Every state in the U.S. has a professional licensing
board that can grant licenses to clinical psychologists, and can revoke or
limit those licenses under certain circumstances. If you Google your own state’s
licensing board, you will probably see that dozens of licensees have been
disciplined during the last year. The online information given will state
whether a license has been revoked, whether corrective action has been required
(like further study of ethical issues), or whether supervision of the person’s
work by another psychologist is needed. In most of the cases you’ll see, the
problem has to do with personal relationships with clients, with financial or
billing problems, with drug or alcohol use, or with criminal conduct.
Only rarely
are licensees disciplined because of harm done to clients as a result of
incorrect diagnosis or choice of treatment, even when children or other
vulnerable persons are in question. In this post, I will describe the events
surrounding the revocation of a license in one such case, that of the Oregon child
clinical psychologist Debra “Kali” Miller. I’ll also point out that, far from
being impressed by the revocation, Miller is starting a new career as a parent
coach—such people are not licensed, so she needn’t fear another loss. How do I
know she’s not impressed? It’s that she is doing this coaching in association
with Nancy Thomas, the self-styled foster parenting expert, and the very person
whose methods led to the license revocation.
A lengthy document (http://obpe.alcsoftware.com/files/miller.debra%20(kali)%20a.f._559.pdf
-- kindly forwarded
to me by Linda Rosa) describes the investigation of Miller’s actions by the
Oregon Board of Psychologist Examiners, including an Order of Emergency
Suspension of her license in March, 2014, and a final order for revocation in
September, 2014. Miller appealed these findings, which were recently (March,
2015) upheld by two administrative law judges.
What events culminated in the license revocation? Because
psychotherapy for children is confidential and known only to the therapist, the
parents, and the children (who are in no position to complain), only the
occurrence of real harm to a child is likely to bring treatment methods to the
attention of a professional licensing board. In Miller’s case, the
precipitating event was the arrival of a twelve-year-old boy (“Client A”) at an
Oregon hospital following an attempt to kill himself by strangulation. At the
hospital, the boy disclosed that as a result of Miller’s recommendations for
treatment, and her diagnosis of Reactive Attachment Disorder, he had received
distressing treatment: “Client A reported that his father and step-mother
required him to engage in routines that were causing distress, to include being
directed to sit in his father’s lap for directed feeding of milk from a baby
bottle while maintain eye contact with his father, to crawl on the floor for 20
minutes a day, to urinate into a jar in his room, to be confined to his room
for extended time periods with his bedroom door set up with an alarm, and being
directed to address his step mother using the term ‘Queen’ before her first
name.” Client A’s father said that their therapist had told them to use certain
treatments, “having Client A drink from a baby bottle while being held in his lap, having Client A engage
in physical exercises to include crawling on the floor and doing jumping jacks,
and directing Client A to in a specified way for time out (‘strong sit’).” In
addition, investigation revealed, Client A was examined and recommendations for
his treatment were made by unlicensed persons, and he was supervised by
unlicensed persons as “respite” for various periods of time.
Client A was diagnosed at the hospital as suffering
from depression and was placed in foster care.
Readers of material about Attachment Therapy will
recognize in Miller’s diagnosis and recommendations a strong resemblance to
ideas and methods promulgated by Nancy Thomas; other material (www.advancedparenting4kids.com
) shows that Miller had been for many years a volunteer worker at Thomas’s “camps”
that are intended to cause attachment between children and their adoptive
parents. These methods are based on two beliefs, neither one supported by
evidence. The first of these is the claim that emotional attachment is brought
about by a cycle of recurring infant needs and their gratification by
caregivers. The second belief is that a failed step in early development can be
created by imitation or reenactment of the needed early experiences. In
addition to accepting Thomas’s basic beliefs, Miller also was committed to the
idea that Reactive Attachment Disorder, rather than being characterized by the
symptoms described in DSM, was a matter of frighteningly violent and angry
behaviors, shown initially in disobedience and lack of affection toward adult
caregivers. These beliefs of Thomas’s are exactly what led to APA cancelling
continuing professional education credits for a presentation by Thomas that had
been scheduled to earn CEUs.
The Board of Psychologist Examiners found that
Miller had violated a series of ethical standards that licensees must comply
with:
- Immoral or
unprofessional conduct or gross negligence in the practice of psychology
- Practicing
outside the boundaries of her competence (“Licensee relies upon her own
methodology and unreliable sources in assessing whether a child has a
diagnosis of reactive attachment disorder and then recommends treatment
that poses the risk of harm to the child”)
- Failing to
use appropriate bases for scientific and professional judgment (“Licensee
uses a methodology in diagnosing and treating reactive attachment disorder
[RAD] that is not based upon established scientific and professional
knowledge in the profession”)
- Failing to
avoid harm (“Licensee … made specific recommendations… that focus on
establishing parental power over the child through psychological
aggression and physically challenging demands, which when implemented
exposed the child to the risk of
harm”)
- Failing to
use an appropriate basis for assessments (“Licensee diagnosed Client A
with RAD without substantiating the diagnosis with clinical findings in
the chart to support her conclusions and recommendations for treatment”)
- Failing to
obtain informed consent to therapy (“Licensee failed to inform Client A’s
father that her methodology in diagnosing RAD and her recommended forms of
treatment do not conform to recognized diagnostic criteria or practice
recommendations…”)
It was as a result of
these violations of ethical standards that Miller’s license was revoked. I
congratulate the Oregon Board of Psychologist Examiners for their meticulous
work in this investigation and their courage in declaring Miller’s methods
improper.
But is the small fact
of a revoked license stopping Miller? Not really-- as we see at www.advancedparenting4kids.com/oregon-trainers/kali-miller/
. The license revocation is not mentioned. Instead, Miller is said on this
Nancy Thomas-related website to have “transitioned from clinical practice and
[to be] bringing her heart for healing to parent coaching and providing
consultation for other therapists”—activities that remain under the
professional radar and without the restrictions of licensure for meeting
ethical standards”. We won’t be finished with regulating potentially harmful
child therapies until licensure for coaches and others is required; even then, of
course, quacks will find a way to cheat.
I plan in a few days to
add to this discussion by a look at Miller’s parent-education material called “Taming
Tiny Tigers”.