When Arguments for Alternative Psychotherapies Cite Chemotherapy

Alternative psychotherapies (APs) are psychological treatments that are unconventional, are without any systematic empirical evidence about their safety and effectiveness, and in many cases are implausible in terms of psychological theory or established facts about child development. Some APs for children are directly harmful, and in the absence of evidence of their effectiveness we can consider all these treatments to be at least indirectly harmful--  for example, to use up families’ resources that would be better spent in other ways.

One possible harm done by APs for children is the infliction of discomfort either physical or emotional, sometimes with real pain and sometimes with the infliction of serious fear. Holding Therapy/Attachment Therapy, sometimes targeting adopted children and aiming at child obedience, gratitude, and the appearance of love for adopted parents, clearly involves both physical and mental discomfort caused by therapists. Nancy Thomas parenting (NTP), although it is not presented as a therapy by its advocates, is intended to bring about attitude and behavior changes like those that are goals of psychotherapy, and it too includes unpleasant, painful, and frightening experiences like being required to sit without moving for periods of time and having food limited in quantity and variety. Conversion therapy, a form of AP argued by its proponents to change same-sex orientation to heterosexuality, sometimes shares characteristics of holding therapy, and according to those who have experienced it, involves intense and disturbing efforts to change the nature of the treated person, in part through threats of eternal damnation.

Treatments for “parental alienation”, like Family Bridges and High Roads, are APs, as they lack empirical evidence of safety and effectiveness and are implausible as well as being unconventional. Like the other APs just mentioned, they depend on threats and fear to bring about certain changes in behavior. Children and adolescents given these treatments have reported not only distressing experiences during treatment, but also terror and discomfort when taken from their homes or schools or even from a courtroom by youth transport service workers who sometimes use handcuffs to restrain their charges.

How do proponents of APs justify the discomfort and fear experienced by children and adolescents receiving treatment—especially given that these methods are without evidence of effectiveness? An argument given by practitioners of Holding Therapy for many years has been that the treatment was analogous to chemotherapy for a child with cancer. Of course chemotherapy is painful, frightening, and distressing, but without it your child will die. The parallel suggested by these practitioners is that Holding Therapy is painful, frightening, and distressing, but without it your child will… perhaps not die, but become a serial killer (if male) or a prostitute (if female; these fates are apparently considered comparable), or will kill you, or will go to prison for some or all of the above. This, of course, is thorough abuse of an analogy, because although many children with untreated cancer do die, and although chemotherapy has been demonstrated to prevent many of those possible deaths, the same does not hold for Holding Therapy for treatment of childhood mental illness, antisocial behavior, or dissatisfaction of adoptive parents. First, although many serial killers have been shown to have had disturbed childhoods, it has not been shown that that childhood behavioral disturbances in general are of necessity followed by serial killing in later life. Second, it has certainly not been shown that children who receive Holding Therapy or other APs become less likely to have serious problems later—in fact, one might well predict that such children become even more likely to have emotional disturbances because of the resemblance of some AP techniques to other adverse childhood experiences.

Discussion of “parental alienation” treatments is beginning to focus on the distress and discomfort experienced by children and adolescents who undergo them. Advocates of these treatments argue that the untreated outcomes would be so bad that the discomfort is completely worth the benefits achieved. They claim, on the basis of very little evidence, that mental illness will result if a child is alienated from a parent and has no contact with that person. They argue also, without evidence, that children and adolescents who avoid one parent already have cognitive problems and disordered critical thinking.

I have yet to see practitioners of “parental alienation” treatments bring up the very faulty chemotherapy analogy as advocates of other APs have done, but no doubt someone will bring it up soon.

Judge Richard Dollinger Brings Common Sense to Parental Alienation Arguments

In a document posted at https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-51829-u.html, the Rochester, New York judge Richard Dollinger brought some common sense to the issue of parental alienation (PA).

 PA advocates generally claim that when children of a divorced family are reluctant to have contact with one of the parents, their behavior is evidence that the preferred parent has “brainwashed” them to dislike the nonpreferred parent, that this treatment has caused or will cause mental illness in the children, that the preferred parent is thus guilty of child abuse, and that a complete custody change plus special PA treatment should be ordered. In a number of cases, judges have accepted this argument—often when no expert had testified about the serious problems of the PA concept and the lack of evidence for safety and effectiveness of the proposed treatments.

In the case about which Judge Dollinger opined, the experts testifying that PA was present and custody change was required were three well-known PA advocates, Amy Baker, Linda Gottlieb, and Robert Evans. As commonly occurs in these cases, they had not interviewed the three daughters of the divorced family, but based their arguments largely on their discussions with the father, who was claiming PA and asking that the girls be ordered to live with him and his girlfriend (the girls’ former nanny).

Judge Dollinger described various actions of the parents as foolish, intemperate, immature, boorish, and charged with a “win at all costs” spirit. However, he did not find these behaviors, or the attitudes of the girls, unusual among divorcing families. In addition, he did not find any evidence that the girls had been influenced to avoid their father, that they have actually avoided their father or that their father’s authority has been lessened. He noted that according to the father, the girls “ are often sullen when they come to his home, and that they do not immediately warm up to him when they arrive for visitation; although they eventually overcome their cooler .disposition and then warmly embrace him after time with him. Like many teenagers, they are not always in accord with the father's direction. He claims that the once close relationship between the nanny and the daughters has been altered since she became his girlfriend. Unsurprisingly, [Judge Dollinger continued] in the father's testimony he never suggests that the change might have something to do with his own conduct and the change of the nanny's role (from nanny to his girlfriend).” In addition, the judge noted, the  ”characterization that the children's undisputed consistent access to their father was nonetheless evidence of being "somewhat alienated" strongly suggests that this expert had no actual proof that the children are alienated from their father”. Consequently, Judge Dollinger did not order a custody change, PA treatment for the girls, or financial obligations of mother to father.

 Advocates of  PA appear to have overgeneralized from a rare although genuine family problem to common, even healthy, reactions of parents and children to changes in family structure. They have assumed that negative views of a former spouse, expressed for good legal or therapeutic reasons and not in the presence of children, should be accepted as evidence that the children are being manipulated by the preferred parent. Notably, they claim that PA is present even in cases where children do not resist or refuse visitation with a parent, and appear to base this claim largely on ordinary adolescent behaviors or preferences which would not be seen as “symptoms” in any intact family.

It will be a step in the right direction if other judges follow Judge Dollinger’s lead in demanding real evidence for claims of PA rather than accepting the unsubstantiated statements of PA advocates.

Childress Is Cross, Or, Don't Say "Ain't" When I Say "Is"

Craig Childress has kindly written my blog post for me today. I give his letter to me, below—it may differ from the original in bold-face parts and in paragraphing and does not bear the signature on the original. In this letter, Childress appears to be referencing my testimony in the Sahar vs Sahar custody case for which I described the judge’s decision and remarks about Childress’s testimony a few days ago.

C. A. CHILDRESS, Psy.D. LICENSED CLINICAL PSYCHOLOGIST, PSY 18857 219 N. INDIAN HILL BLVD., STE. 201 • CLAREMONT, CA 91711 • (909) 821-5398 3/5/19

 To: Dr. Jean Mercer

 Re: Possible Ethics Violations

 I am providing you with this letter pursuant to my professional responsibilities under Standard 1.04 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.

,1.04 Informal Resolution of Ethical Violations When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved. Additionally, I am also concerned that this attempt at informal resolution of these professional concerns may be inadequate to provide patient protection, which may then activate my obligations under Standard 1.05 of the APA ethics.

1.05 Reporting Ethical Violations If an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under Standard 1.04, Informal Resolution of Ethical Violations, or is not resolved properly in that fashion, psychologists take further action appropriate to the situation. Such action might include referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities. Pursuant to my obligations to the involved client, I am currently preparing a written review of your testimony in a matter in California for the involved client.

 Of concern are: 1. Possible Violation of California State Law: In California, the term “psychologist” is a legally protected term and only licensed psychologists may use the term “psychologist” in referring to their professional standing. You are not licensed in the state of California or any state, and your background and training would not qualify you for licensure. To hold yourself out in your testimony to the court as a “psychologist,” either directly or by implication to the court, or as “an expert in the field of psychology” would likely be in violation of California state law. California Business and Professions Code BPC § 2902 (c) A person represents himself or herself to be a psychologist when the person holds himself or herself out to the public by any title or description of services incorporating the words “psychology,” “psychological,” “psychologist,” “psychology consultation,” “psychology consultant,” “psychometry,” “psychometrics” or “psychometrist,” “psychotherapy,” “psychotherapist,” “psychoanalysis, or 2 “psychoanalyst,” or when the person holds himself or herself out to be trained, experienced, or an expert in the field of psychology. California Business and Professions Code BPC § 2903 (a) No person may engage in the practice of psychology, or represent himself or herself to be a psychologist, without a license granted under this chapter, except as otherwise provided in this chapter. The practice of psychology is defined as rendering or offering to render to individuals, groups, organizations, or the public any psychological service involving the application of psychological principles, methods, and procedures of understanding, predicting, and influencing behavior, such as the principles pertaining to learning, perception, motivation, emotions, and interpersonal relationships; and the methods and procedures of interviewing, counseling, psychotherapy, behavior modification, and hypnosis; and of constructing, administering, and interpreting tests of mental abilities, aptitudes, interests, attitudes, personality characteristics, emotions, and motivations. Note that BPC § 2902(c) explicitly identifies “the person holds himself or herself out to be trained, experienced, or expert in the field of psychology” (emphasis added) as being prohibited without a license under BPC § 2903(a). Of concern is that representing yourself to the court as a “psychologist” and rendering testimony as a supposed “expert in the field of psychology” was a fraudulent misrepresentation of your qualifications to the court and was in violation of California state law.

2. Possible Violation of Standard 2.01a of the APA Ethics Code: An additional area of prominent professional concern is the apparent violation of Standard 2.01a of the APA ethics code.

 2.01 Boundaries of Competence (a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience. You have no background education, training, nor experience in the domains of clinical psychology, nor in the assessment, diagnosis, or treatment of pathology. Rendering an opinion on issues of clinical psychology and the assessment, diagnosis, and treatment of pathology is beyond your boundary of competence based on your “education, training, supervised experience, consultation, study, or professional experience.” Of prominent concern is that much of your testimony about the assessment, diagnosis, and treatment of pathology in clinical psychology is factually incorrect, revealing stunning ignorance regarding the practice of clinical psychology (practice beyond the boundary of competence).

 3. Possible Violation of Standard 3.04 of the APA Ethics Code To the extent that your possibly fraudulent and ignorant testimony, in violation of California laws and Standards of practice in professional psychology swayed the court to 3 disregard a confirmed DSM-5 diagnosis made by a licensed clinical psychologist (licensed in the state of California) your testimony likely caused significant harm to the client family in violation of Standard 3.04 of the APA ethics code.

 3.04 Avoiding Harm (a) Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.

 Pursuant to Standard 1.04 of the APA ethics code, I am making you aware of my concerns regarding unprofessional conduct that violates both California state law and Standards of practice in professional psychology. Pursuant to Standard 1.05 of the APA ethics code, I will be providing the client with a report reviewing your testimony regarding its factual errors and my concerns regarding possible violations of California state law, BPC § 2902(c); BPC § 2903(a), and Standards 2.01a and 3.04 of the APA ethics code.

Craig Childress, Psy.D. Clinical Psychologist, PSY 18857

I did not, of course, violate any of the standards of the ethics code, as can be clearly seen in the official transcript of my testimony. I made special efforts to state that I am not a clinical psychologist or qualified to testify about aspects of a particular case, but am an academic psychologist (yes, there are such people) who has spent years studying alternative therapies with the potential for harm to children and adolescents. I commented on the incongruence of Childress’s approach to visitation resistance or refusal with attachment theory as it has developed from the time of John Bowlby. (Incidentally, Childress might like to mull over the fact that Bowlby initially claimed that children formed attachments only to one caregiver, and that one was normally the mother.) I discussed the opinions of current leading attachment researchers and theorists about the lack of predictable connections between early attachment patterns and later personality or mental health status, including a recent article that denied associations between disorganized attachment and adult characteristics. I also described research methods used in establishing diagnostic methods and evaluating the effectiveness and safety of any treatment method, and pointed out that Childress’s claims were not based on research evidence. Childress himself has said that in doing a Psy.D. degree he traded training in research for clinical training, so perhaps he is not aware of the issues about which I testified.

My goal in testifying in this and similar cases was to prevent the harm to children and adolescents that may result from the use of untested diagnostic and therapeutic methods.

Of course, I trust that Childress's letter has no relation to the fact that he and I are both to testify by phone in a Hawaii trial next month. If there were any connection, that might be naughty witness tampering, so I am sure there isn't one.

Judge Considers Childress's Parental Alienation Treatment Drastic and Potentially Damaging

In a recent decision in a California custody case (Sahar vs Sahar, Yolo County), Judge Daniel Maguire rejected the opinions of Craig Childress, an advocate of the parental alienation (PA) treatment High Roads. Childress had been hired by the father in this case to make recommendations about treatment of two teenagers who were resisting or refusing visitation with their father following the parents’ divorce.

Childress argued that the mother in the case was  manipulating the children’s attitudes and causing them to be alienated from their father. Childress had no direct evidence that this was the case, nor had he evaluated the mother, but he opined that the mother was acting to alienate the children because she was suffering from a personality disorder caused by her childhood disorganized attachment status. An independent evaluator did not find that the mother had a personality disorder, and personality disorders are not thought to result from childhood attachment status by well-known attachment researchers. (N.B. I also testified as an expert in this case, commenting on Childress’s purported attachment explanation and the lack of evidence for his various claims.)

Childress proposed that the court reverse past custody decisions and place the resistant teenagers entirely in their father’s custody. He also recommended an untested form of treatment called High Roads, practiced by his colleague, the life coach Dorcy Pruter. When cross-examined by the minors’ counsel, Childress declined to answer some questions on the grounds that his professional license would be affected.

Judge Maguire’s decision in this case was that the teenagers should remain in their mother’s physical custody, but should have three meals a month with their father, each child having one meal alone with the father. They are not prohibited from talking about past circumstances but advised to do this in a constructive way rather than “relitigating” matters. This is seen as a step toward better relationships and a minimum rather than a maximum contact time. The mother is asked to encourage this but not required to force the children physically to attend meals with their father.

Judge Maguire commented on Childress’s testimony. The minors’ counsel had challenged Childress’s appearance on Kelly/Frye grounds, as Childress’s views are not generally accepted in the professional community. However, Judge Maguire stated that under California law Childress was giving an opinion, not employing a “new technique or method” or “novel method of proof”.. The decision should not then be taken to mean that the judge believed that Childress’s views were in fact shared by the professional community (my comment, not part of the decision—JM) or were found persuasive by the court.

Judge Maguire noted that Childress’s diagnosis was presented ipse dixit, as proof by assertion and without evidence. In addition, the judge stated that the proposed treatment appeared “drastic and potentially damaging”. In a footnote, Judge Maguire stated that “The court makes no finding as to whether or not Dr. Childress violated the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, the court does not rely on his testimony”.

This decision should be noted by other courts, by parents of whom parental alienation has been alleged, and by the lawyers representing those parents,

Talkin' Family Hierarchy (Blues)

The idea of a family hierarchy, a form of organization in which members have different amounts of power and authority to make decisions, is far from unreasonable. Groups do tend to work more efficiently when there is clear leadership, even though they may be more creative and effective in other ways when every member has equal say. And, of course, families characteristically are made up of people of a variety of ages and levels of competence, so there are generally a small number of members who have more ability and more authority to make decisions for the group.

 However, families are also different from other organizations in that members who have little competence may also have more important needs than those who are more competent, so good decisions are often made in the interest of the weakest members rather than just according to the wishes of the strongest. In some ways, the youngest and most vulnerable members of a family have more “power” than the older ones, as the older ones recognize the importance of protecting and nurturing the young. An additional difference between family hierarchies and other groups’ hierarchical organizations is that the family organization is dynamic—it changes as individuals develop and their needs and abilities change. A parent who exercised much power in the family may lose that status with age, and a younger person entering adulthood can and often does attain greater authority in the family group. (Those changes can be even more obvious in times of rapid technological change, where younger people may have mastered skills that older people do not have, or may be less when families have money or political power that is managed by elders and sometimes passes to younger adults only at the death of the older.)

These comments about family hierarchy refer to the actual observable (and ever-changing) organization of families and of the relationships among family members. But there is more to family hierarchy than just the ways families work: family hierarchy is a concept that overlaps considerably with ideological positions. For some families, and especially for their senior members, hierarchy and power differentials within the family represent right ways of life. Such power differentials are not expected to change as family members develop, as the structure rather than the function of the hierarchical organization is cherished. Alterations in the hierarchy may symbolize religious issues, as obedience to parents may be equated with obedience to God; a disobedient child may be seen as moving toward eternal damnation, and parents who allow their children to disobey may themselves be seen as failing in their religious duty. Beyond specific religious belief, too, the family hierarchy may represent the authoritarian organization of the community so valued by certain political groups, and power attained by younger members of a family may appear to be a frightening reminder of chaotic revolutionary movements.

Whatever the reasons for the ideological commitment to an unchangeable family hierarchy, those committed to this kind of hierarchy may use it as an essential touchstone for evaluation of families and individuals. For example, the German “family therapist” Bert Hellinger has claimed that in cases where an older family member has sexually molested a younger one, the younger person should apologize to the abuser for his or her own role in the breaking of the hierarchy through criticism or complaints about an older family member. (Hellinger is known for his work with Jirina Prekopova, a Czech psychologist who had proposed that autistic children can be helped only if their mothers are submissive to the fathers, thereby establishing a strong hierarchy.) In the United States and Britain, practitioners of holding therapy have claimed that children’s emotional attachment depends on their experience of powerlessness with respect to adults. Children in that form of treatment are to call adults names connoting authority like “Mom Sally” or “Dad Brian”. Proponents of parental alienation (PA) have made similar arguments. Richard Warshak, for example, considers it inappropriate for children to address their parents by first names, a breaking of the hierarchy that he feels is best maintained by using names that indicate special importance, power, and status such as Mom or Dad. According to sworn testimony, the PA proponent Craig Childress scolded children for their rejection of their father, which was  related to his violence against their mother, and stated that they should not break the hierarchy by criticizing the father’s actions.

Certainly there are families for whom long-term maintenance of a hierarchy of authority is a basic goal, whether because of religious or of broader political beliefs, or as part of a “therapeutic” approach. As long as no one gets hurt, there is no reason why they should not manage their lives in this way, although they may find that adolescents are forced to break with a family whose support they still need, rather than forego and foreclose their own development. For most families, however, the effort to maintain an unchanging family hierarchy is a waste of time as well as potentially damaging to relationships.  In the ordinary course of events, parents who have given up their own sleep or dinner in order to fulfill the needs of infants will come to say that older children can wait a bit or manage their own needs while the parents sleep or eat. Parents who sympathized with the anger or frustration of the tantruming toddler begin to feel justified in demanding some peace and quiet. And parents, who decided what music lessons or sports participation a third-grader should have, come to realize that the interests and abilities of a teenager ought to shape decisions about schooling and career preparation. 

That families have hierarchies of power and authority is clear, and is important to their effective functioning. But the idea that the structure rather than the function of hierarchy must be preserved is a mistake. People change, so family hierarchies change, and attempting to keep relationships the same forever is a mistake, however understandable may be the wish of some family members that time stand still.