Difficult Position

Karen Woodall, I have been in a difficult position since reading one of your recent blogs (Karen’s blog).  In your blog you indicated that you are beginning a personal “research” study (without IRB oversight or review) with adult children of child abuse and childhood trauma. 

In your blog, you announced that you had begun recruiting for your personal research study in order for you to learn from these now-adult survivors of childhood trauma, and that you were going to use what you learned from your “research” to develop a new form of therapy for them.  Here is your exact statement:

From Karen Woodall:  “Last week I put a call out to adults alienated as children, inviting them to take part in my research which will form the basis of a new therapy for this group of people.”

That you would need to conduct “research” to develop a “new therapy” means that you don’t already know what the therapy is for adult children of child abuse and that you have to do “research” to learn what you are doing – to create your “new therapy.”

Those are your words, Karen.  That is your sentence statement.  You are conducting your own personal “research” so that you can learn how to do therapy – this “new therapy” you are creating – for adult survivors of childhood trauma. 

Which means that you currently don’t know how to do therapy with adult survivors of trauma, necessitating your need to conduct your “research.” 

The ethical issue of using people as guinea pigs for your “research” and your new experimental forms of therapy, without IRB oversight and review, is concerning.

The fact that you will be conducting therapy with a new population without proper education, training, and background to ALREADY know the treatment for adult survivors of child abuse would likely represent a violation of Standard 2.01a of the APA ethics code regarding boundaries of competence.  Every ethics code for every level of professional in every country, has a Standard regarding boundaries of competence.

If you have to do “research” on the people in order to learn therapy with that population, that means you are currently not competent to treat that population, and that treating them would be beyond the boundaries of your competence.

Standard 2.01c of the APA’s ethics code on competence governs the requirements for a psychologist expanding an area of practice.

Standard 2.01 Boundaries of Competence
(c) Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.

If you look on my vitae, Karen (Childress Vitae) you will see after I list my work experience, I list a section of Early Childhood Training.  Do you see that?  That involved my expansion of practice into early childhood mental health from ADHD and school-involved psychology. 

Mind you, while at Children’s Hospital of Los Angeles I had early childhood training with the therapeutic preschool there, and at Choc-UCI I was working with ADHD in preschoolers… still, when I moved to early childhood I went and got training.  See that?  That’s what is required when we shift areas of practice.

Interesting note, look right above my Early Childhood Training, since coming over here I’ve taken training in Divorce Mediation.  With everything I know, Karen.  I went and got training in Divorce Mediation.  That’s what we do, Karen.

So it becomes professionally disturbing to hear you “put out a call” for “research” subjects on whom you can practice with your new new forms of experimental therapy.  If you have to research how to do therapy, you don’t yet know how to do therapy with this population.

I do, Karen.  I already know how to do therapy with adult survivors of child abuse.  That is already within the scope of my practice.  I know what the therapy is, and I have treated a range of adult child abuse survivors, including from this divorce-involved psychological abuse.  I already know what the therapy is, and I’ve already worked directly with the population of adult survivors of child abuse (including psychological abuse surrounding divorce).

If you have to do “research” in order to learn what the therapy is for adult survivors of childhood trauma and abuse, you are not currently competent to practice with this population, and according to APA Standards, you should seek additional training, supervised experience, or consultation. 

I’d be more than happy to provide education, training, or supervision for your expansion of practice into adult survivors of childhood abuse and trauma, but for consultation with this population, I would instead refer you to Dorcy Pruter. 

I suspect you will be unwilling to avail yourself of my offer to train or supervise your practice expansion, and I also know that you’ll not find another person as familiar with adult children from this specific “alienation” form of child abuse trauma as Dorcy, she’s world-class in that regard.  If you want to learn therapy for adult survivors of this form of child abuse, turn to Dorcy Pruter for professional consultation, Karen.

I fully understand that you believe yourself to be in some “battle of experts” with me.  I’m not, Karen.  Every act, every sentence, is as a clinical psychologist.  There are professional standards of practice, Karen.  They exist to protect the patient.  It is unwise to flout and disregard professional standards of practice.

When entering a new area of practice, seek training, consultation, or supervision.

If I were to expand my practice into veteran combat PTSD – even with all my background in trauma, I’d be taking at least three trainings and I would be consulting for the first 18 months.  And I am already well familiar with PTSD in combat veterans.

Look at everything I know, Karen, how fully established my vitae is over here, books and everything.  I took a training course in divorce mediation.  Boundaries of competence, that’s what we’re supposed to do. 

I’m not taking any training in child custody evaluations because I’m never doing one.  If I did, I would.  I would not conduct a child custody evaluation (ever) without first receiving additional training.  My child custody evaluation would be a magnificent professional work, far exceeding any standards of practice in child custody evaluations.  I would still seek additional training before conducting a child custody evaluation (never) because that’s what we do.

So, Karen.  If adult survivors of childhood trauma is a new domain for you… seek consultation.  Who is the top professional in adult children of “alienation” – Dorcy.  Stronger even than me.  I will absolutely consult with her on cases of adult children of “alienation” – any hint of a question for me, that’s who I would turn to for professional consultation.

No ego, Karen.  These kids need the best.  Put your ego aside and work to learn before you enter a new area of practice.  That is the Standard that is expected of us.

You also indicated that your “research” subjects would be receiving your new experimental therapy. 

From Karen Woodall:  “Alongside the research, I will treat those adult children who are coming forward using a combination of therapeutic approaches which I consider fits the needs of this overlooked cohort of traumatised individuals.”

So you are serving as both the treating clinician and the Principle Investigator of your private research, without any IRB oversight or review, that sounds like a dual role called a “multiple relationship.” Are you charging your “research” subjects for their new experimental therapy you are providing to them?  That would likely be viewed as exploiting your multiple relationship with them, one serving the other, and both serving your interests.

Here’s an ethical concern if I’m sitting on your IRB, might your role as a treating clinician influence the perceived freedom and self-autonomous decision-making of the research participant regarding their research participation decisions.  Might they agree to participate in new experimental treatments because they want to please you as the treating therapist and keep you as a therapist, rather than from a truly autonomous informed consent for the nature of the experimental research procedures you’re doing.

And if one of your “research” subjects alleges that your therapy harmed them, then your statement that you are doing research in order to learn how to do therapy with that population, meaning that you do not already know what the therapy is for adult children of child abuse and trauma, they are likely to have a very strong legal case.

Are you using an informed consent for treatment or an informed consent for research, or both?  Have these been reviewed?  By whom?  If not, I would recommend you post your Informed Consent for Research to obtain at least some degree of professional review.  I’m seeing liability issues for you on a fairly substantial scale if you fail in your professional obligations surrounding research.

People are not your guinea pigs for your learning.  There are ethical standards of practice, Karen.  If you are entering a new field, seek additional education, training, supervision, or consultation – I suspect your ego will not permit my involvement in your education – but your ego should NOT interfere with your professional duty of care to the client… seek professional consultation with Dorcy, she will substantially improve the quality of care you provide to adult survivors of childhood trauma and child abuse – specifically this type – this “alienation” type of attachment trauma.

This is not an ego thing, Karen.  I know you think you’re in some sort of battle of “experts” with Dr. Childress – because you’re stuck in a mindset of “experts” – that’s all going away, Karen.  Even me. 

This is not an ego thing, Karen.  If you’re moving into treating adult children of “alienation” you must, absolutely beyond all shadow of doubt, consult with Dorcy Pruter.  If it were me, I’d do two-hours monthly, and I’d seriously consider two-hours weekly, for about six months.

No doubt on that, you heard how I phrased that… If it were me.  No ego on this, Karen.  Dorcy absolutely knows her stuff, and, regarding adult children… she is one.  Dang, she will tell you everything you need to know Karen.  Dorcy would be absolutely the person I would consult with personally, no ego. The only thing I care about is the quality of care to my kid, my client.  If Dorcy’s understanding improves that, I’m there, absolutely.  Patient care… my kid… always comes first.  No ego.

If you start working with adult children of child abuse and trauma and you don’t consult substantially with Dorcy… I don’t know what to say, Karen.  That’s getting your ego wrapped up in the quality of care you provide to your patients.  I just can’t understand that type of thinking, Karen.  Where ego takes precedence over patient care.

There are professional standards of practice, Karen. They’re there for a reason. They’re there to protect our patients… and us.  It’s not a good idea to disregard them, Karen.  When going into a new area, seek additional education, training, supervised practice or consultation.  Karen, we’re working with children and families, leave your ego at the door and worry more about the quality of your work, than who’s the “expert.” 

I understand if you won’t accept my knowledge, but then seek and accept Dorcy’s.  This is not a competition… this is not a game of “experts” – we need to have a solution now.  Today.  Yesterday would be even better. 

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