Forensic Corner

Therapy Amid Conflicting Allegations Precautions, Best Practices and Ethical Obligations

In prior columns, we have addressed general considerations and essential competencies for providing effective therapy to court-involved families. Family psychologists can provide effective help to families who are negotiating the transitions and emotional distress that often accompany parental separation or involvement with the courts. A minority of cases, however, present particularly difficult challenges and ethical and clinical risks. These include situations in which a therapist is presented with conflicting allegations of abuse, trauma or the undermining of a parent-child relationship. 
By Lyn Greenberg, PhD

Lyn Greenberg, PhD Situations in which a therapist is presented with conflicting allegations of abuse, trauma or the undermining of a parent-child relationship can put enormous pressure on a therapist. Most therapists want to protect children from harm and are trained to advocate for their clients. Nevertheless, the risks to children may be different from what is initially presented, and serious harm can be caused to children and families if these cases are mishandled (Fidnick & Deutsch, 2012). Appropriately conducted therapy, however, may support children through these crises and help them to develop the coping abilities they will need to adjust successfully. Therapists who do not have specialty training in these issues should carefully consider whether they are qualified to handle them and should, at a minimum, seek consultation and supervision. While a full treatment of these issues is beyond the scope of this article, following are some recommended practices for managing these complex cases.

Obtain Consent from Both Parents

Amid distressing allegations that a child has been mistreated, it may be tempting to accept a child client without obtaining permission from both parents or reviewing the custody order. A parent (or attorney) may convey a sense of urgency and requests that the therapist bypass normal consent procedures and initiate therapy without consent from parents. While it is legal in many states for either parent to consent to medical or mental health treatment, it is extremely risky for therapists to treat a court-involved family without contacting both parents.  In addition to the risk of violating a parent’s rights or court order, therapy based on only one parent’s consent (and narrative) can introduce a level of bias into the therapy that can both harm the family and compromise external investigations into the allegations. (This is discussed in greater detail below.)  Therapists have faced lawsuits and licensing complaints for ignoring these risks.  Detailed guidance on informed consent procedures can be found in AFCC, 2009; Bala & Slabach, 2019; Fidler, Deutsch, & Polak, 2019; Fidler & Greenberg, 2019; Greenberg, Schnider, & Jackson, 2019;  Lebow, 2019.  The important point for this discussion is that therapists not abandon their procedures even in the face of an urgent and compelling story.  It may be helpful for therapists to remember that there are legally constituted authorities (i.e. child protective services and law enforcement), who can provide emergency intervention when necessary.

Maintain Role Boundaries and Avoid Compromising External Investigations

One of most difficult issues in these complex cases is the constant pressure on therapists to violate the boundaries of their roles.  Many psychologists understand, in a general sense, that they cannot simultaneously provide treatment and forensic investigation. But the pressures that arise with court-involved families are often much more subtle than an explicit demand that the therapist engage in incompatible roles. Parents may present concerns about the conduct of the investigation or present information that they want the therapist to explore when they attend therapy sessions. Therapists should, of course, promptly honor their obligation to report suspected child abuse to police or child protective services and should be alert for any current issues creating risks to the child. They are often in a position to observe the child and family over time and may ultimately be asked to provide information to a forensic evaluator. While these investigations are under way, however, it is critically important that therapists avoid doing anything that could compromise those investigations or taint the information available to the investigators.  

For example, while therapists can assist families in cooperating with court orders and dealing with daily stressors, they should not take on the role of “interviewing” children or focus the therapy on allegations that are still being investigated by other professionals or agencies. In most cases, the therapist has a much narrower range of information than what is available to investigators. A therapist who focuses sessions on the adults’ allegations, rather than on the daily life of the child, may unwittingly send a message to the child that the therapist is more interested in the allegations than any other aspect of the child’s experience. Information conveyed to the therapist by invested adults may make their way into the therapist’s questions to the child or be reflected in what the therapist pays attention to. Such bias can be particularly destructive if the therapist is acting on one-sided information or has already drawn conclusions about the accuracy of the allegations or the ultimate issues in the case. Children’s perceptions and statements may be fundamentally altered by their impressions of what adults believe, are interested in hearing and can tolerate. This can impact the information that they present to investigators, making it more difficult to obtain accurate assessments. This problem can be so serious that some authors (Branaman & Gottlieb, 2013) have suggested that children at the center of these allegations not receive therapy unless the child is demonstrating symptoms, particularly if the child is expected to testify. Of course, investigations and litigation that can last for years can cause serious distress and can also cement unhealthy coping skills and inaccurate memories in children who are chronically exposed to adult conflict.  Greenberg, Doi Fick and Schnider (2012; 2016) and Greenberg, Schnider and Jackson (2019) have proposed a treatment model that allows support and assistance to children without compromising external investigations. Professional objectivity is a core element of this and other approaches for court-involved families (Fidler, Ward, & Deutsch, 2017).

Consciously Considering Multiple Hypotheses

Children often exhibit behaviors that may represent trauma. Many symptoms exhibited by children can arise from multiple causes and be responsive to different kinds of interventions.  When one potential cause becomes the focus of adults’ attention, other serious issues may be missed. An objective, open-minded therapist may be the only person engaging with the whole child while competing adults pursue their own interpretations of children’s behavior. Therapists treating court-involved families should consider rival therapeutichypotheses as to the causes of any symptoms or any behaviors in the child for the purpose of identifying the best methods for alleviating the child’s distress, within the confines of the therapist’s role. For example, if a child expresses anxiety about a transition between parents, each parent may present a different belief as to the cause. The therapist may not be in a position to make the ultimate determination as to the cause of the anxiety but can certainly help the family with strategies to alleviate the child’s anxiety and track their responses and progress. If someone refuses to cooperate with safe, common-sense suggestions, this may be part of the information that the therapist provides to the evaluator if privilege is waived. An open minded therapist is also more likely to identify issues in the child’s daily life, such as difficulty with homework or impeded access to activities that the therapist may be able to assist with.

Identifying multiple hypotheses takes practice and a deliberate procedure. Most professionals can’t do it automatically. It may be useful for the therapist to note five possible explanations for each symptom presented by the child or alleged by an adult. It may be useful to request that parents contact the therapist in advance if they observe new symptoms or problems and to remind parents that the therapist is not the investigator and must address parents’ concerns at the appropriate time for the pacing of the therapy.  These procedures may provide the time, tone and structure that allow the therapist to consciously maintain objectivity.

What If the Child Has Been Traumatized? 

Our understanding of stress and trauma has advanced considerably during the past few years. Drozd, Saini, & Vellucci-Cook (2019) have reviewed some of this research in detail, including the relevant evidence of appropriate treatment. Children can be harmed if real sources of trauma are ignored; they can also be harmed by being treated for traumas that they did not actually experience. Nevertheless, many current treatment approaches include common elements that are also central to healthy development, such as learning to manage stress, appropriately express emotion, contain impulses, engage in healthy relationships, use active coping skills and seek support from healthy adults. In fact, the presence of a healthy adult in a child’s life may be a critical factor in promoting resilience and the child’s ability to overcome trauma. While treatment for any specific trauma may need to wait until the court has made its findings, the disciplined therapist may find many opportunities, within the activities and resources of the child’s daily life, to build resilience and healthy coping abilities. If treatment for a specific trauma is eventually needed, these abilities will support that treatment. Healthy coping abilities will also help the child who has not been traumatized to achieve successful adjustment. 

Conclusion

Children at the center of conflict and complex allegations often need the support of skilled, disciplined therapists. These cases may arise in any setting, not just in the office of a family forensic psychologist. This article presents general guideposts for supporting children and avoiding harm and certainly does not substitute for the training, supervision and experience that are important for managing these cases. These cases can be complex and challenging but may also be extremely satisfying if the therapist is able to help a child navigate developmental tasks and survive emotionally despite any unhealthy behavior by adults. 

References

AFCC Task Force on Court-Involved Therapy (2009). Guidelines for court-involved therapy. Family Court Review, 49(3), 564-581.

Bala, N. & Slabach, M.A. (2019). The Role of the Courts in Supporting Therapeutic Interventions. In L.R. Greenberg, B.J. Fidler, & M.A. Saini (Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development. New York, NY: Oxford University Press

Branaman, T. F., & Gottlieb, M. C. (2013). Ethical and legal considerations for treatment of alleged victims: When does it become witness tampering? Professional Psychology: Research and Practice, 44(5), 299-306. doi:10.1037/a0033020

Drozd, L., Saini, M.A., & Vellucci-Cook, K. (2019). Trauma and Child Custody Disputes: Screening, Assessment, and Interventions. In L.R. Greenberg, B.J. Fidler, & M.A. Saini(Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development. New York, NY: Oxford University Press

Fidler, B.J., Deutsch, R., & Polak, S. (2019). “How am I supposed to treat these cases?” Working with families struggling with entrenched parent-child contact problems: A hybrid case. In L.R. Greenberg, B.J. Fidler, & M.A. Saini (Eds.), Evidence-Informed Interventions for CourtInvolved Families:Promoting Healthy Coping and Development. New York, NY: Oxford University Press.

Fidler, B.J. & Greenberg, L.R. (2019). Parenting Coordination: Structures and Possibilities. In L.R. Greenberg, B.J. Fidler, & M.A. Saini (Eds.), Evidence-Informed Interventions for Court Involved Families:Promoting Healthy Coping and Development. New York, NY:Oxford University Press.

Fidler, B.J., Ward, P., & Deutsch, R.M. (2017). Translating the Overcoming Barriers Approach to Outpatient Settings. In A.M. Judge & R.M. Deutsch (Eds.), Overcoming Parent-Child Contact Problems: Family-Based Interventions for Resistance, Rejection, and Alienation. New York, NY: Oxford University Press.  

Fidnick, L., & Deutsch, R.M. (2012). An Introduction to the AFCC Guidelines for Court Involved Therapy. Journal of Child Custody: Research , Issues, and Practices, 9, 5-10.

Greenberg, L. R., Doi Fick, L., & Schnider, R. (2016). Catching Them Before Too Much Damage is Done: Early Intervention with Resistance-Refusal Dynamics. Family Court Review, 54(4), 548-563. doi:10.1111/fcre.12242

Greenberg, L. R., Doi Fick, L., & Schnider, R. (2012). Keeping the Developmental Frame: Child-Centered Conjoint Therapy. Journal of Child Custody, 9:1-2, 39-68. doi:10.1080/15379418.2012.652568

Greenberg, L.R., Schnider, R., & Jackson, J. (2019). Early Intervention with Resistance Refusal Dynamics and Hybrid Cases. In L.R. Greenberg, B.J. Fidler, & M.A. Saini (Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development. New York, NY: Oxford University Press.

Lebow, J. (2019). Specialized Child and Family Interventions. In L.R. Greenberg, B.J. Fidler, & M.A. Saini (Eds.), Evidence-Informed Interventions for Court-Involved Families:Promoting Healthy Coping and Development. New York, NY: Oxford University Press.

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