The Appointment of Minor’s Counsel Must Stop

Appointing minor’s counsel to represent the child in a family custody dispute is the single most destructive action the Court can take.

There are four primary problems with the appointment of minor’s counsel to represent the child:

1.) Appointing minor’s counsel introduces two prominent sources of bias into the legal proceedings that favor one side over the other;

2.) The appointment of minor’s counsel introduces, incites, colludes with, and supports pathological processes within the family to the detriment of the child;

3.) By introducing, inciting, and supporting the family’s psychopathology, the appointment of minor’s counsel undermines and can fully nullify therapeutic efforts to resolve family psychopathology;

4.) In failing to comprehend the complexity of developmental immaturity during childhood and adolescence, appointing a minor’s counsel offers an overly simplistic effort at a solution that will result in misguided advocacy by minor’s counsel for positions that are contrary to the child’s best interests and healthy development.

Bias

The Spectrum of Normal-Range Parenting

Normal-range parenting extends across a continuum from lax and permissive parenting to structured and firm parenting.

Lax and permissive parenting favors relationship development, while structured and firm parenting emphasizes the development of maturity. Both styles can be entirely normal range and healthy parenting approaches, and both parenting styles can lead to mature and healthy child development.

Parental preferences for one style over the other is a matter of parental values which are typically the product of parental experiences within their own families of origin. As such, parental preferences for differing parental styles are culture bound and culturally influenced.

Professional psychology typically favors a balanced approach of parenting styles that is more in the mid-range of parenting approaches, combining flexible negotiation with structured expectations for child behavior. For example, if parenting style were represented by a numerical continuum ranging from 1 to 100, with lower numbers indicating a more lax and permissive parenting style and higher numbers representing a more structured and firm parenting style, then normal-range parenting would extend from a range of 20 to 80 on this scale. The more extreme the parenting becomes the more problematic it becomes, but there is a wide latitude of normal-range parenting. Professional psychology tends to favor parenting in the mid-range represented by a combined parenting style, somewhere between 40 to 60 on the numerical range of parenting style.

Lax and Permissive Parenting: Parents who tend toward the lax and permissive style favor emotional and relationship qualities over maturational and behavioral qualities. Rules and expectations for children’s behavior are more flexibly negotiated, and lax and permissive parents may tend to avoid conflict in an effort to maintain interpersonal harmony within the family. As parenting moves toward the extremes of this style, parenting becomes increasingly over-indulgent and disengaged.

Firm and Structured Parenting: Parents who tend toward a more firm and structured parenting style favor maturation in child behavior, and these parents tend to adopt a more hierarchical family organization that emphasizes parental authority. Rules and expectations for child behavior are more clearly established and maintained, and parents adopting a structured and firm parental approach tend to be more comfortable with managing interpersonal conflicts. At extremes of this parenting style (80-100), parents can become dictatorial and overly inflexible, potentially prompting high levels of parent-child conflict or excessively submissive child behavior.

Within the normal-range of parenting approaches, both parenting styles are acceptable, both parenting styles can produce normal-range and healthy children, and both parenting styles have advantages and disadvantages, which is why professional psychology tends to favor a mid-range balanced approach to parenting that blends both parenting styles. Families can also blend parenting styles between the parents in a healthy and normal way, with one parent tending toward the more lax and permissive (emotionally nurturing) parenting style, while the other parent tends toward the more structured and firm (disciplinarian) parenting role. As long as the spousal unit remains cohesive, this blend of parenting styles can work effectively.

However, in fractured marital relationships differences in parenting style can become the source of inter-parental conflict. From the perspective of either parenting style, the other parenting style will appear problematic. For the lax and permissive parent, the more firm and structured parenting style of the other parent will appear too harsh and insensitive. From the perspective of the structured and firm parent, the lax and permissive style of the other parent will appear too indulgent and disengaged. Yet from the balanced perspective of professional psychology, the differing parenting styles of both parents are recognized as entirely normal-range and healthy, with the differences merely reflecting a matter of differing parental value systems.

Parents have the legitimate parental right to establish their value system with their children and in their families, so wide latitude should be granted to parental prerogatives in the exercise of parental style. As long as parenting avoids the extremes of either parenting approach (i.e., 0-20 the disengaged/neglectful parent; 80-100 the harsh/abusive parent) then due deference should be granted to the legitimate parental rights afforded to parents to establish family structure patterns consistent with their value systems.

Child Preferences

However, from the perspective of the developmental immaturity of children and adolescents, the lax and permissive parenting style will be favored over the structured and firm parenting style until full child-to-adult maturity is achieved, at which point, in retrospect the young adult develops a greater longitudinal appreciation for the benefits afforded by a firm and structured parenting style that led to the development of greater personal maturity. For example, the child may not like practicing the piano or doing homework for 90 minutes every night, yet by adulthood the once-child-now-adult may appreciate knowing how to play the piano and may be more successful in his or her academics and career because of the structured expectations provided by parents during childhood and adolescence.

But if we ask the child at the time, the developmental immaturity of the child would prefer to eat ice cream rather than vegetables, and the developmental immaturity of the adolescent would prefer to play video games or talk with friends rather than do homework and complete household chores. Yet the parental structure of insisting that the child eat healthy meals and insisting that the child complete responsibilities before indulging in play or leisure activities – even though these parentally directed activities are not preferred by the child, and even though parental insistence on these child behaviors can lead to increased parent-child conflict – can nevertheless promote the child’s healthy emotional and psychological maturation and development over more indulgent and permissive parenting.

Yet the developmental immaturity of the child and adolescent will nevertheless favor the lax and permissive parent.

So if minor’s counsel is appointed to represent the child’s or adolescent’s expressed preferences, an inherent bias is introduced into the Court proceedings in favor of whichever parent adopts a more lax and permissive parenting style. The more structured and firm parent is then placed in a problematic position through the inherent bias introduced by the Court of altering his or her parenting style and the legitimate expression of parental values within the family in favor of adopting a lax and permissive parenting style commensurate with the other parent in order to seek the child’s favor, since the child’s preferences and favor are being granted weight in the legal proceedings.

The influence of this Court-introduced bias in favor of one parenting style over the other then unbalances the family by requiring that both parents adopt an equally lax and permissive parenting style, which can undermine providing the child with the needed structure and discipline necessary for healthy maturation. However, if the more structured and firm parent continues to act in the best interests of the child by providing normal-range structure and discipline, then the inherent bias introduced by the Court in appointing a minor’s counsel to represent the expressed but developmentally immature preferences of the child will tend to produce unfavorable rulings against the structured and firm parent because of the weight given to the child’s expressed “preferences”.

The deliberate introduction of bias by the Court into legal proceedings is contrary to the principles of balance and fairness within the legal system, and the potentially detrimental impact that such Court-introduced bias has on family relationships, family functioning, and the long-range healthy emotional, social, and psychological development of the child or adolescent is contrary to the best interests of the child or adolescent. Courts should respect the legitimate parental rights and prerogatives of parents to establish within their families interaction patterns with their children that are consistent with parental value systems, and Courts should avoid taking actions that deliberately introduce preferential bias and that give preferential influence to one set of family values over another set of family values, particularly considering that these family values can be culturally embedded.

Second Source of Bias

The second source of inherent bias introduced by the appointment of minor’s counsel is in favor of pathological family processes over healthy family processes.

The appointment of minor’s counsel to represent the child fails to appreciate the complexity of family relationship dynamics, and two particular family relationship patterns are of particular concern relative to the appointment of minor’s counsel, 1) a role-reversal relationship in which the child is being used to gratify and meet the emotional and psychological needs and the psychopathology of the parent, and 2) the child’s triangulation into the spousal conflict through the formation of a cross-generational parent-child coalition of the child with one parent against the other parent.

Role-Reversal Relationship

There are a variety of types of role-reversal relationships. In some role-reversal relationships the child takes on a parental caregiving role for the parent (such as with an alcoholic, depressed, or incapacitated parent). Other types of role-reversal relationships involve the parent using the child as a “regulating object” (such as when the parent prevents the development of the child’s independent autonomy in order to ameliorate the parent’s own abandonment insecurities).

In role-reversal relationships the child is induced or seduced by the parent into taking care of the parent’s emotional and psychological needs, and a role-reversal relationship is considered highly pathological and highly destructive to the child’s healthy emotional and psychological development (for example, the prototype exemplar for a role-reversal relationship is incest, in which the child is used to meet the parent’s sexual/psychological needs).

The outward appearance of a role-reversal relationship, however, is of a bonded parent-child relationship in which the child expresses a high degree of affectional bonding toward the (pathological) needy parent. This pathological bonding motivation is typically at the expense of the child’s relationship with the other parent.

“By binding the child in an overly close and dependent relationship, the enmeshed parent creates a psychological unhealthy childrearing environment that interferes with the child’s development of an autonomous self… Enmeshment in one parent-child relationship is often counterbalanced by disengagement between the child and the other parent (Cowan & Cowan, 1990; Jacobvitz, Riggs, & Johnson, 1999).” (Kerig, 2005, p. 10)

Note that Kerig’s analysis of role-reversal relationships (also referred to as a “cross-generational boundary dissolution”) is published in the Journal of Emotional Abuse. Role-reversal relationships are considered to be highly pathological.

Also of note, is the commentary of Minuchin on the impact of enmeshed parent-child relationships on the cognitive functioning of the child,

“Members of enmeshed subsystems or families may be handicapped in that the heightened sense of belonging requires a major yielding of autonomy… In children particularly, cognitive-affective skills are thereby inhibited” (Minuchin, 1974, p. 55)

The appointment of a minor’s counsel to represent the child’s expressed “preferences” colludes with the psychopathology of a role-reversal relationship within the family and will introduce an inherent bias in the legal proceedings in favor of the pathological parent over the healthy and normal-range parent. The deliberate introduction by the Court of an inherent bias to the Court proceedings that favors the continued maintenance of family psychopathology is exceedingly ill-conceived.

Triangulation and Coalitions

It is both extraordinarily common and unhealthy for children to become triangulated into spousal conflicts. One of the common forms of children’s triangulation into spousal conflict is through the formation of a cross-generational parent-child coalition in which the child is drawn into an alliance with one parent against the other parent.

Salvador Minuchin, considered by many to be the preeminent family systems theorist, described the cross-generational parent-child coalition as a form of “rigid triangle”,

“The rigid triangle can also take the form of a stable coalition. One of the parents joins the child in a rigidly bounded cross-generational coalition against the other parent.” (Minuchin, 1974, p. 102)

Another preeminent family systems theorist, Jay Haley, defines the cross-generational coalition as a “perverse triangle”,

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

Note that it is definitional to the cross-generational coalition that the coalition is denied. The client child or adolescent of minor’s counsel will, by definition, deny the coalition that exists between the child and the allied and supposedly “favored” parent that is against the other parent. This means that in representing the child’s expressed preferences, minor’s counsel is actively colluding with the cross-generational coalition of the child and one parent against the other parent. This then, becomes an inherent source of Court-introduced bias in the legal proceedings.

Note also, that Haley identifies the cross-generational parent-child coalition as “pathological”. The minor’s counsel then is colluding with the family’s psychopathology against the interest of the healthier parent who is seeking resolution of the family’s pathology.

When minor’s counsel is appointed to represent the child who is in a pathological cross-generational coalition with one parent against the other parent, minor’s counsel is essentially being appointed to represent the maintenance of the psychopathology within the family. An inherent bias is thereby introduced into the Court proceedings in favor of maintaining the family’s psychopathology over the healthier elements of the family system that seek resolution of the family’s pathology.

Appointing minor’s counsel is essentially appointing legal representation for the family’s psychopathology. This is both insane and extraordinarily destructive.

If the Court insists on appointing legal counsel to represent the interests of the family’s psychopathology by supporting the child’s role-reversal relationship with the pathological parent and the child’s pathological cross-generational parent-child coalition with one parent against the other parent, and that will inherently introduce bias into the Court proceedings in favor of maintaining the family’s psychopathology over the healthier aspects of the family that seek resolution of the family’s pathology, then additional compensatory and balancing legal counsel should be appointed to represent the healthy aspects of the family that are seeking to resolve the family’s psychopathology.

Better still is for the Court to avoid deliberately introducing an inherent bias into the legal proceedings that favors maintaining the family’s psychopathology by completely avoiding introducing into the legal proceedings the inherent bias associated with the appointment of minor’s counsel to represent the interests of maintaining the family’s psychopathology.

Nullification of Therapy

By appointing minor’s counsel to collude with and support the maintenance of the family’s psychopathology, the actions of the Court will effectively undermine, and in some cases completely nullify therapeutic efforts to treat and eliminate the family’s pathological functioning.

First, as noted above, the appointment of minor’s counsel colludes with and entrenches the pathological processes within the family. Therapy must then OVERCOME the distorting influence of minor’s counsel that supports and colludes with the maintenance of the family’s psychopathology.

Second, the appointment of minor’s counsel destructively inverts the parent-child hierarchy by placing the child in an overly empowered and overly inflated position of judging parents. Salvador Minuchin discusses the importance of parental authority within the family,

“Parenting always requires the use of authority. Parents cannot carry out their executive functions unless they have the power to do so…. Children and parents, and sometimes therapists, frequently describe the ideal family as a democracy. But they mistakenly assume that a democratic society is leaderless, or that a family is a society of peers. Effective functioning requires that parents and children accept the fact that the differentiated use of authority is a necessary ingredient for the parental subsystem. This becomes a social training lab for the children, who need to know how to negotiate in situations of unequal power. (p. 58)

The appointment of minor’s counsel inappropriately and destructively elevates the child’s position in the family hierarchy, which serves to further entrench any pathological processes that exist within the family.

The elevation of the child puts the “non-favored” parent in a position of having to appease the child in order to curry the child’s favor. This is an extremely destructive family dynamic that undermines the therapeutic resolution of the family’s pathology. As long as this family dynamic exists, therapy will be ineffectual because the parent has been disempowered by the Court’s decision to appoint minor’s counsel and so lacks the necessary parental authority to “carry out their executive functions.”

Seeking and giving weight to the child’s preferences regarding his or her parents effectively acts to triangulate the child into the spousal conflict by asking the child, or allowing the child, to form alliances with one parent against the other, and choose one parent over the other. The child’s “preferences” are elevated into becoming a “prize to be won” within the spousal/parental relationship, with each parent competing to be the “winner” of the child’s “preference”. This is an extremely destructive relationship dynamic to introduce into the family, yet it is EXACTLY this destructive triangulation of the child into the spousal conflict as a “prize to be won” that the appointment of minor’s counsel to represent the child’s expressed preferences introduces into the family.

In my professional view, the appointment of minor’s counsel in a family conflict situation is so inherently destructive of the conditions necessary for effective treatment, that professional psychology should strongly consider whether the appointment of minor’s counsel to represent the child in a family conflict precludes and effectively prevents therapy.

Standard 10 of the Ethical Principles of Psychologists and Code of Conduct established by the American Psychological Association addresses the context and conduct of Therapy, and Standard 10.10a requires that “psychologists terminate therapy when it becomes reasonably clear that the client/patient… is not likely to benefit…”

The appointment of minor’s counsel acts to firmly entrench the family’s psychopathology and actively colludes with the family’s psychopathology, and appointment of minor’s counsel both introduces and sustains distorted family relationship dynamics that are likely to prevent and preclude therapy from resolving the family’s pathology, so that under Standard 10.10a of the ethics code for the American Psychological Association psychologists should terminate treatment because the child and family are “not likely to benefit” from therapy in that context.

Developmental Immaturity

The appointment of minor’s counsel grossly misunderstands the nature of child and adolescent immaturity and development. Focusing only on adolescents, brain neurodevelopment is still incomplete during adolescence. While some proto-adult capacities are active and available, other important socio-emotional and judgment capacities remain incompletely developed, so that the judgment of adolescents remains significantly impaired.

If an adolescent is to make an informed “independent” decision (the construct of “independent” is questionable from a socio-neurological perspective, see for example Cozolino, 2006) then the adolescent should be afforded all of the relevant information necessary to make an informed decision. In the context of divorce and the dissolution of the intact family structure, the relevant information can include the reasons for the divorce from each parent’s perspective, since in the absence of balanced information one parent may provide the child with inaccurate and unbalanced information that potentially blames the other parent, thereby inciting and inflaming the child’s anger and hostility toward the other parent.

Simply asking the child if one parent influenced the child is insufficient to guarantee that the child has balanced and accurate information on which to base a decision, since a number of family processes can subtly provide the child with distorted information and interpretations, but the processes by which the child acquired this information may remain below the level of the child’s conscious awareness. So if we are to seek the child’s preferences, then we should guarantee that the child has accurate and balanced information from both sides regarding the family dysfunctions and family relationship dynamics so that the child can make an informed “independent” decision regarding his or her desires and best interests.

So then, let’s have each parent in turn sit before the child and recount the reasons for the divorce and family’s dissolution and describe for the child the failures of the other parent as a spouse and parent, with each parent presenting to the child the reasons the child should choose a particular option. In this way, the child will have balanced and (reasonably) accurate information regarding the family situation from which the child can then make an informed decision about his or her best interests and preferences regarding family relationships.

But is this actually what we want to do? Absolutely NOT.

But in the absence of establishing such a procedure to ensure that the child has accurate and complete information on which to base his or her decisions, then we are vulnerable to advocating for child decisions that are based on the child’s incomplete understanding of the situation and its consequences.

It is best to avoid this whole quagmire by not seeking the child’s supposedly “independent” preferences, and by instead making decisions among adults as to the best interests of the child.

Furthermore, the adolescent brain lacks important executive function abilities that would allow it to make fully reasoned decisions. There is a tendency for the adolescent brain to make impulsive decisions based on indulgent gratification of present-moment desires, and it lacks the capacity for longer-term perspective taking that fully considers future consequences of present decisions.

This is an inherent, neuro-developmentally based limitation on the adolescent brain.

So while it may appear that the adolescent brain has some mature decisional capacities, these capacities are biased in favor of momentary gratification and self-indulgence that inherently favors the lax and permissive parenting style over the structured and firm parenting style, even though the structured and firm parenting style may be in the adolescent’s longer-term best interests.

The immature development of the adolescent’s frontal lobe executive function capacity would recommend that in making decisions the adolescent should be provided with the scaffolding support of a fully mature nervous system of an adult. This raises the question of which adult should provide the scaffolding support (i.e., directive influence) for the adolescent’s still immaturely developed frontal lobe executive function capacity. In normal-range families, this scaffolding support is provided by the adolescent’s parents until the age of 18, at which time this scaffolding support is withdrawn and the late-adolescent is allowed to enter into contracts and make decisions independently of parental permission.

If the Court is to advance the adolescent’s decision making influence into the period of earlier neuro-developmental immaturity and instability by appointing legal counsel to represent the younger-adolescent, then it becomes incumbent upon minor’s counsel to possess a professional level of understanding for the exact nature of the compromises inherent to the cognitive functioning and judgments of the adolescent client. Unless we compensate for the yet uncompleted developmental immaturity of the adolescent brain we will be inadvertently providing support to the compromised decision making by the client that can lead to long-term negative consequences for the adolescent client because of poor decision making which received our misguided and developmentally ignorant support.

Conclusion

Except under extraordinary circumstances, minor’s counsel should NEVER be appointed by the Court to represent the child or adolescent in family conflicts.

The role of representing the child’s (or adolescent’s) interests should be shifted into the domain of professional psychology. If the Court wishes to achieve representation for the child’s interests in the legal proceeding, or for those of an adolescent, then the Court should appoint a family therapist to act as the child’s or adolescent’s representative (the voice of the child) to the Court. This would allow the Court to receive balanced and professionally informed input from the perspective of the child or adolescent while avoiding collusion with the family’s pathology that would undermine the ability of therapy to treat and alleviate the family’s psychopathology.

If the Court insists on appointing minor’s counsel, then standards of practice should be developed to direct and guide the interface of minor’s counsel with the surrounding mental health needs of the family and client. Additional guidelines would be needed to address the inherent biases to the legal proceedings in favor of one party over the other that are introduced as a consequence of appointing minor’s counsel.

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

 References

Cozolino, L. (2006): The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. WW Norton & Company, New York.

Haley, J. (1977). Toward a theory of pathological systems. In P. Watzlawick & J. Weakland (Eds.), The interactional view (pp. 31-48). New York: Norton.

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

Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.

 

Online Seminar Available

On July 18, 2014 I presented an online seminar through the Master Lecture Series of California Southern University regarding the theoretical foundations for an attachment-based model of “parental alienation.”

This online seminar is now posted by California Southern University and is available online to the general public at:

http://www.calsouthern.edu/content/events/parental-alienation-an-attachment-based-model/

On November 21, 2014 I will be presenting a second seminar through the Master Lecture Series of California Southern University regarding therapy of attachment-based “parental alienation. This seminar will also be posted online by California Southern University and will be available to the general public.

During the second seminar on therapy, I will assume that the audience is familiar with the content of this first seminar on theory, so I will NOT re-describe the theoretical foundations but will instead move directly into therapy related applications.

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

Nothing New – No Excuse

There is nothing NEW in an attachment-based model of “parental alienation.”

All of the component elements for an attachment-based model of “parental alienation” are established and accepted psychological principles and constructs. I am not proposing something new. I am simply connecting the dots between several constructs that EVERY mental health professional already knows as part of their professional competence.

Narcissistic and Borderline Personality Disorder

Personality disorders are defined within the DSM diagnostic system, and ALL mental health professionals are expected to be professionally familiar with ALL of the diagnoses within the DSM.  Narcissistic and borderline personality processes are not new or exotic constructs.

The theoretical foundations for narcissistic and borderline personality disorder processes have been extensively described and elaborated in the professional literature (e.g., Beck, et al., 2004; Kernberg, 1975; Linehan, 1993; Millon 2011) and if a mental health professional is not familiar with this literature at a professional-level of competence, then that mental health professional is not professionally competent in the domain of personality disorders and so should refer cases involving narcissistic and borderline personality disorder dynamics to professionals with the appropriate background and expertise

(not only SHOULD the mental health professional refer cases outside of the professional’s “boundaries of competence” to more expert and competent professionals, the mental health professional is actually REQUIRED to refer cases that are outside of the professional’s “boundaries of competence”
under established standards of professional practice.)

Mental health professionals are only allowed to practice within their “boundaries of professional competence.”

American Psychological Association Ethical Principles of Psychologists and Code of Conduct Standard 2.02:

“Psychologists provide services, teach and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience.”

American Counseling Association Code of Ethics; Standard C.2.a

“Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience.”

If a mental health professional is not knowledgeable and experienced regarding the diagnosis and treatment of narcissistic and borderline personality disorder dynamics, then the mental health professional is professionally required to refer the client to someone who is professionally competent.  Plastic surgeons should not diagnose and treat cancer.

Cross-Generational Parent-Child Coalition

Professionally competent treatment of families requires understanding principles of family dynamics. This should be patently obvious.  Therefore, mental health professionals working with families should be professionally familiar with basic family systems constructs. 

For example, the Model Standards of Practice for Child Custody Evaluation proposed by the Association of Family and Conciliation Courts (2006) identifies a set of “areas of expected training for all child custody evaluators” that includes “(2) family dynamics, including, but not limited to, parent-child relationships, blended families, and extended family relationships” (p. 8).

A central construct of family systems theory is the child’s triangulation into the spousal conflict, and among the standard triangulation patterns is a cross-generational coalition of the child with one parent against the other parent.

Salvador Minuchin (1974), considered by many to be THE preeminent family systems theorist, identified this cross-generational coalition of the child with one parent against the other parent as a form of “rigid triangle”,

“The rigid triangle can also take the form of a stable coalition. One of the parents joins the child in a rigidly bounded cross-generational coalition against the other parent.” (p. 102)

Another preeminent family systems theorist, Jay Haley (1977) defined a cross-generational parent-child coalition as a “perverse triangle”,

“The people responding to each other in the triangle are not peers, but one of them is of a different generation from the other two…

In the process of their interaction together, the person of one generation forms a coalition with the person of the other generation against his peer. By ‘coalition’ is meant a process of joint action which is against the third person…

The coalition between the two persons is denied. That is, there is certain behavior which indicates a coalition which, when it is queried, will be denied as a coalition…

In essence, the perverse triangle is one in which the separation of generations is breached in a covert way. When this occurs as a repetitive pattern, the system will be pathological.” (p. 37)

The construct of “parental alienation” is simply a manifestation of a cross-generational parent-child coalition of the child with a narcissistic/(borderline) personality disordered parent. Nothing new. I am simply linking two established constructs that ALL mental health professionals working with children and families are responsible to know and understand within standards of professional practice.

It is the addition of narcissistic/(borderline) personality disorder traits of the allied and supposedly “favored” parent that transforms the family dynamics into a particularly malignant and virulent form of the cross-generational parent-child coalition.

Narcissistic and borderline personality dynamics occur.  Cross-generational parent-child coalitions against the other parent occur.  When the two occur together, the addition of the narcissistic and borderline personality disorder traits of the allied and supposedly “favored” parent transforms the family dynamics into a particularly malignant and virulent form of the cross-generational parent-child coalition.  It is this malignant and particularly virulent form of cross-generational parent-child coalition that has traditionally been described as “parental alienation.” 

Nothing new, nothing exotic.  Personality disorders and cross-generational parent-child coalitions are simply standard psychological constructs with which all mental health professionals working with families should already be familiar as part of their existing professional competence.

No Excuse

Since the constructs of narcissistic and borderline personality disorders and cross-generational coalitions of the child with one parent against the other parent are established psychological constructs about which ALL mental health professionals working with children and families should be familiar, for ANY mental health therapist or child custody evaluator to miss making the diagnosis of the child’s cross-generational coalition involving a narcissistic/(borderline) parent that is targeted against a normal-range and affectionally available parent is simply unacceptable and represents professional incompetence.

The clinical evidence for the child’s cross-generational coalition with a narcissistic/(borderline) parent is clearly evident in the child’s symptom display (see Diagnostic Indicators and Associated Clinical Signs post) and the diagnostic clinical indicators are available to ANY professional who is competent in personality disorders and family systems constructs. If a mental health professional is NOT competent in personality disorders and family systems constructs, then that professional should not be diagnosing or treating family dynamics involving the presence of personality disorder dynamics, and should instead refer the client to a professionally competent child custody evaluator or therapist.

These are NOT new or exotic constructs. There is NO EXCUSE.

To the extent that professional incompetence in diagnosing narcissistic and borderline personality processes involved in a cross-generational parent-child coalition causes developmental, emotional, and psychological harm to the child client through the loss of an affectionally bonded attachment relationship with a normal-range and affectionally available parent (i.e., the parent who is rejected by the child as a result of the undiagnosed and so untreated psychopathology and pathogenic parenting of the narcissistic/(borderline) allied and supposedly “favored” parent within the parent-child coalition), this may represent negligent professional practice that is directly responsible for causing harm to the client.

To the extent that professional incompetence in diagnosing evident narcissistic and borderline personality processes involved in a cross-generational parent-child coalition causes harm to the targeted-rejected parent through the loss of an affectionally bonded attachment relationship with their child as a result of the undiagnosed and untreated psychopathology and pathogenic parenting of the narcissistic/(borderline) allied and supposedly “favored” parent within the parent-child coalition, this may represent negligent professional practice that is directly responsible for causing harm to the client.

Nothing New

No component of an attachment-based model of “parental alienation” is new or exotic.

Personality disorders are NOT new constructs. There is extensive literature regarding the dynamics of narcissistic and borderline personality disorder processes.

The triangulation of the child into the spousal conflict through a cross-generational coalition of the child with one parent that is against the other parent is not a new construct. It is a professionally established construct of family dynamics with extensive support in the family systems literature.

The attachment system and its characteristic functioning and dysfunctioning is not a new construct. There exists extensive professional research and literature regarding the nature, functioning, and dysfunctioning of the attachment system. There is also extensive literature linking narcissistic and borderline personality disorders to patterns of dysfunction in the attachment system, and regarding the transmission of dysfunctional attachment patterns from parents to children.

The psychological decompensation of narcissistic and borderline personality disorder processes into persecutory delusional belief systems is not new. One of the preeminent researchers and theorists in personality disorders, Theodore Millon (2011), explicitly links the decompensation of narcissistic personality processes under stress into persecutory delusional beliefs.

“Under conditions of unrelieved adversity and failure, narcissists may decompensate into paranoid disorders. Owing to their excessive use of fantasy mechanisms, they are disposed to misinterpret events and to construct delusional beliefs.

Unwilling to accept constraints on their independence and unable to accept the viewpoints of others, narcissists may isolate themselves from the corrective effects of shared thinking. Alone, they may ruminate and weave their beliefs into a network of fanciful and totally invalid suspicions.

Among narcissists, delusions often take form after a serious challenge or setback has upset their image of superiority and omnipotence. They tend to exhibit compensatory grandiosity and jealousy delusions in which they reconstruct reality to match the image they are unable or unwilling to give up.

Delusional systems may also develop as a result of having felt betrayed and humiliated. Here we may see the rapid unfolding of persecutory delusions and an arrogant grandiosity characterized by verbal attacks and bombast.” (p. 407)

Delusional beliefs are a well defined construct in the DSM diagnostic system, and ALL mental health professionals are professionally required to be familiar will ALL diagnoses within the DSM diagnostic system.  Nothing new.

And the very term “borderline” as a descriptive label was derived from these personality organizations being on the “borderline” of neurosis and psychosis.

“The diagnosis of “borderline” was introduced in the 1930s to label patients with problems that seemed to fall somewhere in between neurosis and psychosis. (Beck et al, 2004, p. 189)

Nor is the reenactment of past trauma in current relationships new. A “repetition compulsion” was initially proposed by Freud, and there is significant research evidence supporting the reenactment of past trauma (see for example, Trippany, Helm, & Simpson, 2006; van der Kolk, 1989), and the reenactment of relationship patterns is a foundational component of Bowlby’s theoretical formulation for the functioning of the attachment system. We replicate our attachment patterns in future relationships.

Nothing about an attachment-based model of “parental alienation” is new.  All of the component elements are standard and established psychological principles and constructs.  The construct traditionally described as “parental alienation” represents the triangulation of the child into the spousal conflict through the formation of a cross-generational parent-child coalition between the child and a narcissistic/(borderline) parent.  The addition of parental narcissistic/(borderline) psychopathology transforms the cross-generational coalition into a particularly malignant and virulent form of family pathology.

The cross-generational coalition of the child with a narcissistic/(borderline) parent can be reliably recognized by a definitive set of diagnostic indicators and an associated set of predicted clinical signs (see Diagnostic Indicators and Associated Clinical Signs post).

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

Personality Disorders

Beck, A.T., Freeman, A., Davis, D.D., & Associates (2004). Cognitive therapy of personality disorders. (2nd edition). New York: Guilford.

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

Kernberg, O.F. (1975). Borderline conditions and pathological narcissism.. New York: Aronson.

Millon. T. (2011). Disorders of personality: introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley.

Family Systems

Haley, J. (1977). Toward a theory of pathological systems. In P. Watzlawick & J. Weakland (Eds.), The interactional view (pp. 31-48). New York: Norton.

Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.

Trauma Reenactment

Freud, S. (1922). Beyond the Pleasure Principle (The Standard Edition). Trans. James Strachey. New York: Liveright Publishing Corporation.

Trippany, R.L., Helm, H.M. and Simpson, L. (2006). Trauma reenactment: Rethinking borderline personality disorder when diagnosing sexual abuse survivors. Journal of Mental Health Counseling, 28, 95-110.

van der Kolk, B.A. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12, 389-411

Standards of Practice

Association of Family and Conciliation Courts. (2006) Model standards of practice for child custody evaluation. Madison, WI: Author.

American Psychological Association (2002). Ethical Principles of Psychologists and Code of Conduct. American Psychologist, 57, 1060-1073.

American Counseling Association. (2005) ACA code of ethics. Alexaandria, VA: Author.

Diagnostic Indicators and Associated Clinical Signs

Diagnostic Indicators

The presence in the child’s symptom display of a characteristic set of three diagnostic indicators represents definitive clinical evidence for the presence of pathogenic parenting by the allied and supposedly “favored” parent as representing the sole cause for the child’s symptomatic rejection of a relationship with the targeted parent.

(for more on the theoretical underpinnings for an attachment-based model of “parental alienation, see Childress, 2013a: “Reconceptualizing Parental Alienation” on my website or my blog post “Three Levels of Analysis”).

The three definitive Diagnostic Indicators for the presence of an attachment-based model of “parental alienation” are:

Criterion 1: Attachment System Suppression

A: The child’s symptom display evidences a selective and targeted suppression of the normal-range functioning of the child’s attachment bonding motivations toward one parent, in which the child seeks to entirely terminate a relationship with this parent (i.e., a child-initiated cutoff in the child’s relationship with a normal-range and affectionally available parent).

B: A clinical assessment of the parenting practices of the rejected parent provides no evidence for severely dysfunctional parenting (such as chronic parental substance abuse, parental violence, or parental sexual abuse of the child) that would account for the child’s desire to completely sever the parent-child bond.

C: The parenting of the targeted-rejected parent is assessed to be broadly normal-range, with due consideration given to the wide spectrum of acceptable parenting practices typically displayed in normal-range families, and with due consideration given to the legitimate exercise of parental prerogatives in establishing family values, including parental prerogatives in the exercise of normal-range parental authority, leadership, and discipline within the parent-child relationship.

Criterion 2: Narcissistic Personality Symptoms

The child’s symptom display toward the targeted-rejected parent evidences a specific set of five narcissistic and borderline personality disorder symptoms that are diagnostically indicative of parental influence on the child by a parent who has narcissistic/(borderline) personality traits. The specific set of narcissistic and borderline personality disorder symptoms displayed by the child toward the targeted-rejected parent are,

Grandiosity: the child displays a grandiose self-perception of occupying an inappropriately elevated status in the family hierarchy above that of the targeted-rejected parent, from which the child feels entitled to sit in judgment of the targeted-rejected parent as both a parent and as a person. (DSM-5 Narcissistic Personality Disorder criterion 1)

Entitlement: an over-empowered sense of child entitlement in which the child expects that his or her desires will be met by the targeted-rejected parent to the child’s satisfaction, and if the rejected parent fails to meet the child’s entitled expectations to the child’s satisfaction, the child feels entitled to enact a retaliatory punishment on the rejected parent for the judged parental failure. (DSM-5 Narcissistic Personality Disorder criterion 5)

Absence of Empathy: a complete absence of empathy for the emotional pain of the targeted-rejected parent that is being caused by the child’s hostility and rejection of this parent. (DSM-5 Narcissistic Personality Disorder criterion 7)

Haughty and Arrogant Attitude: the child displays an attitude of haughty arrogance and contemptuous disdain for the targeted-rejected parent. (DSM-5 Narcissistic Personality Disorder criterion 9)

Splitting: the child evidences the psychological process of splitting involving polarized extremes of attitude, expressed in the child’s symptoms as the differential attitudes the child holds toward his or her parents, in which the supposedly “favored” parent is idealized as the all-good and nurturing parent while the rejected parent is entirely devalued as the all-bad and entirely inadequate parent. (DSM-5 Borderline Personality Disorder criterion 2)

Anxiety Variant

Some children may display extreme and excessive anxiety symptoms toward the targeted-rejected parent rather than narcissistic and borderline personality disorder traits.

In the anxiety variant of attachment-based “parental alienation” the child’s anxiety symptoms will meet DSM-5 diagnostic criteria for a Specific Phobia.

The type of phobia displayed by the child will be a bizarre and unrealistic “father type” or “mother type.”

Criterion 3: Delusional Belief System

The child’s symptoms display an intransigently held, fixed and false belief (i.e., a delusion) regarding the fundamental parental inadequacy of the targeted-rejected parent in which the child characterizes a relationship with the targeted-rejected parent as being emotionally or psychologically “abusive” of the child.

The child may use this fixed and false belief regarding the supposedly “abusive” inadequacy of the targeted parent to justify the child’s rejection the targeted parent (i.e., that the targeted parent “deserves” to be rejected because of the supposedly “abusive” parenting practices of this parent).

The presence of all three symptoms in the child’s symptom display represents definitive diagnostic evidence for the presence of pathogenic parenting emanating from the allied and supposedly “favored” parent as being the direct and sole causal agent for the cutoff of the child’s attachment bonding motivations toward the other parent.

DSM-5 Diagnosis

When this particular symptom set is displayed by the child, the appropriate DSM-5 diagnosis is:

309.4  Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

(for an analysis of the DSM-5 diagnosis of an attachment-based model of “parental alienation” see “Childress, 2013b: DSM-5 Diagnosis of ‘Parental Alienation’ Processes” on my website)

Response to Intervention

When these diagnostic indicators are sub-threshold for a clinical diagnosis of attachment-based “parental alienation,” then a 6-month Response to Intervention (RTI) trial can be initiated addressing a non-alienation interpretation of the child’s symptomatology to clarify the diagnosis.

The additional presence of the theoretically grounded associated clinical signs of attachment-based “parental alienation” can also help confirm a diagnosis of an attachment-based model of “parental alienation” when the three definitive diagnostic indicators are present but may be sub-threshold for a firm diagnosis of attachment-based “parental alienation.”

Associated Clinical Signs

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent is made solely on the presence in the child’s symptom display of the three primary diagnostic indicators:

  1. Attachment system suppression
  2. Five specific narcissistic & borderline personality disorder symptoms
  3. The presence of delusional beliefs about the supposedly inadequate parenting of the targeted-rejected parent

Additional associated clinical signs are also often present in attachment-based “parental alienation.” The associated clinical signs, however, are not diagnostic. There are potentially a variety of other factors that can result in the presence of any individual associated clinical sign, and the absence of the associated clinical signs does not influence the diagnosis of pathogenic parenting by the allied and supposedly “favored” parent when the three primary diagnostic indicators of an attachment-based model of “parental alienation” are present in the child’s symptom display.

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent is made solely on the presence in the child’s symptom display of the three primary diagnostic indicators.

In order to limit the length of this blog post, the following is simply a “Headings” list description of the associated clinical signs, and a more complete elaboration of each clinical sign and the underlying theoretical justification for its presence from within an attachment-based model of “parental alienation” will be described separately in subsequent blog posts for each clinical sign individually.

  • Child Empowerment: Efforts by the allied and supposedly “favored” parent to empower the child’s active agency in rejecting the targeted parent by advocating that the child be allowed to “decide” issues related to custody and visitation (“we should listen to the child”), including efforts by the allied and supposedly “favored” parent to have the child testify in Court.
  • “Abuse”: The use of the terms “abuse” or “abusive” by the allied and supposedly “favored” parent to inaccurately characterize the parenting practices of the other parent.
  • Display of the “Protective Parent” Role: Displays by the allied and supposedly “favored” parent of the coveted role as the all-wonderful protective parent (e.g., “I only want what’s best for the child”), including the display of protective behaviors (e.g., unnecessarily providing the child with food or clothing to take to the other parent’s home) or “retrieval behaviors” (e.g., excessive or hidden phone calls, texts, and emails to the child when the child is in the care of the other parent).
  • Child Placed in Front: The allied and supposedly “favored” parent places the child in the leadership position of rejecting a relationship with the other parent, particularly at visitation transfers, and then adopts a “helpless stance” of parental incompetence (e.g., “What can I do, I can’t make the child go on visitations with the other parent.”).
  • Shared Victimization: The allied and supposedly “favored” parent and child support each other in their bond of “shared victimization” by the targeted-rejected parent (e.g., “I know just what the child is going through, the other parent treated me the same way during our marriage.”)
  • Repeated Disregard of Court Orders: The allied and supposedly “favored” parent repeatedly disregards Court orders for visitation and custody, which requires that the targeted-rejected parent repeatedly return to Court to seek enforcement of prior Court orders.
  • Characteristic Themes Offered for the Child’s Rejection:

The Insensitive Parent

  • “She always thinks of herself, she never considers what other people want.”
  • “It always has to be his way. He never does what I want to do.”

Anger Management

  • “He gets angry about the littlest things. He has anger management problems.”
  • “She can’t control her temper. She’s always getting angry over nothing.”

Doesn’t Take Responsibility

  • “I don’t trust my mother. She’s such a liar. She doesn’t take responsibility for anything she does wrong.”

Vague Personhood

  • “I don’t know, it’s just something about the way she says stuff… it’s so irritating… like her tone of voice or something.”
  • “He just bothers me. He’ll ask me questions and things. It’s just annoying. I just want him to leave me alone.”

New Romantic Relationship of Parent

  • The theme is that the targeted parent is neglecting giving attention to the child because of the parent’s new romantic relationship or spouse
  • “He is always spending time with his new girlfriend. He doesn’t spend enough special time with just me.” (“… so that’s why I never want to see this parent again, because I want more special time with this parent.” – ???)

The Non-forgivable Grudge

  • “I can’t forgive my mother for what she did in the past. I just can’t get over what happened in the past.”
  • “She deserves being rejected for what she did in the past”

(the assertion or implication that the targeted parent “deserves” to be punished for some past failure as a parent/(person) is highly characteristic of attachment-based “parental alienation”)

  • Vacancy of Attachment System
  • Absence of possessive ownership of the parent (e.g., the child refers to the targeted parent by his or her first name, or the child uses the parental label of “mother” or “father” for the step-parent/spouse of allied and supposedly “favored” parent)
  • Characteristic Double-Binds for Targeted Parent

Accepting the Rejection

  • If the targeted parent does not comply with the child’s desire to discontinue their relationship, then this is used as “evidence” that the rejected parent isn’t being sensitive to what the child wants. (i.e.g, “Maybe I’d want to spend time with my mom if she’d just let me live with my dad.”)
  • If the targeted parent complies with the child’s expressed desire to discontinue their relationship, then the child (and alienating parent) use the absence of the targeted-rejected parent’s involvement as “evidence” that the targeted parent doesn’t care about the child.

Banishment

  • The child banishes the parent from activities
  • “I don’t want my mom to come to my dance performance (baseball games, graduation, etc). It just stresses me out and I can’t concentrate.”
  • The rejected parent is then placed in a double-bind: Go to the child’s event and be blamed for not being “sensitive” to what the child wants, or don’t go to the event and be blamed for not caring about the child and for not being involved with the child.

Discipline

  • The child provokes parental discipline by being rude, defiant, or disrespectful,
  • If the targeted parent responds with discipline, then the child (and alienating parent) use this parental disciplinary response as “evidence” of the overly harsh and punitive parenting practices of the targeted-rejected parent, which is then used to justify the child’s rejection of the targeted parent.
  • If the targeted-rejected parent ignores or accepts the child’s defiance or verbal abuse, then this is offered as “evidence” of the poor parenting skills of this parent that is causing the child’s behavior problems with this parent.

No Apology

  • The child makes the accusation that the targeted-rejected parent never listens to the child’s complaints and/or never apologizes for parental wrongdoing. The child then offers a distorted and inaccurate characterization of a past episode that places the parent in a double-bind:
  • If the targeted-rejected parent tries to correct the child’s false and inaccurate characterization of the event, then this is used as “evidence” that the parent doesn’t listen to the child and doesn’t apologize for past wrongdoing.
  • If, however, the parent accepts the child’s distorted characterization, or apologizes for his or her parental response (often at the misguided and insistent prompting of the therapist), then this gives credence to the child’s false and distorted characterization of the event, which the child then uses from that point on as “evidence” to justify the child’s hostility and rejection of the targeted parent (“I just can’t forgive him/her for what happened in the past”)

Preponderance of Clinical Evidence

While not diagnostic, the presence of the associated clinical signs of attachment-based “parental alienation” in addition to the three primary diagnostic indicators represents supportive diagnostic evidence. When added to the three primary diagnostic indicators, the presence of additional clinical signs results in the clear preponderance of clinical data all constellating around the same clinical diagnosis of pathogenic parenting associated with an attachment-based model of “parental alienation.”

 Beyond Reasonable Clinical Doubt

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent creating the child’s symptomatic rejection of a relationship with a normal-range and affectionally available parent is based SOLELY on the diagnostic features evident in the child’s symptom display.

It is NOT NECESSARY to diagnose the allied and supposedly “favored” parent as a having a personality disorder in order to establish pathogenic parenting inducing the child’s symptom display, since there is no other clinical diagnosis available that could account for the features of the child’s symptom display other than pathogenic parenting associated with an attachment-based model of “parental alienation.”

The diagnosis of pathogenic parenting (associated with attachment-based “parental alienation”) is based SOLELY on the child’s symptom display, and the presence in the child’s symptom display of the three characteristic diagnostic indicators of attachment-based “parental alienation” represents definitive clinical evidence for the presence of pathogenic parenting by the allied and supposedly “favored” parent creating the child’s symptomatic rejection of a relationship with the other parent.

Craig Childress, Psy.D.
Psychologist, PSY 18857

References

Childress, C.A. (2013a). Reconceptualizing Parental Alienation: Parental Personality Disorder and the Trans-generational Transmission of Attachment Trauma. Retrieved 11/18/13 from http://www.drcachildress.org/asp/Site/ParentalAlienation/index.asp

Childress, C.A. (2013b). DSM-5 Diagnosis of “Parental Alienation” Processes. Retrieved 11/18/13 from http://www.drcachildress.org/asp/Site/ParentalAlienation/index.asp

The Detective and the Psychologist

A clinical psychologist is like a detective.  Both systematically collect evidence to reconstruct what occurred in a particular situation.

In the case of the detective, the goal is to rely on the evidence to identify the cause of a crime, while for the psychologist the goal is to rely on the evidence to determine the cause of the symptoms.

Type of Crime = Presenting Problem

The first important information for the detective is the type of crime being investigated.  Is the crime a murder, a burglary, kidnapping, embezzlement?  Each type of crime will have a typical set of important information associated with it, yet the detective also avoids limiting the initial investigation based solely on the type of crime. Murders can occur as part of a burglary or to cover up embezzlement.

The detective uses the type of crime to initially structure the collection of relevant evidence, yet the detective remains open to following the evidence as it emerges and to altering initial impressions based on where the evidence leads.

For the clinical child psychologist, the “presenting problem” represents the “type of crime” in the analogy to the detective. The presenting problem defines the broad domain of initial information that is relevant to collect.  Is the issue child defiance of parental directives, angry parent-child conflicts, school failure and classroom behavior problems, ADHD, child substance abuse?  Each of these presenting problems will have a different set of important information associated with them. 

However, the clinical child psychologist also remains open to following the clinical evidence into other domains that are not necessarily part of the presenting problem.  For example, school behavior problems can result from ADHD or undiagnosed learning disabilities, and parent-child conflicts could be the product of unidentified child substance abuse, or even problems in the marital relationship.  The psychologist uses the presenting problem to initially structure the collection of relevant clinical evidence, yet the psychologist remains open to following the evidence as it emerges from systematic clinical interviewing, and to altering initial clinical impressions when the evidence suggests alternative or additional issues.

Suspects = Differential Diagnoses

Based on the initial analysis of the evidence, the detective develops a tentative hypothesis of what occurred at the crime scene and begins formulating a set of possible suspects.

Additional evidence is then sought to confirm or dis-confirm these initial tentative hypotheses about the crime and possible suspects.  While forming initial “leads” regarding possible causes and suspects in the crime, the detective avoids a rush to judgment that too quickly shuts down consideration of alternative possibilities. 

The detective considers all possibilities and seeks evidence that may support some leads and that may dis-confirm other possibilities and suspects.  For example, in investigating a possible suspect, it may turn out that this suspect has an alibi and so it becomes less likely that this person committed the crime, while following up another lead may result in additional evidence pointing to an alternative suspect as possibly committing the crime. 

The detective considers all possibilities, forms tentative hypotheses, and follows up by collecting additional relevant evidence to support or dis-confirm these tentative hypotheses.

The clinical psychologist similarly considers all possibilities and then systematically collects information (clinical evidence) that dis-confirms some hypotheses and that supports other hypotheses.  This process is called “differential diagnosis.” Gradually, as the clinical evidence is systematically collected, the evidence begins to constellate around some causal possibilities and begins to rule out other possibilities.

When a preponderance of clinical evidence constellates around one clinical diagnosis and rules out alternative possibilities, so that this diagnosis can be established beyond a reasonable level of clinical doubt, then this becomes the clinical diagnosis regarding the causal origins of the child’s symptoms that is then used to organize the development of a treatment plan.

Interpreting Evidence

The more the detective understands about how crimes occur and the more the science regarding crime scene investigation advances, the more the detective is able to collect relevant evidence that leads to an accurate conclusion regarding the causal origins of the crime. 

Rarely is eye witness testimony or a confession available. Instead, the detective must rely on secondary evidence that leads to a particular suspect. In addition to circumstantial evidence such as history, motive, and opportunity, more sophisticated evidence, such as ballistics evidence, fingerprints, and DNA evidence, can all provide additional indirect evidence regarding possible suspects.

However, if a detective doesn’t understand the value or role of this advanced secondary evidence, such as ballistics, fingerprint, or DNA evidence, then the detective might not collect this evidence at the crime scene or might not correctly interpret and integrate this secondary more sophisticated evidence with other more basic information about the crime.

In analyzing and interpreting sophisticated evidence, the detective has an advantage over the clinical psychologist, since the detective can simply collect the sophisticated evidence and then send it out to a crime lab for analysis and interpretation.  Clinical psychologists do not have that luxury with advanced clinical information. 

The clinical child psychologist must understand the nature, role, and interpretation of advanced clinical information so that the clinical psychologist knows both to collect this clinical evidence and also how to interpret the advanced clinical evidence.  The more knowledgeable and experienced the clinical child psychologist is in understanding advanced psychological principles and constructs, the more evidence becomes available to the psychologist and the more accurately the clinical psychologist can determine the causal origins of the child’s symptoms.

If the clinical child psychologist believes that child symptoms are caused by demon possession, then this severely restricts the collection and interpretation of clinical evidence regarding the cause of the child’s symptoms.  If, on the other hand, the clinical child psychologist has a professional understanding for advanced principles of child development and family relationships, such as:

  • the nature and role of the attachment system (Ainsworth, 1989; Bowlby, 1969, 1973, 1980; Bretherton, 1990; 1992; Bretherton & Munholland, 2008; Lyons-Ruth, Bronfman, & Parsons, 1999; van IJzendoorn, Schuengel, & Bakermans-Kranenburg, 1999),
  • the construct of intersubjectivity in relationships (Cozolino, 2006; Fonagy, Luyten, & Strathearn, 2011; Kaplan & Iacoboni, 2006; Shore; 1994; 1996; 1997; Stern, 2004; Tronick, 2003; Tronick, et al., 1998; Trevathan, 2001),
  • the impact of parental narcissistic and borderline personality disorders on family relationships (Beck, et al., 2004; Kernberg, 1975; Kohut, 1972; Millon, 2011; Linehan 1993)
  • and family systems constructs such as triangulation, boundaries, and coalitions (Goldenberg & Goldenberg, 1996; Haley, 1977; Minuchin, 1974)

then this advanced knowledge allows the clinical psychologist to collect valuable secondary evidence that provides a more accurate diagnosis, that then is used to guide the development of an effective treatment plan.

If, however, a detective does not understand the value and role of ballistics, fingerprint, and DNA evidence, then the detective does not look for and collect this evidence and so does not have this advanced level evidence available in solving the crime.

Similarly, if the clinical child psychologist is not knowledgeable about the characteristic “goal-corrected” functioning and dysfunctioning of the attachment system, about intersubjectivity in relationships and the socially mediated neurodevelopment of the brain during childhood, about the characteristic features and influence of parental narcissistic and borderline parenting processes on family relationships, and regarding family systems constructs of triangulation, boundary disturbances, and coalitions, then the clinical psychologist does not look for or collect clinical evidence in these domains and then does not have this advanced level information available in developing a clinical diagnosis.

We would be appalled at a detective who failed to collect, use, and interpret ballistics evidence, fingerprint evidence, or DNA evidence in solving a crime. 

Why then do we accept a such a level of professional ignorance and professional incompetence from mental health professionals? 

It seems we hold mental health professionals to a lesser standard of professional practice than detectives.  I don’t know why.  The failure of the mental health professional to accurately diagnose the child’s symptoms will lead to ineffective treatment that leaves the child symptomatic.  This can have both short-term and long-range negative impacts on the child’s emotional, psychological, and social development that can influence both the child’s latter marital relationship as well as the child’s own parenting with his or her children in the future, thereby transmitting the psychological dysfunction to later generations.

The developmental and psychological costs on the child for the failure of mental health to accurately diagnose the child’s symptoms can be extremely destructive.  So it is beyond me why we should accept and tolerate professional ignorance and incompetence in the diagnosis and treatment of children. 

This blog post has a “Comment” section, perhaps child custody evaluators and mental health therapists who lack an advanced level of understanding for the attachment system, for intersubjectivity and the socially mediated neurodevelopment of the brain during childhood, for the characteristic features and display of parental narcissistic and borderline personality dynamics in family relationships (including the child’s incorporation into a role-reversal relationship with the narcissistic/(borderline) parent and the child’s display of co-narcissistic over-developed social sensitivity and precocious maturity), and for family systems constructs of triangulation, boundary disturbances, and coalitions… perhaps child custody evaluators and mental health therapists who lack a knowledge and understanding for these advanced level domains of psychology can explain to me why they don’t need to know this information, why it is acceptable for them to be ignorant.

In my view, this would be like a detective arguing that he or she doesn’t need to collect and interpret ballistics evidence, or fingerprint evidence, or DNA evidence.  “It’s okay, I don’t need that information.”

That’s a very interesting position.  But one with which I completely disagree.  Our children and families should receive the highest standard of care possible.  Anything less is unacceptable.

Planted Evidence

Imagine a detective who came to investigate a crime scene and found an unsigned typewritten note saying, “My name is Bob Jones and I committed this crime.”

It would be a pretty horrible detective who then said, “Well, I guess this case is solved.  We have a confession from Bob Jones.”  Particularly if the detective subsequently interviewed Bob Jones who denied ever committing the crime and ever having written the note.

“Well, even though you deny the crime and deny writing the note, I have the note saying you committed the crime, so that’s the evidence I’m going to rely on.  Therefore, you committed the crime.”

What a horrible detective.

Any even marginally competent detective would consider the possibility that the unsigned typewritten note was PLANTED evidence trying to frame Bob Jones for the crime. So in addition to investigating whether Bob Jones did indeed commit the crime (i.e., Bob may remain a suspect), the detective would also entertain the possibility that this supposed “confession note” was planted evidence designed to frame Bob Jones and distract the investigation from the true source of the crime.

The detective would then collect evidence, including ballistics, fingerprint, and DNA evidence, and follow wherever the evidence led.

The child’s symptoms of rejection for the targeted parent in cases of attachment-based “parental alienation” represent PLANTED “evidence” designed to frame the targeted parent as being a bad parent.

The key to recognizing the child’s symptoms as PLANTED evidence are the “psychological fingerprints” all over the child’s symptoms of psychological influence and control by a narcissistic/(borderline) parent.  Chief among this “psychological fingerprint” evidence is a specific set of five narcissistic and borderline personality traits evidenced in the child’s symptom display toward the targeted parent.

We cannot psychologically control and induce symptoms in a child without leaving “psychological fingerprints” of our control and influence of the child in the symptom display of the child.

The three diagnostic indicators of attachment-based “parental alienation” (see Diagnosis of Attachment-Based Parental Alienation), and particularly the presence of a specific set of a-priori predicted narcissistic and borderline personality disorder traits in the child’s symptom display, represent the definitive “psychological fingerprint” evidence that the child’s symptomatic rejection of a relationship with the normal-range and affectionally available targeted parent is the result of pathogenic parenting by the allied and supposedly “favored” narcissistic/(borderline) parent.

There is no other possible explanation for this specific set of child symptoms other than the pathogenic influence on the child by an allied and supposedly favored narcissistic/(borderline) parent.

The presence in the child’s symptom display of the three characteristic diagnostic indicators of attachment-based “parental alienation” (see Diagnosis of Attachment-Based Parental Alienation) represents definitive clinical evidence beyond a reasonable doubt that pathogenic parenting by the allied and supposedly “favored” parent represents the sole causative agent for the child’s symptomatic rejection of a relationship with the other, normal-range and affectionally available targeted parent.

Preponderance of Evidence

There are also additional clinical signs evidenced in the child’s symptom display toward the targeted parent that offer additional clinical evidence that the child’s symptomatic rejection of the targeted parent is being induced by the distorted pathogenic parenting practices of the allied and supposedly “favored” parent. 

Taken together with the three definitive diagnostic indicators, the presence of additional clinical indicators results in a preponderance of clinical evidence constellating around the interpretation of the child’s symptom display toward the targeted parent as representing PLANTED evidence designed to frame the targeted parent as a bad parent, while the actual cause of the child’s symptoms lay in the severely distorted pathogenic parenting practices of the allied and supposedly “favored” narcissistic/(borderline) parent.

Only an atrocious psychological detective would miss collecting and interpreting this definitive clinical evidence.

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

References:

Attachment System

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

Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment, . NY: Basic Books.

Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. NY: Basic Books

Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. NY: Basic Books.

Bretherton, I. (1990). Communication patterns, internal working models, and the intergenerational transmission of attachment relationships. Infant Mental Health Journal, 11, 237-252.

Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 1992, 28, 759-775.

Bretherton, I., & Munholland, K. (2008). Internal working models in attachment relationships:  Elaborating a central construct in attachment theory.  In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 102-130). New York: Guilford Press.

Lyons-Ruth, K., Bronfman, E. & Parsons, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. In J. Vondra & D. Barnett (Eds.) Atypical patterns of infant attachment: Theory, research, and current directions. Monographs of the Society for Research in Child Development, 64, (3, Serial No. 258).

van IJzendoorn, M.H., Schuengel, C., & Bakermans-Kranenburg, M.J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–249.

Intersubjectivity

Cozolino, L. (2006): The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. WW Norton & Company, New York.

Fonagy, P., Luyten, P., and Strathearn, L. (2011). Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Mental Health Journal, 32, 47-69.

Kaplan, J. T., & Iacoboni, M. (2006). Getting a grip on other minds: Mirror neurons, intention understanding, and cognitive empathy. Social Neuroscience, 1(3/4), 175-183.

Shore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Earlbaum.

Shore, A.N. (1996). The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology. Development and Psychopathology, 8, 59-87.

Shore, A.N. (1997). Early organization of the nonlinear right brain and development of a predisposition to psychiatric disorders. Development and Psychopathology, 9, 595-631.

Stern, D. (2004). The Present Moment in Psychotherapy and Everyday Life. New York:

Tronick E.Z., Brushweller-Stern N., Harrison A.M., Lyons-Ruth K., Morgan A.C., Nahum J.P., Sander L., Stern D.N. (1998). Dyadically expanded states of consciousness and the process of therapeutic change. Infant Mental Health Journal, 19, 290-299.

Tronick, E.Z. (2003). Of course all relationships are unique: How co-creative processes generate unique mother-infant and patient-therapist relationships and change other relationships. Psychoanalytic Inquiry, 23, 473-491.

Trevarthen, C. (2001). The neurobiology of early communication: Intersubjective regulations in human brain development. In Kalverboer, A.F. and Gramsbergen, A. (Eds) Handbook of Brain and Behaviour in Human Development. London: Kluwer Academic Publishers

Narcissistic & Borderline Personality Disorders

Beck, A.T., Freeman, A., Davis, D.D., & Associates (2004). Cognitive therapy of personality disorders. (2nd edition). New York: Guilford.

Kernberg, O.F. (1975). Borderline conditions and pathological narcissism.. New York: Aronson.

Kohut, H: Thoughts on narcissism and narcissistic rage. Psychoanalytic Study of the Child 1972; 27:560-400.

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

Millon. T. (2011). Disorders of personality: introducing a DSM/ICD spectrum from normal to abnormal. Hoboken: Wiley.

Family Systems

Goldenberg, I. and Goldenberg, H. (1996). Family therapy: An overview. 4th Ed. 
Pacific Grove, CA: Brooks-Cole Publishing Company

Haley, J. (1977). Toward a theory of pathological systems. In P. Watzlawick & J. Weakland (Eds.), The interactional view (pp. 31-48). New York: Norton.

Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.

Stark Reality

To targeted parents:

I am often sought out by targeted parents who want my help to the question,

“How can I reestablish a positive and affectionate relationship with my child?”

My answer is… that’s the wrong question.

The Well-Formed Question

Do you really want me to open the child to a positive and affectionate relationship with you? Knowing full well that the child will pay a terrible price for any show of affection toward you, or even for not rejecting you sufficiently, as a result of the retaliation by the narcissistic/(borderline) parent.

The capacity for psychological cruelty by the narcissistic/(borderline) parent is immense. Just think of it for a second. The narcissistic/(borderline) parent is willing to inflict the immense cruelty on you of taking your most precious beloved child from you, so that you no longer have a child, to inflict on you such intense psychological suffering as revenge for your not sufficiently appreciating the “wonderfulness” of the narcissistic/(borderline) parent.

Their capacity for cruelty is immense, and it is without empathy or pity.

If the child shows any affection toward you, or does not reject you with enough display, then the full force of the psychological cruelty that is capable from the narcissistic/(borderline) parent will be turned on the child. The child will have to endure daily hostility, rejection, contempt, and torment. Irrational rules, irrational punishments. Anger. Rejection. Guilt.

The pathological cruelty capable from the narcissistic/(borderline) parent is hard enough for a fully developed adult psyche to endure, it is devastating to the still in-formation psyche of the child.

So are you asking me how you can expose your child to this retaliation? You’re asking me how to open up your child and expose your child’s authenticity and vulnerability to the immense  psychological cruelty capable from the narcissistic/(borderline) parent.  Is that really what you want to do?

“How can I protect my child?”

That’s a much better question.

Until we can protect the child, we cannot expose the child.

How can we ask the child to show affection toward you unless we can first protect the child from the psychological retaliation of the narcissistic/(borderline) parent that is sure to follow any display by the child of affectionate bonding to you, or even just the child’s insufficient display of rejection of you?

The narcissistic/(borderline) parent REQUIRES the child to reject a relationship with you. If the child shows bonding motivations toward the targeted parent, or even fails to show sufficient rejection of the targeted parent (such as insufficiently dramatic displays of protest at visitation transfers), then the child will be subjected to a withering psychological retaliation from the narcissistic/(borderline) parent.

So, as a therapist, my question to targeted parents is this;

“Do you want me to open the child’s bonding motivations toward you? To stop the child’s displays of rejecting you? To re-form a positive parent-child bond with you? Knowing that to do so will expose the child to an excruciating psychological torment from the retaliation of the narcissistic/(borderline) parent once the child returns to the custody and ‘care’ of the pathological parent.”

As long as the child must live in the world of the narcissistic/(borderline) parent, as long as we cannot protect the child from the psychopathology of the narcissistic/(borderline) parent, the child must find a way to psychologically survive in that world.

My First Exposure

My first case of “parental alienation” involved a 10 year old boy who had to reject a relationship with his mother. I had met with the father on several occasions and the dynamic was obvious. As I sat in the mother-son therapy session with the child sitting apart in a dramatic display of rejection, refusing to play a board game with his mother and me, I decided to reach out with my empathy into the child’s experience.

As I sat talking with the mother, I allowed my empathic resonance to shift over to the child, to the child’s inner experience. I didn’t share this empathic awareness with the child, I just allowed myself to feel what it was like to be him, looking for his authentic self-experience.

As I dropped my empathic awareness into the child’s authenticity, this is what I “heard” in my mind’s imagination,

Child (in my mind’s imagination): “Dr. Childress, can you help me escape from here? I’m trapped, buried deep inside. I don’t want to reject my mother. I love my mother. But I have to reject her because it’s what my dad requires me to do. He’ll torment me if I don’t. Can you rescue me? Can you help me escape from here?

Dr. C (in my mind’s imagination): I’ll see what I can do.

Child (in my mind’s imagination): “But Dr. Childress, don’t get me half the way out. Because if you only get me half the way out my dad will torment me for showing affection for my mom, for not rejecting my mom. If you can’t rescue me, if you can’t get me all the way out, then just leave me here.

Dr. C (in my mind’s imagination): Okay, I’ll see what I can do.

That’s the voice of the child in “parental alienation.”

“Help me. My authenticity is trapped deep inside here. Please, I want you to rescue me. But if you can’t get me all the way out, if you can’t rescue me, then leave me here, because otherwise the pathological parent will torment me if I try to escape but can’t get fully away.”

“At least if my authenticity is buried deep inside, hidden beyond my awareness, then it’s safe. If you expose it but cannot protect it, then the narcissistic/(borderline) parent will destroy it.”

We must first protect the child. Only then can we ask the child to expose his or her authenticity.

Protecting the Child

I am a therapist. I am not the child’s parent. I cannot do what is necessary to protect the child. You must do that.

I can support you. I can write, I can film Youtubes, I can describe what “parental alienation” is for mental health professionals and the Court. I will do everything in my power. But I cannot achieve the child’s protection. Each parent must accomplish that for each child. Every situation has its own individual characteristics, and only you can achieve your child’s protection.

Unless you can protect the child, how can you ask the child to love you? Knowing that to love you will expose the child to the abusive psychological retaliation of the hostage taker?

Or is that just the child’s problem? After all, if we restore the child’s positive relationship with you then you’ll be fine. You’ll have a positive, normal-range relationship with the child. Whatever happens to the child at the other parent’s house, well, that’s the child’s problem.

I know that’s not how you feel. But how, then, can we ask the child to bond to you? We can’t. Not until we achieve the child’s protection from retaliation.

Allies

You, the targeted parent, cannot protect the child unless you have allies. The principle ally is mental health.

It is the responsibility of mental health to recognize the degree of psychopathology and to voice this diagnosis in your support. You are the normal-range and healthy parent. The allied and supposedly “favored” parent is the pathology.  You know that.  I see that.  All of mental health should similarly see it.  But they don’t.

We need to solve that.

Then, once you have a strong ally in mental health, we turn to the Court system. The united voice of mental health can then provide you with the institutional power you need to enlist the power of the Court as your ally, and it is with the power of the Court that we can protect the child.

The solution to “parental alienation” is not through the legal system, it is to be found in the mental health system. When mental health speaks with a single voice, the legal system will be able to act with the decisive clarity necessary to protect the child and solve “parental alienation.”

Until mental health speaks with a single voice, no solution to “parental alienation” is possible. Not for you.  Not for the next parent.  This isn’t because we can’t fix your relationship with your child, it’s because we can fix it.  Yet how can we ask for the child’s authenticity if we are unable to first protect the child’s authenticity?

Do you really want to expose the child to the immense psychological cruelty capable from the narcissistic/(borderline) parent?  If we open the child’s affectionate bonding toward you, that’s exactly what we will be doing.

Securing the Mental Health Ally

Currently, one of the major problems in securing mental health as an ally for targeted parents is the massive level of professional incompetence in both the diagnosis and treatment of “parental alienation.” Mental health doesn’t understand what it’s dealing with, what “parental alienation” is.

The first step to securing mental health as an ally is to clear the field of professional incompetence, so that ONLY professionally knowledgeable and competent mental health professionals treat this “special population” of children and families.

Key to achieving professional competence is defining “standards of practice” to which ALL mental health professionals can be held accountable. A Gardnerian PAS model does not allow us to establish professional standards of practice because Gardner too quickly abandoned established and accepted psychological constructs to describe what he thought was a new “syndrome.” We need to return to the foundations and re-define the construct of “parental alienation” entirely from within standard and established psychological constructs, so that we can then use this definition to establish “standards of practice” for ALL mental health professionals who work with this “special population.”

That’s what I set about to do, and that’s what I have accomplished with an attachment-based model of “parental alienation.”

I cannot enact the protection of your child. You must accomplish that. But I can give you the weapons from within professional psychology to achieve your child’s protection and the recovery of your child’s authenticity.

The Next Step

The next step in achieving mental health as your ally is to establish these “standards of practice” within mental health, so that ALL diagnosing and treating mental health professionals are knowledgeable and competent.

If you are going to rely on me for that, I would anticipate that this will take between 10 to 15 years for an attachment-based model of “parental alienation” to achieve professional acceptance.

Within two years I will submit for publication. It will take about a year and a half for the article to be published. It will languish in obscurity for another two years, when my second and third articles become published. A little more interest will emerge. I’m currently 60 years old. Within the year I’m going to be shifting my focus back to my primary professional practice domain of ADHD (I’ve actually solved what “ADHD” is and how to treat and resolve it, and in order to accomplish this I had  to advance child therapy into the 21st century, so I need to get back to these areas of prime importance. Solving “parental alienation” is a side-track for me). At some point in the next decade I’ll retire. At some point I’ll pass away. Then my work will gradually be “discovered” and picked up by younger therapists and researchers, and it will gradually find its way into the professional mainstream.

My estimate is that if you leave it to me to carry the solution, it will take between 10 to 15 years to achieve mental health as an ally.

What I’ve tried to do is give you the professional weapons you need to carry the fight for your children. I’ve defined the theoretical foundations for the construct of “parental alienation” on the solid and scientifically supported bedrock of attachment theory and personality disorder dynamics. From a professional psychology standpoint, I’ve done the heavy lifting for you. You now have a theoretical foundation built on solid bedrock that you can leverage to achieve the solution. But the fight for your children must be yours.

If you take up this fight to establish an attachment-based model of “parental alienation” within mental health, to require a “standard of professional practice” with this “special population” of children and families, then you may perhaps shorten the time-frame needed to acquire mental health as an ally. Perhaps to as little as a year or two. The theoretical foundations are extremely solid. You have everything you need.

Along the way, I’m willing to do whatever I can to support your voice within mental health.

Stark Reality

Because of my understanding of what “parental alienation” is, I’m often asked by targeted parents what they can do to restore a relationship with their child.

The stark reality is, nothing.

How can we ask the child to love you, to bond with you, to expose their authenticity, if we cannot also protect them from the torment of psychological retaliation that is sure to be inflicted on them by the narcissistic/(borderline) parent?

We must first protect the child.

Then, and only then, does a solution become available. And in order to protect the child we MUST have the strong and steadfast support of mental health. This requires that we clear the field of professional incompetence by establishing professional “standards of practice” for ALL mental health professionals who work with this “special population” of children and families.

An attachment-based model of “parental alienation” provides the necessary theoretical foundations on the established bedrock of attachment theory and personality disorder dynamics.  An attachment-based model of “parental alienation” can be leveraged into standards of professional practice for ALL mental health professionals who work with this “special population” of children and families.

How long this solution takes to enact, how long before we are able to protect our children… that’s up to you.

Craig Childress, Psy.D.

Standards of Practice for Court Ordered Parent-Child Therapy

The Court has the right to expect the highest standards of professional practice from psychotherapists who conduct therapy in response to Court orders.

The professional practices of therapists who provide Court-ordered psychotherapy to children and families should therefore reflect the highest standards of professional practice.

Professionally established guidelines exist that define standards of professional practice for forensic psychologists (Specialty Guidelines for Forensic Psychology, 2013) and guidelines have been proposed for professional standards of best practice regarding child custody evaluations (Patel, & Choate, 2014), yet no professional guidelines have been proposed or established for mental health therapists providing Court-ordered therapy.

I would propose that this is easily rectified: Mental health therapists should always render services at the highest professional standard of practice.

If our child had cancer, wouldn’t we want THE BEST doctors and THE BEST treatment available anywhere for the treatment of our child.  Why should we expect any less from psychotherapy?  Children’s futures, their healthy or unhealthy development, their future success, struggles, and pain, can all depend on the quality of the psychotherapy services they and their families receive.  This is an awesome professional responsibility.

Mental health therapists should provide to their clients exactly the same standard of professional care that the therapist would want for his own daughter or for her own son.  For our own children we would want the best possible treatment, whether for cancer or psychological issues. Why should we provide less professional competence to our client children and families than we would want for our own children and families?

Mental health therapists should always render services at the highest standard of professional practice.

And Courts have the right to expect the highest standard of professional practice for child and family litigants referred by the Court for therapy.

Defining the Quality of Care

For many years now I have taught clinical assessment and treatment planning to Master’s level students seeking to become psychotherapists. Prior to my entering private practice I served as a psychologist on medical staff at Children’s Hospital of Orange County where I supervised pre-doctoral and post-doctoral psychology interns and fellows in the APA accredited internship at the hospital. I later served as the Clinical Director for a children’s assessment and treatment center, where I trained and provided clinical supervision in child and family therapy for psychology interns and post-doctoral fellows treating young children who were primarily referred through the Department of Children’s Services and the foster care system.

The following framework for clinical assessment represents the professional standard of practice that I would EXPECT from any graduate student I teach or therapist I supervise if they were to provide Court-ordered family therapy to restore a fractured parent-child relationship, and the following framework would definitely be what I would expect of therapists at the professional level who provide Court-ordered psychotherapy to children and families.

The Court and our clients have the right to expect the highest standard of professional practice from psychotherapists who provide Court-ordered psychotherapy to children and families, and therapists who provide Court-ordered psychotherapy to children and families should expect to provide the highest quality of care to their clients.

Source of Clinical Information

Therapists conducting Court-ordered therapy to treat and resolve parent-child conflict should collect appropriately comprehensive clinical data necessary to develop an accurate case conceptualization which is needed for the development of an effective treatment plan.

For child and family issues, the collection of appropriately comprehensive clinical information would typically involve collecting information from the following sources:

Parental Clinical Interviews: Clinical interviews conducted with each parent individually to obtain each parent’s perspective on background history and symptom information. 

Parent-Child Assessment: Initial parent-child therapy assessment sessions with the parent and child who are the clients targeted for treatment, to observe and conduct clinical probes of individual functioning and conjoint relationship dynamics, including client responses to clinical intervention probes.

Child Assessment: Separate child clinical assessment interviews that include clinical probes and assessment of the child’s emotional and psychological functioning.

Relevant Collateral Sources: Review of relevant reports and documents and clinical interviews with relevant collateral sources of information, such as additional family members.

Written Case Conceptualization and Treatment Plan

Therapists providing Court-ordered psychotherapy to restore a fractured parent-child relationship should, within 4 to 6 weeks of the initial intake assessment, produce a written case conceptualization and treatment plan.

Content Domains of the Case Conceptualization

This written case conceptualization should document the following:

  • Presenting Problem:  A brief introduction to the issues and symptoms that necessitate therapy
  • History of the Presenting Problem:  A description of how the presenting problem emerged, its developmental course over time, and its severity
  • Family History:  A description of current family relationships, the family’s history, and relevant information about the parents’ family of origin history
  • Academic & Work History:  A description of the child’s school behavior and academic performance, and the work history of the parents
  • Additional Relevant History:  A description of additional relevant information, such as possible trauma history within the family (including in the childhood of the parents or with the grandparents), histories of alcoholism and substance abuse within the family (including in the parent’s childhood or with the grandparents), and histories of psychiatric diagnoses within the family (including the extended family). Additional relevant social, legal, and medical histories should be documented.

Jones, K. D. (2010). The unstructured clinical interview. Journal of Counseling and Development, 88, 220-226.

  • Case Conceptualization: The symptoms to be addressed by therapy should be specified and a theoretically substantiated clinical determination should be made regarding the apparent origins of these symptoms.

The theoretical framework that organizes the case conceptualization can be from any of the six primary schools of psychotherapy; psychodynamic, humanistic-existential, cognitive-behavioral, family systems, post-modern social constructionism, neuro-social developmental, or can draw from and integrate several theoretical models (the anticipated length of this case conceptualization would be 1-2 pages and would assume the reader has a professional level knowledge of the theoretical foundations).

Content Domains of the Treatment Plan

The written treatment plan should specify a set of theoretically substantiated treatment interventions that are directly linked to the clinical case conceptualization regarding the origins of the symptoms.

The written treatment plan should specify an estimated timeframe for accomplishing the resolution of the identified symptoms, with due consideration given to the variability of treatment related influences that may arise and alter this estimated timeframe. The written treatment plan should also offer an estimated prognosis for recovery of normal-range development and relationships.

If the estimated timeframe for resolving the symptoms exceeds six months, then a six month benchmark of anticipated gains should be identified and the reasons for the longer than six month estimate of therapy should be documented.

Treatment Progress Updates

At six-month intervals during the course of therapy, the therapist should provide written treatment progress updates specifying the treatment gains to date and the estimated timeframe for achieving a resolution of the symptoms.

If treatment progress has not been substantial in six months of therapy, then an explanation of the barriers to treatment should be documented, and adjusted interventions should be identified to address these barriers.

There are a variety of possible reasons for the failure to achieve substantial treatment progress in six months,

Neuro-biological limitations. These include factors such issues as autism-spectrum limitations, prenatal child exposure to drugs or alcohol that affects cognitive and behavioral development, parental psychiatric disturbances such as bipolar disorder or schizophrenia, etc. These types of issues present an inherent limitation to the treatment gains that can be expected, and realistic treatment expectations need to be established.

Therapist failure. The therapist may lack adequate knowledge and expertise to enact the therapy, or the client-therapist fit may not promote treatment success. A change in therapists may be indicated.

Inaccurate case conceptualization. The initial case conceptualization may have been in error leading to treatment interventions that were off-target to the origins of the symptoms. A revision in the case conceptualization and the treatment plan may be necessary.

Note: Research in psychotherapy efficacy finds that all theoretical orientations are effective (Wampold, 2001). According to the empirical research, the key determinative feature in psychotherapy efficacy is that the therapist has a model of psychotherapy for case conceptualization and that the client accepts this model as an explanation for the problem.

Client factors. A client within the family system may be resistant to the goals of treatment, resulting in slowed treatment progress. The nature of the client factors affecting therapeutic progress should be identified and revised treatment interventions to address and adjust to client factors should be specified.

Inadequate time. Treatment progress is being made, but the prior issues creating the symptoms are complex and deeply embedded and require a longer period of time to resolve. The underlying issues slowing treatment progress should be documented along with an estimated time frame and prognosis, and the factors affecting prognosis should be identified.

Treatment expectations:

  • In most cases of parent-child conflict, substantial treatment progress should be expected from six months of therapy.
  • Treatment should be expected to resolve the symptoms in no longer than one year of therapy.
  • Failure to meet these expectations should generate documentation as to the reasons for the failure of therapy to meet these expectations.

Note on Child Development:

The developmental phases of childhood are relatively brief and each phase is associated with important child experiences and emerging developmental capacities that build sequentially and cumulatively upon earlier developmental maturation.

Child developmental phases occur at approximately three-month intervals during the first year, six-month intervals during the second year, and then express a roughly two-year interval pattern between subsequent developmental phases:

Ages
0-1 infancy development, early emergence of foundational brain systems
1-2 toddler development, socio-language integration and exploratory locomotion
2-4 preschool socio-emotional-behavioral integration
4-6 early school entry and more elaborated socio-cognitive development
6-8 increasing stability in self-regulation and enhanced maturation in family bonding
8-10 elaborated personal and peer (social) achievement motivations
10-12 enhanced social awareness and modeling of same-gender parent, enhanced early proto-adult cognitive reasoning
12-14 increasing independence in self-identity, physio-social puberty changes
14-16 stabilization of adult-like cognitive reasoning and enhanced adult-like self-independence, gender-bonding motivations emerge
16-18 emergence of adult-level cognitive and social maturation
18-20 transition into young adult responsibilities and self-reliance

A six month time period reflects fully ¼ of the timeframe for a developmental phase. Disruptions to normal-range development lasting longer than six months will have increasingly deleterious effects on healthy child development, as the phased sequencing of later developmental experiences become increasingly desychronized with developental readiness.

When treating children, therapy should have as its goal, and should make significant efforts toward achieving, a substantial resolution of treatment-related issues within six months, and no longer than one year.

Failure to achieve this goal, important to maintaining the healthy developmental trajectory of the child, should receive examined scrutiny to identify the reasons why therapy was unable to achieve this goal, leading to appropriate treatment modifications to address and resolve the limitations to the extent possible and in the least amount of time feasible.

Therapy lasting one year is fully ½ of a developmental phase. Therapy should achieve substantial resolution of developmental child symptomatology within a year. Given the critical importance of time-related factors in child development, failure to achieve this standard should receive review and require specific documentation of the factors limiting therapeutic progress. Substantial alteration of the treatment context and organization of therapy may be indicated.

Clinical Review of Treatment

In any initial review of the case conceptualization and treatment plan, broad latitude should be granted to the therapist’s identification of the theoretical framework for case conceptualization and treatment planing. Later reviews should expect moderate to substantial treatment progress with due consideration for legitimate barriers to treatment progress identified in the update report and within the context of the therapist’s responsibilities to resolve the family conflicts.

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

References

Professional Practice Guidelines

Specialty guidelines for forensic psychology. (2013). American Psychologist, 68(1), 7-19

Patel, S.H. & Choate, L.H. (2014). Conducting child custody evaluations: Best practices for mental health counselors who are court-appointed as child custody evaluators. Journal of Mental Health Counseling, 36, 18-30

Jones, K. D. (2010). The unstructured clinical interview. Journal of Counseling and Development, 88, 220-226.

Psychotherapy Research

Wampold, Bruce E. (2001). The Great Psychotherapy Debate: Models, Methods and Findings. Routledge.