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Concerned About Unconventional Mental Health Interventions?

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

Friday, October 26, 2012

When Psychologists and Others Abandon Ethical Principles: Child Custody Issues

Like physicians, psychologists are expected to follow the dictum primum non nocere--  first, do no harm. Ethical principles like beneficence, respect for people, and justice all seem to me to follow from that original rule.

Psychologists who teach, do clinical work, or concentrate on research all have obligations to pay attention to ethical guidelines and to do no harm. But, of course, there are tasks done by psychologists where the possibility of doing harm--  and the importance of avoiding harm—is especially great. One of these is child custody evaluation, in which a psychologist assesses children and parents with an eye to making a recommendation about primary custody, about visitation, or even about termination of parental rights. Such recommendations walk a fine line between possible errors, and always involve some risk of causing harm to the child and/or interfering with the rights of parents to retain a relationship with a child. Inaccurate assessments may cast serious aspersions on the characters of parents and interfere with their professional lives as well as personal relations with the child or with other people—or, on the other hand, they may expose a child to continued harm from an abusive parent.

We usually hope that psychologists making custody recommendations will pay heed to ethical standards and will not deliberately flout them, even though they may still, being human, make mistakes in their assessments. Unfortunately, these hopes are not always realized. One story of an apparently intentional abandonment of ethical principles is told at In writing about this situation, I will refer to the psychologist as Dr. X, which seems a bit fatuous because anyone who reads about this can identify her, but somehow it seems appropriate to me.

Dr. X specialized in child custody evaluations in divorce cases, so her job was to assess children and divorcing parents and to make recommendations to the court about appropriate parenting plans, including primary custody, visitation, and supporting procedures like psychotherapy. In one case, when a divorcing mother thought that her former husband might have sexually abused their toddler daughter, Dr. X conducted play therapy sessions with the child and used them to put together a report to the court claiming that the child’s play and statements indicated that the sexual molestation had taken place. Dr. X refused to let the father speak to the child on the telephone and told the child that the father did not want to talk to her. She also told the father that he could speak to the child only if he admitted wrongdoing and apologized to the child.

The father maintained that he had never molested the child, and hired another psychologist, the well-respected Dr. David Martindale, to review Dr. X’s report and the videotapes she had made of the play sessions. Dr. Martindale concluded that the videotapes did not support Dr. X’s claims and that she had reported to the court only statements that she had coached or elicited from the child, and not the child’s actual uncoached comments. In other words, there was no evidence that the father had been abusive in any way.

A second complainant against Dr. X came into the picture by accidentally overhearing Dr. X’s name discussed with respect to the situation just described. She filed her own complaint, which stated that when she sought Dr. X’s help during a divorce, and when it was known that her former husband had been treated for sexual addiction, Dr. X suggested that to accuse the husband of molesting their infant would be an excellent ploy to make sure she retained custody of the child. She also reported that Dr. X said that she herself had done this during her divorce and had succeeded in terminating the father’s parental rights.

Dr. X denied all these allegations, and has argued at that she is the victim of a politically-motivated attack by father’s-rights groups. Nevertheless, the court concluded that Dr. X “has engaged in gross and repeated malpractice which damaged or endangered the welfare of [a child] and threatened [the child’s] relationship with her father. [She] misused her influence in a manner that exploited [the child’s] trust and dependency, resulting in the creation of great distress and confusion for the child… [In addition, she] created a situation whereby law enforcement would have been unable to conduct a criminal investigation had such action been appropriate. She isolated the child from all outside help had it been warranted.” Dr. X was also concluded to have deliberately misled the court and misrepresented her training, and in particular to have improperly acted as both therapist and forensic psychologist. The court recommended the revocation of Dr. X’s psychology license by her state’s board of professional licensing.

There are several points I would like to make about this egregious situation, in addition to noting that videotaping of the therapy sessions was the key to unraveling this set of twisted claims. One important consideration is the extraordinary ease with which mental health practitioners can state that if someone denies an action, this is proof positive that they actually committed it. If it appears that they genuinely believe they did not do it, the argument becomes all the stronger--  look, he’s even repressed it because it was so bad! Whether the accused person confesses (perhaps untruthfully and in order to bring an ordeal to an end) or denies guilt, it doesn’t matter; either outcome is interpreted as indicating wrongdoing.

Because men are somewhat more likely to approach children sexually than women are, it is not surprising that fathers are more often the targets of this strategy than mothers . However, mothers too may be accused of physical abuse. In one case I’ve recently been observing, the children are in the custody of a stepmother who has placed them in an unconventional treatment. The therapist is acting as an evaluator, and the mother has been told that she cannot have contact with the children unless she admits to having abused them physically and apologizes to them. Medical records exist that show no evidence of the children having been abused while in their mother’s care, but part of the unconventional therapy in use involves extracting from children statements about their mistreatment by an adult. Although being accused of sexual abuse carries much greater penalties in our society than accusations of physical abuse, this mother has already been denied a professionally-related activity because of her legal situation.

One more point here: as Dr. X’s case shows, it is considered improper for psychologists to act both as evaluator and as therapist, and this was one of several concerns that caused the court to recommend license revocation. As far as I am able to tell, however, there are no similar restrictions for social workers. The therapist and evaluator in the case I described in the last paragraph is a social worker, so the mother appears to have no way to demand correction of this situation. In cases where courts accept recommendations from other types of mental health professionals, the same problems may well exist.

Not only do psychology licensing boards need to take special care about these child custody issues, but other mental health professions need to set standards and demand that they be observed.


  1. Dr. X is in trouble again for the same thing:

  2. I've noticed that she claims that she isn't really doing therapy in some contacts she has with patients. This is reminiscent of situations where practitioners say they are working as volunteers in some settings, so the usual rules don't apply. Nonetheless, I think they do apply.