Category: Uncategorized

There are three Diagnostic Indicators that will always be present in an attachment-based model of “parental alienation” (AB-PA),

1) Attachment Suppression: the child will show suppression of attachment bonding motivations toward a normal-range parent.

2) High Protest Behavior: the child will evidence either high-anger protest (DI-2a) diagnostically defined as the presence of five specific narcissistic personality traits, and/or high-anxiety protest (DI-2b) as defined by meeting DSM-5 diagnostic criteria for a Specific Phobia with the parent as the target.

3) Persecutory Delusion: the child will evidence a persecutory delusion toward a normal-range parent.

A normal-range parent is diagnostically defined as a rating from the assessing mental health professional as either Level 3 (Normal-Range Problematic) or Level 4 (Normal-Range Healthy) parenting on the Parenting Practices Rating Scale.

Abusive-range parenting is diagnostically defined as a rating from the assessing mental health professional as either Level 2 (Highly Problematic) or Level 1 (Abusive) parenting on the Parenting Practices Rating Scale.

In addition to the three Diagnostic Indicators of AB-PA that are always present, there are also 12 Associated Clinical Signs which, while not always present, are often present surrounding the shared persecutory delusion of AB-PA.

ACS-1: Use of the Word “Forced”

This symptom represents a manipulative communication used to disable efforts to resolve the child’s symptoms by disempowering any attempts to change the child’s views and behavior.

• • The child shouldn’t be “forced” to have a relationship with the other parent.

• • “What can I do? I can’t “force” the child to go on visitations with the other parent.” (“…get in the car”, etc.)

The accurate reframing of the situation actual situation is that the child is being given the “opportunity” to have a bonded relationship with both parents.

ACS 2: Empowering the child:

The child is empowered by the allied parent to reject the other parent.

ACS-1 and ACS-2 are typically used in tandem; we should not influence the child (ACS-1) and the child should be allowed to decide (ACS-2).

• • “The child should decide on visitation”

• • “We need to listen to the child”

• • Seeking the child’s testimony in court, empowering the child to reject the parent directly to the judge

ACS 3: “The Exclusion Demand”

The child seeks to exclude the targeted parent from the child’s activities (sporting events, award ceremonies, music recitals).

• • The child’s role is as a “regulatory object” to stabilize the narcissistic/(borderline) parent.

• • The narcissistic/(borderline) parent becomes dysregulated when the targeted parent attends the child’s activities, and the child feels the stress of keeping the narcissistic/(borderline) parent regulated.

• • It is the allied parent who wants to exclude the other parent, and the child is then manipulated as the “regulatory object” to achieve the parent’s objectives.

This symptom is not present in any other pathology and is not present in normal-range children. When this symptom is present, it is nearly 100% diagnostic of AB-PA.

ACS 4: Parental Replacement

The child rejects ownership of the targeted parent, either by calling the targeted parent by his or her first name or by calling the new step-parent spouse of the allied narcissistic/(borderline) parent by the parental appellations of “mom” or “dad.”

This never happens with an authentic child attachment system.  When the symptom of Parental Replacement is present, it is nearly 100% diagnostic of AB-PA.

ACS 5:  The “Unforgivable Event”

A negative past event is used as justification for all current and future rejection of the targeted parent.

This is a feature of the symptom of splitting:

From Linehan: “It is not uncommon for such individuals to believe that the smallest fault makes it impossible for the person to be “good” inside. Things once defined do not change.  Once a person is “flawed,” for instance, that person will remain flawed forever.” (Linehan, 1993, p. 35)

ACS 6:  Liar– “Fake”

The child claims that the targeted parent is “fake” or that the targeted parent is a liar, often said when responding to the parent’s sadness or love.

This symptom arises from the child’s efforts to cope with the child’s guilt for rejecting a beloved and loving parent. The child seeks to discount the authenticity of the parent’s sadness and loss (and the authenticity of the child’s own sadness and loss).

ACS 7:  Themes for rejection

A characteristic set of reasons are offered for the rejection of the parent:

• • Too controlling
  • Too angry – anger management problems
  • Targeted parent doesn’t take responsibility – doesn’t apologize
  • New romantic relationship neglects the child
  • Prior neglect of the child by the parent
  • Vague personhood
  • Non-forgivable grudge
  • Not adequately feeding the child

ACS 8:   Unwarranted Use of the Word “Abuse”

The allied parent (or child) uses the word “abuse” to describe the normal-range parenting practices of the targeted parent. Borderline personalities frequently characterize other people’s normal-range actions using the term “abusive.”  Normal-range people typically use less inflammatory words to characterize disagreements with others.

• • Using the word “abuse” has two differential diagnostic possibilities: 1) authentic abuse, 2) borderline personality pathology.

The unwarranted use of the word “abuse” originates in the unresolved childhood of the pathological parent that currently distorts perceptions of current interactions.

ACS 9:   Excessive texting

The child and the allied parent maintain almost continual contact while the child is with the targeted parent.

The child acts as a “regulatory object” for the fragile personality structure of the narcissistic/(borderline) parent, who becomes excessively anxious when separated from the child (because the child might bond with the targeted parent). Intrusion into the other parent’s time prevents bonding to this parent and regulates the anxiety of the narcissistic/(borderline) parent.

ACS 10:  Role-reversal use of the child

The allied parent abdicates parental decision making to the child, placing the child out front as supposedly wanting what the allied parent wants.

• • “It’s not me, it’s the child who wants…”

The narcissistic/(borderline) parent first manipulates the child’s desire and then hides their manipulation behind the child’s supposed “independent” decision (“It’s not me, it’s the child who…”).

ACS 11:  The parent “deserves” to be rejected

The child and the allied narcissistic/(borderline) parent both maintain the theme that the targeted parent “deserves” to be rejected.

This represents a classic spousal abuse theme (“of course I hit her, my dinner was cold, she deserved to be hit”). When challenged on the cruelty done to the targeted parent by the child’s angry-hostile rejection, the response of the child and targeted parent is that the targeted parent “deserves” to be rejected (the narcissistic value of justifying abuse and cruelty toward another person).

Note: the healthy value we teach is that we are not nice to other people because of who they are, we are nice because of who we are. This is the healthy counter-value to the narcissistic value that it is okay to be cruel as long as the target of our “deserves” it for some justification.

ACS 12:  Disregard of court orders

The narcissistic personality does not recognize the construct of “authority” – for the narcissistic personality “authority” is synonymous with “power.”

This symptom represents narcissistic entitlement, i.e., that they are exempt from rules that govern other ‘ordinary’ people (i.e., they’re ‘special’).

From Beck et al: “Narcissistic individuals also use power and entitlement as evidence of superiority… As a means of demonstrating their power, narcissists may alter boundaries, make unilateral decisions, control others, and determine exceptions to rules that apply to other, ordinary people.” (Beck, et al., 2004, p. 251)

Interpretation

The 12 ACS offer additional supporting symptoms for the diagnosis when the three Diagnostic Indicators of AB-PA are present. A general interpretation for the degree of support offered by the Associated Clinical Signs identified for the family would be:

2-3 ACS: Mild Support

4-5 ACS: Moderate Degree of Support

6-8 ACS: High Degree of Support

9-12 ACS: Extremely High Degree of Support

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

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

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

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

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

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