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Attachment and the Psychoanalytic School of Psychology

Court-Involved Clinical Psychology and Child Custody Decision-Making

Targeted parents are human beings.  They are people.  Psychologists are not allowed to hurt people.  Anyone.  Targeted parents qualify.

Psychologists are not allowed to hurt people.  We’re not allowed to do anything that would hurt the targeted parent.

Making professional recommendations that would limit the time that targeted parents share with their children to anything less than the maximum time possible, hurts the targeted parent.  It makes them sad, very sad, it takes away from them a fundamental self-identity role of mother or father, it takes from them life experiences with their ever-growing child that can never be recaptured or recovered, the child is only five once, only ten once, only fifteen once, never again.  Lost time is lost, and this hurts the targeted parent.

Psychologists are not allowed to hurt people, not even targeted parents.  They are people.

What is the maximum amount of time?  Following divorce, that would be 50-50% shared custody visitation.  We learn about sharing in preschool.  We take turns.  It’s a fundamental principle of social cooperation.  We share.  We take turns.

Following a divorce, that would a be 50-50% shared time.  A psychologist cannot advocate for anything other than that, because anything other than that will hurt one parent or the other, will make one or the other sad, very sad, and will take from them a fundamental life role, an important experience of self-identity, their role and experience of being a mother or father.  That would hurt them.  Psychologists are not allowed to hurt people.

But sometimes situations and limitations imposed by external factors make a shared 50-50% custody visitation schedule impractical or impossible.  What do psychologists do then?  We work to limit the harm.  We don’t make decisions as to who is harmed.

This is the APA ethics code on Avoiding Harm to the client, Standard 3.04a:

3.04 Avoiding Harm
(a) Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.

We’re not allowed to harm people, and if harm is unavoidable, we “minimize harm where it is forseeable and unavoidable.”

Sometimes the child’s need to attend a single school requires that the child has a school-week residence with one or the other parent.  This will hurt the less involved parent, it will make them sad and damage their life experience as a mother or father.  But it is unavoidable.  The child needs to be at a single school location during the school week, the child needs a single school residence.

If both parents can live close enough to each other that they can share custody visitation time with the child and the child can also have a single school, then this is the best option, then we share, we take turns, and a 50-50% shared visitation schedule is the best in “minimizing harm” caused by the divorce itself – the separation of the family structure.

But if that’s not possible, then an every-other-weekend to one parent and primary school-week custody visitation with the other parent becomes the next available option for a fair distribution of time with a minimization of the unavoidable harm to one parent or the other from divided custody time.

Giving one parent only every-other-weekend is a severe restriction on this parents time, and is less than the maximum possible.  The maximum possible would be every weekend.  If the limitation is the child’s need for a single school so that one parent is the school-week parent, then the more limited-time parent could be the weekend-parent, this would be the best outcome for the more-limited, and therefore harmed, parent.

But then the school-week parent is harmed in another way.  The school week is task oriented with homework and after-school activities, and coincides with the work-week schedule and stresses.  Weekends are a time of relaxing and quality bonding.  If we take all of these weekend times of bonding relaxation away from the school-week parent, this harms them because it harms the quality of their relationship with the child.  One parent, the weekend parent, would receive all the quality bonding time of relaxation, and the other parent would receive all the task-oriented time of schoolwork and activities.

We want to balance the quality bonding time of weekends, so we assign an every-other-weekend schedule for visitation.  But then this is less than the maximum time available for the limited-time parent, and an every-other-weekend schedules imposes a two-week absence between only brief visitation times.  We would like to provide additional time to this limited-time parent if possible, to maintain a consistent presence of contact and involvement.

Because the more infrequent time parent is being harmed, and because of the long period of absence between weekend visitations, we try to add some additional consistent time for this parent.   Typically this is through additional weekday time, often a Wednesday or Thursday dinner with the child every week, sometimes for a block of time, sometimes overnight if the infrequent time parent is able to maintain the child’s single school attendance the following day.

Psychologists, however, do not decide which parent is the school-week parent and which parent is the every-other-weekend parent.  That is not our role.  Ever.  It is not the role of a psychologist to decide who is harmed, who is sacrificed.  The second clause of Standard 3.04 says we “minimize harm” – it does not direct us to decide who is harmed.  The recommendations provided above regarding shared 50-50% custody visitation time, and an alternative every-other-weekend custody visitation schedule when the harm is “unavoidable,” meets this standard to “minimize harm where it is forseeable and unavoidable.”

We do not decide on who is harmed.

But what about the greater good?   If the child would benefit from more time with one parent than the other?

Two responses.  First, psychologists do not judge people to decide who deserves to have children and who doesn’t.  That is NOT our role.  Parents have the right to parent according to their cultural values, their personal values, and their religious values.  Psychologists should NOT assume a professional role of judging which parent is the “better parent” based on criteria that cannot be supported.  If there is no child abuse, then parents have the right to be parents.  If there is child abuse and child protection factors are a consideration, then there should be a corresponding DSM-5 diagnosis of child abuse.

Psychologists should not be in a role of judging who “deserves” to be a parent and who doesn’t.

Second, the “greater good” argument for causing harm is specifically prohibited by the APA ethics code.  Standard 3.04b prohibits psychologists from consulting for or collaborating with torture practices (enhanced interrogation) of terrorists.  Even terrorists, where there is a greater-good argument about the information they possess, psychologists are not allowed to harm terrorists.  The greater-good argument for causing harm is specifically prohibited.

Psychologists are not allowed to harm people.

Targeted parents are people.  We are not allowed to harm them.

The argument made by the allied parent is that the targeted parent “deserves” to be harmed, because they are a “bad parent,” and the allied  parent wants psychology and the court to judge the targeted parent, and to punish the targeted parent because they are a “bad parent” by limiting or restricting the parent’s time with the child.

It is not the professional role of psychologists to judge people to decide if the person “deserves” to suffer and be punished for some flaw or frailty.  That is never the professional role of psychologists.  If the court wishes to take up the matter of whether one parent deserves to be punished for bad parenting, that is a legal consideration of the court.  Psychologists are never in the role of judging someone’s frailty or vulnerabilities to decide if they should be a parent, or to decide if they need to be punished for their frailty.

Psychologists do not harm people.  Targeted parents are people.

If there are frailties, we fix them.  Parents have the right to parent according to their cultural values, their personal values, and their religious values.

Everyone can recognize how we do not override cultural or religious values in parenting rights, I want to highlight personal values.  Society has no authority to override parents in their right to parent according to their personal value system.  This provides a broad latitude to parents regarding their decisions as parents.  As long as there is no child abuse (documented with a corresponding DSM-5 diagnosis of child abuse), then parents have the human right to parent according to their personal values.

Personal values are embedded in cultural values, personal values are embedded in spiritual and religious belief systems.  Personal values are respected by professional psychology.  Psychologists do no judge who is the “better parent” who “deserves” to have a larger share of time with the child, psychologists do not judge who is a “bad parent” who deserves to be less involved with the child.

If there is no child abuse, then the rights of parents to parent according to their cultural values, their personal values, and their religious values is their human right and is respected.

If there is child abuse, then this needs to be documented by a corresponding DSM-5 diagnosis of child abuse, V995.54 Child Physical Abuse, V995.53 Child Sexual Abuse, V995.52 Child Neglect, V995.51 Child Psychological Abuse.  If there is no DSM-5 diagnosis of child abuse, then there is no justification for restricting a parent’s time and involvement with their child.

Custody Visitation Schedules

The practice of child custody evaluation is a professional abomination, psychologists should never be in the role of judging parents and parceling out pain and suffering based on some ill-formed and arbitrary criteria.

Psychologists do not harm people.  Anyone.  Ever.

Targeted parents are people.  They qualify.

Child custody decision-making following divorce is not complicated.  A shared 50-50% recommendation would be the default option in all cases because in minimizes harm to each parent created by the separated family structure and need to divide visitation time with the child.  We share, we take turns.  This is a foundational principle of social cooperation taught to all of us in preschool.  It applies in adult social cooperation as well.

We share.  We take turns.

If this is not possible, and harm must be done to one or the other parent by limiting their time and involvement with their child, then an every-other-weekend (and an evening during the week) custody visitation schedule becomes the second option.

This is not complicated.  That is the recommendation of professional psychology in all cases.  Professional psychology is not in the role of judging parents and parceling out pain based on who “deserves” to suffer because they are a “bad parent” (bad spouse).

Geographic Separation

In some cases, parents are geographically separated by long distances.  In these cases, neither the 50-50% shared visitation schedule nor the every-other-weekend visitation schedule is possible.  Additional harm is unavoidable.

In geographically separated families, the child’s need for a single school location requires that one parent be designated as the school-year parent, and the other parent will receive visitation time during the child’s school vacations.  As with the every-other-weekend schedule, the limited-time parent should receive all of the vacation time to maximize their available time with the child, but then this would harm the school-year parent by taking from them all of their relaxed bonding time with the child.

Similar to weekends, holiday and vacation bonding time is typically divided equally in geographically separated families, although sometimes additional time considerations are granted to the limited-time parent during summer vacations, and a strong argument can be made in favor of this compensation summer-bump to the limited-time parent’s custody visitation time with the child.

Move Aways

When a separated family structure occurs because of the parents’ divorce, the geographic location is established and the rights of each parent-spouse are established.  No move aways are permissible except in the most exceptional of circumstances.  Each parent’s individual rights are equally valid.  To take the child away from either parent would significantly harm the limited-time parent.

Psychologists are not allowed to harm people.  Any people.  Deciding if someone should be harmed is not the professional role of psychologists.  Once the home geographic location is established, if one of the spouse-parents wants or needs to move away from that region, for whatever reason, that is their choice.  Their choice, however, should not impinge on the liberties of the other spouse-and-parent, which include the right to be an active and involved parent with their child.

Life circumstances can be difficult and can impose difficult choices.  Personal life situations and choices, however, are not the responsibility of the ex-spouse following divorce, and the rights of the ex-spouse and parent to be an active and involved parent are not made void by the wants and needs of the other spouse-and-parent.

The court may decide that special extenuating circumstances exist that warrant allowing the move away of one parent with the child.  In these circumstances, the geographically separated custody visitation schedule of a school-year parent and a vacation-primacy parent becomes the recommended custody visitation schedule.

All Children – All Families

These recommended custody visitation schedules and the sequencing of their application applies to all children and all families.

Altering these schedules for child protection factors should be accompanied by a DSM-5 diagnosis of child abuse.

Psychologists are not allowed to harm people.  Anyone.  Targeted parents are people, they qualify.  Psychologists are not allowed to do anything that harms the targeted parent…. Standard 3.04 of the APA ethics code, Avoiding Harm.

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

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Standard of Practice: 2007 Documentation of Court-Involved Case Management

Standard of Practice: 2007 Documentation of Court-Involved Case Management

I want to share something with you. Actual progress notes from therapy, not with this pathology of complex family conflict surrounding divorce, but from therapy with abused children in the foster care system. 

The physical and sexual abuse of these children was confirmed by the Department of Children’s Services, and they had placed these children in foster care.  For treatment, they were sent to my clinic.  I was the Clinical Director for a three-university collaboration treating the impact of childhood trauma within our foster care system.

In my role as the Clinical Director, I supervised interns and post-docs, which meant I signed off on their chart notes.  I also trained them in how to do trauma therapy with children, and how to document the therapy in their chart notes.  Over time in my training role as Clinical Director I de-identified some of the notes that came across my desk to use in the training of interns and post-docs regarding treatment, and treatment documentation.

When I left to enter private practice I apparently kept a file of these de-identified sample notes from actual cases tucked in a file cabinet in my garage.  I had forgotten I had them.  My goodness, they’re from 2007, tucked in a file folder in a file cabinet in my garage.  I now recollect thinking that these de-identified chart note samples might be useful if I ever entered another supervisory training role, as training examples of child trauma therapy and therapy documentation.

I’ve been going through and organizing the stuff in my garage.  My last round of doing this was with my books, this time is with my journal articles and folders.  I’m clearing my emotional-psychological decks for action; opening the gun ports in preparation for the upcoming ship-to-ship engagement, so to speak.  In going through stuff folder-by-folder I came across my folder of sample notes, and I started to read them.

Interesting stuff.  Not to me.  It’s just work stuff to me from 2007, long before I came to work with families of court-involved divorce.  But these notes reveal important stuff about professional standards of practice, because they are not created for this pathology of post-divorce family conflict, and they are not related to anything controversial.  They are just standard of ordinary practice from 2007.

At the time of these notes, and at the time they were archived away in my files, I had plans to die happily in complete obscurity, and having never even heard of anything called “parental alienation.”   In 2007, I had never heard the term, “parental alienation.”  This note is from trauma.  These are the actual notes for therapy with young kids in the foster care system. 

This one documenting court-involved case management is from a post-doc psychologist.  It’s a case-management note for billing her report for the guardian (probably grandparents) regarding treatment progress which will be submitted to the court.  I’ve been a court-involved clinical psychologist before, just not a divorce-involved one.  I’ve been trauma and child abuse court-involved clinical psychologist.

You know how the pathogenic parent is so concerned about the supposed “abuse” of their child?  I am exactly the psychologist that you want to send an abused child to.  I am that psychologist – except now I’m here with divorce-related pathology.  But I am an abuse and trauma clinical psychologist.  Foster care.  Early childhood, ages birth to five, up to eight…).

For all of these kids discussed in these actual chart notes, the pathology is confirmed physical or sexual child abuse, often including parental drug use, and possible prenatal exposure of the child to drugs and alcohol.  Anything that gets a child from birth to age 6 into the foster care system; that was our client population; the child and the siblings were our client, along with the (hopefully) recovering parents, the grandparent guardians providing kinship care, the foster parents with four to seven children in their care, adoptive parents adjusting to trauma in children, the social workers in child protective services, and the court.

Been there.  Here is a case management note.


Case Management with the Court

Purpose of Case Management

For the courts to make an educated decision regarding <child name>’s future , it is necessary for the court to consider the child’s mental health and functioning in her current placement.  Consultation and linkage with the client guardian’s legal counsel is meant to facilitate the continued stability and progress of the client.  The legal proceedings regarding guardianship will determine <child name>’s contact with her biological mother, which would have a direct impact on her behavioral and emotional functioning.

Summary of Case Management/Linkage Provided

In her placement with the current guardians, <child name> has made significant gains in the reduction of anxiety and aggression. This therapist wrote a progress letter at the request of the current guardians and their legal counsel to inform the guardianship proceedings.  Specifically legal counsel was interested in the progress that <child name> has made in therapy while in the care of her current guardians, dates of attendance, and wanted to know if her biological mother had participated in treatment.

Treatment Recommendations/Considerations

Recommended that if client mother resumes caregiving involvement she be required to participate in collateral therapy to prevent deterioration in reported gains.  Noted that <child name>’s progress can be attributed in large part to the current secure and stable caregiving environment.  For specific progress and treatment recommendations please refer to the document in client file.

Care Plan

Goal Objective

By 8/13/07, will reduce the severity of client’s anxious/distressed presentation upon separation from 7 times a week to four times a week as measured by parent report, will reduce client lying about significant events to 3 times per week as measured by parent report, will reduce non-compliant behavior in the home from 3 to less than 1 time per week based on parent report, client will follow caregiver direction with only two prompts 90% of the time based on parental report.

Intervention

Will provide linkage and consultation with the court through the legal counsel for client’s guardian in order to support placement decisions that provide the necessary stability and security needed for client’s continuing treatment progress.

Client Will Participate By

Clinical functioning and progress will be reported to the court through the legal counsel of the client’s guardian.



That’s the note example.

Documentation Standard of Practice

I would estimate that the child described in this note by Dr. Excellent has been physically abused, mother is probably meth-addicted, the child is probably in the 5 to 6 year old age-range.  I can tell all that based on how the post-doc worded things.  I know the post-doc who wrote this, and if it was sexual abuse there would be different sentences.  The treatment goals she describes are consistent with physical abuse, and the lying is probably neglect from a meth-addicted mother (neglect leaves an imprint where the child takes whatever they want on impulse and then lies without remorse; it’s a survival symptom of neglect, particularly characteristic of meth-addicted mothers).

Notice the category headings for the note, these are standard mandated headings for a case management note for county-funded work.  We were county funded, foster-care work.  We had county mandated documentation requirements.  All of these note examples are county-level standard of practice for documentation.

This note is for billing purposes.  The post-doc is doing non-treatment activity and is billing the county under a billing code for case management.  This is her billing documentation note.  She has to justify the time spent.  This starts by identifying the child’s needs that are being addressed by the case management.

Note that she is working with the guardian’s attorney to provide information about treatment recovery to the court.  The guardian is likely the grandparent, and they are probably worried about the potential return of the child to an actively meth-addicted and physically abusive mother (the grandparent’s daughter).  The post-doc therapist is working with the grandparent to help stabilize the child’s recovery.

Childhood Trauma and Abuse

This note is from 2007.  This is the world I come from; the treatment of childhood trauma.

Forensic psychology uses the words trauma and abuse a lot, but they don’t actually ever work with trauma and abuse, just this court-involved divorce related family conflict. 

They don’t actually treat children in the foster care system who have been physically and sexually abused by parents.  I do.  Those are my clients.  I’m that guy,  that clinical psychologist, my clinic, that’s where they sent the abused kids for treatment.  To me.

I’ve worked with the courts before this current family-divorce pathology.  Only back then, I was on the foster care child abuse consultation side.  But I’m completely familiar with court-involved consultation surrounding child abuse, and in my world – this is what a case management note looks like.

Notice the treatment plan documentation.  Standard of practice on every progress note…. progress note.  That’s just on the note, there’s a whole four to six page treatment plan in another section of the chart. 

We do in-house QA on our charts every six months – no fun, Saturdays with pizza, and our charts are audited by the county – at random intervals.  Standard of practice, at CHLA, at Choc, at my clinic in 2007.

This is what I would consider a standard of practice note for case management in my world as a clinical psychologist.

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

Director of Psychological Services,
CCPI; Custody Resolution Method

 

 

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