International: England

In addition to changes occurring here in the United States, I am attending to the situation internationally as well.

In 2019, I was invited to present at a conference in the Netherlands and I had an invited meeting with representatives of the Dutch Ministry of Justice along with Ms. Pruter. We recommended developing a pilot program for the family courts in the Netherlands with university involvement (Maastricht University?) to conduct the outcome evaluation research.

In the fall of 2019, I traveled to Barcelona to meet with the parents there. There are a set of YouTube videos available online that were made by the parents from my Q&A with them. I would recommend the same thing for Spain as we recommended in the Netherlands, a  pilot program for the family courts with university involvement to conduct the program evaluation research.

I have testified in Canada, Sweden, and New Zealand, and I have written reports providing an analysis of English mental health reports. I am attending internationally. My focus is on the U.S. because as professional psychology in the U.S. goes, so international professional psychology will follow. Once knowledge breaks through the ignorance – knowledge will provide solutions and knowledge belongs to everyone.

We are changing the world for all children everywhere. We never abandon a single child to child abuse. Not one. We’re coming, one-by-one if need be… it shouldn’t be needed, they have obligations they are not meeting – Standard 2.04 for the application of knowledge – Standard 2.01 to know the knowledge – Competence. Each ethics code for all levels of professional both in the U.S. and internationally have Standards requiring professional competence.

International – England & Ireland

I am attending with focus to both England & Ireland – because I only speak English, other nationalities will need to adjust to my limitations. My personal focus is on Ireland, and I plan a personal trip there once Covid leaves us and we can return to travel. My professional interest is with England, with a focus on Cafcass.

I recently had an English parent contact me about my potential involvement in their matter. This parent is wanting to make an argument to the court for a treatment-oriented approach to the resolution of the family conflict that is currently locked in the courts.

This parent is representing without legal counsel (it’s too expensive for the parent’s means), and the parent asked if I would be available in the matter for consultation with the involved psychologists regarding a treatment-oriented solution rather than a custody-focused orientation.

I said I was available for a second-opinion consultation with the involved mental health people in England if they or the court believed this would be helpful.

I am providing my email response to this parent on this blog to provide the information in my response to this parent more broadly to all parents – foreign and domestic – for your possible use in your matters.

Knowledge belongs to everyone.

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Response to English Parent

Based on your description, I have two concerns, 1) Informed Consent for treatment, and 2) potential misdiagnosis of a shared persecutory delusion.

Informed Consent:

The issue of informed consent to treatment in healthcare rose to prominence after WW-II and the “medical” experiments performed in German concentration camps. In the United States, this horrific experience following WW-II resulted in the Belmont Report that guaranteed patient rights to informed consent to research – both parts – informed and agree.

In clinical psychology, this principle extends to the informed consent to treatment, and every professional ethics codes requires patient informed consent to treatment.

Indications in your current circumstances are that you have not been informed of the diagnosis that is being “treated” with a “treatment” of non-specific description, and by all indications the diagnosis for the “treatment” is a misdiagnosis. Furthermore, by all indications, you do not agree to the treatment being suggested. By all indications of your reporting, you are not informed and you do not give consent to the treatment.

British Psychological Society Code of Ethics

3.1 Respect

Respect for the dignity of persons and peoples is one of the
most fundamental and universal ethical principles across
geographical and cultural boundaries, and across professional
disciplines. It provides the philosophical foundation for many
of the other ethical Principles. Respect for dignity recognises
the inherent worth of all human beings, regardless of perceived
or real differences in social status, ethnic origin, gender,
capacities, or any other such group-based characteristics. This
inherent worth means that all human beings are worthy of
equal moral consideration.

Statement of values: Psychologists value the dignity and worth
of all persons, with sensitivity to the dynamics of perceived
authority or influence over persons and peoples and with
particular regard to people’s rights. In applying these values, Psychologists should consider:

• • • Privacy and confidentiality;
    • Respect;
    • Communities and shared values within them;
    • Impacts on the broader environment – living or otherwise;
    • Issues of power;
    • Consent;
    • Self-determination;
    • The importance of compassionate care, including
      empathy, sympathy, generosity, openness, distress
      tolerance, commitment and courage.

You will want a second opinion on the diagnosis and treatment plan being offered.

Misdiagnosis and Competence

By all indications from your reporting, a proper assessment for a possible thought disorder, a shared persecutory delusion (ICD-10 F24), was not conducted. By all indications, a proper risk assessment for possible child psychological abuse was not conducted (ICD-10 T74.32). By all indications, a proper risk assessment for possible Intimate Partner Violence (IPV) involving the emotional and psychological abuse of the mother by the father using the child as the weapon was not conducted (ICD-10 T74.31).

Note my citation in the flagship peer-reviewed journal of the Association of Family and Conciliation Courts (AFCC), Family Court Review:

From Walters & Friedlander: “In some RRD families, a parent’s underlying encapsulated delusion about the other parent is at the root of the intractability (cf. Johnston & Campbell, 1988, p. 53ff; Childress, 2013). An encapsulated delusion is a fixed, circumscribed belief that persists over time and is not altered by evidence of the inaccuracy of the belief.”

References:

Childress, C. A. (2013). Reconceptualizing parental alienation: Parental personality disorder and the trans-generational transmission of attachment trauma. Retrieved from https://drcachildress.org/wp-content/uploads/2019/11/Reconceptualizing-Parental-Alienation-Parental-Persoonality-Disorder-an-the-Trans-generational-Transmission-of-Attachment-Trauma-Childress-2013.pdf

Walters, M. G., & Friedlander, S. (2016). When a child rejects a parent: Working with the intractable resist/refuse dynamic. Family Court Review, 54(3), 424–445. https://doi.org/10.1111/fcre.12238

I am also attaching a handout regarding my specialized domains of professional expertise based on my education, training, and experience.

Domains of Specialized Expertise: Dr. Childress

Professional Competence is a requirement of all professional ethics codes

British Psychological Society Code of Ethics

3 .2  C O M P E T E N C E

Our members offer a range of services that usually require specialist knowledge, training, skill and experience. Competence refers to their ability to provide those specific services to a requisite professional standard. Members should not provide professional services that are outside their areas of knowledge, skill, training and experience.

Statement of values: Members value the continuing development and maintenance of high standards of competence in their professional work and the importance of working within the recognised limits of their knowledge, skill, training, education and experience. In applying these values, members should consider:

• • • Possession or otherwise of appropriate skills and care needed to serve persons, peoples and organisations;
    • The limits of their competence and the potential need to refer on to another professional;
    • Advances in the evidence base;
    • The need to maintain technical and practical skills;
    • Matters of professional ethics and decision-making;
    • Any limitations to their competence taking mitigating actions as necessary;
    • Caution in making knowledge claims.

The assessment for delusional thought disorder pathology is a Mental Status Exam of thought and perception.

Thought and Perception

The inability to process information correctly is part of the definition of psychotic thinking. How the patient perceives and responds to stimuli is therefore a critical psychiatric assessment. Does the patient harbor realistic concerns, or are these concerns elevated to the level of irrational fear? Is the patient responding in exaggerated fashion to actual events, or is there no discernible basis in reality for the patient’s beliefs or behavior?

Of all portions of the mental status examination, the evaluation of a potential thought disorder is one of the most difficult and requires considerable experience. The primary-care physician will frequently desire formal psychiatric consultation in patients exhibiting such disorders.

From the American Psychiatric Association

From the APA: “Usually the primary case in Shared Psychotic Disorder is dominant in the relationship and gradually imposes the delusional system on the more passive and initially healthy second person… If the relationship with the primary case is interrupted, the delusional beliefs of the other individual usually diminish or disappear. Although most commonly seen in relationships of only two people, Shared Psychotic Disorder can occur in larger number of individuals, especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent’s delusional beliefs.” (American Psychiatric Association, 2000, p. 333)

From the APA: “Course – Without intervention, the course is usually chronic, because this disorder most commonly occurs in relationships that are long-standing and resistant to change.  With separation from the primary case, the individual’s delusional beliefs disappear, sometimes quickly and sometimes quite slowly.” (American Psychiatric Association, 2000, p. 333)

By all indications of your reporting, you will need to obtain an accurate diagnosis of the pathology in your family to guide the development of an effective treatment plan. I am attaching a handout on diagnosis in healthcare.  (Improving Diagnosis in Healthcare)

From Improving Diagnosis: “Diagnostic errors can lead to negative health outcomes, psychological distress, and financial costs. If a diagnostic error occurs, inappropriate or unnecessary treatment may be given to a patient, or appropriate—and potentially lifesaving—treatment may be withheld or delayed.” (Improving Diagnosis in Healthcare, 2015)

From Improving Diagnosis: “Clinicians may refer to or consult with other clinicians (formally or informally) to seek additional expertise about a patient’s health problem. The consult may help to confirm or reject the working diagnosis or may provide information on potential treatment options.” (Improving Diagnosis in Healthcare, 2015)

From Improving Diagnosis: “If a patient’s health problem is outside a clinician’s area of expertise, he or she can refer the patient to a clinician who holds more suitable expertise.” (Improving Diagnosis in Healthcare, 2015)

Consultation Involvement

You requested information to provide the court regarding my possible involvement as a second opinion consultation on your matter. My involvement and its scope depends on how the court and the involved psychologists wish to structure my second-opinion consultation.

You may want to reference my 50-page booklet, Assessment of Attachment-Related Pathology Surrounding Divorce.

I will work-up a formal statement regarding my time that you can submit (attached is my vitae). What my time entails depends on what they want.

I would suggest my involvement on the assessment.  This would be six 90-minute assessment sessions, and a 60-minute professional-to-professional consultation before and after with the involved assessing psychologist. Then I anticipate 4 hours in report writing.

• • • Six 90-minute sessions = 9 hours,
    • Two professional-to-professional consultations = 2 hours
    • Report writing = 4 hours.

Total time = 15 hours

OR… I can provide a single 90-minute consultation at the start with the assessing psychologist and then review and provide an opinion on the report afterwards. My report-writing time will be more extensive since I was not part of the interviews and I estimate between 10-20 hours for an analysis of a completed report, dependent on the report.

• • • One  90-minute session = 1 1/2 hours
    • Report writing = 10 hours

Total time = 11 hours

OR… they may simply want two consultation hours, one before and one after, with no review and report from me of the outcome product.

• • • Two 90-minute sessions = 3 hours

Total time = 3 hours

OR… they may want my in-session consultation on a Mental Status Exam of thought and perception with the allied parent and child, that would be two 90-minute sessions and two 90-minute consultations, one before and one after. An additional report would be approximated to be 4 to 10 hours.

• • • Two 90-minute MSE sessions = 3 hours
    • Two 90-minute consultation sessions = 3 hours
    • Report writing = 4 hours

Total time = 10 hours

OR… they may decide that their needs are met in some other consultation format.

OR… they can read my book Foundations and booklets:

Assessment of Attachment-Related Pathology Surrounding Divorce

Contingent Visitation Schedule

Single-Case Assessment & Remedy

The Narcissistic Parent

A time estimate depends on what I am being asked to do. The more I’m asked to do, the more time I will spend. Professional-to-professional second opinion is immensely common throughout all of healthcare. The healthcare professionals in England should be familiar with the process of obtaining a second opinion. The extent and nature of the services provided by the consultant are dependent on the needs and existing knowledge of the involved professionals.

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