day of our therapy, it was his way of managing anxiety and inner stress – that’s his coping style – he has a high-set point for social regulation.  So he regulated the stress of day 1 with a 7-spike in SI.  Day 2, his Aff took a leap.  He is so happy.  His Co takes an even bigger leap. He’s relaxed.  They both merge spot on at 5.  He figured it out.  Now, the day-2 7-spike in SI is happiness.

(12)  Whew

Boy, that session 2 stuff took a lot of processing across a lot of systems.  He’s recovering his stability.  There’s a down-regulation consolidation of all three systems, a release of 2 points for SI, 2 points for Aff, and 3 points for Co (he’s pooped), into a three-system consolidation V.  Look how synchronous those systems are.  That is a clean nervous system. 

Notice the consolidation V is identical to data point (6), with SI on top, one point higher than Aff, which is one point higher than Co, identical to the consolidation V of data point (6).

This is interesting.  At the consolidation V, Aff remained stable at 3, and so did the entrained Co, while SI completed the bounce back of the consolidation V, then Aff and Co completed their bounce back the following day, back into integrated entrainment at 5 (high-normal).  That is some hefty consolidation.  Two days of Aff-4 and Co-3 synchronized consolidation before an integration at 5.  Session 2 gave him some stuff to think about.  Whew.

His exit set points leaving this series are: Aff 4-5, Co 3-4, SI 5-6.  An entirely healthy and normal-range set of regulatory networks

Conclusion from the Clinical Data Set

The High Road workshop of Dorcy Pruter achieved a remarkable – truly breathtaking – recovery of healthy and normal-range functioning of a wonderful child, in two days, following three years of documented child abuse.  The recovery from complex trauma and child abuse is full, it is strong, and robust.  She handed into my clinical care, a totally normal-range and wonderful young man.  As a clinical psychologist, I am in deep respect for what Ms. Pruter accomplishes on a regular basis. 

And if there is any question about how the kids feel about the High Road workshop, for my client it was Aff-5.5, Co-6, SI-6.  He loved it.

I’ll bet he did.  Because as far as I can tell, the High Road protocol, administered in two days by Dorcy Pruter, achieved a full recovery of the child’s healthy and normal-range development.  I’ll bet that did feel pretty good.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

 

 

 

 

Flying Monkeys

My client is at risk.

My child is at risk from a group of people who seek to disrupt and damage the recovery of children from complex trauma and child abuse that are achieved by Dorcy Pruter. My client’s recovery is at risk from these people.  We have taken to calling this symptom feature of the pathology, the allies who seek to facilitate the enactment of narcissistic child abuse, “flying monkeys”, after the popular culture label for these people:

Wikipedia: Flying monkeys (psychology)

“Flying monkeys is a phrase used in popular psychology mainly in the context of narcissistic abuse. They are people who act on behalf of a narcissist to a third party, usually for an abusive purpose.”

Urban Dictionary: Flying monkey

“In popular psychology, a flying monkey is someone who does the narcissist’s bidding to inflict additional torment to the narcissist’s victim.”

This is a symptom feature of narcissistic abuse pathology – people are a symptom of pathology.  That, is pretty amazing for a pathology.  No other pathology except this – attachment trauma pathology of pathological narcissism – has other people as a symptom of the pathology. 

I find that remarkable.  People are a symptom of pathology.  They don’t know it.  It is an irrational delusional belief involving the splitting pathology of trauma (demonization).  The allegations made are hyperbolic extremes, alleging Dorcy Pruter specifically, and anyone associated with her, are “abusive” of children – and that society needs to be “protected” from Dorcy Pruter and anyone associated with her.

They are delusional.  And they are malignant, savage, and evil people – the absence of the capacity for empathy; they are narcissistically self-absorbed without the capacity for social connection. 

They have no concern for, or ability for, rational discussion, they are driven by irrational delusions of supposed threat that only they see, in which they demonize the target (Dorcy Pruter in this specific case) and then they engage is a focused campaign of vile smears, slander, and an intentional effort to damage and disrupt the work of Ms. Pruter, including breaking the identity of her recovered children, seeking to ally with the abusive parent in the return of the child’s hostile rejection of the other parent again.

At its upper extremes, the “flying monkey” symptom of narcissistic abuse pathology reaches the level of “gang-stalking”

Urban Dictionary: Gang Stalking

“Gang stalking is organized harassment at it’s best. It is the targeting of an individual for revenge, jealousy, sport, or to keep them quiet, etc.  It’s organized, widespread, and growing.  Some describe this form of harassment as, “A psychological attack that can completely destroy a persons life, while leaving little or no evidence to incriminate the perpetrators.”

I have had clinical treatment experience with this “gang-stalking” symptom feature of malignant narcissism.  It is extremely disturbing.  APA, you must get over here to look at this pathology; narcissistic child abuse and trauma.  That is the pathology I am asking you to look at… specifically.

This – social distribution – symptom feature of the pathology arises because this is an attachment trauma pathology.  It spreads from brain to brain through inhabiting specific networks created by abuse and victimization.  The damage caused to the attachment networks seeks, it is a motivational system, it seeks and locates the false trauma reenactment narrative of the narcissistic child abuse, and the brains of trauma join the trauma reenactment for the vicarious resolution of their own childhood trauma.

The “flying monkey” people are vicariously working through their own childhood trauma (and narcissistic pathology of inadequacy; the grandiosity of their “savior” role), by adopting the self-assigned role as “savior” and “protector” of children, they then demonize their target (the person seeking to end the narcissistic abuse), and they begin a relentless campaign of malignant smear, abuse, and hyperbolic slander against the targeted person (or racial/ethnic groups in other variants of the trauma pathogen; demonization).

Dorcy Pruter and Dr. Childress are both targets of this vicious, slanderous, and malignant campaign by a group of people seeking to destroy both of our professional careers in slander and lies.  The goal of the “flying monkey” people is to prevent our ability to end narcissistic child abuse, and narcissistic spousal abuse.

They don’t realize this.  They live in a delusional world of self-construction in which they have self-appointed themselves as “Saviors of children” and “Protectors of children,” and from the delusional grandiosity of their narcissistic pathology they feel entitled by their grandiose self-anointment (they are anointing themselves) as the “Savior” and annointed “protector of children” – to then engage in their vile campaign of assault, lies, and slander against their targeted victim.

They are blind to their vile malignancy by the delusion of their self-annointment as the “Savior of children.”  In Nazi Germany, the blindess of the malignancy is evident in the “savior” of the Arian race justification.  Abuse justified by the “savior” of a cause.  Racist nationalism. 

These are variants on an underlying structure of a trauma pathogen in the attachment networks – the pattern is abuse justified by a “savior” role.  In the case of the flying monkeys, it’s the abuse, lies, and slander toward Dorcy Pruter (and by extension, Dr. Childress) justified by their self-anointed role as the “Savior of children.” 

One example of this is Dr. Mercer and her blog.  A self-anointed savior of children.  She is not a clinical psychologist.  Never has been.  No training in assessment, diagnosis, or treatment of any pathology.  Yet she opines in the most irrational and vehement tones of “protection” about the assessment, diagnosis, and treatment of pathology – far-far beyond any boundaries of professional competence.  And she feels entitled do this because of her grandiose belief in her self-anointed role as a “Savior” of children.

Do you see the pattern.  Trauma is pattern.  Once you see pattern, you’ll be able to see trauma.

Dorcy has the identities of the most prominent current enactors of the most severe elements of the harassment.  Dorcy Pruter’s personal safety has been at risk for years from this symptom feature of narcissistic abuse.  This “flying monkey” symptom of extreme malignancy has attached to her as its focus for slander and abuse.  She has been, and continues to be, the recipient of lies, vicious slander, and abuse from this symptom feature of the pathology.

She has endured the vile malignancy of this narcissistic abuse for years, and has taken personal steps to protect her safety, she is in physical jeopardy for her safety  – that’s how severe this symptom feature is – her personal safety is at risk because she recovers children from the trauma of child abuse.  No professional should have to place themselves at such risk to recover children from child abuse and trauma.

APA, you must get over here to look at this pathology; narcissitic child abuse and trauma.

As a clinical psychologist, I love what the “flying monkey” symptom reveals about the nature and functioning of the attachment system and attachment trauma.  The symptom of the “flying monkeys” (people) surrounding narcissistic trauma and abuse has been a goldmine of professional-level knowledge about attachment and complex trauma that is created from, and creates, child abuse. 

My doctorate degree protects me somewhat.  Without a doctorate degree, Dorcy is more exposed to their lies and slanderous abuse.

I have been collecting documented evidence of this symptom feature of complex trauma and narcissistic abuse.  I’m a clinical psychologist.  The pathogen has never met a clinical psychologist like me before.  As we solve this pathology, I will be exposing the “flying monkey” symptom to professional psychology, and it will be addressed within the professional solution developed within professional psychology.

“Flying monkeys” exist – and they are targeting Dorcy Pruter and her work with their vile malignancy.

Breaking Treatment Identity

Of most clinical concern is that this group of people (the carriers of the “flying monkey” symptoms) believe from the grandiostity of their narcissistic entitlement that they are entitled by their narcissistic self-anointed roles as “Savior” and “Protector of children” to break identity coverage on Dorcy Pruter’s recoveries, and then begin an organized campaign to re-establish the child’s pathological rejection of the targeted parent.

Once they have broken the identify cover for her recovered child, they contact the allied narcissistic parent and work in tandem with this abusive parent to re-initiate the psychological abuse of the child, because these non-involved people have a delusional belief that they are “rescuing” the children from the “abuse” of Dorcy Pruter.

It is delusional.  I am a clinical psychologist.  It is a delusion.  They are working-through their own childhood trauma by their self-anointed vicarious trauma role as the “protector of children” in a splitting pathology of their own grandiose idealization of self-perception, and their demonization (splitting pathology) of their abuse victim – in this case, Dorcy Pruter.

Why they have targeted Dorcy Pruter specifically is a matter for professional speculation, I have my thoughts on the matter.  At this point, the “why” is not relevant, the symptom feature of “flying monkeys” (people) that surrounds pathological narcissistic abuse of its victim is documented and confirmed.

And the symptom feature of the “flying monkeys” surrounding narcissitic trauma and abuse, is placing my client-child at risk.

My Clinical Care of My Patient

The “flying monkey” symptom of narcissistic abuse will seek to break protective identify of my patient, and these people (the carriers of the “flying monkey” symptom of childhood trauma) will seek to destroy the treatment gains achieved by the High Road protocol and the follow-up therapy of Dr. Childress, simply because the recovery was achieved by Dorcy Pruter (the demonization of their “splitting” within their own pathological narcissism).

The risk they pose to my client is of such significance, that the potential intrusion of the “flying monkey” symptom of narcissistic abuse into my clinical care of my patient has been charted twice into the medical record for my patient care.

Once in treatment planning for the end of the protective separation period.  This represents a high-risk time for “flying monkey” intrusion into and disruption of recovery.  They may potentially seek to break protective identify cover for the patient child, and then will begin a coordinated campaign with the abusive father to re-initiate and reestablish the child’s pathological hatred for his mother created by the father’s psychological abuse of the child.

I have a bullet point on my treatment plan to address risk factors to my child’s recovery posed by the intrusion of people (“flying monkeys”) who have no involvement in the case, but who simply seek to harass Dorcy Pruter and destroy the recovery gains she achieves with the High Road protocol.

My second entry into the medical record of my patient surrounding the risk to treatment posed by the “flying monkey” symptom of pathological violence and abuse is surrounding the current release of data from patient care in association with the High Road recovery workshop data for my patient; the clinical data points on the PC-RRS for the single-case ABA of the High Road workshop. 

Highlighting my collaborative work with Dorcy Pruter and her recovery of the child from complex trauma and child abuse will potentially increase the risk to my client-child from the intrusion of non-involved people into my therapy and my child’s recovery in order to specifically damage and destroy the child’s recovery and treatment gains with his mother.

They will seek to return the child to the father’s abusive care, and they will seek to re-initiate and reestablish the child’s hostile rejection of his mother created by the psychological abuse of the father.  They will do this for no other reason than the child’s recovery from complex trauma and child abuse was achieved by Dorcy Pruter.

They have a delusional fixation (of erotomanic proportions) with Dorcy Pruter.  I have my interpretation as to why their fixation is with her.

My client is at risk from people unrelated to anything about the case, who are on a delusional “mission” to “protect children” –  grandiose self-proclaimed saviors of children – they are delusional.  This is a delusional pathology.   My DSM-IV diagnosis would be a Shared Psychotic Disorder.

This post represents one of my efforts, documented in the medical record of my patient as a full bullet point under treatment planning considerations, along with other protective steps to ensure the privacy of my patient and the integrity of his recovery of healthy childhood relationships with his parents.

Dorcy Pruter has documented intrusions of this symptom feature into her prior recoveries – it is a symptom feature of the pathology.  It is the most interesting of pathological features, that the actions of non-involved people are symptom features of the narcissistic abuse pathology, and it is an extremely vicious and malignant symptom feature – the splitting demonization of pathological narcissistic abuse made manifest.

I wish to send a clear message to the “flying monkey” symptom of pathological narcissistic abuse… don’t come near this child.

You have harassed and assaulted Dorcy Pruter for years, you have sought to undermine her recoveries at every turn, to destroy the lives of children and return them to their narcissistic abuse by a parent.  Don’t come near this child.

This is my patient.  You’ve never dealt with a clinical psychologist like me before.  I will protect my child with all the professional power that is available to me as a clinical psychologist.  Don’t come near this child.

Choose another one. Better still, don’t choose any.  Stop intruding into the recovery of healthy development achieved by the High Road workshop.  You are not involved.  Re-direct your interests. 

It is my 100% mission that, as we solve the pathology of childhood narcissistic abuse, we will be exposing the extent and nature of the “flying monkey” symptom of narcissistic abuse pathology.

And if you don’t think Dorcy Pruter has identities from her years of targeting by this most vile and malevolent of symptoms from narcissistic abuse and trauma, she knows who you are.  She protects her kids.

This child is the patient of Dr. Childress.  I am monitoring the child’s recovery on a daily basis.  I will protect my child’s recovery.

It is time to expose the “flying monkey” symptom of childhood narcissistic abuse.  The people who manifest this symptom feature are a malignancy of narcissistic child abuse, a ripple from their own unresolved childhood trauma.

My client-child is at risk from them.  I have charted into the medical record the steps I am taking to protect the recovery of my client child from intrusion into treatment by people unrelated to the case who have a grandiose and delusional belief in their entitlement as self-anointed “Saviors” and supposed “Protectors of children” in their delusional reenactment of their own child abuse trauma histories.

Stay away from my patients and their recovery.  Choose another avenue for the manifestation of your delusions.

Professional psychology – APA – you must get over here to look at this.  The pathology of narcissistic child abuse – as exposed in the family court system – requires your immediate and focused attention.

The Petition to the APA:  313 days and counting.  Silence.  No response from the APA to a Petition signed by 20,000 parents.

The APA: Complicity with Child Abuse

Flying monkeys:  The allies in the narcissistic abuse of children. 

Some allies of the pathology are active in enacting the abuse, some allies of narcissistic child abuse are silent in fulfilling their obligation to protect.  Allies of narcissistic child abuse. 

Those that should protect – but don’t – are called the “bystander role” in the trauma recovery literature.  Look it up.

Silence is complicity.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

Single-Case ABA: High Road Protocol

I want to report on a clinical case from my practice, a 16 year-old male adolescent with a significant history of aggression and hostility toward his mother, provoked and supported by his father. 

The mental health documentation of the family pathology goes back to 2016.  Treatment reports from three prior mental health professionals, two PhD psychologists and an MFT marriage and family therapist, are all in complete agreement.  All three diagnosed Child Psychological Abuse in the period from the spring of 2016 to the summer of 2017, with the most recent psychologist giving a formal DSM-5 diagnosis in his written report of V995.51 Child Psychological Abuse (summer of 2017).

Both psychologists, one in 2016 and the other in 2017, expressed concerns about frequent and “inappropriate” kissing on the mouth between the son and father.  All three mental health professionals diagnosed the father with extremely pathological narcissistic personality disorder, with strong IPV (Intimate Partner Violence; domestic violence) components of spousal abuse, and directly observed hostile, verbally abusive episodes toward the spouse (and therapist) are reported by multiple therapists. 

It took a year and a half from the time that the DSM-5 diagnosis of Child Psychological Abuse was made by the treating psychologist in the summer of 2017 (after the two previous mental health providers also diagnosed psychological abuse) for the mother to finally get a protective separation order from the court.  The child was left in the care of a diagnosed abusive parent for 18 months following the formal diagnosis of child abuse by a licensed psychologist with 37 years of professional experience (and after the two prior therapists also diagnosed child abuse by the father).

A year and a half after the DSM-5 diagnosis of Child Psychological Abuse made by the treating psychologist, the court granted the mother’s request for a protective separation order.  In February of 2019 the court granted the mother full custody of her snarling, hateful, and aggressively violent 16 year-old son, so that she and her son could receive treatment after years of dominating and controlling, documented psychological abuse of the child by the father had entirely destroyed the child’s relationship with the mother. 

Mental Health Reports: Documented Pathology

The first mental health report regarding the family pathology is from the spring of 2016.  In it, a psychologist with 40 years of professional experience said,

“The father displayed in my office the most extreme, antagonistic, narcissistic-based behavior I have ever seen.”

“The father’s full manipulation of the child has completely dominated every area of his life, school, friends, family, and in particular, his displays of kissing his father repeatedly on the lips in public, these are all inappropriate.  The child lives in constant fear of displeasing his father, and has no independent thinking, apart from what his father requires.”

These are the statements from the report of a PhD psychologist in the spring of 2016.

The next report is from a marriage and family therapist (MFT) who treated the family in the spring and summer of 2017.  In this report, the MFT states,

“It is my belief that <child name> is a victim of Child Psychological Abuse from his father.  It is my belief that the messages <child name> has been receiving from his father have resulted in significant psychological harm to the child.  He is experiencing severe reactions to stress.”

The next mental health report is from a PhD psychologist with 37 years of professional experience.  In his report he states,

“It is clear to me that <child name>, who lives with his dad and gets a few hours per week of visitation with his mom, has been mentally and emotionally abused by his father for the past year.”

That was in the summer of 2017.  This third psychologist gave a DSM-5 diagnosis of V995.51 Child Psychological Abuse and he referred the child and mother to the High Road workshop of Dorcy Pruter.

In February of 2019, a year and a half after the formal DSM-5 diagnosis of Psychological Child Abuse, a protective separation order was granted by the court and the mother and child entered the High Road workshop.

Following the recovery through the High Road workshop, I became the treating clinical psychologist for follow-up care with the recovered child and restored mother-child bond. 

This clinical case report represents the application of a single-case ABA design to assess the effectiveness of the High Road workshop for recovery from complex trauma in childhood.  The form of complex trauma is child psychological abuse, created in the context of high-intensity family conflict and parental narcissistic and borderline pathology.

In this current case, the child had been exposed to at least three years of professionally documented child abuse.  In February of 2019, the child entered two days – two days – of the High Road workshop.  I began treatment of the mother-son relationship following the two days of the High Road workshop conducted by Dorcy Pruter.

During the workshop, Ms. Pruter collected parent rating data every morning and evening for the child’s relationship with the targeted parent, the mother, using the Parent-Child Relationship Rating Scale (PC-RRS).  When I began my treatment in March of 2019, I continued to collect the mother’s ratings on the PC-RRS for the child’s relationship behavior with her. 

This is a report on the PC-RRS data for a single-case ABA clinical recovery from the complex trauma of psychological child abuse, using the High Road protocol.

Single-Case ABA Research Design

When most people think of research, they think of an experimental research design where many people are separated into different groups, these groups then receive different experimental procedures, and group differences are measured using statistics; the experimental design.

There is a second research methodology that is equally as effective in demonstrating causality, and which is commonly used in assessing treatment efficacy, the single-case research design.

Wikipedia: Single-Subject Design

“In design of experiments, single-subject design or single-case research design is a research design most often used in applied fields of psychology, education, and human behavior in which the subject serves as his/her own control, rather than using another individual/group.”

In a single-case research design, the subject moves through a series of phases of intervention.  The initial phase (A) is a baseline assessment phase.  This is followed by a period of intervention (B), which is followed by the withdrawal of intervention and return to the baseline of no-intervention (A).

For the single-case ABA clinical recovery and treatment reported here, the initial A (baseline) phase was the pre-intervention (pre-HR) ratings on the Parent-Child Relationship Rating Scale (PC-RRS).  The intervention (B) was two days of the High Road workshop conducted by Dorcy Pruter.  The withdrawal of intervention (second A) was entry into my clinical care as the treating clinical psychologist following the High Road recovery workshop.

Instrument: PC-RRS

The Parent-Child Relationship Rating Scale (PC-RRS) is a parent rating of three features of the parent-child relationship; Affection, Cooperation, and Social Involvement.  During the High Road workshop period, these ratings were made twice daily (morning, evening).  In the follow-up clinical care with the treating psychologist, these parent ratings were made daily (end of the day).

The three items rated on the PC-RRS (Affection, Cooperation, and Social Involvement) are rated on a 7-point Likert scale from problematic (1s and 2s) to exceptionally positive (6s and 7s).  The Affection scale monitors parent-child attachment bonding.  The Cooperation scale monitors emotional disruptions (emotional flexibility and inflexibility).  The Social Involvement scale monitors arousal emotions (anxiety, stress, sadness, and depression).  The PC-RSS is designed to pick up key features of emotional and psychological functioning in healthy and unhealthy relationships.

The items are structured to reflect a normal-curve distribution, with normal-range being a middle rating of 4, extremely problematic behavior is rated a 1, and highly favorable behavior is rated a 7.  The goal for healthy development and for treatment is to achieve reasonably sustained periods of stable normal-range behavior (ratings in the 3 to 5 range) across all three indicators, Affection, Cooperation, and Social Involvement. 

Occasional drops into problematic 1 and 2 rated behaviors is normal and is anticipated from time to time in healthy child development.  However, sustained periods of low-level ratings of 1s and 2s would indicate issues of clinical concern.  Occasional elevations into 6 and 7 behaviors of high affection, cooperation, and social involvement are hoped for and desirable.  However, healthy child development is not a sustained period of hyper-affection, hyper-cooperation, and hyper-social involvement. 

The goal for child development is a healthy regulated state; mid-range is normal-range.  For the most part, healthy child development occurs in a regulated mid-range of flexibility.  The treatment goal using the PC-RRS is the mid-range of well-regulated relationship behavior; ratings in the 3 to 5 range for all three scales, Affection, Cooperation, and Social Involvement.

The Data

data3

A: Child Psychological Abuse

PC-RRS ratings were not collected during the baseline period because the child’s overt hostility toward the mother that was created by the father’s psychological control of the child prevented the mother’s access to the child.  The reasonably assigned ratings for the child’s relationship behavior toward the mother during this period, based on reports from three separate clinical therapists, would be Affection=1-2; Cooperation=1-2; Social Involvement=1-2.   

B: Intervention – the High Road Protocol

In February of 2019, a protective separation order was granted by the court, and mother and son entered a 2-day High Road workshop conducted by Dorcy Pruter.  On their evening arrival the day before the workshop began, the child’s ratings on the PC-RRS were Affection=2; Cooperation=2; Social Involvement=1.

On Day 1 of the workshop, the child’s ratings on the PC-RRS began a rise that would be continual across the 2-day workshop period, reaching an evening rating on the first day of Affection=3; Cooperation=3; Social Involvement 4.5.  A normal-range parent-child relationship with the formerly targeted-rejected parent was achieved by the end of the workshop’s first day.

On Day 2 of the workshop, the child’s previous gains continued their improvement, reaching evening ratings at the end of the 2-day workshop of Affection=5.5; Cooperation=6; Social Involvement=6.

The 16 year-old adolescent had gone from a severely problematic relationship with his mother (ratings of 1-2) to a normal-range relationship by the end of the first day (ratings of 3-5), and rose into the highly affectionate, highly cooperative, and highly social range by the end of the second day (ratings of 6-7).

This represents a remarkable recovery of normal-range, and then superior functioning in the parent-child relationship within two days, following three years of documented psychological child abuse by a severely narcissistic personality parent.  In one day, the High Road workshop achieved normal-range bonding and normal-range child development.  In two days, the High Road workshop achieved superior bonding and healthy child development.

As a clinical psychologist, I am deeply impressed with the documented effectiveness of the High Road recovery workshop for complex trauma in children.

A: Withdrawal of Intervention – Follow-up Care

In March of 2019, I became involved as the follow-up clinical care treatment provider for the mother and son, following the three years of documented child psychological abuse, and two days of the High Road recovery workshop.

My first session with the mother and son begins the first data points for the clinical care ratings.  The mother’s initial daily ratings of the parent-child relationship were consistent upon their entry into therapy; Affection=3; Cooperation=4; Social Involvement=6.  The recovery gains documented for the High Road workshop are confirmed by the entry data into follow-up care with the clinical psychologist, with five straight data points in the normal-range.  

There is no reason to expect that the mother (the formerly targeted-rejected parent) would falsely report a positive relationship that did not exist.  If the mother is reporting a normal-range relationship with the child, then this is true and accurate data concerning their relationship.  The mother’s daily ratings are discussed in weekly therapy to verify rating calibration and ensure the validity of the ratings.  Problematic relationship issues that produce lowered daily scores are discussed in therapy using behavior-chain interviewing to verify rating accuracy and validity.

As therapy began to have impact, the initial stability of the normal-range relationship achieved by the High Road workshop began to fluctuate in response to my treatment interventions.  The rise in the ratings surrounding the 3/24/19 period reflects my first session of substantive treatment following my initial entry-sessions.  The fluctuations surrounding the 4/3/19 period reflect my second therapy session of substance. 

The sensitivity of the PC-RRS ratings to the effects of therapy, with distinctive periods of visible impact from therapy sessions, means that these rating are accurate and sensitive indications of the parent-child relationship.  The recovery of healthy and normal-range child development documented during the High Road workshop is confirmed by the treatment data in follow-up therapy.

The High Road workshop recovers children from abuse and trauma, and restores loving bonds of affection and healthy child development.  That is a fact.  The success of the High Road recovery protocol is documented by evidence, by the data.  It is a scientifically established fact.

There’s a reason it’s called a “single-case” research design; causality can be proven in a single case.

Findings of the Single-Case ABA for the High Road Workshop

As the current treating clinical psychologist for the mother and son relationship, it is my confirmed professional opinion that the mother-son affectional attachment bond has been fully recovered by the High Road workshop.  Not a doubt in my mind. 

The child’s healthy development has been recovered, and the child’s healthy and bonded relationship with his mother has been restored by the High Road workshop of Dorcy Pruter.  That is a scientifically confirmed fact.  Just look at the data.

From the first moment the mother-son relationship entered my treatment, their relationship was entirely in the normal-range, and their relationship has maintained that stability in response to the intrusions and perturbations introduced by therapy.  If the rating scales are picking up the effects of my therapy, the ratings are accurate reflections of the parent-child relationship.  Dorcy Pruter achieved a full recovery of the child, in two days… one day actually; normal-range ratings on the PC-RRS were achieved by the end of the first day of the High Road workshop.

The variability in the mother’s scores suggests that she has a sensitive internal calibration for her ratings.  The daily ratings are verified in family discussion with the mother and child during the weekly therapy session using behavior-chain interviewing around incidents of concern and ratings.  This data is accurate.  Not a doubt in my mind.

Following three years of psychological child abuse, child abuse confirmed independently by three separate mental health professionals, Dorcy Pruter and the High Road workshop recovered the child’s healthy and normal-range functioning in two days.  That is remarkable.

The success of the child’s recovery is remarkable, the success of Ms. Pruter’s achievement with the High Road protocol is remarkable.  Much respect from a licensed clinical psychologist. 

The recovery she achieved is verified by the ratings upon entry into my follow-up care, and has remained stable during my treatment period.

Remarkable.

There is a reason it is called a “single-case” design – care to hazard a guess as to why?

The single case research design was the favorite research methodology of B.F. Skinner, a researcher of exemplary talent who helped found the fields of behavioral psychology and learning theory.  He didn’t trust the group differences in experimental design that might be “statistically significant” but so small as to be clinically irrelevant.  If an intervention is effective, we should be able to see the results.  That’s why B.F. Skinner preferred the single-case methodology in his research.

The effectiveness of the High Road workshop is confirmed.  I will verify the data points from my therapy, Ms. Pruter will verify her data points from the recovery workshop.  It’s true.  Absolutely verifiably true.  There is documented evidence for the effectiveness of the High Road workshop for recovering children from complex trauma and child abuse.

The High Road workshop represents evidence-based practice. 

There’s the evidence.  Right there.  It’s a lock.

Journal publication will come.  The next phase for Ms. Pruter is replication.  Do it again. 

She has already done it over 100 times.  She’s just been so busy recovering children that she hasn’t been focused on research protocols.  She has PC-RRS data on many, many families during the workshop.  And each new case represents a new single-case ABA.  Data will be collected using the PC-RRS for each new workshop and recovery, and the success of recovery – for each case – will be documented by evidence.

The data is in, the High Road workshop is evidence-based practice.  There is the evidence, right there, and each new workshop becomes a new single-case ABA, documented using the PC-RRS.  Want to replicate this research?  Please do.

What my therapy data does, is confirm her data from the workshop.  I see the recovery with my own eyes, in my treatment sessions, I see the success of the High Road workshop in the real-world recovery of my client-child and his healthy and bonded relationship with his mom.  She is beyond herself with joy.

I’m sure this research will generate further discussion in the months ahead.  As far as I’m concerned as a clinical psychologist, it’s a lock.  The High Road workshop of Dorcy Pruter is evidence-based practice and it will recover the child’s healthy and normal-range development in a matter of days.  That is a scientifically proven fact.

Not a doubt in the world.  There’s a reason it’s called a “single-case” design.  Just look at the data.  How can anyone possibly argue with that.  It’s a lock, it’s a fact.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

Standards of Practice: 2007 Written Treatment Plans

I’ve opened my folder of teaching tools for teaching documentation of therapy.  It’s from 2007, long before I even knew that “parental alienation” existed.  I was in trauma world, working with kids in the foster care system. These documentation standards are from that time period.

This is a treatment plan form for the San Bernardino Department of Behavioral Health.  They were the county funding agency for mental health services in the foster care system.

SB-DBH Treatment Plan Form

The actual form is on blue paper, and it extends over several paper pages, so I just transcribed it to a Word table format and condensed redundancy. 

Those three empty boxes in the middle… that’s where all the action is on this form; Objectives, Clinical Interventions, and Outcomes.  It’s in those three empty boxes that we’d write our answers to those three important questions; goals, how are you going to get there, did it work?

Objectives – Clinical Interventions – Outcome

That’s the structural backbone of a written treatment plan.

What is the goal to be achieved by therapy (Objectives)?

How are you going to achieve those goals (Clinical Interventions)?

Did you achieve those goals (Outcome)?

I’ll go into each of these areas in a moment, but before leaving the form I want to point out a couple of other important features of a written treatment plan demonstrated by this county form.

First, notice that right above the Signatures box there’s a Frequency of Care Plan Review line, with boxes for 30 Days, 3 Months, 6 Month, and 12 Months.  Those time-frames are typically considered the standard of practice review points for treatment plans.  Treatment goals should typically be for a three- to six-month range for resolution of the pathology.  Short-term goals in the four- to six-week range are helpful progress milestones toward achieving the longer 3 to 6-month solutions. 

That’s what a treatment plan does, it lays out the course for solution, and that course is reviewed regularly; we’d hope for a treatment plan with a 3 to 6-month resolution of the pathology.

Notice too, the box off to the side of the signatures that says, “Client Received a Copy of the Care Plan” with a place for the client’s initials and date.  The written treatment plan is reviewed with the client, and the client gets a copy of it.  In fact, the Department of Behavioral Health wants to make certain that the client has a copy of the written treatment plan.  This documents that we reviewed the treatment plan with the client… at 3 months, and 6 months, and 1 year; each time the client initials a new signature line with a new date.

That’s considered standard of practice in county work in the foster care system.  Written treatment plan, review it with the client, client gets a copy of the written treatment plan.

Let’s take a closer look at those three empty boxes, and see what the county Department of Behavioral Health wants.

Objectives

OBJECTIVES: (Must be specific, measurable/quantifiable, attainable, realistic, time-bound.  Must be related to assessment, presenting problems/symptoms and functional impairment.  Include cultural/linguistic, co-occurring factors, if appropriate.  Include Med Support and Targeted Case Management, if appropriate)

Let me highlight a couple of things from this documentation requirement – measurable/quantifiable – time-bound.  Those features of the treatment plan are not optional, they are part of the list of required components.   Notice the instructions say “Must be” – not “Should be” – Must be… measurable and time-bound Objectives are requirements of the written treatment plan.

We must be able to measure treatment outcome, and our treatment goals must be time-bound.

Let me also highlight that the goals of treatment must be linked to the assessment information, to the presenting problem and symptoms, and to the impairment caused by the symptoms. The treatment plan describes what the problem is, and how to fix it.

Treatment plans link to the assessment data and describe a coherently organized approach to fixing the presenting problem – to solving things.

If a mental health professional cannot develop a written treatment plan for a pathology, then that mental health professional should not be working with that pathology.  Simple as that.

If I’m working with eating disorders, I must be able to develop an effective treatment plan for eating disorders.  If I am working with depression, I must be able to come up with an effective treatment plan for depression.  In professional psychology, that’s called “boundaries of competence,” that I only work with types of pathology that I know about, for which I am able to develop a written treatment plan.

If you know what you’re doing, then you have a plan for treatment. If you have a plan for treatment, write it down on a piece of paper and tell everyone what the plan is.   A written treatment plan.  A standard of professional practice – Department of Behavioral Health, San Bernardino County.

Clinical Interventions

CLINICAL INTERVENTIONS: (Must be related to objective. List clinical intervention for each group/individual service.  Includes Med Support and Targeted Case Management, if appropriate).

Tell us what you’re going to do.  This is the application of knowledge section of the treatment plan.  Objectives is being able to define goals in achievable and measurable ways, Clinical Interventions is knowing what to do about it.

Personally, I’d apply the scientifically established knowledge of professional psychology, in whatever domain of pathology I was working in, from geriatrics, to ADHD, or autism.  What’s the science say, that’s where I’ll be.  For this court-involved family conflict pathology, I apply the knowledge from attachment, and family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain during childhood.  I think it’s tremendously relevant information that helps make sense of everything.

I’d recommend it; attachment, family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain in childhood.

But everyone’s free to apply the knowledge they’d like.  A psychoanalytically oriented psychologist might apply Adler or Kohut, a humanistic psychologist might apply Rogers and Pearls, a CBT therapist will apply learning theory and Beck.  What knowledge is applied in this box, Clinical Interventions, is given broad latitude… but it is documented in the treatment plan.

It doesn’t matter what you do… just tell us what it is.

Because, you see, in telling us what it is you’re going to do to fix things, we’ll be able to tell if you know what you’re doing.  First, if you can’t tell us anything at all about how you are going to fix things (the clinical interventions), then you don’t know what you’re doing.  So that’s an easy one right there.

Then, for those therapists who do provide a description of their clinical interventions, we can look at their case formulation and applied knowledge to see what information and knowledge from professional psychology they used in their case conceptualization and treatment approach.  This will allow parents to make informed decisions regarding treatment, a requirement of informed consent to treatment.  It’s the informed part.

Don’t care what the answer is to this box, Clinical Interventions, just tell us what you plan to do.  After that, then we’ll care about what the answer is to this box.  But for right now, just tell us what you’re going to do to fix things.  Whatever you think is best.

Outcome

OUTCOMES/date/initials: To be completed at the end of the Care Plan Review timeframe, 30 days, 3, 6, 12 months or more frequently as appropriate

At every outcome review point specified in the treatment plan (typically 3-month and 6-month, and by then things should be substantially solved), the treatment goals and clinical interventions to achieve those goals are reviewed.  Remember, the treatment objectives are identified in ways that are “measurable” and “time-bound” – permitting review of goal accomplishment.

In child and family therapy, clinical impact is typically targeted for four to six-weeks.  Even in autism, significant measurable impact of clinical involvement should be evident by four to six weeks.  For autism, the clinical impact in six weeks would not necessarily be directly measurable in the child’s symptoms, but the caregivers should have substantially increased knowledge and skills in how to respond to the child (changes in caregiver stress and responding skills that are measurable).  The improved responding from the caregivers then leads to the more productive longer-range progress toward the treatment goals, gains which should become directly evident in the child’s symptoms on the 3-month and 6-month reviews of the treatment goals. 

So even with autism pathology, we would expect to see measurable gains in caregiver response competence in a four to six week period of initial intervention, leading toward longer-range goal achievement.

This is true for all pathology, from autism to oppositional defiant disorder.  It’s usually reasonable to expect a positive impact from intervention on some measurable area of functioning in four to six weeks, improvements moving toward a 3- to 6-month resolution of the presenting problem.

Does treatment with some childhood pathology take longer than six months to solve?  Of course.  But for each time-period longer than six months, professional concerns about the accuracy of the case conceptualization and treatment plan increase.   Treatment should solve things.  If treatment is not solving things within three to six months, we need to closely examine the diagnostic premise and clinical approach involved.

If we treat diabetes with insulin but the patient actually has cancer and needs chemotherapy, then the sooner we re-evaluate our diagnosis based on absence of treatment progress the sooner we will be able to get the proper diagnosis of cancer and the proper treatment of chemotherapy.  If things aren’t working, it’s time to look closely at possibly changing what we’re doing.

Does that mean that longer treatment is always due to earlier misdiagnosis?  No.  It just means that with each increment of time over six months, the review scrutiny of the case conceptualization, diagnosis, and clinical interventions used to achieve a solution becomes more exacting.

Even for chronic pathologies like autism that will require years of developmentally supportive intervention, we would want to achieve a stabilization of intervention where the child is receiving the proper intervention at the proper dosage level, and measurable progress from the intervention is continuing.  Continuing measurable gains from the consistent application of developmentally supportive intervention becomes a steady state treatment plan, measurable and time-bound review, and the same in its consistency of measurable effectiveness. 

This is the desired steady-state treatment plan we want for chronic pathology, always then closely monitoring scientific advancements that can improve the treatment plan for increasingly positive outcome.

If, however, the child ceases to make gains in a time-frame of review, then a reconsideration of case conceptualization and treatment plan is indicated.  When progress is not made, we develop a new treatment plan.  This may involve altering our case conceptualization, or altering the clinical interventions applied.

The important thing is that the progress is measurable, and that the treatment plan is time-bound to periods for review and modification.

School IEP

If an additional example is needed for a written treatment plan related to commonly occurring childhood pathology, I would refer to the school IEP (Individual Education Program).  The school IEP represents a written treatment plan surrounding a variety of possible issues, some possibly medical, some possibly emotional and psychological. 

What does the school do about the presenting problem referred for an individualized educational approach; the IEP referral?  The school develops a written treatment plan, discusses this written treatment plan with the parents, obtains the parent’s approval for the written treatment plan, and then the school implements the treatment plan as described by the written treatment plan. 

Once implemented, this written treatment plan of the IEP is reviewed on a periodic schedule to ensure measurable gains from the education-related treatment plan described by the IEP.

The school IEP is an education-related treatment plan, but many of the issues addressed by the IEP are emotional and psychological disturbances of childhood, so often the educational intervention co-occurs within the context of the psychological intervention.

A written treatment plan is everyday standard of practice in the school system.  The county of San Bernardino Department of Behavioral Health mandated a written treatment plan as a requirement for funding treatment of children and families in the foster care system.  In the world I come from, a written treatment plan is common standard of professional practice.  No big deal.

What are the Objectives of treatment (measurable and time-bound), what are the Clinical Interventions to be used to achieve those Objectives, and did it work, what is the Outcome?

The standard of professional practice in clinical psychology is for written treatment plans.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

Standards of Practice: 2007 Documentation of Child Therapy Session

This is an actual therapy progress note from February of 2007.  It’s from the intern doing child therapy with a foster care child now adopted, probably about the 3 to 4 year-old age range judging by the treatment interventions being described.

These de-identified treatment notes I’m sharing come from a time before I was involved in the court-involved divorce-related conflict that I’m currently working with.

In those days I worked with kids in trauma and foster care.  We had a two-therapist treatment model, with one child therapist working directly in session with the child, and a second therapist meeting collaterally with the parent, or foster parent, or adoptive parent – whoever was the day-to-day adult caregiver for the child.

This treatment note indicates that I was serving as the collateral therapist for the adults while the intern worked directly with the child.  Our interns typically did the direct child therapy, while our licensed staff did the collateral caregiver therapy work.  Our post-docs straddled the two.  Post-docs are trainees who have earned a doctorate degree and they already have a full year of pre-doctoral supervised internship training, but now they need an additional year of post-doctoral supervised training before they can be licensed.

Licensing in psychology takes two full years of supervised clinical training, one year pre-doctoral and one year post-doctoral.  This note is likely from one of our post-docs, she’s reporting on some sensitive work with the child’s anger modulation system.

I used these de-identified notes in training interns and post-docs on features of treatment and treatment documentation.  For example, one of the things I might use this note for is to demonstrate expected specificity in treatment documentation.  It’s not a long note, but the therapist does a nice job of presenting what happened in terms of therapy. What were the therapy interventions, and what were the results. 

Not in blow-by-blow detail of “he did then I did”; but in an organized description using constructs that have meaning.  For example, the therapist notes that, “client began to demonstrate a turn-taking rhythm” – a turn-taking rhythm is an important feature of anger modulation therapy. 

Anger is explosive and draws the person into a self-engaged focus of venting.  In therapy for developing anger-modulation networks, we want to keep the child socially engaged with us, so that we can help in regulating the child’s anger and frustrations.  Once the child collapses out of the social field, anger is vented.  As long as we can keep the anger contained in the social field, we build the neural networks needed for anger modulation.

The basic rhythm of social engagement is the turn-taking rhythm of back-and-forth dialogue.  It starts with eye-gaze and smiling dialogues of infancy, pre-verbal dialogues of babbling, and into verbal dialogues of speech and the social rhythms of back-and-forth turn-taking conversation and dialogue.

All of this is captured by this intern in that one notation phrase.  Not only did the therapist and client make an important step forward in anger modulation for the child when mid-way through the session the child “began to demonstrate a turn-taking rhythm”  This documentation shows that the therapist knows what she’s doing.  If she’s noting an incident of establishing a turn-taking rhythm, she knows how to build the anger-modulation system of the brain’s emotional networks.

There are two levels of a chart note description.  The first is the reporting of pattern.  The documentation needs to describe the clinical psychology features of note; in this case the turn-taking rhythm.  The second level is documenting the evidence of the pattern, in this note it’s the specific notation of the child saying “Wait” to manage the back-and-forth rhythm.  Specifics do not exist of their own importance, only related to the pattern they reveal. It’s the pattern of interaction that’s important.  And when the therapist knows what they’re doing, they document the patterns and use details only to support descriptions of patterns.

Notice in the therapist’s description how chaotic the child’s activity is.  The child asks to leave the session to find the mother but when outside the session office the child didn’t seek mom’s therapy room, but instead began to play with other toys in other areas of the clinic.  The child didn’t want to find mom, the child just wanted – well, that’s not exactly clear – disorganized wants, no clear focus or purpose.

That’s such a classic symptom of trauma.  Disorganization; to behavior, to emotions, to thinking.  The impact of trauma is that we cannot organize our states, any state.  Our arousal level is too high, and in children it’s a “building the brain networks” thing for modulating arousal and anxiety, and anger, and sadness, and love… love is called attachment and empathy in the professional literature.

How does this exceptionally good child therapist respond to the child’s disorganization?  With gently applied containment.  Boundaries by which to establish self and other.  Poor kid.  Someone had so overwhelmed his boundaries that he had none left, he was flowing in a continual sea of chaos and fear management.  The therapist in this note was going into his world to find him, and recover him to us.

The headings for the note structure were mandated documentation format by the county Department of Behavioral Health.  Standard of ordinary practice in foster care world.


MHS: Individual Therapy

Client’s Role (Mental Status/Verbalizations)

Client was accompanied to the session by his adoptive parents.  He appeared clean, well groomed, and was dressed in age appropriate casual clothing.  Therapist was greeted with appropriate eye contact, but no smile. Client willingly accompanied therapist to play room.

Role of Significant Others (Verbalizations)

Client’s adoptive parents were in session with Dr. Childress, and were therefore not present during the session.

Therapist’s Role (Actions/Interventions)

Maintained focus on providing a supportive and responsive relationship with the child to foster his ability to cooperate.  This therapist provided client with craft activities and set limits on what toys client could access to help organize his play.  Actively established appropriate boundaries to help client understand that aggressive behavior is not acceptable.

Client’s Response to Above

Client presented as disinterested in craft activities provided by therapist as evidenced by stating he needed to see his mother.  Therapist followed client, who did not seek his mother, but attempted to retrieve toys from a different room.  When therapist re-directed client to return to the session room client complied.  Mid-way through session client began to demonstrate a turn-taking rhythm with therapist by stating “Wait” when he and therapist were cutting strips of paper.  During this activity the client began to “cut” the therapist’s hand with the child-safety scissors.  When therapist distanced herself and verbally stated that aggressiveness was not OK, client waited approx. 30 seconds while watching therapist and then asked for therapist to reengage stating “I’ll be nice”.  Client watchfulness may be indicative of his monitoring to see if therapist was angry and would abandon him.

Clinical Plan for Upcoming Session

Therapist will continue to introduce minor intrusions into client’s activities to strengthen client flexibility in organizing his behavior around adult directives without aggression and/or opposition.  Will actively maintain appropriate boundaries with client to provide modulated stress experiences that will help the child to reduce his aggressive behavior.



That’s the clinical chart note.  That was a case where the child had been abused, moved into the foster care system, and the abusive parent could not be recovered, parental rights were terminated and the child was adopted.  This was one of those cases.  The adoptive parent is sometimes the foster parent who has been with the child for awhile.

We were untangling all the impacts of childhood trauma.  The child therapist was skillfully working with the child to build social-related networks involved in emotional regulation flowing into behavioral regulation (containment of anxiety).  In a separate session the collateral therapist for the parents (adoptive parents in this case) would be teaching the parent about trauma-informed responding in ways that support the child’s recovery. 

Chart notes need to reflect the treatment plan.  What’s the problem, and how do we fix it.  This therapist clearly understands what she’s doing to fix things, and we can feel the treatment plan concepts that guide her work.  That’s what a chart note should do, document the application of a coherent treatment framework for child and family therapy.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

Standard of Practice: 2007 Documentation of Court-Involved Case Management

I want to share something with you. Actual progress notes from therapy, not with this pathology of complex family conflict surrounding divorce, but from therapy with abused children in the foster care system. 

The physical and sexual abuse of these children was confirmed by the Department of Children’s Services, and they had placed these children in foster care.  For treatment, they were sent to my clinic.  I was the Clinical Director for a three-university collaboration treating the impact of childhood trauma within our foster care system.

In my role as the Clinical Director, I supervised interns and post-docs, which meant I signed off on their chart notes.  I also trained them in how to do trauma therapy with children, and how to document the therapy in their chart notes.  Over time in my training role as Clinical Director I de-identified some of the notes that came across my desk to use in the training of interns and post-docs regarding treatment, and treatment documentation.

When I left to enter private practice I apparently kept a file of these de-identified sample notes from actual cases tucked in a file cabinet in my garage.  I had forgotten I had them.  My goodness, they’re from 2007, tucked in a file folder in a file cabinet in my garage.  I now recollect thinking that these de-identified chart note samples might be useful if I ever entered another supervisory training role, as training examples of child trauma therapy and therapy documentation.

I’ve been going through and organizing the stuff in my garage.  My last round of doing this was with my books, this time is with my journal articles and folders.  I’m clearing my emotional-psychological decks for action; opening the gun ports in preparation for the upcoming ship-to-ship engagement, so to speak.  In going through stuff folder-by-folder I came across my folder of sample notes, and I started to read them.

Interesting stuff.  Not to me.  It’s just work stuff to me from 2007, long before I came to work with families of court-involved divorce.  But these notes reveal important stuff about professional standards of practice, because they are not created for this pathology of post-divorce family conflict, and they are not related to anything controversial.  They are just standard of ordinary practice from 2007.

At the time of these notes, and at the time they were archived away in my files, I had plans to die happily in complete obscurity, and having never even heard of anything called “parental alienation.”   In 2007, I had never heard the term, “parental alienation.”  This note is from trauma.  These are the actual notes for therapy with young kids in the foster care system. 

This one documenting court-involved case management is from a post-doc psychologist.  It’s a case-management note for billing her report for the guardian (probably grandparents) regarding treatment progress which will be submitted to the court.  I’ve been a court-involved clinical psychologist before, just not a divorce-involved one.  I’ve been trauma and child abuse court-involved clinical psychologist.

You know how the pathogenic parent is so concerned about the supposed “abuse” of their child?  I am exactly the psychologist that you want to send an abused child to.  I am that psychologist – except now I’m here with divorce-related pathology.  But I am an abuse and trauma clinical psychologist.  Foster care.  Early childhood, ages birth to five, up to eight…).

For all of these kids discussed in these actual chart notes, the pathology is confirmed physical or sexual child abuse, often including parental drug use, and possible prenatal exposure of the child to drugs and alcohol.  Anything that gets a child from birth to age 6 into the foster care system; that was our client population; the child and the siblings were our client, along with the (hopefully) recovering parents, the grandparent guardians providing kinship care, the foster parents with four to seven children in their care, adoptive parents adjusting to trauma in children, the social workers in child protective services, and the court.

Been there.  Here is a case management note.


Case Management with the Court

Purpose of Case Management

For the courts to make an educated decision regarding <child name>’s future , it is necessary for the court to consider the child’s mental health and functioning in her current placement.  Consultation and linkage with the client guardian’s legal counsel is meant to facilitate the continued stability and progress of the client.  The legal proceedings regarding guardianship will determine <child name>’s contact with her biological mother, which would have a direct impact on her behavioral and emotional functioning.

Summary of Case Management/Linkage Provided

In her placement with the current guardians, <child name> has made significant gains in the reduction of anxiety and aggression. This therapist wrote a progress letter at the request of the current guardians and their legal counsel to inform the guardianship proceedings.  Specifically legal counsel was interested in the progress that <child name> has made in therapy while in the care of her current guardians, dates of attendance, and wanted to know if her biological mother had participated in treatment.

Treatment Recommendations/Considerations

Recommended that if client mother resumes caregiving involvement she be required to participate in collateral therapy to prevent deterioration in reported gains.  Noted that <child name>’s progress can be attributed in large part to the current secure and stable caregiving environment.  For specific progress and treatment recommendations please refer to the document in client file.

Care Plan

Goal Objective

By 8/13/07, will reduce the severity of client’s anxious/distressed presentation upon separation from 7 times a week to four times a week as measured by parent report, will reduce client lying about significant events to 3 times per week as measured by parent report, will reduce non-compliant behavior in the home from 3 to less than 1 time per week based on parent report, client will follow caregiver direction with only two prompts 90% of the time based on parental report.

Intervention

Will provide linkage and consultation with the court through the legal counsel for client’s guardian in order to support placement decisions that provide the necessary stability and security needed for client’s continuing treatment progress.

Client Will Participate By

Clinical functioning and progress will be reported to the court through the legal counsel of the client’s guardian.



That’s the note example.

Documentation Standard of Practice

I would estimate that the child described in this note by Dr. Excellent has been physically abused, mother is probably meth-addicted, the child is probably in the 5 to 6 year old age-range.  I can tell all that based on how the post-doc worded things.  I know the post-doc who wrote this, and if it was sexual abuse there would be different sentences.  The treatment goals she describes are consistent with physical abuse, and the lying is probably neglect from a meth-addicted mother (neglect leaves an imprint where the child takes whatever they want on impulse and then lies without remorse; it’s a survival symptom of neglect, particularly characteristic of meth-addicted mothers).

Notice the category headings for the note, these are standard mandated headings for a case management note for county-funded work.  We were county funded, foster-care work.  We had county mandated documentation requirements.  All of these note examples are county-level standard of practice for documentation.

This note is for billing purposes.  The post-doc is doing non-treatment activity and is billing the county under a billing code for case management.  This is her billing documentation note.  She has to justify the time spent.  This starts by identifying the child’s needs that are being addressed by the case management.

Note that she is working with the guardian’s attorney to provide information about treatment recovery to the court.  The guardian is likely the grandparent, and they are probably worried about the potential return of the child to an actively meth-addicted and physically abusive mother (the grandparent’s daughter).  The post-doc therapist is working with the grandparent to help stabilize the child’s recovery.

Childhood Trauma and Abuse

This note is from 2007.  This is the world I come from; the treatment of childhood trauma.

Forensic psychology uses the words trauma and abuse a lot, but they don’t actually ever work with trauma and abuse, just this court-involved divorce related family conflict. 

They don’t actually treat children in the foster care system who have been physically and sexually abused by parents.  I do.  Those are my clients.  I’m that guy,  that clinical psychologist, my clinic, that’s where they sent the abused kids for treatment.  To me.

I’ve worked with the courts before this current family-divorce pathology.  Only back then, I was on the foster care child abuse consultation side.  But I’m completely familiar with court-involved consultation surrounding child abuse, and in my world – this is what a case management note looks like.

Notice the treatment plan documentation.  Standard of practice on every progress note…. progress note.  That’s just on the note, there’s a whole four to six page treatment plan in another section of the chart. 

We do in-house QA on our charts every six months – no fun, Saturdays with pizza, and our charts are audited by the county – at random intervals.  Standard of practice, at CHLA, at Choc, at my clinic in 2007.

This is what I would consider a standard of practice note for case management in my world as a clinical psychologist.

Craig Childress, Psy.D.                             
Clinical Psychologist, PSY 18857

Director of Psychological Services,
CCPI; Custody Resolution Method

 

 

The Legal Argument Package: Forensic or Clinical Psychology

Things are changing. 

We are shifting from a forensic psychology non-solution to a clinical psychology solution for complex family conflict surrounding divorce.

This is not a child custody issue.  The conflict surrounding child custody is a symptom. The issue is family pathology that is creating complex attachment-related  pathology in the family; complex family conflict surrounding divorce.

This is a family pathology and treatment issue.  Conducting family therapy is the domain of clinical psychology, treating attachment pathology in the family is the domain of clinical psychology (a child rejecting a parent is an attachment-related pathology), treating the expression of parental personality disorder pathology in parenting and the family is the domain of clinical psychology, and treating the trans-generational transmission of complex trauma is the domain of clinical psychology.

This is a clinical psychology issue, diagnosing and treating family pathology; the attachment system, family systems therapy, personality disorder pathology, complex trauma.  Clinical psychology.

The DSM-5 diagnosis for pathogenic parenting that is creating significant psychopathology in the child is V995.51 Child Psychological Abuse.  Diagnosing and treating child abuse is the domain of clinical psychology.  This is not a child custody issue; it’s a child protection issue. 

The clinical psychology concern is the significant degree of psychopathology being created in the child by the pathogenic parenting of the allied narcissistic-borderline personality parent… assessing, identifying (diagnosing), and treating psychopathology is the domain of clinical psychology.

Following divorce, a spouse is using the child as a weapon of revenge and retaliation against the other spouse-and-parent in the divorce, in order to inflict severe emotional abuse on the other spouse-and-parent through the psychological trauma of losing their child (traumatic grief).  This pathology is a form of domestic violence (Intimate Partner Violence; IPV), the emotional abuse of the ex-spouse using the child as a weapon of spousal revenge and retaliation for the divorce, and in the process psychologically abusing the child by creating severe pathology in the child.

The assessment, diagnosis, and treatment of Intimate Partner Violence (IPV; domestic violence) and child abuse is the domain of clinical psychology.

This is not a child custody issue.  The child custody conflict is a superficial symptom of much deeper clinical pathology in the family.  The issue is one of psychopathology, that’s the domain of clinical psychology.  The clinical psychology argument package represents the return of clinical psychology to court-involved consultation, court-involved assessment of pathology, and court-involved treatment of pathology.

Identification of pathology is called diagnosis.  Assessment leads to diagnosis, and diagnosis guides treatment.  Treatment solves conflict and restores the child’s healthy family context and healthy development.

We are shifting the legal argument package that is being presented to the court.   Parents and their attorneys will be asking the court for a clinical psychology assessment of family pathology, not a forensic psychology assessment for child custody.

The Forensic Package

Up until now there has been only a single option for parents and their attorneys, the forensic psychology legal argument package that frames the issue as one of custody and visitation.  That has changed.  There is now an alternative approach; a treatment focused approach from clinical psychology.

The clinical psychology legal argument package is grounded on a different set of constructs in professional psychology (Bowlby; Minuchin; Beck) than is the forensic psychology argument package (arbitrary and unknown foundations), and the clinical psychology option seeks a different remedy from the court than the forensic psychology argument package. 

Since the focus of the forensic psychology legal argument is on child custody, the initial forensic psychology remedy moves inexorably into a “child custody evaluation” as the only means to obtain the input of professional psychology into the question of the child’s non-compliance, and potentially influenced child behavior regarding compliance, with the custody visitation orders of the court.

The task of each parent then becomes proving their position regarding the child’s rejection of a parent to the child custody evaluator, who will decide on the “evidence” presented to the custody evaluator regarding the relative merits of each party’s position, and will decide on the custody and visitation schedule for the family – thereby ABROGATING the duties of the judge… to hear argument and evidence, to make a determination of fact, and to render a decision regarding the custody visitation schedule.

All done by the custody evaluator – not the judge.  The judge may either then accept or reject and alter the ruling of the custody evaluator – typically without benefit from a second opinion from professional psychology regarding the family symptoms and family pathology.

Custody and visitation decision-making has essentially been assigned out of the courts to forensic psychology, and the only approach available from forensic psychology is an invalid (no inter-rater reliability) six- to nine-month forensic child custody evaluation costing between $20,000 to $40,000. 

Each parent tries to influence the custody evaluator to their position.  The position of the allied parent (supported by the child) is that the targeted parent is “abusive” and “deserves to be rejected” by the child.  The position of the targeted parent is that the child’s attitudes and behavior is being influenced and controlled by the allied parent as a means to inflict emotional suffering on the targeted parent for the divorce (that the child is being used as a weapon of spousal revenge and retaliation for the divorce).

The custody evaluator meets with everyone to hear their “arguments” – exposing the evaluator to their influence and efforts at manipulation of the evaluator’s opinion.  This is a deeply concerning assessment process because of its vulnerability to the unconscious biases of the evaluator (called counter-transference in clinical psychology). 

Counter-transference (unconscious bias) from the psychologist ALWAYS exists, in all cases, in all contexts.  The introduction of the psychologist’s own unconscious biases are identified as “schemas” in professional psychology.  Personal biases in the assessment of information is always present, and is entirely unconscious to the person.  This is a fact of psychology, and of all assessment processes.

In the forensic psychology process, the custody evaluator acts as the “judge” regarding the relative arguments offered by each parent, and the custody evaluator makes a determination of fact – typically whether a poorly defined construct called “parental alienation” is present and to what degree – and decides on the remedy based in the child’s custody visitation schedule with each parent.

Note: There is no pathology known as “parental alienation” in clinical psychology.  That is a new form of pathology that is entirely the construction of forensic psychology.  It does not exist.  In clinical psychology, defined knowledge exists, and the identification of pathology (called diagnosis) is based solely on the established constructs and principles of professional psychology (attachment; family systems therapy; personality disorder pathology; complex trauma).

The alternative focus on the treatment of family pathology will move this into clinical psychology and a clinical psychology assessment of pathology. 

Which legal argument and remedy package to present to the court is a decision for parents and their attorneys.

The Challenge of the Forensic Psychology Argument

The focus of the forensic psychology argument for the targeted parent is to prove a pathology (“parental alienation”) to a judge in order to obtain the remedy, typically a reversal of custody from the supposedly “favored” parent to the currently rejected targeted parent. 

That is the burden, proving the family pathology of “parental alienation” to a judge at trial.  The sole means to prove “parental alienation” to a judge at trial is through a forensic psychology child custody evaluation.  A child custody evaluation costs between $20,000 to $40,000 and takes between six- to nine-months to complete.

There is no other option from the forensic psychology legal argument package.  No second opinion is available because of the expense ($20,000 to $40,000) and length of time required (six to nine-months) for a child custody evaluation.

This approach is hardly ever successful for the targeted parent.  This approach typically takes years of litigation and potentially hundreds of thousands of dollars in legal costs, with substantial damage to both the parent-child relationship and the family’s financial foundations during and throughout the years of litigation required by the forensic psychology approach.

Successful resolution of the family conflict is exceedingly rare using the forensic psychology legal argument package, because it’s not a treatment focused approach.  Treatment is clinical psychology, and a clinical psychology assessment of pathology has not been conducted.

The forensic psychology approach typically only achieves success in the most severe cases of “parental alienation” in which the pathology of parental influence on the child is clearly evident, and then only after years of conflict and litigation have already robbed the child of a normal-range and healthy parent-child relationship with a loving and beloved parent (their mom or their dad; the targeted parent), and the loss of a normal-range childhood of healthy emotional and psychological development (bonded in loving relationships with both parents).

The forensic psychology approach offers no solution, it is destructive of families and children’s healthy emotional and psychological development, and this approach needs to change – because it offers no solution.  It is not treatment focused.  Treatment of child and family pathology is the domain of clinical psychology.

Clinical Psychology Argument

Clinical psychologists create change.  We create change in individuals (individual therapy) and we create change in families (family therapy).  Clinical child and family psychologists solve complex family conflict.  That’s what we do.   We solve complex family conflict.  It’s called family systems therapy.  Solving complex attachment-related family pathology surrounding divorce requires a solution from clinical psychology.

Clinical psychology can absolutely – 100% – solve this family pathology (cross-Slide52generational coalition; emotional cutoff; narcissistic-borderline parent (“splitting”); multigenerational transmission of complex trauma). 

The solution requires the application of professional knowledge from four domains of professional psychology: the attachment system, family systems therapy, personality disorder pathology, and complex trauma.  So it is not easy to solve. But it is entirely solvable with the application of the established knowledge of professional psychology.

Attachment – family systems therapy – personality disorder pathology – complex trauma.  Established knowledge in professional psychology.  Bowlby – Minuchin – Beck – van der Kolk.

I have posted a Curriculum Knowledge Checklist to my website that identifies the books from professional psychology that contain the professional knowledge needed to solve complex family conflict surrounding divorce.

It is a complex and difficult pathology.  But it is both understandable and solvable.

Court Involvement

Solving this pathology will require a cooperative relationship between clinical psychology and the Court.  The narcissistic-borderline parent will lead this family conflict into the court system by manipulatively creating and then exploiting the child’s refusal to comply with court orders for custody and visitation.  Once the child begins refusing visitation contact with the targeted parent (with the tacit support of the allied narcissistic-borderline parent), the targeted-rejected parent must then return to court seeking enforcement of the existing court orders for custody and visitation.

That’s how the pathology of one spouse-and-parent (the allied parent who forms a cross-generational coalition with the child) drives the post-divorce family into the family court system.  The family pathology will enter the legal system because the targeted parent needs to seek enforcement of the existing court orders for custody and visitation as a consequence of the child’s (manipulated and psychologically coerced) refusal to cooperate with the court orders for custody and visitation.

Since the issue is superficially the enforcement of orders for child custody and visitation, the issue will present to the court as one of “child custody” – but it’s not about custody and visitation.  Court orders already exist.  It’s about parental pathology in the family creating attachment-related pathology in the child in order to exploit the child’s symptoms to manipulate the court’s orders for custody and visitation (using the pathology – the rejection of a parent – created in the child).

This is a family pathology issue.  That’s the domain of clinical psychology.

Victimized Child – Influenced Child

Upon entry into the legal system, the narcissistic-borderline parent will present the “victimized child” argument to the court; that the child is supposedly being “victimized” by the allegedly “abusive” parenting of the targeted parent, and the remedy sought by the allied narcissistic-borderline personality parent will be to severely limit the other parent’s time with the child ostensibly to limit the child’s contact with the supposedly “abusive parent.”

The targeted parent, on the other hand, will present the court with the “influenced child” argument surrounding the child’s refusal of contact, and the targeted parent will seek the remedy of limiting and restricting the child’s time with the allied and “favored” parent in order to resolve the “influenced child” refusal of the court-ordered custody and visitation.

The judge will need to resolve between these two argument packages; “victimized child” offered by the allied and supposedly “protective” parent, and the “influenced child” argument offered by the targeted and rejected parent.  Once the judicial decision is made regarding the arguments, an appropriate remedy will then need to decided upon by the Court.

Adjusting the Argument Package

The clinical psychology argument package adjusts both the focus (treatment of family pathology rather than child custody schedules) and the framing for how the “influenced child” argument is presented to the court.

The clinical psychology argument will NOT use the construct of “parental alienation” – and indeed, the use of the construct of “parental alienation” would be considered beneath professional standards of practice in clinical psychology.  In clinical psychology, if a psychologist wants to apply a “new form of pathology” (such as “parental alienation”) to the interpretation of symptoms, this is done only AFTER having applied the standard and established knowledge of professional psychology; the attachment system literature, constructs from family systems therapy, personality disorder pathology, complex trauma, and the DSM diagnostic system.  After.

The clinical psychology argument does NOT use the construct of “parental alienation” (because this construct is non-supported in the scientific literature of professional psychology), and is instead based entirely and solely on the solidly established constructs and principles of professional psychology (the attachment system, family systems therapy, personality disorders, complex trauma) – (Bowlby, Minuchin, Beck, van der Kolk, Millon, Kernberg, Perry, Haley, Bowen, Madanes, Linehan, Ainsworth…) – the standard and established knowledge of professional psychology applied to the symptom features of the pathology.

Up until now, the only option available to targeted parents and the court for obtaining input from professional psychology surrounding complex family conflict has been through forensic psychology and a child custody evaluation regarding the structure of the child custody schedule – and NOT the resolution of the family pathology issue.

The legal argument presented to the court is changing – from a forensic psychology package to a clinical psychology legal argument package.  Parents and their attorneys are now beginning to ask for a clinical psychology assessment of family pathology; the pathology that is creating the complex family conflict that has entered the legal system.

The narcissistic-borderline parent has forced the targeted parent to return to court to seek enforcement of the existing child custody orders because the child has become severely symptomatic and non-cooperative with the established custody visitation schedule.  This is the manipulative set-up by the narcissistic-borderline spouse-and-parent to make this about custody and visitation, driving the conflict into a forensic psychology approach focused on child custody (possession of the child) rather than a clinical psychology approach of diagnosis and treatment of pathology.

That is changing.  An alternative legal argument package is available from clinical psychology for a treatment-focused assessment of the family.  The referral question for the clinical psychology assessment is:

Referral Question: Which parent is the source of pathogenic parenting creating the child’s attachment-related pathology, and what are the treatment implications?

This clinical psychology referral question can be answered by a limited-scope clinical psychology assessment, typically requiring about six sessions and costing approximately $2,500 to complete.  It is structured around two symptom documentation instruments, the Diagnostic Checklist for Pathogenic Parenting and the Parenting Practices Rating Scale.

The relatively low cost (~ $2,500) and short time frame (six to eight weeks) for the clinical psychology assessment allows for a second opinion assessment if desired, and the use of structured symptom documentation instruments (the Diagnostic Checklist and Parenting Practices Scale) allows for easy and clear comparison of findings from a first and second opinion report from clinical psychology.

The targeted parent is still offering the “influenced child” argument to the court, but is changing how that argument is structured and presented for the court’s consideration. Instead of using the incredibly weak construct of “parental alienation” that will drive the assessment into forensic psychology, the clinical psychology argument is solidly grounded in the established knowledge of professional psychology: the attachment system, complex trauma, and family systems therapy.

Of note is that the clinical psychology argument package presented to the court will not be using the personality disorder information sets from professional psychology in the argument presented to the court.  The personality pathology information from professional psychology will emerge over time within the broader background understanding within the legal and mental health systems that develops from increasing familiarity with the pathology.

From the perspective of a clinical psychology family therapy solution, we do not want to emphasize the other parent’s pathology.  There are other ways.  Identifying pathology is important, because diagnosis guides treatment – but diagnosis is only important because it guides treatment.  We do not want our focus to be on diagnosis, but on treatment.  We want to pivot as quickly as we can away from identifying pathology (the diagnosis) and over to treatment.

The clinical psychology approach is solution focused; not problem driven.  How do we fix things, how do we restore healthy parent-child bonds of affection, how do we restore the child’s normal-range and healthy childhood development?  Solution focused.

What’s the pathology?  A cross-generational coalition and emotional cutoff (attachment pathology).  Minuchin’s diagram provides strong support for this argument.  It displays exactly the pathology of concern.

Slide52The Family Pathology: The child’s “triangulation” into the spousal conflict through the formation of a “cross-generational coalition” with the allied parent against the targeted parent, resulting in an “emotional cutoff” of the child’s relationship to the targeted parent (Minuchin; Haley; Bowen; Madanes; family systems therapy).

This type of family pathology is caused by “multigenerational trauma” (Bowen), also referred to as the trans-generational transmission of trauma in the attachment and complex trauma literature (Bowlby; van der Kolk).

The clinical psychology argument package presented to the court is that significant family pathology is resulting in the obstruction of court orders for custody and visitation.  The remedy sought by the targeted parent is a treatment focused, trauma-informed, clinical psychology assessment of the family pathology.

That’s quite the mouthful for the assessment description. 

Treatment Focused:  The “treatment focused” indicator shifts the focus of the assessment off of the false child custody issue over to identifying a treatment oriented solution for the complex family conflict (through a written treatment plan for the resolution of child and family pathology; identified by the assessment). 

Trauma Informed:  The indicator of “trauma-informed” ensures that proper information sets from professional psychology are applied by the assessment. 

Clinical Psychology:  The clinical psychology orientation is to move the family conflict out of forensic psychology that offers no solution and over to clinical psychology for the identification (diagnosis) and treatment of the (“high-conflict”) pathology in the family.

The initial remedy sought is:

Initial Remedy:  A treatment-focused, trauma-informed, clinical psychology assessment of complex family conflict surrounding divorce.

The clinical psychology referral question is:

Referral Question:  Which parent is the source of pathogenic parenting creating the child’s attachment-related pathology, and what are the treatment implications?

The focus is NOT child custody (which parent should “possess” the child following the divorce), it’s treatment.  How do we restore normal-range and healthy child development?  The targeted parent is making a treatment-focused argument to the court; that the custody violations to the court orders are a symptom of family pathology, and the targeted parent is seeking a clinical psychology assessment of the family pathology (along with the enforcement of existing court orders for custody and visitation) as the remedy.

This clinical psychology argument package effectively nullifies the “victimized child” argument offered by the narcissistic-borderline parent, since the treatment-focused, trauma-informed, clinical psychology assessment addresses the arguments from each parent and provides remedy for both.

If the child is indeed being victimized by an abusive parent (thereby justifying the child’s reluctance to be with the rejected parent) as is alleged by the allied parent and child, then a trauma-informed, treatment focused assessment from clinical psychology is just the assessment to identify this child abuse and victimization of the child by the targeted parent.

The narcissistic-borderline parent is using (exploiting) the child’s induced pathology (the child’s rejection of a mother or father) to make the issue about child custody (“possession” of the child following divorce; who’s the “better parent” – who “deserves” possession of the child).  The targeted parent is altering this, and is instead using the induced child pathology created by the other parent to make the issue about the diagnosis and treatment of pathology. 

Since both agree on the existence of pathology, just not its causal source, a clinical psychology assessment and diagnosis, that identifies the treatment implications, is entirely warranted as the initial remedy for both arguments.  Let’s find out what’s causing the child’s attachment-related pathology following the divorce – that’s a clinical psychology issue – identifying pathology is called diagnosis.

A clinical psychology argument package will extract targeted parents from the court system and return the assessment, diagnosis, and treatment of complex family conflict to clinical psychology, and it will prevent families with newly emerging divorce-related conflict from entering years of litigation in the family courts surrounding child custody, by making identification of the pathology in the family the first order from the court.  Identify (diagnose) what is causing the child’s attachment-related pathology surrounding the divorce.

Initial Orders Sought for Remedy

Custody and visitation are not the focal point, they are symptom features of the complex family conflict.  We need a treatment focused assessment from clinical psychology to determine what is going on, what the source for the complex family conflict is – using the standard and established knowledge of professional psychology (a trauma-informed assessment of complex family conflict).

A secondary remedy sought by the targeted parent is the enforcement of existing court orders for custody and visitation (and possibly sanctions on the allied parent for their responsibility in creating the breaches to the court orders).

In response to the clinical psychology argument package from the targeted parent, that carries a secondary remedy of enforcement and possible sanctions surrounding existing court orders for custody and visitation, the judge may decide to wait until the results of the clinical psychology assessment of family pathology before making a ruling on the custody orders from the court, and the judge will likely rule in favor of the targeted parent’s request for a “trauma informed, treatment focused, clinical psychology assessment of the complex family conflict.”

Second Opinion

The other party will possibly argue against this clinical psychology assessment.  The rebuttal to this argument that can be offered by the attorney for the targeted parent is “second opinion”; that the opposing party is free to obtain a second opinion, a second trauma-informed clinical psychology assessment of the complex family conflict.

If someone is concerned about a diagnosis in clinical psychology, get a second opinion.  That’s how it’s done in clinical psychology (and health care generally). Get a second opinion if you’re concerned about the accuracy of diagnosis.

Child Protection Issue

Child pathology and child protection is the framing for the clinical psychology legal argument package.

The “custody” symptom (the child refusing court orders for custody and visitation) is a symptom of the family pathology.  This is not a child custody issue, this is a child pathology issue.  Is the targeted parent an “abusive” parent creating the child’s rejection, or is it the allied parent who is creating the child’s pathology through pathogenic parenting of psychological control and manipulation?

The referral question for the (“trauma-informed”) clinical psychology assessment is:

Referral Question: Which parent is the source of pathogenic parenting creating the child’s attachment-related pathology, and what are the treatment implications?

If the pathogenic parenting of the allied parent is creating significant developmental pathology in the child (attachment system suppression; diagnostic indicator 1), personality disorder pathology in the child (narcissistic personality traits; diagnostic indicator 2), and delusional-psychiatric pathology (encapsulated persecutory delusion; diagnostic indicator 3), the DSM-5 diagnosis is V995.51 Child Psychological Abuse, Confirmed, and the considerations shift to child protection.

In all cases of child abuse, physical child abuse, sexual child abuse, and psychological child abuse, the professional standard of practice and duty to protect requires the child’s protective separation from the abusive parent.  The child’s healthy development is then recovered and restored, and once the child’s healthy development is stabilized, contact with the formerly abusive parent is reestablished with sufficient safeguards to ensure that the child abuse does not resume once contact is restored.

This is true for physical child abuse, this is true for sexual child abuse, this is true for psychological child abuse.

That’s the shift that is occurring.  The legal argument package being presented to the court, both in its foundations (Bowlby, Minuchin, Beck) and in the remedy sought (a clinical psychology assessment; psychological child abuse diagnosis; protective separation period and treatment recovery) is shifting to a clinical psychology legal argument package of solution

The world is changing.  An attachment-based and trauma-informed model of complex family conflict surrounding divorce represents the return of clinical psychology to court-involved practice.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857