Working with Families Experiencing High-Conflict Divorce: Ethical - PowerPoint Presentation

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Working with Families Experiencing High-Conflict Divorce: Ethical Issues and Clinical Practices

Canadian Counselling & Psychotherapy Association, May 8, 2018Jeff Chang, PhD, R.Psych.Athabasca University & Calgary Family Therapy Centre Drjeffchang.webs.comSlide2

Acknowledgements Athabasca UniversityCalgary Family Therapy Centre

The families who generously allowed me to share their experience Slide3

Background

Professor at Athabasca University Master of Counselling Program23 years of excitement working with high-conflict divorce and parenting in private practiceBilateral parenting evaluationsMediationParenting coordinationLitigation support for family lawyersSlide4

Background

Clinical supervisor and therapist at Calgary Family Therapy Centre Seeing families experiencing high conflict separations and post-separation parenting PI for controlled multi-site study of New Ways for Families (funded by Palix Foundation)Slide5

Background InformationSlide6

The Legal Context

A common law legal system in the British Commonwealth and the USAParties to a legal action are automatically defined as adversaries Default position: “Kramer vs. Kramer”Important feature of the high-conflict parenting families Slide7

Your Experiences

…. with high-conflict post-divorce parents/families?Slide8

High Conflict Divorce

About one-third of former spouses have significant difficulty establishing a healthy relationship with each other after divorce75% of divorces with children have no court appearances that are not “by agreement”Another 10 to 15% require one contested applicationbetween 5 to 15% have what can be described as high conflict relationshipsSlide9

High Conflict Divorce

Emotional reactivity Immediate blamefulness and attribution of intentionality for parenting slip-upsExaggeration of parenting differencesCourt applications to restrict the parenting time of the other parent, and to manage issues that most former couples can manage on a month-to-month or season-by-season basisSlide10

High Conflict Divorce

Four levels of problems/one level of intensity:Conduct that would require a report to child protectionInadequate parenting that does not require a report to child protectionBig disagreements about generally adequate parentingProblems that arise simply because parents cannot communicate productivelySlide11

High Conflict Divorce

Children whose parents divorce at 2-3 x as likely to be referred to mental health treatment; children in high conflict divorces are more than 2x again likely to seek treatmentSymptoms: You don’t need a list – everything you can think ofMost problematic and intractible: child refusing contact with a parent“Parental alienation” vs. realistic estrangement.Slide12

Football Shoes and Camping Gear: Dad Writes

Have not seen what you are looking for. I believe Jason's [school] camping trip has been known for quite some time and it is unfortunate you have not organized his equipment before now, a lot on your plate with the girls’ horse show and overnight/out of town guests you were entertaining….Slide13

Football Shoes and Camping Gear: Dad Writes

… Unfortunately also for Jason is that Jason has no shoes for the first half hour of his 1.5 hour football clinic at 5pm today and that he had to participate in his socks. Please advise if you would like me to have standby items that you can't locate. Thank you. JohnSlide14

Football Shoes and Camping Gear: Mom Responds

Yes we all had a fantastic weekend and wonderful memorable times with our out of town guests. BTW Kyle had Jason's shoes and he forgot practice started at five and brought them late. But I will be sure to show him this email so I can pass your criticism along to him….Slide15

Football Shoes and Camping Gear:

Mom Responds… As for standby items John. I think it is long long overdue for you to get a job and contribute to supporting your children. And yes fill your home with clothes and shoes and toys and bikes and helmets and scooters and

sport equipment and pay for some of their education and activities.

That would

be amazing!! It's

funny but Chris says in the U.S.

people

who don't pay child support

go to

jail. DEAD BEAT DADSlide16

The Professionals

Invitations to pathologizeHard work and heart-breaking for usScares many practitioners offArea of practice drawing the most ethical complaintsPractitioners feel threatened by high conflict-parents, and “fire” children as clients to minimize risk.Slide17

The Professionals

And the toll it takes on us….Slide18

Competence

: Knowledge, Skills, and AttitudesKnowledge:Supervisees should have better than basic proficiency with:Case

conceptualization and treatment planning

Typical child development

Ethical

reasoning

Dual roles and relationships

Informed consent and access to informationSlide19

Competence: Knowledge, Skills, and Attitudes

Family systems conceptualizationSeeing things in patterns and in terms of social organization is essential for avoiding aligning too much with one parentFamily life cycleDivorce process and dynamics of high-conflict divorce

Dynamics

of abuse -- “subclinical

”Slide20

Competence: Knowledge, Skills, and Attitudes

SkillsExecuting basic interventionsBalancing support with confrontation

Managing the working alliance with multiple clients simultaneously

Engaging and interviewing

childrenSlide21

Competence: Knowledge, Skills, and Attitudes

Managing highly conflictual interactionsMaintaining even emotional demeanor in the face of provocative and blameful statements (“poker face”)Acknowledging without endorsing truth (“accurate” empathy

)

“When he does X, you experience that as an effort at control.”

“You interpret her asking the kids about the time they spent as monitoring you.”Slide22

Competence: Knowledge, Skills, and Attitudes

AttitudesTherapeutic neutrality

Best

interests of the children = effective parental decision-making

Patience

: the long

viewSlide23

Self of the Therapist Issues

Countertransference Avoiding triangulationDealing with helplessness

Parallel process/isomorphism

Dealing with professional attack – sometimes via complaint to regulatory bodiesSlide24

Operating PrinciplesSlide25

Operating PrinciplesThe parental subsystem is where the action is.

The legal system can be a help or a hindrance, but is ill-equipped to provide solutions in high conflict situations. While individual pathology on the part of one parent may be an important contributor to problem, thinking about interpersonal patterns (the ipScope) is more useful.Slide26

Operating PrinciplesChildren are resilient

.Safety first.Keep the big picture in mind and take a long view.Acknowledge problems, while focusing on possibilities, strengths, and resources.Slide27

The parental subsystem is where the action is.

Children are innocent victimsThe vast majority of the time, children (even if they seem to have very clear ideas) are standing on the shoulders of one parent.The adversarial legal system takes on a life of its own when the parental subsystem does not do its job. Slide28

The

legal system can be a help or a hindrance, but is ill-equipped to provide solutions in high conflict situations.“… family justice issues are primarily social and relationship problems that contain a legal element” (Reforming the Family Justice System, Alberta)Slide29

The legal system…

Parent education and alternate dispute resolution approaches like mediation and parenting coordination help, but are not capable of dealing with complex high conflict situationsTherapists must understand the family legal system get over their “court-phobia”Slide30

While

individual pathology on the part of one parent may be an important contributor to problem, thinking about interpersonal patterns (the ipScope) is more useful.The presenting problem is likely to be a child or adolescent emotional or behavioral problem – not an adult problem.Developing a connection with a parent may enable some change, and using the child’s problem as an entry point is helpfulSlide31

Individual pathology…

Everyone likes to asked to be part of the solution; no one likes to blamed for the problem. We are unable to exert much influence on individual parents, anyway.Exercise: The ipScopeSlide32

HIPs and PIPsDr. Karl Tomm

and colleagues at Calgary developed the ipScope: “IP”=interpersonal patternsPIPs= “pathologizinginterpersonal patterns”HIPs= “healing inter-personal patterns”Slide33

HIPs and PIPsIn pairs, the speaker describes two typical recurrent interactions

between you and a loved one – one positive and one negativeThe listening takes notes about the interactions.Discuss the situation with the goal of expressing the interaction in at least one set of coupled behaviorsSlide34

HIPs and PIPsExpress it the “gerund” (--

ing) form of the verbThese “vicious cycles” can amplify pre-existing problemsSlide35

Individual pathology…

It is possible to be engaged in a PIP when you are not in the same room, in the same house, or in the same cityAn individual problem is exacerbated by a PIP and can be deescalated by a HIPUnfortunately, these family systems are predisposed PIPsSlide36

Children are resilient

We cannot rescue them from the unpleasantness of their situationWe can offer them a neutral environment, support, and understanding We can work on moderating their parents’ behavior and improving their relationship with parents.We can help children develop the skills they need to manage.Slide37

Safety firstOBVIOUSLY

…. but understand the effects of interpersonal interactional patterns on behaviors that threaten safetyTherapists require sophisticated knowledge of intimate partner violence – not all IPV is created equalSandra Stith, MFT Program at Kansas StateSlide38

Keep the big picture in mind and take a long view

A systemic approach helps us see the big picture – in a situation where, in all likelihood, no one else doesIf your setting allows it, be prepared for a long-term, if intermittent, relationshipSlide39

Acknowledge problems, while focusing on possibilities, strengths, and resources.

Empathize carefully and purposefully when parents are discussing the problems of the other parentDon’t try to convince, teach, or lectureSlide40

Acknowledgement… possibilities…

Listen carefully for openings when someone is describing changes or differencesStart by asking about descriptions and speculation, and coping. Be careful about asking for commitments for changeSFBT: Visiting relationship, complainant relationship, customer relationshipSlide41

So What to Do?Slide42

InterventionSlide43

Intervention

Managing the referralDeveloping a working alliance with each parentWorking the parental subsystem Developing shared or parallel treatment goals Intervention and reevaluation cycles“Termination” and intermittent meetings Slide44

Managing the referral

The initial call: In addition to everything else you do… Ask about the parenting scheduleBe aware that some parents generously represent a parenting order in their favor – obtain the order on the first sessionAsk about whether the other parent is on board with treatmentSlide45

Managing the referral

Exercise due caution about IPV, substance misuse, persistent mental illness, etc.Listen carefully for hidden agenda – letter for courtWe are permitted to see children with one parent’s consent – it’s legal but is it wise?Explain why it is useful to include both parents: Phone call demonstrationSlide46

Developing a working alliance with each parent

Obtain the background from the parent’s perspectiveEmpathize carefully. Affirming one parent’s perspective might lead him/her to think you agree:“So your perception is…“You experience him as abusive…”“You’ve felt she has not attended to the needs of the kids when goes out with friends …”Slide47

Developing a working alliance with each parent

Listen carefully for their beliefs about the cause of the problemsAsk coping questions:“How do you maintain an even keel?”“When you feel provoked how do you keep your cool?”“With everything that’s going on, how do you manage to keep going?”Slide48

Developing a working alliance with each parent

If you hear something, ask for a description (not what the parent can do to make it better)“Oh, what did he do?”“That must have been a surprise. How did you respond?” “Then what happened?”“What do you suppose the kids noticed?”Slide49

Developing a working alliance with each parent

Listen, do not encourage, and try to move on during:Pathologizing the other parentConversations about litigation: “Ask your lawyer about that?”Gently and firmly reiterate that you will not take one parent’s side in CourtI’ll tell them what you both have been working on, but I’m not permitted to say anything about parenting time.”Slide50

Developing a working alliance with each parent

Consider the relationship pattern as per solution-focused brief therapy:Visiting: no complaint – give complimentsComplainant: complaint, but no sense of contributing to solution – give tasks of observation or predictionCustomer: can articulate how to contribute to solutions – give tasks of action

Usually, since they blame the other party, use tasks of observation and prediction: “Keep on the look-out for when things are better.”Slide51

Developing a working alliance with each parent

Make suggestions tentatively and only when you think there is a customer relationship“This might sound crazy, but…”Another client tried this, but that might not fit for your situation…”Base suggestions on:What the children say with an emphasis on they say is helpful.What the parent him/herself says worksSlide52

Working with the parental subsystem

Get them together when they think that they can – do not do prematurelyAgenda and ground rules:Focused on present and future, not past: “I will be very focused on managing the session.”Describe some PIPs and discuss antidotesFeedback on what they do well -- complimentsOutcome: presenting a joint message

to the child(ren)Slide53

Working with the parental subsystem

Be task-oriented more than therapeuticFocus most of the conversation toward the therapist and use circular questions – carefully Don’t let them speak to each other unless you are darn sure that can do soWork to give equal air-timeAs before, acknowledge with “accurate” empathy without endorsing truth.Manage the session carefully – this requires advanced skills Slide54

Developing shared or parallel treatment goals

Suggest ideas for “projects” What you would work on?Who would be involved and in what capacity?How would others recognize progress?Keep in mind, these are only suggestions!Ideas have to fit into people’s livesSlide55

Intervention and Reevaluation Cycles

Setting and maintaining the relational foundationListening for clients’ world view, strengths, and preferences Negotiating a solvable problem or an achievable projectOpening meaningful experiences of differenceWithin sessionBetween sessions Circulating

these experiences of differenceSlide56

Setting and maintaining the relational foundationPlay

with children before you work with themBe a therapeutic “uncle” or “aunt,” or…Slide57

Positioning as a Professional

Think of one professional person (education, health, or mental health) with whom you interacted as a child in your growing-up years. Perhaps you were the patient/client, or perhaps a family member was. What did you appreciate and find supportive? What did you not? How, and how well, did the professional tailor his/her approach to “where the child was at.”Slide58

Setting and maintaining the relational foundation

The relationship must support everythingWho is concerned or involved with the problem?Include others in a non-blameful waySpend lots of time connecting with everyone, especially if the family is polarizedTherapeutic relationship and problem definition/goal are interrelated – how you talk about it mattersSlide59

Listening for clients’ world view, strengths, and preferences

Getting to know the child apart from the problem What are the parents' beliefs about this problem? and about parenting?What is the child good at? How did he/she get that way? “wonderfulness conversations”Slide60

Listening for clients’ world view, strengths, and preferences

Sometimes you can find something to utilize…The child’s experience will give you ideas about how the child acquires skills, useful “character traits,” good habits, etc.… or sometimes not…Slide61

Negotiating a solvable problem or an achievable project

Elicit a problem description that everyone can buy into – at least “sort of”Minimize blame and create space for respectful disagreement beware of clashing problem definitions/ beliefschild vs. parentparent vs. schooltherapist vs. parentSlide62

Negotiating a solvable problem or an achievable project

Despite your best engagement strategies, things can turn negative in a hurry.Miracle Question: Hypothetical solutions that bypass the need for mutual blame Externalize the problemNaming the goal or project in a way that fits for everyone“Shared sense of purpose” – the most crucial aspect of the working alliance with familiesSlide63

Opening meaningful experiences of difference… within session

“Inter-Viewing”What’s different?Behavioral sequence:EmotionCognitionBehaviorSensationInterpersonalPast real-life exceptions may be more accessible than hypothetical ones: “Can you remember…?”Slide64

Opening meaningful experiences of difference

the highlight packageusing drawings to elicit exceptionsscaling drawingsmiracle drawingsexception/new story drawingsrehearsal in sessionsSlide65

A Miracle…Slide66

A Good Time With Dad…Slide67

Find, elicit, or create meaningful experiences of difference

Contradiction/contrastsIdentity and preferencesWhat kind of person do you want to be?Slide68

Find, elicit, or create meaningful experiences of difference

Using numerical or visual means to track progressScaling for:ProgressConfidence MotivationWhat is different between a 3 and a 4?Detailed description of pattern, sequences, and modalitiesSlide69

Find, elicit, or create meaningful experiences of difference

Macro-descriptionSkimming the surface of exceptions and joining themDeveloping an attributional descriptionMicro-descriptionDetailed sequential description of:ActionsThoughtsEmotions

Sensationsinterpersonal

Connecting themes

Eliciting a past instance: An

actualSlide70

Find, elicit, or create meaningful experiences of difference

Between sessions (end of session interventions)observational tasks for parents and teacherspracticing one or two thingsbragging meetingsreading a new story togetherSlide71

Amplify, anchor, and maintain new experiencesrituals

and celebrationscertificates and lettersreflecting teamsSlide72

Therapeutic Letters

Offer commendations to individual family members and/or to the family as a whole, highlighting strengths and competenciesAcknowledge problems and their effectHighlight particular words, ideas, or recommendations that stood out from the therapy session.Pose questions about future directionshow to keep changes goingwhat developments or new insights will followHighlight

what you are learning from the client(s) or

from

your work with them

. Slide73

Reflecting Teams

Observing team exchanges positions with the client(s)The team presents mulitple perspectives tentativelyProcess:Physical separationNot addressing the clients directlyOwning one’s own perspectiveExpressing observations tentativelyThis permits clients to take or leave the team’s perspective, and for the therapist to interview the lcient

(s) about what they noticedSlide74

“Termination” and intermittent meetings Active treatment versus maintenance

“How long can you keep up these changes without any coaching?”Keeping the file open as long as your organization permits you. Expect to see them recurrentlySlide75

Overcoming Lawyer- and Court-PhobiaSlide76

Overcoming Lawyer- and Court-Phobia

Most therapists enter the field to be altruistic and conciliatory, not adversarialLawyers are obligated to advocate for their clientsSome have not “gotten the memo” about adversarial process not being helpful for childrenSlide77

Overcoming Lawyer- and Court-Phobia

If a lawyer thinks you know something that is helpful to his/her position, they may come fishing in your pondDon’t expect them to know or care about our ethics or standards of practiceEven though we might say we won’t go to Court, there is no real way to decline to go if a judge thinks you know something worthwhile – so go on your own terms!Slide78

Overcoming Lawyer- and Court-Phobia

Remember – the author of any document placed in evidence can be examined and cross-examinedFact witnessOnly “direct knowledge”What you have actually seen or heardExpert witness

Qualified by experience and trainingRequired when knowledge is outside of the scope of the general public Slide79

Overcoming Lawyer- and Court-Phobia

May give opinion evidenceMay use hearsay“There is no property in a witness”CCPA has an excellent brochure on responding to subpoenas

You may be required to turn over a file, but you can often negotiate to release less informationSlide80

Overcoming Lawyer- and Court-Phobia

Get paid! Even agencies should be in the habit of billing for their employees’ timeBill for admin time for copying, professional rates for redacting, for preparing to give evidence, and for actually giving evidence (including waiting time)Slide81

Developing a School- Based Response (optional – time permitting)Slide82

Developing a School-Based Response

Focus on the big pictureUse the core business of education as the entry pointBe on the same page and have a go-to personInteract purposefully with the parents and stepparentsCreate a safe neutral space for the childProvide supportive and skill-based counselling for studentsSlide83

Focus on the big picture

Think of this as long-term endeavor.Don’t expect things to change right away and respond calmly to recurring crisesBe familiar with existing district policy (if any) – likely not specific enough, but sets out the required elements Get a clear picture of the CFAM – in bits and piecesUnderstand the thinking of each parentFocus on the PIPs of HIPs of the parents (and new partners)Slide84

Use the core business of education as the entry point

Make it clear to each parent that your role is to educate the child, and that you are happy to do whatever it takes to do thatChair meetings assertively to keep on topicUse the child’s academic development as an opening to motivate the parentsSlide85

Be on the same page and have a go-to person

Have one person or a team (counsellor and/or AP/VP) to:Be the “big-picture” guideThink about the patterns Be the school’s institutional memoryCoach the rest of the staffTake responsibility for including high-conflict parenting situations for discussion in the School Resource Group meetingsIn accord with legislation and district policy, share information equally (and if possible simultaneously

).Slide86

Be on the same page and have a go-to person

Be warmly skeptical about statements like, “I have full custody,” or “The father is not involved.” Obtain court orders, keep them on file, and make sure that everyone on staff knows what they say. Consult legal counsel to interpret if necessaryPlan carefully for meetings with parents – do them separately if necessarySupport each other – exercise good self-careDon’t forget the clerical staff – loop them in and support them (bus drivers too)Slide87

Interact purposefully with parents and step-parents

Focus on supporting the child’s academicsListen supportively but set boundariesListen for when, somehow, things are better, or when things are not as bad…..If you hear something, ask for a description (not what the parent can do to make it better)Keep the PIPs in mind – listen for both sides of the loopMake suggestions tentatively and give parents lots of room to not take up a suggestionSlide88

Interact purposefully with parents and step-parents

Be careful when empathizing. Affirming one parent’s perspective might lead him/her to think your agree:“So you perception is…“You experience him as abusive…”“You’ve felt she has not attended to the needs of the kids…”Listen for when they report doing things that seem to help. Ask intently for them to describe what they didSlide89

Create

a Safe, Affirming, and Neutral Space for StudentsResilience literature states that children surpass negative environments when:Children have a connection with adult who is warm and has firm valuesChildren are given an outlet for a skill or aptitudeProvide supportive counselling for the student if the child will cooperate – listen!Slide90

Create

a Safe, Affirming, and Neutral Space for StudentsWhen the child reports the parents are getting along better, or the child is less stressed about the parents’ relationship, feed that information back to the parents, focusing on what the parent did.Refer to targeted interventions if needed, while keeping an eye on the big pictureSlide91

Supervision (optional – time permitting)Slide92

Competence in SupervisionACES Best Practices in Supervision

11.a.i. The supervisor is a competent and experienced practitioner who has knowledge of a range of theoretical orientations and techniques and experience with diverse client populations, as relevant to their counseling setting.Slide93

Competence in SupervisionAPA

Guidelines for Clinical Supervision in Health Service Psychology Domain A: Supervisor Competence 1. Supervisors strive to be competent in the psychological services provided to clients/patients by supervisees under their supervision and when supervising in areas in which they are less familiar they take reasonable steps to ensure the competence of their work and to protect others from harm.  Slide94

Screening and Case Assignment

Screening is an imperfect scienceCases that seem straightforward may throw you a curveball.Look carefully at child therapy referrals when parents are separated or divorced Support the supervisee in the initial call to parentsSome parents generously interpret parenting arrangements in their own favour – obtain court orders to confirm parental decision-making.Slide95

Setting up for Success: Ethics

 Consent of one parent or two? What’s legal vs. what’s wise? Clarify informed consent (age of consent) and access to information.Slide96

Competence: Knowledge, Skills, and Attitudes

Knowledge:  Ethical standards – advanced knowledgeCase conceptualization and treatment planningTypical child development Family systems conceptualizationFamily life cycleDivorce processDynamics of abuse -- “subclinical”Slide97

Competence: Knowledge, Skills, and Attitudes

Skills:Executing basic interventionsBalancing support with confrontationManaging the working alliance with multiple clients simultaneouslyEngaging and interviewing childrenSlide98

Competence: Knowledge, Skills, and Attitudes

Skills:Managing highly conflictual interactionsMaintaining even emotional demeanour in the face of provocative and blameful statements (“poker face”)Acknowledging without endorsing truth (“accurate” empathy)Slide99

Competence: Knowledge, Skills, and Attitudes

Attitudes:Therapeutic neutrality Best interests of the children = effective parental decision-makingPatience: the long viewSlide100

Self of the Therapist Issues Countertransference

Dealing with helplessnessDealing with professional attack – sometimes via complaint to regulatory bodiesParallel process/isomorphismSlide101

Contact me:E-mail: Jeffc@athabascau.ca

Web: drjeffchang.webs.comVoice: 1-866-901-7647Chang, J. (2016). Postdivorce counselling and dispute resolution: Services, ethics, and competencies. Canadian Journal of Counselling and Psychotherapy, 50(3S), S23–S42.