Forensic Psychology: Standards of Practice

This is a work product sample of what I run across from forensic psychology.  I redacted red for the sentences of the Evaluator, and blue for direct quotes.

Notice the extent of direct quotes.  She tape recorded the sessions and simply used the transcripts from the sessions as her History and Symptoms.  Then she provided three paragraphs in the concluding “Opinions” section of her report, giving her judgement; her decree on the child custody schedule.

Forensic Psychology: Standard of Practice

When the Checklist for Applied Knowledge is used on her report, her report evidenced the application of no knowledge from any domain of professional psychology.  The red-redacted sentences in the body of the report were mostly transitional statements from one block quote to the next in the recorded transcript.  Her final three paragraphs were entirely her opinion and judgement recommendations.

Her “Opinions” recommended that because the 12 year-old son didn’t want to live with his mother that the father should have sole physical custody of him, and even though the 10 year-old daughter explicitly said in the direct quotes in the report of the Evaluator that she wanted 50-50% shared custody visitation with both parents when the custody Evaluator asked her what she wanted, the Evaluator said the daughter’s custody visitation schedule should only be every-other-weekend with the mother, with no rationale given.


This is considered an acceptable standard of practice child custody assessment in forensic psychology. 

Notice the signature line for this psychologist, all the puffy titles, Queen protector of the realm of Zambeezeland.  Sounds impressive, doesn’t it.

I say “sounds impressive” because I have her actual work product.  I know what this psychologist actually does.  Now you do too.  You’re pretty much looking at it. She tape records her sessions, uses the transcript as her History and Symptoms, she applies no effort, no knowledge, nothing to the actual analysis of anything, then she just writes three paragraphs at the end saying, “The 12 year-old child says he doesn’t want to live with XYZ parent so full custody should go to ABC parent” – Next…

Unbelievable, but oh so true.  I run into this abysmal level of professional practice from forensic psychology all the time – and much-much worse – every single day.  I exaggerate.  Three times a week, four tops.

Look at the lines of her signature. She’s one of the “top people” in forensic psychology.  She’s one of their supposedly best people… and this is her actual work product.  She’s a fraud.

Holy cow, do you understand the implications of that?  One of the top people in forensic psychology is a fraud.  Ask me if I’m surprised.  I read their stuff all they time.  Typically, they’re better at hiding it.  Typically it’s not this completely and utterly lazy and incompetent.

She didn’t know that anyone in the world would be reviewing her report, and certainly not Dr. Childress.  She probably would have done things differently if she had known her report was going to be “reviewed” by somebody who actually knew something about professional psychology.  Which is what makes it perfect… this is an example of what they do.  Routinely.

Did you know it’s illegal for me to have an opinion about the work of a forensic psychologist.  Yeah, only other forensic psychologists are allowed to express an opinion about the work of a forensic psychologist.  So you’ll never hear me express an opinion about the actual practice involved with a specific child custody evaluation.  I’m legally not allowed to do that, only they can “review” their work – and this is one of their top people who would do the “review” – APA you MUST come look at this – from the outside – do NOT let forensic psychology review itself.  This is an example of their “top people”.

I’m different, though.  I’m a clinical psychologist.  I’m treatment guy.  My focus is on treatment plans for the family.  What do we do about things.

The forensic psychology report almost always refers for therapy.  That’s me, I’m therapy psychologist.  I’m the one who catches the family as they’re jettisoned from the child custody “evaluation”.  That’s where I come into the mix, talking about treatment issues of concern surrounding the family data.

Do I have an opinion about the child custody evaluation?  Oh yeah.  I’ve made my opinions about child custody evaluations abundantly clear.  No inter-rater reliability, no validity (by definition if there’s no reliability), voodoo assessments, rattle some beads, chant some incantations, and read the entrails of a goat.  That’s my opinion.

But I just can’t say that about any specific forensic psychology evaluation.  Only they are allowed to critique each other’s work.  How… convenient.

I am in professional jeopardy because of my critical statements about forensic psychology.  This is a prominent financial industry for them.  They will NOT like me calling attention to their deficits and critiquing their work.  They’re not used to having their work critiqued by “outsiders” like me.

Don’t care.  Standard 1.04 and 1.05 of the APA ethics code are clear.

Because of the professional threat to me personally from forensic psychology’s retaliation, this full redaction of one of their reports is great, because it is so incredibly blatant.  From someone who is considered a “top” forensic psychologist.  One of their best.  Honest to god, this is the standard of practice.  It is arrogance, arrogance, arrogance through and through.  Do you know why?  No oversight or review.

Their reports are sealed by the court to protect the child, and only other forensic psychologists can review what each other do… and this is considered standard of practice.  Anything is.  Usually it is more structured, but that’s for the big nine-month version for lots of money.  This psychologist appears to have thrown this one off in a few sessions.  The family probably didn’t have enough money for the longer version.

This is considered top-level standard of practice in forensic psychology.  Look at the credentials she cites for herself.  Hey, American Board of Assessment Psychology, this is the standard of practice work for one of your “Diplomats” – this is the product of your training – you – the American Board of Assessment Psychology – are confirming the quality of her work… See, right there in her signature line to her court report, she’s saying she’s a Diplomat of your training.  Her quality of work is your product. This is the quality of work produced by your Diplomats.

The forensic psychology people (I refuse to call them professionals until they start acting like professionals; standard of practice) may start making noises about this redacted report being an “exception” – no.  Actually it’s not. I read their reports all the time.  This is typical, they even get worse.  Most are irrational and lazy.  Then there’s the behemoth 9-month $40,000 monstrosities.

No application of any knowledge, no diagnosis, everybody just makes stuff up.  Look.  Right there.  See.  This forensic psychologist just made something up.  That’s all over the place, they all do it.  That is considered normal everyday run-of-the mill sort of stuff for this psychologist.  For all of them.  I read their reports.  Listen carefully – I – read – their – reports.

And my head is exploding at how bad it is.  Have we even touched on cultural competence yet?  Holy cow, is that a nightmare and a thousand over here in forensic psychology.  But they review themselves.  Don’t you see the problem with that?  They – review – themselves.  And this report is from one of their “top” forensic psychology people.  She’s one of the people they’d ask to review the reports of other forensic psychologists.  You don’t see the problem with that?

If you don’t believe me, just look for yourself.  Please.  Come over here and look.  APA.  I’m pleading with the APA, please, please, please come look at this “forensic psychology” world, it’s a nightmare of professional ignorance and professional sloth – and a true paradise of pathological narcissism… in the mental health professionals.

Haughty arrogance.  You see that in this report can’t you?  Of course.  That sense of haughty and arrogant entitlement, she’s above the rules, the rules don’t apply to her.  All the lines following her name, she’s a sham grandiosity – an outward appearance of pompous grandiosity without substance.  Don’t believe me?  Look at her work product.  That’s who she actually is.  A sham.  A fraud.  But showy pomp.

THAT is her actual work product.  I didn’t produce that report, SHE did.  That is her work product.  Do you think that is in any way acceptable professional practice?  Yikes cowabunga not from my world of clinical psychology.  That is not even practicum student level.  If an intern gives me that report, I’m booting the intern out of the training program and contacting the graduate school about their inferior training of their students.

And this person is considered a “top” person in forensic psychology. APA, this needs OUTSIDE review.  Bring cultural, bring psychometrics, bring clinical, bring ethics.  Do NOT let forensic psychology “review” themselves.  This is one of their “top people” – this person is who will be doing their “review” of themselves.

That’s standard of practice in forensic psychology.  She’s just one of the gang.  In fact, she’s one of the top in their gang.  She’s a leader of their little group of “forensic Evaluators” – she’s a Diplomat in Assessment.  Wow, she’s their best.

And this is her work product.

Defend it forensic psychology.  Defend this report.  Tell me that amount of block quotes and a three paragraph summary that entirely lacks the application of any professional knowledge, tell me that’s “okay”.  That this is acceptable standard of practice.

Because… if you don’t… then this psychologist is going to face a malpractice lawsuit from mom, and she’s going to get one of you forensic psychologists to “review” the work of this psychologist for “standards of practice” related to fraud and incompetence.  It will be based on your testimony, forensic psychology – remember, I’m not legally allowed to review the work of forensic psychologists, so mom is going to ask you… forensic psychology… is this fraud and incompetence?

What’s your answer forensic psychology?  Is this fraud and incompetence?

These people’s lives hang in the balance, her opinion holds the lives of these people.  The child’s development, the child’s life, is in this woman’s hands. 

Is this level of professional practice what you would want from your “Evaluator” if your children and your lives depended on the “Opinion” you received from “the Evaluator”?

Doesn’t that even sound creepy?  The “Evaluator” – the child custody “Evaluator” – like the Inquisitor from the Church of forensic psychology, who judges parents and decides the fates of children and parents, whether parents “deserve” to have children.  The child custody “Evaluator”.

They abrogate the obligations of the court.  The “Evaluator” from forensic psychology hears evidence (the history of the conflict in vivid and voyeuristic detail), they make a finding of fact (regarding the supposed cause of the conflict), and they order the remedy (of child custody and visitation schedules; who should have the children and when).

Isn’t that the court’s job, to hear evidence, make a finding of fact, and determine the remedy? 

Why is a child custody “Evaluator” doing that, based on this sort of shoddy report?  She tape records sessions, uses the transcript as her History and Symptoms, and gives a three-paragraph pronouncement of her rulings from the bench – excuse me, from the couch.

Isn’t hearing evidence, making a finding of fact (based on the law, not opinion), and making an order for the custody and visitation schedule (based on the law, not opinion), isn’t that the court’s obligation?  How is it that we have an “Evaluator” doing this, this… one person.  Why them?  Why any of it?   We should be focused on treatment, not custody.

The courts can make decisions.  Professional psychology is about pathology and treatment.  This isn’t a child custody issue, it’s a family pathology and treatment issue.  Professional psychology needs to stay away from custody and visitation schedules.  I don’t care.

Three options:

1.)  50-50.  That’s my recommendation as a clinical child and family psychologist. That is the best I can come up with if you ask me. Mother-daugher, father-daughter, mother-son, father-son, all unique, all equally important, 50-50.  Like kindergarten and Legos, we learn to share.

2.)  Every-other-weekend.  If, for some reason a shared 50-50 isn’t workable, then the default is primacy to one parent and the other parent gets every-other-weekend and one weekday (maybe dinner, maybe overnight) during the week.  Still okay. Everything is fine.

3.) School year/vacations.  If distance factors make an every-other-weekend schedule impractical, then the next default is primacy to one parent during the school year and vacation bonus time to the other parent.  This is not great, we’d prefer every other weekend, and we’d actually prefer 50-50, but the world has its limitations and context.

Which of these three options the court chooses is for the court to decide based on the application of its legal criteria for its decision-making.  Psychologists do not make decisions about custody and visitation schedules, courts do.

I can provide counsel to the court on family pathology, its treatment and its resolution.  Here’s my counsel surrounding custody visitation schedules.

First, I don’t care what the schedule is.  The only thing that’s important is the flow of love from the parent to the child – we always want 100 mom-love and 100 dad-love reaching the child whenever they see each other.   Zero mom-love or Zero dad love is a very-very-very bad thing.  If there are problems, we fix them.

Second, the only time we ever separate a child from a parent is for child abuse and child protection.

When we act for child protection, it should accompany a DSM-5 diagnosis of child abuse.  If there is no DSM-5 diagnosis of child abuse, then there is no justification for restrictions on the child’s access to the parent.  The directional flow of love that is of professional concern is from the parent to the child, we want the child receiving and accepting abundant parental love from each and both parents.

The only justification for interrupting the flow of love from the parent to the child is a threat of child abuse.  A threat of child abuse should be documented by a corresponding DSM-5 diagnosis of child abuse. 

Designating someone a “bad parent” based on arbitrary criteria arbitrarily applied is frightening in its implications – and it’s application.  The “Evaluator” system of forensic psychology is a frightening system, both traumatic and abusive.

Look at her “credentials” – her vitae gets even puffier… she’s a big-wig I’m sure.  A full narcissist display of show without substance.

Work product assessment is the best assessment there is – bar none.  If you want to know what somebody’s work is going to be like, get a sample.  Work product sample is a lock assessment.

This is a report from a big-wig in forensic psychology, standard of practice in forensic psychology.  Please, APA, get over here to look at this.

The review committee should include representation from cultural psychology, from psychometrics, from trauma, from attachment, from clinical psychology, and from ethics.

DO NOT allow “forensic psychology” to review itself.  They will select this person or someone similar to “review” the work of forensic psychology.  You will be decieved by the lines following their names.  THIS is an actual sample of their work product. 

Please, APA.  Bring review and scrutiny to the world of “forensic psychology” from OUTSIDE of forensic psychology.  They must NOT be allowed to continue to self-review.  The “Evaluator” system of judgment with no oversight or review is not working.  Severely not working.

There is zero application of knowledge. 

Professional review needs – needs – to include representation from psychometrics and assessment design.  Please, please, please, they have constructed a nightmare assessment of narcissistic self-indulgence.  Please, APA, we need psychometrics to review the evaluation procedures.

Lest forensic psychology start to babble at me at this point, I have three words – inter-rater reliability.  What is the inter-rater reliability for your assessment procedure?  Zero.  If there is no reliability to the assessment procedure, it cannot possibly be a valid assessment of anything.  That is axiomatic in the psychometrics of assessment design, construction, and use.

I have a professional obligation under Standards 1.04 and 1.05 of the APA ethics code to speak, and to continue to speak until appropriate professional review and oversight occurs.

This – this report – is considered high-quality standard of practice in forensic psychology.

If an intern gave me a report like that, I’m terminating the intern’s placement at my agency and I’m contacting the graduate school immediately to express my deep-deep concerns about their training program – and I’m not accepting another intern from that school.

That’s for an intern. This is from what’s considered to be a “top professional” in forensic psychology.  This is top-quality work product in forensic psychology.

This is not unusual.  I run into this level, and worse, routinely.

I am appalled.  Standard 1.04 and 1.05 are applicable.





































































































I love science. 

There’s this wonderful motivational system in our brains, called curiosity. 

When curiosity is satisfied, it feels good, not like other goods, like the taste of food, or a beautiful sunset, or a loving embrace – all wonderful goods – the satisfaction of curiosity has a deep-sort of glow, that… satisfies.  It feels… good when curiosity receives knowledge.

School crushes that out of us, the joy of curiosity’s satisfaction.  It makes knowledge tedious and boring.  It’s a product of trauma, childhood trauma.  Our educational model is called the “Cathedral Schools” model from the 12th Century.  Education was centered around the Cathedral and priests, learning Latin and things.  We still have that model.  I hate it.  We need a complete overhaul of that.

School crushes curiosity, crushes joy in learning and knowledge.

I endured school.  They skipped me a grade, back when I was like six.  I went into the principal’s office and this man gave me a bunch of puzzle stuff (I now recognize the puzzles as the Stanford-Binet, which would have been about right for 1960).  That was at the end of first grade.  At the start of the next year I was in third grade.  I skipped second. 

School was still boring.  It wasn’t the stuff, it was the pace.  Oh my god, soooo slooooow.  And then, in third grade, I’m now a year younger than everyone on the playground.  The education system needs a complete top-to-bottom overhaul of the “Cathedral Schools” model – iSchools.  Bill, Melinda?  Dreamworks?  Pixar?  Universities can provide curriculum for each developmental stage, can you package it for kids please.

I endured school.  My parents were happy with A-B range so I maintained an A-B range without much effort.  My dad went to UCLA, both my brothers went to UCLA, guess where I went?  That was when the intellectual brutalization of our school system began to open up, when I began college.  I remember the thrill of curiosity spring back the first time I held a “Catalogue of Classes” in my hands.  You mean… I could choose?  Anything I wanted?  Really?  Oh my god, that was delight.

So that was pretty fun.  Course content was still pretty easy, but I could wander all over the place – satisfying curiosity.  I wandered in art history, and political science, and biology, and chemistry, and literature, and anthropology, history, sports, all over the place.  It was wonderful.  My major starting as a Freshman was psychology.  I’ve always wanted to be a clinical psychologist – it’s a family thing, understanding, working through, and helping.

So my core line was psychology from the git-go, and I love science.  It satisfies… curiosity.  the deeper the curiosity – the greater that… good feeling… is from knowledge.  It’s like Ben and Jerry’s without the calories, mmmm, that’s rich and tasty knowledge.

With the brain, we build what we use.  If you want to play the piano, what do you do?  You practice, over-and-over again – using the muscles in the patterns, recognizing the sheet music and translating the dots into muscle movement – over-and-over again.  We build what we use.  You begin to get better at playing the piano.  Soon, you’re playing simple songs – use-use-use – practice – then you’re playing better.  We build what we use, the brain circuits and networks.  We sort of “groove in” the neural pathways.

I’ve got a deep groove on curiosity and its satisfaction.  Over and over again, Sumerians, cell biology, quantum physics, origin of human languages, evolution of species, history of Europe, Asia, Africa, America, knowledge, curiosity.  It’s just a nice feeling.

I am a quantum physics junkie, and YouTube is like my crack cocaine of curiosity satisfaction – just straight mainline fixes with all the lectures and documentaries and stuff.

I am NOT a math guy.  I hate math, oh my god.  Back in the “educational” system the math stuff was like torturing me on the Rack for however long they did it to me, hours, days.  Oh, math was awful.  Slide3

Not because I didn’t understand it, but because I did.  Math “class” was essentially doing big long worksheets of problems, oh my god that was torture.  I’d get it by the third problem. Okay, got it. Can we move on please?  No.  What?  You have to do it for an hour. What?  Why? I’ve got it.  Math was just torture. 

With the other classes, at least the information kept coming – slowly – but it was nevertheless coming. Math was just the SAME thing over-and-over on these worksheets.

My Freshman year in college at UCLA (yay, release) I took a calculus course.  UCLA is on the quarter system, I’m living in the dorms on campus first semester away from home, UCLA is on a quick-quick 10-week Quarter system, I’m a Freshman, taking a required math course for the psychology major (calculus-math is needed for statistics knowledge in psychology).  Needless to say, I didn’t do much work… or any work.  Finals came, I hadn’t turned in any homework, my entire course grade rested on the final to pull my grade for the course out of the fire.  I read the calculus textbook the night before the final and got a B, A on the final, B for the course.  It’s math.  Same thing over and over.  What’s the “thing” this time? Okay.  It’s not hard, the same thing every time.  New formulas are just new “things” to do over-and-over.

Those were the days before calculators.  Advanced technology was a slide rule.  Did you see the movie Apollo 13 with all those rocket scientists pulling out their slide rules?

I stopped working at one point in school.  Fourth grade.  I just stopped turning stuff in.  Pretty much everything.  Reports and homework.  I just stopped turning stuff in.  I was a good kid, well-behaved, I didn’t act out or anything. I just stopped participating. That’s what it felt like on my end.  I just wasn’t going to participate anymore.

I remember they had all sorts of parent-teacher conferences, and I talked to the school counselor and stuff.  When my mom asked what was wrong, I said it was really-really boring and I’m just not interested, which was the truth. 

They moved me up again, this time to a fourth-fifth grade combination class, so I was still with some fourth graders developmentally (who were still a year older than me), but I could also be doing the fifth grade curriculum with the other fifth graders in the class.  That helped a lot.

School and I are old-old adversaries.

But I love knowledge and learning – knowledge is the satisfaction of curiosity. When curiosity is strong, the satisfaction is so sweet a feeling.

I fully understand that other people aren’t like that.  Some are, some aren’t. Some enjoy the good-feeling of physical exercise and working out – I understand that good feeling, but it’s not the spot-on one for me.  Couch potato has its good too.  Some people love that good feeling from social bonding, and I know that one too, but again, for me, that’s not my spot-on good one. 

There’s lots of sources of that good feeling, different textures and qualities.  People choose the ones that work for them, kind of trial and error.  For me, curiosity is like a hunger, like a physical hunger for food, but in the brain, in my thinking systems, they want food, knowledge.

And when my curiosity gets knowledge, it’s like a big Thanksgiving turkey dinner and that sleepy full happy feeling.  Ahhhhhh.

Quantum physics is my Thanksgiving dinner, mmmhmm. I put the math in a little package to the side (I basically know what you’re saying but I’m not interested in it at your level, unless I have to – and sometimes it is… but nothing more than necessary on the math, okay. I’m a psychologist, that’s where I live).

Do you know how I relax and unwind? – how I unstress – 

I watch episodes of PBS Space Time. I love that series.

That’s how I relax, watching explanations of physics and cosmology and stuff.  My favorite – and one you most definitely should watch – is entitled:

Are Space and Time an Illusion.  Poof.

But I wander from there.  YouTube is amazing.  I’m old guy.  I grew up with black-and-white television; I Love Lucy and Milton Berle.  And now there’s “YouTube” on my “laptop” – a magical world indeed.  These new phone-video-picture thingies – Harry Potter pictures.  Amazing. 

I have a lot of fun on YouTube.  Have you heard about the Reptoids living at the center of the Earth?  That was an interesting wander into psychotic-land.  YouTube spans Reptoids to Sir Roger Penrose.

Science.  that’s where we’re headed with this court-involved family conflict thing.  To science.  To quantum physics level of science in professional psychology.  Why not?  Is there a reason not to go to the scientific knowledge of professional psychology?


I’ve done that with every pathology I’ve worked with, ADHD, autism, trauma, now this.  Did you know there’s research linking gut flora to autism (those little bacteria microbes in your digestive system; they’re called our “gut flora”).  What the dickens do the microbes in our intestines have to do with the brain-based pathology of autism?  Research is there, figure it out.

As a science-based clinical psychologist, I’m heavily into brain neurology and the research on regulatory systems and representational networks of the brain, how they’re organized, how they function, how they’re integrated.

Before I enter with everyone the science world of professional psychology and child development (the neuro-development of the brain and brain systems), I want to set the standard for science. 

Biology as a standard gets messy because we don’t know a lot (they know a lot – but life is sooooo complicated), chemistry is too narrow, math is too narrow (somewhat; but I hate math anyway, so we won’t use math as the standard), history is too vague and open to interpretation.  Science is in Galileo, Newton, Einstein, Feynman. In Maxwell and electricity, in Bohr and the atom, in Hawing and black holes (I hear you, math people; Mysteries of the Mathematical Universe). 

That’s where science is clearly revealed, in the Galileo-Newton-Einstein line.

That’s the standard of science.  So let me share two, what I consider to be required curriculum pieces for all clinical psychologists working with court-involved pathology – these two YouTube videos represent the standard of science – which we will then apply with the scientifically established knowledge of professional psychology.  The child is not a black hole, but science is science. 

This is the standard set by science:

Einstein’s Unfinished Revolution: Lee Smolin public lecture webcast

The Origin of the Universe and the Arrow of Time

I understand that not everyone shares my love of science, some enjoy the good feelings from physical exercise and they work-out, some are filled by the joys of ambition and they succeed and build empires, some enjoy the social joys and they become actors on the stage.  Each of us finds our joy and satisfaction.

Mine is science.  Science is truth.  It can answer from the origins, to the end, and all things between.  From galaxies and the Hubble telescope, to genetics and medical miracles, personal phones and the Internet of information.  Science seeks truth, and solutions are found in the application of science – in the application of scientific knowledge – in the application of the scientific method.

Science is lively with debate – about data.  String theory does not produce a provable-disprovable prediction – is it worthy of interest?  Science enjoys debate.  Look at this picture of science. Amazing.  There’s Einstein and Bohr, and Max Planck, Marie Curie, Dirac, and Heisenberg (not quite sure if he’s there, he’s there but you can’t tell exactly where).wallpaper-2260834

The story surrounding of this conference is amazing, Einstein and Bohr debating every day, Einstein offers a problem to quantum physics every morning, Bohr an answer every evening. This is the standard of science.

That’s what a professional conference looks like.

Do you know what the current interpretation of the data in quantum physics is called?  The Copenhagen interpretation.  This conference picture of an all-star physics line-up came from the conferences that brought the Copenhagen interpretation into mainstream.

Denmark.  In the solution we are creating for this court-involved family conflict pathology – why isn’t Denmark leading in the application of science?  Attachment, complex trauma, personality disorders, family systems therapy – and – the neurological development of the brain within the parent-child relationship.  Science.  Current science in professional psychology and child development.  Why isn’t Denmark – the origin for the Copenhagen interpretation in quantum physics – leading in the application of psychological science with children?

I recently traveled to the Netherlands to present.  The Netherlands is home of Gerard t’Hooft, a world-leading physicist.  Why isn’t the Netherlands matching their scientific knowledge in physics to their application of scientific knowledge with children?  England has produced Niels Bohr, Paul Dirac, and Stephen Hawking in physics, and yet doesn’t apply the scientific knowledge from psychology to solution with their own children. Why not?

Because they don’t care about children.  Trauma.  Our neglect of children is the ripple of out own childhood trauma.  Read deMause on the history of childhood, and Robin Grille’s book, Parenting for a Peaceful World based on the work of deMause.

The history of childhood is the history of child abuse.  Did you know that?  Probably not.  No one cares.  That’s called the bystander role in childhood trauma – the ones who don’t care, who don’t look, who don’t see.  An awful feeling, isn’t it.  That’s the feeling of children abandoned to child abuse.  You should learn more about the history of childhood.  We’ve been abusing children for so long, and so frightfully, violence and sexual abuse, right up to.. today.

I don’t expect everyone to have my love of science.  But science is the source of truth, and the application of scientific knowledge and the scientific method is the source of solutions.  For everything.

Including court-involved complex family conflict surrounding divorce.  Science: the neuro-development of the brain during childhood, regulatory and representational networks, complex trauma and the attachment system. 

Science. The foundation to solution.

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



High Road ABA: Clinical Data Discussion

Discussion of Twelve Clinical Data Points in the High Road Single-Case ABA Data

C.A. Childress, Psy.D. (2019)

Parent-Child Relationship Rating Scale (PC-RRS)

Affection (Aff):  Attachment networks – blue line

Cooperation (Co):  Emotional regulation – gold line

Social Involvement (SI):  Arousal and mood regulation – silver line


High Road Workshop Data

The PC-RSS data from the two-days of the High Road workshop represent a truly remarkable rocket into a joyful, healthy, and happy child by the end of the 2-day workshop.  The exit level data points are in the superior range.  The child’s affection is 5.5, his emotional system is 6, and his mood is 6.   He is immensely happy.

Of note is that this is a 2-day High Road workshop.  Typically, Ms. Pruter’s High Road recovery workshops are 4-days.  The actual recovery of the parent-child bond typically occurs sometime during the second day of the workshop, and then there are two additional days of recovery stabilization, structured through the workshop protocol, that takes place following the recovery of the parent-child bond of love and affection. 

The data from the workshop reflects a typical half-way point of the workshop; the recovery point.  Based on the data from the High Road workshop, the recovery of healthy child development occurs in the context of a very happy child.  Affection and attachment bonding networks are glowing wonderfully warm and positive, emotional systems are happy and alive, and mood is wonderful. The child is relaxed and happy during the recovery of healthy authenticity.  This data provides a remarkable insight into the recovery process from complex trauma.  Seeking additional information from Ms. Pruter about this recovery process and how she accomplishes such relaxed joy in the child is recommended.

In the interpretation of the follow-up clinical care data for this initial ABA with the High Road protocol, it is important to note that the typical High Road workshop is an integrated intervention of 4-days, and the protocol is structured for a 4-day recovery.  The additional two days of the High Road recovery workshop are important.  That Ms. Pruter conducted the recovery in two-days was a feature of her response to trauma and the needs of the case for immediate response when the child became available for her workshop.

The child’s supremely relaxed happiness reflected in the day-2 recovery data from the High Road workshop is a product of the workshop, it is not the actual set points of the child’s regulation systems.  They might become his set points if the child spent enough time with Ms. Pruter, but two days is not likely to alter the regulation set points of his nervous system created by three-years of continual psychological child abuse by his pathologically narcissistic father. Once the workshop is over, the child will (if recovered) return to his established neurological set points for these three regulatory systems (attachment; emotions; arousal-mood).

If the child’s ratings on the PC-RRS from the workshop are merely a product of the workshop, then the child’s functioning will collapse into disorganization and chaos once the recovery workshop ends.  The initial data into the clinical care period reflects the stable set-points for the three regulatory networks (attachment systems, emotional systems, arousal-mood systems).   She recovered the child’s authenticity.

(1)  Set-Point for Social Involvement

It is reasonable to expect a drop in functioning evidenced on the PC-RRS data from the end of the HR workshop to entry into my clinical care a week and a half later as a natural function of his return to his established regulatory set-points, and this expected drop to set-points is reflected in the data.  The entry points into my clinical care reflect the set-points for these three regulatory systems of the brain: attachment systems (Aff-3), emotional systems (Co-4), and arousal-mood systems (SI-6). 

Of first note is the separation of the SI system from the other two.  The SI (arousal-mood) system is two points higher than the next regulatory system, and is in the upper-range of regulation – a 6.  This suggests anxiety, and likely sustained anxiety/stress, that has elevated the set-point for this regulatory system.  The elevated set point also suggests that the child may use better-than-average social skills as an avenue for acquiring nurture, and as a vehicle for anxiety regulation.

A 6 set-point for SI regulation is too high.  The child’s nervous system is in a chronic up-regulated state from the years of trauma exposure.  The down regulatory systems of the brain are the sadness emotional networks.  The 6 set-point of SI suggests inadequate counter-regulation from the down-regulatory systems of sadness.  The child has unprocessed sadness.  Sadness is metabolized through the attachment networks.  The next clinical focus becomes the attachment system.

(2)  Set-Point for Attachment

The set-point for the attachment networks upon entry into follow-up clinical care is 3.  This is in the normal-range, but the Aff ratings also took the largest drop from the second day of High Road recovery to the stabilization.   This may reflect the absence of the final two days of the workshop protocol.  I have reviewed the protocol, and I understand how it achieves its effectiveness.  The final two days are important regulatory stabilization days for the newly activated attachment networks.  The 3 as a set-point for the attachment networks likely reflects the absence of the final two days of the workshop. 

The entry set-points into follow-up recovery care represent the half-way set-points in these regulatory systems achieved by the High Road workshop, a snap-shot of the regulatory networks set-points at the time recovery of authenticity occurs.  Of note in this regard is the higher regulatory set-point for emotional regulation systems (Co:4) than attachment systems (Aff:3).  I have some hypotheses as to why this set-point configuration would occur at the mid-way point of the workshop. 

Notice in the workshop data how Co (emotional networks) aligns with SI (the anxiety of trauma), in the context of a meteoric rise in affectionate bonding (Aff; attachment networks), I would offer the suggestion that during the recovery process the emotional systems lay on the trauma networks, and the trauma networks receive the elevated glow of attachment bonding (love) from the attachment networks of the child’s brain.  It is my professional opinion that we are watching the extraction of complex trauma – not healing – extraction of damage to the neurological networks of the brain.

In healthy child structures, the set-point for attachment networks (Aff) is above the set-point for the protest behavior (Co), and the two systems are entrained.  In the entry data into clinical care, the set-point hierarchy is inverted, and the two systems are not entrained.  Based on the speed by which clinical intervention achieved both a reversal of attachment and emotional set-points and entrainment of the two systems, it is likely that this early disruption represents the missing two final days of the High Road workshop. 

Additional entry data from clinical care following the full 4-day recovery workshop would be extremely helpful in interpreting this 2-day workshop data.  The recovery of attachment bonding with the full 4-day workshop protocol is anticipated to be more robust.

(3)  Co-2 Tiffy with Sad

My active clinical intervention does not begin until data point (5).  At the first Co drop to 2, I had not applied any clinical interventions of note.  In my first session I had done some stabilization, but it was mostly entry work.  My second session was with the mother (that released the ratings from their High Road stabilization). 

One interpretation of entry level stability is that both mother and child were afraid to do anything.  The recovery was great and they didn’t want to do anything to mess it up (reflecting the missing two days of the High Road workshop that are designed to address this “deer-in-the-headlights” experience).  Once I became involved as a support to mother, she became more comfortable with the recovery, and as she became relaxed the child became relaxed, and this is reflected in the release of ratings.  Everybody relaxed.

Follow the Co line once my intervention releases the ratings from their High Road stability.  Notice the drop to the Co-2, with a simultaneous drop in Aff to 3 and SI to 4.   The drop in Co represents a protest behavior display, something hurt, or there is a growth occurring.  The drop in Aff along with the drop in SI indicates sadness (down regulation of SI and lowered affectional warmth; the child is sad).  The drop is to a 2 (not a 1), so it’s a tiff of protest behavior rather than a fight of conflict.

This Co-2 drop occurred three days before my next session with the mother and child, and the first active session of my therapy.  Given the history of conflict in this relationship, a drop to 2 in Co is of note for recovery stability.  I had not yet had time to become an active stabilizing agent for the relationship, I had unlocked the stability of Dorcy’s recovery, and Dorcy only had 2-days of her workshop protocol rather than the structured and standard 4-day recovery protocol.   The mother-child bond may be fragile, and a Co-2 may collapse the recovery achieved by the 2-day workshop.  I took no direct steps, but I monitored the following day’s ratings to see if my active intervention was required.

The next day, the Co rose two points, to 4.  They had resolved their interaction without the need for my intervention.  Attachment bonding remained stable at its set-point of 3, and SI took a 2-point hop to its set-point of 6, indicating the absence of sadness.  The Co-2 tiffy with sad had been fully and successfully resolved.  We discussed the incident in session and it involved miscommunication and he became frustrated (and used inappropriate language).  A normal-range parent-child conflict, resolved entirely normally.  We developed communication and problems solving skills in our session.

This data point, Co-2 tiffy with sad, represents an important data point in the High Road ABA recovery profile.  It is the data point that indicates the degree of stability to the recovery achieved by the High Road workshop.  It is entirely stable.

(4)  Dyssynchrony

Before leaving the High Road stabilization phase of the data to enter my clinical care sessions, the variability in the three systems is notable.  The attachment system does not vary with the other two, and there is seeming synchrony of the emotional networks (Co) with the trauma impact (SI; arousal-anxiety), which is not the desired synchrony.  The nervous system of the child his healthy, but it is not yet organized. 

The focus of my first therapy session was to impact the stability of the attachment recovery.  I hoped to raise the set-point on attachment networks to 4 (with rises into 5), I wanted to reverse the set-points for Aff and Co (attachment higher than protest), and I wanted to entrain the emotional system (protest behavior; Co) with the attachment networks (Aff).  My intervention in session 1 was on the attachment networks as the ground to organizing the regulatory systems.

(5)  Session 1: 7-Spike SI

My first therapy session is indicated by the spike in SI to 7, the arousal system became very active with the material from my first session.  Note also the rise in Aff to 4 and the 4-point rise in Co (loss of protest, increased emotional flexibility and cooperation).  He liked my session.  The rise in Aff and spiking of SI (arousal-mood) suggest he was happy, and the 4-point rise in Co indicates he was relaxed.  He liked my first session.

On the following day, Aff continued to rise to 5, SI continued to spike at 7, and Co dropped one point on rebound to 5.  He continues to be happy and relaxed, and attachment bonding is increased from my session.

(6)  Consolidation V

Two days after my session, his nervous systems consolidate the gains from the intervention, with a rebound (bounce-back) of Aff to 4, Co to 3, and SI to 5.  A nice tight synchrony of all three regulatory systems is evidenced, and in a healthy order of set-points, attachment (Aff-4) above protest (Co-3).  This V shape of three systems represents the consolidation of the therapy intervention from two days previously.  Consolidation occurs on the down-regulatory networks.  Then watch what happens.

(7)  Integration Triad

The following day, three days after the therapy session, all three regulatory networks converge on a 5 rating, high-normal.  This is an integration of the therapy intervention from three days ago.  Integration occurs on the up-regulatory networks.  The consolidation V to the integration triad is magnificent.  Then watch what happens.

(8)  Synchrony: Attachment and Protest

Once the three lines converge in integration, where did the blue line go?  Attachment (Aff) and emotional regulation (Co) are perfectly synchronized for the next four days, even on a one day bounce they remain synchronized.  The correlation of the Aff and Co ratings before the three-line integration point is r=.60, following the three-line integration point the correlation of Aff and Co is r=.94.  The two systems achieved synchrony at that three-line integration following the three-line V consolidation, and remained in complete synchrony until the intervention of my second session.

(9)  Set-Point Stability

I had introduced organizing disruption followed by consolidation and integration by the intervention of my first session, and the regulatory systems stabilized into new set-points following their consolidation and integration from the therapy intervention.  The new stabilization set-point for SI across 3 days was 5, one point lower than it’s entry at 6, and now in the normal-range.  The new stabilization set-points for Aff and Co combined appear to be in the 4-5 range, a 1-point increase for attachment regulation from the entry levels.  All three regulatory systems are within one point or less of each other.

(10)  Session 2:  Something to Consider

The stability of synchrony achieved between Aff and Co at the integration point continues for five days following the integration, with my interventions in session 2 becoming the disruptive agent.  Session 2 of my therapy produced another immediate spike to 7 in SI, his arousal level was high.

Aff dropped by one point, and Co dropped by two, breaking their synchrony, with Aff settling on a set-point (3) one point higher than Co which dropped in the Co-2 range of “protest behavior.”  I had given him something to ponder, not verbally, but in the process of our session, as I wove our session I gave him an issue to consider.  

You can see the impact.  His stress level went up (SI-7), his emotions became more inflexible, he’s processing something (Co-2), and he didn’t like what he was processing (drop in Aff).  What happened?

He figured it out.  The next day was a 3-point rise in Aff, to a 6.  The last time there was a 6 in Aff was the three-line integration.  Now, again, Aff and Co rejoin in synchrony at 6.  The only missing component of a three-system integration is that arousal-mood is too high at 7.  He’s too happy about what he figured out.  That makes me smile.

Notice the nice V drop of entrainment in this “considering” episode, between the attachment system and emotional system (protest behavior system).  We want protest contained within the attachment networks.  Co-2 drops represent minor breach-and-repair sequences of self-individuation in a social context.  The issue is not minor disagreements, it’s how we handle them.  If we bring problematic things to the breach, the minor breach can turn into a major one.

Occasional Co-2 drops are healthy individuation, especially in an adolescent-age child.  But we want protest behavior contained within the context of healthy attachment bonds.  We want the set point for Aff to be higher than for Co, we want them entrained, and we want Aff to always remain in the normal-range or above (3-5, with occasional elevations into 6 and 7). 

The entrainment Vs of Aff and Co at data points (6), (10), and (12) all reflect the desired Aff over Co organizational structure (protest behavior guided by and within the context of attachment), with Aff remaining 3 or above (normal and healthy attachment bonding), and no Co-1 (no severely painful breach for the child).

(11)  Two-Day 7-Spikes

I find those two-day 7-spikes in SI from my sessions interesting.  On the first session they reflect the child’s happiness and relaxation as Aff moves up consistently and Co spikes to 7 and only drops one point to a 6 the following days  He felt much more relaxed following my first session of active intervention.  The second day of the SI-7 means he continued to be very social with his mother, likely his gregariousness was because he was just a relaxed and happy guy.  He’s a great guy.

The second session 7-spikes on the SI scale are different.  The first one is an increase in arousal (stress) because of the – thing – I gave him to consider in our session.  You can see his Aff drops one and his Co drops two.  He’s not happy about that thing I gave him to consider.  He’s pondering it, that’s the arousal SI-7.  It’s troubling him, that’s the drop in Aff and Co.

He figured it out.  The next day, that bounce up for Aff of 3 points and Co 4 points is his figuring it out.   That’s an impressive impact.  He’s happy and relaxed.  Good for him that he’s figuring things out.

The 7-spike in SI on the day following our session is because he’s happy again.  The SI scale measures social involvement. He was socializing a lot with his mom.  On the day of our therapy, it was his way of managing anxiety and inner stress – that’s his coping style – he has a high-set point for social regulation.  So he regulated the stress of day 1 with a 7-spike in SI.  Day 2, his Aff took a leap.  He is so happy.  His Co takes an even bigger leap. He’s relaxed.  They both merge spot on at 5.  He figured it out.  Now, the day-2 7-spike in SI is happiness.

(12)  Whew

Boy, that session 2 stuff took a lot of processing across a lot of systems.  He’s recovering his stability.  There’s a down-regulation consolidation of all three systems, a release of 2 points for SI, 2 points for Aff, and 3 points for Co (he’s pooped), into a three-system consolidation V.  Look how synchronous those systems are.  That is a clean nervous system. 

Notice the consolidation V is identical to data point (6), with SI on top, one point higher than Aff, which is one point higher than Co, identical to the consolidation V of data point (6).

This is interesting.  At the consolidation V, Aff remained stable at 3, and so did the entrained Co, while SI completed the bounce back of the consolidation V, then Aff and Co completed their bounce back the following day, back into integrated entrainment at 5 (high-normal).  That is some hefty consolidation.  Two days of Aff-4 and Co-3 synchronized consolidation before an integration at 5.  Session 2 gave him some stuff to think about.  Whew.

His exit set points leaving this series are: Aff 4-5, Co 3-4, SI 5-6.  An entirely healthy and normal-range set of regulatory networks

Conclusion from the Clinical Data Set

The High Road workshop of Dorcy Pruter achieved a remarkable – truly breathtaking – recovery of healthy and normal-range functioning of a wonderful child, in two days, following three years of documented child abuse.  The recovery from complex trauma and child abuse is full, it is strong, and robust.  She handed into my clinical care, a totally normal-range and wonderful young man.  As a clinical psychologist, I am in deep respect for what Ms. Pruter accomplishes on a regular basis. 

And if there is any question about how the kids feel about the High Road workshop, for my client it was Aff-5.5, Co-6, SI-6.  He loved it.

I’ll bet he did.  Because as far as I can tell, the High Road protocol, administered in two days by Dorcy Pruter, achieved a full recovery of the child’s healthy and normal-range development.  I’ll bet that did feel pretty good.

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





Flying Monkeys

My client is at risk.

My child is at risk from a group of people who seek to disrupt and damage the recovery of children from complex trauma and child abuse that are achieved by Dorcy Pruter. My client’s recovery is at risk from these people.  We have taken to calling this symptom feature of the pathology, the allies who seek to facilitate the enactment of narcissistic child abuse, “flying monkeys”, after the popular culture label for these people:

Wikipedia: Flying monkeys (psychology)

“Flying monkeys is a phrase used in popular psychology mainly in the context of narcissistic abuse. They are people who act on behalf of a narcissist to a third party, usually for an abusive purpose.”

Urban Dictionary: Flying monkey

“In popular psychology, a flying monkey is someone who does the narcissist’s bidding to inflict additional torment to the narcissist’s victim.”

This is a symptom feature of narcissistic abuse pathology – people are a symptom of pathology.  That, is pretty amazing for a pathology.  No other pathology except this – attachment trauma pathology of pathological narcissism – has other people as a symptom of the pathology. 

I find that remarkable.  People are a symptom of pathology.  They don’t know it.  It is an irrational delusional belief involving the splitting pathology of trauma (demonization).  The allegations made are hyperbolic extremes, alleging Dorcy Pruter specifically, and anyone associated with her, are “abusive” of children – and that society needs to be “protected” from Dorcy Pruter and anyone associated with her.

They are delusional.  And they are malignant, savage, and evil people – the absence of the capacity for empathy; they are narcissistically self-absorbed without the capacity for social connection. 

They have no concern for, or ability for, rational discussion, they are driven by irrational delusions of supposed threat that only they see, in which they demonize the target (Dorcy Pruter in this specific case) and then they engage is a focused campaign of vile smears, slander, and an intentional effort to damage and disrupt the work of Ms. Pruter, including breaking the identity of her recovered children, seeking to ally with the abusive parent in the return of the child’s hostile rejection of the other parent again.

At its upper extremes, the “flying monkey” symptom of narcissistic abuse pathology reaches the level of “gang-stalking”

Urban Dictionary: Gang Stalking

“Gang stalking is organized harassment at it’s best. It is the targeting of an individual for revenge, jealousy, sport, or to keep them quiet, etc.  It’s organized, widespread, and growing.  Some describe this form of harassment as, “A psychological attack that can completely destroy a persons life, while leaving little or no evidence to incriminate the perpetrators.”

I have had clinical treatment experience with this “gang-stalking” symptom feature of malignant narcissism.  It is extremely disturbing.  APA, you must get over here to look at this pathology; narcissistic child abuse and trauma.  That is the pathology I am asking you to look at… specifically.

This – social distribution – symptom feature of the pathology arises because this is an attachment trauma pathology.  It spreads from brain to brain through inhabiting specific networks created by abuse and victimization.  The damage caused to the attachment networks seeks, it is a motivational system, it seeks and locates the false trauma reenactment narrative of the narcissistic child abuse, and the brains of trauma join the trauma reenactment for the vicarious resolution of their own childhood trauma.

The “flying monkey” people are vicariously working through their own childhood trauma (and narcissistic pathology of inadequacy; the grandiosity of their “savior” role), by adopting the self-assigned role as “savior” and “protector” of children, they then demonize their target (the person seeking to end the narcissistic abuse), and they begin a relentless campaign of malignant smear, abuse, and hyperbolic slander against the targeted person (or racial/ethnic groups in other variants of the trauma pathogen; demonization).

Dorcy Pruter and Dr. Childress are both targets of this vicious, slanderous, and malignant campaign by a group of people seeking to destroy both of our professional careers in slander and lies.  The goal of the “flying monkey” people is to prevent our ability to end narcissistic child abuse, and narcissistic spousal abuse.

They don’t realize this.  They live in a delusional world of self-construction in which they have self-appointed themselves as “Saviors of children” and “Protectors of children,” and from the delusional grandiosity of their narcissistic pathology they feel entitled by their grandiose self-anointment (they are anointing themselves) as the “Savior” and annointed “protector of children” – to then engage in their vile campaign of assault, lies, and slander against their targeted victim.

They are blind to their vile malignancy by the delusion of their self-annointment as the “Savior of children.”  In Nazi Germany, the blindess of the malignancy is evident in the “savior” of the Arian race justification.  Abuse justified by the “savior” of a cause.  Racist nationalism. 

These are variants on an underlying structure of a trauma pathogen in the attachment networks – the pattern is abuse justified by a “savior” role.  In the case of the flying monkeys, it’s the abuse, lies, and slander toward Dorcy Pruter (and by extension, Dr. Childress) justified by their self-anointed role as the “Savior of children.” 

One example of this is Dr. Mercer and her blog.  A self-anointed savior of children.  She is not a clinical psychologist.  Never has been.  No training in assessment, diagnosis, or treatment of any pathology.  Yet she opines in the most irrational and vehement tones of “protection” about the assessment, diagnosis, and treatment of pathology – far-far beyond any boundaries of professional competence.  And she feels entitled do this because of her grandiose belief in her self-anointed role as a “Savior” of children.

Do you see the pattern.  Trauma is pattern.  Once you see pattern, you’ll be able to see trauma.

Dorcy has the identities of the most prominent current enactors of the most severe elements of the harassment.  Dorcy Pruter’s personal safety has been at risk for years from this symptom feature of narcissistic abuse.  This “flying monkey” symptom of extreme malignancy has attached to her as its focus for slander and abuse.  She has been, and continues to be, the recipient of lies, vicious slander, and abuse from this symptom feature of the pathology.

She has endured the vile malignancy of this narcissistic abuse for years, and has taken personal steps to protect her safety, she is in physical jeopardy for her safety  – that’s how severe this symptom feature is – her personal safety is at risk because she recovers children from the trauma of child abuse.  No professional should have to place themselves at such risk to recover children from child abuse and trauma.

APA, you must get over here to look at this pathology; narcissitic child abuse and trauma.

As a clinical psychologist, I love what the “flying monkey” symptom reveals about the nature and functioning of the attachment system and attachment trauma.  The symptom of the “flying monkeys” (people) surrounding narcissistic trauma and abuse has been a goldmine of professional-level knowledge about attachment and complex trauma that is created from, and creates, child abuse. 

My doctorate degree protects me somewhat.  Without a doctorate degree, Dorcy is more exposed to their lies and slanderous abuse.

I have been collecting documented evidence of this symptom feature of complex trauma and narcissistic abuse.  I’m a clinical psychologist.  The pathogen has never met a clinical psychologist like me before.  As we solve this pathology, I will be exposing the “flying monkey” symptom to professional psychology, and it will be addressed within the professional solution developed within professional psychology.

“Flying monkeys” exist – and they are targeting Dorcy Pruter and her work with their vile malignancy.

Breaking Treatment Identity

Of most clinical concern is that this group of people (the carriers of the “flying monkey” symptoms) believe from the grandiostity of their narcissistic entitlement that they are entitled by their narcissistic self-anointed roles as “Savior” and “Protector of children” to break identity coverage on Dorcy Pruter’s recoveries, and then begin an organized campaign to re-establish the child’s pathological rejection of the targeted parent.

Once they have broken the identify cover for her recovered child, they contact the allied narcissistic parent and work in tandem with this abusive parent to re-initiate the psychological abuse of the child, because these non-involved people have a delusional belief that they are “rescuing” the children from the “abuse” of Dorcy Pruter.

It is delusional.  I am a clinical psychologist.  It is a delusion.  They are working-through their own childhood trauma by their self-anointed vicarious trauma role as the “protector of children” in a splitting pathology of their own grandiose idealization of self-perception, and their demonization (splitting pathology) of their abuse victim – in this case, Dorcy Pruter.

Why they have targeted Dorcy Pruter specifically is a matter for professional speculation, I have my thoughts on the matter.  At this point, the “why” is not relevant, the symptom feature of “flying monkeys” (people) that surrounds pathological narcissistic abuse of its victim is documented and confirmed.

And the symptom feature of the “flying monkeys” surrounding narcissitic trauma and abuse, is placing my client-child at risk.

My Clinical Care of My Patient

The “flying monkey” symptom of narcissistic abuse will seek to break protective identify of my patient, and these people (the carriers of the “flying monkey” symptom of childhood trauma) will seek to destroy the treatment gains achieved by the High Road protocol and the follow-up therapy of Dr. Childress, simply because the recovery was achieved by Dorcy Pruter (the demonization of their “splitting” within their own pathological narcissism).

The risk they pose to my client is of such significance, that the potential intrusion of the “flying monkey” symptom of narcissistic abuse into my clinical care of my patient has been charted twice into the medical record for my patient care.

Once in treatment planning for the end of the protective separation period.  This represents a high-risk time for “flying monkey” intrusion into and disruption of recovery.  They may potentially seek to break protective identify cover for the patient child, and then will begin a coordinated campaign with the abusive father to re-initiate and reestablish the child’s pathological hatred for his mother created by the father’s psychological abuse of the child.

I have a bullet point on my treatment plan to address risk factors to my child’s recovery posed by the intrusion of people (“flying monkeys”) who have no involvement in the case, but who simply seek to harass Dorcy Pruter and destroy the recovery gains she achieves with the High Road protocol.

My second entry into the medical record of my patient surrounding the risk to treatment posed by the “flying monkey” symptom of pathological violence and abuse is surrounding the current release of data from patient care in association with the High Road recovery workshop data for my patient; the clinical data points on the PC-RRS for the single-case ABA of the High Road workshop. 

Highlighting my collaborative work with Dorcy Pruter and her recovery of the child from complex trauma and child abuse will potentially increase the risk to my client-child from the intrusion of non-involved people into my therapy and my child’s recovery in order to specifically damage and destroy the child’s recovery and treatment gains with his mother.

They will seek to return the child to the father’s abusive care, and they will seek to re-initiate and reestablish the child’s hostile rejection of his mother created by the psychological abuse of the father.  They will do this for no other reason than the child’s recovery from complex trauma and child abuse was achieved by Dorcy Pruter.

They have a delusional fixation (of erotomanic proportions) with Dorcy Pruter.  I have my interpretation as to why their fixation is with her.

My client is at risk from people unrelated to anything about the case, who are on a delusional “mission” to “protect children” –  grandiose self-proclaimed saviors of children – they are delusional.  This is a delusional pathology.   My DSM-IV diagnosis would be a Shared Psychotic Disorder.

This post represents one of my efforts, documented in the medical record of my patient as a full bullet point under treatment planning considerations, along with other protective steps to ensure the privacy of my patient and the integrity of his recovery of healthy childhood relationships with his parents.

Dorcy Pruter has documented intrusions of this symptom feature into her prior recoveries – it is a symptom feature of the pathology.  It is the most interesting of pathological features, that the actions of non-involved people are symptom features of the narcissistic abuse pathology, and it is an extremely vicious and malignant symptom feature – the splitting demonization of pathological narcissistic abuse made manifest.

I wish to send a clear message to the “flying monkey” symptom of pathological narcissistic abuse… don’t come near this child.

You have harassed and assaulted Dorcy Pruter for years, you have sought to undermine her recoveries at every turn, to destroy the lives of children and return them to their narcissistic abuse by a parent.  Don’t come near this child.

This is my patient.  You’ve never dealt with a clinical psychologist like me before.  I will protect my child with all the professional power that is available to me as a clinical psychologist.  Don’t come near this child.

Choose another one. Better still, don’t choose any.  Stop intruding into the recovery of healthy development achieved by the High Road workshop.  You are not involved.  Re-direct your interests. 

It is my 100% mission that, as we solve the pathology of childhood narcissistic abuse, we will be exposing the extent and nature of the “flying monkey” symptom of narcissistic abuse pathology.

And if you don’t think Dorcy Pruter has identities from her years of targeting by this most vile and malevolent of symptoms from narcissistic abuse and trauma, she knows who you are.  She protects her kids.

This child is the patient of Dr. Childress.  I am monitoring the child’s recovery on a daily basis.  I will protect my child’s recovery.

It is time to expose the “flying monkey” symptom of childhood narcissistic abuse.  The people who manifest this symptom feature are a malignancy of narcissistic child abuse, a ripple from their own unresolved childhood trauma.

My client-child is at risk from them.  I have charted into the medical record the steps I am taking to protect the recovery of my client child from intrusion into treatment by people unrelated to the case who have a grandiose and delusional belief in their entitlement as self-anointed “Saviors” and supposed “Protectors of children” in their delusional reenactment of their own child abuse trauma histories.

Stay away from my patients and their recovery.  Choose another avenue for the manifestation of your delusions.

Professional psychology – APA – you must get over here to look at this.  The pathology of narcissistic child abuse – as exposed in the family court system – requires your immediate and focused attention.

The Petition to the APA:  313 days and counting.  Silence.  No response from the APA to a Petition signed by 20,000 parents.

The APA: Complicity with Child Abuse

Flying monkeys:  The allies in the narcissistic abuse of children. 

Some allies of the pathology are active in enacting the abuse, some allies of narcissistic child abuse are silent in fulfilling their obligation to protect.  Allies of narcissistic child abuse. 

Those that should protect – but don’t – are called the “bystander role” in the trauma recovery literature.  Look it up.

Silence is complicity.

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

Single-Case ABA: High Road Protocol

I want to report on a clinical case from my practice, a 16 year-old male adolescent with a significant history of aggression and hostility toward his mother, provoked and supported by his father. 

The mental health documentation of the family pathology goes back to 2016.  Treatment reports from three prior mental health professionals, two PhD psychologists and an MFT marriage and family therapist, are all in complete agreement.  All three diagnosed Child Psychological Abuse in the period from the spring of 2016 to the summer of 2017, with the most recent psychologist giving a formal DSM-5 diagnosis in his written report of V995.51 Child Psychological Abuse (summer of 2017).

Both psychologists, one in 2016 and the other in 2017, expressed concerns about frequent and “inappropriate” kissing on the mouth between the son and father.  All three mental health professionals diagnosed the father with extremely pathological narcissistic personality disorder, with strong IPV (Intimate Partner Violence; domestic violence) components of spousal abuse, and directly observed hostile, verbally abusive episodes toward the spouse (and therapist) are reported by multiple therapists. 

It took a year and a half from the time that the DSM-5 diagnosis of Child Psychological Abuse was made by the treating psychologist in the summer of 2017 (after the two previous mental health providers also diagnosed psychological abuse) for the mother to finally get a protective separation order from the court.  The child was left in the care of a diagnosed abusive parent for 18 months following the formal diagnosis of child abuse by a licensed psychologist with 37 years of professional experience (and after the two prior therapists also diagnosed child abuse by the father).

A year and a half after the DSM-5 diagnosis of Child Psychological Abuse made by the treating psychologist, the court granted the mother’s request for a protective separation order.  In February of 2019 the court granted the mother full custody of her snarling, hateful, and aggressively violent 16 year-old son, so that she and her son could receive treatment after years of dominating and controlling, documented psychological abuse of the child by the father had entirely destroyed the child’s relationship with the mother. 

Mental Health Reports: Documented Pathology

The first mental health report regarding the family pathology is from the spring of 2016.  In it, a psychologist with 40 years of professional experience said,

“The father displayed in my office the most extreme, antagonistic, narcissistic-based behavior I have ever seen.”

“The father’s full manipulation of the child has completely dominated every area of his life, school, friends, family, and in particular, his displays of kissing his father repeatedly on the lips in public, these are all inappropriate.  The child lives in constant fear of displeasing his father, and has no independent thinking, apart from what his father requires.”

These are the statements from the report of a PhD psychologist in the spring of 2016.

The next report is from a marriage and family therapist (MFT) who treated the family in the spring and summer of 2017.  In this report, the MFT states,

“It is my belief that <child name> is a victim of Child Psychological Abuse from his father.  It is my belief that the messages <child name> has been receiving from his father have resulted in significant psychological harm to the child.  He is experiencing severe reactions to stress.”

The next mental health report is from a PhD psychologist with 37 years of professional experience.  In his report he states,

“It is clear to me that <child name>, who lives with his dad and gets a few hours per week of visitation with his mom, has been mentally and emotionally abused by his father for the past year.”

That was in the summer of 2017.  This third psychologist gave a DSM-5 diagnosis of V995.51 Child Psychological Abuse and he referred the child and mother to the High Road workshop of Dorcy Pruter.

In February of 2019, a year and a half after the formal DSM-5 diagnosis of Psychological Child Abuse, a protective separation order was granted by the court and the mother and child entered the High Road workshop.

Following the recovery through the High Road workshop, I became the treating clinical psychologist for follow-up care with the recovered child and restored mother-child bond. 

This clinical case report represents the application of a single-case ABA design to assess the effectiveness of the High Road workshop for recovery from complex trauma in childhood.  The form of complex trauma is child psychological abuse, created in the context of high-intensity family conflict and parental narcissistic and borderline pathology.

In this current case, the child had been exposed to at least three years of professionally documented child abuse.  In February of 2019, the child entered two days – two days – of the High Road workshop.  I began treatment of the mother-son relationship following the two days of the High Road workshop conducted by Dorcy Pruter.

During the workshop, Ms. Pruter collected parent rating data every morning and evening for the child’s relationship with the targeted parent, the mother, using the Parent-Child Relationship Rating Scale (PC-RRS).  When I began my treatment in March of 2019, I continued to collect the mother’s ratings on the PC-RRS for the child’s relationship behavior with her. 

This is a report on the PC-RRS data for a single-case ABA clinical recovery from the complex trauma of psychological child abuse, using the High Road protocol.

Single-Case ABA Research Design

When most people think of research, they think of an experimental research design where many people are separated into different groups, these groups then receive different experimental procedures, and group differences are measured using statistics; the experimental design.

There is a second research methodology that is equally as effective in demonstrating causality, and which is commonly used in assessing treatment efficacy, the single-case research design.

Wikipedia: Single-Subject Design

“In design of experiments, single-subject design or single-case research design is a research design most often used in applied fields of psychology, education, and human behavior in which the subject serves as his/her own control, rather than using another individual/group.”

In a single-case research design, the subject moves through a series of phases of intervention.  The initial phase (A) is a baseline assessment phase.  This is followed by a period of intervention (B), which is followed by the withdrawal of intervention and return to the baseline of no-intervention (A).

For the single-case ABA clinical recovery and treatment reported here, the initial A (baseline) phase was the pre-intervention (pre-HR) ratings on the Parent-Child Relationship Rating Scale (PC-RRS).  The intervention (B) was two days of the High Road workshop conducted by Dorcy Pruter.  The withdrawal of intervention (second A) was entry into my clinical care as the treating clinical psychologist following the High Road recovery workshop.

Instrument: PC-RRS

The Parent-Child Relationship Rating Scale (PC-RRS) is a parent rating of three features of the parent-child relationship; Affection, Cooperation, and Social Involvement.  During the High Road workshop period, these ratings were made twice daily (morning, evening).  In the follow-up clinical care with the treating psychologist, these parent ratings were made daily (end of the day).

The three items rated on the PC-RRS (Affection, Cooperation, and Social Involvement) are rated on a 7-point Likert scale from problematic (1s and 2s) to exceptionally positive (6s and 7s).  The Affection scale monitors parent-child attachment bonding.  The Cooperation scale monitors emotional disruptions (emotional flexibility and inflexibility).  The Social Involvement scale monitors arousal emotions (anxiety, stress, sadness, and depression).  The PC-RSS is designed to pick up key features of emotional and psychological functioning in healthy and unhealthy relationships.

The items are structured to reflect a normal-curve distribution, with normal-range being a middle rating of 4, extremely problematic behavior is rated a 1, and highly favorable behavior is rated a 7.  The goal for healthy development and for treatment is to achieve reasonably sustained periods of stable normal-range behavior (ratings in the 3 to 5 range) across all three indicators, Affection, Cooperation, and Social Involvement. 

Occasional drops into problematic 1 and 2 rated behaviors is normal and is anticipated from time to time in healthy child development.  However, sustained periods of low-level ratings of 1s and 2s would indicate issues of clinical concern.  Occasional elevations into 6 and 7 behaviors of high affection, cooperation, and social involvement are hoped for and desirable.  However, healthy child development is not a sustained period of hyper-affection, hyper-cooperation, and hyper-social involvement. 

The goal for child development is a healthy regulated state; mid-range is normal-range.  For the most part, healthy child development occurs in a regulated mid-range of flexibility.  The treatment goal using the PC-RRS is the mid-range of well-regulated relationship behavior; ratings in the 3 to 5 range for all three scales, Affection, Cooperation, and Social Involvement.

The Data


A: Child Psychological Abuse

PC-RRS ratings were not collected during the baseline period because the child’s overt hostility toward the mother that was created by the father’s psychological control of the child prevented the mother’s access to the child.  The reasonably assigned ratings for the child’s relationship behavior toward the mother during this period, based on reports from three separate clinical therapists, would be Affection=1-2; Cooperation=1-2; Social Involvement=1-2.   

B: Intervention – the High Road Protocol

In February of 2019, a protective separation order was granted by the court, and mother and son entered a 2-day High Road workshop conducted by Dorcy Pruter.  On their evening arrival the day before the workshop began, the child’s ratings on the PC-RRS were Affection=2; Cooperation=2; Social Involvement=1.

On Day 1 of the workshop, the child’s ratings on the PC-RRS began a rise that would be continual across the 2-day workshop period, reaching an evening rating on the first day of Affection=3; Cooperation=3; Social Involvement 4.5.  A normal-range parent-child relationship with the formerly targeted-rejected parent was achieved by the end of the workshop’s first day.

On Day 2 of the workshop, the child’s previous gains continued their improvement, reaching evening ratings at the end of the 2-day workshop of Affection=5.5; Cooperation=6; Social Involvement=6.

The 16 year-old adolescent had gone from a severely problematic relationship with his mother (ratings of 1-2) to a normal-range relationship by the end of the first day (ratings of 3-5), and rose into the highly affectionate, highly cooperative, and highly social range by the end of the second day (ratings of 6-7).

This represents a remarkable recovery of normal-range, and then superior functioning in the parent-child relationship within two days, following three years of documented psychological child abuse by a severely narcissistic personality parent.  In one day, the High Road workshop achieved normal-range bonding and normal-range child development.  In two days, the High Road workshop achieved superior bonding and healthy child development.

As a clinical psychologist, I am deeply impressed with the documented effectiveness of the High Road recovery workshop for complex trauma in children.

A: Withdrawal of Intervention – Follow-up Care

In March of 2019, I became involved as the follow-up clinical care treatment provider for the mother and son, following the three years of documented child psychological abuse, and two days of the High Road recovery workshop.

My first session with the mother and son begins the first data points for the clinical care ratings.  The mother’s initial daily ratings of the parent-child relationship were consistent upon their entry into therapy; Affection=3; Cooperation=4; Social Involvement=6.  The recovery gains documented for the High Road workshop are confirmed by the entry data into follow-up care with the clinical psychologist, with five straight data points in the normal-range.  

There is no reason to expect that the mother (the formerly targeted-rejected parent) would falsely report a positive relationship that did not exist.  If the mother is reporting a normal-range relationship with the child, then this is true and accurate data concerning their relationship.  The mother’s daily ratings are discussed in weekly therapy to verify rating calibration and ensure the validity of the ratings.  Problematic relationship issues that produce lowered daily scores are discussed in therapy using behavior-chain interviewing to verify rating accuracy and validity.

As therapy began to have impact, the initial stability of the normal-range relationship achieved by the High Road workshop began to fluctuate in response to my treatment interventions.  The rise in the ratings surrounding the 3/24/19 period reflects my first session of substantive treatment following my initial entry-sessions.  The fluctuations surrounding the 4/3/19 period reflect my second therapy session of substance. 

The sensitivity of the PC-RRS ratings to the effects of therapy, with distinctive periods of visible impact from therapy sessions, means that these rating are accurate and sensitive indications of the parent-child relationship.  The recovery of healthy and normal-range child development documented during the High Road workshop is confirmed by the treatment data in follow-up therapy.

The High Road workshop recovers children from abuse and trauma, and restores loving bonds of affection and healthy child development.  That is a fact.  The success of the High Road recovery protocol is documented by evidence, by the data.  It is a scientifically established fact.

There’s a reason it’s called a “single-case” research design; causality can be proven in a single case.

Findings of the Single-Case ABA for the High Road Workshop

As the current treating clinical psychologist for the mother and son relationship, it is my confirmed professional opinion that the mother-son affectional attachment bond has been fully recovered by the High Road workshop.  Not a doubt in my mind. 

The child’s healthy development has been recovered, and the child’s healthy and bonded relationship with his mother has been restored by the High Road workshop of Dorcy Pruter.  That is a scientifically confirmed fact.  Just look at the data.

From the first moment the mother-son relationship entered my treatment, their relationship was entirely in the normal-range, and their relationship has maintained that stability in response to the intrusions and perturbations introduced by therapy.  If the rating scales are picking up the effects of my therapy, the ratings are accurate reflections of the parent-child relationship.  Dorcy Pruter achieved a full recovery of the child, in two days… one day actually; normal-range ratings on the PC-RRS were achieved by the end of the first day of the High Road workshop.

The variability in the mother’s scores suggests that she has a sensitive internal calibration for her ratings.  The daily ratings are verified in family discussion with the mother and child during the weekly therapy session using behavior-chain interviewing around incidents of concern and ratings.  This data is accurate.  Not a doubt in my mind.

Following three years of psychological child abuse, child abuse confirmed independently by three separate mental health professionals, Dorcy Pruter and the High Road workshop recovered the child’s healthy and normal-range functioning in two days.  That is remarkable.

The success of the child’s recovery is remarkable, the success of Ms. Pruter’s achievement with the High Road protocol is remarkable.  Much respect from a licensed clinical psychologist. 

The recovery she achieved is verified by the ratings upon entry into my follow-up care, and has remained stable during my treatment period.


There is a reason it is called a “single-case” design – care to hazard a guess as to why?

The single case research design was the favorite research methodology of B.F. Skinner, a researcher of exemplary talent who helped found the fields of behavioral psychology and learning theory.  He didn’t trust the group differences in experimental design that might be “statistically significant” but so small as to be clinically irrelevant.  If an intervention is effective, we should be able to see the results.  That’s why B.F. Skinner preferred the single-case methodology in his research.

The effectiveness of the High Road workshop is confirmed.  I will verify the data points from my therapy, Ms. Pruter will verify her data points from the recovery workshop.  It’s true.  Absolutely verifiably true.  There is documented evidence for the effectiveness of the High Road workshop for recovering children from complex trauma and child abuse.

The High Road workshop represents evidence-based practice. 

There’s the evidence.  Right there.  It’s a lock.

Journal publication will come.  The next phase for Ms. Pruter is replication.  Do it again. 

She has already done it over 100 times.  She’s just been so busy recovering children that she hasn’t been focused on research protocols.  She has PC-RRS data on many, many families during the workshop.  And each new case represents a new single-case ABA.  Data will be collected using the PC-RRS for each new workshop and recovery, and the success of recovery – for each case – will be documented by evidence.

The data is in, the High Road workshop is evidence-based practice.  There is the evidence, right there, and each new workshop becomes a new single-case ABA, documented using the PC-RRS.  Want to replicate this research?  Please do.

What my therapy data does, is confirm her data from the workshop.  I see the recovery with my own eyes, in my treatment sessions, I see the success of the High Road workshop in the real-world recovery of my client-child and his healthy and bonded relationship with his mom.  She is beyond herself with joy.

I’m sure this research will generate further discussion in the months ahead.  As far as I’m concerned as a clinical psychologist, it’s a lock.  The High Road workshop of Dorcy Pruter is evidence-based practice and it will recover the child’s healthy and normal-range development in a matter of days.  That is a scientifically proven fact.

Not a doubt in the world.  There’s a reason it’s called a “single-case” design.  Just look at the data.  How can anyone possibly argue with that.  It’s a lock, it’s a fact.

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

Standards of Practice: 2007 Written Treatment Plans

I’ve opened my folder of teaching tools for teaching documentation of therapy.  It’s from 2007, long before I even knew that “parental alienation” existed.  I was in trauma world, working with kids in the foster care system. These documentation standards are from that time period.

This is a treatment plan form for the San Bernardino Department of Behavioral Health.  They were the county funding agency for mental health services in the foster care system.

SB-DBH Treatment Plan Form

The actual form is on blue paper, and it extends over several paper pages, so I just transcribed it to a Word table format and condensed redundancy. 

Those three empty boxes in the middle… that’s where all the action is on this form; Objectives, Clinical Interventions, and Outcomes.  It’s in those three empty boxes that we’d write our answers to those three important questions; goals, how are you going to get there, did it work?

Objectives – Clinical Interventions – Outcome

That’s the structural backbone of a written treatment plan.

What is the goal to be achieved by therapy (Objectives)?

How are you going to achieve those goals (Clinical Interventions)?

Did you achieve those goals (Outcome)?

I’ll go into each of these areas in a moment, but before leaving the form I want to point out a couple of other important features of a written treatment plan demonstrated by this county form.

First, notice that right above the Signatures box there’s a Frequency of Care Plan Review line, with boxes for 30 Days, 3 Months, 6 Month, and 12 Months.  Those time-frames are typically considered the standard of practice review points for treatment plans.  Treatment goals should typically be for a three- to six-month range for resolution of the pathology.  Short-term goals in the four- to six-week range are helpful progress milestones toward achieving the longer 3 to 6-month solutions. 

That’s what a treatment plan does, it lays out the course for solution, and that course is reviewed regularly; we’d hope for a treatment plan with a 3 to 6-month resolution of the pathology.

Notice too, the box off to the side of the signatures that says, “Client Received a Copy of the Care Plan” with a place for the client’s initials and date.  The written treatment plan is reviewed with the client, and the client gets a copy of it.  In fact, the Department of Behavioral Health wants to make certain that the client has a copy of the written treatment plan.  This documents that we reviewed the treatment plan with the client… at 3 months, and 6 months, and 1 year; each time the client initials a new signature line with a new date.

That’s considered standard of practice in county work in the foster care system.  Written treatment plan, review it with the client, client gets a copy of the written treatment plan.

Let’s take a closer look at those three empty boxes, and see what the county Department of Behavioral Health wants.


OBJECTIVES: (Must be specific, measurable/quantifiable, attainable, realistic, time-bound.  Must be related to assessment, presenting problems/symptoms and functional impairment.  Include cultural/linguistic, co-occurring factors, if appropriate.  Include Med Support and Targeted Case Management, if appropriate)

Let me highlight a couple of things from this documentation requirement – measurable/quantifiable – time-bound.  Those features of the treatment plan are not optional, they are part of the list of required components.   Notice the instructions say “Must be” – not “Should be” – Must be… measurable and time-bound Objectives are requirements of the written treatment plan.

We must be able to measure treatment outcome, and our treatment goals must be time-bound.

Let me also highlight that the goals of treatment must be linked to the assessment information, to the presenting problem and symptoms, and to the impairment caused by the symptoms. The treatment plan describes what the problem is, and how to fix it.

Treatment plans link to the assessment data and describe a coherently organized approach to fixing the presenting problem – to solving things.

If a mental health professional cannot develop a written treatment plan for a pathology, then that mental health professional should not be working with that pathology.  Simple as that.

If I’m working with eating disorders, I must be able to develop an effective treatment plan for eating disorders.  If I am working with depression, I must be able to come up with an effective treatment plan for depression.  In professional psychology, that’s called “boundaries of competence,” that I only work with types of pathology that I know about, for which I am able to develop a written treatment plan.

If you know what you’re doing, then you have a plan for treatment. If you have a plan for treatment, write it down on a piece of paper and tell everyone what the plan is.   A written treatment plan.  A standard of professional practice – Department of Behavioral Health, San Bernardino County.

Clinical Interventions

CLINICAL INTERVENTIONS: (Must be related to objective. List clinical intervention for each group/individual service.  Includes Med Support and Targeted Case Management, if appropriate).

Tell us what you’re going to do.  This is the application of knowledge section of the treatment plan.  Objectives is being able to define goals in achievable and measurable ways, Clinical Interventions is knowing what to do about it.

Personally, I’d apply the scientifically established knowledge of professional psychology, in whatever domain of pathology I was working in, from geriatrics, to ADHD, or autism.  What’s the science say, that’s where I’ll be.  For this court-involved family conflict pathology, I apply the knowledge from attachment, and family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain during childhood.  I think it’s tremendously relevant information that helps make sense of everything.

I’d recommend it; attachment, family systems therapy, personality disorders, complex trauma, and the neuro-development of the brain in childhood.

But everyone’s free to apply the knowledge they’d like.  A psychoanalytically oriented psychologist might apply Adler or Kohut, a humanistic psychologist might apply Rogers and Pearls, a CBT therapist will apply learning theory and Beck.  What knowledge is applied in this box, Clinical Interventions, is given broad latitude… but it is documented in the treatment plan.

It doesn’t matter what you do… just tell us what it is.

Because, you see, in telling us what it is you’re going to do to fix things, we’ll be able to tell if you know what you’re doing.  First, if you can’t tell us anything at all about how you are going to fix things (the clinical interventions), then you don’t know what you’re doing.  So that’s an easy one right there.

Then, for those therapists who do provide a description of their clinical interventions, we can look at their case formulation and applied knowledge to see what information and knowledge from professional psychology they used in their case conceptualization and treatment approach.  This will allow parents to make informed decisions regarding treatment, a requirement of informed consent to treatment.  It’s the informed part.

Don’t care what the answer is to this box, Clinical Interventions, just tell us what you plan to do.  After that, then we’ll care about what the answer is to this box.  But for right now, just tell us what you’re going to do to fix things.  Whatever you think is best.


OUTCOMES/date/initials: To be completed at the end of the Care Plan Review timeframe, 30 days, 3, 6, 12 months or more frequently as appropriate

At every outcome review point specified in the treatment plan (typically 3-month and 6-month, and by then things should be substantially solved), the treatment goals and clinical interventions to achieve those goals are reviewed.  Remember, the treatment objectives are identified in ways that are “measurable” and “time-bound” – permitting review of goal accomplishment.

In child and family therapy, clinical impact is typically targeted for four to six-weeks.  Even in autism, significant measurable impact of clinical involvement should be evident by four to six weeks.  For autism, the clinical impact in six weeks would not necessarily be directly measurable in the child’s symptoms, but the caregivers should have substantially increased knowledge and skills in how to respond to the child (changes in caregiver stress and responding skills that are measurable).  The improved responding from the caregivers then leads to the more productive longer-range progress toward the treatment goals, gains which should become directly evident in the child’s symptoms on the 3-month and 6-month reviews of the treatment goals. 

So even with autism pathology, we would expect to see measurable gains in caregiver response competence in a four to six week period of initial intervention, leading toward longer-range goal achievement.

This is true for all pathology, from autism to oppositional defiant disorder.  It’s usually reasonable to expect a positive impact from intervention on some measurable area of functioning in four to six weeks, improvements moving toward a 3- to 6-month resolution of the presenting problem.

Does treatment with some childhood pathology take longer than six months to solve?  Of course.  But for each time-period longer than six months, professional concerns about the accuracy of the case conceptualization and treatment plan increase.   Treatment should solve things.  If treatment is not solving things within three to six months, we need to closely examine the diagnostic premise and clinical approach involved.

If we treat diabetes with insulin but the patient actually has cancer and needs chemotherapy, then the sooner we re-evaluate our diagnosis based on absence of treatment progress the sooner we will be able to get the proper diagnosis of cancer and the proper treatment of chemotherapy.  If things aren’t working, it’s time to look closely at possibly changing what we’re doing.

Does that mean that longer treatment is always due to earlier misdiagnosis?  No.  It just means that with each increment of time over six months, the review scrutiny of the case conceptualization, diagnosis, and clinical interventions used to achieve a solution becomes more exacting.

Even for chronic pathologies like autism that will require years of developmentally supportive intervention, we would want to achieve a stabilization of intervention where the child is receiving the proper intervention at the proper dosage level, and measurable progress from the intervention is continuing.  Continuing measurable gains from the consistent application of developmentally supportive intervention becomes a steady state treatment plan, measurable and time-bound review, and the same in its consistency of measurable effectiveness. 

This is the desired steady-state treatment plan we want for chronic pathology, always then closely monitoring scientific advancements that can improve the treatment plan for increasingly positive outcome.

If, however, the child ceases to make gains in a time-frame of review, then a reconsideration of case conceptualization and treatment plan is indicated.  When progress is not made, we develop a new treatment plan.  This may involve altering our case conceptualization, or altering the clinical interventions applied.

The important thing is that the progress is measurable, and that the treatment plan is time-bound to periods for review and modification.

School IEP

If an additional example is needed for a written treatment plan related to commonly occurring childhood pathology, I would refer to the school IEP (Individual Education Program).  The school IEP represents a written treatment plan surrounding a variety of possible issues, some possibly medical, some possibly emotional and psychological. 

What does the school do about the presenting problem referred for an individualized educational approach; the IEP referral?  The school develops a written treatment plan, discusses this written treatment plan with the parents, obtains the parent’s approval for the written treatment plan, and then the school implements the treatment plan as described by the written treatment plan. 

Once implemented, this written treatment plan of the IEP is reviewed on a periodic schedule to ensure measurable gains from the education-related treatment plan described by the IEP.

The school IEP is an education-related treatment plan, but many of the issues addressed by the IEP are emotional and psychological disturbances of childhood, so often the educational intervention co-occurs within the context of the psychological intervention.

A written treatment plan is everyday standard of practice in the school system.  The county of San Bernardino Department of Behavioral Health mandated a written treatment plan as a requirement for funding treatment of children and families in the foster care system.  In the world I come from, a written treatment plan is common standard of professional practice.  No big deal.

What are the Objectives of treatment (measurable and time-bound), what are the Clinical Interventions to be used to achieve those Objectives, and did it work, what is the Outcome?

The standard of professional practice in clinical psychology is for written treatment plans.

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

Standards of Practice: 2007 Documentation of Child Therapy Session

This is an actual therapy progress note from February of 2007.  It’s from the intern doing child therapy with a foster care child now adopted, probably about the 3 to 4 year-old age range judging by the treatment interventions being described.

These de-identified treatment notes I’m sharing come from a time before I was involved in the court-involved divorce-related conflict that I’m currently working with.

In those days I worked with kids in trauma and foster care.  We had a two-therapist treatment model, with one child therapist working directly in session with the child, and a second therapist meeting collaterally with the parent, or foster parent, or adoptive parent – whoever was the day-to-day adult caregiver for the child.

This treatment note indicates that I was serving as the collateral therapist for the adults while the intern worked directly with the child.  Our interns typically did the direct child therapy, while our licensed staff did the collateral caregiver therapy work.  Our post-docs straddled the two.  Post-docs are trainees who have earned a doctorate degree and they already have a full year of pre-doctoral supervised internship training, but now they need an additional year of post-doctoral supervised training before they can be licensed.

Licensing in psychology takes two full years of supervised clinical training, one year pre-doctoral and one year post-doctoral.  This note is likely from one of our post-docs, she’s reporting on some sensitive work with the child’s anger modulation system.

I used these de-identified notes in training interns and post-docs on features of treatment and treatment documentation.  For example, one of the things I might use this note for is to demonstrate expected specificity in treatment documentation.  It’s not a long note, but the therapist does a nice job of presenting what happened in terms of therapy. What were the therapy interventions, and what were the results. 

Not in blow-by-blow detail of “he did then I did”; but in an organized description using constructs that have meaning.  For example, the therapist notes that, “client began to demonstrate a turn-taking rhythm” – a turn-taking rhythm is an important feature of anger modulation therapy. 

Anger is explosive and draws the person into a self-engaged focus of venting.  In therapy for developing anger-modulation networks, we want to keep the child socially engaged with us, so that we can help in regulating the child’s anger and frustrations.  Once the child collapses out of the social field, anger is vented.  As long as we can keep the anger contained in the social field, we build the neural networks needed for anger modulation.

The basic rhythm of social engagement is the turn-taking rhythm of back-and-forth dialogue.  It starts with eye-gaze and smiling dialogues of infancy, pre-verbal dialogues of babbling, and into verbal dialogues of speech and the social rhythms of back-and-forth turn-taking conversation and dialogue.

All of this is captured by this intern in that one notation phrase.  Not only did the therapist and client make an important step forward in anger modulation for the child when mid-way through the session the child “began to demonstrate a turn-taking rhythm”  This documentation shows that the therapist knows what she’s doing.  If she’s noting an incident of establishing a turn-taking rhythm, she knows how to build the anger-modulation system of the brain’s emotional networks.

There are two levels of a chart note description.  The first is the reporting of pattern.  The documentation needs to describe the clinical psychology features of note; in this case the turn-taking rhythm.  The second level is documenting the evidence of the pattern, in this note it’s the specific notation of the child saying “Wait” to manage the back-and-forth rhythm.  Specifics do not exist of their own importance, only related to the pattern they reveal. It’s the pattern of interaction that’s important.  And when the therapist knows what they’re doing, they document the patterns and use details only to support descriptions of patterns.

Notice in the therapist’s description how chaotic the child’s activity is.  The child asks to leave the session to find the mother but when outside the session office the child didn’t seek mom’s therapy room, but instead began to play with other toys in other areas of the clinic.  The child didn’t want to find mom, the child just wanted – well, that’s not exactly clear – disorganized wants, no clear focus or purpose.

That’s such a classic symptom of trauma.  Disorganization; to behavior, to emotions, to thinking.  The impact of trauma is that we cannot organize our states, any state.  Our arousal level is too high, and in children it’s a “building the brain networks” thing for modulating arousal and anxiety, and anger, and sadness, and love… love is called attachment and empathy in the professional literature.

How does this exceptionally good child therapist respond to the child’s disorganization?  With gently applied containment.  Boundaries by which to establish self and other.  Poor kid.  Someone had so overwhelmed his boundaries that he had none left, he was flowing in a continual sea of chaos and fear management.  The therapist in this note was going into his world to find him, and recover him to us.

The headings for the note structure were mandated documentation format by the county Department of Behavioral Health.  Standard of ordinary practice in foster care world.

MHS: Individual Therapy

Client’s Role (Mental Status/Verbalizations)

Client was accompanied to the session by his adoptive parents.  He appeared clean, well groomed, and was dressed in age appropriate casual clothing.  Therapist was greeted with appropriate eye contact, but no smile. Client willingly accompanied therapist to play room.

Role of Significant Others (Verbalizations)

Client’s adoptive parents were in session with Dr. Childress, and were therefore not present during the session.

Therapist’s Role (Actions/Interventions)

Maintained focus on providing a supportive and responsive relationship with the child to foster his ability to cooperate.  This therapist provided client with craft activities and set limits on what toys client could access to help organize his play.  Actively established appropriate boundaries to help client understand that aggressive behavior is not acceptable.

Client’s Response to Above

Client presented as disinterested in craft activities provided by therapist as evidenced by stating he needed to see his mother.  Therapist followed client, who did not seek his mother, but attempted to retrieve toys from a different room.  When therapist re-directed client to return to the session room client complied.  Mid-way through session client began to demonstrate a turn-taking rhythm with therapist by stating “Wait” when he and therapist were cutting strips of paper.  During this activity the client began to “cut” the therapist’s hand with the child-safety scissors.  When therapist distanced herself and verbally stated that aggressiveness was not OK, client waited approx. 30 seconds while watching therapist and then asked for therapist to reengage stating “I’ll be nice”.  Client watchfulness may be indicative of his monitoring to see if therapist was angry and would abandon him.

Clinical Plan for Upcoming Session

Therapist will continue to introduce minor intrusions into client’s activities to strengthen client flexibility in organizing his behavior around adult directives without aggression and/or opposition.  Will actively maintain appropriate boundaries with client to provide modulated stress experiences that will help the child to reduce his aggressive behavior.

That’s the clinical chart note.  That was a case where the child had been abused, moved into the foster care system, and the abusive parent could not be recovered, parental rights were terminated and the child was adopted.  This was one of those cases.  The adoptive parent is sometimes the foster parent who has been with the child for awhile.

We were untangling all the impacts of childhood trauma.  The child therapist was skillfully working with the child to build social-related networks involved in emotional regulation flowing into behavioral regulation (containment of anxiety).  In a separate session the collateral therapist for the parents (adoptive parents in this case) would be teaching the parent about trauma-informed responding in ways that support the child’s recovery. 

Chart notes need to reflect the treatment plan.  What’s the problem, and how do we fix it.  This therapist clearly understands what she’s doing to fix things, and we can feel the treatment plan concepts that guide her work.  That’s what a chart note should do, document the application of a coherent treatment framework for child and family therapy.

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