Slide4

Peer Review

I agree with peer review.  If someone wants to peer-review my work, peer-review Foundations.  If you want the research support, here it is:

AB-PA Reference List

Nothing about an attachment-based description of this pathology is new, go argue with Bowlby, Minuchin, and Beck.  It is all standard and established knowledge applied to a set of child and family symptoms.

Solution is the DSM-5

The core line to solution though, is through the DSM-5.  All the rest is foundation, the central issue for solution is the application of the DSM-5.  That is the solution in its entirety.  This pathology is a persecutory delusion, a shared persecutory delusion with the allied parent who is the “primary case” of the persecutory delusion.

Presenting Problem

The child presents as being “victimized” by a parent.  That’s called the “presenting problem.” 

Differential Diagnosis

The first question for diagnosis is, is the child’s belief in “victimization” by a parent true or false?

If it’s true, then that is a DSM-5 diagnosis of child abuse.  Make the diagnosis and protect the child.  There are four diagnoses of child abuse in the Child Maltreatment section of the DSM-5:

V995.54 Child Physical Abuse
V995.53 Child Sexual Abuse
V995.52 Child Neglect
V995.51 Child Psychological Abuse

If the child is being “victimized” by a parent, diagnose child abuse and protect the child.

If, however, the child’s belief in “victimization” is false, then that is called a “persecutory” belief.  The diagnostic question then becomes, is it a perecutory delusion? A delusion is a fixed and false belief that is maintained despite contrary evidence.

This diagnostic question can be answered through the application of the Brief Psychiatric Rating Scale (BPRS) to the symptom.  The BPRS is one of the oldest, most widely used scales to measure psychotic symptoms for both clinicians and researchers.

From Wikipedia:  “The Brief Psychiatric Rating Scale (BPRS) is a rating scale which a clinician or researcher may use to measure psychiatric symptoms such as depression, anxiety, hallucinations and unusual behaviour. Each symptom is rated 1-7 and depending on the version between a total of 18-24 symptoms are scored. The scale is one of the oldest, most widely used scales to measure psychotic symptoms and was first published in 1962.”

BPRS Item 11 is the rating for delusional beliefs.  The diagnostic consideration separating Slide4an “idea of persecution” from a “delusion of persecution” is whether there is “full conviction” in the false belief.  The BPRS instructs  the rater to “Consider the individual to have full conviction if he or she has acted as though the delusional belief were true.”

Has the child acted as though the false belief in supposed “victimization” by the normal-range parent is true? 

Yes, the child is refusing contact and involvement with the targeted parent based on the false belief that the child is being “victimized” by this parent. The child displays “full conviction” in the false belief.

Slide6The anchor description for a BPRS rating of 3 says that the belief is held “without full conviction.” 

The child in this case has full conviction as evidenced by acting on the false belief.  The BPRS rating for the child’s persecutory belief is, at least, above a 3 Mild score.

A BPRS rating of 4 is the cutoff rating for the difference between a persecutory Slide7idea (2 and 3) and a persecutory delusion (4 and above).  The anchor point for a rating of 4 Moderate specifies that it might be an “encapsulated delusion” (limited scope), and states that there is no preoccupation or no functional impairment.

Is there impairment in the child’s functioning caused by the persecutory delusion? 

Yes, in the child’s family relationships.  The false belief in “victimization” is creating a cutoff in family bonding to a normal-range parent, it is impairing the child’s functioning in the family.

There is functional impairment, the BPRS rating for the child’s false belief is therefore higher than a 4, 

The anchor point for a BPRS rating of 5 Moderately Severe states that “more areas of functioning are disrupted.”  This captures the child’s symptom severity.  The BPRS rating for the child’s perscutory belief is at least a 5 Moderately Severe.

The anchor description for a 6 Severe delusion states that there is “much preoccupation OR many areas of functioning are disrupted.”  If either of these criteria are met, then the BPRS rating is a 6 Severe.  Slide8

If there is “almost total preoccupation OR most areas of functioning are disrupted,” then the BPRS rating is 7 Extremely Severe.

This is not something from Dr. Childress.  This is the American Psychiatric Association and the BPRS, “one of the oldest, most widely used scales to measure psychotic symptoms.”

Shared Psychotic Disorder

The child displays a Moderately Severe persecutory delusion toward a normal-parent.  How does a child acquire a persecutory delusion toward a normal-range parent?  From the influence and psychological control of the allied parent, it is the parent who is the origin for the persecutory delusion; the “primary case” (APA, 2000).

The “primary case of the persecutory delusion” is the allied parent, who then “imposes the delusional system” on the child.

Here is the description of a shared delusional disorder from the American Psychiatric Association:

From the APA: “Usually the primary case in Shared Psychotic Disorder is dominant in the relationship and gradually imposes the delusional system on the more passive and initially healthy second person…  Although most commonly seen in relationships of only two people, Shared Psychotic Disorder can occur in larger number of individuals, especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent’s delusional beliefs.” (American Psychiatric Association, 2000, p. 333).

The American Psychiatric Association even offers guidance on the treatment of a shared delusional disorder,

From the APA: If the relationship with the primary case is interrupted, the delusional beliefs of the other individual usually diminish or disappear.” (American Psychiatric Association, 2000, p. 333).

From the APA:  “Course Without intervention, the course is usually chronic, because this disorder most commonly occurs in relationships that are long-standing and resistant to change.  With separation from the primary case, the individual’s delusional beliefs disappear, sometimes quickly and sometimes quite slowly.” (American Psychiatric Association, 2000, p. 333).

Here is the description of a persecutory delusion from the American Psychiatric Association,

From the APA: “Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.”(American Psychiatric Association, 2000)

Does the allied parent share the false belief that the child (i.e., someone to whom the parent is close) is being “malevolently treated in some way” by the other parent? 

Yes.

The diagnosis is a Shared Psychotic Disorder.  In the ICD-10 diagnostic system, the formal diagnosis is F24 Shared Psychotic Disorder.  The DSM-5 diagnosis is V995.51 Child Psychological Abuse.

Pathogenic parenting that is creating delusional-psychotic pathology in the child is a DSM-5 diagnosis of V995.51 Child Psychological Abuse.  Creating delusional-psychotic pathology in the child through aberrant and distorted parenting practices is child psychological abuse.

That is the truth.

None of that is an opinion of Dr. Childress, it is all entirely the American Psychiatric Association, the DSM-5, and the BPRS, “one of the oldest, most widely used scales to measure psychotic symptoms.”  Go argue with the APA and the DSM-5.

Diagnosis.

Peer Review

There are a lot of mental health people holding themselves out as “experts” and who are offering interventions that they have crafted for this pathology.

I am going to want to see the protocols for their interventions.  Consider it peer review of your work.  I want to see your protocols.

I understand that Linda Gottlieb is offering something, some short-term intervention workshop model she’s created.  I’m extremely concerned about that.  Models of psychotherapy don’t work in intensive application situations.  Intense for psychotherapy models is two hour a week, the most intense is four or five hours of week of psychoanalysis.

Psychotherapy is not made for high-doseage intensity, it can do bad things if offered in too high an intensity.

There is no model of psychotherapy for what she’s doing, so she is stepping outside of any established model of known psychotherapy for what she’s doing – psychotherapy is NOT supposed to be delivered in that sort of intensive format, psychotherapy doesn’t work in intensity, and it can even be destructive at high-levels of intense application.

I’ll want to see Linda Gottlieb’s protocol to review it.

There’s also apparently a group in Arizona, I think, Overcoming Barriers I think it’s called.  Another short-term intensive intervention model.  I’ll want to see their protocol.

Cafcass, I’ll want to see what their doing.  Anyone who is holding themselves out as.an expert, bring your vitae, anyone doing intervention, I’ll want to review their protocol – consider it peer review.  I’ll start formally requesting protocols for review as a licensed. clinical psychologist somewhere around May or June of 2020, just putting out a heads up.

They won’t want to show me their protocols, and I strongly suspect it’s because what they are doing is seriously flawed and doesn’t work.  If they refuse to provide me with professional review of their protocol, I may  to get access to their protocols through other avenues, such as when I’m a consultant on a case where they’ve been the treatment provider.  The moment that happens, I’ll request their treatment records for continuity of patient care.  It’s a mandatory release under Standard 3.09 of the APA ethics code.

Standard 3.09 Cooperation with Other Professionals
When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately.

If I’m on a case as a clinical psychologist consultant and they were a prior treatment provider, then I’ll request their treatment records pursuant to Standard 3.09 ‘of the APA ethics code in order “to serve the clients/patients effectively and appropriately.”  It’s called “continuity of care.”

If I have to go that direction in order to review their treatment protocols, i.e., through my personal involvement as a licensed clinical psychologist with a client who has been treated by them, it won’t be simply a request for their protocols, I’ll want to see their treatment notes, intakes, treatment plans, outcome measures for that particular client.  I’ll want to see their individual treatment record and the protocol at that point.

Outcome measures too.  All interventions should be collecting outcome data.  That’s mandatory professional standard of practice with all pathology, ADHD, eating disorders, autism symptoms, depression and anxiety treatment.  Standard of practice; outcome measures.  What are the treatment outcome measures being used by Gottlieb and Overcoming Barriers, and any other intervention out there?

One of the primary things I will focus on in my peer review will be what their DSM-5 diagnosis is.  Diagnosis guides treatment.  They’re doing treatment, what’s their DSM-5 diagnosis.  What pathology do they think they’re treating.

A question will be, did they miss the diagnosis of a shared delusional disorder?  That would be a major problem, if they have no idea what the pathology is that they are even treating, yet they are developing treatment interventions for it, something – whatever it is they think their treating.  So I’ll want to see what their DSM-5 diagnosis is.

Consider it peer review.  I will be formally requesting their protocols for review at some point.  They’ll probably say no, probably ignore my request.  I’ll post my letter of request.  I’ll discuss their programs anyway, with whatever information I have available.   The exploitation of these parents ends.

I want to see your protocols.  If you’re offering some sort of treatment intervention for this pathology, I’ll want to review your protocol.  Consider it peer review.

If you want to peer review my work, great.  It’s the DSM-5 and the American Psychiatric Association – shared delusion – ICD-10 F24 Shared Psychotic Disorder (persecutory delusion) – DSM-5 diagnosis of V995.51 Child Psychological Abuse.

Peer review that.

None of this is Dr. Childress.  It’s the American Psychatric Association and the DSM-5. It’s Bowlby, Minuchin, Beck, van der Kolk, Tronick.  It is the application of established knowledge to a set of symptoms – that’s called diagnosis.

So to all my professional colleagues, what’s your diagnosis, and why?  Let’s see your support for your diagnosis.  That’s Standard 9.01a of the APA ethics code,

Standard 9.01 Bases for Assessments
(a) Psychologists base the opinions contained in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings.

Your “opinions and recommendations” contained in your reports, including your “diagnostic or evaluative statements” and “forensic testimony,” needs to be based on an assessment that is “sufficient to substantiate their findings.”

So… let’s see it.  Let’s see your “information and techniques sufficient to substantiate” your findings that there is NO spousal IPV emotional abuse of the ex-spouse/targeted parent using the child as the weapon; that there is NO cross-generational coalition and emotional cutoff in the family caused by unresolved multi-generational trauma in the parent; that there is NO encapsulated persecutory delusion in the child, and shared persecutory delusion with the allied parent.

Let’s see your documentation from your assessment that rules-out these potential diagnoses.  Dr. Chlidress is going to be doing peer review, used to do it all the time with interns and post-docs.  Your turn.

I’ve reviewed Dorcy’s protocols, all of them, for the High Road workshop, the Higher Purpose Parenting course curriculum, the CRM data tagging protocols.  I know exactly how they work, I am fully comfortable with them as a clinical psychologist, I can explain them all at a professional level.  She collects outcome data on all her workshop recoveries, documented success with each case, she has lock-solid single-case ABA data demonstrating effectiveness of the High Road workshop.

So… mental health people.  Let’s see your protocols, let’s see your outcome data.  Have I protected propriatary intellectual property rights with Dorcy?  Absolutely.  No worries on your intellectual property rights.  It’s called peer review.

The rampant ignorance and incompetence ends.  The violations to the APA ethics code and professional standards of practice surrounding these families, ends. The exploitation of these families, ends.  From equine therapy to magical workshops, Dr. Childress wants to review your protocol, starting with what you’re using as an outcome measure.

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

 

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