November

I want to talk about my November seminar series with Dorcy. 

Here is what I’m going to talk about.

I’m going to start the morning of the first day talking about the foundations of the pathology.  I will assume everyone at the seminar knows Foundations, so I’m going to take a line that moves into diagnosis, that will be on the attachment trauma line, the reenactment narrative and delusional pathology.

In the afternoon of the first day I’m going to cover diagnosis.  I am going to assume everyone knows the three diagnostic indicators.  I am going to focus on the clinical diagnosis of the attachment pathology in the child, and the 12 Associated Clinical Signs (ACS).  Each of the ACS symptoms has a reason.  I will explain the reason for each of them.

The morning of the second day, I’m going to start Assessment.  I’m a clinical psychologist, my goodness, assessment is what we do.  If you want to know the sweet-spot of professional expertise in assessment… that’s clinical psychologists.  Personality assessments, educational assessments, MMPIs, Rorshachs.  Want a Rorshach Inkblot Test?  Sure I can do that.  Time consuming and better ways to get the information, but sure, I can do that.  The most interesting case I ever had where I used the Rorshach was to diagnose possible childhood schizophrenia.  It can be difficult to separate psychosis from pretend-fantasy in a child, and the Rorshach helped.

I was mostly over in learning disability, ADHD, and educational assessments, intelligence tests, child behavior tests.  That’s what psychologists are trained to do, specifically that.  Assessments.  Design assessments, develop assessment instruments, research assessment, clinical assessment, personality, behavioral… that’s what we do.  All things assessment, that is spot-on the professional specialty of clinical psychologists.

Psychiatrists  prescribe medication, MFTs provide therapy, architects build buildings, plumbers fix sinks, psychologists do assessment.  That’s what we do.  Day two with Dr. Childress is assessment of this pathology.

I’m going to start with a collection of skill sets.  So the morning of day two I’m going to discuss the behavior-chain sequence and behavior-chain interviewing (before-during-after; thoughts-feelings-actions) and I’m going to describe stimulus control.  This is from Applied Behavioral Analysis. 

Another assessment skill will be response to intervention.  This diagnostic skill will be used during the afternoon’s discussion of the six sessions of the clinical assessment protocol, it’s used during the sessions with the children and parent together.  Change things and see what happens.  Change what things?  That’s what we’ll talk about.  It’s called response-to-intervention (RTI). Used extensively in school-based psychology and is sometimes used by psychiatrists with medication in achieving diagnostic clarity.

I will close the morning by discussing the Assessment Report.  There are structures for these things.  I will offer examples of several alternative structures for reporting on the results for court-involved pathology… for court-involved pathology.  If the report were headed to the school system and IEP hearings, that has a structure and format based on its function.  These assessment reports should be assumed to be headed to the court.  There’s a format to clinical psychology reports.

If a report is to be used in court-involved family conflict, then it should consider certain professional standards of practice in format.  Clinical psychology reports are not child custody reports.  We are streamlined and we are efficient, and we do not disclose private information without a purpose.  If private information is not relevant to the diagnosis or treatment, then it is not relevant for disclosure in a report for distribution.  If the content area is of note, then we frame the issue with as much protection of privacy as possible in the report.

Clinical psychologists are not forensic psychologists.  We don’t disclose privacy unless it’s relevant to the solution, and then only as much privacy as is relevant to the solution.  Even if we can, we don’t.  That’s clinical psychology.  We’ll talk about reports from clinical psychology on the morning of the second day.

On the afternoon of the second day, I’m going to talk about each of the six sessions of a treatment-focused assessment protocol.  Sessions one and two are with each parent individually.  Doesn’t really matter which one you start with, advantages and disadvantages to each option.  Then two sessions with the targeted parent and child together.  You want to see the child’s symptoms directly, and the targeted parent’s behavior.  This is where behavior-chain interviewing and response to intervention probes come in.  Then two sessions to finish the assessment protocol, one with each parent.  Provide them with feedback from your assessment and note their response. This is an assessment of their schema organization for processing information.

That’s the afternoon of the second day.  Day two is entirely assessment.

Then I have a day off.  Dorcy is going to talk to them.  Yay for that.  They will learn oodles from her.

I’ll let Dorcy decide on what she tells the mental health people.  I’ll be with my popcorn in the back.  She has dealt with mental health professionals for so long, some huge number of ineffective mental health people in childhood family conflict, and lots and lots of mental health people now that she’s working with this court-involved pathology.  I have complete confidence that she know exactly what they need to learn.

She was that child, in that family.  She recovers that child, in that family.  I am a psychologist consultant to her. I have co-presented with her at the AFCC national convention in Boston, and at the APA national convention in Chicago.  I have received a client from the High Road workshop and I served as the maintenance care provider for the family.

As far as I’m concerned, the High Road workshop is evidence-based practice for recovery of children from complex trauma and child abuse.  The High Road ABA single-case data is remarkable and compelling.  The High Road workshop is phase B on that chart.   A rocket from 1s and 2s to 5s and 6s. Two days.

She recovered the child’s healthy normal-range emotional and psychological development in two days, after three years of documented child abuse by the father, documented by three separate mental health professionals over the three year period.  Two days, full recovery.

Not a doubt in my mind that Dorcy will provide the mental health professionals with valuable information for recovering kids from complex trauma and child abuse.

She also has three things beyond her knowledge, the High Road workshop, a parenting curriculum, and the Custody Resolution Method.  Court-involved psychologists should learn about all three.  Learning the skill sets for maintenance care is also valuable in case you get a client out of a High Road workshop.  She is not training in how to do the High Road workshop.  She is providing knowledge on recovering children from complex trauma and child abuse.

You’ll get more practical information from Dorcy in ten minutes than you’ll get from hours of AFCC lectures.  If they could solve it, they’d solve it.  Dorcy solves it, empirically validated.  She collects PC-RRS outcome data on every single workshop client.  Collect follow-up PC-RRS data, and there’s your replication. Every single workshop is a single-case ABA research quality clinical intervention, N=1.  That is the highest quality of clinical intervention, a single-case ABA design.

Yeah, she’ll figure out what to tell them.

Fourth day, Dr. Childress and Dorcy Pruter talk treatment and solutions in a family therapy context.  There will be discussion of solution-focused therapy and trauma pathology, of parent and child support, and of written treatment plans.  Examples of written treatment-plan components will be discussed.  Outcome measures will be discussed. 

Family therapy insights from Cloe Madanes, from her 2018 book Changing Relations: Strategies for Therapists and Coaches will be discussed.  Strategic family systems therapy.  Very powerful.  I’ll introduce the Contingent Visitation Schedule, a Strategic family systems intervention designed for this type of trans-generational trauma pathology.  Fourth day morning, family therapy and family solutions.

On the afternoon of the fourth day, I will discuss the ABAB single case clinical intervention and assessment protocol.  Dorcy absolutely loves the single-case ABAB design, and she’s right.  Single case research methodology applied in a clinical setting is considered the highest caliber of assessment and intervention. Each case is a research study with an N=1. 

In the application of the single-case ABAB design to assessment and intervention, the child is systematically moved through a structured series of steps, conditions, the A-B-A-B sequence, and the child’s response is measured using a designated outcome measure.  There is no doubt on establishing causality and the solution using the single-case ABAB design. It is an established research design used for exactly this purpose when applied in clinical practice; to determine causality and solution.

Dorcy loves it, the ABAB single-case assessment and remedy.  I keep telling her that she won’t find anyone in forensic psychology world to run an ABAB single-case clinical intervention.  We’d have to grab someone from autism world or school learning disabilities and cross-train over to high-intensity family conflict.  Welcome to the jungle.  My poor little autism therapist or school-based learning disabilities therapist would be over-matched trying to handle this high-intensity family conflict pathology.  Eaten alive.

It’s gotta come from trauma and IPV.  Running the ABAB single case protocol has to come from trauma and IPV pathology, we can cross-train to the program’s structure.  Easy-peasy, simple as pie.  Single-case research protocols are simple.  Define the phases, define transition criteria, identify the outcome measure, move though the sequence of phases collecting data.  Not complicated, just gotta stay structured to the defined criteria, collect data.  The data will answer the questions.

The afternoon of day four, I’ll speak to the ABAB single-case design.  Dorcy likes role-play active experiential learning.  I’m lazy, I’ll let her do that.  We’ll see how much of an Eveready bunny she is on the afternoon of the forth day.

Then, after the first of the year I’ll start online clinical case consultation groups.  These will be with four or five clinicians, once a month clinical case consultation discussions for six months.  I would anticipate each participant in the consultation group to have one or two scheduled case presentations during this period, and still allow time for material of the moment.

These are separate from the November and spring trainings, but enrollment is limited to participants in a training series with me.  I don’t want to teach basic things at the same time as provide clinical psychology consultation on a client.  Know basic things, so we can talk psychotherapy with a complex and difficult client system.  Once we work together in a seminar to establish the basic stuff, then clinical consultation groups with Dr. Childress become available. 

Six month series, four to five therapists, based on demand.  Each participant is anticipated to present a scheduled case presentation at least once during this six month period.  Ongoing case material will also be addressed.  Don’t share identifying patient information, confidentiality is maintained, and a collective decision-making approach of inter-professional consultation on difficult cases improves the quality of professional care by improving the quality of professional decision-making.

The clinical case consultation groups depend on demand.  Four to five clinicians.  One group.  More, two groups.  More, three groups.  No demand, no groups.

I’m a resource.  You’re the ones who need to do this, you, the mental health people. That’s your client in your office. I’m in Southern California.  That family is not my client.  I’m a resource to you, you’re the source of change for this family.  You’re the catalyst, change will occur because you apply knowledge to solve pathology. 

I’ll do what I can to provide support.  You, the mental health professional, are the source of change.  Your power is diagnosis.  You’re licensed to identify and diagnose pathology.  That’s what your license means.  We need an accurate trauma-informed diagnosis for the child and family, so we can develop an effective treatment plan.

The courts and children deserve the highest quality in professional standards of care.  That’s considered standard of practice in clinical psychology.  In clinical psychology, competence is defined as knowing everything there is to know about that pathology, and then reading journals to stay current.  That means if you’re treating attachment pathology, you know everything there is to know about the attachment system, and then read journals to stay current.  Same for the trans-generational transmission of trauma, same for family systems therapy, everything there is to know, then read journals to remain current.

Dust off your copy of Boszormenyi-Nagy’s Invisible Loyalties: Reciprocity in Intergenerational Family Therapy.  Everything to know, and then read journals to remain current.

If that’s too much, then don’t work with children and the courts.  Decisions made by the court are too important in the lives of these children and these parents.  Expected standard of practice for professional competence is to know everything there is to know about the pathology, and then read journals to remain current.

That was the standard of practice at UCLA when I worked there. That was the standard of practice when I worked at Children’s Hospitals.  That was the standard of practice at UCI when I worked there.  That has been the expected standard of practice everywhere I have ever worked… know everything there is to know about the pathology, and then read journals to stay current.  That is the standard of practice for court-involved family conflict.  Because that’s just the expected standard of practice in clinical psychology.

In November, I’ll begin teaching to that standard.

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