TREATING HIGH CONFLICT FAMILIES: ETHICAL AND PROFESSIONAL ISSUES

TREATING HIGH CONFLICT FAMILIES: ETHICAL AND PROFESSIONAL ISSUES

PPA ETHICS CONFERENCENovember 3, 2011

Bruce E. Mapes, Ph.D.610-696-8741

[email protected]

CURRENT RESEARCH

Condcuting Child Custody Evaluations: From Basic to Complex Issues

Phillip M. Stahl, Ph.D.

Sage Publications2011

WHO GOES THERE?

• Normal

• Compliant

• Character Disordered

CHARACTER DISORDERED

• Cause problems for others and do not adapt well.

• Externalize blame and have poor or limited insight into how they contribute to problems

• May show signs of depression, self-destructive behaviors, aggressiveness, brief psychotic episodes.

Character disordered - continued

• Tend to use emotional persuasion by escalating their emotions, becoming louder, blaming, increasing seriousness of allegations.

• Confuse emotional facts with actual facts. Generate facts to support how they feel, and emotions often triggered by cognitive distortions. Often leads to more cognitive distortions, exaggerations, and overt fears. Tend toward dyscontrol or overcontrol.

Character disordered - continued

• Fear being taken advantage of if let their guard down so they are very rigid.

• Winning or losing is closely linked to self-worth and self-esteem.

• Character pathology is often exacerbated within the intimate relationship but may not be as evident in other relationships.

PHYSICAL VIOLENCE

• Situational Couples Violence (SCV)

• Separation Instigated Violence (SIV)

• Coercive Controlling Violence (CCV)

NO PHYSICAL VIOLENCE

• The conflict is often at a level where it may distract the parent from parenting functions (nurturing, love, supervision)

• The child may intentionally or unintentionally be alienated from one parent.

• Child may develop deficits in the control and expression of emotions, as well as social competence.

No physical violence

• Chronic exposure can have a cumulative effect on physiological and neuroendocrine regulation.

• Possible aggression, conduct disorder, delinquency, antisocial behavior, anxiety, depression, suicide.

• Increased rates of physical health problems across the lifespan.

RESILLIENCE

• How a child responds to high conflict is dependent upon such factors as genetics, temperament, physiology, cognitive development, life experiences, the availability of protective factors (e.g. grandparents, other relationships, extracurricular activities, and many other factors.)

FATAL ASSUMPTION

• Do not assume because a child has been exposed to a high conflict family that the child suffers from a specific disorder (e.g., PTSD).

PROCEDURAL CONSIDERATIONS

• Many high conflict families are involved in custody evaluations or other litigation, or are creating a paper and professional trail to support some type of litigation, or even a criminal complaint. Said processes often exacerbate polarization and blame.

ATTORNEYS

• Some attorneys become too involved with their clients and may even personalize the feelings of their clients. Some may find litigation to be financially rewarding. The egos of some may not let them lose.

THERAPISTS

• Therapists who have an inadequate information base or who have trouble maintaining appropriate boundaries may write letters or provide therapy which allows the client to avoid accepting responsibility for his or her actions.

FRIENDS AND FAMILY

• Friends and family may reinforce cognitive or factual distortions, may reinforce projection of blame, and may otherwise reinforce or exacerbate conflict.

TREATMENT CONSIDERATIONS

• Avoid supportive therapy. Parents often need therapeutic confrontation.

• Teach parents how to differentiate between their own thoughts, needs, and feelings, and those of the children.

• Teach parents to take personal responsibility.• Help the parents to develop empathy and

understanding of their children’s feelings and needs.

TREATMENT

• Teach parents to consider alternative solutions, problem solving, and conflict resolution skills

• Help the children learn coping skills

• Help children to understand their feelings and to develop healthy ways to express their feelings.

TREATMENT

• Help children to separate their feelings from those of their parents in order to reduce loyalty conflicts.

• Give clear, structured recommendations. The more vague or flexible the recommendations, the greater the risk for manipulation or new conflicts.

PARALLEL PARENTING

• Parents parent at different times but no direct contact with each other.

• They perform the same or complementary parenting tasks.

• A clear plan is developed to define how each parent will participate in extracurricular activities, help with school work, take care of medical needs.

Parallel parenting

• Initially requires a neutral third party to develop the plan.

• Encourage parents to communicate through e-mails and faxes.

SAFETY FIRST

• Regardless of the issues involved, your first responsibility should be the physical safety of each individual.

DUAL ROLES / RELATIONSHIPS

• Hidden agendas• Manipulation• Splitting• Trust

BOUNDARIES

• Who is your patient? What is your role?• Do you have information base necessary to

offer an opinion?• Do you have independent evidence to support

allegations?• Can you offer an opinion concerning someone

you have not met?

THIRD PARTIES

• If you are treating a couple or family, avoid consulting with one party

• Beware of talking with attorneys• Beware of talking with families and friends• Fully inform all parties of any third party

inquiries or communications

RELEASING RECORDS

• Subpoena v. Court Order

• Written authorizations and compliance

• Confidentiality and privilege

INFORMED CONSENT

• Specify all policies, procedures, and your role up front. Preferably in writing.

• Do not deviate from the four corners of your informed consent.

• New informed consent for each episode of treatment.

RECORD KEEPING

• If it is not written in your notes, it didn’t happen

• Document everything

• Make sure you can explain your decision-making at a later date.