AFCC Webinar Not Just Alienation (Pruett Drozd 2019) Webinar Not Just... · 2019-05-08 · 5/7/19...

5/7/19

Pruett & Drozd 2019 1

NOT JUST ALIENATION: RESISTANCE, REJECTION, REINTEGRATION, AND THE

REALITIES OF THE REALITIES OFTROUBLED PARENT‐CHILD

RELATIONSHIPS

Marsha Kline Pruett, PhD, MSL, ABPP

Smith College School for Social Work

Leslie M. Drozd, Ph.D.

Independent Practice

AFCC May 7, 2019Sponsored by OurFamilyWizard.com

Why These Cases Matter‐1• Relatively low frequency, but on the rise

• They take up a large percentage of the Court’s time and parents’ resources

•Outcomes for children can be very poor

• ACES studies show that interparental problems alone is associated with increased risks (odds ratio3:1) for disruptive behaviors and contribute to externalization & internalization when other risks also present

•Negative parent–child relationships in preadolescence reduced the likelihood of High Quality peer relations in mid‐adolescence, especially for girls (Kretschmer et al., 2015)

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Why These Cases Matter‐2•Outcomes for children can be very poor (continued)

• Extensive national and international studies have revealed children of divorce show better outcomes on measures of emotional, behavioral, psychological, physical, and academic well‐being when they maintain close emotional bonds, frequent contact, and quality relationships with both parents

• Especially as children get older, it can be very difficult to make effective changes

•Our traditional interventions (e.g., litigation, individual therapy) don’t work with this intractable population

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Why These Cases Matter‐3• These cases involve high conflict. Conflict (and poor parenting affect children.

• These cases can result in trauma and chaos in a child’s life.

• These cases take more than a fair share of resources

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Many Terms for High Conflict P‐C Dynamics• Intractable Conflict (Moran, 2019)

• Maladaptive Restrictive Gatekeeping (Saini, Drozd, & Olesen, 2017)

• Strained Parent‐Child Relationship (Fidler, Bala & Saini, 2012)

• Unjustified Restrictive Gatekeeper (Austin et al, 2011);

• Parental Alienation Syndrome (Burrill, 2006)

• Parental Alienation (Baker, 2005)

• Threatened Mother Syndrome (Klass & Klass, 2005)

• Pathological Alienation (Warshak, 2003)

• Alienated Child (Kelly & Johnston, 2001)

• Visitation Interference and Divorce‐Related Malicious Mother Syndrome (Turkat, 1999)

• Parental Alienation (Darnall, 1998)

• Garrity & Baris, 1994

• Toxic Parent (Cartwright, 1993)’

• Pathological Alignments and Visitation Refusal (Johnston, 1993)

• Parental Alienation Syndrome (Gardner, 1985)

• Johnston & Campbell, 1988

• Wallerstein & Kelly, 1980 5

Child’s Response

Intense Marital Conflict Before/After Separation

Divorce Conflict & Litigation

Personality of Rejected Parent

Personality of Aligned Parent

Humiliating Separation

Child’s Vulnerability

Aligned Parent’s Negative Beliefs, Behaviors

Rejected Parent’s Reactions

Sibling Relationships

Adapted from Kelly & Johnston, 2001

Lack of Functional Coparenting

Extended FamiliesAligned Professionals (Education, Health, Legal)

Factors Contributing to & Sustaining Parent-Child Contact Problems

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Saini, Drozd, & Olesen, 2017

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Polarized Positions Reflect Like a Mirror‐1

• Controversy on how best to identify, assess and respond to resist / refusal cases.

• If a child resists/refuses contact with a parent, then alienation is the cause…

•Alienation claims are fabricated by perpetrators of IPV to exert control over the victim...

• Narrow and polarizing gendered narratives mirror the inflexible, “all or none” thinking of families involved in child custody disputes. (Fidler, Bala & Saini, 2012)

•

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Polarized Positions Reflect Like a Mirror‐2

•There is general agreement PA occurs regardless of gender of parent or child (i.e., sons and daughters can become alienated from either their fathers or mothers), but it is more often towards the non‐custodial parent, who is usually the father (Bala, 2010)

•Evidence‐informed practice allows for critical appraisal of evidence based on quality, strength, applicability and transferability.

•Helps to move away from binary arguments of the presence / absence of alienation.

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Show Me the Evidence• Prevalence rates vary depending on the operational definition & sampling strategy used• 15‐40% across studies depending on definition and sampling

• ‐‐There remains the debate about whether there is sufficient quality and rigor in the current literature to make accurate assertions about the etiology, prevalence, and consequences of alienation for describing strained parent‐child relationships. Most of the current literature is based on clinical illustrations and expert opinions and testimonials (“qualitative”).

‐‐‐Perfection is not the standard to assess the credibility of research results.

• All research is flawed, so the challenge is to distinguish minor flaws from major ones, from fatal ones.

• ‐‐Need to assess the relative strengths and limitations of research to determine the credibility of the results, potential influences of bias and the applicability of inferences

• ‐‐ Beware of the G2I problem (Do general findings apply to an individual matter?)12

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Alienation• 58 studies included between 1993 and 2015: 45 published papers and 13 doctoral dissertations

• Among 58 studies located and assessed, none were considered high quality.

• Range of methods used: qualitative, cross‐sectional, administrative data, within group pre‐experimental, longitudinal.

• Limits of generalizability across studies as to incidence, causes, and outcomes of alienation

• There is agreement about the types of strategies that parents can and do use to manipulate children’s feelings, behaviors, and beliefs

• Alienation is not a diagnostic syndrome at this time, but rather a cluster of commonly recognized symptoms/behaviors on the part of various family members simultaneously

• There is insufficient empirically validated evidence about how it is caused, best ways to treat it, or likelihood of successfully treating it

• Limits of generalizability across studies as to incidence, causes, and outcomes of alienation

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What We Know from Research Overall(Saini, 2016)

• As a group, studies found to be methodologically weak; limited ability to generalize findings

• Lack of consensus and use of varying non‐standardized measures and procedures make doing research difficult

• Small, non‐random samples with no comparison group

• Need large‐scale empirical studies

• Studies use cross‐sectional or retrospective designs to test simple hypotheses

• Need prospective longitudinal studies to better understand and unpack complex interaction effects and compare outcomes over time

• Insufficient evidence regarding what works best, for which cases

• Individually crafted legal & mental health interventions needed to comprehensively assess the multiple factors predisposing, precipitating, perpetuating the problem AND of the protective factors 14

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It isn’t Just an Alienation Problem

• After a critical appraisal of 60,352 articles from 170 journals, McKibbon et al., (2004) found that only 6.8% of published articles were deemed “high quality” studies

Concerns for Family Law:

• Published reports can make claims that may not be based on high quality evidence

• Contradictions in research findings may have more to do with the quality (or lack of) of the studies, as well as the lack of synchronicity

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Integrating Research into Practice and Policy: The Impacton Families and ChildrenOctober 31‐November 2, 2019Omni William Penn HotelPittsburgh, Pennsylvania

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In the absence of research, we do have… Evidence Informed Practice and Decisions

• Evidence suggests that strained relationships and alienation, in particular, is a family relational problem, not individual pathology of one parent or child

• Begin with a comprehensive assessment of the many factors that may impede or facilitate parent‐child contact problems

• Refrain from being too quick to place blame on one factor until each factor is considered and assessed for its potential contribution to the strained parent‐child relationship problem

• Assessment should include an analysis of each family member and the interactions and relationships among these members (Polak & Saini, 2015)

• Avoid labels, and instead, describe the behaviors that indicate a strained parent‐child relationship

• Use specific examples of the behavior and the impact the behavior has on the child17

Early Identification as Tertiary Prevention

• Already late by the time parties get to court; think about intervention as prevention of further escalation

• RED FLAGS: Allegations of alienation OR abuse; request to stop OR restrict access

• Contact problems more difficult to remedy with the passage of time –children and parents more likely to become entrenched in their positions, further exacerbated by litigation over parenting and financial matters

• Giving the child time or “space” often recommended by therapists, teachers, physicians, lawyers, judges & favored parent –misses the boat and reinforces likelihood of loss of child’s relationship with parent and extended family

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Commonalities Across Types of Interventions Accumulated from Practice Wisdom‐1

• Involvement of the court, monitoring/accountability, reviews are all essential

• Requires specialized skill and experience with high conflict parenting and personalities and intimate partner violence

•Uses combination of therapeutic approaches, models:• psychodynamic, family systems, cognitive‐behavioral (e.g., systematic desensitization), solution‐focused, narrative, motivational interviewing, adult and child attachment models, educational (incl. skills‐based), experiential, recreation

• Involves psycho‐education, coaching, facilitating contact, clinical interventions

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More Commonalities‐2

• Involves ENTIRE family in various combinations as determined by therapist (noted in order)

• Individual therapy for child alone contraindicated• Reinforces the resistance/refusal

• Identifies child as the problem or responsible to fix it

• If there is an individual therapist for child, also need one for parents/family

•May require additional parenting coordinator or med/arbitrator

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Parent Behaviors That Contribute to E/R/R DynamicsGeneral agreement about behaviors that parents can use to manipulate children’s feelings, behaviors, and beliefs (Saini, et al., 2016):

• Badmouthing/denigration of rejected parent; refusal to hear positive comments about other parent;

• Emotional manipulation; Indulges child with material possessions and privileges• Limits and/or monitors contact; • Allows child to make adult decisions. • Allows and insists that child makes decisions about contact• Rarely talks about the other parent; • Uninterested in child’s time with other parent after contact; quick to discount good times • Tells child fun things that were missed during visit with other parent• Gives a cold shoulder, silent treatment, or is moody after child’s return from visit. Body language and nonverbal communication reveals lack of interest, disdain and disapproval

• No photos of other parent; removes reminders of the other parent; no encouragement of calls between visits (child “does not ask”)

• Refuses to speak directly to parent; refuses to be in same room or close proximity; does not let other parent come to door to pick up child

• No concern for missed visits with other parent 21

Risk Factors and Indicators for Alienation (Fidler, Bala, & Saini, 2013)

Favored Parent• Psychopathology, mental illness, personality disorders or characteristics

• Drug/alcohol abuse

• Separation experiences as humiliating

• Role reversal

• Emotional Enmeshment

• Unfounded allegations of abuse/IPV

• Behaviors on previous slide: limiting contact, forcing child to choose, denigrating other parent

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Risk Factors and Indicators for Alienation Child

(Fidler, Bala, & Saini, 2013)

Child triangulated between parents

Age

Temperament and personality characteristics

Behavioral problems of serious nature, oppositional issues

Anxiety and phobias

Inconsistent behavior across situations

Use of borrowed scenarios when describing rejected parent

Lack of opportunity for external supports (e.g. extended family)23

Risk Factors and Indicators for Alienation Rejected Parent(Fidler, Bala, & Saini, 2013)

• Psychopathology, mental illness, personality disorders or characteristics

• Drug/alcohol abuse

• Counter‐rejection of child

• Inadequate parenting skills and/or lacking competencies

• Harsh, rigid, and authoritarian parenting styles

• Passivity and withdrawal of parenting in the face of high conflict

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What Needs to be Assessed?(Fidler, Bala, & Saini, 2012)

• Parental conduct

• Protection vs Probability of harm

•Rigidity of child’s perceptions/behaviors towards parents

• Frequency of parent‐child contact

• Duration of strained relationships

• History of parents’ rigidity

• Responsiveness to education/treatment as suggested

• Compliance with court orders, parenting plans, and treatment agreements

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Interventions That Don’t WorkIndividual Therapy

• Internet survey of 1172 Mental Health and Legal professionals indicates most frequently recommended intervention for alienated child is individual therapy for child and for parents (Bow, Gould & Flens, 2006)

Reunification Therapy (with rejected parent and child)

Questions that are sometimes missed:•What if the child resists?

•What is the role for parents of individual child treatment?

•Where does the coparental hostilities fit in?26

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Treatment for Resist/Refusal Cases‐1

Saini & Deutsch (2017) found 8 studies evaluating the effectiveness of diverse interventions for strained‐parent child relationships, all claiming varying levels of success, with the results being mixed:

• Gardner, 2001 • Kumar, 2003 • Rand, Rand, & Kopetski, 2005 • Sullivan, Ward, & Deutsch, 2010 • Baker, Burkhard & Albertson‐Kelly, 2012 • Toren, Bregman, Zohar‐Reich, Ben‐Amitay, Wolmer & Laor, 2013 • Reay, 2015 • Warshak, 2010, 2018

Saini (2019). Strengthening Coparenting Relationships to Improve Strained Parent–Child Relationships: A Follow‐Up Study of Parents’ Experiences of Attending the Overcoming Barriers Program. Family Court Review, First published: 23 April 2019 https://doi.org/10.1111/fcre.12405

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Treatment for Resist/Refusal Cases

Factors for successful outcomes range from:

• early intervention• younger age of child• the capacity of parents to communicate• Improvements in coparenting dynamics• absence of reactive abuse, neglect, or abandonment by either parent

• court orders that protect the child’s right of access to both parents

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What about Reunification Therapy?

•Focus on Strained/Estranged relationship

• Child likely to resist

•Does not address relationship with favored parent

•Does not address the coparenting conflict/dysfunction

•Not systemic solution

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Work with the Whole Family: Family Systems Approach

• Individual work with each parent: parenting, support, education

• Individual work with each child: “feeling work”, education

• Begin heavy with Favored Parent and FP with child initially

• Coparenting ‐working with parents together and individually

• All members of family together

• Repeated loop, does not progress in straight line from one modality to another

•Needs intensity: several hours a week initially, or longer sessions; multi‐day sessions

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Lessons Learned•Work must begin with the favored parent

• Coparent work precedes child and unfavored parent reconnection

• Coparents need preparation and agreements

• Children need preparation and a ladder of desensitizing activities

• Structured, planned recreational activities provide new opportunities and new perspectives

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CHANGE CUSTODY TO REJECTED PARENT

• When all other interventions have failed

• The alienating behavior rises to emotional abuse

• Work must be done separately with the favored parent

• Refer to a Residential Transition Program

• No contact with the favored parent for specified period of time

• Need to enforce no contact

• Provide necessary support to child

• Require specific behavior in FP and child for resumption of contact

• Requirements for resumed contact to continue

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REJECTED PARENT LETTING GO

•What are the considerations of sole custody with the favored parent?• In the child, favored parent, rejected parent, larger system

• How do you implement this decision?• Components of letting go ritual

• Ongoing work with the child

• Expectations of the favored parent• coparenting work

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Cognitive Distortions

• Grandiose sense of empowerment

• Lack of remorse for hurting family members

• Entitled to defy authority (court orders)

• Simplistic thoughts about complex matters

• Phobic-like anxiety and avoidance of rejected parent

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FOCUS in R/R Treatment

• Providing a safe place

• Keeping conversation on-track

• Minimizing talk of past

• Focus on solutions/proposals rather than problems

• Redirect aggressive language

• Move family forward (new chapter, second chance for rejected parent)

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Coparenting Skills Development: Building TrustFor both the rejected parent and the favored parent

• Active Listening and Validation

• From Problem‐Focused to Proposal‐Focused

• From Blame and Rigid Thinking to Shared Responsibility

• Parents Admit Shared Mistakes and Regrets

• Non‐reactance and Conflict De‐escalation

• Emotional Triggers and Self‐Soothing

• Reworking the Divorce Narrative

• Both Parents Admit Mistakes

• Psychoeducational work

• Coaching the Rejected Parent

• Coaching the Favored Parent 36

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Goals for favored parent‐1

In order to move the family forward, the favored parent must help the children tolerate the disequilibrium that results from a change in path.

The favored parent needs to:

• Encourage children to have voice, not total choice as appropriate for age/stage of development

• Teach children skills to face & manage problems, not avoid problems

• Take back good enough parenting function

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Goals for favored parent‐2

The favored parent needs to (continued)

• Set appropriate limits and expectations

• Set appropriate boundaries

• Diminish enmeshment

• Encourage age‐appropriate separation & individuation

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Goals for rejected parents‐1•Rejected parents are often angry and blame the favored parent for the rupture. Sometimes that is the case. Often they have contributed to the contact problem.

• The rejected parent needs support:• Regulating emotions

• Taking responsibility for their contribution

• Seeing the long game

• Therapists provide corrective feedback

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Goals for rejected parents‐2Coaching pre contact is critical• How to listen without reacting

•How to respond in welcoming way

•Accepting small steps

• Engage in negotiation, not demands

• At times, put the court order aside

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Intervention goals for children• Build strong positive therapeutic alliance with family members

• Create tools in their tool box for healthy boundaries and development of a sense of self

• Increase resiliency factors

• Increase appropriate taking of responsibility for own, not others, behaviors including differentiation of self/others

• Encourage healthy risk‐taking

• Encourage problem‐solving

• Regulate emotions

• Manage anxiety by moving from avoidance to approach

• Express anger appropriately so it can be heard

• Provide corrective feedback41

Preparing the Children • The parents have made agreements about moving forward. Child is listening to plan and possibly offering input (voice, not choice)

• Prepare with strategies to:• Regulate emotions

•Manage anxiety as they move from avoidance to approach

• Appropriately express anger so it can be heard

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Accountability

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Accountability

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NEW: Coparenting Nuts and Bolts:

Overcoming Disrupted Parent‐Child

Contact Problems.

Authored by Drs. John Moran, Shawn McCall and Matt Sullivan. It will discuss intractable conflict and provide solutions for daily interaction for those in conflict.

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Family Court ReviewApril 2020Special IssueParent‐Child Contact ProblemsEditors: Barbara Jo Fidler & Nicholas Bala

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NOT JUST ALIENATION: RESISTANCE, REJECTION, REINTEGRATION, AND THE REALITIES OF THE REALITIES OF

TROUBLED PARENT‐CHILD RELATIONSHIPS

AFCC WEBINAR MAY 7, 2019

Marsha Kline Pruett, PhD, MSL, [email protected] M. Drozd, Ph.D.

[email protected]

AFCC Webinar Not Just Alienation (Pruett Drozd 2019) Webinar Not Just... · 2019-05-08 · 5/7/19...

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