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LEGAL  ISSUES  AND  FAMILY  INTERVENTIONS  WHEN  CHILDREN  RESIST  CONTACT  WITH  A  

PARENT    

September  13,  2014  San  Francisco  

Rebecca  Bailey  Marge  Slabach  Ma?  Sullivan  

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Old  Problems  &  New  Concepts    Resistance  of  children  to  visitaJon,  especially  in  high  conflict  separaJons  has  always  been  an  issue    c.1900  concern  about  “poisoned  minds”  

  1987:  Richard  Gardner  -­‐  “parental  alienaJon  syndrome”  (PAS)    important  concept  but  original  arJculaJon  was  inadequate    and  does  

not  meet  Daubert  standard  (rule  of  evidence  regarding  admissibility)  

  2001:  The  Marin  Group    Not  a  “syndrome”    

  DSM  5  rejected  PAS    Not  “mental  disorder”  of  the  child    O\en  not  all  fault  of  one  parent  

   Focus  on  the  “alienated  child”  and  consider    Conduct  of  both  parents      Vulnerability  of  child  

  Age    Temperament    Anxiety,  dependency    

  Parent-­‐child  “fit”  

Normal Development

Parenting Problems

Affinity

Alignment

Alienating

Self-centered

Enmeshment

Intrusive

Too Lax/Too Rigid

Misattuned

What Causes a Child to Reject a Parent?

Abuse

Child AbuseIntimate Partner

Violence [IPV]

Estrangement

Identification with the aggressor

Substance Abuse

Child’s Reaction Parent’s Behavior

Sabotaging by either parent

Leslie Drozd, Ph.D. Nancy Olesen, Ph.D.

lesliedrozd@gmail.com olesenphd@aol.com

What Causes a Child to Reject or Resist Contact with a Parent?

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Concepts  •  Kelly  &  Johnston  (2001):  Alienated  Child:  “child  who  freely  and  

persistently  expresses  unreasonable  negaJve  feelings  and  beliefs  (such  as  anger,  hatred,  rejecJon,  and/or  fear)  toward  a  parent  that  are  disproporJonate  to  their  actual  experience  of  that  parent.”  

•  AlienaJon  vs.  JusJfied  RejecJon  [“estrangement”]  –  Need  to  determine  whether  child’s  conduct  is  jusJfied                (e.g.  abuse,  inJmate  partner  violence,  poor  parenJng,  step  parent  rejecJon  etc.)  

•  Many  cases  are  “mixed”  with  both  parents  engaging  in  alienaJng  conduct  or  having  some  responsibility  for  break-­‐down  in  relaJonship  with  one  parent.    

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•  In  high  conflict  cases,  alienaJng  parental  behavior  is  common  – Disparaging  comments  about  other  parent  are  common  

– May  escalate  to  acJve  undermining  of  relaJonship  to  other  parent  

– O\en  both  parents  are  engaging  in  poor  parenJng,  but  one  parent  has  primary  responsibility  for  contact  problems    

•  Despite  alienaJng  conduct  by  one  or  both  parents,    most  children  not  alienated  (approximately  80%,  Johnston,  2003)  

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 AlienaJon  o\en  starts  as  child  ages    &  they  can  hold  onto  their  anger  and  remember  their  script  (e.g.  7-­‐12yrs).    Children  may  be  less  socially  competent  and  more  emoJonally  troubled  (Johnston,  2003)   Cases  may  change  over  Jme  –  someJmes  quickly  

 AlienaJon  may  start  a  considerable  Jme  a\er  separaJon  

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NegaJve  Effects  Of  AlienaJon   Most  kids  want  contact  with  both  parents  (even  if  abuse)  

 AlienaJon  is  emoJonally  harmful  to  children    Loss  of  contact  with  parent  &  extended  family   Guilt,  self  hatred,  self-­‐esteem  issues   ConJnued  unconscious  idenJficaJon  with  rejected  parent  

 Child  may  come  to  believe  unfounded  abuse  allegaJons  

 Behavioral  disturbances  in  alienated  children   Aggression  &  conduct  disorders   Poor  impulse  control  

 Research  suggests  long  term  negaJve  effects  into  adulthood  

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Developmental  Consequences  

•  Younger  children  exposed  to  alienaJon  dynamics  in  family:      confusion  and  anger  – O\en  leads  to  alienaJon  later  

•  Enmeshment  with  a  parent  interferes  with  normal  developmental  autonomy  and  development  of  separate  idenJty-­‐  may  affect  social,  peer  relaJonships  

•  What  is  real?    Problems  with  reality  tesJng  – Problems  of  mispercepJon,  misinterpretaJon,  misa?ribuJon  

•  Depression,  low  self-­‐esteem,  substance  abuse    

All  Cases  are  nuanced  and  on  ConJnuum    

•  Conflict  •  Abuse  •  A?achment  •  AlienaJon  •  ParenJng  •  Child  Vulnerability  

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Abuse  ConJnuum:    from  puniJve  to  abusive  parenJng  

•  Put  children  in  the  middle,  use  the  children  as  messengers,  tell  the  children  negaJve  things  about  other  parent  

•  PuniJve  in  response  to  child’s  rejecJon  •  Physically  force  compliance  •  Harm  to  other  parent,  threaten  pets  •  Child  neglect,  emoJonal  abuse    •  Child  physical  abuse,  sexual  abuse  •  Violence  to  other  parent  

   Mild  -­‐  -­‐  -­‐  Moderate  -­‐  -­‐  -­‐  Severe  

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ParenJng  ConJnuum  

 Good  Enough  Parents  (warm,  empathic,  a?uned,  involved,  authoritaJve,  can  contain  negaJve  feelings  about  other  parent)  

 Compromised  Parents  (who  with  help  can  become  good  enough,  harsh,  self-­‐centered,  criJcal,  non-­‐empathic)  

 Impaired  Parents  (mental  Illness,  substance  abuse,  personality  disorders,  with  more  help  can  become  good  enough  parents)  

 Neglecqul  or  Abusive  Parents  (who  need  higher  level  of  intervenJon)  

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Disciplinary  Styles  

•  Authoritarian:    conform  to  expectaJon,  child  should  accept  parent’s  word  and  rules,  puniJve  measures  used      

•  AuthoritaJve:  facilitate  change  in  child’s  behavior  and  sense  of  self  through  reason,  encourage  independence  and  normaJve  values  

•  Permissive:    few  restraints,  opposed  to  authority,  accepJng    

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AlienaJon  ConJnuum  -­‐  Parent  

 PosiJve  support  for  Involvement  with  other  parent   Excludes  other  parent    Induces  Loyalty  Conflicts   AcJvely  Interferes  with  contact  with  rejected  parent   Exposes  Child  to  NegaJve  Beliefs  about  rejected  parent   Communicates  rejected  parent  is  Neglecqul   Communicates  rejected  parent  is  dangerous  

  Johnston  2004/2010    Child  AlienaJon  Project  

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GATEKEEPING  CONTINUUM  

•  Ranges  in  ADtudes/Behavior  •  from  FacilitaNve  Gatekeeping  (FG)    to  RestricNve  Gatekeeping  (RG)  

•  Very  FacilitaNve  →CooperaNve→Disengaged→  RestricNve  →  Very  RestricNve  •  ProacNve  Toward  Other  Parent  →    Severely  AlienaNng  Behaviors  •  Inclusive  of  Other  Parent      →    Marginalizes  Other  Parent  •  Boosts  Image  of  Other  Parent    →    Derogates  Other  Parent  •  Ongoing  Efforts  at  CommunicaNon  →    Refuses  to  Communicate  •  Flexible  Time-­‐sharing        →    Rigid  Adherence  to  ParenNng    •                        Time  Schedule  •  Ensures  Child’s  Opportunity  to    •  Develop  RelaNonship  with  Other  Parent      →  Severe  Child  AlienaNon    •     •  ©  William  G.  AusNn,  Linda  Fieldstone,  Marsha  K.  Prue`,  2012.  •     

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AlienaJng  Behavior  of  Parents  -­‐  Examples    DenigraJng  other  parent,  extended  family  &  even  pets  

  Asking  child  to  carry  hosJle  messages  

  Asking  child  intrusive  quesJons  about  other  parent  (“spying”)    CreaJng  a  need  for  child  to  hide  informaJon  &  conceal  posiJve  feelings  

about  other  parent  

  Providing  warm  involvement  in  return  for  loyalty;  rejecJon  for  own  point  of  view  

  Inappropriate  empowerment        “You  can  decide  whether  you  want  to  see  your  Dad”  [but  not  whether  

you  go  to  school.]  

  CreaJng  fears    False  allegaJons  of  abuse  

  Borrowed  or  exaggerated  stories:    “My  Dad  beat  my  Mom  when  I  was  in  her  tummy”  

  Arranging  fun  events  that  conflict  with  visits  

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Just  Remember  Son,  it  doesn‘t  ma?er  whether  you  win  or  lose  –  unless  you  want  Daddy’s  love  

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AlienaJon  ConJnuum  -­‐Child  

  Child  ambivalent,  statements  made  over  short  Jme,  child  can  take  two  perspecJves  about  family,  negaJve  statements  made  only  to  other  parent  

  Child  more  entrenched,  tell  more  people  complaints  extended  to  whole  extended  family,  child  resistant  to  contact  but  sJll  going  and  engaging,  some  pleasant  Jmes,  able  to  express  love  for  other  parent,  able  to  remember  good  Jmes  

  Child  refusal  to  see  parent,  no  ambivalence,  feelings  and  behavior  not  match  other  parents  acJons,  overt  scorn  and  denigraJon,  freely  discusses  dislike  of  other  parent  with  others,  reasons  for  lack  of  contact  vague  and  non  specific,  states  desire  to  terminate  relaJonship  with  one  parent  

  Mild  -­‐  -­‐  -­‐  Moderate  -­‐  -­‐  -­‐  Severe  

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Resistance  to  Contact:  A  ConJnuum  

•  Child  has  contact  with  both  parent  •  Child  has  an  affinity  toward  one  parent  because  of  temperament,  gender,  age,  familiarity,  greater  Jme  spent,  shared  interests  (normal)  

•  Child  is  aligned  with  one  parent  due  to  non-­‐preferred  parent’s  minimal  involvement  in  parenJng,  inexperience,  poor  parenJng  or  because  a  child  is  angry  or  upset  with  a  parent  who  leaves,  angry  or  upset  with  the  parental  conflict    

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Child  Vulnerability  

 Temperament  (high  acJvity,  li?le  regularity,  avoidance,  intense  reacJons  and  moods,  distracJble,  not  adaptable)  

 EmoJonal:  Anxious,  avoidant,  fearful,  withdrawn   A?achment:    Insecure  (anxious-­‐resistant,  anxious  avoidant),  Disorganized  

 Parent-­‐Child  Fit  not  “good  enough”  for  child’s  needs  

 Child  special  academic,  social,  emoJon  needs   Family  isolated,  li?le  supports  in  place  

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Other  reasons  for  child’s  rejecJng  behavior  

•  JusJfiable  estrangement  from  abusive  parent  •  Pathological  a?achment  to  abusive  parent  (idenJficaJon  with  aggressor);  o\en  child  has  PTSD  and  avoids  conflict  situaJons  

•  Child  enmeshed  with  emoJonally  dependent  needy  parent-­‐  role  reversal  

•  Folie-­‐a-­‐deux:    shared  delusional  belief  about  other  parent  with  very  disturbed,  thought  disordered  and  powerful  parent  

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RealisJc  Estrangement:  Abuse  (can  someJmes  co-­‐exist  with  alienaJon)  

Child’s  resistance/  refusal  may  be  result  of:  

 Witness  to  domesJc  violence  

  Experience  of  their  own  abuse  (physical,  sexual,  emoJonal)  

  Exposure  to  significantly  inept  or  neglecqul  parenJng  

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Complexity  of  High  Conflict  Cases:  Looking  at  Conflict,  Abuse  and  AlienaJon  

•  Causes  •  Dynamics    •  DifferenJaJon  of  various  types  of  parent  –  child  problems  (from  abuse  to  alienaJon)  

•  Significant  porJon  of  cases  in  which  alienaJon  is  alleged  are  not  alienaJon  cases  

•  When  alienaJon  is  determined  to  be  present  intervenJons  vary  depending  on  degree  of  alienaJon  

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Cycle  of  fear  and  anxiety  

•   ParenJng  flaw  or  pracJce  repeated  and  exaggerated  by  favored  parent  

•   Child  exposed  to  this  story  and  begins  to  shi\  view  of  rejected  parent  to  abusive  or  unworthy  

•   Child  becomes  increasingly  anxious  

•   AnJcipatory  anxiety  reinforces  avoidance  and  rejecJon  

•   Child’s  distress  triggers  more  protecJon,  concern,  a?enJon  from  in  parent  

ConJnued  Key  Elements  in  Cycle  of  EscalaJon  

  Child’s  relaJonship  with  the  rejected  parent  is  not  supported  by  the  alienaJng  parent  (not  encouraged  to  see  good  and  bad  in  other  parent)    

  Child  not  required  to  sort  out  or  resolve  difficulJes  or  conflicts  (as  would  happen  in  other  situaJons/  friend/  teacher/  coach)  

  RelaJonship  improvement  with  other  people  seen  by  child  as  more  important  to  deal  with  than  relaJonship  with  other  parent  

  Parent  “leaves  decision  to  child”  and  DOES  NOT  help  child  see  things  from  another’s  perspecJve,  resolve/not  avoid  conflict/  model  compassion  empathy  and  forgiveness  as  would  with  other  relaJonships  

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INTERVENTION  WITH  CASES  OF  VISITATION  RESISTANCE:    IF,  WHEN,  

AND  HOW  DOES  IT  WORK?  

Child’s  resistance:  Legal  Adversarial  Context  

PeJJoner  -­‐-­‐-­‐-­‐-­‐-­‐-­‐Child’s  response-­‐-­‐-­‐-­‐-­‐-­‐Respondent  

CausaJon/Fault  

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•  Out  beyond    ideas  of  wrongdoing  and  rightdoing,  there  is  a  field…  

             Meet  me  there.  

                       Rumi  

Child’s Response

Intense Marital Conflict

Divorce Conflict and Litigation

Personality of Rejected Parent

Personality of Aligned Parent

Humiliating Separation

Child’s Vulnerability

Aligned Parent’s Negative Beliefs, Behaviors

Rejected Parent’s Reactions

Sibling Relationships

Factors  contribuNng  to  &  sustaining    parent-­‐child  contact  problems          

Adapted  from  Kelly  &  Johnston,  2001  

Lack of/Inefficient Co-parenting

Extended Families Aligned Professionals (Education, Health, Legal)

IntervenNons  

•  Internet  survey  of  1172  Mental  Health  and  Legal  professionals  indicates  most  frequently  recommended  intervenJon  for  alienated  child  is  individual  therapy  for  child  and  for  parents  (Bow,  Gould  &  Flens,  2006).    

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A  Family  Systems  Model:  

•  Family-­‐focused  intervenJon  presented  in  Johnston,  Walters  &  Friedlander  (2001)  and  Sullivan  &  Kelly  (2001)  –  Careful  assessment  

–  SJpulaJon  or  Court  Order  –  TherapeuJc  work  with  Aligned  Parent  (AP)  –  TherapeuJc  work  with  the  Rejected  Parent  (RP)  –  TherapeuJc  work  with  the  Alienated  Child  (AC)  –  TherapeuJc  work  with  selected  combinaJons  of  family  members  

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Intensive  IntervenJons  

•   Intensive  residenJal  – Rand  &  Warshak  (2006)  

•  Family  Bridges  

– Sullivan,  Ward,  Deutsch  (2010)  •  Overcoming  Barriers  

– Bailey  •  TransiJoning  Families  

Lessons  Learned:    The  IntervenNon    

•  More  complex  even  than  the  complex  model  we  outlined  in  2001  

•  Reinforce:  –  Importance  of  comprehensive  understanding  and  formulaJon  

–  Importance  of  including  all  relevant  individuals  in  the  intervenJon  

–  Importance  of  Coordinated  intervenJon        CollaboraJve  Team  and  Team  Leader  

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   Lessons  Learned:    Reality  

•  IntervenJons  are  o\en  neither  pracJcal  nor  realisJc  – Time,  money,  human  resources  –  IntervenJon  with  and  without  the  benefit  of  a  Custody  EvaluaJon  

–  IntervenJon    with  and  without  the  benefit  of  the    “Case  Management”    legal  structure,  accountability  and  support  afforded  by  Court  Orders  

 Lessons  Learned:    Outcomes  

•  Results  have  been  disappoinJng  from  various  perspecJves  – Amount  of  Jme  required  for  the  treatment  – Progress  and  outcomes  not  quickly  achieved  

•  Or  not  achieved  period  – Need  for  pa+ence  when  most  other  factors  miJgate  against  paJence  

– Especially  true  for  RP  and  the  goal  of  “reunificaJon”  

Lessons  Learned:    Reminder  

•  reunificaJon  with  the  rejected  parent  is  not  the  primary  goal  of  the  intervenJon…  

•  …although  it  may  be  a  consequence  of  achieving  the  primary  goal.  

•  Defining  the  goals  of  the  intervenJon  •  Crea+ng  a  “tenable  middle  space”  

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Lessons  Learned:    Reasonable  ExpectaNons      

•  It  is  therefore  important  to:  –  Select  appropriate  cases,  for  types  intervenJons    –  Formulate  case-­‐appropriate  goals    

–  Determine  a  reasonable  Jmetable  

•  IntervenJon  as  a  diagnosJc  process  –  IdenJfy  areas  of  relaJve  strength  and  weakness  to  specify  where  change  might  occur  

–  A?enJon  to  one  component  may  affect  the  other—The  “bubble  under  the  rug”  

–  Open  and  flexible  to  revision  of  focus,  goals,  etc.  

Lessons  Learned:    AlienaNon  and  Estrangement  

•  Understanding  the  nature  of  the  alienaJon  and  how  it  affects  the  intervenJon,  the  focus,  the  goals,  and  the  definiJon  of  “success”  

•  RealizaJon  that  alienaJon  and  estrangement  are  not    always  easily  disJnguished  concepts  –  Both  alienaJon  and  estrangement  are  o\en  present  in  the  more  difficult,  unresponsive  cases  

–  This  may  limit  goals    

Lessons  Learned:    Obstacles  to  Progress  

•  RecogniJon  that  each  parJcipant  has  a  different  agenda,  more  or  less  in  their  conscious  awareness,  when  entering  this  work  

•  Factors  outside  of  awareness  o\en  drive  this  behavior  •  Appreciate  and  respect  the  role  of  these  less  conscious  factors  •  These  factors  limit  the  usefulness  of  coaching  and  educaJve  

intervenJons  and  extend  the  Jme  required  to  achieve  goals    •  Dumb  Spots  and  Blind  Spots  

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Lessons  Learned:  Forcing  Contact  

•  Forcing  contact  does  not  work…but  some+mes  it  does  – When  the  Moon  is  in  the  Seventh  House  and  Jupiter  aligns  with  Mars  

•  May  backfire  

•  Will  it  create  a  more  “secure  base”  for  the  child?  

Lessons  Learned:    The  Rejected  Parent  

•  ParenJng  behavior  of  the  RP  –  RelaJonship  capacity  and  parenJng  skills  

•  Lacks  warmth  and  empathy  •  Not  a?uned  to  child’s  feelings  and  needs  •  NarcissisJc  •  Controlling  •  Demanding  •  Authoritarian  

–  A  common  and  o\en  fatal  mistake  is  the  failure  to  integrate  the  reality  of  the  alienaJon  into  the  RP’s  interacJon  with  the  child,  especially  the  effort  to  parent  and  discipline  

•  “De-­‐parented”-­‐-­‐Role  as  parent  undermined  •  Responsibility  without  authority  •  Parental  “rights”  vs.  child’s  feelings  and  needs  •  Learning  trials  vs.  ExJncJon  trials  

–  The  myth  of  “compensatory  parenJng”  

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Lessons  Learned-­‐  The  Child    

Framing  the  intervenJon  to  maintain  focus  on  the  child  •  Reasons  why  the  child  is  at  the  center  of  the  therapist’s  

concern    •  Timing/  pacing  based  on  assessment  and  understanding  of  

the  child    •  PotenJal  impact  of  intervenJon  on  the  child  •  Uncovering  the  meaningful  issues  in  the  P/C  relaJonships    •  Power  Issues  between  parent  and  child    •  Shared  control  of  the  agenda  •  Safety  issues    

Lessons  Learned:  The  Aligned  Parent    

•  Inclusion  in  treatment  –  To  assess  supporJveness  of  child  having  relaJonship  with  other  parent  

–  Clarify  possible  “Enmeshment”    –  Bring  into  focus  possible  “alienaJng  behaviors”  –  To  learn  about  view  of  child  – Willingness/Openness  to  nudge  child  

•  Possible  re-­‐establishment  of  co-­‐parenJng  alliance  

Lesson’s  Learned:  ProblemaNc  Aligned  Parent    

– “Enmeshment”  

– EmoJonally  fragile  and  needy  – Role  reversal  –  Indulges  and  empowers  the  child  

– Helpless  in  the  face  of  the  empowered  child  – Compromised  ability  to  parent  and  discipline    

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Lesson’s  Learned:  Structural  IntervenNons  with  Alienated  Children  •  These  are  the  Court  Orders  that  Specify  the  parenJng  plan  and  family  intervenJons  

•  Contact  specified  and  non-­‐discreJonary  •  Clear  specificaJons  of  therapeuJc  intervenJons  •  Case  Management  role  essenJal  

•  They  are  necessary,  but  not  sufficient  •  You  can’t  succeed  if  you  are  not  impeccable  about  them,  but  may  not  succeed  even  if  you  are  

Hard  Lesson  #1  

•  Must  move  families  out  of  the  legal-­‐adversarial  context  – LiJgants  don’t  make  good  coparents  – Conflict  is  experienced  by  child  as  perpetrated  by  the  rejected  parent  

– The  pressures  to  align  are  intensified  – Big  problems  when  there  is  a  custody  dispute  

–  CreaJng  a  collaboraJve  professional  system  around  the  family  is  extremely  difficult  

Hard  Lesson  #2  

•  Authority  is  elusive    •  Clear,  detailed  orders  are  nice,  but  try  enforcing  them  

•  Special  Master  is  a  misnomer  •  Turning  to  the  Court  for  help  is  a  crap  shoot  •  If  you  can’t  deal  with  compliance  issues,  you’ve  lost  the  case  

Geyng  Johnnie  to  treatment  Geyng  Johnnie  to  the  visit  

•  Finding  Ways  to  maintain  authority  

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Hard  Lesson  #3  

•  Legal  Custody  on  paper  is  not  worth  the  paper  it’s  wri?en  on  – No  Contact  with  the  child,  school,  acJviJes,  etc.  – No  sharing  of  informaJon  – MarginalizaJon  – Mom  doesn’t  have  to  deal  with  dad  anymore,  why  should  I  have  to?  

–   Mandate  informaJon  exchange,  coparent  structures  you  would  expect  in  shared  legal  custody    

Hard  Lesson  #  4  

•  CollaboraJve  Professional  teams  don’t  just  form  and  run  themselves  – Finding  the  right  professionals  – Team  essenJals    

– OrganizaJon  -­‐  goals,  accountability  – Leadership  -­‐  hierarchy  – CommunicaJon  – InformaJon  control/loyalty  – Loyalty  

Challenges  

•  Therapists  do  not  typically  take  the  Jme  to  coordinate  their  work  with  the  work  of  other  therapists  – The  Jme  required  in  high  conflict  cases  may  be  considerable  

•  The  therapy  systems  readily  becomes  isomorphic  with  the  conflict  in  the  family  system  with  therapists  supporJng  their  clients  in  movement  in  different  direcJons  

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CollaboraJve  Teams  

   The  role  of  organizer/leader   Parameters  in  place  to  protect  team  

 ConfidenJality,  releases,  control  of  informaJon  

 Goals  and  specific  plans,  coordinaJng,  monitoring,  modifying  

 CollaboraJve  system  around  family   Professional  loyalty/client  loyalty  

 Team’s  involvement  in  coparenJng  issues   ProtecJng  the  therapeuJc  relaJonship  

CoordinaJng  TherapeuJc  IntervenJons  

  EssenJal  and  o\en  powerful  role  of  a  PC  •  Greenberg,  L.  R.,  &  Sullivan,  M.  J.  (2012).  ParenJng  coordinator  and  

therapist  collaboraJon  in  high  conflict  shared  custody  cases.  Journal  of  Child  Custody,9(1–2),  85-­‐107.  

  CombinaJon  of  a  PC  and  a  child  therapist  can  be  very  effecJve  

  Offers  more  protecJon  to  children’s  confidences  while  sJll  providing  accountability  necessary  to  progress  

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Hard  Lesson  #5  

SomeJmes  all  the  kings  horse  and  all  the  kings  men…      SomeJmes  the  least  detrimental  alternaJve  is  ending  work  on  reunificaJon      Keep  child  focused      Don’t  get  into  blame  and  get  puniJve      intervenJons  carry  a  cost,  resistance  can  build  to  the        intervenJon  -­‐  -­‐Treatment  alienaJon      Older  children  can  be  over  it  

     

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When  does  treatment  not  work?  

•  Severe  parent  psychopathology  and  personality  disorders  including  paranoia,  encapsulated  psychosis,  severe  untreated  mental  illness,  and  sociopathy  

•  Capacity  for  insight  is  severely  compromised  

•  Coercive  measures  do  not  change  behavior  

When  the  IntervenNon  Isn’t  Working  

•  Steps  to  closure  •  Doors  le\  open  •  “ParJng”  messages  •  Mapping  needs  for  treatment  of  individual  family  members    

•  Monitoring  for  future  possibiliJes  

The  Conundrum  

•  Harm  to  child  of  staying  in  severe  alienaJng  family  situaJon  including  significant  impairment  in  social-­‐emoJonal  development  and  funcJoning  and  cogniJve  processing    

•  Versus  Risks  to  child  of  change  in  custody  

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One  Model:  Whole  Family  Intensive  •  Overcoming  Barriers  Family  Programs    

–  5-­‐day  family  camp  program  (Sullivan,  Ward,&  Deutsch,  2010)  

–  Intensive  Family  Weekend  IntervenNon    with  1  day  follow  up  (Ward,  Deutsch,  &  Sullivan,  2012)    

•  Involve  both  parents  and  children  in  intensive  program  •  Usually  involved  in  liJgaJon  •  Psycho-­‐educaJon  groups  (east,  west,  common  ground)  

including  role  plays  •  Intensive  clinical:    combinaJons  of  individual  family  

members  •  Strategic  use  of  acJviJes  to  engage      •  Enjoyable  acJviJes  and  camp  experience  •  Detailed  A\ercare  arrangements  and  follow-­‐up  

Common  Ground  Center,  VT  

Program  components  -­‐Overview  

 Camp  seyng  –  the  milieu    Seasoned  staff  –  admin,  clinical,  camp   Camp  acJviJes    Treatment  Program  

 Parent  and  Child  groups   PsychoeducaJon  and  group  work  

 Planned  intervenJons   ExploiJng  criJcal  incidents/therapeuJc  opportuniJes  

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The  Milieu  

 Use  of  Space  

 Planned  and  spontaneous  intervenJons  

  Structuring  of  acJviJes     Strategic  manipulaJon  of  group  involvement   Phasing  of  acJviJes  

Other  intervenJons  

 CoparenJng  work   Daily  meeJngs  

 Address  dynamics  of  interparental  conflict   Structure,  plan  and  support  the  connecJon  between  the  child  and  rejected  parent  

 Address  disputes  in  the  parenJng  plan   Agree  to  an  a\ercare  program  

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A\ercare  

•  Reaching  out  to  professionals  working  with  the  family  at  intake  contributes  to  effecJve  a\ercare.  

•  A\ercare  discussed  while  in  program  

•  Memorialized  in  agreement  signed  by  all  clinicians  and  parents    -­‐  see  example  

•  Includes  A\ercare  pathways/intervenJons      •  Need  legal  and  therapeuJc  professionals  in  place  to  implement  follow  up    

Deutsch,  Fidler,  Sullivan  2014  

Role  of  ParenNng  Coordinator    with  Aier-­‐Care  

•  Work  with/evaluate  exisJng  intervenJons  •  Make  Referrals  •  Mandate  informaJon  exchange,  co-­‐parent  structures    

•  Work  with  CollaboraJve  team  – Define  Roles  – CommunicaJon  with  team:    meeJng,  email,  phone  

– Hold  the  conflict  Deutsch,  Fidler,  Sullivan  2014  

Finding  The  Right  Therapists    

•  Disciplined,  balanced  procedures  •  ConsideraJon  of  mulJple  hypotheses  

•  Adherence  to  role  boundaries  •  Able  to  tolerate  pulls  for  polarizaJon  •  Respect  for  the  legal  process  •  A?enJon  to  development  and  coping  skills  

Deutsch,  Fidler,  Sullivan  2014  

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ExpectaNons  of  Therapists  

•  Structure  (as  balanced  as  possible)  •  ExpectaJons  of  parent  cooperaJon,  including  seyng  limits  with  the  child  as  required  

•  RealisJc  view  of  intervenJon  (may  extend  beyond  standard  sessions)  

•  Clear  Payment  responsibiliJes  •  Thorough  consent  process  

– Court  order  and  service  agreement  Deutsch,  Fidler,  Sullivan  2014  

ReflecJons  

•  A\er  care  criJcal  –  Immediate  – Court-­‐monitored  

•  Regional  camps  – Access  to  families,  access  to  professionals  

•  Moving  the  camp  intervenJon  to  earlier  in  the  process  – Malignancy    – Resistant  to  a\ercare  intervenJons  

TransiNoning  Families  

www.transiJoningfamilies.com  

Family  Programs  for:    -­‐High-­‐conflict  

-­‐VisitaJon  resistance  -­‐Trauma  experiences  -­‐AbducJon  dynamics    

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TransiNoning  Families  

•  Each  family  program  designed  to  family's  needs  •  Can  include  2-­‐5  days  overnight  program  and  repeat  "check  in's"  and/or  refresher  visits  

•  EnJre  family  or  specific  subgroups  (one  parent  and  child)  

•  ConnecJon  based  therapy  •  All  interacJons  with  staff  are  mindful,  authenJc  and  purposeful    

•  Use  of  various  team  members  depending  on  family    

•  Equine  and  other  animal  work  

TransiNoning  Families  Video  

•  Insert  TF  video  

Staff  Roles  

•  Core  Team  Members:  

– Clinical  Director  – Support  Clinician  – RecreaJonal  Specialist  – Cook  

•  As  Needed  – Support  Clinician  – Support  Staff  – Support  Cook  

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Role  of  the  RecreaNonal  Specialist  

•  Support  parents-­‐child  connecJons  •  Child  advocate/child  specialist  •  Build  rapport  with  kids  (begins  with  intake)  •  Provide  posiJve  experience  for  kids  •  Frame  the  weekend  (“this  program  is  about  

geyng  kids  needs  met”)  

•  Report  to  clinical  team  

•  Fill  holes/program  needs  

RecreaNonal  ObjecNves  •  Build  rapport  •  Assess:  coping  skills,  problem  solving  skills,  aggression,  cogniJve/processing,  teamwork,  communicaJon,  trust,  fear,  etc.  

•  OpportuniJes  to  model  problem  solving  •  Paper-­‐scissor-­‐rock  (metaphor  for  parents  –  agree  before  hand  how  to  resolve  stalemate)  

•  PracJce:  problem  solving,  teaching,  building  self  esteem  

•  Buy  in  for  program  from  kids  (incenJve)  •  Fun  &  posiJve  connecJon  between  kids  and  parents  (see  parents  together  in  posiJve  way)  

•  Exercise  

Teamwork  •  Leveraging  use  of  team  members  requires  lots  of  communicaJon,  planning  and  pracJce.    

•  Understanding  of  rapport,  gender,  relaJonships,  allies,  training/cerJficaJon  to  best  move  family  forward  

•  Leverage  of  non-­‐clinical  role  (mistrust  of  therapists  is  common)  

•  Leverage  proven  skill/trust  of  kids