Class Action Lawsuit

I am a psychologist, not an attorney.  My opinions represent those of an old-school clinical psychologist, not an attorney.  But given the profoundly incompetent and professionally negligent practices surrounding mental health’s involvement with the family law system (sometimes called “court-involved therapy” or “court-involved mental health” services), I’d be open to collaborating with a legal team of substance in exploring the possibility of a class action lawsuit.


Negligent Professional Practice

In my non-legal view… the professional negligence involves the consistent and system-wide failure to apply standard and established constructs and principles of professional psychology to the professional work of court-involved mental health professionals working in the family law system, resulting in the system-wide failure by mental health professionals to appropriately and accurately diagnose child psychological abuse and respond with an appropriate child protection response consistent with their “duty to protect.”

As a result of a consistent and negligent disregard for the application of standard and established psychological constructs and principles to their work surrounding the family law system, mental health professionals are failing in their professional “duty to protect” children from psychological child abuse, resulting in significant and potentially irrevocable developmental harm to children, and in significant emotional and psychological trauma to parents.

Is a Test Case Needed?

The Tarasoff case in professional psychology explicated a mental health professional’s “duty to warn” the potential intended victims of violence.  A similar legal landmark case may be needed regarding the mental health professional’s “duty to protect” obligations surrounding the role of professional psychology in family law and child custody decisions made by the court which have profound and lasting impact on the family, centering on the application of standard and established constructs and principles in the diagnosis of child psychological abuse.

The pathology we are discussing (traditionally called “parental alienation” in the common culture but more accurately conceptualized as the trans-generational transmission of attachment trauma, mediated by the personalty disorder pathology of the allied parent), conceptually represents psychologically “killing” the targeted parent’s child.  Prior to the enactment of this severe form of delusional-psychiatric pathology by the allied parent, the other parent, the targeted parent, has a child.  After the enactment of this emotionally and psychologically brutal pathology, the targeted parent no longer has a child. This parent’s relationship with the child has been killed.  For all intents and purposes, this parent’s child has been psychologically murdered.

The consistent and negligent disregard by court-involved mental health professionals for the application of standard and established psychological constructs and principles to their work within the family law system is directly responsible for their failure to protect the child and targeted parent victims of this brutal emotional and psychological pathology. 

The psychological murder of one’s child – to lose completely one’s relationship with a beloved child – is a severe emotional and psychological trauma of profound proportions for the targeted parent; and for the child, the loss of a parent (the “psychological death” of this child’s parent for the child) can have profoundly negative developmental repercussions throughout the child’s life, including carrying this emotional and psychological trauma into the child’s own marriage and family. 

Standard and Established Constructs

The rejection of a parent is an attachment-related pathology

This form of brutal family pathology is driven by the narcissistic/borderline personalty disorder pathology of the allied parent, triggered by their perceived rejection and abandonment surrounding the divorce.

This form of brutal family pathology represents the child’s triangulation into the family conflict through the formation of a cross-generational coalition with one parent against the other parent.

These are standard and established forms of mental health pathology.

Because court-involved mental health professionals are involved in family matters of such profound consequence to the child and targeted parent, a high degree of professional expertise is expected in the relevant domains of pathology which they are tasked with assessing, diagnosing, and treating; i.e., attachment trauma and the trans-generational transmission of attachment trauma; the assessment and diagnosis of personality disorder pathology and its impact on family relationships, including the assessment and diagnosis of encapsulated delusional pathology emerging from the personality disorder pathology of the parent; and family systems constructs regarding the causal interrelationships of family behavior.

Child Psychological Abuse

The clinical psychology term for this form of family attachment-related pathology is pathogenic parenting by the allied narcissistic/(borderline) parent (patho=pathology; genic=genesis, creation).  Pathogenic parenting is the creation of significant psychopathology in the child through aberrant and distorted parenting practices.

Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent, and that results in the loss for the child of a healthy attachment bond to a normal-range and affectionally available parent, represents a DSM-5 diagnosis of Child Psychological Abuse, Confirmed.

A mental health professional’s “duty to protect,” especially under circumstances of such profound developmental consequence to the child and emotional trauma for the parent who is targeted by this brutal family pathology, would seemingly engage the professional’s obligation to apply standard and established psychological principles and constructs in the assessment, diagnosis, and treatment of this pathology in order to fulfill the professional’s “duty to protect” relative to the psychological abuse of the child and the infliction of potentially lifelong emotional trauma on the targeted parent.

The failure to reasonably employ standard and established psychological principles and constructs (from attachment theory relative to an attachment-related pathology, from the field of personality disorder pathology relative to the impact of parental personality disorder pathology on the family, and from family systems theory relative to the interrelationship of causality for family behavior) would seemingly represent negligent professional practice. 

But that’s just my non-legal, psychologist opinion.  Maybe I’m wrong.  Maybe court-involved mental health professionals don’t need to know about the functioning and dysfunctioning of the attachment system when they treat attachment-related disorders.  Maybe court-involved mental health professionals don’t need to know about personality disorder pathology when they treat families whose relationships are being heavily influenced by parental personality disorder pathology.  Maybe court-involved mental health professionals don’t need to know about standard constructs from family systems theory when they are assessing, diagnosing, and treating families.

Maybe I’m wrong.  Maybe court-involved mental health professionals don’t need to properly diagnose child psychological abuse, even through V995.51 Child Psychological Abuse is a DSM-5 diagnosis and all mental health professionals are responsible for knowing and properly diagnosing all disorders in the DSM diagnostic system as a standard of professional practice.

Maybe I”m wrong… but personally, I don’t think so.  Personally, I think it’s negligent professional practice to so cavalierly disregard standard and established psychological constructs and principles in the assessment, diagnosis, and treatment of mental health pathology.  Personally, I think it’s negligent professional practice to not know what you’re doing.

Extended Responsiblity

Again, I’m not a legal professional.  But from where I sit as a simple clinical psychologist, it would seem that by providing professional “guidelines” for the practice of court-involved mental health, both the American Psychological Association (APA) and the Association of Family and Conciliation Courts (AFCC) have seemingly taken professional responsibility and provided their professional imprimature for the professional practices of court-involved mental health.  But, then again, maybe I’m wrong.

I can’t help but wonder though… in providing guidelines for the practice of court-involved mental health, would their imprimature for the practices surrounding court-involved mental health make the APA and AFCC legally liable for those practices?  I don’t know.  I’m just a psychologist.

However, if a legal team ever wanted to consider a class action lawsuit, I can certainly point out the relevant professional literature regarding attachment theory, personality disorder pathology, and family systems theory which, in my opinion, should reasonably be guiding professional practice in assessing, diagnosing, and treating an attachment-related pathology involving a potentially allied narcissistic/(borderline) parent in a cross-generational coalition with the child against the other parent following divorce.

(Attachment: Bowlby, Ainsworth, Mains, Sroufe, Fonagy, Ruth-Lyons; Bretherton; )

(Personality Disorder: Kernberg, Millon, Beck, Linehan; Dark Triad Personality)

(Family Systems: Bowen, Minuchin, Haley)

According to the ethical code of the American Psychological Association, mental health professionals are not allowed to be incompetent.  I would think this would extend to negligently incompetent.  Profoundly incompetent… resulting in the destruction of children’s lives and the destruction of parent-child relationships.  But what do I know.  Maybe I’m wrong.


Child Custody Evaluations

The professional practices surrounding court-involved mental health lack scientific and professional foundation in the established psychological principles and constructs of professional psychology.  For example, there is not a single research study establishing the validity of the conclusions and recommendations derived from child custody evaluations.  Not one.  Nothing.

No study demonstrating the face validity of the conclusions and recommendations of child custody evaluations.

No study demonstrating the content validity of the conclusions and recommendations of child custody evaluations.

No study demonstrating the construct validity of the conclusions and recommendations of child custody evaluations.

No study demonstrating the predictive validity of the conclusions and recommendations of child custody evaluations.

No study demonstrating the discriminant validity of the conclusions and recommendations of child custody evaluations.

Nothing.  Zero.  There is no scientifically established foundation for the validity of the conclusions and recomendations of child custody evaluations.

Nor is there any research study demonstrating the inter-rater reliability of the conclusions and recommendations of child custody evaluations.

If the results of an assessment are not reliable, they cannot, by definition, be valid.  So what is the data regarding the inter-rater reliability of the conclusions and recommendations from child custody evaluations?  There is none.  Nothing.  No data whatsoever.

There is no scientifically established foundation for the validity of the conclusions and recommendations of child custody evaluations.

But it’s even worse…

There are no operational definitions for the key constructs that are supposedly being assessed by child custody evaluations; the “best interests of the child” and “parental capacity.”  The absence of operational definitions for the key constructs of the assessment violates a basic tenet of professional assessment.

I want to be very clear on this, because I teach assessment, and I do assessment as a clinical psychologist.  I know assessment.  The absence of operational definitions for the key constructs of the assessment violates a basic tenet of professional assessment.

Prior to assessing for “intelligence” we must first define what we mean by the construct of “intelligence.”

Prior to assessing for “self-esteem,” we must first define what we mean by the construct of “self-esteem.”  This is a foundational tenet of professional assessment.

We are not allowed to assess first and then define the construct afterwards based on the results of our assessment because then the assessment would be subject to… wait for it… inherent bias.  If I define the construct after the assessment, then I can make the construct be whatever I want the results to be.  That’s not allowed.  We define the construct first, and then we assess.

Child custody evaluations violate this basic tenet of professional assessment practice by not first defining the meaning of the key constructs of the assessment; what represents the “best interests of the child” and what represents “parental capacity.”

Instead, these key constructs are defined idiosyncratically after-the-fact by the child custody evaluator.

In their analysis of child custody evaluations, Stahl and Simon (2013) describe the absence of any coherent operational definition for the key construct of the best interest of the child:

“A critical subject facing those working in the field of family law, whether they are legal professionals or psychological professionals, is the concept of the best interests of the children.  Even recognized experts in this concept differ with regard to what it means, how it should be determined, and what factors should be considered in determining what is in the best interest of a child.  Thus, this ubiquitous term escapes consensus and remains fundamentally vague.” (Stahl & Simon, 2013, p. 10-11)

If you have not defined the central construct of the assessment PRIOR to the assessment, then the assessment lacks scientific credibility.  You can’t just do an “assessment” and then make up what it means after-the-fact based on personal whims and biases (this form of bias is called “counter-transference” in the clinical psychology literature).

Bias:  Counter-Transference

Q:  If a child custody evaluator has “mother-issues” or “father-issues” from his or her own childhood and family of origin, what protection is there that these buried psychological issues from the evaluator’s own childhood won’t influence his or her interpretation of the data? 

A:  None.  There are no protections whatsoever against this subtle but pervasive – and indeed expectable – form of bias from entering into the current practice of child custody evaluations.

Q:  Is it possible that these “mother-issues” or “father-issues” from the evaluator’s own childhood might color the evaluator’s interpretations of the data from the child custody evaluation? 

A:  Yes.  Absolutely. In fact, from all the scientific research on schemas and internal working models within the attachment system, it is extremely likely that these subtle forms of personal bias will influence the evaluator’s interpretation of the data.  This form of inherent bias should be expected.

Q:  Child custody evaluators are typically confronted with differing and conflicting narratives about what is occurring within the family.  What protections are there that the potential “mother-issues” or “father-issues” of the evaluator won’t influence the evaluator toward accepting and co-constructing a narrative of the family conflict influenced by the evaluator’s own family-of-origin issues? 

A:  There are no protections against this form of bias whatsoever.  And this bias can be 100% unconscious for the evaluator.  The evaluator may 100% believe that he or she is being “objective” because the source of the bias in the family-of-origin issues of the child custody evaluator can be unconscious.   This is called “counter-transference” in the psychological literature.

The protection against this form of inherent, 100% expectable, and likely pervasive “counter-transference” bias in ALL child custody evaluations is to follow the standard and established professional practices for creating assessment protocols:

1.)  Operational Definition:  Operationally DEFINE the construct being assessed in terms of how the construct is to be measured – whether it’s “intelligence,” or “self-esteem,” or the “best interests of the child” in the case of child custody evaluations.

2.)  Construct the Protocol to the Operational Definition:  Construct the collection of data to address the operational definition of the construct by defining how the data leads to a conclusion about the construct (e.g., high scores compared to the general population on a visual puzzle task are evidence of the construct of “intelligence” – endorsing a pre-specified level of positive or negative self-statements from a list of positive, negative, and neutral self-statements is evidence for the construct of positive or negative “self-esteem.”).

3.)  Establish the Reliability and Validity of the Protocol:  Collect reliability and validity data on the assessment protocol.  In the case of child custody evaluations, it would likely be inter-rater reliability data and at least face validity data (the assessment protocol superficially “looks like” it measures what it purports to measure). 

Construct and content validity data would be recommended.  This might involve subjecting the assessment protocol to a panel of experts to critique the operational definition of the construct (construct validity) and whether the assessment protocol actually measures the definition of the construct (content validity).

Given the importance of the decisions involved for the family, predictive validity data for the assessment would be recommended.  This might involve follow-up assessments of family functioning regarding whether the assessment was successful in predicting outcome based on some pre-defined outcome criteria.

That’s how professional assessment practices protect against the introduction of inherent bias into the assessment practice.  Professional psychology knows how to construct assessments.  Child custody evaluations have followed none of these procedures.


Reunification Therapy

From what I can see, many, most, nearly all, court-involved therapists are simply making things up without reliance on any standard or established constructs of child development and family pathology, and then they are using vague psychological words to cover their nearly complete absence of the application of standard and established psychological principles and constructs from unknowing legal professionals and the general public, who unfortunately simply trust that the mental health professional knows what he or she is doing.

From what I can see, this public trust is unwarranted.

Take, for just one example, the ubiquitous use of the term “reunification therapy.”  There is no such thing as “reunification therapy.”  No such thing exists.  There is no model anywhere that has ever been defined or described about what “reunification therapy” is, what it entails, or or how it accomplishes “reunification.”   Nothing.  Zero.

The term “reunification therapy” is snake oil, pure and simple.  It’s a term that sounds like it has meaning when used by a mental health professional to a parent or attorney, but which, in truth, is an unknown concoction of unknowable ingredients that’s guaranteed to “cure what ails ya” but which actually winds up killing the patient.  Snake oil pure and simple.  It allows mental health professionals to do whatever they want, without any reference to established psychological or psychotherapeutic models, under the guise of so-called “reunification therapy.”

“Reunification therapy” doesn’t exist.  There is not one professional description of what “reunification therapy” entails.  Zero.  Nothing.  If any mental health professional uses the term “reunification therapy,” ask for a citation reference to the theorist who describes what “reunification therapy” is.

Parent or Attorney:  I’d like to know more about reunification therapy.  Can you please direct me to a book or author who describes the process of reunification therapy.

MH Professional:  Well, that’s just a term we use to describe this, and there isn’t really one place that… obfuscate, double-talk.  Bottom-line… no reference.

The correct psychological term for the therapy is family systems therapy.  Family systems therapy is fully defined and described by such preeminent figures in professional psychology as Murray Bowen, Salvador Minuchin, Jay Haley, Chloe Madanes, Virginia Satir, and others.  Family systems therapy describes both the origin of the family relationship problem and its solution.

Family systems therapy is one of the four primary schools of psychotherapy (the others being psychoanalytic, cognitive-behavioral, and humanistic-existential), and family systems therapy is the only school of psychotherapy that deals with resolving current interpersonal relationships within the family – the others are all forms of individual therapy.  Family system therapy is the correct and applicable model to use in conceptualizing and resolving family-related problems.

I’m a clinical psychologist.  I teach models of psychotherapy.  I know what I’m talking about.

Central to family systems therapy is the construct of the triangle; the child is being triangulated into the spousal conflict.  This is the technical clinical psychology term for the child being “put in the middle.”

There are two forms of triangulation.  In one, the parents unite to form a coalition against the child.  This occurs when the level of inter-spousal conflict threatens to tear the marriage apart in divorce, so the child develops symptoms that divert and distract the parents’ attention away from the spousal conflict over onto the child’s behavior problems.  The child (who is called the “identified patient” in this form of triangulation) develops a symptom in order to bring the parents together in their shared concern over the child’s symptom, thereby saving the marriage by diverting the attention and conflict away from the marital conflict and onto the child.

The second type of triangulation is a cross-generational coalition in which one parent forms a coalition with the child against the other parent.  This is the type of triangulation involved in the pathology traditionally called “parental alienation” in the general-culture.  It is a cross-generational coalition of one parent (the allied and supposedly “favored” parent) against the other parent (the targeted and rejected parent).

From a professional diagnostic standpoint, this is no big deal.  This is all standard and fully established principles of family therapy that are amply described and explained in the family systems literature.

But from what I see, many, most, nearly all court-involved mental health professionals do not rely on family systems constructs in their case conceptualization, diagnosis, and treatment.  Instead, they just make stuff up based on their whims and fancies.  But then they use the term “reunification therapy” to hide from parents and legal professionals that they’re actually just making stuff up.  By using vaguely defined terms that sound as if they had meaning, these court-involved therapists can essentially make up whatever they want and do whatever they want, in complete ignorance and without any reference to any standard principles or constructs of professional psychology.

Oh, and by the way, did I mention that court-involved mental health professionals can make a lot of money off of this, because families are so desperate for solutions and the court often mandates the family’s participation in court-involved mental health services.  Hmmm, who reviews the practices of court-involved mental health professionals?  Oh, other court-involved mental health professionals.  Sweet deal.

But I have a question, by providing guidelines and, through these guidelines, their official imprimature for the practice of court-involved mental health services, do the APA and AFCC incur any liability for the system-wide negligent conduct of court-involved mental health services?  Maybe not.  What do I know.  I’m just a psychologist.


Standard and Established Constructs

A child’s rejection of a parent is an attachment-related pathology.  The attachment system is the brain system for managing all aspects of love and bonding throughout the lifespan, including grief and loss.

Court-involved mental health professionals should therefore be relying on constructs from attachment theory – a fully established and well-researched domain of professional psychology – for the application of standard and established psychological principles and constructs.

In the pathology traditionally called “parental alienation” in the common-culture, the child is being triangulated into the spousal conflict through the formation of a cross-generational coalition with one parent against the other parent.

Court-involved mental health professionals should therefore be relying on constructs from family systems therapy – a fully established and well-documented domain of professional psychology – for the application of standard and established psychological principles and constructs.

The pathology traditionally called “parental alienation” in the common-culture represents the trans-generational transmission of attachment trauma from the childhood of a narcissistic/(borderline) parent to the current family relationships, mediated by the personality disorder pathology of the narcissistic/(borderline) parent which is itself a product of the childhood attachment trauma of this parent.

Court-involved mental health professionals should therefore be relying on constructs from personalty disorder pathology – a fully established and well-documented domain of professional psychology – for the application of standard and established psychological principles and constructs.

Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.

Court-involved mental health professionals should therefore be relying on constructs from the DSM-5 diagnostic system – a fully established professional diagnostic system – for the application of standard and established psychological principles and constructs.

But that’s just the non-legal opinion of a clinical psychologist.

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

References

Stahl, P.M. and Simon, R.A. (2013). Forensic Psychology Consultation in Child Custody Litigation: A Handbook for Work Product Review,Case Preparation, and Expert Testimony, Chicago, IL: Section of Family Law of the American Bar Association.

 

6 thoughts on “Class Action Lawsuit”

  1. It’s about time the GALs, the courts, parent mediators, and judges be held accountable for their own bias when making “professional” recommendations and/or decisions. I had a parent mediator who consistently demonstrated in her “professional” recommendations that she preferred to side with abusive parents and alienating parents. The courts are no better. In MA custody decisions were made based on the county the parents resided. One county was pro-father while another was pro-mother. I have been wondering when someone was going to bring a class action suit against this “cottage industry”.

  2. Reblogged this on | truthaholics and commented:
    “The pathology traditionally called “parental alienation” in the common-culture represents the trans-generational transmission of attachment trauma from the childhood of a narcissistic/(borderline) parent to the current family relationships, mediated by the personality disorder pathology of the narcissistic/(borderline) parent, which is itself a product of the childhood attachment trauma of this parent.

    Court-involved mental health professionals should therefore be relying on constructs from personalty disorder pathology – a fully established and well-documented domain of professional psychology – for the application of standard and established psychological principles and constructs.

    Pathogenic parenting that is creating significant developmental pathology in the child (diagnostic indicator 1), personality disorder pathology in the child (diagnostic indicator 2), and delusional-psychiatric pathology in the child (diagnostic indicator 3) in order to meet the emotional and psychological needs of the parent represents a DSM-5 diagnosis of V995.51 Child Psychological Abuse, Confirmed.”

  3. I am a mom of 2 kids and I just went through this. This past Monday I went to court requesting my children be part of reunification therapy. The basic outcome was that the kids don’t want to do therapy so they shouldn’t have to (said by both the judge and ocl). Imagine giving a 12 and 14 year old the choice of whether to do counselling. Really? Is that a choice they can make? Are we not the adults who need to make wise choices for our children, even if they don’t see the benefit. I took my kids to the doctor for a vaccination recently. They did not want to go. Should I have given them the choice? Of course not! But we give the choice on therapy? The court completely disregarded anything I said about my ex husband alienating my kids, even after all the evidence I provided. When the ocl spoke of what the children said they were twisted stories of the truth. Stories that I think my children actually believe about me. My ex has been on a crusade for 4 years to turn the kids against me and it seems that he is slowly winning. The courts and mental health professionals have no idea the magnitude of this and they just don’t know how to deal with it. Courts and therapist need to be help accountable. More needs to be done. Professionals need to be educated in this field. If we don’t stand up and put a stop to this we will have an epidemic of alienated parents. It hurts and it leaves a parent helpless.

  4. My kids were 12 and 15. Their “choice” was also the sole deciding factor of where they would live. Insanity. They also refused counseling, and the court did nothing to mandate it. You’d think counseling would be important to help girls their age deal with Mommy deciding to pursue a lesbian life and drag them along to a loving and welcoming community. Nope… Four years on now and I’ve seen them for less than 10 hours total. And I can’t do a damn thing about it.

    So frustrating to see the gulf between the brilliance of Dr. Childress’ explanations of this dysfunction vs the total ineptitude, if not outright bias, of the justice (sic) system.

  5. Dear Dr. Childress, You are the perfect Advocate, Authority and Answer to this Social Terror faced by targeted parents. To have you address this problem with such focus, passion, integrity and authenticity is nothing short of a miracle, therapy and a blessings.  You, my invaluable ally, have in such a short time, validated those of us who have been check-mate into silence by the abuse of Attachment-Based Parental Alienation and continue to scream aloud and silently hoping, praying, begging to be heard. Then came Dr. Craig Childress, who heard us loudly and turned up the volume of our tragedy for the world to hear, also. And where we missed the mark, he pin-pointed it, and delivered it in a way we were ill-equipped to. Someone without a hidden agenda, ulterior motive or ax to grind…someone in the very field where the most damage is taking place…someone who offers his time and expertise to correct this dilemma…looks like the answer to countless prayers  New York is well overdue for a visit from you. It will happen. I know I am not the only ally who tears up upon reading ‘new post’ from your blog,the class-action post in particular. My federal lawsuit was recently dismissed. Now forthe appeal process. Of course, this is meant to wear me down further. So your post was most welcome, a wonderful boost.  On behalf of targeted parents everywhere, Thank You. Best Karlene Gordon

    From: Dr Craig Childress: Attachment-Based Parental Alienation To: kgordon4jc@yahoo.com Sent: Monday, September 5, 2016 3:51 PM Subject: [New post] Class Action Lawsuit #yiv7091018311 a:hover {color:red;}#yiv7091018311 a {text-decoration:none;color:#0088cc;}#yiv7091018311 a.yiv7091018311primaryactionlink:link, #yiv7091018311 a.yiv7091018311primaryactionlink:visited {background-color:#2585B2;color:#fff;}#yiv7091018311 a.yiv7091018311primaryactionlink:hover, #yiv7091018311 a.yiv7091018311primaryactionlink:active {background-color:#11729E;color:#fff;}#yiv7091018311 WordPress.com | drcraigchildress posted: “I am a psychologist, not an attorney.  My opinions represent those of an old-school clinical psychologist, not an attorney.  But given the profoundly incompetent and professionally negligent practices surrounding mental health’s involvement with the famil” | |

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