Proper Protocol for the Use of Child Psychologists in High

Report
Proper Protocol for the Use of
Child Psychologists in HighConflict Cases (Therapeutic)
William M. Pinsof, Ph.D.
The Family Institute at Northwestern University
Domestic Relations Division Child Representative Seminars
March 19, 2014
[email protected]
Who Am I?

The President and CEO of The Family Institute at Northwestern University—
an independent, not-for-profit affiliate of NU

A Clinical Professor in the Dept. of Psychology at Northwestern

A clinical/family psychologist and marriage and family therapist in
practice for 42 years (20 hrs/wk)

Specializing in treating couples (and families)

Worked with court or lawyer referred high conflict couples in therapy and
“therapeutic mediation” since 1990

Facilitated and oversaw the development and implementation of the Family
Institute’s Custody Evaluation Program (1985-1992) for court referred families

Disclaimer: Not a legal expert or specialist in custody evaluation or mediation
Where Am I Coming From?

I work with families and believe in a “family systems perspective” that


Looks at the family (even the divorced family) as a system (set of people
and their relationships) that is governed by rules (boundaries) about who
can do what, where and with whom.
I believe that the best gift a therapist can give a child is “a healthy family” with

Good (appropriate) boundaries

Trusting and respectful interactions

Good intimacy processes


The “co-creation of meaning”
Good conflict processes (“good fights”)

All families have problems and fall short of the ideal

People (families, co-parents) have the capacity to change when challenged
and supported properly (good therapy)
(Broadening) The Focus of Today’s Talk

A clinical and therapeutic perspective on how child psychologists should
be used by lawyers and the legal system in cases with high conflict
couples with children

What is a child psychologist?

Broadening the definition to include child psychiatrists, clinical/counseling
psychologists, family therapists and counselors—licensed mental health professionals
who work with children and families

Revised title: Protocol for using “mental health professionals, therapeutically, in
high conflict cases”

“Therapeutically” means that the goal of the intervention is to help the
couple/family resolve or manage their conflict processes more effectively,
primarily and particularly in regard to their children
What is a High Conflict Couple?

High conflict couples

High conflict couples are couples that engage in frequent
and generally unresolvable conflictual interactions
Couples, with or without children, that present for therapy and
are not engaged in any type of litigation or separation
process—“gruesome twosomes” that should get divorced but
won’t—referred to as “spouses”
 Couples with children that are divorcing (separated or
cohabiting) or divorced with unresolvable conflicts that pertain
to and may include the children—referred to as “co-parents”

Types of High Conflict Couples

Triangling Couples that try to induct a child into the role of ally against the other
parent (extreme variety is “alienation of affection”)

Contained, non-triangling couples (good co-parental boundary)

Symmetrical (battling warriors)

Complementary (Active Aggressor/Passive Aggressive Victim)

Abusive Couples (physical and emotional) that traumatize their children
vicariously (by watching—not abusing the child)

Impossible co-parent--a “disturbed” parent with whom it is impossible to resolve
anything (sadist, anti-social personality disorder, person low on
“agreeableness”) with a reasonable, healthier co-parent
Types of Co-Parental Conflicts

Conflicts that pertain to the couple only (“why didn’t you tell me that Sara
and Allan got divorced?” or “You never could manage money.”)

Conflicts that affect the child, but do not pertain to the child (“why
haven’t you sent me your child support this month?” or “You did not call
and let me know that you were not going to be on time.”)

Conflicts that directly involve or are about the child (“You need to set
firmer limits with him. You spoil him rotten” or “Why are you always so hard
on her? Let her breathe and relax a little.”)
What are the Goals with Families with
High Conflict Co-parents?

From the most to the least ideal

The co-parents learn to resolve their conflicts—they become a “good conflict”
couple

The co-parents create a better boundary and buffer between their conflict
process and their child(ren)—de-triangling
 The
child is protected from the conflict (it does not
happen in front of or within earshot of or the child
is not told about it afterwards)

The co-parents avoid overt triangling and maintain appropriate conflict
processes (stay above the belt), but children are aware of and sometimes see
or hear the conflict
Goals of Therapeutic Intervention
(cont.)


The child (if old and strong enough) learns to detriangle and protect
him/herself from the parents conflict

The child deals with his business with each parent with that parent and does
not triangle the parents (“Dad is such an asshole.” “You just discovered
that?”)

The child accepts the “impossibility of change with his/her parents” and
avoids dealing with the impossible parent or both parents as much as
possible—dis-engagement
The child learns to engage others to help him with and when his/her
parents engage in destructive and inappropriate conflict

This appropriately triangles a third party—seeking help
Common and Critical Steps in the
Therapeutic Process

Interventions primarily aimed at the parents (ideally together)

Teaching them good conflict management skills—how to fight fair

Focus and stay focused on the issue or problem (don’t “gunny sack” and/or
jump from problem to problem or go back into older marital conflicts)

Criticize the behavior of the other parent, not the person, personality or integrity
of the other co-parent

Be constructive--focus as much as possible on what you would like to see
changed in the other co-parent, not what they have done or are doing wrong

Diminish defensiveness (stop defending and explaining why you did something)
and start listening to the other co-parent more

Discontinue escalating conflict--develop a strategy for taking “time outs” that is
not just another power tactic—(“You are too crazy and I can’t talk to you
anymore.”)
Steps in the Therapeutic Process
(cont.)

Parent focused interventions (continued)

Teaching good conflict management skills (continued)

Only use email for conveying factual information—anything critical or “hot” or that
might be interpreted negatively should be communicated over the phone or in person

Anything critical or negative in email hits harder and harsher

Teach parents to look at themselves and Identify and take responsibility for their own
negative or destructive behavior—the skill of owning up

Teach parents to apologize (as part of owning up)—”I am sorry for what I did” versus “I
am sorry that you got upset about what I did”

Help parents deal with issues as they come up, rather than keeping their own counsel
and then finally exploding at the other parent
Steps in the Therapeutic Process
(cont.)

Parent-focused interventions (continued

Addressing constraints to parents learning to behave better (probably in individual therapy)


Help the parent grieve the old relationship or the other partner—understand function
of the conflict

As a way of staying engaged and not letting go of the other

As a way of not moving on and building a new life
Help the parent understand and change his/her role in the “high conflict process“

Who is the other co-parent to him or her (Mom, Dad, sibling)?

How does s/he feel about his/her role—what s/he says and does when they are in
conflict?

What would s/he like to change about his or her behavior and what might be
preventing that?

Help the parent accept the other parent as a limited or “flawed” human being

If necessary, help the parent get individual therapy and/or medication) to change
Steps in the Therapeutic Process
(cont.)

Child focused interventions

Help the child learn to avoid triggering conflict


Don’t do stupid things that will set your parents off
Help the child stop triangling—talking to one parent about the other

Go to the source and/or object of your unhappiness

Sessions with the parent (source/object) can be very helpful

As appropriate, help the child realize that his/her parents’ inability to get along
and communicate effectively is not his/her fault

Help the child confront his parents with the impact of their conflict on him/her
(what it does to him/her and how it makes him/her feel)

Sessions with the parents are the ideal format for this intervention
Steps in the Therapeutic Process
(cont.)

Child focused constraint Interventions

Help the child evaluate the extent to which triggering or stimulating conflict

Preserves the pre-divorce “family”--brings mom and dad together

Engages a disengaged parent who would otherwise stay disengaged

Help the child grieve the “old family” that is gone

Help the child find healthier ways to engage a disengaged parent

Sessions with the parent can be very helpful in this regard

Help the child address his/her fears and feelings about each of his parents
(“I can’t talk to my dad because he will get angry and I hate him”)

With impossible parents, help the child accept parental limitations—(“He will
never be the father you want.” “Where does that leave you?”).
The Therapeutic Skills Necessary
Reduce High Conflict

What therapeutic skills need to be brought to bear on the high conflict family in
order to accomplish the goals and changes outlined above?

The ability to see and understand the “family system” (roles, functions,
boundaries, etc.)

The ability to work directly with families (parents and children) and couples

The desire to change the system (versus helping people adapt to it)

The ability to work individually with adults and children


In working with adults, the ability to confront each parent with their own
destructive behavior and help them behave better

The ability to help a child identify and get prepared to express his/her
feelings and thoughts to their parent(s)

The ability to help people grieve and accept what they cannot change
The ability to reach out, collaborate and coordinate with other mental health
professionals
How to Pick a Mental Health
Professional to Intervene

Whether you realize it or not, you are bringing in a mental health
professional (or team) to change the family system


Pick someone with the skills and competencies mentioned above

Discipline (psychiatry, psychology, social work) and degrees (M.D., Ph.D.,
M.A.) are not as important as the skills and competencies of the therapist

The therapist does not need to possess all of the abovementioned skills, but
should be able to bring in or work with other mental health professionals with
complementary skills to change the family system as well as the individuals
within it
Talk to the therapist before engaging them to determine (as much as possible) if
they have the requisite skills
How to Pick a Mental Health
Professional to Intervene (cont.)

Get permission and then talk with the other mental health professionals
that are working with the family (Mom’s therapist, Dad’s therapist, the
school counselor)

Think of them as members of the “system” with whom you have to work and
with whom whoever you bring in will have to work

Talk and collaborate (and meet with if necessary) the other attorneys (and
judges) that are involved with the case in picking the therapist(s)

The parents should ideally agree about and be comfortable (as much as
possible) with the therapists that are being brought in

Bringing in the wrong therapist creates more trouble (increase polarization, vilify
the “other” parent, etc.).

A “pretty good” non-controversial therapist is better than a “best” controversial
one
The Problem Centered Therapeutic
Process

Guidelines for practice and referral

Interpersonal—start out the with whole family (parents and children) and go to
subsystems (couple, kids) or individuals when that does not work
 Family

Couple
Individual
Cost-Effectiveness—try the simplest and most direct interventions before trying
more complex and indirect interventions
 Simple
and Direct
Complex and Indirect
The Problem Centered Therapeutic
Process (cont.)

Guidelines cont.

Temporal—begin by focusing primarily on the here-and-now and shift to the
past as necessary—in the face of the failure of current interventions
 Here

and Now
Past
Health—Assume that people are healthy (capable of solving their
problems with direct interventions) until proven otherwise
 People
are Healthy
People are sick
Referral as a Clinical-Experimental
Process



Starting with the couple or family, try

The simplest most direct interventions first; if they do not work, try

More indirect, complex and multi-pronged interventions; if they do not work
Work with the individuals (adults and children)

Focusing increasingly on constraints to change from the past (childhoods of the
parents) in individual contexts (therapy)

And/or biological constraints (hormones, brain chemicals with psychotropic
medications; if they do not work)
Treatment must focus on the development of a transformative relationship
with a therapist that can build the self of the adult and/or child
Who to Bring in When: Preferred Order
of a Failure Driven Process

Couple and Family therapists—coordinators/managers

Individual therapists to work with the adults and children

Psychiatrists to evaluate and prescribe medication

Psychodynamic therapists who can rebuild the selves of the
adults (and children)
You Are Part of the System

Why am I a family psychologist and why are you a family lawyer?



Our own agendas to repair ourselves and our families
Watching our countertransference—What we bring to the case and
situation from our pasts

Am I protecting my mother, my self, my sister or brother?

Am I stopping my abusive, critical father?

Am I rescuing myself, because no one did when it counted?
Knowing and restraining ourselves—you cannot not be personally involved

But you can know and manage yourself so as not to make a situation worse
Conclusions and Summary

See the Child and Parents as a System

Bring in therapists who will address the System first and coordinate with
other therapists

Assume health—that people want to do the right thing for their children

When they don’t

Address their deficits with individual therapy and/or medication
You are trying to change a system and you are part of that
system—The Importance of our
Hope and Humility to make a Better World

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