Exploitation of a Vulnerable Population

I should discuss my consultation practice. You are a “vulnerable population” and I need to be careful with you.

You are what’s considered a “vulnerable population” in professional psychology because of your compromised autonomy in decision-making due to the court’s involvement in your lives, and because of the immense emotional distress and need you are experiencing.

That makes you vulnerable to exploitation.

Psychologists are not allowed to directly market to possible mental health clients because of your vulnerability. But we have to earn a living. Often the way we recruit into our practice is by giving lectures and talks to the target population of our referral base, such as to PTAs for a school=based practice, or to autism parent groups if that’s where we are, and we leave our cards in the back of the room for people to take.

We also collect into professional groups and then refer among our colleagues based on our personal connections within these groups, “You should go see so-n-so, they specialize in that.”

You families in the courts are even more vulnerable, and you qualify as a special designation within professional psychology – a “special population” (like prisoners) – because of your compromised autonomy in decision-making surrounding your life resulting from the court’s involvement.

You are vulnerable to exploitation – and – you are being financially exploited by all the professionals around you. They take your money and solve nothing. That’s called financial exploitation of a vulnerable population.

I need to tread carefully with you when I discuss my consulting practice. I make my living from you – and – you are a needy population and an especially vulnerable population.

I’m fine making my living from you – I’m a clinical psychologist, it’s my job. My current practice is fine without you entering my practice, there are enough clients coming to me that I do not necessarily need to recruit more – there is always a risk of exploitation with a vulnerable population.

Spousal Financial Abuse

The primary difficulty surrounding your vulnerability is the potential financial spousal abuse of the targeted parent by the narcissistic-borderline Dark Triad-Tetrad personality, using the court system and the high cost of attorneys to drain the targeted parent of the financial resources they need to protect themselves and their child.

To the extent that forensic custody evaluations charge parents from $20,000 to $40,000 for a custody evaluation that solves nothing, this represents financial exploitation of a vulnerable population by the forensic psychologists and participation in the spousal financial abuse of the targeted parent.

The forensic psychologists are participating in the spousal financial abuse of the targeted parent by exploiting the vulnerability of these parent rather than solving the pathology in the family. They take the parent’s money for an activity – but that activity solves nothing and the family continues to its destruction.

The forensic psychologists are participating in the financial spousal abuse of the targeted parent by the narcissistic-borderline Dark Triad-Tetrad personality parent. I won’t participate.

I make my living from your families – from human suffering – I’m a clinical psychologist, it’s my job to go to the suffering to help lessen it and hopefully end it. I’m a trauma psychologist out of foster care, this is my pathology, child abuse and complex trauma. Specifically, the trans-generational transmission of trauma.

We need outside and independent review of the practices in court-involved professional psychology – of everyone. You are a vulnerable population and you warrant professional designation as such, subject to additional safeguards and protections surrounding your compromised autonomy in decision-making regarding your life because of the court’s involvement.

We need to develop procedural safeguards and steps to protect this vulnerable population from exploitation of their vulnerability by the surrounding mental health professionals.

Until that occurs, how do you protect yourself from exploitation?

Get a second opinion for your decisions. Talk to a family member support person, discuss your options with your attorney. In the legal system, always follow the advice of your attorney. In the healthcare system, follow the advice of your doctor. If there is a question about their advice, get a second opinion.

You have a court-involved problem that needs a healthcare solution.

Dr. Childress Consulting Practice

I have a clinical psychology (treatment) consulting practice in the courts surrounding divorce, parent-child attachment pathology, and child custody conflict. I don’t do direct treatment anymore, I have no real-world office. I am an old clinical psychologist in a consulting practice now.

Once things settle-down in the family courts, I may develop a private online psychotherapy practice with something OTHER than court-involved family conflict.

Currently, I hold general public consultations the first week of every month at my online office (doxy.me/drchildress) with scheduling through my website. For non-California residents, I limit these general public consultations to one session (maybe two depending on circumstances).

Attorneys seeking consultation on any mental health issue (I am a full-service clinical psychologist in the domains of by expertise) can contact me directly through my email at: drcachildress.bainbridge@gmail.com.

I am typically engaged in three possible roles:

1) Content Expert Testimony – I am provided with no material specific to the situation and my testimony is limited to the knowledge domains of professional psychology.

I bill my expert testimony separately from any other scope-of-service agreement, and I bill in 4-hour blocks of time reserved from my schedule for testimony at my standard clinical rate.

2) Document Review & Consultation – I am provided with material from the attorney to review, typically surrounding mental health reports (and perhaps some additional material) to provide an opinion from clinical psychology on the material reviewed. My involvement is developed through a scope-of service-agreement developed with the attorney and their client.

I bill to the scope of service agreement, not to my hours. For my billing purposes, I think in small-package (one or two therapy reports with minimal additional information), or large-package (a forensic custody report or complex cases with extensive information needing to be reviewed). I provide the client with a set-fee for the scope of service sought, this provides the parent-client with a set cost for my involvement for the scope of service.

3) Second-Opinion Consultation on Active Assessment – In this role, I am engaged as a clinical consultant to the involved mental health professionals in conducting a current clinical assessment with the family. The Tele-Health Consulting Handout available on my ‘gold-trees’ Consulting website Attorney Resources section contains more information about options for my clinical second-opinion consultation with the involved mental health professionals.

You are a vulnerable population who warrant additional safeguards and protections from exploitation by the involved mental health professionals – I am an involved mental health professional.

Protections come from established standards of practice, such as those required by the APA ethics code. Additional protections are afforded by second-opinion consultations.

If you are considering involving Dr. Childress into your matter, I recommend you seek a second opinion from someone else that you trust – hopefully you trust your attorney, and that should be the person whose judgment you should rely on when navigating the legal system.

Other trusted family members or close friends can provide valuable counsel in decision-making.

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

Court-Involved Clinical Psychology

I wrote this email to an attorney. I am sharing it more broadly here on my blog:

I am defining a role – a court-involved clinical psychologist – treatment not custody.
 
It’s a dangerous world for us here – the pathology is dangerous and opposing counsel wants to discredit us in any way possible.
 
That’s why no one comes. We’ve abandoned you to your own “special” psychologists and they are the worst imaginable. We don’t care. If you threaten us… we won’t come – good luck.
 
It’s a passive-aggressive response from clinical psychologists – fine – we don’t care, good luck with your own “special” psychologists, and then we walk away – We’re Pilate washing our hands of the courts and allowing the sacrifice of the innocent, of our children… until you’re finished and you want our help.
 
I’m the first back because this is my pathology. I’m a trauma psychologist out of foster care, I’m not from here, I’m from there and I’ve come back.
 
It is immensely dangerous for me here. The pathology wants my license, the opposing counsel wants my license, the DV-monkeys want my license, the forensic psychologists want my license (witness Oregon). No one will work with these families, and I am alone and entirely exposed to a lot of people who want to hurt me for what I’m doing in the courts.
 
We, the clinical psychologists, don’t care about you or the families in the courts. I am NOT putting my license on the line for this nightmare conflict that no one wants to solve – so we’ve given you your own “special” psychologists… leave me alone. They will not come because you threaten their license. If you lost your law license whenever you lost a case in the family courts, would you work in the family courts if you always had to win, with so many people actively going after your law license all the time?
 
It’s a passive-aggressive thing from clinical psychology to the courts… screw you… we’re not coming. Good luck.
 
I’m back. My task is to make it safe for the others to return. Walk where I walk, step where I step, and you’ll be safe.
 
I’m a “judge” in healthcare – I’m a doctor – same level in my system as judges in yours. We don’t have attorney-advocate roles, we don’t need advocates in healthcare, my diagnosis is always accurate (if there’s a question, I get an immediate appellate decision from a second-opinion consult), we turned that role into nurses to assist in our care.
 
Judge & attorney – Doctor & nurse
 
As a court-involved clinical psychologist, I’m one “judge” talking across systems to another judge. I’m not part of your attorney taking-side thing.
 
I’m a doctor. I always stay a doctor. When I move systems I become evidence, but I’m still a doctor-in-evidence, I’m never part of your system. Forensic psychologists forgot that and have lost their way.
 
I don’t work for you or your client – I work for the child, that’s who holds my “duty of care” obligations as a doctor (like parens patriae for my counterpart). In a family my client is always the child, and then it broadens out. When the court is involved, I get a second client, the Court.
 
I now have two clients, the child in the matter and the Court. I don’t work for you or your client, you’re the ones who are the connection from one “judge” in healthcare to the judge in the legal system.
 
I have to do right by the child – I have to do right by the Court. Sometimes the parent-attorney may not like everything I say to the Court, but I have an obligation to the Court as my client to not take sides –  a “judge”-to-judge obligation as a doctor. I’m treatment not custody.
 
Because of that, the Court can trust my opinion as a doctor, and it can rely on my doctor-opinions from the “judge” in healthcare for its decisions – I don’t intrude on the Court’s jurisdiction, I’m entirely treatment. I remain in my world and role.
 
The reason the attorney-and-parent want me involved is not because I’m on their side, but exactly because I’m not – they may not like everything I say, but the Court will appreciate my role. It’s to the Court’s decision not mine. The legal system has advocates, they’re called attorneys. I remain contained in my role.
 
As a doctor reviewing my own in my healthcare system, I’m an appellate judge. I can apply the criteria to the evidence and see if things were properly done. I’m not the trial “judge” – my strongest recommendation is that another “trial” in my system needs to be conducted, and I kick the decision-made back to a lower-“court” for retrial.
 
The appellate judge does not retry the case. Nor do I as a doctor, I don’t have “duty of care” for the family. I always have duty to protect obligations when I’m in any professional role.
 
I’m defining a role. I’m bringing my people back, the clinical psychologists – they will refuse to come – good luck.
 
I am focusing on the DBT therapists because they’re my trauma people – they’re tough enough for personality pathology, they have the model for personality pathology, and they won’t be afraid to come if they can bring their DBT model.
 
That’s where things stand.
 
The therapies that will be coming here once we get them here will be DBT first, “informed” by EFT. Either one of those as the point-person (if they agree) would serve for assessment with telehealth consultation support.
 
 
 
We are building the plane while flying it – we need local airports to land at – their current runways are too small. I can help them enlarge their runways to increase capacity – that’s the phase we’re in right now with mental health… it’s called “developing and increasing capacity” in the mental health system to meet the needs of the court.
 
I keep a Current Vitae on my Consulting Website – Attorney Resource page.
 
Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857

Gardner PAS “experts” Are No Longer Relevant

The Garnerian PAS “experts” are no longer relevant to professional discussion.
 
The Gardnerian PAS “experts” let by Bill Bernet, Linda Gottlieb, Demosthenes Lorandos, Jennifer Harman and others represent a fringe group of marginal professionals who are substantially outside the mainstream of professional psychology.
 
The Gardnerian PAS “experts” reject the diagnostic guidance of the American Psychiatric Association and they reject the ethical guidance of the American Psychological Association. They are unwise and reckless, and they are practicing substantially outside the boundaries of their professional competence.
 
They rely on “new pathology” proposals because they are ignorant of the actual established scientific and professional knowledge of the discipline. They are reckless, unprofessional, and unethical.
 
As a licensed clinical psychologist, I have active duty to warn and duty to protect obligations relative to the Gardnerian PAS “experts”. In two separate matters in which I am personally involved, I have an identifiable victim in imminent danger directly as a result of the reckless, unethical, and irresponsible actions of Dr. Bernet, Dr. Lorandos, Ms. Gottlieb, and Dr. Harman.
 
Criteria are met for my duty to protect obligations and for my duty to warn obligations – on two separate matters – one involving Drs. Bernet and Lorandos, and a separate matter involving Ms. Gottlieb and Dr. Harman.
 
I anticipate that all four of those individuals will likely find themselves at the center of professional controversy. I anticipate Ms. Gottlieb will surrender her license and that Dr. Harman may lose her academic appointment.
 
To be clear – the Gardnerian PAS “experts” represent a fringe group of ‘professionals’ who are substantially outside the mainstream of professional psychology. They believe they are smarter and know more than the American Psychiatric Association about diagnosis, and they disregard their ethical obligations as professionals.
 
Ms. Gottieb developed a 4-day “intensive” therapy completely of her own devising, unlike any other form of therapy in professional psychology. No 4-day treatments exist for any other pathology – not depression – not anxiety – not ADHD – not Oppositional-Defiant Disorder, not eating disorders, not substance abuse, not trauma… in no other pathology in any field of psychology is there a 4-day “intensive” treatment.
 
Ms. Gottlieb took it upon herself to create a 4-day intensive “therapy” of her own devising, something no one else has ever done before… this is her educational background to accomplish this task:
 
MSW, Adelphi University of Social Work 1980
BA, City College of the City of New York 1968
 
She graduated city college in 1968, 50 years ago, and she became a social worker forty years ago in 1980.
 
That is the entirety of Ms. Gottlieb’s educational background that prepares her to develop a new “intensive” 4-day therapy unlike anything that exists anywhere in any domain of professional psychology.
 
Ms. Gottlieb believes she’s a special “expert” in a new form of pathology that she’s an “expert” in – the reason she’s an “expert” in this new form of pathology is because she tells us she is.
 
This is the list of ethical concerns surrounding Ms. Gottlieb’s Turning Points program:
 
APA Ethics Code
 
• Standard 2.04 Bases of Scientific and Professional Judgments
• Standard 2.01 Boundaries of Competence
• Standard 9.01 Bases for Assessment
• Standard 10.01 Informed Consent for Therapy
• Standard 5.01 Avoidance of False and Deceptive Statements
• Standard 3.04 Avoiding Harm
• Standard 2.03 Maintaining Competence
 
NASW Ethics Code
 
• Standard 1.04 Boundaries of Competence
• Standard 4.04 Dishonesty Fraud and Deception
• Standard 1.02 Self-determination
• Standard 1.03 Informed Consent
• Standard 2.05 Consultation
• Standard 4.07 Solicitations
• Standard 5.01 Integrity of Profession
 
To say that Linda Gottlieb is ethically challenged is clearly evident in her reckless behavior.
 
By all indications, the Turning Points program is a ‘bait-and-switch’ on the courts. She seemingly makes promises to the court and parents of a 4-day treatment that requires a 90-day no-contact order from the court toward the other parent.
 
By all indications, no change occurs in the child’s rejecting attitudes, beliefs, or opinions in the 4-day “treatment” of Ms. Gottlieb’s devising. By indications, she collects no outcome measures and her “treatment” is entirely unsuccessful in changing anything.
 
At the end of the 90-day no-contact period, when no attitude or belief change has occurred from Ms. Gottlieb’s failed “treatment”, she then asks the court for an extension of the 90-day no-contact because there has been no change in the child.
 
When there continues to be no change in the attitudes and beliefs  at the end of this 90-day no contact period, Ms. Gottlieb then requests another extension of the 90-day no-contact period – that is her “treatment” – the continued extension of the no-contact period with the other parent – because she has no treatment other than that.
 
Her “4-day” treatment appears to be a bait-and-switch on the courts and parents to get her foot-in-the-door. Once she’s obtains the court order for no-contact and obtains control of the situation, – she dominates and controls everyone to her will with the threat of extending the no-contact order unless the child submits to Ms. Gottlieb’s will and beliefs.
 
By all indications, her grueling 4-hour marathon “therapy” sessions each day with the child would meet criteria for an “invalidating environment” of borderline personality processes (Linehan).
 
Ms. Gottlieb is old, misguided, and reckless. Her judgement should not be relied on and her professional practices are unsound. The Turning Points “therapy” of Ms. Gottlieb’s sole devising warrants and will certainly receive additional administrative review.
 
Dr. Harman conducted a highly questionable “research” study in support of Turning Points and Ms. Gottlieb that looks very much like a pre-determined biased marketing use of Dr. Harman’s role-and-credibility with her university standing for an intentional marketing purpose. I anticipate the academic institution of Dr. Harman will be reviewing her methodology.
 
I anticipate Dr. Harman is not long for the academic community. Her research standards are highly suspect and warrant, and will likely receive, additional review from her academic institution.
 
Ms. Gottlieb and the rest of this fringe group of professionals present clear and imminent risk to children and to the general public. I have two identifiable victims in two separate matters who are at risk of harm directly because of the reckless, irresponsible, and unethical activity of Dr. Bernet, Dr. Lorandos. Ms. Gottlieb, and Dr. Harman.
 
My duty to protect and duty to warn obligations as a clinical psychologist are active. I have mandated – required – obligations under Standard 1.05 of the APA ethics code.
 
1.05 Reporting Ethical Violations
If an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under Standard 1.04, Informal Resolution of Ethical Violations , or is not resolved properly in that fashion, psychologists take further action appropriate to the situation. Such action might include referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities.
 
Of note is that I have been in consultation with my own personal consultant for the past two years – a PhD psychologist who is also an attorney, his practice specialty is consulting with mental health professionals on ethical issues. I engaged him when the Oregon board matter first arose.
 
He is in agreement with my perceptions and that my ethical obligations are active under Standards 1.04 and 1.05 of the APA ethics code relative to both the forensic custody evaluators and the Gardnerian PAS “experts”.
 
Criterion 1: An apparent ethical violation has substantially harmed or is likely to substantially harm a person – met.
 
Criterion 2: It is not appropriate for informal resolution under Standard 1.04, Informal Resolution of Ethical Violations , or is not resolved properly in that fashion – met.
 
Obligation: Psychologists take further action appropriate to the situation.
 
What “further action” am I required to take that is appropriate to this situation?
 
I have two separate matters, one where Lorandos & Bernet (2020) is being used by the incompetent forensic custody evaluator as the reason to argue that there is NO “parental alienation” in the family so the child should be left with the abusive allied parent.
 
In the other matter, Linda Gottlieb so far overstepped professional standards of practice that she will likely surrender her license, and Dr. Harman’s “research” will likely receive addition review from her academic institution.
 
What is the “further action appropriate to the situation” I am required to take under Standard 1.05 of the APA ethics code? – mandatory, not optional, ethical Standards of practice are mandatory.
 
Dr. Bernet, Dr. Lorandos, Ms. Gottlieb. Dr. Harman, and Ms. Woodall, are all in serious trouble and will likely become increasingly focused toward their own personal concerns surrounding their continued distorted beliefs and practice in the courts.
 
To the extent that Dr. Childress can be called to rebut the testimony of this fringe group of professionals will likely prove problematic for their continued role in the courts as “experts” in anything. If they testify in court, they will likely face repercussions on their licensed status as professionals.
 
I recommend they all leave court-involved practice. They are not needed for any solution, they are a barrier to the solution, they are unethical, reckless, and unprofessional in their actions. They need to go away.
 
They need to work with ADHD or autism, with eating disorders, or substance abuse, with depression or anxiety – anywhere they want except here in the family courts.
 
Their careers here in the family courts are over.
 
It’s coming. As sure as the sun rises – it’s coming. Their time in the family courts is over.
 
Not from me. I’m just a point on a line. They moved into their own self-destruction from their arrogance, ignorance, reckless, and unethical professional behavior.
 
Dr. Childress has active duty to protect and duty to warn obligations with identifiable victims in imminent danger from the reckless and unprofessional behavior of Dr. Bernet, Dr. Lorandos, Ms. Gottlieb, and Dr. Harman. Dr. Childress has active mandatory ethical obligations under Standard 1.05 of the APA ethics code. My consultant agrees with both.
 
Ethical practice is not optional. It is mandatory – required.
 
Dr. Bernet believes he knows more about diagnosis than the American Psychiatric Association. Dr. Bernet believes he is right and the American Psychiatric Association is wrong.
 
Bill Bernet is wrong, the APA is right.
 
Dr. Childress agrees with the American Psychiatric Association.
Dr. Bernet does not.
 
The Gardnerian PAS “experts” are a fringe group in professional psychology who reject the diagnostic guidance of the American Psychiatric Association and the ethical guidance of the American Psychological Association.
 
They are reckless in their judgment and irresponsible in their actions, and I have active duty to protect and duty to warn obligations.
 
It is a cesspool here. These “professionals” degrade professional standards of practice, they don’t improve them.
 
Parents will want Dialectic Behavior Therapy (DBT; Linehan) adapted to the family courts, informed by Emotionally Focused Therapy (EFT; Johnson).
 
Dialectic Behavior Therapy in a Nutshell
 
The Garnerian PAS “experts” are no longer relevant to professional discussion.
 
Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857

 

Oregon: State Answering Brief

Oregon has filed their answering brief to my appeal of their sanctions for practice in Oregon without a license for a Custody Resolution Method (CRM) consultation report I wrote for CCPI.
 
Oregon statues specifically exempt consultation to “organizations or institutions” from Oregon jurisdictional authority. But the Oregon licensing board disregarded Oregon law and sanctioned me for practice in Oregon without a license.
 
I provided the Conscious Co-Parenting Institute (CCPI) with a consultation report on the CRM data profile they generated from a qualitative research method called Content Analysis and coding of the documented data surrounding the family conflict, such as emails, texts, reports, and court documents.
 
CRM compiles this mountain of raw data into categories of interest using Content Analysis and coding (“tagging”) the data. CCPI codes for the three Diagnostic Indicators for an attachment-based model of “parental alienation” that I describe in my book, Foundations (Childress, 2015).
 
My CRM report provides education surrounding the pathology of concern in high-intensity custody conflicts, i.e., a shared persecutory delusion and cross-generational coalition, I review the frequency counts for the various categories of concern, and I render an opinion based on the frequency counts of data coded by CRM.
 
When significant symptom elevations are indicated by the data, my opinion is that there may be child psychological abuse (i.e., a shared persecutory delusion) and that this possibility should be assessed.
 
That is all I say. I conducted no assessment. I make no diagnosis. I state that repeatedly in my CRM consultation report – I conducted no assessment and I make no diagnosis – the concerns indicated by the CRM data profile need to be assessed. That is all I say.
 
There was no injured party in the Oregon matter. The child turned 18 and ‘aged-out’ of the court’s jurisdiction for custody before my CRM report could be submitted. My CRM report had no impact on the case because it was never submitted into evidence.
 
The mother in this matter was not affected. The father in this matter wanted my consultation report from the CRM data profile. There was no injured party. So who filed the licensing board complaint for practice in Oregon without a license?
 
As a result of my CRM report, the father filed a licensing board complaint against the involved forensic psychologists. The ‘injured’ party was the incompetent and unethical forensic psychologist. The Oregon licensing board opened no investigation of the Oregon forensic psychologist, and instead sanctioned Dr. Childress because my report generated a licensing board complaint against the incompetent and unethical forensic psychologist.
 
Licensing boards do not protect the consumer from unethical professional practice by forensic psychologists, they protect the unethical forensic psychologists from accountability for their negligent malpractice.
 
The Oregon licensing board is seeking to cover-up the unethical malpractice of Oregon forensic psychologists.
 
I am appealing the Oregon board sanctions into the Oregon courts. The licensing boards are controlled by the forensic psychologists, they are covering up for themselves, they are covering up their negligent and unethical malpractice. I am turning to the Oregon courts for a fair and just review of the merits of my position.
 
So far, my appeal of the Oregon sanctions has cost me $20,000 of my own money in legal fees to fight a $7,500 sanction… for the benefit of parents and your children. We need to expose the corruption of the licensing boards who are covering up the unethical malpractice by forensic psychologists.
 
Do the right thing. Don’t worry about outcomes. Outcomes will take care of themselves, do the right thing. The right thing to do is to stand and fight. I was not practicing in Oregon, I never met with the parent, I provided consultation to an “organization or institution”, the Conscious Co-Parenting Institute, on a data profile they generated through a qualitative research methodology called Content Analysis and coding (“tagging”).
 
I will be sharing more information about this matter in upcoming blogs. If, as you learn about this matter, you wish to support me in my battle with the forensic psychologists on the Oregon licensing board – write to the Oregon licensing board expressing your disapproval of sanctions on Dr. Childress rather than a focus on the ignorant, incompetent, and unethical malpractice of Oregon forensic psychologists.
 
Tell the Oregon board your story of unethical malpractice by forensic psychologists. The first defense of the pathogen is to hide. Not anymore.
 
I have already spent $20,000 of my own money and the appeals process is just beginning. I don’t know how long I can maintain the financial expense – I will last as long as I can.
 
You’re costing me money – you and your children. Now is the time. Rise. Stand. Let them hear your voice. Speak your truth to the licensing boards – Standards 2.04, 9.01, 2.01 and failure in their duty to protect. They have obligations, but only if you demand your rights.
 
Oregon has just filed their answering brief, we will now answer theirs ($$$). My attorney has their response. Here are my observations to my attorney to the Oregon appeal answering brief:
 

Thank you.
 
My observations:
 
1. There was no injured party in Oregon. My report resulted in a licensing Board complaint made by the father against the Oregon forensic psychologist. The only injured party was the forensic psychologist who had a Board complaint filed against them. The forensic psychologists on the Oregon board are retaliating.
 
2. There is no such thing as a “preliminary diagnosis.” In healthcare, there is a diagnosis and there is no diagnosis. If you tell me a person has hallucinations, delusions, and conceptual disorganization and ask for my opinion, I’ll say “That sounds like it could be schizophrenia, you should have that assessed.” That is not a “preliminary diagnosis”, that is an opinion based on the information presented. In healthcare, there is no such thing as a “preliminary diagnosis”. I conducted no assessment and I made no diagnosis. I said that repeatedly in my report. How much more clear do I need to be – I conducted no assessment and made no diagnosis.
 
3. Am I allowed to provide a consultation report on a CRM data profile if that CRM data profile is submitted to me by an attorney? Is it only a procedural error on my part in who submitted the CRM report to me? If an attorney had submitted it to me would I have been able to provide a report? Or am I prohibited from providing an opinion on a CRM data profile for an Oregon matter no matter how the CRM data profile is submitted to me?
 
I have consulted with the Trust malpractice carrier on my future liability because of the Oregon sanctions. As a result of their consultation. I am now declining to provide consultation to any Oregon attorney or parent on any matter, and I will not speak to an Oregon resident even once to even find out what they want to talk to me about, by recommendation of the Trust insurance carrier from my consultation for my risk-management.
 
I am involved as an expert witness in other cases across the country. Am I allowed to provide an opinion on a CRM data profile in those cases, or is the Oregon Board prohibiting me from providing an opinion on a CRM data profile under any circumstances? If some circumstances are allowed, under what circumstances? Am I allowed to provide an opinion on a CRM data profile if it is submitted to me by an attorney, but just not if it is submitted to me by CCPI? If I am allowed to provide a consultation report to an attorney, what about to a parent who is representing pro se? Am I allowed to provide a consultation report on a CRM data profile to an attorney and Oregon parent representing pro se, but just not to CCPI who generated the data profile? Or am I only allowed to provide a consultation report on a CRM data profile submitted to me by an attorney, not by a parent representing pro se, and not from CCPI who generated the data profile? Or am I prohibited from providing a consultation report on a CRM data profile no matter who submits it to me?
 
I will need greater clarity on the allowed paths and disallowed paths for submitting a CRM data profile to me, or is the prohibition against my providing a consultation report on a CRM profile absolute no matter how it is submitted to me?
 
This absence of clarity is affecting custody cases nationally. Note the domain of concern – child psychological abuse. The diagnosis of concern in these cases is a potential DSM-5 diagnosis of Child Psychological Abuse (V995.51). Information about possible child abuse by a parent is being withheld from the court’s consideration in multiple cases nationally because I am prohibited from providing an opinion on a CRM data profile that child psychological abuse is a concern based on the symptoms in the surrounding data and should be assessed.
 
Until I have an answer, I have stopped providing consultation to CCPI (which is affecting custody cases nationally) and I have stopped providing any consultation to any Oregon attorney or resident pending further clarification on the allowed and prohibited consultation to CCPI regarding their CRM data profile.
 
Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857

Therapy for Attachment Pathology in the Family Courts

The universe has this. We are part of an integrated weave. This is a narcissistic pathology – the solution must be non-narcissistic. The Age of Experts is over. Apply knowledge to solve pathology. Knowledge belongs to everyone.
 
We each have our role in the solution. I’m a clinical psychologist, assessment, diagnosis, and treatment. That’s my role. I don’t create knowledge, I apply it.
 
I cannot solve this for everyone one at a time. We must come together in our collective approach seeking a solution. My role is to provide consultation from clinical psychology to the families and the court regarding assessment, diagnosis, and treatment of pathology.
 
In this case, high-intensity family conflict and severe attachment pathology surrounding divorce.
 
There are no clinical psychologists working with court-involved family conflict. They have abandoned parents and children to a “specialty” field called “forensic” psychology. Forensic psychologists are the worst imaginable.
 
Forensic psychologists are ignorant, incompetent, and unethical. Rehabilitating unethical and lazy psychologists is not a goal. We will need clinical psychologists to return to court-involved family conflict.
 
I’m the only clinical psychologist over here. It’s my call right now what therapy we do for this court-involved family conflict. The clinical psychologists will refuse to come because it is too professionally dangerous. My role is to make it safe for them.
 
I have. If they walk where I walk, and step where I step, clinical psychologists will be safe in resolving court-involved family conflict.
 

Requirement 1. We need to establish basic-fundamental standards of practice.

There is no such thing as “parental alienation”, that’s a made-up diagnosis. We need to establish our diagnosis based on real pathology – diagnosis guides treatment.

There is no such thing as “reunification therapy”, that’s a made-up therapy. We need to use real therapy for real pathology. The diagnosis is a shared (induced) delusional disorder; a DSM-5 diagnosis of V995.51 Child Psychological Abuse.
 
What is the therapy?
 
The treatment will need to meet several requirements.
 
It can’t be anything Dr. Childress. Nothing about the solution can be Dr. Childress, not the diagnosis of the pathology, not the treatment of the pathology. I’m solving this pathology with both hands tied behind my back.

The Age of Experts is over, this must be a distributed solution. Apply knowledge to solve pathology. Knowledge belongs to everyone.
 
This pathology is court-involved, the courts are an adversarial system that, by its fundamental nature, encourages conflict. Added to that is the splitting pathology of personality disorder pathology, this means we will fight about everything, even the solution.
 
We must bring the fighting to an end.
 
The pathogen wants to make the fight-and-fight about Dr. Childress. I’m not a real thing, I’m a catalyst not a thing of substance. Nothing about the solution is Dr. Childress.
 
This is personality disorder pathology (narcissistic-borderline), a high-conflict personality. Narcissistic-borderline personality pathology is highly disorganized. We will need an appropriately structured therapy to contain the disorganization of the personality pathology (trauma).
 
This is a trauma pathology, the trans-generational transmission of trauma. Our treatment needs to be a trauma relevant treatment appropriate to personality disorder pathology.
 
That’s Dialectic Behavior Therapy (DBT – Linehan).
 
DBT will bring a basic-fundamental standard of practice to court-involved family conflict. I am not anticipating forensic psychologists becoming DBT therapists, I anticipate DBT therapists will return to work with this court-involved family conflict.
 
We need to turn to clinical psychology for solutions – treatment not custody.
 
Who? Who do parents turn to in clinical psychology to come treat their families? DBT trained psychologists and therapists. Applied Behavioral Analysis, behavior-chain interviewing, skills instruction and coaching.
 
Currently, DBT therapists are not familiar with court-involved practice. No one is. Court involved families have been abandoned to a “specialty” field of “forensic” psychology, they are the worst imaginable. We need to orient the returning clinical psychologists to routine court-involved clinical psychology with high-intensity family conflict.
 
That’s my role. I am a court-involved clinical psychologist. Walk were I walk, step where I step, and clinical psychology can resolve the family conflict pathology in the courts. Come back. We need clinical psychology in the family courts.
 
There’s more. This is an attachment pathology, the trans-generational transmission of attachment trauma. We need an attachment therapy.
 
That’s Emotionally Focused Therapy (EFT – Johnson).
 
We will be integrating DBT and EFT. Doing that is my role, I am a clinical psychologist. I know DBT. I know EFT.
 
The core structure will be DBT. The therapy I recommend will be court-involved DBT family therapy. DBT is based on a Behavioral model with mindfulness added. Fundamentally, DBT is in the Behavioral school of psychotherapy (B.F. Skinner).
 
DBT is sufficiently structured to bring basic standards of practice back to court-involved family conflict. DBT is sufficiently structured to bring organization to the disorganized personality pathology processes of this pathology. DBT is substantially empirically validated as a treatment for personality pathology.
 
My recommended therapy for this court-involved family conflict will be DBT family therapy. The principles of DBT and the skill sets taught and applied will need to be adapted to the specifics of this court-involved family conflict.
 
There is more. The pathology is an attachment pathology displayed in a parent-child relationship, the pathology is not a behavior, the pathology is a fundamental attachment bond. The therapist will need to know about the attachment system and how to treat attachment pathology.
 
That’s Emotionally Focused Therapy (EFT -Johnson). I am not recommending EFT as the front-line treatment for this court-involved family conflict. The front-line treatment is Dialectic Behavior Therapy (DBT-Linehan).
 
Emotionally Focused Therapy (EFT – Johnson) will be an integrated treatment that provides the core understanding for the treatment of attachment pathology. EFT is from the Humanistic school of psychotherapy (Rogers – empathy) and relies on the research surrounding the attachment system (Bowlby), incorporating the most advanced current scientific research on attachment and brain development (Tronick).
 
EFT’s Rogerian acceptance will be integrated with DBT along the mindfulness line. The expansion into family systems is through Satir and into Minuchin. I love Satir, she is found throughout EFT. Virginia Satir is Humanistic family systems therapy, she’s wonderful.
 
Court-involved DBT family therapy will be an integrative therapy, integrating three schools of psychotherapy within the DBT structure, Behavioral (DBT; Skinner/Mindfulness), Humanistic (EFT; Rogers; attachment), Family Systems (EFT; Satir, Minuchin – systems).
 
A competent therapist for this court-involved family conflict will work from a DBT family therapy model, and will have background competence in complex trauma (van der Kolk) and in the treatment of attachment pathology (EFT – Johnson).
 
I have placed three PESI trainings on my vitae as demonstrations of my competence in these three domains of knowledge necessary for professional work with this pathology (Standard 2.01 Boundaries of Competence).
 
I recommend that all mental health professionals working with court-involved family conflict obtain these three trainings from PESI or equivalent. I recommend that parents look for these three domains of knowledge in their mental health professional.
 
  • Complex Trauma: Bessel van der Kolk. How the Body Keeps Score: Intensive Trauma Treatment Course – 12-hour PESI seminar, online.
  • Dialectic Behavior Therapy (DBT): Dialectic Behavior Therapy Intensive Training; 12-hour PESI seminar, online.
  • Emotion Focused Therapy (EFT): Sue Johnson. Intensive Course in Emotionally Focused Therapy: Attachment-Based Interventions for Couples in Crisis; 12-hour PESI seminar, online.
Complex Trauma – knowledge of child abuse
 
Dialectic Behavior Therapy (DBT) – behavioral analysis; treatment of invalidating environment; skills-based coaching
 
Emotionally Focused Therapy (EFT) – attachment bonding; process analysis; Rogerian  empathy
 
Sue Johnson: Emotion Focused Therapy
None of this information is new to me. I am a trained behavioral psychologist. I cite my work with Jim Swanson, Ph.D. and the UCI Child Development Center. I trained in DBT during my foster care days.
 
I know Emotionally Focused Therapy and more – I know the basics from which EFT derives. My specialty practice is the attachment system and attachment pathology – i.e., Early Childhood Mental Health. I know everything about the attachment system – everything – I know everything about the development of the brain in childhood – everything. I know everything about its treatment – everything.
 
That’s what an Early Childhood Mental Health specialization means.
 
I know two treatments for attachment pathology in early childhood – I treat the attachment system, I treat attachment pathology – THAT is my specialty practice in Early Childhood Mental Health – I even have Infant Mental Health certification from Fielding Graduate Institute. I was the Clinical Director overseeing a three-university assessment and treatment center for children ages zero-to-five in the foster care system.
 
I know the attachment system. I know behavioral psychology. This is not new information for me. I am selecting from among the various treatment options available.
 
The disorganization, personality pathology, and child abuse component all require a structured approach. A structured data-driven therapy also integrates well with the court’s reliance on evidence. The behavioral-mindfulness treatment of DBT provides the necessary structure, and the mindfulness component of acceptance blends seamlessly into the Rogerian approach of EFT.
 
The skill sets of DBT will need to be attachment informed and guided since this is an attachment bonding pathology. The focus is not a behavior, it’s a relationship. The model offered by EFT provides the roadmap into the relevant information for resolving attachment pathology.
 
The process analysis of EFT is exactly the Applied Behavioral Analysis of DBT, just less formally applied and with a different focus (on relationship sequences in the session, not behavioral sequences outside the session).
 
The enactments of emotional experiences in EFT is the role-playing of skills in individual DBT therapy. EFT is more emotionally focused, DBT is more cognitively focused. This is an attachment pathology. The attachment knowledge of Bowlby and Tronick is superior in application to the behavioral strategies of B.F. Skinner. The schemas described by Beck (and Piaget) have application.
 
In treatment we have two questions, the what and the how. What are we treating, and how? The what is attachment pathology (EFT), the how is through structure (DBT). Diagnosis guides treatment. The diagnosis involved is DSM-5 V995.51  Child Psychological Abuse.
 
The structure of a behavioral approach can help bring organization to disorder, and when child abuse is a consideration, structure and organization in symptom monitoring are necessary for treatment efficacy.
 
There is a coaching and skills component to DBT. There is no coaching of skills in EFT which relies entirely on Rogerian principles – for a reason. The EFT Rogerian approach is what behaviorism finds in mindfulness – except Rogerian therapy is distilled mindfulness to a purpose. Rogerian therapy is an artful movement in mindfulness. Rogerian therapy is the core of empathy.
 
The structured skills coaching and data documentation focus of DBT will violate the Rogerian principles necessary for EFT. The treatment will be fundamentally a DBT model. The adaptation of the DBT model to court-involved attachment pathology and family conflict will be to bring in EFT as the guiding principles for treatment. The structure is DBT, the content is EFT along the mindfulness line.
 
In DBT, the therapy is through an Applied Behavioral Analysis, with the addition of psycho-educational skills training. EFT is entirely Rogerian therapy, remaining in the here-and-now of empathic tracking, which represent a moment-to-moment relationship-behavior analysis, a process analysis of the relational moves.
 
The DBT therapist does a behavioral analysis, the EFT therapist does a process analysis. The information is the same. A process analysis is simply conduced in the here-and-now of relationship with a focus on experiential change.
 
The mindfulness and radical acceptance of DBT is the Rogerian acceptance of EFT, which is the key bridge of their integration.
The integration of DBT structure with EFT content should be an interesting alchemical transformation. EFT combines Humanistic-Existential therapy (Rogers) with Psychoanalytic object relations (Bowlby), with a Family Systems orientation of Satir and Minuchin.
 
The one school that’s missing is CBT. Court-involved DBT therapy with an EFT content core integrates all four schools of psychotherapy, and is on the leading edge of scientific research (Tronick) on child development.
 
Apply knowledge to solve pathology. Ignorance solves nothing.
 
Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857
 
 
 

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.


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

Principle E: Respect for Rights and Dignity

Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

Principle E: Respect for People’s Rights and Dignity

Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination. Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making.


Forensic custody reports are consistently in violation of Principle E of the APA Ethics Code on two separate counts.

  • Unwarranted Violation of Privacy.

Forensic custody evaluators routinely disclose entirely irrelevant personal information about the parents for public display that is unnecessary for the purpose of the evaluation and violates the parent’s privacy.

While psychologists may be permitted to disclose private and confidential information about a person for a specific purpose based on the circumstances and appropriate releases  for the information, psychologists may only disclose as much personal and private information about the person as is necessary for the purpose of the disclosure.

Psychologists are ethically obligated to respect the dignity and the right to privacy of the parents, if a disclosure of personal and private information disclosed about one spouse-and-parent in reporting by the spouse-and-parent is not relevant to the purpose of the evaluation, then the individual’s right to privacy needs to be respected.

The disclosure of personal and private information about an individual that is irrelevant to decision-making is not warranted, rights to personal privacy need to be respected.

2)  Violation of parent’s right to self-determination.

The recommendations made by forensic custody evaluators routinely violate the parent’s right to self-determination by restricting a parent’s access to their own child for reasons other than child protection.

In the absence of child abuse, parents have the right to parent according to their cultural values, their personal values, and their religious values.  Psychologists should not violate these fundamental parent rights to self-determination regarding their families and children.

In the absence of child abuse, each parent should have as much time and involvement with the child as possible. To restrict either parent’s time and involvement with their child for any reason other than child abuse, would harm the parent, would harm the child’s attachment bond to the parent, and would harm the child, in violation of Standard 3.04 Avoiding Harm of the APA Ethics Code.

The only ethical recommendation allowed for child custody is that, in the absence of child abuse, each parent should have as much time and involvement with the child as possible.

When possible child abuse is a considered diagnosis, our diagnosis must be accurate 100% of the time. The consequences of misdiagnosing child abuse are too severe and destructive for the child.

The only relevant consideration is whether there child abuse, in which case we always protect the child.

A proper risk assessment for possible child abuse needs to be conducted and the outcome reported.  Diagnosis guides treatment.  In healthcare, the treatment for cancer is different than the treatment for diabetes – diagnosis guides treatment – and the treatment for child abuse is always to protect the child.

Is there child abuse?  That is the relevant consideration to be answered.

A proper risk assessment for possible child abuse needs to be conducted to reach an accurate diagnosis to guide decision-making surrounding the child.

Forensic psychologists do not conduct a risk assessment for possible child abuse.  Their recommendations to restrict a parent’s time and involvement with their child are for reasons other than a child abuse diagnosis and child protection, and the recommendations of forensic custody evaluators violate the parent’s right to self-determination in having access to and parenting their own child.

Special Population & Special Safeguards

Parents in the family courts represent a “special population” because of their compromised autonomy in decision-making about their lives as a result of the court’s involvement.

Special safeguards are necessary to protect the rights and welfare of parents involved in the family courts whose vulnerabilities from their family conflict being litigated in the courts impairs their autonomous decision making regarding their children and family.

A necessary safeguard to protect these court-involved families is requiring identified specialized professional knowledge in several directly relevant domains of professional knowledge which would be required for ethically competent practice with court-involved family conflict:

Attachment – Bowlby and others

Family systems therapy – Minuchin and others

Personality disorders – Beck and others

Complex trauma – van der Kolk and others

Child development – Tronick and others

ICD-10 & DSM-5 diagnostic systems

Parents in the family courts represent a “special population” who warrant special safeguards from the application of specialized advanced professional knowledge from psychology because of compromised autonomy of these parents in decision-making surrounding their children and families as a result of the court’s involvement in their family conflict.

Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 188578

Healthcare & Legal: Two Parallel Systems

There are two parallel and co-equal systems – healthcare and legal. They are built around identical structures to serve different roles and functions.

Authority:

Legal: judges
Healthcare: doctors

Fact Finding:

Legal: trials
Healthcare: clinical interviews

Facts:

Legal: evidence
Healthcare: symptoms

Applied Knowledge:

Legal: laws & statutes
Healthcare: diagnostic criteria

Modified Knowledge

Legal: precedents
Healthcare: research

Decision

Legal: ruling by judge
Healthcare: diagnosis by doctor

Outcome:

Legal: court orders
Healthcare: doctor’s orders

There are two separate and co-equal systems that serve different roles and functions.

Pathology in the family is a treatment issue and is within the scope of the Healthcare system to resolve. When the courts are also involved, the two systems must exchange the child and family back-and-forth to resolve the pathology in the family.

Professionally, we must first diagnose what the pathology is before we know how to treat it, i.e., we must first identify what the problem is before we know how to fix it.

Diagnose = identify
Pathology = problem
Treatment = fix it

When mental health pathology (a family problem) enters the courts, it needs to be turned back into the mental healthcare system to receive a proper assessment, that leads to an accurate diagnosis, that will guide the development of an effective treatment plan.

Once this diagnosis and written treatment plan is returned from the doctors in the healthcare system, then this becomes evidence within the legal system. The legal system then applies its rules and procedures to its evidence to make its decisions based on the law and circumstance.

The two systems must work back-and-forth together, each performing its role within the limits and scope of its role. Clinical psychology offers no recommendations on child custody, that is the court’s role and decision.  It is not the role of doctors to determine who “deserves” to be a parent. Doctors can identify (diagnose) the problem (pathology) and tell you how to fix it (treatment).

Treatment vs Custody Approaches

The position of clinical psychology regarding child custody is that, in the absence of child abuse, each parent should have as much time and involvement with the child as possible.

In the absence of child abuse, parents have the right to parent according to their cultural values, their personal values, and their religious values. In the absence of child abuse, professional psychology should not intrude onto these fundamental parental rights to be parents. If there are problems, we fix them through a written treatment plan with specified Goals, Interventions, Timeframes, and Outcome Measures.

Google “mental health treatment plans” and read the top two returns for a description of a written treatment plan with Goals, Interventions, Timeframes, and Outcome Measures, so standard of practice that the description returns on a simple Google search.

Is there child abuse? DSM-5 V995.51 Child Psychological Abuse. That is the question of concern.  That is the question clinical psychology can answer.

It is the obligation of clinical psychology to accurately diagnose child abuse when it is present, and it is the obligation of clinical psychology to protect the child 100% of the time.

When possible child abuse is a considered diagnosis, the diagnosis from healthcare must be accurate 100% of the time. The consequences for the child of misdiagnosing child abuse are too severe and destructive.

In healthcare, the appellate system for a disputed diagnosis is second opinion, or even third. Throughout all of healthcare, diagnosis guides treatment, if we treat cancer with insulin the patient dies from the misdiagnosed and mistreated cancer. In healthcare, our diagnosis must be accurate 100% of the time because when we misdiagnose and mistreatment pathology people get hurt – badly hurt.

Misdiagnosis is unacceptable.  Diagnosis guides treatment.  Always.  An accurate diagnosis is needed to guide effective treatment for the pathology (for the problem).

When possible child abuse is a considered diagnosis, as it often is in the family courts, the diagnosis from the mental healthcare system must be accurate 100% of the time, and since it is anticipated to be a disputed diagnosis, a second opinion consultation should be common and frequent in court-involved clinical psychology.

The Application of Knowledge

All psychologists should be applying the same knowledge and information (the best) to reach exactly the same diagnostic conclusions (accurate), with the same recommendations (effective).  Second opinion consultation improves decision-making and the quality of healthcare received by the patient.

Standard 2.04 Bases for Scientific and Professional Judgments
Psychologists’ work is based upon established scientific and professional knowledge of the discipline. (APA Ethics Code)

The established scientific and professional knowledge of the discipline is:

Attachment – Bowlby and others
Family systems therapy – Minuchin and others
Personality disorders – Beck and others
Complex trauma – van der Kolk and others
Child development – Tronick and others
Self Psychology – Kohut and others
ICD-10 & DSM-5 diagnostic systems

In the legal system, the appellate process is applied in sequence, first the ruling by the judge and then the appeal. In the healthcare system, on the other hand, the appellate process begins early and is used often, doctors consult with each other before reaching a diagnostic decision, and will often reach a consensus diagnostic opinion through consultation.

The healthcare and legal systems are different systems built on the same underlying structures. In healthcare, the doctors are the “judges” and there are no attorney-level roles, the doctors conduct the clinical interviews personally (“try the case”), and doctors then consult in second, or even third, opinions frequently and easily (the appellate system for diagnosis).

For example, when a patient goes to their primary care physician with a pain, if the pathology is unusual the primary care physician may refer to a specialist doctor for a specialized assessment. This specialist may then also seek consultation from a third doctor specialist if the case has complex features. Referrals for second opinion is common practice in healthcare.

Consultation among doctors (the “judges” in the healthcare system) happens early, often, and easily. This improves the accuracy of diagnosis and the quality of decision making and patient care.

In court-involved family conflict, the diagnosis is anticipated to be disputed, so the diagnosis and treatment plans for court-involved family conflict should almost always be supported by second opinion for clarity and certainty in the court’s subsequent decisions.

The consulting second opinion should concur with the diagnosis given by the primary involved doctor.  If a significant dissent occurs regarding the diagnosis, then a consulting third opinion should be sought from another doctor specialized in the field, forming a three-doctor appellate panel for the diagnosis and recommended treatment plan.  That’s how the healthcare system works to reach its decisions.  The appellate system for a disputed diagnosis is second opinion, and it is activated early and often.

Custody & Child Abuse

In the absence of child abuse, each parent should have as much time and involvement with the child as possible.

The question is, is there child abuse?

When child abuse is a considered diagnosis, our diagnosis must be accurate 100% of the time. The consequences of misdiagnosing child abuse for the child are too severe.

Tele-medicine and tele-psychology allows doctors to consult easily through secure Internet videoconferencing platforms. Remote testimony is also easily handled now by the courts following their adjustments for Covid. We live in an emerging age of the Internet. This provides substantial advantages for both the healthcare and legal systems in successfully resolving court-involved family conflict.

To achieve solutions for the child’s healthy development, the two systems must work in cooperation toward achieving an effective treatment plan to successfully resolve the family conflict, with each system performing their role in parallel structures, that will allow us to return to the child a healthy and normal-range childhood.

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

Domains of Specialized Professional Background

I am appending my vitae in support of three domains of specialized expertise in professional psychology:

1.) Thought disorders and delusional pathology

2.) Child abuse assessment, diagnosis, and treatment

3.) The attachment system and attachment pathology

Thought Disorders & Delusions

In support of my specialized expertise in the assessment and diagnosis of thought disorders and delusions are 12 years of experience at a major UCLA clinical research project on schizophrenia where I received annual training in the assessment and diagnosis of delusions and thought disorders using the Brief Psychiatric Rating Scale (BPRS) to diagnostic reliability of r=.90 to the co-directors of the Diagnostic Unit at the UCLA-Brentwood VA, Dr. Lukoff and Dr. Ventura.  The entry on my vitae for this work experience while I was at Dr. Nuechterlein’s project at UCLA is:

9/85 – 9/98  Research Associate
UCLA Neuropsychiatric Institute
Principle Investigator: Keith Nuechterlein, Ph.D.

Area: Longitudinal study of initial-onset schizophrenia. Received annual training to research and clinical reliability in the rating of psychotic symptoms using the Brief Psychiatric Rating Scale (BPRS).  Managed all aspects of data collection and data processing.

Note that I was trained annually in the rating of delusional and psychotic symptoms using the Brief Psychiatric Rating Scale (BPRS).  Wikipedia describes the BPRS:

From Wikipedia: “The Brief Psychiatric Rating Scale (BPRS) is a rating scale which a clinician or researcher may use to measure psychiatric symptoms such as depression, anxiety, hallucinations and unusual behaviour. The scale is one of the oldest, most widely used scales to measure psychotic symptoms and was first published in 1962.

From Wikipedia: “An expanded version of the test was created in 1993 by D. Lukoff, Keith H. Nuechterlein, and Joseph Ventura.”[6]

The Expanded version cited by Wikipedia links to a professional reference available online from Drs. Nuechterlein, Ventura, and Lukoff, note the date of the revision – 1993.  Note where I was from 1985-to-1998, i.e., at Dr. Neuchterlein’s UCLA research project being annually trained in the assessment and diagnosis of delusional and thought disorder pathology to an r=.90 diagnostic reliability with the co-directors of the Diagnostic Unit at the UCLA-Brentwood VA and authors of the Expanded BPRS, Dr. Ventura and Dr. Lukoff.  I have considerable professional training, background, and experience in assessing and diagnosing thought disorders and delusional pathology,

Child Abuse Pathology

Regarding my background in child abuse pathology, I served as the Clinical Director for a three-university assessment and treatment center for children ages zero-to-five in the foster care system.  Our primary referral source was Child Protective Services (CPS).  I have personally worked with all four DSM-5 child abuse diagnoses and have led and supervised the multi-disciplinary assessment and treatment of child abuse as the Clinical Director for a three-university treatment center.  The entry for this experience on my vitae is:

10/06 – 6/08:  Clinical Director

START Pediatric Neurodevelopmental Assessment and Treatment Center
California State University, San Bernardino
Institute of Child Development and Family Relations

Clinical director for an early childhood assessment and treatment center providing comprehensive developmental assessment and psychotherapy services to children ages 0-5 years old.  Directed the clinical operations, clinical staff, and the provision of comprehensive psychological assessment and treatment services across clinic-based, home-based, and school-based services. A three-university collaboration with speech and language services through the University of Redlands, occupational therapy through Loma Linda University, and psychology through Calif. State University, San Bernardino.

Attachment System & Attachment Pathology

I have specialty background in Early Childhood Mental Health, ages zero-to-five.  This is a specialty domain of practice because it requires extensive knowledge of brain development in infancy through the first five years of life.  Early Childhood Mental Health specialization requires understanding the neuro-development of each brain system individually (cognitive, language, sensory-motor, emotional, memory, relationship) as well as how they integrate with each other at each developmental period of maturation in the first year of infancy and beyond into all the subsequent maturational changes.

The period of early childhood is directly the developmental period of the child’s early attachment formation to the parent.  With this specialty background, I know two additional diagnostic systems for early childhood besides the DSM-5 and ICD-10, the DC:0-3 which is more attachment sensitive and the DMIC which is stronger with autistic spectrum disorders.  I also know two early childhood attachment therapies, Watch, Wait, and Wonder for infants and Circle of Security for preschool-age children, and I am Certified in Infant Mental Health.

The attachment system is the brain system that governs all aspects of love and bonding throughout the lifespan, including grief and loss.  The attachment system develops its patterns for love-and-bonding during childhood and then we use these internalized patterns for love-and-bonding (attachment) to guide our expectations and our approach to all future love and bonding experiences in adulthood.  The clinical domain of attachment and attachment pathology is Early Childhood Mental Health specialization, and my clinical experience is with children ages zero-to-five in foster care, which is directly attachment pathology.  A child rejecting a parent is a problem in attachment, a problem in the love-and-bonding system of the brain,

I have specialized professional background, training, and expertise in multiple relevant domains of knowledge, 1) thought disorders and delusions, 2) child abuse pathology, and 3) the attachment system and attachment pathology.  I also am trained in family systems therapy (Bowlby, Minuchin, Haley, Madanes, Satir), and I have worked with court-involved family conflict for the past decade, with professional presentations to the American Psychological Association, the Association of Family and Conciliation Courts, an invited presentation at the Erasmus Medical Center in the Netherlands, and an invited presentation to the Law Society of Saskatchewan. 

I have a broad array of directly relevant domains of professional background and experience.

Dr. Childress Vitae:

Click to access 1-childress-vitae-8-1-21-BI.pdf


Attachment Pathology in the Family Courts

C.A. Childress, Psy.D. (2021)

The pathology of concern in the family courts is an attachment pathology that potentially rises to the level of child abuse.  When a potential child abuse diagnosis is a consideration, the diagnosis returned from the mental health care system for the Court’s consideration in its decisions must be accurate 100% of the time. 

The consequences of an incorrect decision by the Court when a child abuse diagnosis is involved can be severe for the child.  Leaving a child with an abusive parent can lead to the destruction of the child’s life.  When a child abuse diagnosis is among the possible differential diagnoses for the child’s symptom display, the diagnosis returned from the mental health care system for the Court’s consideration must be accurate 100% of the time.

If there is any question, if there is any dispute about the diagnosis (and the diagnosis is anticipated to be disputed in court-involved family conflict), then get a second opinion, or even a third.  When a possible child abuse diagnosis is involved, do whatever it takes to make sure the diagnosis that is returned from the assessment is accurate. 

The appellate system in healthcare for a disputed diagnosis is second opinion, or even a third.  The damage done to the child from a misdiagnosis of child abuse is too severe.  When child abuse by a parent is a diagnostic consideration, which it is with severe attachment pathology displayed by a child, then the diagnosis returned from the mental health care system must be accurate 100% of the time. 

The Pathology

The pathology of clinical concern for the family is a possible shared persecutory delusion created by the pathogenic parenting of the allied parent, a thought disorder in the allied parent from unresolved trauma that is being imposed on the child, which then destroys the child’s attachment bond to the other parent. 

In this pathology, the allied parent forms a cross-generational coalition (Haley)[1] with the child against the targeted parent, resulting in an emotional cutoff in the child’s attachment bond to the targeted parent.  The allied parent is triangulating the child into the spousal conflict to use the child as a weapon of spousal revenge and emotional abuse directed at the ex-spouse, i.e., Intimate Partner Violence (IPV), the emotional abuse of the ex-spouse using the child as the weapon.  In weaponizing the child into the spousal conflict, the allied parent creates such significant pathology in the child that it rises to the level of a DSM-5 diagnosis of psychological child abuse. 

The needed risk assessments for the family pathology surrounding court-involved family conflict are for:

  • Child Abuse: potential child abuse by the targeted parent (to be specified), or potential psychological child abuse by the allied parent (DSM-5 V995.51 Child Psychological Abuse)
  • Spousal Abuse: potential IPV emotional abuse of the ex-spouse and parent using the child as the weapon (DSM-5 V995.82 Spouse or Partner Abuse, Psychological)

Whenever child abuse is a diagnostic consideration, the diagnosis returned from the mental health care system must be accurate 100% of the time.  The Court needs an accurate diagnosis for its decisions, and the child needs an accurate diagnosis when the potential diagnosis is child abuse by a parent. 

There are four DSM-5 diagnoses of child abuse, each DSM-5 diagnosis of child abuse warrants a proper risk assessment; Child Physical Abuse (V995.54), Child Sexual Abuse (V995.53), Child Neglect (V995.52), Child Psychological Abuse (V995.51).  All of these child abuse diagnoses are equivalent in the severity of the damage they do to the child, they differ only in the type of damage done, not in the severity of damage done to the child.  Psychological child abuse destroys the child from the inside out.

When a child rejects a parent, the clinical concern is child abuse, the diagnostic questions is, which parent?  When the possible diagnosis is child abuse by a parent, both the child and the Court require that a proper risk assessment be conducted that will reach an accurate diagnosis 100% of the time. 

If the diagnosis is disputed, the appellate system in healthcare is not litigation in the courts, it’s second opinion, or even a third opinion from other doctors.   All doctors, all psychologists, should be applying exactly the same sets of knowledge (the best) to reach exactly the same conclusions (accurate) and recommendations (successful).   Standard 2.04 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association requires that the established scientific and professional knowledge of the discipline serve as the bases for professional judgments.

  • 2.04 Bases for Scientific and Professional Judgments
    Psychologists’ work is based upon established scientific and professional knowledge of the discipline.

The established scientific and professional knowledge of the discipline surrounding court-involved family conflict is:

  • Attachment – Bowlby and others
  • Family systems therapy – Minuchin and others
  • Personality disorders – Beck and others
  • Complex trauma – van der Kolk and others
  • Child development – Tronic and others
  • Self psychology – Kohut and others
  • ICD-10 & DSM-5 diagnostic systems

Diagnosis is a pattern-match of the symptoms to the diagnostic criteria.  If there is a disputed application of the diagnostic criteria to a set of symptoms, get a second opinion, or even a third if necessary.  When the potential diagnosis is child abuse, we must not get it wrong.  We must be accurate in our diagnosis 100% of the time.  Misdiagnosis hurts people – badly.  A misdiagnosis of child abuse is extremely bad.

Misdiagnosis of a shared persecutory delusion has particularly troubling implications.  If you believe a shared delusion then you become part of the shared delusion, you become part of the pathology.  When the pathology is child abuse, you become part of the child abuse. 

If the involved mental health professional misdiagnoses the pathology and believes the delusional disorder as if it were real, and if the Court then makes its decisions based on the false beliefs of a pathological parent that are misdiagnosed, then they all become part of the shared delusion, they all become part of the pathology, they all become part of the child abuse. 

The potential damage from the misdiagnosis of a shared delusional disorder and child abuse can be severe, and the potential implications for the involved professionals can be profound.  The diagnosis returned from the mental health system must be accurate 100% of the time.  

Attachment Pathology

A child rejecting a parent is an attachment pathology, a problem in the love-and-bonding system of the brain.  There are two potential causes, 1) child abuse by the targeted-rejected parent (to be specified by the assessment), or 2) child psychological abuse by the allied parent who is using the child as a weapon of IPV spousal abuse (Intimate Partner Violence; i.e., emotional abuse of the ex-spouse using the child as the weapon).

A child rejecting a parent is a problem in love-and-bonding.  A child rejecting a parent is an attachment pathology, a problem in the love-and-bonding system of the brain.  The attachment system is the brain system governing all aspects of love and bonding throughout the lifespan, including grief and loss.  It is a primary motivational system of the brain, like other primary motivational systems for eating and sex.  A breach in the attachment bonding between children and their parents is a pathology in a primary motivational system of the brain, the love-and-bonding system; the attachment system. 

There is no more severe form of attachment pathology than the termination of the child’s attachment bond to the parent.  There is nothing worse in terms of attachment pathology, for pathology in a primary motivational system of the brain, than a severing of the parent-child attachment bond.  That is as bad as attachment pathology in childhood gets, pathology in a primary motivational system of the brain that is developing its patterns to guide love-and-bonding throughout the lifespan during childhood through the relationship bonds with both parents.  A child rejecting a parent is the worst possible attachment pathology in childhood.

To understand the severity we can use an analogy to another primary motivational system, the eating system.  The worst possible eating pathology is anorexia, the person refuses to eat, their bond to food is completely severed, they starve, and they die.  By analogy, a complete severing of a child’s attachment bond to a parent represents “anorexia” of the attachment system, the worst possible form of attachment-related pathology. 

There is nothing worse in terms of attachment pathology, that’s as bad as it gets.  It is exceedingly important for the healthy development of children that their attachment pathology toward their mothers and fathers be effectively treated and resolved as quickly as is possible. 

The differential diagnosis for the attachment pathology (i.e., for a child’s rejection of a parent) is that either 1) the parent who is the target of rejection is causing the attachment breach through possibly severe maltreatment of the child, or 2) the allied parent is creating the attachment breach through their extremely problematic parenting, called a “cross-generational coalition” with the child against the other parent.  The coalition of the child with one parent against the other parent leads to the “emotional cutoff” in the child’s attachment bond to the targeted parent out “loyalty” to the coalition with the allied parent.

            The diagnosis of clinical concern is potential Child Psychological Abuse (pathogenic parenting) by the allied parent (DSM-5 V995.51), a thought disorder in the allied parent (a persecutory delusion) that is being imposed on the child, destroying the child’s attachment bond to the other parent in spousal revenge and retaliation for the failed marriage and divorce (DSM-5 V995.82 Spouse or Partner Abuse, Psychological).  This needs a proper assessment to reach an accurate diagnosis to guide both the Court’s decisions and the development of an effective treatment plan.

Family Systems Therapy

There are four primary schools of psychotherapy; psychoanalytic (Freud and the couch), humanistic-existential (self-actualization and growth), cognitive-behavioral (B.F. Skinner, rewards and punishment), and family systems therapy (describing how families work and how to fix problems in families).  Of the four primary schools of psychotherapy, the appropriate school for developing a treatment plan for resolving family conflict is family systems therapy (Minuchin, Bowen, Haley, Madanes, Satir).   Parents and the Court will want an assessment of the family conflict and attachment pathology that applies the constructs of family systems therapy toward resolving the family conflict. 

The family systems diagnostic description of concern for assessment would be that the child is being triangulated into the spousal conflict through the formation of a cross-generational coalition with one parent against the other parent, that is then resulting in an emotional cutoff in the child’s attachment bond to the targeted parent.  This specific pathology is depicted by a Structural family diagram from the preeminent family systems therapist, Salvador Minuchin. 

This Structural family diagram depicts the relationship pattern of concern, a cross-generational coalition of a father with his son against the mother.  The triangle pattern to the family relationships is clearly evident in the diagram, i.e., the child becomes “triangulated” into the spousal conflict by the alliance with the father against the mother.

Also evident is a symptom feature called the inverted hierarchy in which the child becomes over-empowered by the coalition with the allied parent into an elevated position in the family hierarchy above that of the mother, from which the child becomes empowered (by the allied parent’s support) to judge the adequacy of the other parent as if the other parent were the child and the child were the parent.  In the Structural family diagram from Minuchin, this symptom feature of the inverted hierarchy is reflected in the child’s elevated position above the hierarchy line to be with the father in a “co-parenting” role over the mother, who is in the child’s relative position, and who’s adequacy as a parent is being judged by the child.

  • From Krugman: “The child is elevated into the parental hierarchy and the system is stabilized through role reversal.  The child may thus be either covertly allied with one parent against the other, or parentified and obliged to care for a parent.” (p. 139)[3]

The emotional cutoff  caused by the cross-generation coalition is reflected in the broken lines from the child to the mother, and from the father to the mother.  An emotional cutoff is created by unresolved trauma in the parent being transferred to the child through aberrant and distorted parenting practices, called multi-generational trauma by Bowen (Bowen; Titelman).[4]

The three lines joining the father and son in the diagram represent a psychologically fused and over-involved relationship called enmeshment (i.e., the psychological control of the child), which leads to the emotional cutoff in the child’s attachment bond to the other parent.   In the Journal of Emotional Abuse, Kerig notes the intertwined relationship between enmeshment and disengagement within families,

  • From Kerig: “Enmeshment in one parent-child relationship is often counterbalanced by disengagement between the child and the other parent (Cowan & Cowan, 1990; Jacobvitz, Riggs, & Johnson, 1999).” (p. 10)[5]

An enmeshed and psychologically over-intrusive parent-child bond is a very destructive psychological relationship for a child to have with a parent, and it is why Jay Haley, the co-founder of Strategic family systems therapy, calls the cross-generational coalition a “perverse triangle,” i.e., because it violates the child’s psychological self-integrity and boundaries.  The psychological boundaries and self-autonomy of the child should always be respected by the parent, but are violated by a cross-generational coalition. 

  • From Kerig: “The breakdown of appropriate generational boundaries between parents and children significantly increases the risk for emotional abuse.” (p. 6)
  • From Kerig: “Rather than telling the child directly what to do or think, as does the behaviorally controlling parent, the psychologically controlling parent uses indirect hints and responds with guilt induction or withdrawal of love if the child refuses to comply. In short, an intrusive parent strives to manipulate the child’s thoughts and feelings in such a way that the child’s psyche will conform to the parent’s wishes.” (p. 12)

This is the pathology of clinical concern relative to the family conflict and attachment pathology in the family courts, and this is the family pathology that requires a focused diagnostic assessment.   

Psychological Control of the Child

Psychological control of the child by a parent is a scientifically established family relationship pattern in dysfunctional family systems.  In his book regarding parental psychological control of children, Intrusive Parenting: How Psychological Control Affects Children and Adolescents,[6] published by the American Psychological Association, Brian Barber and his colleague, Elizabeth Harmon, identify over 30 empirically validated scientific studies that have established the construct of parental psychological control of children. 

In Chapter 2 of Intrusive Parenting: How Psychological Control Affects Children and Adolescents, Barber and Harmon define the construct of parental psychological control of the child:

  • From Barber & Harmon: “Psychological control refers to parental behaviors that are intrusive and manipulative of children’s thoughts, feelings, and attachment to parents.  These behaviors appear to be associated with disturbances in the psychoemotional boundaries between the child and parent, and hence with the development of an independent sense of self and identity.” (Barber & Harmon, 2002, p. 15)[7]

According to Stone, Bueler, and Barber:

  • From Stone, Bueler, & Barber: “The central elements of psychological control are intrusion into the child’s psychological world and self-definition and parental attempts to manipulate the child’s thoughts and feelings through invoking guilt, shame, and anxiety.  Psychological control is distinguished from behavioral control in that the parent attempts to control, through the use of criticism, dominance, and anxiety or guilt induction, the youth’s thoughts and feelings rather than the youth’s behavior.” (Stone, Buehler, & Barber, 2002, p. 57)[8]

Soenens and Vansteenkiste (2010) describe the various parental methods used to achieve psychological control over the child:

  • From Soenens & Vansteenkiste: “Psychological control can be expressed through a variety of parental tactics, including (a) guilt-induction, which refers to the use of guilt inducing strategies to pressure children to comply with a parental request; (b) contingent love or love withdrawal, where parents make their attention, interest, care, and love contingent upon the children’s attainment of parental standards; (c) instilling anxiety, which refers to the induction of anxiety to make children comply with parental requests; and (d) invalidation of the child’s perspective, which pertains to parental constraining of the child’s spontaneous expression of thoughts and feelings.” (Soenens & Vansteenkiste, 2010, p. 75)[9]

Stone, Buehler, and Barber (2002) describe the link between psychological control of the child and the cross-generational coalition formed with one parent against the other parent:

  • Stone, Buehler, & Barber: “The concept of triangles “describes the way any three people relate to each other and involve others in emotional issues between them” (Bowen, 1989, p. 306).  In the anxiety-filled environment of conflict, a third person is triangulated, either temporarily or permanently, to ease the anxious feelings of the conflicting partners.  By default, that third person is exposed to an anxiety-provoking and disturbing atmosphere.  For example, a child might become the scapegoat or focus of attention, thereby transferring the tension from the marital dyad to the parent-child dyad.  Unresolved tension in the marital relationship might spill over to the parent-child relationship through parents’ use of psychological control as a way of securing and maintaining a strong emotional alliance and level of support from the child.  As a consequence, the triangulated youth might feel pressured or obliged to listen to or agree with one parents’ complaints against the other.  The resulting enmeshment and cross-generational coalition would exemplify parents’ use of psychological control to coerce and maintain a parent-youth emotional alliance against the other parent (Haley, 1976; Minuchin, 1974).” (Stone, Buehler, & Barber, 2002, p. 86-87)

Diagnosis Guides Treatment

Parents and the Court will need a written treatment plan.  Google “mental health treatment plans” and read the first two returns.  Those are descriptions of the structure for a written treatment plan.  To formulate a written treatment plan will require a diagnosis.  The treatment for cancer is different than the treatment for diabetes – diagnosis guides treatment.  In order to obtain an accurate diagnosis, parents the the Court will need an appropriate assessment of the child’s attachment pathology.

Appropriate Assessment

An appropriate assessment for the type of attachment-bonding pathology in the family courts involves three components representing a trauma-informed clinical psychology assessment of the child’s attachment pathology

  • Trauma-informed: A “trauma informed” assessment ensures the proper application of information sets from complex trauma and the multi-generational transmission of trauma from a parent to a child.
  • Clinical psychology: A clinical psychology assessment is focused toward developing a written treatment plan (as contrasted with a “forensic psychology” assessment focused on child custody schedules).  Clinical psychology is focused on treatment.
  • Attachment pathology: The goal of the assessment is on developing a written treatment plan to resolve the children’s attachment pathology relative to their parents.  This involves the application of information sets surrounding the attachment system in childhood.

Assessment is always directed toward answering a referral question. The recommended referral question for a trauma-informed clinical psychology assessment of a child’s attachment pathology displayed toward a parent surrounding divorce would be,

  • Referral Question for Assessment:  Which parent is the source of pathogenic parenting[11] creating the child’s attachment pathology, and what are the treatment implications?

Obtaining an Accurate Diagnosis

The differential diagnosis for attachment pathology is between severely problematic parenting by the targeted parent (i.e., child abuse) or severely pathogenic parenting by the allied parent (i.e., a cross-generational coalition of the child and parent).  A trauma-informed clinical psychology assessment of the child’s attachment pathology should address this differential diagnosis. 

There are three diagnoses that parents and the Court will want returned from the trauma-informed diagnostic assessment of the family surrounding children’s attachment pathology:

 1) ICD-10 Diagnosis 

The ICD-10 diagnostic system is from the World Health Organization.  It is the formal diagnostic classification coding system for all medical and psychiatric diagnoses, from high blood pressure, to cancer, to diabetes, to depression, to ADHD.  The ICD-10 diagnostic system is the formal diagnostic system internationally, and in the U.S. it is used as the diagnostic coding system for all medical and psychiatric pathology for insurance billing purposes.

The ICD-10 diagnosis of concern for attachment pathology in the family courts is a possible thought disorder emanating from the allied parent’s influence and affecting the child, an ICD-10 diagnosis of F24, a shared persecutory delusion of the child with the allied parent, with the parent as the “primary case” (also called the “inducer”).  This is the description of a shared delusional disorder 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…  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)

2) DSM-5 Diagnosis

The DSM-5 diagnostic system is from the American Psychiatric Association.  It is a specialty diagnostic system focused solely on psychiatric disorders (as contrasted with the ICD-10 that is both medical and psychiatric diagnostic codes).  In its more specialty focus, the DSM-5 offers greater descriptive elaboration on each psychiatric disorder.  The ICD-10 is the diagnostic coding system, the DSM-5 is the description.  Parents and the Court will want the assessment to generate both. 

For the pathology of concern, the ICD-10 diagnosis is F24 Shared Psychotic Disorder (a shared persecutory delusion), and the DSM-5 diagnosis for creating a thought disorder in the child that then destroys the child’s attachment bond to the other parent would be V995.51 Child Psychological Abuse.  These specific diagnoses should be part of the differential diagnoses considered by the assessment.

3) Case Conceptualization Diagnosis – Family Systems Therapy

The “case conceptualization” diagnosis is the organizing framework for the treatment.  The treatment approaches available for resolving family pathology are guided by the constructs and principles of family systems therapy, one of the four primary schools of psychotherapy.  To develop a written treatment plan we also need a case-conceptualization diagnosis from family systems therapy (as contrasted with the “categorical” diagnoses of the ICD-10 and DSM-5).

The family systems pathology of concern is that the child is being triangulated 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 in the child’s relationship to the targeted parent.

  • Triangulated: Child put in the middle.
  • Cross-generational coalition: the problematic parenting of the allied parent.
  • Emotional cutoff: a family member rejecting a family member; a child rejecting a parent (caused by “multi-generational” unresolved trauma originating in the parent).

Treatment Considerations

Diagnosis guides treatment.  If a thought disorder (shared persecutory delusion) is present, then the DSM-5 diagnosis would be Child Psychological Abuse (V995.51).  In all cases of child abuse, the standard of practice and professional duty to protect requires the child’s protective separation from the abusive parent.  The child’s normal-range and healthy development is then recovered and restored.  Once the child’s healthy development has been recovered, contact with the abusive parent is reestablished with enough safeguards in place to ensure that the child abuse does not resume when contact with the abusive parent is restored.

With regard to treatment for a shared delusional disorder, the American Psychiatric Association twice indicates that a protective separation of the child from the primary case (the “inducer”) will resolve the child’s delusional beliefs.

  • From the APA: “If the relationship with the primary case is interrupted, the delusional beliefs of the other individual usually diminish or disappear.” (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)

The assessment for a thought disorder pathology is a Mental Status Exam of thought and perception.  For more information on the Mental Status Exam of thought and perception, Google the search term “mental status exam” and read the NCBI return, Chapter 207 of Clinical Methods, scroll to the section on Thought and Perception.  That is the clinical assessment for a possible thought disorder pathology, i.e., a Mental Status Exam of thought and perception.

Treatment Plan

A treatment plan is structured around four major components – Goals – Interventions – Timeframes – Outcome Measures.  For a description of mental health treatment plans, I recommend a Google search for the term “mental health treatment plans” and read the top two returns.  The structure for a mental health treatment plan is so standard-of-practice it returns on a simple Google search.  The family therapy should be guided by a written treatment plan that follows this standard of professional practice and should include:

  • Short- and long-term goals, identified in measurable ways,
  • Specified interventions to achieve those goals,
  • Timeframes for achieving the treatment goals, with measurable benchmarks,
  • Treatment outcome data collection on symptoms and recovery

The type of therapy should be trauma-informed family therapy.  The pathology creating the children’s attachment pathology involves the trans-generational transmission of trauma (van der Kolk), also called multi-generational family trauma (Bowen).  The additional information sets from complex trauma and personality disorders provide valuable additions to the established constructs of family systems therapy. 

An additional focus on the work of Marsha Linehan surrounding the “invalidating environment” that is created by a pathogenic parent would also be particularly helpful for treatment,

  • From Linehan: “A defining characteristic of the invalidating environment is the tendency of the family to respond erratically or inappropriately to private experience and, in particular, to be insensitive (i.e., nonresponsive) to private experience… Invalidating environments contribute to emotional dysregulation by: (1) failing to teach the child to label and modulate arousal, (2) failing to teach the child to tolerate stress, (3) failing to teach the child to trust his or her own emotional responses as valid interpretations of events, and (4) actively teaching the child to invalidate his or her own experiences by making it necessary for the child to scan the environment for cues about how to act and feel.” (p. 111-112)[12]
  • From Linehan: “They tend to see reality in polarized categories of “either-or,” rather than “all,” and within a very fixed frame of reference. For example, it is not uncommon for such individuals to believe that the smallest fault makes it impossible for the person to be “good” inside. Their rigid cognitive style further limits their abilities to entertain ideas of future change and transition, resulting in feelings of being in an interminable painful situation. Things once defined do not change.  Once a person is “flawed,” for instance, that person will remain flawed forever.” (p. 35)[13]
  • From Fruzzetti et al: “In extremely invalidating environments, parents or caregivers do not teach children to discriminate effectively between what they feel and what the caregivers feel, what the child wants and what the caregiver wants (or wants the child to want), what the child thinks and what the caregiver thinks.” (p. 1021)[14]

Family systems therapy is a primary school of psychotherapy and it is the appropriate school of psychotherapy to apply to resolving family conflict (Minuchin, Bowen, Haley, Madanes, Satir).  The case conceptualization for treatment should derive from the application of family systems therapy constructs (i.e., triangulation, cross-generational coalition, emotional cutoff). 

Adjunctive Solution-Focused Therapy:

The addition of Solution-Focused Therapy[15] (Berg) will provide an additional important trauma recovery component that will substantially improve prognosis for treatment efficacy.  Trauma pathology pulls toward an unsolvable past.  The present and future orientation of solution-focused family therapy will counteract the pull of trauma toward an unsolvable fixation on the past.

Treatment Goals

Restoring the healthy attachment bonds of children with their mothers and fathers is of high and immediate priority.  Healthy and affectionate attachment bonds between children and their parents need to be restored as quickly as possible. 

The parent-child attachment bond is too important to a child’s healthy psychological development to remain unrepaired when damaged, and lost time during childhood can never be recovered.  Childhood is once.  The goal of psychotherapy is not merely to eliminate pathology, the goal is to achieve healthy child development.  The goal of psychotherapy is to achieve a healthy attachment system in the child, with a healthy attachment bond to their mother and to their father – neither parent is expendable, and both are vital to the child’s healthy development. 

In American Psychologist,[16] the primary journal of the American Psychological Association, Mary Ainsworth, a leading figure in attachment research provides the following description of a healthy attachment bond:

  • From Ainsworth:  “I define an “affectional bond” as a relatively long-enduring tie in which the partner is important as a unique individual and is interchangeable with none other.  In an affectional bond, there is a desire to maintain closeness to the partner.  In older children and adults, that closeness may to some extent be sustained over time and distance and during absences, but nevertheless there is at least an intermittent desire to reestablish proximity and interaction, and pleasure – often joy – upon reunion.  Inexplicable separation tends to cause distress, and permanent loss would cause grief.” (p. 711)
  • From Ainsworth:  “An ”attachment” is an affectional bond, and hence an attachment figure is never wholly interchangeable with or replaceable by another, even though there may be others to whom one is also attached.  In attachments, as in other affectional bonds, there is a need to maintain proximity, distress upon inexplicable separation, pleasure and joy upon reunion, and grief at loss.” (p. 711)

A child rejecting a parent is the worst attachment pathology possible in childhood, pathology in a primary motivational system of the brain developing its patterns to guide love-and-bonding throughout the lifespan during childhood, through relationships with both parents.  Leaving the worst possible attachment pathology untreated and unrepaired is the worst possible thing we can do. 

It is always in the child’s best interests to have a healthy and normal-range attachment bond to both parents.  It is always in the child’s best interests for the family to make a successful transition to a healthy and normal-range post-divorce separated family structure.  Successful treatment that restores a healthy and normal-range attachment bond between children and their parents is always in the child’s best interests.

The child unites two families into the very fabric of their being, two family lineages, two family heritages, two family cultures are brought together and united in who they are.  For a child to reject either parent is for the child to reject half of themselves. 

Children are not weapons.  Children should never be used as weapons in the spousal conflict surrounding divorce.  When one parent weaponizes the child into the spousal conflict, we must protect the child.  The clinical concern is for a DSM-5 diagnosis of Child Psychological Abuse by the allied parent (V995.51), a thought disorder in the parent imposed on the child.  This needs a proper assessment to reach an accurate diagnosis. 

When potential child abuse is a considered diagnosis, the diagnosis returned from the mental health system for the Court’s consideration must be accurate 100% of the time.  Do whatever it takes to answer any question that needs to be answered, seek any consultation for information that is needed, conduct any response-to-intervention trial required to achieve an accurate diagnosis, do whatever it takes.  Because when child abuse by a parent is a considered diagnosis for the Court’s decision, the diagnosis from the mental health care system must be accurate 100% of the time.

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

Footnotes


[1] Haley, J. (1977). Toward a theory of pathological systems. In P. Watzlawick & J. Weakland (Eds.),

From Haley: “The people responding to each other in the triangle are not peers, but one of them is of a different generation from the other two… In the process of their interaction together, the person of one generation forms a coalition with the person of the other generation against his peer. By ‘coalition’ is meant a process of joint action which is against the third person… The coalition between the two persons is denied. That is, there is certain behavior which indicates a coalition which, when it is queried, will be denied as a coalition… In essence, the perverse triangle is one in which the separation of generations is breached in a covert way. When this occurs as a repetitive pattern, the system will be pathological.” (Haley, 1977, p. 37)

[2] The DSM-5 diagnostic system is from the American Psychiatric Association.  It is a specialty diagnostic system focused solely on psychiatric disorders (as contrasted with the ICD-10 that is both medical and psychiatric diagnostic codes).  In its more specialty focus, the DSM-5 offers greater descriptive elaboration on each psychiatric disorder, as well as diagnostic criteria for each disorder.  The ICD-10 is the diagnostic coding system, the DSM-5 is the description. 

[3] Krugman, S. (1987). Trauma in the family: Perspectives on the Intergenerational Transmission of Violence. In B.A. van der Kolk (Ed.) Psychological Trauma (127-151). Washington, D.C.:

[4] Bowen, M. (1978). Family Therapy in Clinical Practice. New York: Jason Aronson.

Titelman, P. (2003).  Emotional Cutoff: Bowen Family Systems Theory Perspectives. New York: Haworth Press.

[5] Kerig, P.K. (2005). Revisiting the construct of boundary dissolution: A multidimensional perspective. Journal of Emotional Abuse, 5, 5-42.

[6] Barber, B. K. (Ed.) (2002). Intrusive parenting: How psychological control affects children and adolescents. Washington, DC: American Psychological Association.

[7]  Barber, B. K. and Harmon, E. L. (2002). Violating the self: Parenting psychological control of children and adolescents. In B. K. Barber (Ed.), Intrusive parenting (pp. 15-52). Washington, DC: American Psychological Association.

[8] Stone, G., Buehler, C., & Barber, B. K.. (2002) Interparental conflict, parental psychological control, and youth problem behaviors. In B. K. Barber (Ed.), Intrusive parenting: How psychological control affects children and adolescents. Washington, DC: American Psychological Association.

[9]  Soenens, B., & Vansteenkiste, M. (2010). A theoretical upgrade of the concept of parental psychological control: Proposing new insights on the basis of self-determination theory. Developmental Review, 30, 74–99.

[10] The Bowen Center for the Study of the Family: https://www.thebowencenter.org/triangles

[11] Pathogenic parenting: patho=pathology; genic=genesis, creation.  Pathogenic parenting is the creation of significant pathology in the child through aberrant and distorted parenting practices.

[12] Linehan, M. M. & Koerner, K. (1993). Behavioral theory of borderline personality disorder. In J. Paris (Ed.), Borderline Personality Disorder: Etiology and Treatment. Washington, D.C.: American Psychiatric Press, 103-21.

[13] Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder.  New York, NY: Guilford

[14] Fruzzetti, A.E., Shenk, C. and Hoffman, P. (2005). Family interaction and the development of borderline personality disorder: A transactional model.  Development and Psychopathology, 17, 1007-1030.

[15] Solution-Focused Therapy Wikipedia: https://en.wikipedia.org/wiki/Solution-focused_brief_therapy:

“SFBT has been examined in two meta-analyses and is supported as evidenced-based by numerous federal and state agencies and institutions, such as SAMHSA’s National Registry of Evidence-Based Programs & Practices (NREPP). To briefly summarize:

  • There have been 77 empirical studies on the effectiveness of SFBT,
  • There have been 2 meta-analyses (Kim, 2008; Stams, et al, 2006), 2 systematic reviews.
  • There is a combined effectiveness data from over 2800 cases.
  • Research was all done in “real world” settings (“effectiveness” vs. “efficacy” studies), so the results are more generalizable.
  • SFBT is equally effective for all social classes.
  • Effect-sizes are in the low to moderate range, the same that are found in meta-analyses for other evidence-based practices, such as CBT and IPT. Overall success rate average 60% in 3–5 sessions
  • The conclusion of the two meta-analyses and the systematic reviews, and the over-all conclusion of the most recent scholarly work on SFBT, is that solution-focused brief therapy is an effective approach to the treatment of psychological problems, with effect sizes similar to other evidenced-based approaches, such as CBT and IPT, but that these effects are found in fewer average sessions, and using an approach style that is more benign (Gingerich et al, 2012; Trepper & Franklin, 2012). That is, the more collegial and collaborative approach of SFBT does not involve confrontation or interpretation, nor does it even require the acceptance of the underlying tenets, as do most other models of psychotherapy. Given its equivalent effectiveness, shorter duration, and more benign approach, SFBT is considered to be an excellent first-choice evidenced-based psychotherapy approach for most psychological, behavioral, and relational problems.”

[16] Ainsworth, M.D.S. (1989). Attachments beyond infancy. American Psychologist, 44, 709-716.