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Sunday, December 17, 2017

What Do Evidence-Based Psychotherapies for Children Look LIke?

Adults who have been in psychotherapy as children may have had a lot of different experiences, but most of them had to do with talking—often a rather general “free association” kind of talking, or play with toys or drawings. A few others may recall more hands-on work, sometimes painful or frightening for the child. But evidence-based treatments for children, the ones supported by empirical research into outcomes of treatment, are more directed, and do not involve intentional pain or fear.

Here are links to some youtube clips of evidence-based treatments, made by developmental psychopathology graduate students under the supervision of their professor, Dr. Cynthia Hartung of the University of Wyoming.



Modular Cognitive-Behavioral Therapy for Childhood Anxiety
by Lauren Zimmerman & Angeline Bottera

Multifamily Psychoeducational Psychotherapy for Childhood Bipolar Spectrum Disorders
by Kandice Perry & Katy Richardson

Trauma-Focused Cognitive-Behavioral Therapy for Children & Adolescents
by Kati Lear & Sarah Steinmetz

Cognitive-Behavioral Therapy for Adolescent Depression
by Brooke Merrow & Kendal Binion

Cognitive-Behavioral Therapy for Adult Attention-Deficit Hyperactivity Disorder
by Christopher Shelton & Ryan Kozina

Coping Cat to Treat Anxiety in Children and Adolescents
by Andrea Slosser & Shira Kern

Parent Management Training for Childhood Behavior Problems
by Adam Ripley & Alejandra Reyna



Most of these include actors’ performances of child and parent behaviors that are related to the original problem and to the therapeutic methods. You will see that most of the problems under treatment involve seriously concerning behaviors like undue aggressiveness, profound sadness, and unusual levels of disobedience and opposition to adult wishes—problems that  some unconventional therapists often problematically attribute to difficulties of attachment. Rather than trying to create or manipulate emotional attachments, evidence-based treatments usually concentrate on helping parents manage children’s behavior effectively, and on offering children tools and skills they can use to help themselves cope with anxiety or anger. They are certainly not about encouraging child disobedience or talking about parents' sex lives!

Wednesday, December 13, 2017

APA Continuing Education Courses: When Approved Providers Make Mistakes

In most states of the U.S., clinical psychologists have to be licensed to practice on their own, and often hospitals or other agencies prefer to hire licensees, even though sometimes a practitioner could be covered by supervision from a licensed psychologist. In order to maintain this valuable licensure, clinical psychologists must do a certain amount of continuing professional education. Although a state psychology board can approve continuing education (CE) courses for their state’s licensees, the CE courses are most often identified by approval of the American Psychological Association (APA). If the CE courses are approved by APA, all states will accept them as evidence of licensees’ compliance with continuing education requirements—and other professional organizations, like those for licensed professional counselors, usually accept APA-approved courses for their own licensing requirements. The standards for APA-approved courses are on paper more stringent than those of organizations like, say, the National Association of Social Workers.

Of course, there are thousands of licensed psychologists, and more thousands of clinical social workers, counselors, licensed mental health professionals, etc., etc. Providing and approving CE courses for all those people is a monumental task, and a big business, as fees are charged for CE credits. Although APA provides some CE courses at major conferences, most of the APA-approved CE courses are provided by organizations known as APA “approved providers”. These groups, which may be hospitals, universities, or free-standing businesses, acquire information about proposed presenters and presentations, vet it for compliance with APA standards, permit conference organizers to state CE awards in their brochures, and provide certification of attendance at CE courses to be used by licensees. Some approved providers also supply on-line courses with brief examinations on the presented material, but conference presentations do not include examinations. Conference brochures generally state that the conference organizers do not guarantee content accuracy; to the extent that this guarantee is possible, it’s the task of the approved provider.

Well, so far, so bureaucratic. Why am I getting into this at all? Here’s the problem: not all approved providers are doing their jobs properly. As a result, APA CE credits have been given for material that in no way meets APA’s stated standards, which include the existence of publications on the topic in peer-reviewed professional journals. This results in a potentially harmful situation, in which licensed psychologists may believe that content is accurate when it is not, and may base their continuing professional education on inaccurate content and miss out on other, more accurate material.

Fortunately, APA provides recourse to such problems through its Office of CE Sponsor Approval, and it’s my experience that complaints to that office are thoroughly dealt with. The complainant is fully informed, and additional information is requested if needed.

My first experience with complaining about a CE course took place several years ago when I received a brochure in the mail from the Lorman organization, an APA approved provider, advertising CE-carrying presentations by Nancy Thomas, the self-designated foster parenting and attachment expert. Thomas and her presentations fail on a number of points to meet the requirements for APA CE credits. Thomas is not a psychologist, nor does she have any other professional training, and no material supporting her methods has ever been published in a peer-reviewed professional journal. On the contrary, a joint task force of APA Division 37 and the American Professional Society on the Abuse of Children specifically condemned Thomas’s methods (Chaffin et al, 2006).  Following my complaint, the Office of CE Sponsor Approval directed Lorman to remove CE credits from courses given by Thomas. (Lorman continues, however, to sponsor and advertise Thomas’s courses, without CE credit; in my opinion, this practice raises questions about Lorman’s approved provider status as a whole.)

In Spring 2017 I brought a complaint about CE credits advertised by ATTACh, the Association for Training on Trauma and Attachment in Children, for a number of presentations to be given at their annual conference in October. The R. Cassidy organization was the approved provider in this case.The conference brochure offered APA CE credits across the board, for all presentations, although many of the presentations did not meet APA guidelines. I received a message from the Office of CE Sponsor Approval the day before the conference was to begin, stating that after investigation CEs had been refused for some of the presentations but allowed for others. A colleague who visited the conference reported that this did not seem to have been announced to attendees.

In September 2017 I filed a complaint about a presentation by Craig Childress and Dorcy Pruter at the conference of the Association of Family and Conciliation Courts (AFCC) earlier in 2017. AFCC had given APA CE credits across the board for presentations at this conference, and had included this presentation although one presenter, Pruter, has no professional training, and the material presented has never been supported by peer-reviewed publications. This complaint remains under investigation.

Within the last few weeks, I have filed two other complaints with the Office of CE Sponsor Approval. One of these concerned CE awards for presentations arranged by the Association for Comprehensive Energy Psychology (ACEP), which is for reasons that are not clear to me an APA approved provider. The CE material included claims for the effectiveness of “tapping” therapies, which are unsupported by any well-designed empirical study, as well as being contrary to any established view of the universe. In addition, I filed an objection to CE credits offered by the organization PESI, Inc., for presentations by the psychologist Terry Levy. The brochure for the Levy presentations claimed that Levy’s methods were effective, despite the absence of any peer-reviewed publications of empirical work or even of theoretical considerations. The PESI brochure’s biographical material on Levy referenced two of his books that include material making unsupported claims about the nature of attachment disorders and material written by Nancy Thomas that advocates limiting children’s diets as a therapeutic tactic. These complaints are also under investigation.

If you come across material offering APA CE credits for inappropriate material, I hope you will join me in complaining to the APA Office of CE Sponsor Approval. If you are not sure what the standards are, you can find them at www.apa.org.

Or, if you are not sure how to go about this, send your concerns to me and I will file a complaint if I agree with you.

  

Tuesday, December 12, 2017

Statutes of Limitations, Sexual Abuse, and Non-Sexual Abuse

The term “statute of limitations” is one that may be familiar to people who have tried to get recourse against those who have cheated or mistreated them. Such a statute is a law that time-limits lawsuits of some kinds. A person who seeks justice after a certain period has passed may find that he or she can no longer bring a suit for compensation for harms experienced.

It’s not unreasonable to have statutes of limitations for some problems. If too much time has passed, there may be no living witnesses to an event, and other evidence may have been corrupted or lost. Even the victim’s memories may have faded or become distorted. Few people would want to claim that someone who is 75 should be able to bring a lawsuit about something that happened when he or she was five years old, however terrible that event might have been.

However, many states have very short time limits on a range of harmful events that happened during childhood; not only are children unable to bring their own lawsuits and are helpless if their abusers are their own parents or guardians, but there are severe limits on the time that can  have passed after an abused person has reached adulthood before he or she can no longer sue.

In the current climate of concern and justified moral panic about sexual assaults, some organizations are working to alter states’ statutes of limitations on lawsuits concerning sexual abuse of children. These issues were discussed in detail by the New York Times reporter Elizabeth Harris at https://www.nytimes.com/2017/12/04/nyregion/prep-school-sex-abuse-statute-of-limitations.html and

For readers outside the United States, I should point out that statutes of limitations in the U.S. are matters of state and not Federal law. Every state has its own laws on this matter, although many states’ laws resemble each other in various ways. Elizabeth Harris’s articles focus on the laws of New York State, which are rather stringent in their time limitations, although not more so than some other states. According to Harris, residents of New York State have only until they are 21 years old to sue schools or institutions where they suffered sexual abuse, and until age 23 to sue an attacker or bring criminal charges (except for rape). For some years, activists in New York have been attempting to pass legislation to change this situation. Currently, a bill before the legislature, the Child Victims Act, proposes allowing survivors to sue until they are 50 years old and to bring criminal charges until they are 28. It would also provide a one-year window during which complaints from any previous time could be brought.

Although the Child Victims Act has been brought to the legislature repeatedly over the last 11 years, without being passed or even brought up for a vote in some cases, it is possible that the current climate of opinion, with its strong concerns about sexual misconduct, will support its passage. It is difficult to imagine resistance to such an act except among organizations that have reason to protect predators.

I would be most happy to see the Child Victims Act passed in New York and to see its passage tip off real changes in other states as well. But I want more.

Yes, sexual abuse of children is a heinous crime and one deserving of special attention. However, it is not the only form of child abuse for which recourse is subject to statutes of limitations. Legislation like the Child Victims Act should include cases of non-sexual abuse, especially if they occurred in institutions or were protected through bureaucratic or institutional means. Currently, statutes of limitations can easily prevent survivors of abusive treatment from bringing suits against their abusers.

Why do I say this? It’s apparent that many victims of sexual abuse were reluctant to come forward because they felt they would be attacked for complicity or for malicious intent. Both men and women felt correctly that publicizing their sexual histories would “punish” them and their reputations as much or more than it would hurt their molesters. It may seem less obvious why victims of non-sexual abuse would not quickly seek justice—but there are real reasons why they might not.

1.      1. They don’t have any money for legal representation. Individuals who have been in abusive institutional environments as children usually “age out” at 18 and have all they can do to take care of themselves. They do not have the background or the contacts that would enable other 18-yer-olds to get some kind of job, and they often rapidly move into homelessness, a condition that makes employment even less likely. It can take years to find their feet financially, if indeed they ever do so.

2.     2. They don’t have much education. Institutions in which abusive treatment takes place do not usually provide more than a minimum of education. As a result, individuals leaving such institutions may have no idea about lawsuits, about compensation for abusive treatment, about courts, even about what a lawyer is. Certainly they don’t know about pro bono legal work or about resources in law schools. Eventually they may learn some of these things, but it takes a while.

3.      3.They don’t know that what happened to them was abusive. How people define abuse changes over time, and most of us are really aware only of abuse that is different from what we are used to seeing (e.g., the example of debates over spanking). When children have spent years in an abusive family or foster care, and then have gone to an abusive institution, they may regard mistreatment as “par for the course”, and only with years of later experience look back and realize what happened to them.

4.     4. They think the abuse they experienced was their own fault, as they were often told. It is easy to make children feel as if adult attacks on them occur because they were “bad” in some way. Even adolescents who are coerced into false confessions of crimes may actually believe for some years that they are guilty of things they said they did—but did not actually do. Only as the years pass and more mature thinking develops do they realize that they were innocent of the charges they admitted to.

All of these are reasons why non-sexual abuse, especially in institutional settings, should not be subject to the present severe time limitations for recourse.

It is clear that institutions where abuse has taken place are quick to defend themselves by claiming time limitations for suits against them. Here is an example that I have blogged about previously. A 17-year-old girl in a Southern state, whom I will call Sophie, was placed in residential treatment center by her mother, who was concerned about the girl’s state of mind following a parental divorce that involved some sexual allegations about the father. During her time in the RTC, Sophie was subjected to withholding of food, water, and toilet facilities. When she had her period, she was not allowed sanitary materials, and was mocked as stinking. This treatment was continued until she conceded, falsely, that she had been molested by her father. The treatment then continued until she stated, again falsely, that she had herself molested a younger brother. The facility staff then reported her as a sexual predator, a label that meant she could not return to her mother’s house where there were younger children.  At 18, Sophie left the RTC, got a job, and saved up $200 for an hour of an attorney’s time (a feat that was probably possible for her only because she had not been in the RTC for as many years as she might have been). The attorney, fortunately, agreed to represent Sophie without further charge and brought a complaint against the RTC.

As you might guess, the RTC’s lawyers responded by pointing to the statute of limitations. It had taken Sophie more than a year to get her life together enough to seek legal representation, and under case law and legislation in that state she had no recourse for the harm done her. However, happily, a judge considered all the aspects of Sophie’s life and why she might not immediately have brought her complaint—and her case is going forward. (I notice that the RTC is no longer shown on the Internet under its old name.)


Including non-sexual abuse under Child Victims Acts would be a great help for the Sophies of this world.

Monday, December 11, 2017

Parental Alienation Advocate Invites Fox to Watch Henhouse


Well, I really thought I had made a couple of things plain on this blog: 1) that although I am sure that intentional “parental alienation” and manipulation of a child’s emotions toward a parent’s former partner could be the cause of a child’s avoidance of contact with one parent, this is far from the only explanation of the child’s attitude (even when the child gives no “rational” explanation for avoidance) and without a clear evidence basis no one has any business attributing the child’s feelings and behavior to a parent’s influence; and 2) that persons who attribute the child’s reluctance to problems of attachment, and who purport to treat attachment difficulties when they propose removing a child from contact with the preferred parent, do not understand the last 50 years of attachment theory and research, but instead want to hitch a ride on the attachment-fad bandwagon. (I have named Craig Childress specifically as making this latter mistake, though there are quite a few others.)

But perhaps I was not as clear as I thought… or perhaps PA advocates do not read as closely as they think they do. Some days ago I received an email from one Sarah Beeler, who said the following:

Dear Mrs. Mercer

I have read this discussion online between you and Dr. William Bernet: http://childmyths.blogspot.ch/2015/12/parental-alienation-advocates-cite-who.html?m=1
 
So I wanted to reach out to you to ask for your support. We have a new model to solve PA, a model that wil help millions of children and families around the world, it's called the attachment based model of "parental alienation". This model is only using established constructs and principles of professional psychology (no new syndrome).

The APA unfortunately does not realise that this is nothing new, they want to form a working group to research what is already established psychology (see email below).



Ms. Beeler then continues with many references to Craig Childress and his various claims to have shown that “parental alienation” is associated with a blocking of the attachment system [pretty much sic ] which is to be corrected by forbidding the child to have contact with the preferred parent (and thus his or her home and the rest of the family) and by psychoeducation in the form of videos, etc. It appears that although she read the discussion I had with William Bernet, but not everything else I said, nor the lengthy comments from Childress fans that I posted, nor my responses to those lengthy comments.

Ms. Beeler’s assumption about my position seems to have been based on the highly polarized views of Childress—that he has the right answer to the postulated problem, and that anyone who disagrees is against him—even those who also postulate PA and have their own proposed treatments. In line with the idea that the enemy of my enemy is my friend, she figures that if I disagreed with William Bernet (which I did), I must therefore be willing to agree with Childress! I am sure Childress and his various minions will be cross with Ms. Beeler, even though the sort of  careless or intentional cherry-picking of information she did is exactly like their own habit of making claims without evidence.

Childress’ blog post, quoted and linked by Ms. Beeler, states that APA should not appoint a task force to consider evidence about PA and treatments, on the grounds that the matter is urgent and that his methods and beliefs are “established psychology”. Personally, I would suggest that the task force is not really necessary (although it should be interesting), because the lack of evidence (i.e., “established psychology”) on the topic is so striking.  On the other hand, perhaps this is the time for a task force of the type APSAC and APA Division 37 appointed some years ago to look into the harm done by unconventional beliefs about and potentially harmful treatments for attachment disorders (Chaffin et al, 2006). Those beliefs and treatments were also without an adequate evidence basis, but they were being used freely by various mental health practitioners, just as various PA ideas are being put to work freely by a few practitioners and apparently quite a few lawyers.

Urgent needs, even if they exist, do not justify jumping to conclusions. Conclusions drawn on inadequate grounds have every bit as much chance of exacerbating a problem and harming families as they have of helping anyone. If Childress wants to influence APA or most other psychologists, his job should be to stop the theatricals and start doing the kind of serious research that could convince others of his position if the results were what he predicts.



Friday, December 8, 2017

Eye Contact Question

There is no more space for comments on the post mentioned here, so although I don't know whether the writer will look at this answer, I will reply here.


zhee yee has left a new comment on your post "Eye Contact With Babies: What, When, Why, and How": 

Hi dr,
My baby born at week 40 and she is now 3 months old. But she has poor eye contact with everyone, no cooing, and no respond to human voice. She is very good in tracking object, and respond to sound by her toy. She also awake from sleep if any loud noise. All these symptoms have freak my out as she is already 3 months old. I would need your advice on this. 

Thanks for your time. 

I am not completely sure what Zhee Yee is worried about or whether she is concerned that she is seeing signs of autism in her baby. I would have to say that the baby is too young for autism to be diagnosed, and that although most babies this age make some eye contact, it is usually "poor" by adult standards. Again, although most babies this age have begun to coo, there are some who vocalize very little but develop normally. I would be more concerned about the lack of response to voices, especially when there are some sounds she responds to. 

I would suggest that it might be good to have the baby's hearing tested, if this service is available. She may have some hearing loss for some frequencies of sound which would make her less able to hear voices. If this is the case, her language development will be affected unless she receives help.

For other people with queries like this, please don't try to post on the Eye Contact with Babies: What, When, Why, and How page! I have set up other pages for you to use--  just search "infant eye contact childmyths" and you will find them.