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 The online information given will state whether a license has been revoked, whether corrective action has been required (like further study of ethical issues), or whether supervision of the person’s work by another psychologist is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”.