Proper Protocol for the Use of Child Psychologists in High-Conflict Cases (Therapeutic)

William M. Pinsof, Ph.D. The Family Institute at Northwestern University

Domestic Relations Division Child Representative SeminarsMarch 19, 2014

wpinsof@family-institute.org

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-trianglingThe 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 interventionsHere 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