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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Monday, February 24, 2020

PA, CC, and ABAB


I recently had an inquiry from a mother who is about to face a child custody trial in which a fan of Craig Childress is advising her opponent about “parental alienation”. This mother and others find it hard to figure out what Childress is talking about in his book “An Attachment-based Model of Parental Alienation”, published by a company that shares his office address. They are often especially concerned about Childress’s way of identifying “parental alienation” (PA) in children of divorce who want to avoid contact with one of their parents. 


People have frequently asked me about Childress's diagnostic methods. What I am about to discuss is in his book "An Attachment-based Model of Parental Alienation", pp. 308-310. 

Childress suggests that diagnosis should be done using an ABAB single-case protocol. This is a real thing. It is intended to help decide whether a particular treatment is helpful to a particular person. Here's what happens with the ABAB method:

Condition A is a set of circumstances that the client is experiencing. During these circumstances, observations are made of a concerning behavior. For example, a child is living with his mother and has no contact with father; behaviors showing hostility and rejection toward the father are recorded.

In Condition B, the client is placed in a different set of circumstances and the concerning behavior is again observed. For example, a treatment is started, and the child's rejection of the father is recorded.

Condition A is repeated and the concerning behavior is recorded. For example, the child is returned to the mother's custody and attitudes toward the father are again recorded.

Finally, Condition B is repeated.

If the concerning behavior (rejection of father) is less in condition B than in A, this is an indication that the treatment may be effective. Childress also concludes on p. 310 that if the treatment is effective, this is powerful evidence that the mother's pathogenic parenting is responsible for the child's behavior.

BUT! Here's where his claims fall apart.

1.      When the ABAB protocol is used, Conditions A and B must be different only in one characteristic. If they are different in more than one way, it is impossible to know which factor might cause the difference. So, typically, ABAB might be used to test a treatment (Condition B) for bedwetting. The child stays at home and follows his ordinary habits, but sometimes receives the treatment and sometimes does not. Differences in bedwetting between A and B suggest that B is an effective treatment (although it could also be that the child just matured)....In Childress's method, however, there are many differences between A and B. B includes separation from the preferred parent, much contact with the nonpreferred parent, possibly different behavior from the nonpreferred[parent than occurred in the past, and four days of “High Road” treatment, which may include transportation by youth transport service workers. The child is frightened and has no idea what is happening. As most of these kids are not very young children, we can expect them to catch on to what they are supposed to do and to do it in order to avoid further unpleasant events. Whether behavior is different in A and B because of separation, because of treatment, because of fear, or whatever-- that cannot be told from this approach.
2.      The ABAB approach could only be considered diagnostic if there were just one cause for the behavior, and just one treatment that was already well demonstrated to treat the problem effectively. This is not true of rejection of a parent, so whatever happens on ABAB, it does not show what caused the problem. With respect to the ABAB evidence showing what caused the rejection, Childress seems to envision only one way in which the behavior can be caused. Like other PA advocates, he has a single-factor theory that omits to consider any of a myriad causes of behavior and especially does not look into the rejected parent's own actions, whether abusive or simply awkward and lacking in parenting and communication skills. The ABAB protocol is a real set-up, as most children are likely to alter behavior as instructed when powerless in a strange situation; when they do so, Childress then points to this-- skipping a number of logical steps-- as empirical evidence of the diagnosis. (What he would conclude if the child did not change, I cannot guess, but it would probably be that the preferred parent has caused serious mental illness in the child!)

The ABAB protocol sounds most impressive to those who have never heard of it, but the way Childress uses it (if indeed he does—he does not seem to provide any examples of actually doing this) cannot demonstrate that a treatment works with a particular child. (It is not intended to, and cannot, show that a treatment is generally effective). The ABAB protocol, no matter how well implemented, cannot show the cause of a problem unless there is only one cause AND unless it has been demonstrated that the treatment is generally effective.

A long time ago, Dr. Spock wrote that if your child has a fever, you can sponge her with cool water and it helps as much as an alcohol rub, but “it doesn’t smell so important”. Childress’s ABAB protocol smells important to people who don’t understand it, but in fact the odor you detect is not alcohol.

Tuesday, December 17, 2019

Getting Emails From Forbrain(TM)?


In the last several months I’ve had several emails from an outfit called Forbrain™. These emails give purely anecdotal evidence for the use of some devices that are supposed to treat a variety of childhood problems such as motor and balance difficulties, autism, sensory processing disorders, and ADD/ADHD. As these problems probably have different causes and certainly have different trajectories, it seems unlikely that one form of treatment can help all of them, but who knows? I would not care to swear that it can’t, without further evidence.

However, neither would I swear that it can help without further evidence. One email I received stated that there were “scientific studies” supporting this view, but when I clicked on the link I got a warning so I didn’t go any further. The email described the case of a child named Josephine who was said to have had her speech and general conduct much improved by use of Forbrain™ technology and even stopped having frequent tantrums. This is very nice,(although obviously it can’t be checked, nor could we know whether Josephine would have started doing better even without this treatment. Nothing here seems to be providing the kind of information that consumers should demand before they commit to a treatment for children.

Forbrain™ apparently involves the wearing of a headset that provides conduction of sounds through bones into the inner ear, rather than stimulation of the inner ear in the usual way by the passage of sound waves through air in the auditory canal, followed by movement of the eardrum, etc. The Forbrain™ device also filters some sounds and is said to allow practice on the “audio-vocal loop". A second device advertised by the Forbrain™  advocates is called Soundsory ®; this one uses “specially designed music processed with neuro-acoustic modifications as well as a series of movement-based exercises” and is intended to “establish good foundations, from the fundamentals of sensory integration to more complex cognitive functions”.

Listening to special music? Being exposed to certain kinds of sound patterns? It’s all rather familiar—and the name Tomatis springs to mind. Yes, an Internet search shows Tomatis therapy , Forbrain ™ and Soundsory® on the same page. It would appear that there is no systematic evidence to support any of these practices.

What should consumers ask for before they commit to the trouble and expense of methods like these? Anecdotes are not good enough. It may be that Josephine’s condition did improve—but would this necessarily be true for any other child? Was Josephine’s improvement caused by Forbrain™? Might it have happened anyway? Or could it even have been that she would have improved more without Forbrain™?  These questions can’t be answered by even the most touching story, but touching stories are likely to make us forget to ask the right questions.

For adequate demonstration that either Forbrain™ or Soundsory® technology are useful for any of the problems mentioned earlier, we need the following: A large group of children who share a problem that can be evaluated and quantified. These children are to be divided into two groups (treatment and comparison) with equivalent age ranges, gender proportions, and severity of problems. Assignment to groups is done by staff who do not have information that identifies individuals. Treatment is done by staff who do not know which group each child belongs to. One [treatment] group is given the treatment recommended by Forbrain™ advocates. The other [comparison] group receives a “sham” program—they wear headsets for the same amounts of time as the treatment group but hear different things. At the end of the treatment period, all children are re-evaluated by staff members who do not know which group a child was in. Finally, changes seen in the treatment children are compared to changes seen in the comparison children. If the changes seen in the treatment children are positive, and are statistically greater than those in the comparison group, then advocates of Forbrain™ and Soundsory® can say that they have evidence that their treatments are effective.

Until this happens, caveat emptor!

Wednesday, December 11, 2019

Can Policemen Be Trained to Identify Parental Alienation? (Not Kidding Here, Unfortunately)


I hear from concerned people in the Netherlands that a new issue about “parental alienation” (PA) has arisen. Not only are some divorced parents accused of “alienating” children who do not want to have contact with the other parent, even though many factors other than alienating behavior are likely to be responsible for the children’s attitudes, and not only is notional PA argued to be a reason for prohibiting contact between children and their preferred parents. Now, in addition, it has been proposed that policemen can be trained to identify PA cases!

Let’s examine this proposal under a strong light.

The first question we need to ask is a simple but critical one: can anyone identify PA? Is there any established, evidence-based protocol that can be used to differentiate PA cases from other cases in which children’s refusal can be based on a range of causes, from domestic violence and abuse to dislike of a step-parent or step-sibling to situations where contact with one parent interferes with sports or friendships?

No, there is no such method. Identification of PA cases is a subjective process based on the opinions of PA proponents. In no case does such identification involve observation or even corollary evidence for alienating behavior by preferred parents. In a few cases known to me, the PA identification did not even consider whether a child had refused contact. In one I can think of, a girl actually asked to have contact with her father and he refused on the ground that she would accuse him of molesting her if he saw her; he stated that he planned to send her to boarding school if he got custody. In another case, a 17-year-old who had for years been alternating weeks at her mother’s and father’s houses said she needed more stability and wanted to have a “home” at her mother’s house while continuing to visit her father, and this was alleged to be a PA case.

Interestingly, Richard Warshak, a long-term proponent of PA and supporter of the Family Bridges treatment, has written of his concerns about false positive identifications of PA and about the need to discriminate between PA and other causes of contact refusal. He appears to  recognize that children have been identified as PA cases when in fact they were not. (Although Warshak did not express concern about this point, the consequences of PA identification can include custody change and prohibition of contact with the preferred parent as well as court orders for that parent to pay extravagant fees for PA treatment. As PA proponents also argue that PA is child abuse, such parents are in danger of being affected personally and professionally when mistakenly identified as abusers.) However, Warshak did not mention false negative cases in which PA was not identified even though it was present. I assume that this means that he feels all PA cases—and then some—are being identified, and that only one kind of mistake is being made: the mistake that has the most obvious and serious bad consequences for the child and the preferred parent.

So it seems that nobody can clearly identify PA in a way that would allow others to confirm the identification. On the contrary, people are concluding that PA is present when even its proponents admit that this may not be correct. Among the undesirable consequences of this situation are possibilities that a child’s custody may be given to a genuinely abusive parent—and research has already indicated that this has happened.

Let’s get back to these policemen in the Netherlands. Can they be trained to assess PA? Well, it’s possible that they could, IF anyone else was able to make this assessment. As there is no one who can identify PA validly and reliably, with some known proportion of false positives and false negatives, it would appear that we have nobody to train the policemen. You can’t teach what you don’t know.

One more point: when child custody evaluations are done, they are supposed to include information from corollary sources. What do neighbors, teachers, grandparents, family friends think about the parents and children? Has domestic violence formed part of the background for the child’s refusal? Gathering this kind of information takes time and expertise. No doubt policemen could be trained to do this, but it hardly seems like their job. Of course, PA proponents are not doing this kind of investigation either, even though it should be part of their job.

Perhaps the conclusion here should be that policemen are just as capable as PA proponents of identifying PA: in other words, not particularly capable at all, and possibly not particularly interested in doing the job as they should.


Infant Mental Health: When a Mother Takes the Baby to the ER Too Often


I have been neglecting this blog so badly, because a lot of my time in the last six months has been taken up by writing and talking about “parental alienation” (PA) and I don’t suppose anyone wants to read about that every day. But a few days ago someone asked me a question about a non-PA issue and I think it’s one that may be of interest to a number of people.

My correspondent is a lawyer who works with an anti-child-abuse non-profit organization. She wrote to me to ask if I could recommend a psychologist who could diagnose a type of factitious disorder or “Munchausen’s by proxy”. These terms are used to describe cases in which an adult, usually a parent and often the mother, asks for medical treatment for her child but secretly does things that would cause the child to seem to need treatment. For example, the adult might substitute something else for the child’s urine for a urinalysis, or more seriously--  and this has been videorecorded—partially suffocate the child and then call for help because the child has stopped breathing.  These cases are obviously to be taken very seriously. What if the child actually is sick but no treatment is provided because it’s mistakenly thought that the parent is causing the symptoms? What if the parent is causing the symptoms, this is not recognized, and the child dies because of the parent’s actions? It’s no wonder that there is much concern when such a situation is suspected.

 Here is the story my lawyer-correspondent gave me. (Readers with infant mental health background will quickly see why I am bringing this up.) A woman of 40, who had a 5-year-old child, began to make frequent emergency room visits when her second child was about 2 months old. When I say frequent: she took the baby in on 27 of 30 possible days. No medical problems were detected. A neighbor reported that she had come into the house to find the baby turning blue and had restored the airway; as far as I know, she did not see the mother causing this episode.

Medical personnel were worried about this situation and suspected factitious disorder. They moved to have the baby placed in foster care and the mother has for at least a month had only supervised visitation. A forensic psychologist, who may or may not have any infant mental health training is to evaluate the mother. My lawyer-correspondent was concerned about the extent of the evaluation, and that was why she asked me to recommend an evaluator.

My response was that everyone was ignoring the most obvious explanation of the mother’s behavior: a perinatal mood disorder (PMD).  PMD, sometimes called post-partum depression, is a state of anxiety and depression that sometimes occurs during pregnancy and/or after childbirth. Mothers with PMD may feel incapable of caring for the children and sometimes focus on the idea that there is something terribly wrong with a baby. By far the largest number of comments and queries I have had on this blog have come from mothers who were tortured  by their beliefs that their babies were somehow damaged; many of the mothers were convinced that a baby of a few weeks of age might be autistic. When I answered these queries I usually recommended that the mothers see their ob-gyns for PMD evaluation and receive the treatment they needed, because the problem was in their own conditions, not in the babies. Many of them subsequently wrote and said that they had done this and had been helped a great deal.

PMDs have been known for quite a long time to be identifiable and treatable. They are no one’s fault and although the mothers often blame themselves, the rest of us should not blame or punish them. About 15 years ago, several states had innovative programs to educate people about PMD. New Jersey, for example, had a program called “Speak Up When You’re Down” that was sponsored very effectively by the wife of the then-governor. (I was at that time part of the train-the-trainer program for that program.) Regrettably, political forces cancelled funding for these programs and it appears that we are back where we started on this issue.

Ob-gyn offices should be making regular use of a screening instrument for PMD, the Edinburgh Depression Scale. This is quick and easy to use and identifies women who may benefit from treatment for PMD. In addition, I would argue that its use with every new mother benefits everyone, not just those with mood problems, as it reminds everyone of the potential for PMD in themselves and others. This is especially important as PMD symptoms may not occur until later in the first year after childbirth, and women who were screened early may realize later that new symptoms they experience are related to what they were asked on the screening instrument. In the case brought up by my lawyer-correspondent, the mother had apparently not been assessed for PMD, and candidly I remain unsure whether this is happening at this point, although I suggested some possible resources in addition to her ob-gyn.

I want to take a moment to talk about the experience of the mother in this case. I’m basing my comments on the assumption that PMD is at work here—I do not have enough details to know this, of course. The mother’s anxiety about her baby, expressed by multiple ER visits, has not been understood as an expression of her disordered mood, but instead has been interpreted as highly abnormal maternal behavior that is a danger to the baby. The obvious solution from that viewpoint is to put the baby in foster care. But what if the mother’s behavior is symptomatic of PMD and is thus both identifiable and treatable, but neither identified nor treated?  In that case, the mother’s experience is of validation of her abnormal mood. Yes, we say to her, you are right to be anxious and depressed and feel that something is wrong, and we are taking your baby away because something is so wrong with you that you cannot be helped.

The mother now sees the baby only under supervision, and it is no longer “her baby”. The constant tiny maturational changes of the early months go by between visits without the mother having any chance to learn from them, and the baby at each visit is a somewhat different person than the mother saw the last time. Her behavior toward the baby is bound to be out of synch for exactly that reason, so she will be observed on each visit to be awkward and uncertain with the baby and not to behave like a “normal mother”. This kind of experience adds to her sense of anxiety and sadness, which apparently is not being treated by appropriate medication and talk therapy. Who will step in to help this family? When will anyone do anything to support the mother in her fight with PMD and to facilitate her relationship with her baby? Or is the solution seen to be indefinite foster care, even termination of parental rights?

N.B. I should point out that there is a severe form of perinatal mood disorder, sometimes called post-partum psychosis, and some readers will recall the tragic case of Andrea Yates, who killed all her children after repeated post-partum problems that were ignored by the children’s father. But these horrible cases are very unusual, and most cases of PMD, when identified, can be treated  quite effectively.




Monday, October 28, 2019

Why Parental Alienation Should Not Be Indexed in ICD-11: Caveat Woozles


As many readers already know, the term “parental alienation” (PA) refers to a parent-child situation and to the explanation of that situation by proponents of the PA belief system. PA describes a situation in which the child of a divorced couple rejects one of the parents and resists or refuses contact with that parent but there appears to be no serious reason (like experiences of abuse) for the child to take that position. The explanation put forward by PA proponents for this scenario is that the child’s preferred parent has worked in various ways to manipulate the child’s feelings and to make him or her afraid of or angry at the nonpreferred parent.

Human beings do some very peculiar things, so this could certainly happen. However, to know that it had happened—to “diagnose” PA—you would need to have clear assurance that the child had no serious reason for rejection, AND evidence that the preferred parent had acted in ways that persuaded the child that the other parent should be avoided. You would also need to have good evidence that the child had once liked and associated with the now nonpreferred parent.

Unfortunately, courts around the world have fallen for the argument that PA is present in a child’s reluctance for contact with a parent—and they have fallen for the claim without demanding the evidence described in the previous paragraph. The consequences that follow such decisions are serious ones for children and families. Family court judges are asked by PA proponents to order a complete change of custody from the preferred to the nonpreferred parent, prohibition of contact with the preferred parent, and child attendance at non-evidence-based treatment programs that are to be paid for by the preferred parent. Young adults who earlier went through these programs have reported their own distress and the potential for harm to be done by the programs.

Because of these and other problems, in spite of lobbying by PA advocates, PA was not accepted for inclusion as a diagnosis in DSM-5 in 2013. Now, efforts are being made to include a reference to PA in a volume that may be less familiar to some readers in the U.S., the International Classification of Diseases (ICD), issued at intervals by the World Health Organization. ICD lists both physical and mental disorders, and there is currently discussion about what will be included in the next volume, ICD-11.

There is no question of including PA as a diagnosis in ICD-11. However, PA advocates are pressing to have it included as an index term; this means that if a person were to look for PA in the index it would appear but would be linked to a legitimate diagnosis. People who are concerned about the potential harmfulness of PA concepts and practices object strongly to this, feeling that indexing the term would lend PA spurious respectability and allow PA advocates to claim that PA is “in ICD-11” when this will not be true in any real sense, Linking PA to a real diagnosis may also suggest to some ICD users that the two terms actually mean the same thing, when they do not.

Here are some reasons why PA should not be included as an index term in ICD-11:

1.    1.  PA has never been operationally defined. That is, no one has outlined the measures or observations needed in order to identify PA. There is neither a way to identify the quality of behavior that would indicate PA nor a way to quantify PA (and thus to be able to see whether treatments are beneficial). One author who has looked at the effects of a treatment program, Richard Warshak, identified the children participating in the program as having been found to have PA by a family court judge—certainly a new approach to diagnosis of mental disorders.

2.    2.  PA advocates label preferred parents as abusers and claim that the child’s rejection of one parent is a sign of mental illness that has been caused by the preferred parent, who is therefore abusive and should not have contact with the child. In spite of this claim, PA advocates rarely if ever report this notional abuse to child protective services even though they may be mandatory reporters of abuse.

3.    3.  PA principles and practices are pseudoscientific. The mechanism PA advocates propose for persuasion of the child by the preferred parent, “brainwashing”, is a legal concept and not a psychological one. The language proponents choose for discussion of PA is obfuscatory, using the same terminology to refer to a child’s feelings and to efforts a parent might have made to change those feelings. Irrelevant information is often brought in to discussion of PA, as when problems of critical thinking are claimed without evidence to be responsible for a child’s resistance to contact with a parent. Claims of an evidence basis for PA treatments are based on research designs that are too weak to indicate the actual outcomes of the treatment. As Washburn et al. commented in a 2019 article in Professional Psychology: Research and Practice, “Entire fields can be regarded as pseudoscientific when there is a seemingly wholesale absence of systematic safeguards against confirmation bias (e.g., randomized controlled trials, blinding of observers…” (p. 80). Although this comment was not directed at PA in particular, it is an excellent description of PA and the reasons it can be described as pseudoscientific despite claims to the contrary
.
4.    4.   PA has the potential for harming children and their families both directly and indirectly. Children have reported being taken under duress, even in handcuffs, to PA treatment sites, having their money and phones taken away, and being prohibited from contacting people they trusted. This would be frightening and distressing for all children but is especially so for any who have special vulnerabilities like autism or like previous experiences of abuse. As for indirect harm, preferred parents who have to pay large sums for these treatments will find themselves without the funds to pay for needed services or even to maintain their home. Parents who work with children as teachers, pediatricians, day care providers, and so on, may lose their jobs if labelled child abusers in the course of PA claims.

Now, what about the woozle part? That's the reason for being particularly concerned about what seems to be a trivial matter of indexing. It is understandable that PA advocates want to get a toehold in ICD-11, even if only having PA as an index term. Although in the past few psychologists had ever heard of PA, more and more now recognize the term and understand the reasons for rejecting it. Unfortunately, however, for those who come across PA only in passing or are never exposed to any of the related issues, the term PA has the makings of a “woozle”—an idea that seems to refer to something real only because it has become familiar as it is mentioned repeatedly. Including PA as an index term would help push forward the “woozle” process which adds to the obfuscation and muddled thinking already associated with PA ideas. Rampant woozles make it easier for alternative psychotherapists to persuade people that they are legitimate-- and in the case of PA, being persuaded can lead to very disturbing consequences.  

Thursday, August 22, 2019

Childress Brings Lloyd DeMause to APA



When I realized that Craig Childress and his life coach sidekick Dorcy Pruter had had a paper accepted for presentation at the 2019 convention of the American Psychological Association, I was alarmed. As I have said in the courtroom and in published articles as well as here on this blog, I consider Childress’s views on Parental Alienation (PA), its identification and treatment, to be implausible, lacking in an evidence basis, and potentially harmful to children and families. In other words, I would categorize the High Road treatment that Childress recommends as an alternative psychotherapy, foreign in its principles and methods to mainstream psychology. Childress, of course, says it is not a therapy at all but “psychoeducation”—a claim that does not actually bring this treatment any further into the mainstream.

Yes, I was alarmed by the idea that Childress’s views were going to be presented in a way that implied APA approval. But now that I have seen the paper presented at the conference (see https://drcraigchildress.org/asp/Site/ParentalAlienation/index.asp, or if that doesn't work search Childress APA 2019), I am also flabbergasted. The central part of the paper is basically a series of claims about the High Road treatment of a teenager who avoided contact with one of his parents, and in that it was no different than what Childress has previously stated; that was not the flabbergasting part. What amazed and frightened me was that the High Road narrative was embedded in one of the wilder psychological ideas of the 1970s, an idea that would have passed quickly from the scene had not its originator had sufficient personal funds to maintain for many years a journal promulgating his beliefs. The originator was Lloyd DeMause, the idea was what he called “psychohistory”, and the journal was the Journal of Psychohistory.

I first encountered DeMause at a history conference in 1974. I attended this small local conference because I was given to understand that presenters would discuss associations between child rearing and historical events. To my surprise, the first paper I heard attempted to trace personality disorders to the unborn baby’s experience of the tightness of the womb. I pointed out during the discussion period that there is variation in that “tightness” and it would be possible to examine the empirical support for the hypothesis. This proposal was far from welcome, and I caught on to the fact that the psychohistory group thought that theory was far more important than evidence.

My next DeMause (it’s pronounced Dee Moss, not like the Mickey kind) experience came about years later as I tried to trace the beginnings of some alternative psychotherapies, especially the ones that resemble Scientology in their reliance on what they believe to be the experiences that occur before or during birth and serve to shape personality at an unconscious level (i.e., it makes you do things but you don’t know it). DeMause, a political scientist who became a lay psychoanalyst, wrote in loving (perhaps even salivating) detail about the history of child abuse and claimed that human history has been shaped by children’s trauma (you can see some of this at psychohistory.com). DeMause’s fascination with trauma and the unconscious made him a favorite with the primal therapy group and later with the Association for Pre- and Perinatal Psychology and Health (APPPAH), whose members believed that unborn babies were in telepathic communication with their mothers and that all babies remember the details of their births. William Emerson, a member of APPPAH, recommended massaging babies’ heads roughly in imitation of the birth experience and allowing them to cry uncomforted for purposes of catharsis. This way of thinking dates back at least to Freud’s friend Georg Groddeck, and it temporarily rose to prominence again when Lawrence Durrell engineered a translation into English of Groddeck’s Book of the It in the late 1940s. It was further cultivated during the irrationalism and anti-rationalism of the ‘60s and ‘70s.

Incidentally, I presented about DeMause at EPA several years ago, in the history of psychology section, and I don’t think anyone present had ever heard of him before (not even sure they listened at the time)—so I would suppose that Childress’s APA audience did not know any of the background. And indeed I wonder whether Childress knew who he was referring to, or whether he just chose for a sort of camouflage an obscure author who talked about trauma a lot. I am not sure which is worse, whether DeMause was just pulled DeMause from the ether as an impressive-sounding name, or whether Childress knew full well what DeMause’s beliefs were and has subscribed to them. It may be that an obscure book by Robert Grille was Childress’s introduction to DeMause.

In creating the wraparound “theoretical” piece in which his claims about High Road were embedded, Childress oddly included a story about the World War I Christmas truce in which German and allied soldiers stopped shooting at each other. He spoke of the way the soldiers’ animosity was disarmed and implied that similar mechanisms could reduce the animosity the teenager in his case felt toward his parent. Unfortunately, Childress seems to have missed the point that the soldiers did not feel personal animosity, but were forced by those in power to fight against people with whom they actually had much in common— hardly a good example of the use of change agents outside psychotherapy to produce alterations in attitudes. The reference to the truce seems to have come from a TED talk by Robert Sapolsky, so perhaps this example was no better thought through than the DeMause reference.

 In any case, none of the flabbergasting material, and none of what Childress presented as support for his High Road claims, offered any convincing supporting evidence. I do wish I could know what APA Division 24 (theoretical and philosophical psychology) now thinks of the decision to accept this presentation—but perhaps they never heard of DeMause themselves. Or, it may be that they are pleased with this little visit to the counter-Enlightenment and wish APA would drop all this concern about evidence-based treatment.

Thursday, July 25, 2019

Fighting Parental Alienation Allegations? Here's Something Useful If You're on Your Own


The National Council of Juvenile and Family Court Judges has posted an interesting report at https://www.ncjfcj.org/policyinfo#policyissues discussing child custody decisions in the presence of domestic violence. The report notes that “Parental Alienation Syndrome (PAS), discredited by the scientific community, is not admissible evidence and any reference should be stricken under the standards established in Daubert and Frye”, (“Daubert” refers to standards for acceptable scientific evidence, “Frye” to standards based on whether most members of a profession support an idea.)

In spite of this recommendation from NCJFCJ—echoed by many other sources—family courts daily admit evidence about parental alienation (PA) and even make decisions based on that evidence. Parents whose children avoid contact with or who reject the other parent are increasingly accused of creating PA by manipulating and exploiting their children. People who are accused of PA risk losing custody of and even contact with their children even when there is no evidence that they have caused the children’s attitudes. Worse, advocates of PA argue that most children who reject a parent are emotionally disturbed, that the emotional disturbance was caused by the preferred parent, and thus that the preferred parent is an abuser and must be removed from the child’s life, in the child’s best interests. For parents who are teachers, psychologists, or physicians, a court’s acceptance of this argument can have a devastating effect on their professional lives in addition to the tragic effects on family relationships.

Fighting allegations of PA can be ruinously expensive. A lawyer I talked to yesterday estimated possible costs to one parent at $100,000 to $150,000 over several years. As a result, it is common for the accused parent to run out of money and no longer to be able to afford legal representation. (This situation may allow for legal aid in Canada and the United Kingdom, but to the best of my knowledge this is not the case in the United States.) Thus, although we all know that “the person who has himself for a lawyer has a fool for a client”, many people sooner or later find that they have to represent themselves in family court—or simply give up their attempts to have contact with their children.
NCJFCJ has prepared a document called “10 Things to Know About Family Court” (https://www.ncjfcj.org/sites/defaut/files/NCJFCJ_10ThingsKnowFamilyCourt_Final.pdf). This document describes family courts’ officers and their functions and defines and discusses some important terms that should be kept in mind if you have to represent yourself when fighting PA allegations.

Here are some terms and concepts that are especially important to parents accused of PA:

1.     1.  In discussing presumptions made by courts, the NCJFCJ document refers particularly to  the role of child abuse in custody decisions. They say “many states …have a presumption forbidding a court from awarding custody to a parent who has abused the child or the other parent, if the abuse is properly proven, unless the court finds reasons that would not be in the child’s best interests.” This item is highly relevant to the claims made by PA advocates that PA can be determined simply on the basis of a child’s attitude and behavior, and that PA is by definition a type of abuse. Although neither of these claims is generally accepted by psychologists, there is nothing to stop a family court from basing decisions on them unless strong arguments to the contrary are presented – or even then.

2.      2.The NCJFCJ document points to the role of the “burden of proof” in family courts. People who ask for unusual decisions or who make unusual claims must present more convincing evidence to support what they say than those who have more typical claims or requests. Because PA concepts and their associated treatments are poorly substantiated by empirical research , related claims and requests should bear a heavy burden of proof and should be required to address either the Daubert or the Frye standards mentioned above, depending on what a state’s laws determine. Requests for ordinary, normal parenting plans and schedules should not require much proof, nor should refutation of PA claims require much proof to be offered. When PA claims are made, claimants should be asked to provide published evidence of research support for the claims. If an evaluator has stated that PA is present, the evaluator should be asked to show how his or her methods met the guidelines of the American Psychological Association given at https://www.apa.org/practice/guidelines/child-custody. A very important point about these guidelines is that a psychologist making a custody recommendation should have interviewed all family members as well as looking for supportive evidence from teachers, neighbors, etc. PA recommendations are often made on the basis of an interview with one parent and are based on the belief that a child’s avoidance of the nonpreferred parent is caused by the machinations of the preferred parent.
3.
3.       The NCJFCJ document discusses settlement out of court and points to problems of reaching agreement when one parent is threatening or has been involved in domestic violence.   Allegations of PA by the nonpreferred parent may arise following complaints about child abuse or domestic violence, so this issue may be an important one. In many ways court orders may work better for parents who have been accused of PA, but there are also downsides to court involvement that may lead to orders of complete custody change.

If you are fighting allegations of PA and must represent yourself, the NCJFCJ document can be helpful--  but it is not the same as having experienced counsel.



Questions and Comments

Hello folks-- Blogspot has changed its method of handling comments and I have just figured out how they are doing it. If you posted a comment in the past months, I apologize for not seeing it! Please try doing it again and I will try to stay on top of this. Problem is, they used to send me an email reminder when there was a comment, now they don't. So sorry! 

Astakhov Called It: Closing Ranch for Kids


 Discussion of current events shows that there is still much confusion about the relationship between the U.S. Magnitsky Act of 2012 and Russian prohibition of adoption of Russian children to the U.S. It’s commonly said that the strictures on adoption were a “tit for tat” response to the Magnitsky Act, and some private discussions with Russians have been claimed to be about the adoption prohibition when in fact they were apparently about something else entirely.

In fact, in 2012, the Russian children’s ombudsman at that time, Pavel Astakhov, was already seriously concerned about mistreatment and even murder of Russian children adopted to the U.S. He attempted to visit the “Ranch for Kids” in Montana, a facility that had received a number of Russian adoptees who were placed there by their adoptive families. But he could not get in and was told that the children had gone away for the day. That and other experiences moved Astakhov to require that adopted Russian children should remain Russian citizens and should be in contact with Russian consuls while in the U.S. Eventually, the practical difficulties with this idea and resistance to it led to a blanket prohibition of adoption of Russian children outside Russia (and not just to the United States).

The concerns about Ranch for Kids expressed by Astakhov and others appeared for a long time to have been ignored by the Montana authorities. However, as of July 1, 2019, the Montana Department of Public Health and Human Services took over regulation of facilities like Ranch for Kids. As of July 23, Ranch for Kids was closed down with its license suspended(https://flatheadbeacon.com/2019/07/23/state-removes-27-children-ranch-kids-amid-allegations-abuse/; my thanks to my colleague Linda Rosa for this reference). The reasons for the license suspension were described as “egregious abuse”. Ranch for Kids staff were said to have hit, kicked, body-slammed, and spat on children. Other concerning actions, according to this report, were using inappropriate harsh discipline like requiring 15-20 mile walks in harsh conditions with improper or no shoes; withholding food; prolonged isolation of children; shooting a nail gun at a child; and failure to give needed medical attention or deal properly with medications. Runaways were not consistently reported to law enforcement, even in harsh winter weather.

Why would Ranch for Kids staff mistreat children in these ways, especially after attention had been drawn to their methods after Astakhov’s abortive visit? It is easy to assume that this situation resulted simply from the kind of people staff members were, and it may well be true that an isolated facility like this one may not draw staff from an ideal pool of people who ought to be working with at-risk children. However, to conclude that adult personality characteristics alone drove the child maltreatment is to commit the fundamental attribution error, a mistake of critical thinking that ignores multiple factors that affect any behavior.

A clue to the factors contributing to Ranch for Kids mistreatment is found on the facility’s website, which declares that their program is directed toward children who have Reactive Attachment Disorder (FASD is also mentioned).   The RAD reference suggests reasons behind the abusive behavior, with a belief system and a set of misguided principles that encourage mistreatment.
Reactive Attachment Disorder (RAD) is indeed an “official” diagnosis found in the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This disorder, which must be diagnosable before age 5, is associated with inconsistent and insensitive early care and is shown in withdrawn behavior and failure to seek comfort from familiar people when in distress. Effective treatment for RAD involves working with parents and other caregivers to help them become more sensitive and responsive to a child’s communications.

When organizations like the Ranch for Kids use the term RAD, however, they are not actually referring to the social and emotional problems described in DSM-5. Instead, they are indicating their commitment to an “alternative psychology” in which children’s symptoms of RAD are those which conventionally would be classed as conduct disorders, oppositional and defiant disorder, or obsessive and compulsive disorder. Instead of using those disorders as frameworks for discussing a child’s problems, alternative psychologists use an unconventional, non-evidence-based system in which behaviors like aggressiveness, disobedience, and lack of affection are all attributed to attachment problems and described as symptoms of RAD—which in fact they are not.

When facility staff are committed to the idea that undesirable child moods and behaviors are caused by failures of attachment, they readily accept two other propositions. One is that adopted or foster children are likely to have difficulties with attachment even if their placement occurred before they were 6 months old, the age at which emotional attachment to adults and attachment behaviors really begin. Adopted and foster children thus become the special focus of the facility. Second, staff also tend to accept the belief that “fixing” the child’s problems is a matter of “fixing” attachment, and that this is to be accomplished by methods that establish the absolute authority of adults over the children. Such methods, often known collectively as attachment therapy, are without any evidence basis but have been promulgated and encouraged by people like Foster Cline, Nancy Thomas, and Forrest Lien. The writings of this group propose that attachment problems (and therefore disobedience etc) are cured by the same methods used at Ranch for Kids—difficult physical tasks, limiting food, social isolation, and use of physically  and emotionally stressful conditions and punishments (usually referred to as “consequences”).

Mistreatment of children at Ranch for Kids was based on a disturbing unconventional belief system. It would have been possible years ago to examine this fact and to prevent the resulting harm to children, but it has only been with the recent changes in regulation that facilities that claim religious connections or purposes have become open to this kind of examination.

An important question: what is going to happen to the 27 kids removed from the Ranch? The news reports mention placing them elsewhere (but where?) or finding their families and achieving reunification. But what would be the results of reunifying children with families who presumably share the belief system of Ranch for Kids or they would never have placed their children there? Ranch for Kids is appealing the DPHHS decision; is it possible that some or all of the children will end up back where they started?  
 
****More on this subject—my colleague Yulia Massino has sent me the following:

In the article, published (in Russian)  in July of 2013, in Kasahstan Today   ( https://www.kt.kz/rus/society/detej_na_rancho_v_montane_vospitivali_bivshie_dressirovshtiki_sobak_1153575282.html     ), one can see such remark by Pavlov Astachov as regards his investigation of this ranch (the quote, translated by Google):
 
"P. Astakhov noted that the authorities of the state of Montana checked the ranch (Ranch for kids) at the request of the Russian guardianship authorities twice and twice found violations there. "The fire alarm system is not arranged on the ranch, and the houses there are wooden, there is no fire extinguishing system," said Mr. Astakhov after meeting with the Ombudsman of the Republic of Kazakhstan Askar Shakirov. 
 
According to him, ranch specialists in the past were engaged in a completely different activity. 
 
“We looked at these specialists, for example, the procedure of cultivating attachment.   You know, this is more like torture, it can be seen on Youtube. These specialists are licensed. There’s such a woman (I can’t remember her name), in the past she has been training dogs during 20 yerars, and for the last seven years she has been raising difficult children. She comes, teaches how to educate a child,   to raise child’s attachment. There are such specialists", - he said."


 Yulia has suggested the wonderful term “RAD-ranch” to describe this kind of place! 

N.B. Yulia has written a further analysis of the Ranch for Kids on her Russian blog https://yuliamass.livejournal.com/268211.html
 This can be translated with Google Translate. Some important additional information Yulia has provided shows the links on the Ranch for Kids website to Nancy Thomas and to Ronald Federici, both proponents of alternative therapies that have abusive components. Thank you, Yulia, for your work on this and for your demonstration of similar beliefs and practices in Russia! 



Monday, May 13, 2019

The Burden of Proof for Parental Alienation Claims (and Other Alternative Psychotherapies)



Most people know that in legal systems that derive from the British common law, an accused person is held to be innocent until proven guilty. The burden of proof is on the accuser and the prosecutor—the accused person should not have to prove that he or she is innocent of wrongdoing, and of course in many cases it would be impossible to prove that something does not exist or did not happen.

It’s less well known that the idea of the burden of proof also applies in scientific investigation. The assumption is always that an effect (like the outcome of a psychological treatment, for instance) does not exist, and anyone who claims that it does must provide strong evidence that it does. The burden of proof that “something happened” is on the people who claim that it did. Others do not have the job of proving that there is no effect of a treatment or other event, and once again, as with the legal system, it can be impossible to show that there is no effect.

Unfortunately, rather than accepting and working on the burden of proof that their treatments are safe and effective, proponents of alternative psychotherapies all too often rely on “proof by assertion”. They repeatedly state that their diagnoses are correct and meaningful, or that their treatment methods are effective, and rely on this repetition to convince not only people in general, but courts in particular. Proof by assertion does not yield evidence that a diagnosis is correct or that a treatment has good outcomes, but as the advertising industry knows, it can be hard to resist repeated claims, especially for anyone who has good reason to want to believe them. If those claims are obfuscated by reference to apparently scientific terms or methods, so much the more likely that they will be convincing.

Proponents of parental alienation (PA) concepts and methods have made rather a specialty of proof by assertion combined with obfuscation. Consider the diagnostic methods that are used, first of all. These range from “scales” created by Craig Childress for the rating of normal parent and child behavior to the use of various more or less standardized tests (some of these, like the MMPI, are quite standardized; others, like the Bricklin, much less so). Tests for any behavioral or emotional disorder must be reliable (that is, give about the same results every time), but they must also be valid. A valid test is one that tests what it is claimed to test, and there must be evidence that a test does this before it is used for decision-making. The whole point of a psychological test is that it should be able to determine quickly information that would otherwise be time-consuming and difficult to obtain. But unless such a test’s result is highly correlated with the information obtained in the more difficult way, the test cannot be considered valid.

To show that any test for PA is valid, it would be necessary to demonstrate that the test gave the same results as would be obtained by interviews and observations of a family in which a child was rejecting contact with a parent. By definition, PA is present when a child rejects contact with one parent, that rejected parent has not behaved abusively, AND the preferred parent has worked to create alienation by manipulating and exploiting the child’s thoughts and feelings. Thus, anyone who claims that a psychological test or set of tests validly diagnose PA would have the burden of proof of showing that the tests are highly correlated with information that includes the three factors just mentioned—including observational evidence that the preferred parent’s actions have created rejection that would not have occurred otherwise. It is certainly true that there could be cases in which all three of those factors are present, but we cannot assume that psychological tests are valid measures of PA until someone systematically demonstrates that this is the case. An adequate test of PA must be able to discriminate between child rejection of a parent with and without the intervention of the preferred parent, but none of the tests in use have been shown to do that. In reality, the tests used to claim PA are “validated” against the opinion  of one or more PA proponents rather than against empirical evidence—in other words, not validated at all.

PA treatments (including Family Bridges, etc.) have been claimed to be effective by their advocates, but as was the case with diagnosis, no one has accepted the burden of proof and done the work needed to demonstrate this. (Once again, this is the job of those claiming the effectiveness of a treatment; it is not the job of others to show that it is not effective.) Given the nature of the family situations and treatments, it is probably too much to ask that PA treatment advocates do randomized controlled studies, but it would be quite possible to do controlled clinical trials in which outcomes for children receiving PA treatment are compared to outcomes for children of similar characteristics who receive no treatment or some conventional form of psychotherapy. The burden of proof is not carried unless there is a well-defined, transparent standard of comparison presented. Published research on PA treatments so far has compared children’s attitudes and behavior before treatment to their own attitudes and behavior ; this is not adequate because there is rapid developmental change in adolescence and because even low-conflict families go through many changes following divorce, with or without psychological treatment.

When attorneys and family court judges meet arguments about PA diagnoses and treatments, they need to think about the right questions to ask and to realize that the burden of proof on these topics is on those making the claims, not on those who deny the claims.